Search

Background: Obstructive sleep apnea (OSA) is an under-evaluated and under-treated problem, particularly among individuals with type 2 diabetes mellitus (T2DM). Therefore, in this study, we aim to determine the risk of OSA among adults with T2DM residing in an urban area of Mangalore and to elucidate the determinants of OSA among the study participants. Materials and Methods: A cross-sectional study was conducted for a period of 2 months among adult patients (≥ 18 years) with T2DM seeking health care at a primary care setting located in an urban area of Mangalore. Face-to-face interviews were conducted using a semi-structured proforma. STOP-BANG questionnaire was used to assess the risk of OSA among the study participants. The measurements, such as height, weight, and neck circumference, were conducted using standard techniques Results: The mean age of the study participants was 58.12 ± 11.60 years. The majority, (58.30%), were males, and 45.0% reported a family history of T2DM. A total of 108 (60.0%) experienced loud snoring while asleep, while 149 (82.80%) experienced tiredness during daytime. The mean body mass index (BMI) was 24.64 ± 4.9 kg/m2, while a neck circumference of >40 cms was found in 28.90%. A total of 69 (38.30%) had a high risk of OSA with a STOP-BANG score ranging from 5 to 8, while 71 (39.40%) had a score ranging from 3 to 4 (intermediate risk). The statistically significant associations were found between age >50 years, male gender, and diabetes for ≥ 7 years and high risk of OSA (P < 0.001). Conclusion: More than a third of the study participants had a high risk of OSA. Age > 50 years, male gender, and diabetes for ≥7 years were the factors associated with OSA.

Background: Spirituality and spiritual health are an integral component of an individual’s health and wellbeing. Among medical undergraduates and professionals, spiritual health has positive effects on the individual by decreasing burnout, psychological distress, and rates of substance abuse. Spiritual health is also correlated with increased satisfaction and meaning in life. Spiritual health also influences future patient care, builds patient- provider communication channels, and improves patient outcomes. Methods: A cross-sectional study was conducted to assess the spiritual health levels of medical undergraduates in a medical college, in Karnataka, India, and to identify the factors associated with it. Using a pre-designed, validated semi-structed questionnaire, 600 medical undergraduates were approached and provided the forms. Spiritual health was assessed across the three domains of self-development, self-actualization, and self-realization using the Spiritual Health Assessment Scale (SHAS). Results: A total of 436 medical undergraduates participated. Majority (67.7%) of participants were girls. Most (62%) were found to have fair spiritual health with a large portion of the rest (36%) having good spiritual health and 2% had poor spiritual health. A significant association was found between spiritual health and the father’s (p=0.005) and mother’s (p=0.012) education levels. Spiritual health was also found to be associated with living in a nuclear family (p=0.04). Conclusions: Majority of the medical undergraduates had fair spiritual health. Parents' education levels and nuclear family were significantly associated with spiritual health.

Background: Depression in pregnancy affects nearly one in five women in low- and middle-income countries and is associated with adverse obstetric and neonatal outcome. Burden of morbidity is high, but specialized mental health resources are meager. Effective low intensity psychosocial interventions hold promise to fill the treatment gap for maternal depression. In this paper, we aim to describe the process of development of a stepped care model incorporating screening, providing brief intervention, and referral pathways developed for managing depression in pregnancy in antenatal care health facilities in India. Methodology: Using complex intervention development and evaluation method of Medical Research Council, United Kingdom, we searched evidence-based strategies from preexisting manuals, conducted formative research for need assessment and stakeholder engagement, and developed the intervention following an expert review panel. We conducted pilot testing to assess the feasibility and acceptability of intervention supplemented by three focused group discussions. Results: Manual review identified psychoeducation, empathetic listening, behavior activation, and supportive counseling as important elements. Need assessment revealed huge gap in perinatal mental health knowledge. Nearly 92% of total 272 perinatal women had poor awareness and 35%–70% of total 62 health-care providers had poor knowledge. In qualitative interview, women reported depressive symptoms as a normal part of pregnancy and had poor help seeking, behavior symptoms of depression were more prominent. A stepped care algorithm was developed for screening all expectant mothers in each trimester for depression using Patient Health Questionnaire-9 (PHQ-9). Women with PHQ-9 score >19 or reporting self-harm ideation were urgently referred to psychiatrist. Women with PHQ-9 score 5–19 were given brief intervention for depression in pregnancy intervention by antenatal nurse. The intervention developed consists of three sessions of psychoeducation, relaxation exercise, and mental health promotion, each lasting 20 min and at gap of 2 weeks each. Service providers and mothers reported good acceptability of psychosocial intervention and reported satisfaction with content and delivery of intervention. Conclusion: Low intensity brief psychosocial interventions can be adapted for implementation if relevant stakeholders are engaged at each step right from development of such as screening, intervention pathway to delivery, and effectiveness study.

BackgroundCOVID-19 vaccine hesitancy (CVH) is common among perinatal women in low and middle-income countries (LMICs), but it is often unaddressed. This could be due to a lack of feasible, scalable, and acceptable interventions and models for CVH in LMICs. Our study aimed to develop a CVH intervention model that can be implemented in LMICs using existing human healthcare resources.MethodsA literature review was conducted on aspects of vaccine hesitancy, pre-existing interventions, and models for addressing vaccine hesitancy (COVID-19 and non-COVID-19). The lead authors (RR and PKuk) formed a team consisting of vaccinators, experts, and stakeholders. Members shared their perspectives and proposals for various models and interventions that could be implemented in LMICs. A CVH intervention model was developed using a logic model, a WHO implementation toolkit, experts' feedback, and consensus.ResultsA consensus was reached to develop a COVID-19 Vaccine Confidence Project for Perinatal Women (CCPP), which is a primary health care worker (HCWs)-based stepped-care model. The CCPP model includes HCW training, integration into ongoing COVID-19 vaccination programs, CVH screening, CVH intervention, and referral services suitable for implementation in LMICs.ConclusionThe CCPP project/model provides a practical approach that can help in the early detection and management of CVH. The model can be tailored to different healthcare settings to improve COVID-19 vaccine uptake among perinatal women in LMICs.

Background: With the implementation of lockdown and all students restricted to their houses, medical education has shifted towards the online mode. The objective of this study was to assess stress during the pandemic and the association between stress and involvement in online classes among students of a medical college in Mangalore, Karnataka, South India. Methods: A cross-sectional study was conducted among 324 undergraduate students at a medical college in Mangalore, Karnataka, South India. The extent of stress was assessed using a perceived stress scale (PSS), and a questionnaire was used to identify different stressors and to understand the participant’s involvement in online classes. Results: In this study, the mean perceived stress score was 21.66 ± 4. Moderate stress was observed in 262 (85%) students. The main stressors noted were inability to focus (173 (56.4%)) and fear of exams (153 (49.8%)). A significant association was noted between stress and involvement in online classes. Conclusions: This study thereby highlights the need for more attention to the various stressors among students and for making online classes student friendly.

BACKGROUND: Social support among pregnant women is identified to have a positive influence on maternal, fetal outcome, personal competence, and self-esteem. This study was conducted with the aim to assess the social support as perceived by pregnant women and to find out the association between perceived social support and sociodemographic, obstetric variables. MATERIALS AND MATERIALS: After obtaining approval from the Institutional Ethics Committee, a cross-sectional study was carried out among pregnant women attending the Antenatal Clinic of a Tertiary Care Hospital for a period of two months. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to assess social support among study participants. RESULTS: A total of 111 pregnant women were included. Majority, 98 (88.30%), were educated till High School. Nearly 87 (78.40%) were in the third trimester and 68 (61.30%) were primigravidae. Mean MSPSS score was found to be 5.36 ± 0.83. Majority, 75 (67.60%), had high social support (mean total score of 5.1-7.0). Those engaged in occupation had 2.922 odds for high social support (adjusted odds ratio = 2.92, 95% confidence interval = 0.612-13.95) when compared to housewives (P < 0.05). Women in third trimester had 2.104 odds for high social support, when compared to those in first and second trimesters (adjusted odds ratio = 2.014, 95% confidence interval = 0.715-6.185). CONCLUSION: Majority scored high on MSPSS. Furthermore, involvement in occupation was found to be a significant predictor of high social support among the study participants.

Introduction: Knowledge of obstetric danger signs among pregnant women is of paramount importance in improving maternal, and fetal health outcomes. This study aims to determine the knowledge of danger signs among pregnant women seeking antenatal care in a teaching hospital. Materials and Methods: A cross-sectional study was carried out for two months among pregnant women who visited the antenatal clinic of a teaching hospital. A pre-tested and pre-designed proforma was used. Mean knowledge scores were computed and knowledge was classified into adequate and inadequate. Results: A total of 170 pregnant women fulfilling the inclusion criteria were included. Mean age of the study participants was found to be 26.40 ± 4.14 years. Nearly 67.10% were aware of bleeding per vagina being a danger sign, 50.0% stated excessive vomiting as a danger sign, 23.50% knew that blurring of vision was a danger, while a mere 20.0% reported that convulsions were a danger sign. Overall, adequate knowledge (total knowledge score of 5 and above) was observed in 54.70% of the participants. Conclusion: Majority of the study participants had adequate knowledge of danger signs in pregnancy. However, when knowledge about specific individual danger signs were further assessed, a high proportion had very poor knowledge. The mean knowledge scores were found to be low.

Background: Perinatal depression (PD) has important implications for maternal and infant well-being but largely goes undetected. There is a need to develop low-intensity psychosocial interventions applicable to obstetric health care facilities. Objective: To assess the effectiveness of a brief psychological intervention for mild to moderate PD delivered by a nurse as compared to treatment-as-usual (TAU). Methods: This study is a randomized, open-label, parallel-group, multicentric trial being conducted in four sites of India. A total of 816 pregnant women with mild to moderately severe depression (Patient Health Questionaire-9 score of 5–19) are being assessed for the effectiveness of the intervention. Participants are randomly allocated to two groups of trial intervention (psychological intervention given by nurse) and TAU. The primary outcome is to compare the proportion of women reporting improvement across both groups. Participants are serially followed-up in each trimester and at 6, 10, 14 weeks, and 6 months postpartum. Secondary outcomes include pregnancy outcomes, feeding practices, physical growth, and immunization status of the infants. Conclusion: It is a prospective pregnancy birth cohort with a robust design and long-term follow-up. This is one of the largest studies utilizing non-specialist health workers for the screening and management of PD. This study also holds promise to cast light on the course and outcome of depression during pregnancy in different parts of India. It is envisaged to help in developing a sound screening and referral-based protocol for obstetric settings.

Background: Opportunistic screening for individuals aged ≥30 years at all levels of healthcare for early detection of diabetes mellitus (DM) and hypertension (HTN) is an integral strategy under the national program to control non-communicable diseases. There has been no systematic assessment of the screening process in primary care settings since its launch. The objective was to determine the number and proportion eligible for screening, number screened, diagnosed and treated for DM and HTN among persons aged ≥30 years in two selected primary health centres (PHCs) in Dakshina Kannada district, Karnataka, India during March-May 2019 and to explore the enablers and barriers in the implementation of screening from the perspective of the health care providers (HCPs) and beneficiaries . Methods: This was a sequential explanatory mixed-methods study with a quantitative (cohort design) and a descriptive qualitative component (in-depth interviews and focus group discussions) with HCPs and persons seeking care. Those that were not known DM/HTN and not screened for DM/HTN in one year were used to estimate persons eligible for screening. Results: Of 2697 persons, 512 (19%) were eligible for DM screening, 401 (78%) were screened; 88/401 (22%) were diagnosed and 67/88 (76%) were initiated on treatment. Of 2697, 337 (13%) were eligible for HTN screening, 327 (97%) were screened, 55 (17%) were diagnosed with HTN; of those diagnosed, 44/55 (80%) were initiated on treatment. The documentation changes helped in identifying the eligible population. Patient willingness to undergo screening and recognition of relevance of screening were screening enablers. Overworked staff, logistical and documentation issues, inadequate training were the barriers. Conclusion: Nearly 19% were eligible for DM screening and 13% were eligible for HTN screening. The yield of screening was high. We noted several enablers and barriers. The barriers require urgent attention to reduce the gaps in delivery and uptake of services.

Of patients with multidrug-resistant tuberculosis (MDR TB),

Introduction: Knowledge of obstetric danger signs among pregnant women is of paramount importance in improving maternal and fetal health outcomes. This study aims to determine the knowledge of danger signs among pregnant women seeking antenatal care in a tertiary care hospital. Methods: A cross-sectional study was carried out for two months among pregnant women who visited the antenatal clinic of a teaching hospital. A pre-tested and pre-designed proforma was used. Mean knowledge scores were computed and knowledge was classified into adequate and inadequate. Results: A total of 170 pregnant women fulfilling the inclusion criteria were included. Mean age of the study participants was found to be 26.40±4.14 years. Nearly 67.10% were aware of bleeding per vagina being a danger sign, 50.0% stated excessive vomiting as a danger sign, 23.50% knew that blurring of vision was a danger, while a mere 20.0% reported that convulsions were a danger sign. Overall, adequate knowledge (total knowledge score of 5 and above) was observed in 54.70% of the participants. Conclusion: Majority of the study participants had adequate knowledge of danger signs in pregnancy. However,, when knowledge about specific individual danger signs were further assessed, a high proportion had poor knowledge. The mean knowledge scores were found to be low.

Background: In March 2018, the Government of India launched a direct benefit transfer (DBT) scheme to provide nutritional support for all tuberculosis (TB) patients in line with END TB strategy. Here, the money (@INR 500 [~8 USD] per month) is deposited electronically into the bank accounts of beneficiaries. To avail the benefit, patients are to be notified in NIKSHAY (web-based notification portal of India’s national TB programme) and provide bank account details. Once these details are entered into NIKSHAY, checked and approved by the TB programme officials, it is sent to the public financial management system (PFMS) portal for further processing and payment. Objectives: To assess the coverage and implementation barriers of DBT among TB patients notified during April–June 2018 and residing in Dakshina Kannada, a district in South India. Methods: This was a convergent mixed-methods study involving cohort analysis of patient data from NIKSHAY and thematic analysis of in-depth interviews of providers and patients. Results: Of 417 patients, 208 (49.9%) received approvals for payment by PFMS and 119 (28.7%) got paid by 1 December 2018 (censor date). Reasons for not receiving DBT included (i) not having a bank account especially among migrant labourers in urban areas, (ii) refusal to avail DBT by rich patients and those with confidentiality concerns, (iii) lack of knowledge and (iv) perception that money was too little to meet the needs. The median (IQR) delay from diagnosis to payment was 101 (67–173) days. Delays were related to the complexity of processes requiring multiple layers of approval and paper-based documentation which overburdened the staff, bulk processing once-a-month and technological challenges (poor connectivity and issues related to NIKSHAY and PFMS portals). Conclusion: DBT coverage was low and there were substantial delays. Implementation barriers need to be addressed urgently to improve uptake and efficiency. The TB programme has begun to take action.

Introduction: Non-communicable diseases (NCDs) contribute to 65% of all the deaths and 80% of these are in developing countries. Medical colleges have a large workforce with risk for NCDs similar to general population. Methodology: A cross-sectional survey among the 65 of 88 non-teaching staff members of the medical college was done to screen for NCDs using WHO STEPS with necessary modifications. This was done as part of student research project through regular undergraduate curriculum where the undergraduate medical students are taught basic research skills. Results: There were six self-reported diabetics and five self-reported hypertensives. Risk factors such as high salt intake (77%), high waist-hip ratio (15% women), and overweight (22%) were detected. Conclusion: The exercise gave an opportunity for screening and spreading awareness for health promotion and risk reduction for NCDs.

Background: Spirituality and spiritual health are an integral component of an individual’s health and wellbeing. Among medical undergraduates and professionals, spiritual health has positive effects on the individual by decreasing burnout, psychological distress, and rates of substance abuse. Spiritual health is also correlated with increased satisfaction and meaning in life. Spiritual health also influences future patient care, builds patient- provider communication channels, and improves patient outcomes. Methods: A cross-sectional study was conducted to assess the spiritual health levels of medical undergraduates in a medical college, in Karnataka, India, and to identify the factors associated with it. Using a pre-designed, validated semi-structed questionnaire, 600 medical undergraduates were approached and provided the forms. Spiritual health was assessed across the three domains of self-development, self-actualization, and self-realization using the Spiritual Health Assessment Scale (SHAS). Results: A total of 436 medical undergraduates participated. Majority (67.7%) of participants were girls. Most (62%) were found to have fair spiritual health with a large portion of the rest (36%) having good spiritual health and 2% had poor spiritual health. A significant association was found between spiritual health and the father’s (p=0.005) and mother’s (p=0.012) education levels. Spiritual health was also found to be associated with living in a nuclear family (p=0.04). Conclusions: Majority of the medical undergraduates had fair spiritual health. Parents' education levels and nuclear family were significantly associated with spiritual health.

Background: With the implementation of lockdown and all students restricted to their houses, medical education has shifted towards the online mode. The objective of this study was to assess stress during the pandemic and the association between stress and involvement in online classes among students of a medical college in Mangalore, Karnataka, South India. Methods: A cross-sectional study was conducted among 324 undergraduate students at a medical college in Mangalore, Karnataka, South India. The extent of stress was assessed using a perceived stress scale (PSS), and a questionnaire was used to identify different stressors and to understand the participant’s involvement in online classes. Results: In this study, the mean perceived stress score was 21.66 ± 4. Moderate stress was observed in 262 (85%) students. The main stressors noted were inability to focus (173 (56.4%)) and fear of exams (153 (49.8%)). A significant association was noted between stress and involvement in online classes. Conclusions: This study thereby highlights the need for more attention to the various stressors among students and for making online classes student friendly.