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Background: Children suffering from allergic rhinitis (AR) in their earlier days of life, not receiving proper treatment, subsequently develop asthma. To sensitize the first-year medical undergraduates about AR by implementing pediatric allergic rhinitis (PAR) module as a part of their attitude, ethics, and communication (AETCOM) curriculum. Materials and Methods: Triangulation type of mixed method study was conducted from January 2021 to June 2021 among 125 first-year medical undergraduate students. The PAR module communication checklist was developed and validated by an interprofessional (IP) team. Twenty multiple-choice questions (MCQs) were framed for both pretest and posttest cognitive assessment of the students. The pretest assessment was done (first 15 min) followed by the teaching of the PAR module (30 min), and lastly the posttest assessment along with open-ended feedback (last 15 min). Objective Structured Clinical Examination (OSCE) communication checklist along with the guidelines was given to the observer during the student-patient encounter to score the learner and to assess the communication skill. Apart from descriptive analysis, paired t-test and content analysis were done. Results: A statistically significant difference in the mean scores before and after the PAR module and communication checklist (P < 0.001). Majority (78/81, 96%) of the students favored this module, while (28/81) 34.6% suggested modifications. Most of the parent's feedback was good about the student's communication skill in terms of empathy (118), behavior (107), and greet (125); however, 33 parents were about the opinion of difficulties in closing the session, 17 parents commented about student's language problem and 27 about feedback. Conclusion: The PAR module should be taught in the current medical curriculum as a part of AETCOM in the foundation course as early clinical exposure with some modifications in the existing module. [ABSTRACT FROM AUTHOR]

Background: The current situation of Comprehensive Primary Healthcare (CPHC) in India with reference to its characteristics is lesser known. Objectives: 1. To explore various characteristics of research based on CPHC in India. 2. To identify gaps in research on CPHC. Materials and Methods: A broad search strategy was developed to obtain articles on CPHC from PubMed and Google scholar. Out of 218 articles, 17 were explored for objectives, key findings. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR) was used. Results: Most were on reproductive and child health, non-communicable diseases, and utilization & gaps in services. Only one study was randomized controlled trial, followed by mixed method (n=2). Fourteen studies focussed on current situation of CPHC and none on service delivery of CPHC. Conclusion: Limited studies have been conducted on CPHC in India. Significant number of research are needed for strengthening primary health care. [ABSTRACT FROM AUTHOR]

Introduction: Proper positioning and attachment play a key role in exclusive breastfeeding. Whereas incorrect breastfeeding techniques lead to poor milk transfer and early discontinuation of breastfeeding. Objectives: 1. To assess the breastfeeding techniques among postnatal mothers and to identify the factors associated with improper positioning and poor attachment. 2. To prioritize the action points to improve the poor breastfeeding practices according to the viewpoint of the staff nurses. Materials and Methods: A hospital-based mixed-methods study was carried out in Puducherry for 6 months. In quantitative phase, 99 postnatal mothers were interviewed consecutively and breastfeeding techniques were observed based on Baby Friendly Hospital Initiative and Integrated Management of Neonatal and Childhood Illness guidelines. In qualitative phase, 45 staff nurses ranked the action points to improve the poor breastfeeding practices. Bivariate and multivariate analyses were employed. Mean rank and Kendalls' Concordance Coefficient were calculated for the ranked data. Results: About 28.3% and 27.3% of mothers demonstrated improper positioning and poor attachment, respectively. Young mothers, housewives, <10 days old infants, and failure to receive breastfeeding counseling were associated with poor breastfeeding techniques. Poster displays, healthcare workers' training, targeted counseling, and assistance were the priority action points suggested by the staff nurses. Conclusion: Maternal age, maternal occupation, infants' age, and breastfeeding counseling influenced breastfeeding techniques. The prioritized action points need to be implemented to achieve the level of Baby Friendly Hospital. [ABSTRACT FROM AUTHOR]

Background: Despite government legislations for protection of women, domestic violence (DV) continues to remain as a public health problem in India. Objectives: 1. To find out the prevalence of various types of self-reported DV among married women of 18-45 years of age and to identify its social determinants and their help-seeking behavior. 2. To understand the solutions from key informants' point of view. Methods: It was a sequential explanatory mixed methods study design, which consisted of quantitative (Survey) followed by qualitative (Interviews) phase. A representative sample of 360 married women was chosen by two-stage cluster sampling from villages in Tamil Nadu, South India. The female investigator conducted the survey by house to house visit. Post-survey, six key informant interviews were conducted to explore the solutions and suggestions from experts' point of view. Bivariate and multivariate regression analysis was carried out to identify the significant predictors of DV. Manual content analysis of qualitative data was done. Results: The overall prevalence of spousal DV was 49.5% [95% CI: 44.3-54.6] in the last one year. In multivariate analysis, two factors namely 'current alcoholism in husband' and 'controlling behavior of husband' were found to be the significant predictors of DV. In order to prevent alcoholism in husband, the key informants suggested deaddiction services and measures to limit access to alcohol. Furthermore, to prevent controlling behavior of husband, the key informants suggested women's empowerment, employment, helplines, responsible parenting, social change in dowry practice and gender equality. Conclusions: The prevalence of spousal DV was found to be high. Current alcohol consumption and controlling behavior of the husband were the important determinants of domestic violence. Key informants suggested interprofessional approach consisting of deaddiction services, women empowerment and strengthening of family life to address the problem of DV. [ABSTRACT FROM AUTHOR]

Background: There are some risky practices such as preloading or pregaming which exist among college students. When students pregame, compared with drinking episodes when they do not, they consume a greater number of drinks and have higher blood alcohol concentrations. Objectives: (1) To explore the perceptions about pregaming among male college students in Puducherry. (2) To study the prevalence of pregaming among current alcohol users. Materials and Methods: A sequential exploratory mixed-method study (Qualitative-Focus Group Discussion [FGD] to explore pregaming followed by Quantitative-self-administered questionnaire [survey]) was conducted among 450 male engineering college students by simple random sampling. Results: The prevalence of pregaming among current alcohol users was 66.7%. Among all occasions, the students were involved in pregaming mostly on birthdays 92.5% and marriages 92.5% followed by college cultural events 90%. All of the students 100% wanted to pregame for anticipated alcohol cost problems, 100% pregamed for fun and 87.5% easy conversations with the opposite sex and majority 66.6% had the intention to quit pregaming among current users. Conclusion: The prevalence of pregaming is high among current users however, the majority of them had the intention to quit this behavior. Counselors and health care professionals working in alcohol de-addiction centers should specifically question pregaming and its associated symptoms. Tailor-made interventions should be promoted to target the concept of pregaming-related consequences of alcohol addiction. [ABSTRACT FROM AUTHOR]

Introduction: Perception of women about postmenopausal bleeding (PMB) may have a greater influence on their treatment-seeking behavior. Objectives: The objective was to explore the perceptions of causes and treatment of PMB among menopausal women and to quantify its perceived reasons. Materials and Methods: It was a sequential exploratory mixed-method study design, with two group interviews (qualitative phase), followed by a survey among 1530 postmenopausal women (quantitative phase). The qualitative data were analyzed by thematic analysis and quantitative data using descriptive statistics. Results: Lack of seriousness about PMB and stigma were stated as barriers for the treatment of PMB. Among 1530 women, 40.8% of them did not know the cause for PMB. The problem in the uterus, cancer, and improved nutrition were stated as reasons by 17.6%, 16.8%, and 15.8% of women, respectively. Conclusion: Most of the women did not know the reason for PMB and its awareness is crucial for better uptake of screening and detection of pathology at an early stage. [ABSTRACT FROM AUTHOR]

Background: Previously, we had a course in epidemiology for medical undergraduates that was based on traditional lecture methods with no formal formative assessment (FA). We found poor uptake of our course in terms of learning and attendance by students. Objective: The objective was to assess the effect of improved course (interactive lectures and formal FA) in epidemiology on student learning and attendance. Materials and Methods: It was a triangulation type of mixed-methods program evaluation, where both quantitative (quasi-experimental design) and qualitative (open-ended responses) analysis was done. This study was carried out in the department of community medicine in a tertiary care teaching hospital, Puducherry. We improved the quality of the course material, interaction in lectures and included formal structured FA in the last course. Kirkpatrick's framework was used for the course evaluation. We compared the performance of three batches to check the effect of our revisions on students' learning and their attendance. Results: Student's learning outcome was measured using end-of-course assessment scores (Level-2). The percentage of students successfully completing the course improved from 39% to 81% and attendance status of ≥90% improved from 50% to 57%. Learner's immediate reactions (Level-1) were captured using open-ended questions, and content analysis was done. Students appreciated the course material, FAs, and in-class activity. Conclusions: Little improvement in a traditional epidemiology course for undergraduates in the form of interactive lectures and formative feedback and providing the student with course material led to significant gains in students' knowledge and attendance. [ABSTRACT FROM AUTHOR]

Background: Most households in rural India have potential environmental hazards for fall among older people. There is limited information available on magnitude of these factors in our context. Objective: To assess the potential environmental risk factors for fall in and around the rural households of older people. Methods: The cross sectional survey was done in 14 villages of Primary Health Care Centre (PHC) Thirubhuvanai, Pondicherry. Representative samples of 570 houses were observed for risk factors using predesigned and pre-tested checklist, which was carried out by the trained post-graduates in Community Medicine. Environmental factors such as the type of house, presence of stairs without support, unstable furniture, adequate lighting arrangement, presence/use of latrine, supports in the toilet and bathroom were observed. Frequencies of variables were obtained by using SPSS (Version 24.0). Results: Out of 570 houses, 285(50%) houses were pucca and 340 (59.6%) houses had cemented floor. Unstable furniture was present in 203 (59.4%) houses. Among houses, the latrine was present in 333 (58.4%) houses, where toilet was in use 284 (85.2%) and 315 (94.3%) houses don't have any support in their latrine. Bathroom was present in 338 (59.3%) houses and only 11 bathrooms (3.2%) had support. Majority of the houses had adequate lighting in living room and toilets; however, it was relatively low in the kitchen. Conclusion: Majority of households had potential environmental risk factors. Interventions at household level are required to minimize these risk factors. The results of this study indicate the need for environmental inspection and hazard reduction measures in their houses. [ABSTRACT FROM AUTHOR]

Objective: To find out the relationship of collective social, economic, and cultural properties of a population on the perceived quality of life (QOL) among old age people. Materials and Methods: In a community-based cross-sectional study, we analyzed information on a representative sample of 900 old age (aged > 60 years) from 28 villages in Kollam district of Kerala. "WHO-Quality of Life - BREF questionnaire" was used. Ethical clearance from Institutional Ethics Committee was obtained. The mean scores for "perceived" QOL for domains such as physical health, psychological health, social relations, and control of environments were calculated. The three scales (social capital, cultural capital, and economic capital) were standardized using z-score transformation to make them comparable. Using multiple linear regression, we calculated the independent effect of economic capital, social capital, and cultural capital on perceived QOL among old people adjusted for age, sex, and the presence of chronic disease. Results: For overall QOL, only cultural capital contributed significantly. An increase of one unit z-score cultural capital led to three units increase in overall QOL score (β = 3.362; 95% CI: 2.645-4.078). Social capital and cultural capital contributed significantly to the physical health domain of QOL. With one z-score increase in social capital and cultural capital, QOL score of physical health domain increased by 0.2 units (β = 0. 227; 95% CI: 0.020-0.434), and 0.5 (β = 0. 596; 95% CI: 0.384-0.808) units, respectively. Psychological health domain and environmental domain were affected by all three capitals significantly. But, the social relations domain was significantly affected only by cultural capital (β = 0. 576; 95% CI: 0.373-0.779). Conclusion: Hence, the policies for old people should envision retaining our cultural and social norms along with the economic interventions for a better palliative care. [ABSTRACT FROM AUTHOR]

Background: HelpAge India has been facilitating community-managed palliative care program in the villages of Tamil Nadu, India. Objective: To evaluate the effect of perceived quality of life in the elderly in the project villages in rural Tamil Nadu. Materials and Methods: It was a community-based evaluation study. Considering the mean difference of 0.6, design effect-2, precision-5%, power 80%, and 10% non-response, a sample size of 450 elderly persons (more than 60 years) was adequate. Sample was selected by two-stage cluster sampling. Tamil version of "WHO-Quality of Life-brief questionnaire" was used. Trained interviewers made house-to-house visits and obtained information by personally interviewing the subjects. Results: The mean score for perceived physical quality of life in the project area was (10.47 ± 1.80 SD) high than the mean score (10.17 ± 1.82 SD) in the control area (P = 0.013) and the mean score for psychological support (10.13 ± 2.25 SD) in project area was high than the mean score (9.8 ± 2.29 SD) in control area (P = 0.043). There was no effect on domain of social relationship and environment. Conclusions: In the project villages, the perceived physical quality of life and psychological support among elderly persons was significantly better than the control villages. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to understand the social determinants of quality of elderly life in rural central India and describe their perspectives on various issues related to their quality of life. Materials and Methods: It was a community-based mixed-methods study in which quantitative (survey) method was followed by qualitative (Focus Group Discussion, FGD). The study was done in field practice area of a Rural Health Training Centre. We decided to interview all the elderly (>60 years) in two feasibly selected wards of village Anji by using the "WHO-Quality of Life (WHOQOL)-brief questionnaire." We used WHOQOL syntax for the calculation of mean values of four domains. Following survey, four FGDs were carried out. Results: The determinants of perceived physical health, amenable for intervention were their currently working status, not being neglected by the family, and involvement in social activities. The determinants for psychological support were health insurance, and their current working status. The determinants for social relations were membership in social group and their present working status. The determinants for perceived environment were membership in social groups and relationship with the family members. In qualitative research, factors such as active life, social activity, spirituality, health care, involvement in decision making, and welfare schemes by the Government were found to contribute to better quality of elderly life. Problems or conflicts in family environment, lack of shelter and financial security, overtapped resources, and gender bias add to negative feelings in old age life. Conclusions: There is a need for intervention at social and family level for elderly friendly environment at home and community level. [ABSTRACT FROM AUTHOR]

Background: To find out the prevalence of 'all' injuries, its nature, outcome and sources of treatment among rural population of Pondicherry. Methods: It was a triangulated study of quantitative (survey) and qualitative (Focus Group Discussion, FGD) methods. The trained second year medical undergraduate students paid house visits to all houses in five feasibly selected villages of our field practice area. The students interviewed the housewife and obtained information for all injuries for each family member in last one year and its sources of treatment. We could obtain information for 1,613 (96.7%) households. Postsurvey, FGDs were undertaken to explore the various traditional treatments for the common injuries. The data was entered and analyzed using Epi_info 6.04d software package. Results: Overall, the prevalence of all injury among all age groups was 30.6% in last one year. Injuries were significantly more after 18 years of age and among men (p was less than 0.001). About 99.2% injuries reported were accidental and majority (58.2%) went to government doctor for treatment. Most common causes of injuries were fall on the ground from height or due to slip (7.4%), road traffic accidents (5.6%), agriculture related injuries (5%) and bites by scorpion/ insects/snakes /dogs (4.1%). FGDs explored some potentially harmful traditional remedial measures at village level such as application of mud or cow dung on the injury and burning the site of thorn prick on foot sole. Conclusions: Considering the high prevalence of all injuries related to road traffic accidents, fall from height and agriculture work related injuries across all age groups, especially among men and some potentially harmful traditional treatments, an intervention in the form of targeted injury prevention program for different age and sex group, focusing health education efforts based on local epidemiology and behavioral practices is needed. [ABSTRACT FROM AUTHOR]