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Abstract Background Incident reporting is the prevailing approach to gathering data on accidental falls in hospitals for both research and quality assurance purposes, though is of questionable quality as staff time pressures, perception of blame and other factors are thought to contribute to under-reporting. Methods This research aimed to identify contextual factors influencing recording of in-hospital falls on incident reports. A qualitative multi-centre investigation using an open written response questionnaire was undertaken. Participants were asked to describe any factors that made them feel more or less likely to record a fall on an incident report. 212 hospital staff from 30 wards in 7 hospitals in Queensland, Australia provided a response. A framework approach was employed to identify and understand inter-relationships between emergent categories. Results Three main categories were developed. The first, determinants of reporting, describes a hierarchical structure of primary (principle of reporting), secondary (patient injury), and tertiary determinants that influenced the likelihood that an in-hospital fall would be recorded on an incident report. The tertiary determinants frequently had an inconsistent effect. The second and third main categories described environmental/cultural facilitators and barriers respectively which form a background upon which the determinants of reporting exists. Conclusion A distinctive framework with clear differences to recording of other types of adverse events on incident reports was apparent. Providing information to hospital staff regarding the purpose of incident reporting and the usefulness of incident reporting for preventing future falls may improve incident reporting practices.

Background: There is scanty evidence regarding the magnitude of COVID-19-related psychological distress (PD) among the general population of India. Objectives: This study aimed to estimate the pooled prevalence of PD among the general public of India during the COVID-19 pandemic. Material and Methods: We conducted a meta-analysis of 21 online surveys conducted across the Indian subcontinent and published between 2020 and 2021. Results: Overall estimates of PD among the general public during the COVID-19 pandemic by the random-effects model is 33.3% (95% confidence interval: 23.8%-42.8%; n = 21 studies). The level of heterogeneity was high among the included studies (I2 = 99.67%). In subgroup analysis, it was found that the survey tool and the methodological quality had a significant effect on the overall prevalence estimates. Approximately 33% of the general public reported to have PD during the COVID-19 pandemic in India, although the overall prevalence varied based on survey tools and quality of studies. Conclusion: As the pandemic crisis seems to be ebbing across the world, the current findings are a wake-up call to devise pragmatic strategies to curtail the burden of similar pandemics and to successfully meet the challenges ahead.

Background: COVID-19 vaccines, we believe, have come to rescue us from the clutches of the dreaded severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With rapid ongoing mutations, it is difficult to predict the effectiveness of seroconversion following vaccination. This study aims to find out the proportion of people with seroconversion following first dose of Covishield vaccine. Methods: Randomly selected health-care workers were followed up for SARS-CoV-2 immunoglobulin G (IgG) antibodies between 28 and 42 days after receiving their first vaccine dose. The VITROS SARS-CoV-2 IgG test (Ortho-Clinical Diagnostics, USA) with 100% specificity and > 90% sensitivity was used to assess seroconversion. Results: The first dose of vaccine induced seroconversion in 91.7% of beneficiaries. Nearly one-third (30.2%) of them had high antibody titers, and it showed a significant association with female gender (9.6 ± 5.5 vs. 7.6 ± 5.6) and younger age (P = 0.008). In addition, those with previous COVID infection showed a more robust immune response when compared to others (P = 0.001). Conclusion: Seroconversion rate of more than 90% offers a promising hope toward successful pandemic control. In the current scenario, the inability to attain the targeted coverage due to an upsurge in vaccine hesitancy, compounded with only lower proportion of seroconversion in elderly, faster rollout of the vaccines without any age limit, will help achieve the herd threshold more rapidly.

Introduction: There is a wide variation in stroke epidemiology in India due to the differences in culture and the variability in the distribution of risk factors across the states. The present meta-analysis provides a pooled estimate of age, gender, and region-based stroke epidemiology in India based on epidemiological transition level (ETL) groups described in the Global Burden of Disease (GBD) Study (2016). Methods: We searched in PubMed and Google Scholar, and relevant studies published till February 2022 were included. Observational studies conducted in the Indian setting were included and global or Indian studies that exclusively estimated the prevalence, incidence, or mortality data among patients with stroke were excluded. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used for the risk-of-bias assessment and publication bias was evaluated by funnel plots and Egger’s test. The R software was used to perform this meta-analysis; I2 statistics were calculated to measure heterogeneity among studies. Results: We included 58 studies in the systematic review, and after quality assessment, 47 studies were finally included for meta-analysis. The sample sizes of the included studies ranged from 40 to 4989 and the mean age of the participants ranged from 31.7 (Standard Deviation, SD-7.4) to 70.5 (SD-10.7). The burden of stroke was estimated based on the ETL groups described in the GBD Study 2016. We found a male preponderance (64.5%; 95% confidence interval [CI]: 62.5%-68.3%) in the gender distribution of strokes and 75.2% (95% CI: 68.7%-81.7%) of the stroke occurred above the age of 50 years. Ischemic stroke is the predominant subtype of stroke in India, with a higher proportion in the middle ETL region (74.0%; 95% CI: 65.1%-81.3%) as compared to those with low ETL (67.2%; 95% CI: 49.9%-80.8%) and high ETL regions (67.5%; 95% CI: 57.0%-76.4%). Conclusion: There was a significant heterogeneity among the included studies. Majority of strokes occurred in the age group of more than 50 years with a male preponderance. Ischemic stroke was the most common type of stroke with its proportion varying from 67% to 74% depending on ETL. PROSPERO Registration: CRD42022316774.

Background: Traumatic dental injuries are most commonly seen in school age children. This not only affects physical, but, also, the psychological and social well-being of a child. The aim of the present study was to assess the prevalence of traumatic dental injuries in school children aged between 8 and 13 years and their association with the demographics and other predisposing risk factors. Materials and Methods: The present study was conducted as a cross-sectional study design on 1500 school children aged between 8 and 13 years. Apart from clinical examination, all the participants were asked to complete a questionnaire related to the injuries sustained. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 21.0 (IBM, Chicago). Pearson’s Chi-square (Χ²) test was used for categorical data analysis and distribution to determine the association between categorical variables, while P < 0.05 was considered statistically significant. Results: The prevalence of traumatic dental injuries in the present study was calculated at 9.7%. Also, the occurrence of such injuries was found to be higher in the age group of 8–11 years with 10 years being the peak age of incidence for sustaining such injuries. Again, crown fracture involving enamel was found to be the most common type of injury sustained, while proclination observed in relation to upper anterior teeth, and incompetent lips were found to be the independent, significant risk predictors associated with the frequency and severity of such injuries. Conclusions: The results obtained in the present study suggested a high prevalence of traumatic dental injuries in school children aged between 8 and 13 years highlighting the need for conducting educational programs, for increasing knowledge and awareness of parents, school children and school faculty in this regard to save the affected child patients from the more dreaded sequelae including complete loss of tooth structure, and social and emotional trauma.

Summary: Background: Ross River virus (RRV), Australia's most notifiable vector-borne disease transmitted through mosquito bites, has seen increased transmission due to rising temperatures. Quantifying the burden of RRV infection attributable to increasing temperatures (both current and future) is pivotal to inform prevention strategies in the context of climate change. Methods: As RRV-related deaths are rare in Australia, we utilised years lived with disability (YLDs) associated with RRV infection data from the Australian Institute of Health and Welfare (AIHW) Burden of Disease database between 2003 and 2018. We obtained relative risks per 1 °C temperature increase in RRV infection from a previous meta-analysis. Exposure distributions for each Köppen-Geiger climate zone were calculated separately and compared with the theoretical-minimum-risk exposure distribution to calculate RRV burden attributable to increasing temperatures during the baseline period (2003–2018), and projected future burdens for the 2030s and 2050s under two greenhouse gas emission scenarios (Representative Concentration Pathways, RCP 4.5 and RCP 8.5), two adaptation scenarios, and different population growth series. Findings: During the baseline period (2003–2018), increasing mean temperatures contributed to 35.8 (±0.5) YLDs (19.1%) of the observed RRV burden in Australia. The mean temperature attributable RRV burden varied across climate zones and jurisdictions. Under both RCP scenarios, the projected RRV burden is estimated to increase in the future despite adaptation scenarios. By the 2050s, without adaptation, the RRV burden could reach 45.8 YLDs under RCP4.5 and 51.1 YLDs under RCP8.5. Implementing a 10% adaptation strategy could reduce RRV burden to 41.8 and 46.4 YLDs, respectively. Interpretation: These findings provide scientific evidence for informing policy decisions and guiding resource allocation for mitigating the future RRV burden. The current findings underscore the need to develop location-specific adaptation strategies for climate-sensitive disease control and prevention. Funding: Australian Research Council Discovery Program.

Introduction: Analysis of the coronavirus disease 2019 (COVID-19) surveillance system in the first wave indicated that the data-driven approach helped in resource allocation and public health interventions. Objectives: We described the epidemiology of COVID-19 cases in Chennai, Tamil Nadu, India, from February 2021 to February 2022. Materials and Methods: We analyzed the COVID-19 surveillance data from Chennai City, Tamil Nadu, India's Greater Chennai Corporation. We described the deidentified line list of COVID-19 cases and deaths by months, zones, age, and gender. We estimated the incidence of COVID-19 cases per million population, test positivity rate (TPR), and case fatality ratio (CFR). Results: Of the 434,040 cases reported in Chennai from February 1, 2021, to February 28, 2022, 53% were male. The incidence per million peaked in May 2021 (19,210) and January 2022 (15,881). Age groups more than 60 years reported maximum incidence. Southern region zones reported higher incidence. Overall TPR was 5.8%, peaked in May 2021 (17.5%) and January 2022 (15.1%). Over half of the 4929 reported deaths were in May 2021 (56%). Almost half of the deaths were 61–80 years (52%), followed by 41–60 years (26%). Overall CFR was 1%, which peaked in June 2021 (4%). Conclusion: We conclude that Chennai city experienced a surge in COVID-19 due to delta and omicron variants. Understanding descriptive epidemiology is vital for planning the public health response, resource allocation, vaccination policies, and risk communication to the community.

Background: COVID-19 has become a global pandemic, prompting lockdowns in practically every country. To prevent the spread of the disease, India has enforced a rigorous nationwide lockdown that commenced in March 2020. The lockdown imposed amid the pandemic ensured that most commercial activities and vehicle transportation ceased, resulting in a significant reduction in air pollution levels. Material and Methods: The value of air pollutants PM10, PM2.5, NO2, and SO2 from January to May 2020 was obtained from the Indian Central Pollution Control Board. Before lockdown and during lockdown, relative fluctuations in ambient concentrations of four air contaminants were investigated. The Box–Jenkins approach was used to estimate future air pollution data points using time series data analysis. Results: The PM10 level reduced by 61%, 30%, 68%, 37%, and 43% in the selected cities, respectively. Comparison of other pollutant concentrations before and after the lockdown also found a reduction in ambient pollutant concentrations, resulting in improved air quality. Inference of predicted model values to observed values revealed a significant increase in the concentrations of all pollutants. The percentage increases in AQImean from predicted to observed values were 206% in Ghaziabad, 148% in Delhi, 59% in Hyderabad, and 160% in Cochin. Conclusion: The strict lockdown has resulted in a significant drop in air pollutant levels. Upgrading present technologies could help keep pollution to a minimum of 37% under control. The findings would prompt the government to consider how to strictly reduce vehicle and industrial pollution to improve air quality and maintain improved public health.

Background: The COVID-19 pandemic era had witnessed an upsurge of healthcare-associated infections (HAI) in COVID intensive care units (ICUs), which can be reduced by following proper hand hygiene (HH) practice. Performing HH auditing in COVID ICUs and providing timely feedback to the stake holders is crucial to reduce HAIs. Methods: From July 2021 to December 2021, HH auditing was conducted in COVID ICUs. (HH) complete adherence rate (HHCAR), HH partial adherence rate (HHPAR) and HH total adherence rate (HHTAR) were analysed. Profession-specific HHTAR and moment-specific HHTAR (for each WHO moment) were also calculated.Results: HHCAR, HHPAR and HHTAR were found to be 47%, 19% and 66%, respectively. There was a significant increase in the monthly HHTAR from 62.2% to 72.2% (p

Introduction Prior studies on public attitudes and awareness of clinical research (CR) in India before the pandemic identified significant knowledge gaps. Thus, we aim to investigate if the pandemic has influenced awareness and attitudes towards CR given the wide mass and social media coverage on drug/vaccine development process.Methods This was an online survey conducted among young adults enrolled as students in a university in south India between 15 September 2022 and 31 October 2022. Until recently, these students attended online classes from various locations across India, likely reflecting a diverse regional and traditional background. Information regarding their sociodemographic status, awareness and perception about CR was collected and analysed applying the principle of descriptive and inferential statistics.Results A total of N=4796 eligible survey responses were analysed. Approximately, 50% were unfamiliar with CR but 42.4% expressed willingness to participate in a future CR. The significant predictors for a higher favourable perception score were having heard about CR (p

BackgroundThe Network University Medicine projects are an important part of the German COVID-19 research infrastructure. They comprise 2 subprojects: COVID-19 Data Exchange (CODEX) and Coordination on Mobile Pandemic Apps Best Practice and Solution Sharing (COMPASS). CODEX provides a centralized and secure data storage platform for research data, whereas in COMPASS, expert panels were gathered to develop a reference app framework for capturing patient-reported outcomes (PROs) that can be used by any researcher. ObjectiveOur study aims to integrate the data collected with the COMPASS reference app framework into the central CODEX platform, so that they can be used by secondary researchers. Although both projects used the Fast Healthcare Interoperability Resources (FHIR) standard, it was not used in a way that data could be shared directly. Given the short time frame and the parallel developments within the CODEX platform, a pragmatic and robust solution for an interface component was required. MethodsWe have developed a means to facilitate and promote the use of the German Corona Consensus (GECCO) data set, a core data set for COVID-19 research in Germany. In this way, we ensured semantic interoperability for the app-collected PRO data with the COMPASS app. We also developed an interface component to sustain syntactic interoperability. ResultsThe use of different FHIR types by the COMPASS reference app framework (the general-purpose FHIR Questionnaire) and the CODEX platform (eg, Patient, Condition, and Observation) was found to be the most significant obstacle. Therefore, we developed an interface component that realigns the Questionnaire items with the corresponding items in the GECCO data set and provides the correct resources for the CODEX platform. We extended the existing COMPASS questionnaire editor with an import function for GECCO items, which also tags them for the interface component. This ensures syntactic interoperability and eases the reuse of the GECCO data set for researchers. ConclusionsThis paper shows how PRO data, which are collected across various studies conducted by different researchers, can be captured in a research-compatible way. This means that the data can be shared with a central research infrastructure and be reused by other researchers to gain more insights about COVID-19 and its sequelae.

INTRODUCTION: Dental education assumes an indispensable role in adequately equipping students for a successful career in dentistry. Error-based active learning, an innovative approach in dental education, is a combination of mistake-driven learning (MDL) and case-based learning (CBL) to provide a transformative learning atmosphere for students. While active learning has gained popularity in dental education, the effectiveness of error-based active learning remains unexplored. This study aims to evaluate the effectiveness of error-based active learning among final-year dental undergraduate students in comparison with the conventional lecture-based approach. MATERIALS AND METHODS: A parallel-arm single-blind randomized controlled trial was conducted in a dental institute in India from November 2022 to December 2022. A total of 74 students were randomly allocated to two groups: Group A (n = 37) received error-based active learning and group B (n = 37) received conventional lecture-based learning approach. Atraumatic restorative treatment (ART) was chosen as the topic for the study. The knowledge of students was assessed at three intervals: baseline, post-intervention, and 4 weeks after the intervention, using a self-designed and validated questionnaire with Cronbach’s alpha of 0.87 and a content validity ratio of 0.84. A standard survey questionnaire was employed to evaluate students’ perceptions of the teaching methods. RESULTS: Error-based active learning group outperformed the lecture-based group significantly in the post-intervention test (20.92 ± 1.42 vs 16.97 ± 3.06), with better knowledge retention (18.30 ± 2.02 vs 14.05 ± 4.26) and positive feedback from the students. CONCLUSIONS: The error-based active learning approach proved superior to the conventional lecture-based method in enhancing and retaining knowledge regarding ART.

We assessed adverse events in hospitalized patients receiving selected vesicant antibiotics or vasopressors administered through midline catheters or peripherally inserted central catheters (PICC). The rates of catheter-related bloodstream infections, thrombosis, and overall events were similar across the two groups, while occlusion was higher in the PICC group.

Abstract Objective: Carbapenem-resistant organisms (CROs) are an urgent health threat. Since 2017, Alameda County Health Public Health Department (ACPHD) mandates reporting of carbapenem-resistant Enterobacterales (CRE) and encourages voluntary reporting of non-CRE CROs including carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Surveillance data from ACPHD were analyzed to describe the epidemiology of CROs and target public health interventions. Methods: Healthcare facilities in Alameda County reported CRO cases and submitted isolates to ACPHD to characterize carbapenemase genes; deaths were identified via the California Electronic Death Registration System. CRO cases with isolates resistant to one or more carbapenems were analyzed from surveillance data from July 2019 to June 2021. Results: Four hundred and forty-two cases of CROs were reported to Alameda County from 408 patients. The county case rate for CROs was 29 cases per 100,000 population, and cases significantly increased over the 2-year period. CRPA was most commonly reported (157 cases, 36%), and cases of CRAB increased 1.83-fold. One-hundred eighty-six (42%) cases were identified among residents of long-term care facilities; 152 (37%) patients had died by January 2022. One hundred and seven (24%) cases produced carbapenemases. Conclusions: The high burden of CROs in Alameda County highlights the need for continued partnership on reporting, testing, and infection prevention to limit the spread of resistant organisms. A large proportion of cases were identified in vulnerable long-term care residents, and CRAB was an emerging CRO among this population. Screening for CROs and surveillance at the local level are important to understand epidemiology and implement public health interventions.

Summary: Background: This report details how one large medical center in the Metropolitan New York area re-purposed a drive-through COVID-19 vaccination structure to handle a surge in Mpox cases in July 2022.Methods/Results: Simultaneous to on-going COVID -19 vaccination and testing, Mpox vaccination was rolled out in the same drive through structure. More than 1,820 Jynneos (Smallpox and Monkeypox Vaccine, Live, Non-replicating) vaccine dosages were delivered subcutaneously and then intradermally to 1,123 individuals through the open window of their vehicles, averaging 8–10 patients an hour. Five vaccine recipients suffered Mpox rash; there was no exposure among healthcare providers. Conclusion: Drive-through vaccination is an efficient model to be redeployed for future unexpected vaccine initiatives.

Summary: Background: The dual impacts of a warming climate and population ageing lead to an increasing kidney disease prevalence, highlighting the importance of quantifying the burden of kidney disease (BoKD) attributable to high temperature, yet studies on this subject are limited. The study aims to quantify the BoKD attributable to high temperatures in Australia across all states and territories, and project future BoKD under climatic, population and adaptation scenarios. Methods: Data on disability-adjusted-life-years (DALYs) due to kidney disease, including years of life lost (YLL), and years lived with disability (YLD), were collected during 2003–2018 (baseline) across all states and territories in Australia. The temperature-response association was estimated using a meta-regression model. Future temperature projections were calculated using eight downscaled climate models to estimate changes in attributable BoKD centred around 2030s and 2050s, under two greenhouse gas emissions scenarios (RCP4.5 and RCP8.5), while considering changes in population size and age structure, and human adaptation to climate change. Findings: Over the baseline (2003–2018), high-temperature contributed to 2.7% (Standard Deviation: 0.4%) of the observed BoKD in Australia. The future population attributable fraction and the attributable BoKD, projected using RCP4.5 and RCP8.5, showed a gradually increasing trend when assuming no human adaptation. Future projections were most strongly influenced by the population change, with the high temperature-related BoKD increasing by 18.4–67.4% compared to the baseline under constant population and by 100.2–291.2% when accounting for changes in population size and age structure. However, when human adaptation was adopted (from no to partial to full), the high temperature-related BoKD became smaller. Interpretation: It is expected that increasing high temperature exposure will substantially contribute to higher BoKD across Australia, underscoring the urgent need for public health interventions to mitigate the negative health impacts of a warming climate on BoKD. Funding: Australian Research Council Discovery Program.

Background The global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. As the number of older adults in LMICs increases, services able to effectively address their physical and mental health needs will be increasingly important. Objective We review the health and socioeconomic resources currently available for older people in South Asian countries, Bangladesh, India, Nepal, Pakistan and Sri Lanka, to identify gaps in available resources and assess areas for improvement. Methods We conducted a search of grey and published literature via Google Search, Compendex, EBSCO, JSTOR, Medline, Ovid, ProQuest databases, Scopus and Web of Science. Data on population demographics, human resources, health funding and social protection for older people were extracted. Local informants were consulted to supplement and verify the data. Results In the study countries, the number of health professionals with expertise in elderly care was largely unknown, with minimal postgraduate training programmes available in elderly medicine or psychiatry. Older adults are therefore cared for by general physicians, nurses and community health workers, all of whom are present in insufficient numbers per capita. Total average healthcare expenditure was 2.5–5.5% of GDP, with 48.1–72.0% of healthcare costs covered by out-of-pocket payments. Pakistan did not have a social pension; only India and Nepal offered financial assistance to people with dementia; and all countries had disproportionately low numbers of care elderly homes. Conclusions Inadequate healthcare funding, a shortage of healthcare professionals and insufficient government pension and social security schemes are significant barriers to achieving universal health coverage in LMICs. Governing bodies must expand training programmes for healthcare providers for older adults, alongside increasing social protection to improve access to those in need and to prevent catastrophic health expenditure.

Background: Spectacle compliance is vital among the young population to combat visual impairment arising from untreated refractive errors. Encouraging spectacle use is crucial, despite the challenges they present, such as fogging, scratches, and discomfort when prescribed wrong Objectives: 1. To study the obstacles faced by medical undergraduates while using spectacles. 2. To find out the various factors associated with the obstacles faced by undergraduates while wearing spectacles. Methodology: The study protocol was submitted for the approval from the Institutional Ethics Committee (IEC) of Kasturba Medical College, Mangalore. After obtaining the approval from ethics committee, permission was obtained from the Dean of Kasturba Medical College, Mangalore and data collection was done after receiving informed consent from the participants. A semi- structured questionnaire was distributed to the participants Results: 72.7% faced obstacle of dependency on spectacles and 71.5% faced difficulty of adjusting spectacles with gloved hands. · Out of 60(34.9%) study participants who ride two-wheeler, 21(35%) participants faced difficulties while riding due to spectacle use and wearing helmet(42.8%), glaring(19.1%) and fogging(14.2%) were the major difficulties faced. · Among 54(32%) study participants who drive 4-wheeler, 9(16.6%) participants faced difficulties while driving due to spectacle use and the major difficulties encountered were glaring(55.5%) and restricted field of vision(22.2%). · A statistically significant association with P value of 0.001 was established between duration of spectacle usage and dependency on spectacles Conclusion: Based on our study, we have found that most of the participants have been using spectacles for 1-10 years mainly for correction of refractive errors like myopia and thus use spectacles throughout the day.

BackgroundSaudi Arabia’s health sector is experiencing a significant transformation toward an emphasis on the public health model. This model is a population-based approach to preventing and controlling disease, and its importance becomes evident during infectious outbreaks and pandemics, such as COVID-19. This study aimed to assess the awareness and attitudes of health students in Jazan toward the public health model.MethodsThis study applied a cross-sectional online survey. Data were collected from 3–18 November 2020 using Google Forms. A convenience sampling method was used with a final sample of 425 participants.ResultsMost participants (71%) were aware of the public health model, with an average score of 11.36 out of 16. Multiple regression analysis revealed a significant association between the awareness level of the public health model and participants’ demographics, namely, gender, major of study, year of study, and prior training in public health. Participants who completed public health training (β = 0.220) had higher awareness scores than others. On the other hand, participants from public health (β = −0.342), medicine (β = 0.164), and nursing in Jazan (β = 0.128) had higher awareness of the public health model than the reference group (Nursing at Addayer College). Addayer is an area located in the rural northeast of the Jazan region. In addition, final-year students (β = 0.113) had higher awareness of the public health model than the reference group (year 2 pre-final students). Female participants (β = −0.142) had lower awareness of the public health model than male participants. Most participants (95.3%) believed that the clinical care and public health models are essential for promoting people’s health. However, 4.7% of participants believed that clinical health care is more important than public health.ConclusionHealth students, who are future healthcare professionals, must understand and value the public health model to support the planned health system reforms. It is recommended to evaluate how the education and training of students in public health, medicine, and nursing in Jazan impact the understanding and views of this cohort on the public health model compared to those of students in other health-related majors.

Abstract Background Vaccines are an important public health measure and effective strategy to protect the population from COVID‐19. Front‐line healthcare personnel should receive priority in vaccination programs. However, the reported hesitancy among healthcare workers (HCWs) toward the COVID‐19 vaccines cannot be ignored. It widely influences the level of vaccine hesitancy in the general population. Hesitancy, fear, and anxiety were documented in first and second rounds of COVID‐19 vaccination. This study assessed the acceptance of COVID‐19 booster doses among the HCWs in Qatar. Methods A web‐based cross‐sectional online survey was conducted using the 7C Vaccine Readiness Scale to evaluate the preparedness of the HCWs to receive COVID‐19 vaccines. Descriptive and inferential statistics were used to identify factors associated with preparedness for vaccination. Results A total of 382 participants completed the survey. Allied health professionals scored the least on the readiness score (−7.0 ± 9.9) compared to the physicians (3.1 ± 7.2) and nurses (3.0 ± 7.8). Physicians scored higher on confidence (58.8%), calculation (64.7%), and complacency (60.8%). Nurses scored higher on constraints (51.6%), collective responsibility (62.7%), and compliance (39.1%), and allied health professionals scored higher on (67.9%) conspiracy. There was a significant association between readiness score and not being infected with COVID‐19, post‐vaccine symptom experience, and hesitancy for the initial two doses. Conclusion This study reports higher complacency and constraints with the perception of lower risks and the lack of interest in taking collective responsibility among the HCWs. Addressing vaccine hesitancy among them is critical to ensure successful vaccination campaigns and promote community safety during future pandemics.

Background: Transport workers have a haphazard and incongruent schedule which makes it difficult for them to follow proper oral hygiene practices. Bus drivers whose lifestyle is primarily sedentary and characterized by poor eating habits are at increased risk. This study aimed to investigate the association between BMI and oral health status among NWKRTC (North West Karnataka Road Transport Corporation) bus drivers in Belagavi, India. Methods: A self-designed validated questionnaire was employed to assess oral hygiene status and record soft tissue variations among the bus drivers. A sample size of 300 was recruited for the study using the convenience sampling technique. Descriptive statistics, Chi-square, Kruskal Wallis test, Spearman's correlation, and logistic regression analysis were used for statistical analyses. Results: The mean age of the participants was 42.47 ± 8.44 years. The mean BMI score was found to be 25.43 ± 3.51. The prevalence of dental caries and periodontal disease was found to be 82.7% and 67.6%, respectively. Hypertension (15.67%), diabetes mellitus (14.33%), leukoplakia (8.33%), and OSMF (3.33%) were prevalent and statistically significant (P ≤ 0.05). A positive linear correlation and a significant relationship was found between Decayed, Missing, Filled teeth (DMFT) score (r = +0.44) and Community Periodontal Index (CPI) score (r = +0.17) with BMI. Participants with dental caries (aOR:1.20; 95%CI: 0.55–2.61) and periodontal disease BMI (aOR:1.91; 95%CI:1.19–3.06) exhibited increased odds of having higher BMI. Conclusion: The study revealed a significant association between BMI and both oral health status and systemic conditions among government bus drivers in Belagavi.

IntroductionThe clinical incidence of antimicrobial-resistant fungal infections has dramatically increased in recent years. Certain fungal pathogens colonize various body cavities, leading to life-threatening bloodstream infections. However, the identification and characterization of fungal isolates in laboratories remain a significant diagnostic challenge in medicine and public health. Whole-genome sequencing provides an unbiased and uniform identification pipeline for fungal pathogens but most bioinformatic analysis pipelines focus on prokaryotic species. To this end, TheiaEuk_Illumina_PE_PHB (TheiaEuk) was designed to focus on genomic analysis specialized to fungal pathogens.MethodsTheiaEuk was designed using containerized components and written in the workflow description language (WDL) to facilitate deployment on the cloud-based open bioinformatics platform Terra. This species-agnostic workflow enables the analysis of fungal genomes without requiring coding, thereby reducing the entry barrier for laboratory scientists. To demonstrate the usefulness of this pipeline, an ongoing outbreak of C. auris in southern Nevada was investigated. We performed whole-genome sequence analysis of 752 new C. auris isolates from this outbreak. Furthermore, TheiaEuk was utilized to observe the accumulation of mutations in the FKS1 gene over the course of the outbreak, highlighting the utility of TheiaEuk as a monitor of emerging public health threats when combined with whole-genome sequencing surveillance of fungal pathogens.ResultsA primary result of this work is a curated fungal database containing 5,667 unique genomes representing 245 species. TheiaEuk also incorporates taxon-specific submodules for specific species, including clade-typing for Candida auris (C. auris). In addition, for several fungal species, it performs dynamic reference genome selection and variant calling, reporting mutations found in genes currently associated with antifungal resistance (FKS1, ERG11, FUR1). Using genome assemblies from the ATCC Mycology collection, the taxonomic identification module used by TheiaEuk correctly assigned genomes to the species level in 126/135 (93.3%) instances and to the genus level in 131/135 (97%) of instances, and provided zero false calls. Application of TheiaEuk to actual specimens obtained in the course of work at a local public health laboratory resulted in 13/15 (86.7%) correct calls at the species level, with 2/15 called at the genus level. It made zero incorrect calls. TheiaEuk accurately assessed clade type of Candida auris in 297/302 (98.3%) of instances.DiscussionTheiaEuk demonstrated effectiveness in identifying fungal species from whole genome sequence. It further showed accuracy in both clade-typing of C. auris and in the identification of mutations known to associate with drug resistance in that organism.

Background: This study has employed the multidimensional and flexible index that is the Multidimensional Poverty Index (MPI) in achieving the objective of this study. Aims and Objectives: This study intends to assess and quantify the poverty levels of India using MPI. Materials and Methods: This study has selected eight indicators across three dimensions – health, education and social capital, and standard of living – in the estimation and applied the MPI method of cross-dimensional cut off across the indicators. Results: Upon completion, this study showed that India faces multidimensional poverty with an MPI of 0.4328. Conclusion: Estimation of multidimensional poverty can be done by even health-care professionals/institutes, notwithstanding constraints of data availability, to be used for policy considerations.

Background: This study aimed to create an age estimation formula with high sensitivity and specificity using the modified Kvaal's dental radiographic method. The parameters for age estimation were assessed by measuring the length and width of tooth, root, and pulp with the help of a stereomicroscope and digital image analysis. Materials and Methods: Only single-rooted noncarious teeth were included. A total of 203 samples of teeth, with an age ranging from 15 to 85 years, were collected, of which only 123 samples were included in the study. Images of vertically sectioned teeth specimens were captured under a stereomicroscope (version SZ-790, ×10 mm eyepiece), and parameters were measured using Adobe Photoshop. Results: Karl Pearson's correlation coefficient was used to correlate age with the dental parameters, and step-wise regression analysis was used to derive the age estimation formula. A significant correlation of age with pulp length and root and pulp width having P < 0.001 was observed, and an age estimation formula with a standard estimation error of 14 could be derived. Conclusion: Kvaal's parameter in extracted single-rooted tooth showed a better reliability and reproducibility in age estimation. Further studies with a larger sample size and tooth-specific formula using principal component analysis should be considered to validate the accuracy of the present result.

Background: Natural disasters cause much hardship and suffering, loss of property, and increased morbidity and mortality amongst those affected. Timely and effective response for relief and rescue services go a long way in mitigating these consequences. Material and Methods: This population-based cross-sectional, descriptive study conducted in the immediate aftermath of the catastrophic flood that occurred in Kerala, South India, in 2018, documents the experiences of the victims, the community's preparedness, and response to the disaster. Results: Flood waters reached levels of over four feet within the premises of 55% of the houses and nearly 97% had water flooding inside their homes. More than 93% of the households were evacuated to safer locations and relief camps. The elderly and those with chronic illnesses were the worst sufferers, unable to access medical aid. Many families (62%) received help from neighbors. Conclusion: However, the loss of lives was minimal, and could be attributed to the immediate response of the local community in rescue and relief work. This experience underscores the vital importance of the local community as first responders, and their preparedness for disasters.

Across India, there have been multiple studies conducted to address the issues of the mental health of healthcare workers during the COVID-19 pandemic. The present study estimated the pooled prevalence of psychological morbidity among healthcare workers during the early phase of the COVID 19 pandemic in India. We searched the following electronic bibliographic databases: PubMed, ScienceDirect, Wiley online library, and Google scholar for studies conducted from the onset of the COVID 19 pandemic until 25 September 2021. The methodological quality of each study was scored and outcome measures with uniform cut off scores as per various screening measurements were evaluated. According to the current meta analysis, the pooled estimates of depression, anxiety, stress, and insomnia among Indian healthcare workers during the COVID 19 pandemic are 20.1% (95% CI: 15.6 to 24.6%; n = 21 studies), 25.0% (95% CI: 18.4 to 31.6%; n = 20 studies), 36% (95% CI: 23.7 to 48.2%; n = 22 studies) and 18.9% (95% CI: 9.9 to 28.0%; n = 6 studies) respectively. In subgroup analyses, low quality studies based on the JBI checklist (Score < 3/9) and studies using DASS 21 showed a higher pooled prevalence of depression and anxiety. About 20–36% of the healthcare workers in India reported having depression, anxiety, and stress during the early phase of the COVID 19 pandemic. The present study provides a comprehensive review of the overall burden of mental health problems among healthcare workers during the COVID 19 pandemic in India necessitating appropriate intervention strategies to protect these frontline groups before the memory of the pandemic crisis starts to fade.

Introduction: The COVID-19 pandemic, which began in late 2019 and is still ongoing, has affected health and life across the world. Widespread vaccination with highly effective vaccines is an important tool in the efforts to control this pandemic. To determine post-vaccination symptoms after the first dose of Covishield vaccine among health care workers at a tertiary care centre in Pathanamthitta District.Materials and Methods: A descriptive cross-sectional study in a tertiary care hospital in Pathanamthitta District. Data on adverse effects following vaccination with the first dose of Covishield vaccine were collected from health care workers through online surveys and interviews. Baseline characteristics were described with frequency, percentages, and mean. Associations between categorical variables were assessed using the Chi-square test. Results: Of the 1,115 health care workers who participated in the study, the majority were medical students (28.3%), followed by nurses (24.8%), and doctors (19.1%). Post-vaccination symptoms were reported by the majority of the participants (95.1%). The most common symptoms were pain at the site of injection (79.8%), followed by myalgia (67.2%), and tiredness (64.6%). Hospitalization was required for six (0.5%) of the participants. Conclusion: The symptoms reported in the study were those already known to be the general side effects associated with vaccines. The information obtained from this study will aid in health promotion activities related to COVID-19 vaccination.

Abstract Objectives Low-and-middle-income countries (LMICs) bear a disproportionate burden of cervical cancer mortality. We aimed to identify what is currently known about barriers to cervical cancer screening among women in LMICs and propose remedial actions. Design This was a systematic review using Medical Subject Headings (MeSH) terms in Google Scholar, PubMed, Scopus, and Web of Science databases. We also contacted medical associations and universities for grey literature and checked reference lists of eligible articles for relevant literature published in English between 2010 and 2020. We summarized the findings using a descriptive narrative based on themes identified as levels of the social ecological model. Setting We included studies conducted in LMICs published in English between 2010 and 2020. Participants We included studies that reported on barriers to cervical cancer screening among women 15 years and older, eligible for cervical cancer screening. Results Seventy-nine articles met the inclusion criteria. We identified individual, cultural/traditional and religious, societal, health system, and structural barriers to screening. Lack of knowledge and awareness of cervical cancer in general and of screening were the most frequent individual level barriers. Cultural/traditional and religious barriers included prohibition of screening and unsupportive partners and families, while social barriers were largely driven by community misconceptions. Health system barriers included policy and programmatic factors, and structural barriers were related to geography, education and cost. Underlying reasons for these barriers included limited information about cervical cancer and screening as a preventive strategy, poorly resourced health systems that lacked policies or implemented them poorly, generalised limited access to health services, and gender norms that deprioritize the health needs of women. Conclusion A wide range of barriers to screening were identified across most LMICs. Urgent implementation of clear policies supported by health system capacity for implementation, community wide advocacy and information dissemination, strengthening of policies that support women’s health and gender equality, and targeted further research are needed to effectively address the inequitable burden of cervical cancer in LMICs.

Abstract Background Head and neck cancer (HNC) patients often undergo radiation therapy as part of their treatment. However, radiation therapy can have many side effects, including oral toxicities. Evaluating these toxicities is often considered a challenging task for practicing clinicians due to the lack of assessment tools. The objective of this study is to culturally adapt, translate and validate the Vanderbilt Head and Neck Symptom Survey (VHNSS), an instrument designed to assess oral toxicities and changes in oral functioning in HNC patients receiving radiation therapy. Methods The VHNSS 2.0 was first culturally adapted and translated, following which 36 HNC patients undergoing radiation therapy were identified through the incidental sampling method. The translated version of VHNSS 2.0 was then administered to these patients. Internal consistency was assessed using Cronbach’s alpha and Mc Donald’s Omega. Test–retest reliability was also analyzed. Results Items of the translated version of VHNSS 2.0 showed good content validity. The omega values yielded higher reliability coefficients than the Cronbach’s alpha coefficient. Test–retest reliability was found to be 0.8, indicating good reliability. Conclusions Results of this study suggest that the translated Kannada version of the VHNSS 2.0 is linguistically equivalent to the original version. Hence, this tool can be considered a valid and reliable patient-reported tool to evaluate oral symptomatology in HNC patients speaking the Kannada language.

Background and objectives: The main aim of the study is to assess the occurrence of metabolic syndrome among patients with acute coronary syndrome (ACS) and the different risk factors associated with it. Materials and methods: This was a cross-sectional observational study conducted on 515 patients who fulfilled the inclusion criteria. A semi-structured questionnaire was administered to the patients to collect data about socio-demographic factors. Participants men and women are aged 18–80 with ACS. Metabolic syndrome was assessed using National Cholesterol Education Program for Adult Treatment Panel guidelines. Results: In our study, 191 patients had three or more components of Met S which accounts for 37.08% of the total ACS population. Patients with MS had a mean age of 62.60 ± 9.78 years. Abdominal obesity (87.43%), High fasting plasma glucose (FPG) (62.13%), and High BP (85.3%) were found to be the most common risk factors among all the five parameters in both genders. The prevalence of metabolic syndrome was more frequent in men (67.01%) than in women (32.98%). Abdominal obesity (89.06%) was most frequent among males than females. In the present study group, the combinations of three components of metabolic syndrome were more common in men (54.68%) than in women (52.38%). Whereas combinations of four components of metabolic syndrome were more common in women (32.810%) than in men (36.50%). Five-component MS combinations were more common in men (12.5%) than in women (11.11%). Conclusion: Study concluded that metabolic syndrome is very common in patients with the acute coronary syndrome, especially in men and in the younger age groups.

Purpose: Stuttering is a fluency disorder with a worldwide prevalence of 1%. Reports on the epidemiology of stuttering in India is limited. Our primary goal was to examine the prevalence of the disorder among school children. The study also aimed to study the impact of several risk factors on the prevalence of stuttering. Method: A total of 3437 children in the age range of 6–15 years were screened in 16 camps conducted in and around schools of Dakshina Kannada. The children were screened for stuttering using a screening tool by an SLP based on their grade and medium of instruction and further validated using Stuttering Severity Instrument-4. Result: The prevalence of stuttering in school going children was 1.68%. Gaussian test reveals effect of gender on the prevalence of stuttering (Z1 = 3.501, p

Problem considered: The initial foods that children have are critical not only for their immediate survival but also for their long-term potential. This study was done to describe the complementary feeding practices in children aged 6–23 months in rural Lucknow, Uttar Pradesh and to identify the factors associated with appropriate feeding practices. Methods: A community based cross-sectional study was conducted in rural areas of Lucknow district in Uttar Pradesh. The calculated sample of 300 mother-child pairs were selected by multistage random sampling technique. Data was collected using a semi-structured questionnaire and analysis was done using IBM-SPSS version 26. Results: Grains and pulses were the most commonly consumed food groups by children aged 6–23 months. Nearly two-thirds of children had consumed unhealthy food, 20% had sweet beverages and 61% had zero vegetable or fruit consumption in previous twenty-four hours. Appropriate complementary feeding was seen in 51.3% children and it was found to be significantly associated with educational status of mothers, if the mothers had received counselling regarding complementary feeding and on maternal dietary diversity. Conclusion: The diet of children aged 6–23 months in rural Lucknow needs improvement in diversity. Poor vegetable/fruit consumption and high consumption of unhealthy foods is a detrimental trend. Focus should be provided on maternal education and counselling to improve complementary feeding practices.

Objectives: To assess the impact of educating and creating awareness among women on Menstrual Cups (M-Cups) as a healthy, safe, easy-to- use and affordable menstrual hygiene product with the support of medical professionals. Study design: A two-group, non-randomized cross-sectional study. Methods: The M-Cup awareness creation was carried out through the project ‘Thinkal’ and 4345 cups were distributed among the beneficiaries of Alappuzha Municipality in two separate groups. One group received awareness with the help of medical professionals and experienced users whereas the other group collected the M-Cup from the distribution centres (Municipality and Community Development Society) along with the information pamphlets without attending awareness sessions initially. Results: Among the women who received the M-Cups without attending the awareness session, only 20.7% started using the M-Cup, where as 40.6% who received awareness, started the usage which is approximately double. Conclusions: A well curated awareness session was the most important factor which helped in transforming a woman into an M-Cup user.

Introduction : Diabetic foot has got a high prevalence of 52% among diabetics. The duration of hospital stay and physical disability are likely to cause depression and affects overall quality of life. So it is important for general population, to know about Self Care activities which include foot care practice to avert long term complications and improve quality of life which is likely to be effective in reducing the burden of diabetic foot ulcer. Objective: To assess the knowledge, attitude and practice about foot care among Type 2 DM patients in a Tertiary health care center, Tamil Nadu. Method: A cross-sectional study was done during August and September 2021 among diabetic patients after obtaining consent at a Tertiary Hospital in southern district of Tamil Nadu. Results: The mean age of the study participants was 47.56 ± 9.718 years with 55.9% being male and 44.1% female and the majority (65.6%)of subjects was residing in rural areas. Among the participants, 103 (92.8%) were found to have good attitude towards self-care activities whereas69 (62.2%) respondents practiced proper footcare. Age, gender and education were found to have significant association with the practice of proper foot care. Female gender was found to be an independent predictor for practice of adequate foot care. Conclusion: Regardless of good attitude towards diabetic foot care there is considerable resistance in practising it.

Introduction: The 2019 Coronavirus disease (COVID-19) pandemic has been a serious global threat with numerous researchesindicatingthat frontline healthcare personnelinvolved in its management and diagnosis are at risk of experiencing psychologicaldisturbances and deteriorating mental health. By definition, “burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”. Burnout has been associated with increased mortality and morbidity. Objective: To estimate the prevalence of burnout syndrome and to determine the associated factors among healthcare providers in rural Tamilnadu during the COVID-19 pandemic.Method: A cross-sectional study was done among 120 healthcare providers from SreeMookambika Institute of Medical Sciences, Tamil Nadu during July 2021. Participants selected by convenient sampling technique were given pre-tested Maslach Burnout Inventory- Human Services Survey (MBI-HSS) questionnaire. Data were entered in MS Excel 2019 and analysis was done in SPSS v26.0. Descriptive statistics and Chi-square tests were applied.Results: Mean age of the participantswas 25.48±4.66 years.Among them, 46(38.3%) reported emotional exhaustion, 42(35%) depersonalization and 87(72.5%) reported a lower sense of personal accomplishment. The years of professional experience and the number of working hours per day were associated with emotional exhaustion and depersonalization (p

Abstract Background The surge in the COVID-19 related hospitalization has been straining the US health system. COVID-19 patients with underlying chronic conditions have a disproportionately higher risk of hospitalization and intensive care unit (ICU) admission. We developed a retrospective analytical model of COVID-19 related hospitalizations and ICU admissions linked to each of the three major chronic conditions – hypertension, diabetes, and cardiovascular diseases (CVD). Methods Based on the differential probability of hospitalization of the COVID-19 patients with and without a chronic condition, we estimate a baseline cumulative hospitalization rate and ICU admission rate using the population level chronic condition prevalence from the 2019 Behavioral Risk Factor Surveillance System survey. Next, we estimate the hospitalization and ICU admission rates under an alternative scenario of a lower prevalence of the same chronic condition, aligned with the World Health Organization target of 25% relative reduction of prevalence by 2025. We then compare the outcomes of the baseline and the alternative scenarios. Results We estimate that the lower prevalence of hypertension would have lowered the cumulative hospitalization and ICU admission rates by more than 2.5%. The lower prevalence of diabetes and CVD would lower the cumulative hospitalization rate by 0.6% and 1.4% respectively. The decrease in the rates would have been relatively higher among Black and elderly (age 55+). Conclusions Our model, thus, provides evidence on the importance of prevention, control, and management of chronic conditions to lessen the overwhelming financial and public health burden on the health system during a pandemic like the COVID-19.

Abstract Background Implementation studies of complex interventions such as nutrition care pathways are important to health services research, as they support translation of research into practice. There is limited research regarding implementation of a nutrition care pathway in an upper gastrointestinal (UGI) cancer population. The aim of this study was to comprehensively evaluate the implementation process of a perioperative nutrition care pathway in UGI cancer surgery using The Consolidated Framework for Implementation Research (CFIR). Methods This was a mixed methods implementation study conducted during a pilot study of a standardised nutrition care pathway across four major hospitals between September 2018 to August 2019. Outcome measures included five focus groups among study dietitians (n = 4–8 per group), and quantitative satisfaction surveys from multi-disciplinary team (MDT) members (n = 14) and patients (n = 18). Focus group responses were analysed thematically using the CFIR constructs, which were used as a priori codes. Survey responses were summarised using means and standard deviations. A convergent parallel mixed methods approach according to CFIR domains and constructs was used to integrate qualitative and quantitative data. Results Qualitative data demonstrated that dietitian perceptions primarily aligned with five CFIR constructs (networks and communications, structural characteristics, adaptability, compatibility and patient needs/resources), indicating a complex clinical and implementation environment. Challenges to implementation mostly related to adapting the pathway, and the compatibility of nutrition coordination to existing aspects of care within each setting. Identified benefits from dietitian qualitative data and MDT survey responses included increased engagement between the dietitian and MDT, and a more proactive approach to nutrition care. Patients were highly satisfied with the service, with the majority of survey items being rated highly (≥4 of a possible 5 points). Conclusions The nutrition care pathway was perceived to be beneficial by key stakeholders. Based on the findings, sustainability and compliance to this model of care may be achieved with improved systems level coordination and communication.

Background: Problematic internet use (PIU) among school going adolescents constitutes a major area of concern. However, no comprehensive reports are available to determine the magnitude of the problem. This study aimed to estimate the pooled prevalence of PIU among school going adolescents in India. Methods: We conducted a systematic review and meta analysis of 15 studies conducted in various parts of India. Results: The prevalence of moderate and severe PIU among Indian school going adolescents was 21.5% (95% CI: 17.0%–26.8%) and 2.6% (95% CI: 1.6%–4.2%) based on the Young Internet Addiction Test (Y IAT) cutoff points of 50 and 80, respectively. In subgroup analysis, it was found that the year of publication, gender, sampling method, and severity of addiction had a significant effect on the prevalence estimates. Conclusions: Currently, the use of the internet is rampant in India and our findings reflect nationally representative data on the magnitude of PIU among school going adolescents. About one fifth of school going adolescents are at risk of PIU in this setting. There is a need for further research in the reconsideration of cut off points of the Y IAT among Indian adolescents.

Introduction: Violence against women is becoming more prevalent over the world, particularly in India. Assessing the causes of violence in community will aid in planning supports for victims. This study aimed to compare the performance of various regression models for count data and focused on choosing appropriate count regression model to identify factors related with the number of domestic violence experienced by young married women. Methods: Data for this study were retrieved from “The Youth in India: Situation and Needs Study.” The current study took the data of 1495 married women in Tamil Nadu. Factors associated with physical violence considered for the study were place of residence, age of husband and wife, education of husband and wife, dowry, miscarriage, abortion, and marriage type. Ordinary least square, Poisson regression, and negative binomial regression models were fitted for the data, and the best fitted model was identified using Akaike information criterion (AIC) and Bayesian information criterion (BIC). Results: Proportion of married women who have perpetrated any forms of physical violence was 30.8%. Among the fitted models, negative binomial regression model (AIC = 3020.621, BIC = 3079.030) was found to be the best model to predict violence. Significant factors identified were type of residence, marriage type, education of wife and spouse, miscarriage, and abortion. Conclusion: To tackle this public health issue, multisectoral approaches such as boosting literacy, raising awareness about legal assistance, and monitoring victims of violence at primary health facilities should be implemented. Comprehensive model testing is highly suggested for determining the best acceptable analytic model when dependent variable being studied comprises count data.

The soluble urokinase plasminogen activator receptor (suPAR) has been proposed as a biomarker for risk stratification of patients presenting with acute infections. However, most studies evaluating suPAR have used platform-based assays, the accuracy of which may differ from point-of-care tests capable of informing timely triage in settings without established laboratory capacity. Using samples and data collected during a prospective cohort study of 425 patients presenting with moderate Covid-19 to two hospitals in India, we evaluated the analytical performance and prognostic accuracy of a commercially-available rapid diagnostic test (RDT) for suPAR, using an enzyme-linked immunosorbent assay (ELISA) as the reference standard. Our hypothesis was that the suPAR RDT might be useful for triage of patients presenting with moderate Covid-19 irrespective of its analytical performance when compared with the reference test. Although agreement between the two tests was limited (bias = -2.46 ng/mL [95% CI = -2.65 to -2.27 ng/mL]), prognostic accuracy to predict supplemental oxygen requirement was comparable, whether suPAR was used alone (area under the receiver operating characteristic curve [AUC] of RDT = 0.73 [95% CI = 0.68 to 0.79] vs. AUC of ELISA = 0.70 [95% CI = 0.63 to 0.76]; p = 0.12) or as part of a published multivariable prediction model (AUC of RDT-based model = 0.74 [95% CI = 0.66 to 0.83] vs. AUC of ELISA-based model = 0.72 [95% CI = 0.64 to 0.81]; p = 0.78). Lack of agreement between the RDT and ELISA in our cohort warrants further investigation and highlights the importance of assessing candidate point-of-care tests to ensure management algorithms reflect the assay that will ultimately be used to inform patient care. Availability of a quantitative point-of-care test for suPAR opens the door to suPAR-guided risk stratification of patients with Covid-19 and other acute infections in settings with limited laboratory capacity.

The soluble urokinase plasminogen activator receptor (suPAR) has been proposed as a biomarker for risk stratification of patients presenting with acute infections. However, most studies evaluating suPAR have used platform-based assays, the accuracy of which may differ from point-of-care tests capable of informing timely triage in settings without established laboratory capacity. Using samples and data collected during a prospective cohort study of 425 patients presenting with moderate Covid-19 to two hospitals in India, we evaluated the analytical performance and prognostic accuracy of a commercially-available rapid diagnostic test (RDT) for suPAR, using an enzyme-linked immunosorbent assay (ELISA) as the reference standard. Our hypothesis was that the suPAR RDT might be useful for triage of patients presenting with moderate Covid-19 irrespective of its analytical performance when compared with the reference test. Although agreement between the two tests was limited (bias = -2.46 ng/mL [95% CI = -2.65 to -2.27 ng/mL]), prognostic accuracy to predict supplemental oxygen requirement was comparable, whether suPAR was used alone (area under the receiver operating characteristic curve [AUC] of RDT = 0.73 [95% CI = 0.68 to 0.79] vs. AUC of ELISA = 0.70 [95% CI = 0.63 to 0.76]; p = 0.12) or as part of a published multivariable prediction model (AUC of RDT-based model = 0.74 [95% CI = 0.66 to 0.83] vs. AUC of ELISA-based model = 0.72 [95% CI = 0.64 to 0.81]; p = 0.78). Lack of agreement between the RDT and ELISA in our cohort warrants further investigation and highlights the importance of assessing candidate point-of-care tests to ensure management algorithms reflect the assay that will ultimately be used to inform patient care. Availability of a quantitative point-of-care test for suPAR opens the door to suPAR-guided risk stratification of patients with Covid-19 and other acute infections in settings with limited laboratory capacity.

ObjectiveSuicide is a crucial public health concern. However, the interactions between bio psychosocial vulnerabilities and stressors leading to deliberate self-harm behavior remain unexplored, especially in the Indian context. This study examined the experiences leading to self-harm behavior among people who presented to emergency departments with suicidal attempts.MethodsIn this mixed-methods study, we enrolled 44 patients who presented with self-harm behavior at three tertiary health care facilities between October and December 2019. To collect quantitative data, we employed standardized tools: General Health Questionnaire (GHQ-28), General Help-Seeking Questionnaire, Mini International Neuropsychiatric Interview, and the Brief Resilience Scale. Further, we conducted semi-structured interviews to qualitatively explore participants' life experiences and other risk factors. Qualitative analyses were performed using thematic analysis and quantitative descriptive and inferential statistics were performed using STATA software.ResultsThe mean age of subjects were 29.8 years. The mean suicidality score for the patients was 26 (±8.7). In univariate analysis, depression and anxiety were positively associated with suicidality. While help-seeking behavior and resilience were negatively associated with suicidality. Qualitative results were centered on three major themes; life stressors, family related stressors, and social support-related vulnerabilities. The subjects' lived experiences were introduced in the backdrop of the interplay of vulnerabilities and stressors.ConclusionThe biopsychosocial vulnerabilities remain dormant until it is activated by life stressors resulting in severe self-harm behaviors. Mental health team-driven assertive engagement, positive coping, and social support interventions would help prevent reattempts in people with self-harm behaviors.

Background To determine the health system costs and health-related benefits of interventions for the prevention and control of non-communicable diseases (NCDs), including mental health disorders, for the purpose of identifying the most cost-effective intervention options in support of global normative guidance on the best-buy interventions for NCDs. In addition, tools are developed to allow country contextualisation of the analyses to support local priority setting exercises. Methods This analysis follows the standard WHO-CHOICE (World Health Organization-Choosing Interventions that are Cost-Effective) approach to generalized cost-effectiveness analysis applied to two regions, Eastern sub-Saharan Africa and South-East Asia. The scope of the analysis is all NCD and mental health interventions included in WHO guidelines or guidance documents for which the health impact of the intervention is able to be identified and attributed. Costs are measured in 2010 international dollars, and benefits modelled beginning in 2010, both for a period of 100 years. Results There are many interventions for NCD prevention and management that are highly cost-effective, generating one year of healthy life for less than Int. $100. These interventions include tobacco and alcohol control policies such as taxation, voluntary and legislative actions to reduce sodium intake, mass media campaigns for reducing physical activity, and treatment options for cardiovascular disease (CVD), cervical cancer and epilepsy. In addition a number of interventions fall just outside this range, including breast cancer, depression and chronic lung disease treatment. Conclusion Interventions that represent good value for money, are technically feasible and are delivered for a low per-capita cost, are available to address the rapid rise in NCDs in low- and middle-income countries. This paper also describes a tool to support countries in developing NCD action plans.

Background: Antibiotics act as a therapeutic weapon in eradicating pathogens. Antibiotics are the most common group of drugs misused for self-medication. This is a global public health concern and is one of the major contributing factors to antibiotic resistance (ABR). Objective: This study aimed to assess the knowledge and beliefs of the public in Qatar regarding appropriate antibiotic use and antimicrobial resistance. Methods: A cross-sectional research design was used to collect the information from the participants based on an adapted questionnaire from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) between September – November 2018. The study enrolled 1000 participants who visited two large emergency departments (ED) of public hospitals in Qatar. Results: The mean knowledge and belief scores were 55.07±15.87 and 66.57±23.13 respectively. 42% of the participants had moderate knowledge regarding antibiotic and antimicrobial resistance. The majority of the participants (64.8%) believed that antibiotics fight against bacteria and viruses. The educational level significantly influences the belief of the participants. Graduates possess a higher belief score of 11.75±12.5 (P=0.001) compared to others. Conclusion: The key findings of this study highlighted the existing gap in knowledge among the public. A community-based health education program should be launched to raise citizen responsibility to use antibiotics judiciously.

Health systems built on the foundation of primary healthcare (PHC) are essential to achieve universal health coverage (UHC). To adequately respond to the needs of people with non- communicable diseases (NCDs) and enable optimal management in primary care settings, changes are needed at many levels. PHC levers recommended in the UHC framework as the cornerstone of achieving Sustainable Development Goal (SDG) goals by strengthening the primary care system include strategic and operational levers. Experience from hypertension control programs across 18 countries has shown that rapid scale-up can be achieved through systematic improvement of the PHC system brought about by political commitment, financial support, and high-quality people-centred primary care. As countries are gripped with the pandemic the importance of an appropriate and resilient health system fit for the country is emerging as a priority for building preparedness. While there are general principles, each country must learn by doing and scale up models relevant to the national context.

Introduction: Timely, affordable, and sustained interventions reduce the risk of heart attack or Stroke in people with a high total risk of cardiovascular diseases (CVD). Risk prediction tools are available to estimate the cardiovascular risk using information on multiple variables. CVD risk charts prepared by the World Health Organization (WHO) has laboratory-based and non-laboratory-based charts with the latter meant for use in resource limited settings. We conducted a study to determine concordance between the laboratory- and non-laboratory risk charts and to estimate the prevalence of selected CVD risk factors in a rural Indian population. Methods: A community-based cross-sectional study was conducted in rural area of Ballabgarh in district Faridabad, Haryana. Sample of 1,018 participants aged 30–69 years was selected randomly from study area. Information on CVDs risk factors was obtained using WHO STEPS questionnaire, anthropometry and laboratory investigation. Risk distribution among the study participants was observed. Concordance between laboratory- and non-laboratory-based WHO CVD risk charts was determined using agreement analysis. Results: The mean age of the study participants was 43.9 (8.9) years and 55.6% participants were women. Among various CVD risk factors, hypertension (39.4%) was the major factor followed by overweight (34.1%) was found to be major factor, followed by current smoking (23.6%) and hypercholesterolemia (18.7%). The concordance between the two charts was 83.3% with kappa value of 0.64. Considering laboratory-based charts as the gold standard, the sensitivity and specificity of non-laboratory-based risk charts at 5% risk as cut-off was 86.5% and 90.3% respectively. Conclusion: The study shows a good agreement between the laboratory-based and non-laboratory-based risk charts. Thus non-laboratory-based risk charts are suitable for risk estimation of CVDs for use in resource limited settings like India.

Cronbach’s alpha is a very commonly used method in biomedical research. Cronbach’s alpha Indicates the extent to which the items in your questionnaire are related to each other, a useful coefficient for assessing the internal consistency of the items. Although this method is commonly used in medical research, the statistical software packages do not have the direct menu-driven operation for Cronbach’s alpha. Hence this paper intends to provide an R function (Cronbach. Alpha) for Cronbach’s alpha analysis.

Since 2000, a resurgence of syphilis has been noted in many developed and developing countries, especially among men who have sex with men (MSM). Incidence and prevalence of syphilis in pregnant women have been reduced drastically by mandatory screening in early pregnancy. Insufficient data in other populations especially from developing countries limit targeted public health interventions. This study aimed to describe the clinical and epidemiological profile of serologically confirmed syphilis cases among the non-pregnant high-risk group reporting to a tertiary care center in Southern India. A retrospective study was carried out in a tertiary care center in Southern India for 6 years from 2015 to 2020. A total of 265 serologically confirmed syphilis patients were included. A statistically significant increase in positivity from 0.52 to 2.1% was observed in this study (2015 to 2020). Among risk factors, high-risk behavior with multiple heterosexual partners was the commonest (51.3%), followed by marital partners who tested positive (9.4%) and MSM (7.5%). The majority of the patients were diagnosed at the latent stage (79%), followed by secondary syphilis (10%) and tertiary syphilis (8%). A quarter of patients (23%) were coinfected with HIV. Serological non-responsiveness was more common among HIV infected (47 vs. 24%). Sixteen had neurosyphilis and six had ocular involvement. HIV co-infection complicated 50% (8/16) of neurosyphilis patients. Syphilis is still prevalent, especially in high-risk groups including those are attending STI clinics. Further prospective multicentric studies are needed to identify and implement public health measures.

Introduction: Tracheoesophageal speech is a preferred method of alaryngeal voice rehabilitation in persons with a laryngectomy. Periodic replacements, troubleshooting, and stringent care are required to successfully use this device. There is a dearth of information on the perspectives of TE speakers from developing countries regarding the use and handling of this type of pseudo-voice. The current study aims to understand patient's viewpoints regarding their restored voice. Method: The Voice Prosthesis Questionnaire (VPQ) developed by Kazi (2006) was translated into 2 regional languages with the addition of four questions and was used in this study. The questionnaire focused on aspects related to the use and care of the prosthesis device, problems faced, management strategies used, and overall satisfaction. Results: The results indicated the following issues: the cost was a major concern; high tolerance for leakage; not seeking medical advice until serious complications arose; concerns about the physical distance to laryngectomy rehabilitation centers; and absence of trained professionals near their place of stay. Further, it was interesting to note the indigenous solutions for enhanced prosthetic life and humidification of inhaled air. Conclusion: Most participants of this study were satisfied with their restored voices as they believed that the alaryngeal mode of communication improved their quality of life. There is a need to develop indigenous humidification and hands-free speech systems that are affordable and feasible for the climatic conditions of India.

Summary: Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p