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Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China (December 2019). The disease rapidly crossed the barrier of countries, continents and spread globally. Non-pharmaceutical measures such as social distancing, face mask, frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease. OPD, IPD admissions, elective O. Ts were curtailed. Orthopedic care was only limited to emergency and semi-urgent procedures like necrotizing fasciitis, open fracture, and compartment syndrome. These measures were taken to preserve infrastructure and manpower to manage covid-19 pandemic. The children were thought to have a low susceptibility to covid-19 as compared to an adult. Deferring the patient during pandemic has led to high orthopedic disease burden, morbidity and disease-related sequelae, hence elective care must be resumed with modified hospital infrastructure. Resumption of elective/emergent orthopedic care should be slow, phasic and strategic, much similar to unlocking. Cases must be stratified depending on covid status and severity. Dedicated O.Ts with neutral/negative pressure and HEPA filter for covid positive and suspected patients are to be used. All symptomatic and suspected patients should be investigated for covid-19 by RT-PCR, blood counts and CT scan. Regional anaesthesia should be preferred to General anaesthesia. Power drill/saw/burr/pulse lavage should be minimized to avoid aerosol generation. Postoperatively continuous surveillance and monitoring to be done for covid related symptoms. Medical institutes rapidly shifted to the online mode of education. Blended learning (virtual & physical) and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years.

Coronavirus (COVID-19) pandemic spread in India is steeply rising A 21-day lockdown has been imposed by the Government of India, to curtail its spread This has impacted all walks of life, including availability of food and nutrition related services which would affect nutritional status of children throughout India The two major schemes, i e Integrated Child Development Services Scheme and Mid-day Meal Scheme have been affected leading to risk of worsening of child nutrition Some states have evolved their own strategies to mitigate the effect of lockdown Here we discuss the challenges and way forward for ensuring availability of food for child nutrition during this health crisis No single, optimal response to a public health emergency exists The government and non-government partners must coordinate and scale up child nutrition services in the community through strengthening of public distribution system and home delivery of food parcels wherever feasible for beneficiaries of child nutrition programs © 2020, Indian Association of Preventive and Social Medicine All rights reserved

Routine immunizations (RI) keep the infectious diseases under control in the community However, during the coronavirus pandemic, to prevent the associated exponential rise in the number of cases, it became necessary to stop routine health services across the country Routine Immunization also had to be discontinued It is to be realized however that the risk of vaccine-preventable diseases is gradually increasing in direct proportion to the delay in administering vaccinations to eligible children It’s likely that we will face outbreaks of VPD if we keep RI halted for weeks together Various dimensions of RI need to be examined from the perspective of the COVID-19 pandemic ranging from vaccine hesitancy to operationalization of services In this article, we highlight this hidden problem, which has the potential to further challenge our already challenged health and healthcare-related situation The domains which deserve careful consideration are discussed to supporting policymakers in making informed decisions in this regard © 2020, Indian Association of Preventive and Social Medicine All rights reserved

Coronavirus (COVID-19) pandemic has been declared by the World Health Organization after it has gripped many countries of the world The exponential increase in the number of cases has resulted in panic and confusion among healthcare workers and the vulnerable population Pregnant and lactating mothers are a vulnerable group and need evidence-based advice to protect the health of the mother and the child Healthcare workers can play an important role in dispelling the myths and misconceptions among pregnant and lactating mothers regarding COVID-19, if they are equipped with scientific information on antenatal care, care at birth, and breastfeeding This review attempts to summarize the published evidence related to antenatal care, care at birth and breastfeeding during the COVID-19 pandemic © 2020, Indian Association of Preventive and Social Medicine All rights reserved

Context: In the context of competency-based medical education being advocated worldwide, fine needle aspiration biopsy (FNAB) is considered as an entrustable professional activity (EPA). There is no information regarding how much time and training are required to achieve a “competent level” for performing and documenting FNAB in the Indian context. Aim: To determine the time taken by an average postgraduate pathology trainee to become competent in performing FNAB with respect to history taking, clinical examination, and fine needle aspirate adequacy. Settings and Design: A descriptive, retrospective, chart-based audit was conducted in the Department of Pathology. Materials and Methods: FNAB chart records documented during 3 years of postgraduate training by a cohort of 13 postgraduate (PG) resident trainees admitted in 2010 were included in the study. Adequacy rates and criteria for adequacy were defined for the purpose of the study. Statistical analysis: Data was entered in MS Excel and analyzed using the Statistical Package for the Social Sciences version 20.0. The adequacy rates are presented as percentages and time taken to achieve adequacy rates as median values. Results: A total of 3272 charts were audited. Median time taken to achieve 85% adequacy rate for history taking, for clinical examination by the first and the second criteria, and for FNAB were 1 month, 1 month and 3.5 months, and 1 month, respectively. Conclusions: Although the mean time taken to achieve 85% adequacy rates for FNAB was 1 month, there was wide variation in the time durations between the residents to achieve this level.

Background: In spite of the decline observed in total fertility rate (TFR) in India during the last few decades, the unintended pregnancy rates continue to remain the same. With increasing employment levels of women, there has been an increase in the contraceptive usage rates, but evidence among the working women regarding the emergency contraceptive pills is lacking. The Objectives of the study was to assess, among the working women regarding the emergency contraceptive pills (ECP). Methods: A cross sectional survey was conducted among the reproductive age group working women attending the obstetrics and gynecology outpatient department clinic of a private hospital in Delhi. Face to face interviews were conducted using a sem-structured questionnaire. Results: Out of the 206 participants studied, around one-third (35.0%) were not aware about ECPs. Amongst the aware, 81.3% and 44.8 % did not know about the correct indication and correct timing of ECP use respectively. Amongst those who were aware about ECPs, 91.8% had never used it. Conclusions: Even though the awareness about ECPs is not low, the correct knowledge about its indications and correct timing is poor. More emphasis on increasing the awareness about ECPs is required to increase its correct use thereby reducing TFR further.

There is a lack of awareness about the guidelines for standardized and transparent reporting of biomedical research, among the medical professionals. This paper aims to familiarize the clinical researchers and practitioners regarding the issues related to transparency and the evolving guidelines for standardizing them, in the reporting of biomedical research. A narrative review method is adopted here, primarily based on the EQUATOR and SAMPL guidelines for reporting studies and statistical analyses. As study methods and statistical approaches support each other, their reporting practices as per the standardized guidelines have been dealt here in a congruous manner.

Zoonotic diseases are an important public health problem. Keeping this in way, a panel reviewed the discussion around “one health” strategy of the WHO in combating zoonotic diseases during Seventh annual conference of Consortium Against Rabies (CAR) with the theme of “Zoonoses: Thinking beyond Rabies” held on 14th and 15th June 2019. The panel came out a manuscript discussing the need, background, and rationale for basic framework of possible roadmap for one health. Background —About CAR: CAR has been established with the aim to serve as a platform for the control of the rabies menace in India. It will evolve into a full fledged struggle against rabies in the country. The association comprises of medical professionals, veterinary doctors, and public health persons. The idea behind CAR is to bring the best minds in the country for research and information dissemination in the field of rabies. About Academy of Family Physicians of India (AFPI): AFPI is the official association of family physicians in India. Dedicated to provide professional leadership, conduct healthcare advocacy, policy development and a change in health system within the domain of family medicine, and larger public health system in the country, the academy is the recipient of the Healthcare Leadership Award 2012 in the category of Healthcare Governance and Public Administration. The white paper development Process: More than 100 medical experts, veterinary doctors, and public health persons from across the country and belonging to the fields of internal medicine, family medicine, public health, veterinary sciences, nursing science and environmental science and representing reputed medical institutions, government funded research institutions, and policy making bodies participated in discussions on topic of “one health” made during 7th Annual national conference of CAR with the theme of “Zoonoses: Thinking beyond Rabies” held on 14th and 15th June 2019. The panel steering the discussion included leading expert from ICMR, medical colleges, veterinary college, family medicine, private practitioners, and health program managers. The panel committee had prepared a draft document well in advance of the conference, which was communicated to all participants for feedback and comments. The panel was steered by ICMR expert. The discussion of the panellist was presented to the consensus group and unanimously adopted. A writing group worked on the manuscript, which was again circulated by email to all for any comments and suggestions before final publication.

Janani Suraksha Yojana (JSY) was launched in April 2005, to promote institutional deliveries through provision of cash assistance, transport, escort, and referral services. An observational cross-sectional study was conducted to assess the antenatal registrations, postnatal checkups, and institutional deliveries, and to compare the various social groups. Married women of the reproductive age group, having at least two children, were interviewed regarding antenatal care, delivery, and postnatal care in both pregnancies, latest as well as previous. Post JSY implementation, antenatal registrations increased from 61.79 to 96.34%, Deliveries at the Government Health Facility increased from 25.20 to 53.25% and postnatal check-ups increased from 45.93 to 69.51%. In the post-JSY-implementation phase, the Government Health Facility was preferred more by Scheduled Castes (SC), Scheduled Tribes (ST), Other Backward Classes (OBC) (SC/ST = 56.87%, OBC = 60.2%, and general = 43.68%), educated (Illiterate = 17.39%, Primary = 88.14, and Middle or above = 81.94%) and the lower socioeconomic classes (Lower SEC 71.83% and Upper lower and above = 45.71%) for their deliveries. It appears that the socially backward groups have benefited more from JSY.

Background India is highly endemic for rabies. Although fatal, rabies is a preventable disease. Several factors interfere with the timely utilization of post exposure prophylaxis (PEP) in the population. There is a need to explore the factors leading to delay in PEP initiation. Objective To study the factors associated with delay in initiation of PEP among animal bite cases attending anti-rabies clinic in the out-patient department (OPD) of a hospital in Delhi. Materials and methods A cross-sectional hospital based study was conducted among 200 patients attending the anti-rabies clinic. After obtaining informed consent, the patients were interviewed using a pre-tested, semi-structured questionnaire to find out the delay in initiation of PEP and the factors associated with it. Results Most common biting animal was found to be dog (96%). Out of the studied subjects ( n = 200), 134 (67%) were males, 123 (61.5%) were from rural areas and 61 (30.5%) were illiterate. Delay in initiation (vaccine initiation in more than or equal to 48 h) of PEP was found among 41% of the studied subjects. The mean time spent during each visit by the study subjects were 3.46 h (SD 1.60). Delay was more likely in people living at a distance of more than 10 km from the vaccination centre ( p p = 0.004). Delay showed an increasing trend with age ( p = 0.041). Most commonly cited reasons by the respondents ( n = 82) for the inability to come early for vaccination included work related barriers (42.68%), anti-rabies clinic being closed on Sundays/national holidays (36.59%) and unawareness about timely PEP (31.71%). Conclusion Accessibility and lower economic status were the major factors associated with delay in initiation of PEP for rabies prevention.

Study design forms a core component of research, mainly determined by the study objectives, and it in turn further decides the type of statistical analyses to be carried out. Observational studies are devoid of the investigator's control over assignment of a subject to the treated or control group, in contrast to interventional studies Even though randomized controlled trials are seen as the best study design, evidence shows that properly conducted observational studies give similar results, and is relevant in medical research where ethics and feasibility concerns assume great significance. Observational studies point out towards possible causal associations, are less resource intensive than trials and have a better external validity. This review article discusses various types of observational study designs such as case reports, cross sectional, cohort, case-control and nested case-control studies with real literature examples.

Oral health promotion through schools is recommended by the World Health Organization (WHO) for improving knowledge, attitude, and behavior related to oral health and for prevention and control of dental diseases among school children. In low resource settings, it is important to develop evidence for health education methods in oral health behavioral practices. The objectives of this study were to assess both the baseline awareness and practices regarding oral hygiene and the impact of a single education session on the change in oral health behavior. A school based, cross-sectional study on 112 primary school children was conducted after obtaining the consent of the school authorities and parents. A pretested, structured proforma was used for baseline awareness and behavior regarding oral health. A 30 min educational session was imparted and after 1 month, and the oral health practices were reassessed to find out the impact of the education session. Baseline survey revealed the following findings. Self-reported dental problems were found in 48.22% of the children in the last 6 months. When asked about the risk factors for dental problems, 28.57% mentioned eating sweets followed by improper brushing, whereas 40.17% were not aware about any risk factor for dental problems. It was found that 28.57% of the children did not brush their teeth regularly, whereas 35.71% used a tooth-brush for brushing their teeth. After the intervention, it was observed that there was a significant improvement in the proportion of children using a toothbrush for cleaning their teeth and of those who rinsed their mouth after meals. In conclusion, even a single education session was found to be effective in bringing about a change in the oral health behavior of primary school children.