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Planetary Health emphasises the sustainability of natural systems for human well-being, linking human health directly with environmental health. This interdisciplinary concept has gained importance as anthropogenic activities have led to climate changes and health impacts. Despite efforts, a cohesive approach to planetary health from local to global levels remains lacking. The present review analysed 24 sources, including grey literature and published studies, identifying 40 interventions aimed at improving planetary health. The majority of research, primarily from the United States, focuses on reducing air pollution and greenhouse gas emissions. Effective strategies highlighted include promoting active transportation, improving diets, increasing physical activity, and engaging with indigenous communities to protect both environmental and human health. However, a significant gap exists in integrating these interventions through a unified informatics tool, which could enhance coordination and implementation of planetary health measures globally. The review underscores the necessity for a more integrated approach and the development of a global database to consolidate and manage planetary health interventions effectively.

BackgroundUndergraduate programs in public health are becoming increasingly popular in the United States (US). The recent pandemic, growing climate instability, and the aging baby boomers have led to higher demands for skilled public health professionals at various levels of the workforce. This study examines the nature of courses being delivered in undergraduate public health programs across the United States. The goal is to assess domains, themes, competencies, and other specialized skills that are currently covered in these academic programs.MethodologyA search was conducted in February 2023 using the online CEPH program database to identify undergraduate public health programs in the US. In total, 86 institutions and 90 CEPH-accredited undergraduate public health programs were identified. Lists of public health courses were retrieved from each program, and a total of 2,259 unduplicated courses were extracted and analyzed. A content analysis of the extracted topics was conducted to generate 38 common themes among the courses offered. Coded course themes were mapped to the public health domains and competencies listed by the ASPPH and CEPH to evaluate the distribution of themes across course offerings.ResultsAnalysis of course themes found that Foundations of Public Health, Epidemiology, Public Health Management, Policy, and Leadership, Climate and Environmental Health, and Global Health Issues were the most prevalent. When course themes were mapped onto the ASPPH and CEPH domains of critical public health learning, “overview of public health” and “determinants of health” were the most populated domains. Programs had different emphases according to their approach, but overall, about two-thirds of course themes were focused on foundational and theoretical concepts of public health, and one-third were directed toward practical applications of public health concepts.ConclusionAs the demand for skilled public health workers continues to rise, programs will need to watch the skills and competencies required in the current working environment, as well as the ASPPH and CEPH criteria, and adjust their approach accordingly. Given the rapid changes in the public health landscape, schools and programs of public health should evaluate their curricula to ensure that they are meeting the needs of the workforce and the world.

BackgroundWell-being is a multidimensional concept and has been extended to many areas. Student well-being has garnered attention over the last decade due to concerns that have been raised. Digital health interventions have the potential to enhance and improve student well-being. ObjectiveThe objective of the study is to design, develop, and pilot-test a digital health platform to enhance student well-being. MethodsA sample size of 5000 participants will be recruited across Gujarat and Tamil Nadu, India. Students will be enrolled from Parul University in Vadodara, Gujarat, as well as Panimalar Medical College Hospital and Research Institute, Panimalar Engineering College, Panimalar Institute of Technology, and Panimalar College of Nursing in Chennai, Tamil Nadu. Current undergraduate and graduate students consenting to participate will be recruited using convenience sampling from these institutes. The study will collect baseline data to construct the student well-being index. Based on the risk profile, a random subset of the population will be provided access to the digital health intervention, which will deliver tailored interactive messages addressing the various dimensions of well-being among undergraduate and graduate students. The eligible study participants will be aged 18 years and older, enrolled in these institutes, and willing to give their consent to participate in the study. ResultsThe proposed research is an unfunded study. The enrollment of the individuals in the study began in October 2022. Data gathered will be analyzed using SAS (version 9.3; SAS Institute) and results will be reported as 95% CIs and P values. ConclusionsThe proposed study will help to determine the factors affecting well-being among college students and help in designing digital health interventions to improve the well-being of undergraduate and graduate students. International Registered Report Identifier (IRRID)PRR1-10.2196/39779

Background: Cervical cancer remains a significant global health concern, with well-established risk factors. Population-based electronic surveillance tools offer a promising avenue for identifying risk factors associated with cervical cancer development way before it becomes an actual concern for a woman. The objective of this study is to understand and to support the app- based decision-making tool for identifying risk factors of cervical cancer for the women between 30-60 years of age. Method: The study will be conducted in the selected Sampoorna Non-Communicable Diseases (NCD) clinics at Lucknow, Uttar Pradesh (UP). A rigorous review of database was conducted to summarize the evidence on informatics available for early identification of cervical cancer app. An app-based decision- making tool will be developed to identify and detect the high- risk population developing cervical cancer. The app then will be shared with health workers at Sampoorna clinics and will be capacitated for using it to collect real time data. Conclusion: The utilization of a population-based electronic surveillance tool will facilitate the identification of various risk factors contributing to cervical cancer development. The methodology process will help to comprehend the analysis providing the insights. This approach has the potential to enhance targeted interventions, public health policies, and personalized screening programs to mitigate the burden of cervical cancer. The objective of this paper is to understand and to support the design of dashboards for creating transparency and accountability.

Introduction: Mobile phones have become ubiquitous in recent years. This portable device can be efficiently utilised to promote health and deliver high-quality healthcare services via Mobile Health (mHealth) technology interventions. In view of the increasing global burden of breast cancer cases, mHealth interventions can be constructive in breast cancer prevention and management. Nevertheless, there is a paucity of evidence to support the utility of mHealth interventions in breast cancer care. Aim: To analyse and synthesise evidence from published literature on the feasibility and effectiveness of mHealth interventions employed for breast cancer prevention, detection, management, and rehabilitation. Additionally, this study intends to draft a conceptual framework for mHealth intervention strategies in breast cancer management. Materials and Methods: A comprehensive literature search was conducted at Panimalar Medical College Hospital and Research Institute, Chennai, Tamil Nadu, India, from June 2022 to December 2022. Google Scholar and PubMed databases were used to find published articles relevant to the study’s objectives. The reviewers selected articles based on the relevance of the article and eligibility criteria. Articles on mHealth interventions for the female population above 18 years of age with breast cancer were included. Results: A total of 13 articles were selected based on the eligibility criteria. Regardless of the type of mHealth technology employed, target population, and purpose of intervention, all the studies strongly support the use of mHealth technologybased interventions over usual care to enhance breast cancer management. Conclusion: The use of mHealth applications has increased exponentially in recent years. Since then, many studies have been conducted to validate their use. However, the usability of these applications is not well established. The involvement of not only patients but also healthcare professionals is crucial to develop well-equipped digital health applications. Personalised applications that provide security and safeguard user privacy are highly preferred by patients. A collaborative approach involving patients, healthcare professionals, and application developers will aid in the development of highly efficient mHealth applications.

Abstract Biomolecular condensates formed via phase separation of proteins and nucleic acids are thought to be associated with a wide range of cellular functions and dysfunctions. We dissect critical molecular events associated with phase separation of an intrinsically disordered prion-like low-complexity domain of Fused in Sarcoma by performing single-molecule studies permitting us to access the wealth of molecular information that is skewed in conventional ensemble experiments. Our single-molecule FRET experiments reveal the coexistence of two conformationally distinct subpopulations in the monomeric form. Single-droplet single-molecule FRET studies coupled with fluorescence correlation spectroscopy, picosecond time-resolved fluorescence anisotropy, and vibrational Raman spectroscopy indicate that structural unwinding switches intramolecular interactions into intermolecular contacts allowing the formation of a dynamic network within condensates. A disease-related mutation introduces enhanced structural plasticity engendering greater interchain interactions that can accelerate pathological aggregation. Our findings provide key mechanistic underpinnings of sequence-encoded dynamically-controlled structural unzipping resulting in biological phase separation.

Aims: The aim of the study was to provide an articulated body of literature on assessment and consultative exercises of m-health advances in physical activity from an Indian perspective. Settings and Design: Scoping review was conducted using the Arksey and O’Malley framework (2005) and thereafter consultative exercises were performed. Subjects and methods: We searched the electronic databases and available grey literature from last 10 years. PRISMA flowchart for the study selection process was used to guide reporting. Data extraction included information on study design, authors, year of study, location and key findings on assessment of m-health advances in physical activity from an Indian context. Data were compiled and summarized narratively. Results: Total 9 studies were selected for the final review out of 24 review articles searched. Scoping review revealed that six studies measuring physical activity with an accelerometer or pedometer and three studies used Smartphone applications for physical activity promotion. Actigraph Accelerometer, was the most popular tool and pedometer was considered as feasible and effective tool for monitoring physical activity. Stakeholder consultation exercises have indicated that mobile health apps play a valuable role in enhancing accessibility to physical activity resources, promoting behavior modification, and fostering continued user engagement. However, there is a consensus among stakeholders that these apps would be even more beneficial if they provided users with constructive feedback and personalized recommendations. Conclusion: This review highlights how mobile health interventions promote physical activity. However, limited evidence calls for further research in the Indian context.

Background: Barriers to utilize maternal healthcare services amongst pregnant women at community level differs substantial variation among slums and urban areas which is essential to recognize and resolve these issues within framework of district-level policy planning. IRAIVI pregnancy prediction model is developed to enhance optimal utilization of maternal healthcare services. The study was conducted to evaluate usability of IRAIVI using System Usability Scale amongst healthcare workforce. Methods: This model was developed with a set of predictors based on data collected during baseline and follow up visits from currently pregnant women as per study protocol. For evaluating efficiency of this model, System Usability Scale (SUS) was adopted and shared with 25 randomly selected experts in the field of public health. The questionnaire was shared via google form and responses recorded on Likert’s scale were then analysed using SPSS. Results: IRAIVI model's usability assessed using SUS found to be user-friendly, best learning curve, adaptable to new system and highly acceptance by healthcare workforce. The SUS score averaging at 84 demonstrates favourable usability of the model. Conclusion: This model has capability to accentuate maternal health services which in-turn can contribute for better ANC services in resource-constrained settings. Additionally, future opportunities can be explored through field studies in different settings.

Introduction: There has been a gradual increase in the burden of COPD on patients, caretakers, and the health system. Digital health interventions for the self-management of COPD help patients to learn and practice the skills necessary to manage their COPD better. Method: We searched PubMed (NCBI), Scopus (Elsevier), Web of Science (Clarivate), and Cochrane Central Register of Controlled Trials (Wiley) databases from January 1, 2005 to September 30, 2022 and included English language articles that enrolled clinically diagnosed COPD patients of any age with the implementation of digital health intervention for COPD. Result: We identified 3216 records, of which 61 studies were assessed at the full-text screening stage, and 32 met the inclusion criteria. The interventions include patient monitoring, COPD education, physical activity or exercise, pulmonary rehabilitation, inhaler use techniques, breathing exercises, medication management, and counseling. Mobile-based interventions were the preferred mode of delivery of interventions. COPD-related outcomes were measured regarding COPD exacerbations, admissions or readmissions, exercise capacity, lung function, and inhaler use technique. Conclusion: Most studies were conducted in developed countries, but there needs to be more literature on low-to-middle-income countries. The findings of this systematic review would support the development of a smartphone-enabled home-based self-management informatics platform in India.

Introduction: Digital health interventions are gradually being incorporated into the management of tuberculosis to ensure treatment adherence, but only a small number of trials focusing on latent tuberculosis infection (LTBI) care have tested and evaluated them. It is anticipated that 170 million persons with LTBI may eventually develop active TB; thus, treatment of LTBI patients is an important aspect, along with ensuring treatment adherence. Digital platforms can be beneficial to ensure treatment adherence in LTBI patients, as various studies have shown the positive impact of digital interventions in improving patients’ treatment adherence and treatment outcome. This study aims to explore the various available digital interventions worldwide for treatment adherence in LTBI patients and develop an informatics platform for enhancing treatment adherence in LTBI patients. Methods: This will be a quasi-experimental study divided into three phases. In the first phase, a scoping review method will be used to conduct a systematic literature review using the PRISMA tool to report on various digital interventions focused on treatment adherence in LTBI patients. In the second phase, a text message-based digital platform will be developed, and in the third phase of the study, an evaluation of the digital platform will be done using qualitative and quantitative questionnaires. The study will be conducted using a mixed-methods approach between January 2023 and December 2023. The sample size will be 162 participants, of whom 81 will be assigned to an intervention group and 81 will receive the usual care from the respective chest clinic as a control group. Results: A descriptive analysis of demographic variables and other variables will be done. Continuous variables will be described as mean ± standard deviation (M ± SD), medians (inter-quartile ranges) (M (IQR)), and medians (5th percentile to 95th percentile) (P5-P95). A two-sample independent T-test, the chi-square test, and the Mann-Whitney test will be used for comparisons between groups. Treatment success between control and intervention will be compared through a chi-square test. Conclusions: The key finding of the study will be an understanding of the efficiency of digital platforms for improving treatment adherence in latent TB patients in India.

ObjectivesTo analyze the current public health labor market for bachelor’s-level graduates.MethodsPublic health-related job postings (N = 365) from across the United States were collected from an online job portal, Indeed.com, from November 7–14, 2022. Job titles, organization type, degree requirements, work experience, job location, and preferred skills for bachelor’s-level public health positions were analyzed.ResultsThirty-one job titles were identified. Approximately one-third (32.33%) of postings were from the Northeastern US; 23.56% were from the Southeastern region. Thirty-five job skill categories were identified. Most jobs (92.33%) required oral and written communication skills, and 85.21% specified educational skills for public health promotion. Cultural competency, project management, and case management abilities were also highly sought.ConclusionThis study revealed the needs of the public health workforce and bolstered the case that public health degree-seekers should be equipped with a set of strategic skills applicable to a range of multisectoral and multidisciplinary public health jobs.Policy implicationsGiven the rapid changes in the field of public health, ongoing analysis of the labor market benefits educators, employers, and policymakers alike.

Background: The burden of chronic obstructive pulmonary disease to patients, their caretakers, and health system is gradually increasing and is associated with the morbidity, mortality, disability adjusted life years and higher costs. Self-management of COPD is a vital strategy for its management. This study aims to develop, implement, and evaluate an informatics platform for the home-based self-management of Chronic Obstructive Pulmonary Disease. Method: A systematic review will be conducted to synthesize and appraise the evidence on self-management informatics tool or platform for COPD. An evidence-based COPD self-management application will be developed and implemented to 35 COPD patients at identified hospitals of New Delhi using prospective non-randomized study. A mixed methods study will be conducted to evaluate the effectiveness of this informatics platform at selected hospitals of Delhi. Outcomes will be measured in terms of self-management for COPD related exacerbations, number of health care facility admissions for COPD and hospitalization days, adherence to the informatics platform, number of exacerbations requiring hospital visits, health related quality of life. Conclusion: The development and evaluation of home-based self-management of informatics platform for COPD would be an innovative strategy for the COPD patients in India.

The authors introduce a unique single-droplet surface-enhanced Raman scattering (SERS) methodology that illuminates a wealth of molecular information within the mesoscopic liquid condensed phase of Fused in Sarcoma in the absence and presence of RNA.

With the increasing global burden of dyslipidemia over the past 30 years, it is estimated that more than 200 million people worldwide are under statin therapy. In India, roughly 25–30% of urban populations and 15–20% of rural populations have abnormal lipid levels. Statin, which is deemed to be the gold standard lipid-lowering agent, is the first treatment of choice for these patients. Although statins at one end are highly effective against dyslipidemiaand cardiovascular diseases, at the other end, they cause adverse effects including an increased risk of diabetes mellitus. The objective of this study was to understand the coexistence of diabetes and dyslipidemia in patients undergoing statin therapy. A scoping review was conducted with published articles selected from PubMed and Google Scholar. The obtained results were filtered based on inclusion/exclusion criteria. Our database search provided a total of 822 articles, of which 48 were selected for this review, with results concluding that statin users are potentially at a greater risk of developing diabetes mellitus compared with patients who are not using statins. Although many studies have been conducted to ascertain the onset of diabetes mellitus amongst statin users, the exact mechanism is not yet precisely established. Future studies are essential for identifying the exact cause of diabetes mellitus in statin users.

BackgroundWell-being is multidimensional, complex, and dynamic in nature. It is an amalgam of physical and mental health, essential for disease prevention and the promotion of a healthy life. ObjectiveThis study aims to explore the features that impact the well-being of individuals between 18 and 24 years of age in an Indian setting. It further aims to design, develop, and evaluate the usefulness and effectiveness of a web-based informatics platform or stand-alone intervention to enhance the well-being of individuals aged 18-24 years in an Indian setting. MethodsThis study follows a mixed method approach to identify factors influencing the well-being of individuals in the age group of 18-24 years in an Indian setting. The college-going students in this age group from the states of Uttarakhand (urban settings of Dehradun) and Uttar Pradesh (urban settings of Meerut) will be enrolled. They will be randomly allocated to the control and intervention groups. The participants in the intervention group will have access to the web-based well-being platform. ResultsThis study will examine the factors that influence the well-being of individuals aged 18-24 years. It will also facilitate the design and development of the web-based platform or stand-alone intervention, which will enhance the well-being of individuals in the age group of 18-24 years in an Indian setting. Furthermore, the results of this study will help generate a well-being index for individuals to plan tailored interventions. The 60 in-depth interviews have been conducted as of September 30, 2022. ConclusionsThe study will help understand the factors that influence the well-being of individuals. The findings of this study will help in the design and development of the web-based platform or stand-alone intervention to enhance the well-being of individuals in the age group of 18-24 years in an Indian setting. International Registered Report Identifier (IRRID)PRR1-10.2196/38632

Background: In urban slums, pregnant women are a high-risk group with limited access to health facilities due to reported barriers to utilization of maternal health services linked with sociodemographic variations in a few studies. Objective: Our objective is to assess barriers and opportunities in the current utilization of maternal healthcare services during the antenatal period in urban slum settings followed by the development of a conceptual framework utilizing this information to promote the utilization of maternal services in urban slums. Methods: A search was conducted using PubMed with articles published from January 2011 to May 2022. The search terms used were a combination of ‘maternal health services, ‘antenatal care’, ‘urban slums’, and ‘India. Results: A total of eleven studies met inclusion criteria and was critically appraised by two independent reviewers to retrieve relevant information. Most of them were cross-sectional surveys and only one study was a randomized trial that was conducted in the slums of Delhi and Mumbai. The most common age group included in all studies was 15–49 years. The different barriers found in this review include poor access to healthcare, cost, prior experience, domestic responsibility, long distance to facility, long waiting time at the hospital, non-co-operative hospital staff, multiparity, lack of information, and low literacy. Conclusion: Accessibility to healthcare services in urban slums is poor and slum dwellers are still subjected to the hazards of unsafe home deliveries. It is imperative to address different barriers such as poor accessibility, cost, long waiting time, hospital staff behaviour, and efforts to improve maternal literacy. We also proposed a framework to develop an Artificial Intelligence guided tool that will help identify high-risk pregnancies so that they can be motivated to avail of maternal health services more efficiently.

BackgroundAn infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. ObjectiveIn this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. MethodsAn iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health–implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. ResultsThe 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. ConclusionsStandardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers.

BackgroundPregnant women are considered a “high-risk” group with limited access to health facilities in urban slums in India. Barriers to using health services appropriately may lead to maternal and child mortality, morbidity, low birth weight, and children with stunted growth. With the increase in the use of artificial intelligence (AI) and machine learning in the health sector, we plan to develop a predictive model that can enable substantial uptake of maternal health services and improvements in adverse pregnancy health care outcomes from early diagnostics to treatment in urban slum settings. ObjectiveThe objective of our study is to develop and evaluate the AI-guided citizen-centric platform that will support the uptake of maternal health services among pregnant women seeking antenatal care living in urban slum settings. MethodsWe will conduct a cross-sectional study using a mixed methods approach to enroll 225 pregnant women aged 18-44 years, living in the urban slums of Delhi for more than 6 months, seeking antenatal care, and who have smartphones. Quantitative and qualitative data will be collected using an Open Data Kit Android-based tool. Variables gathered will include sociodemographics, clinical history, pregnancy history, dietary history, COVID-19 history, health care facility data, socioeconomic status, and pregnancy outcomes. All data gathered will be aggregated into a common database. We will use AI to predict the early at-risk pregnancy outcomes (in terms of the type of delivery method, term, and related complications) depending on the needs of the beneficiaries translating into effective service-delivery improvements in enhancing the use of maternal health services among pregnant women seeking antenatal care. The proposed research will help policy makers to prioritize resource planning, resource allocation, and the development of programs and policies to enhance maternal health outcomes. The academic research study has received ethical approval from the University Research Ethics Committee of Dehradun Institute of Technology (DIT) University, Dehradun, India. ResultsThe study was approved by the University Research Ethics Committee of DIT University, Dehradun, on July 4, 2021. Enrollment of the eligible participants will begin by April 2022 followed by the development of the predictive model by October 2022 till January 2023. The proposed AI-guided citizen-centric tool will be designed, developed, implemented, and evaluated using principles of human-centered design that will help to predict early at-risk pregnancy outcomes. ConclusionsThe proposed internet-enabled AI-guided prediction model will help identify the potential risk associated with pregnancies and enhance the uptake of maternal health services among those seeking antenatal care for safer deliveries. We will explore the scalability of the proposed platform up to different geographic locations for adoption for similar and other health conditions. International Registered Report Identifier (IRRID)PRR1-10.2196/35452

With the creation of public health management cadre in the state, district, and block levels of India, there is a need for a comprehensive, synergistic education system to ensure efficient public health across the country. This scoping review, therefore, aims to examine the characteristics of public health education programs available in India's varied geographical and regional contexts. It examines 16 program-related descriptors across public health Doctoral, Masters, Bachelors, Post-graduate Diploma, and Diploma education programs offered. Data was retrieved through institutional websites. Results of our analysis showed 84 unique institutions in 20 states and 3 UTs currently offering 116 public health programs across India's 28 states and 8 UTs. Private and public institutes were 65% (n = 75) and 35% (n = 41) respectfully. The majority of universities mainly provided Masters of Public Health (n = 73, 63%) programs followed by Postgraduate Diploma (PGD) and Diploma (n = 17, 15%), BPHSc (n = 14, 12%), and Ph.D. (n = 12, 10%). The majority of Ph.D. programs in public health are offered in Maharashtra, Karnataka, and Haryana, while Masters in Public Health programs are offered highest in Karnataka, Bachelors in Public Health programs in Rajasthan, Post Graduate Diploma in Public Health program in Delhi, and Tamil Nadu had the most number of Diploma in Public Health programs. Thirty-one percent (n = 36) of the public health programs are offered across the south, 28% (n = 32) across the north, and 22% (n = 26) across the west Analyzed descriptors provide comprehensive information on program characteristics, mainly admission, format, and tuition fee. The review offers five suggestions to improve collaborative public health education and prepare a workforce with the skills, knowledge, and expertise to respond to the twentyfirst century's public health threats and challenges in India.

Introduction: Acknowledging the promising role of information and technology, a study was planned to determine the effect of personalized human-centered dietary decision support system (PHCDDSS) on dietary knowledge, attitude, practice (KAP), and mean fasting blood sugar (FBS) among participants with type 2 diabetes mellitus (T2DM). Materials and Methods: A community-based randomized control trial was conducted among 400 individuals with T2DM randomized into the 12-month intervention group (PHCDDSS) and 400 to the control (usual care) group. Results: In the control and intervention groups, 84.7% and 87.0% participants completed the follow-up at the end of 12 months. Mean knowledge score showed a significant (P = 0.00) declining trend (from 28.3 to 22.2) in the control group, but increasing (from 28.9 to 35.4) in the intervention group. Unlike knowledge, mean attitude score observed a significant declining trend in both the groups but less in the intervention group. The mean FBS (in mg/dL) trend was found to be insignificantly declining in control (199.2–195.4) and intervention (194.8–183.1) groups but the decline was relatively less in control when compared with the intervention group. Conclusion: In study participants, PHCDDSS proved to be effective in improving knowledge and attitude toward role of diet in managing T2DM. The intervention showed promising effect in reduction of mean FBS and proportion of individuals with sugar control.

BackgroundHuman-centered dietary decision support systems are fundamental to diabetes management, and they address the limitations of existing diet management systems. ObjectiveThe objective of the proposed study is to evaluate the use of an interactive, telephone-linked, personalized, human-centered decision support system for facilitating the delivery of personalized nutrition care for patients with diabetes. MethodsA quasi-experimental trial was conducted between the period of June and December 2018. Study participants were recruited from Community Health Center, Dharamshala, Kangra (urban population), and Model Rural Health Unit, Haroli Block, Una (rural population). Eligible participants included adults aged ≥30 years with controlled or uncontrolled diabetes, those who agreed to participate in the study, those who were available for follow-up interviews, and those with a telephone or computer at home. Diabetic status was determined via a physician’s diagnosis. Individuals with mental or physical challenges that affected their ability to use an electronic diet record, those who were not available for a telephone follow-up, and those who were involved in other protocols related to dietary assessments were excluded. The study participants were randomized into the following two groups: the intervention group (telephone-linked dietary decision support system) and the control group (paper-based diet record). Study participants in the intervention group recorded their daily dietary intake by using a telephone-linked, personalized, human-centered dietary decision support system and received personalized feedback and diet education via SMS text messaging. Study participants in the control group were provided with only a paper-based diet record for documenting their daily dietary intake. Follow-up visits were conducted at 3 and 6 months from the baseline in both groups. Differences in diabetes knowledge, attitudes, and practices will be measured across groups. ResultsThe collection of baseline data from 800 study participants in both the intervention (n=400) and control groups (n=400), which were stratified by urban (control group: n=200; intervention group: n=200) and rural settings (control group: n=200; intervention group: n=200), has been completed. Follow-up data collection for months 3 and 6 is ongoing and is expected to be completed by October 2019. ConclusionsWe anticipate that the intervention group will show significant changes in nutrition knowledge, attitudes, and practices; satisfaction with care; and overall diabetes management. We also expect to see urban-rural differences across the groups. The uniqueness of our nutrient data capture process is demonstrated by its cultural and contextually relevant features—diet capture in both English and Hindi, diet conversion into caloric components, sustained diet data collection and participant adherence through telephone-linked care, and auto-generated reminders. International Registered Report Identifier (IRRID)DERR1-10.2196/13635

The second wave of the COVID-19 pandemic left the Indian healthcare system overwhelmed. The severity of a third wave will depend on the success of the vaccination drive; however, even with a safe and effective COVID-19 vaccine, hesitancy can be an obstacle to achieving high levels of coverage. Our study aims to estimate the population's acceptance of the COVID-19 vaccine in an Indian district. A pilot community-based cross-sectional study was conducted from March-May 2021. The data was collected from eight primary health centres in Tamil Nadu. The eligible study participants were interviewed using a self-constructed questionnaire. A total of 3,130 individuals responded to the survey. Multinomial logistic regression was performed to assess the factors influencing COVID-19 vaccine hesitancy and refusal. Results of our study showed that 46% percent (n = 1432) of the respondents would accept the COVID-19 vaccine if available. Acceptance for the COVID-19 vaccine was higher among males (54%), individuals aged 18-24years (62%), those with higher education (77%), having the higher income (73%), and employed (51%). Individuals with no education (OR: 2.799, 95% CI = 1.103-7.108), and low income (OR: OR: 10.299, 95% CI: 4.879-21.741), were significant predictors of vaccine hesitancy (p < 0.05). Living in urban residence (OR: 0.699, 95% CI = 0.55-0.888) and age between 18 to 25 years (OR: 0.549, 95% CI = 0.309-0.977) were protective factor of COVID-19 vaccine hesitancy. While individuals in the age group 25-54years (OR = 1.601, 95%CI = 1.086-2.359), fewer education (OR = 4.8, 95% CI = 2.448-9.412,), low income (OR = 2.628, 95% CI = 1.777-3.887) and unemployment (OR = 1.351, 95% CI = 1.06-1.722) had high odds of refusing the COVID-19 vaccine. Concerns and suspicions about the safety of the COVID-19 vaccine (63%) was the major reasons causing hesitancy towards the COVID-19 vaccine The public health authorities and government need to design, develop and implement targeted interventions to enhance awareness about COVID-19 vaccines, and barriers and enablers to vaccine acceptance among individuals across diverse settings. Emphasis on involving local and religious leaders, ASHA workers, community healthcare workers, Anganwadi workers, and auxiliary nurse midwives can help to overcome context-specific barriers in areas of low COVID-19 vaccine acceptance, especially in rural settings.

Background: The ramifications of the existing crisis caused by the coronavirus pandemic are sensed in all walks of life. Among the various efforts made to curb the spread of this novel infection, the development of COVID-19 vaccines had a profound role in flattening the pandemic curve. Even though the rapid vaccine drive received a highly welcoming response among people, the reluctance and ignorance of a part of the population towards available safe vaccines stand as impediments to achieving the desired outcome. The LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual) communities are the least studied groups in this regard. Objective: The purpose of this study is to extensively review and report on COVID-19 vaccine uptake and refusal among the LGBTQIA+ population and enumerate the factors contributing to vaccine hesitancy. The study extends further to outline a conceptual framework for interventions to enhance COVID-19 vaccine acceptance among the LGBTQIA+ population. Methods: We performed a systematic search using key terms on Google Scholar and PubMed. The obtained results were filtered using the eligibility criteria framed for this study. The initial search provided an extensive result of 4510 articles which were later screened at various levels to arrive at the final inclusive collection of manuscripts adding to 17. The studies were analyzed by the authors individually, and the data were categorized using variables. The results are interpreted using charts and graphs. The whole manuscript has been structured in accordance with the PRISMA extension for scoping reviews. Result: The comprehensive search yielded 17 eligible articles for this review. Most of the studies were conducted in the United States (n = 17), and predominantly cross-sectional studies have been conducted. The major comparative factor was the HIV status of the LGBTQIA+ population. HIV-affected patients were more willing to take up COVID-19 vaccination. However, social stigma, discrimination, lack of access and non-prioritization in vaccine drives were found to be the major factors contributing to vaccine hesitancy among this population. Conclusion: The invention of the COVID-19 vaccination revolutionized the healthcare systems burdened with COVID-19. Although this is a breakthrough scientific contribution, many factors are associated with the rate of vaccine acceptance, especially among sexual and gender minorities. The reviewed studies have revealed numerous factors that influence vaccine uptake and refusal with the commonest being concerns on discrimination, social stigma, inequitable access to healthcare, vaccine safety, efficacy, potency, side effects and lack of trust in medical workers. These impediments in vaccine coverage should be meticulously addressed to ensure optimum LGBTQIA+ physical and mental health as well as for providing non-discriminative, equitable and quality healthcare service regardless of the gender or sexual orientation of individuals.

Abstract Background Early childhood caries (ECC) has reached epidemic proportions affecting millions of children worldwide. Its prevention becomes imperative owing to the significant morbidity and financial implications involved with its treatment. The Integrated Child Development Scheme (ICDS), launched in India to provide mid-day meals, pre-school education and primary healthcare to children, can be utilised to counsel and deliver oral health education to mothers. The purpose of the study is to compare the effect of an oral health care package (OHCP) with usual care on the change in dental disease status among 1 to 3-year-old children at Anganwadi centres (AWC) in periurban areas of Chandigarh and rural areas of Cuttack, Orissa over a follow-up period of three years. Methods Two geographically distant ICDS blocks would be selected at each of the two study sites and would be randomly allocated to intervention and control group. Closely located AWCs under each of the selected blocks shall constitute the study setting. OHCP would be delivered to the mothers of the 1–6-year-old children enrolled in the AWCs of the experimental group whereas mothers under control group would receive usual care advice available at the AWCs. Discussion ECC prevention had conventionally focused upon testing effectiveness of programs targeting behaviour change among the caregivers and children, but surprisingly minimal efforts have been made to seek translation of these efforts into reduction of ECC at the community level. The present study has two components; testing effect of altering maternal and child behavioral aspects on ECC incidence through cohort follow up of 1–3-year-old children for three consecutive years and cross-sectional follow up of all available 1–6-year old children at the selected AWCs at regular intervals to look for change in prevalence of ECC at community level. In other regions of the world surveys of ECC prevalence before and after the intensive educational programs have shown a significant reduction in ECC prevalence. A similar decline can be anticipated through this program. Trial registration This trial has been prospectively registered at Clinical Trials Registry, India (CTRI/2019/02/017556, 08 February 2019).

Background: The identification of persistent symptoms of chronic/long COVID-19 is crucial in understanding the management of long haulers of post COVID-19. Methods: Pub Med (Medline) database was scoped for original articles based on a search strategy related to the objectives. The selected articles post-screening were analyzed for variables relating to chronic/long COVID-19. Results were analyzed using descriptive statistics. Results: A total of 33 studies were reviewed. A total of 60% of the studies were observational studies and most of them were from high income countries. Almost half of the studies were in phase 3 of post-COVID-19, i.e., symptoms lasting >24 weeks. Among the physiological and psychological symptoms studied, fatigue, dyspnea, cough, headache, memory loss, depression, brain fog and lack of concentration were found to be the most frequently reported symptoms. Excessive sleep, constipation and neuropathic pain were among the least reported symptoms. Prior hospitalization, the female gender was found to be a risk factor. Limitations were reported by all studies. Conclusions: The major physiological and psychological symptoms of long COVID-19 have been explained with risk factors and its impact on patients’ lifestyles. The findings of this review hope to facilitate clinicians to draw conclusions to manage the long-term effects of post/chronic COVID-19.

COVID-19 vaccine is regarded as the most promising means of limiting the spread of or eliminating the pandemic. The success of this strategy will rely on the rate of vaccine acceptance globally. The study aims to examine the factors that influence COVID-19 vaccine acceptance, intention, and hesitancy. PubMed was searched comprehensively for articles using the keyword “COVID-19 vaccine surveys.” Of the 192 records, 22 studies were eligible for the review. Eighty-two percent of these studies were conducted among the general population. Gender, age, education, and occupation were some of the socio-demographic variables associated with vaccine acceptance. Variables such as trust in authorities, risk perception of COVID-19 infection, vaccine efficacy, current or previous influenza vaccination, and vaccine safety affected vaccine acceptance. Globally, in March 2020, the average vaccine acceptance observed was 86% which dropped to 54% in July 2020 which later increased to 72% in September 2020. Globally, the average rate of vaccine hesitancy in April 2020 was 21%, which increased to 36% in July 2020 and later declined to 16% in October 2020. Large variability in vaccine acceptance and high vaccine hesitancy can influence the efforts to eliminate the COVID-19. Addressing the barriers and facilitators of vaccines will be crucial in implementing effective and tailored interventions to attain maximum vaccine coverage.

BackgroundCOVID-19 vaccines are considered to be a key to limiting and eliminating the infectious disease. However, the success of the vaccination program will rely on the rates of vaccine acceptance among the population. ObjectiveThis study aims to examine the factors that influence vaccine hesitancy and vaccine acceptance, and to explore the unintended consequences of COVID-19 infections. The study will further explore the association between sociodemographic characteristics; health status; COVID-19–related knowledge, attitude, and practices; and its influence on vaccine hesitancy and acceptance among individuals living in urban and rural settings of Chennai, Tamil Nadu in the southern state of India. MethodsA cross-sectional study will be conducted between January 2021 and January 2023. A sample of approximately 25,000 individuals will be recruited and enrolled using a nonprobability complete enumeration sampling method from 11 selected urban and rural settings of Chennai. The data will be collected at one time point by administering the questionnaire to the eligible study participants. The collected data will be used to assess the rates of vaccine acceptance; hesitancy; and knowledge, attitudes, practices, and beliefs regarding COVID-19 and COVID-19 vaccines. Lastly, the study questionnaire will be used to assess the unintended consequences of COVID-19 infection. ResultsA pilot of 2500 individuals has been conducted to pretest the survey questionnaire. The data collection was initiated on March 1, 2021, and the initial results are planned for publication by June 2021. Descriptive analysis of the gathered data will be performed using SAS v9.1, and reporting of the results will be done at 95% CIs and P=.049. The study will help explore the burden of vaccine acceptance and hesitancy among individuals living in urban and rural settings of Chennai. Further, it will help to examine the variables that influence vaccine acceptance and hesitancy. Lastly, the findings will help to design and develop a user-centered informatics platform that can deliver multimedia-driven health education modules tailored to facilitate vaccine uptake in varied settings. ConclusionsThe proposed study will help in understanding the rate and determinants of COVID-19 vaccine acceptance and hesitancy among the population of Chennai. The findings of the study would further facilitate the development of a multifaceted intervention to enhance vaccine acceptance among the population. International Registered Report Identifier (IRRID)DERR1-10.2196/29733

Introduction: Anemia is a common, underestimated problem in cancer patients receiving myelosuppressive chemotherapy and has significant adverse effect on the quality of life and outcome. Darbepoetin has been shown to be effective in this setting, but controversy surrounds it actual use. Methods: We analyzed prospectively collected clinical practice data of patients receiving darbepoetin in a real-world setting for this retrospective audit. Patients with baseline hemoglobin (Hb) of

The purpose of this article is two pronged; first, to identify and report public health implications of the ongoing coronavirus (COVID-19) pandemic, and second, to report challenges uniquely faced by the citizens of India from a population health perspective. We have done both while closely examining epidemiological data that is accessible via SMAART's RAPID Tracker. This policy informatics platform is a live database aimed to track the geospatial spread of the COVID-19 outbreak and policy actions globally and is administered collaboratively by CUNY's Graduate School of Public Health and Health Policy and a global, non-profit public health incubator. Infectivity, incidence, and recovery rates were computed and graphical representations of epidemiological datasets were studied. We have discussed a plausible conceptual framework based on the principles of population health informatics for countries with similar characteristics to build a stronger public and community health foundation in order to safeguard populations during a health emergency in the future.

Background. The novel coronavirus disease (COVID-19) has spread globally from its epicenter in Hubei, China, and was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. The most popular search engine worldwide is Google, and since March 2020, COVID-19 has been a global trending search term. Misinformation related to COVID-19 from these searches is a problem, and hence, it is of high importance to assess the quality of health information over the internet related to COVID-19. The objective of our study is to examine the quality of COVID-19 related health information over the internet using the DISCERN tool. Methods. The keywords included in assessment of COVID-19 related information using Google’s search engine were “Coronavirus,” “Coronavirus causes,” “Coronavirus diagnosis,” “Coronavirus prevention,” and “Coronavirus management”. The first 20 websites from each search term were gathered to generate a list of 100 URLs. Duplicate sites were excluded from this search, allowing analysis of unique sites only. Additional exclusion criteria included scientific journals, nonoperational links, nonfunctional websites (where the page was not loading, was not found, or was inactive), and websites in languages other than English. This resulted in a unique list of 48 websites. Four independent raters evaluated the websites using a 16-item DISCERN tool to assess the quality of novel coronavirus related information available on the internet. The interrater reliability agreement was calculated using the intracluster correlation coefficient. Results. Results showed variation in how the raters assigned scores to different website categories. The .com websites received the lowest scores. Results showed that .edu and .org website category sites were excellent in communicating coronavirus related health information; however, they received lower scores for treatment effect and treatment choices. Conclusion. This study highlights the gaps in the quality of information that is available on the websites related to COVID-19 and study emphasizes the need for verified websites that provide evidence-based health information related to the novel coronavirus pandemic.

ObjectivesThe objective of this study was to evaluate the features of diet and nutrition apps available in the Google Play Store.MethodsA search was conducted in August 2017 using the Google Play Store database to identify apps related to diet and nutrition. Terms entered into the app search engine included ‘diet apps’ and ‘nutrition apps’. The first 50 apps resulting from each search term was assessed. Duplicates were removed, and a comparative analysis was performed on the remaining diet and nutrition apps.ResultsA total of 86 diet and nutrition apps were identified. One hundred percent (n = 86) of the apps retrieved were freely available. More than half of the apps were applicable to a target user group of all ages (94%, n = 81). Stratified analysis across unique diet and nutrition apps (total, n = 72) showed a higher average rating for the diet apps (4.4) in comparison to that for the nutrition apps (4.3). Diet apps were more likely to be recently updated than the nutrition apps (72% vs. 66%), and diet apps were more likely to feature app purchase than nutrition apps (36% vs. 19%). The average rating was slightly higher for diet apps not featuring in-app purchases, but ratings were similar for the nutrition apps.ConclusionsA centralized resource is needed that can provide information on health-related apps to allow for systematic evaluation of their effectiveness. Further research needs to examine improved methods of designing app-store platforms and presenting the available apps to properly guide users in app selection.

Nutrition informatics (NI) is the effective retrieval, organization, storage, and optimum use of information, data and knowledge for food-and-nutrition-related problem-solving and decision-making. There is a growing opportunity to facilitate technology-enabled behavioral change interventions to support NI research and practice. This paper highlights the changing landscape of food and nutrition practices in India to prepare a NI workforce that could provide some valuable tools to address the double burden of nutrition. Management and interpretation of data could help clarify the relationships and interrelationships of diet and disease in India on both national and regional levels. Individuals with expertise in food and nutrition may receive training in informatics to develop national informatics systems. NI professionals develop tools and techniques, manage various projects and conduct informatics research. These professionals should be well prepared to work in technological settings and communicate data and information effectively. Opportunities for training in NI are very limited in developing countries. Given the current progress in developing platforms and informatics infrastructure, India could serve as an example to other countries to promote NI to support achieving SDGs and other public health initiatives.

ObjectivesThe objective of this study was to describe the features of health informatics blogs on the Internet.MethodsA search was conducted in August, 2016 using the search engine, Google, and key words: ‘mobile health blog,’ ‘telehealth/telemedicine blog,’ ‘Electronic Health Record blog,’ ‘personalized health record blog,’ ‘population health decision support system blog,’ and ‘public/population health dashboard blog.’ The first 24 blogs resulting from each key word search were recorded, generating 144 blogs. A total of 109 unique blogs resulted after removing duplicates and non-functional sites.ResultsBlogs with ‘.com’ extensions were most prevalent (72%, n = 79). More than half of the blogs (79%, n = 86) were created by industries. Mobile health (88%, n = 96), telehealth (82%, n = 89), and health IT (78%, n = 85) were the predominant topics covered. Health providers (44%, n = 48), industries (33%, n = 36), patients/consumers (25%, n = 27) and payers/insurance providers (19%, n = 21) constituted the most common target audience. Blogs catering to payers commonly used ‘.org’ extension (n = 10 out of 21), compared to ‘.com’ (n = 7) or ‘.gov’ (n = 2) (p < 0.0001). Significant differences were also observed by topics covered health IT (p = 0.007), subscription (p = 0.048) and LinkedIn social media (p = 0.019) across the website extensions.ConclusionsFurther research is needed to examine the use of blogs as channels of communication of best evidence in health informatics research among diverse stakeholders. The role of blogs as policy informatics tools need to be evaluated in order for stakeholders to collaborate, coordinate and share opportunities and challenges of various public health programs and policies.

This study examined the burden of food insecurity in India's un-notified slums, using an SDG framework to identify correlates of food insecurity. A convenience sampling approach was employed in selecting 38 slums from 675 un-notified slums across four geographic zones. Ten percent of the households in each slum site were selected from each zone, and one household member was interviewed, based on their availability and fulfilment of the eligibility criteria. Eligible individuals included those aged 18 years and above, who were resident in the selected slums and provided consent. Individuals with mental or physical challenges were excluded. A total sample of 907 study participants were included. Results showed that 43% (n = 393) of the participants were food insecure. More than half were females (73%, n = 285), who had not completed any schooling (51%, n = 202). One-third (n = 128) resided in the Northern Region of Delhi. SDG-related predictors of food insecurity included: household educational level (SDG 4 Quality education) (p = 0.03), coverage of health service needs (SDG 3 Good health and well-being) (p = 0.0002), electricity needs (SDG 7 affordable and clean energy) (p

Background: The lack of surveillance system is a major barrier in prevention and control of rheumatic fever/rheumatic heart disease (RF/RHD). Efficacy of school-based surveillance was evaluated for detection of acute pharyngitis and RF/RHD in Shimla district, HP. Methods: The schools in district Shimla were randomly assigned to intervention and controlled arm (442 vs. 441 schools). The trained nodal teachers reported children with symptoms of acute pharyngitis and or RF/RHD in intervention arm and children taken to hospitals by parents for symptoms of acute pharyngitis and or RF/RHD under control arm through mobile phone to coordinating centre. Final outcome for presence of RF/RHD or other heart Diseases was recorded after examination at nearest primary health centers and/or at Indira Gandhi Medical College Hospital, Shimla. Difference in detection rate between intervention arm and control arm was compared using Z test. Results: The number of school children reported from intervention group was significantly higher than in control due to suspected symptoms of acute pharyngitis and or RF/RHD were 65 (2.84/1000) and 15 (0.60/1000), respectively (p

Background: The symptoms of menopause have a negative impact on quality of life, especially in women transitioning to menopause and earlier transitions. This study was conducted with the objective of assessing the effect of obesity on the severity of menopausal symptoms and the clustering of symptoms in postmenopausal women in India. Methodology: The Menopausal Rating Scale (MRS) was used to assess the severity of menopausal symptoms of postmenopausal women of Chennai, visiting Saveetha Medical College, Chennai, India. This cross-sectional study was conducted from August to November 2013 in Chennai, India. Sociodemographic characteristics, anthropometric measurements, blood pressure level, menopausal history, personal health history, and hormonal disorder issues were investigated. Results: The results have shown that 24% of the participants had complaint of mild to severe hot flushes, half of them had reported heart ailments (49%; n = 74), and disturbed sleep (48%; n = 72). The proportion of overweight/obese participants was higher in married (64%) than widows (41%), and this difference was found statistically significant (P = 0.005). There were no significant differences in MRS scores of obese and nonobese postmenopausal participants. Conclusion: There is a need of developing interactive, user friendly, technology based education module for addressing the chronic ailments of postmenopausal women.

AIM: To perform the determination ofthe burden of dry eye syndrome among information technology(IT)professionals and examine association of dry eye syndrome between various daily activities. METHODS: This was a pilot cross-sectional study conducted for a period of 3mo from October-December, 2013 in Chennai, South India. The study population was enrolled from three IT companies in a city in Chennai. The inclusion criteria consisted of individuals working in the IT industry at least for a period of 6mo, aged 18y or above and giving voluntary, written informed consent. Variable information was gathered by using series of questionnaires and ophthalmic assessment. Information about sociodemographic characteristics was also gathered. Schirmer's test was performed for ophthalmic assessment. All of the analysis was performed by using SPSS vs.16. RESULTS: About one fifth(n=36, 18%)of the participants were suspected to have dry eyes, with mean age of 29y(SD=7), and majority of them being males, graduates/ postgraduates, single, living in extended families in urban areas. Windy environment significantly showed to aggravate redness(P=0.04)and burning sensation of the eyes(P=0.000). Similarly, watching television significantly showed to aggravate gritty sensation(P=0.01)and led to excess mucous in the eyes(P=0.02). CONCLUSION:Based on the results of our study, it can be concluded that the exposure to various daily activities such as watching television, using computer, reading, and use of air conditioning and windy environments(dry environments)were associated with signs and symptoms of dry eyes. Also, watching television and windy environment were significantly positively correlated with some of the signs of dry eye. This study emphasizes the urgent need of multi-factorial approach including policy measures for addressing the burden of dry eye in population.

Background: Usability challenges have to be met in an interactive computer program development and should meet all users’ needs. Objective: The study purpose was to conduct heuristic evaluation of an interactive, bilingual touch screen enabled breastfeeding educational program for Hispanic women living in rural settings.Methods: Two usability experts used Nielsen’s heuristics while reviewing the user interface in May 2013 using principles of Nielson’s Heuristics. Nielson’s heuristics are a set of usability engineering principles developed to identify issues in user interface design and involves analysis of the interface. The heuristic evaluations were carried out in the interface, program sections, and interactive educational modules. A total of 271 screens were evaluated and included: interface (n=5), program sections (n=223) and educational content (n=43).Results: A total of 97 violations were identified and were mostly related to interface (8violations/5screens) and program components (89violations/266screens). The most common violations reported were recognition rather than recall (62%, n=60), consistency and standards (14%, n=14), and match between the system and real world (9%, n= 9). Majority of the violations had minor usability issues (73%, n=71). The only catastrophic violation reported was due to the visibility of system status in the assessment modules.Conclusion: The results demonstrated that the system was more consistent with Nielsen’s usability heuristics.

Introduction: Areca nut is highly carcinogenic according to International Agency for Research on Cancer (IARC). Its usage is continuously increasing in children and adolescents in India. Aim: The aim of the study was to understand the reasons for the development of the areca nut chewing habit at early age. Materials and Methods: A total of 2846 subjects were surveyed from rural government schools between ages of 4 to18 years in Western Rajasthan, India. A structured questionnaire was designed to record the factors associated with initiation and continuation of areca nut chewing habits. A systemic oral examination was done to access current oral health status in these users. Students were divided into two groups viz. Group 1 and 2, comprising of students from 4 to 10 years and 11 to18 years respectively. Results: Total 34.5% children in Group 1 and 72.8% in Group 2, were indulged with the habit of chewing areca nut. Study revealed that social environment and secondarily stimulating effect of areca nut have association with initiation and maintenance of habits. A total of 55 subjects were diagnosed at various clinical stages of Oral Submucous Fibrosis (OSMF). Conclusion: Areca nut cessation programs should be initiated on the primary education level for the prevention of this habit in Western Rajasthan, India.

Background: Diabetes and hypertension are the conditions with overlapping risk factors and complications. Objective of present study was to compare the burden of complications of diabetes among hypertensive and non hypertensive diabetes individuals. Materials and Methods: This cross-sectional study was conducted at Saveetha medical college and hospital, Chennai, India. A total of 100 diabetics having hypertension and 50 non-hypertensive diabetic patients were enrolled on the basis of purposive sampling. Information about sociodemograpic characteristics, general health, health distress, diabetes symptoms, communication with physician, healthcare utilization and lifetime occurrence of diabetes related complications. Mean, standard deviation and median of continuous variables and proportion of categorical variables were recorded. Results: Average age of the hypertensive diabetes patients (M=57; SD=11) was higher than non hypertensive diabetes patients (M=52; SD=11) which was statistically significant (p=.009). Diabetic neuropathy was reported by 45% of the hypertensive and 38% of the non-hypertensive diabetics. Mean self reported general health score was higher among hypertensive diabetic participants (M=3.4; SD=1) in comparison to non hypertensive diabetic participants (M=3; SD=1) and it was found statistically significant (p=.03) indicating towards poor self health perception among hypertensive’s. Results of the study have shown that the proportion of participants who have prepared any list of questions before visiting doctor’s clinic (fairly often to always) was significantly higher among hypertensive diabetics (30%) in comparison to non-hypertensive diabetics (14%). Conclusion: The proportion of participants reporting diabetes neuropathy and retinopathy was higher among hypertensive diabetics in comparison to non hypertensive diabetics.

Introduction: Healthy and nutritious diet is very essential component of Antenatal care along with clinical advice. The objective of this study was to understand the dietary choices, preferences, knowledge and related practices among pregnant women living in an Indian setting. Materials and Methods: Hundred pregnant women were enrolled in this cross-sectional study. Information about Sociodemographic profile, food item price and approach during inflation, nutrition related knowledge, attitude and practices and 24 hour dietary recall was acquired. Results: Majority of the participants (87%) reported regular antenatal care visits and intake of iron and folic acid tablets. Eighty two percent of the participants were acquainted with standardized marks on food items and 64% of them reported checking of these marks before purchasing. Thirty two percent of the participants did not know about balanced diet. Fifty eight percent of the participants felled in fair category of dietary recall final scores. Conclusion: There is still vast room for improvement of the nutritional status of pregnant women as none of the participants were able to achieve excellent status on 24 hour food record scoring sheet.

Introduction: Worldwide, cigarette smoking kills 5 million people annually, and leads to illness, disability and death. This study aimed to assess the factors influencing smoking initiation and cessation among current smokers in Chennai, India. Materials and Methods: This cross-sectional study was conducted in September 2013 in Chennai, India. A convenient sample of 100 current smokers aged >15 years was enrolled. A modified version of Alcohol, Smoking and Substance Involvement Screen Test (ASSIST) questionnaire was used to gather information on socio-demographics, smoking initiation and cessation, expenditure on smoking products and perceptions on incentives for smoking cessation. Results: Surrounding influence (44%), stress (42%) and fun (40%) were major reasons for smoking initiation. Majority of participants (68%) attempted to quit smoking within past 6 months but failed. Health promotion programs (61%) and financial incentives (20%) were perceived to be helpful in smoking cessation. Conclusion: Smoking cessation strategies, especially at workplaces, should target the multi-factorial nature of smoking initiation and cessation. There is a need to review national guidelines to evaluate the accessibility and availability of smoking products in and around the workplace.

Introduction: Depression during perinatal period leads to adverse pregnancy outcome and of child growth. Our study aimed to examine the burden of antenatal depression and associated risk factors among pregnant women living in rural settings of Chennai, a southern state of India. Materials and Methods: A pilot cross-sectional study was conducted in the rural settings of Chennai, one of the Southern States of India during August through September 2013. Hundred pregnant women who agreed to participate were enrolled in this study. Edinburg postnatal depression scale was used to assess the depression level of the study participants. Information was also gathered about socio-demographics, obstetric and disease history, social support and marital satisfaction was gathered. Descriptive analysis was performed using univariate statistics to report means and standard deviations for the continuous variables and frequency distribution for the categorical variables. Results: Majority of the participants (65%) had scored 13 or higher on the Edinburg Depression Scale reflecting high likelihood of depression. Majority of the participants (66%) had been bothered due to low feeling, depressed or hopelessness during the previous month. Enriched marital satisfaction scale (p=.025) had shown significant association with Edinburg depression scale. Conclusion: Pregnancy is very crucial period not only for mother but whole family. This study has shown very high frequency of depression among the participants. There is a need for a longitudinal study to design interventions that can address emerging burden of antenatal depression among pregnant women living in rural settings.

The goals of this project were: (1) development of an interactive multimedia medical education tool (CO-ED) utilizing modern features of handheld computing (PDA) and major constructs of adult learning theories, and (2) pilot testing of the computer-assisted education in residents and clinicians. Comparison of the knowledge scores using paired t-test demonstrated statistically significant increase in subject knowledge (p

The aim of this project was construction of a universal platform for rapid development and implementation of interactive computer-based collection of clinical data. A TabletPC was used to pilot-test the platform and to implement two self-administered questionnaires: SF-12 Health Survey (SF-12) and Health Utilities Index (HUI). Qualitative analysis of the system acceptance in 12 patients showed that computer-assisted data collection in elderly patients with no previous computer experience can be successfully implemented using a TabletPC.

Background: Stress among diabetic patients is much more as compared to normal individuals. A delayed recognition of stress undoubtedly worsens the prognosis for survival for many diabetic patients. Hence, this study was planned to develop an intervention model for the reduction of stress among diabetic patients and to evaluate the developed intervention model in the proposed group. Methods: This study was conducted in endocrinology outpatient department of a tertiary care hospital. Starting at random, the patients were allocated to control group and test group. Controls were given printed educational materials. Test group were counseled with intense lifestyle education using both printed materials and computers; they were contacted by telephones by the investigator every 3 weeks for 3 months and SMS were sent every week containing some educational tips. Results: Mean age was 54 ΁ 11.5 years overall ranging from 30 years to 80 years. About two-third of participants were males with similar distribution in both the groups (intervention = 66%, control = 64%). Half (50%) of the participants lived in joint families, followed by nuclear families (40%). Most (83%) were married and with either graduate or above graduate education (n = 39%). No significant difference was observed in socio-demographic characteristics among both control and intervention groups (P > 0.05). The average stress scores were similar (18.9) at baseline for control and intervention arms. At 3-month follow-up, however, these scores reduced to 17.05 in the intervention arm while they increased to 20.7 in the control arm. At 3 months follow-up, higher proportion of stress reduction was seen in the intervention group. Conclusions: Intervention in the form of intensive lifestyle education and phone calls and SMS significantly decrease their stress score. Mobile-based education has great potential to improve their mental status and increase patient-provider communication, and to decrease stress.