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    Table of Contents - Current issue
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April-June 2020
Volume 45 | Issue 2
Page Nos. 111-247

Online since Tuesday, June 2, 2020

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EDITORIAL COMMENTARY  

COVID-19: Epidemiology and public health aspects Highly accessed article p. 111
T Rajgopal
DOI:10.4103/ijcm.IJCM_167_20  
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Our fight against the rapidly evolving COVID-19 pandemic: A review of India's actions and proposed way forward Highly accessed article p. 117
Sanjay Zodpey, Himanshu Negandhi, Aman Dua, Akshaya Vasudevan, Mitali Raja
DOI:10.4103/ijcm.IJCM_221_20  
A new strain of coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has overwhelmed the world with its rapid spread and high number of cases. SARS-CoV-2 causes COVID-19 disease which may present with mild, moderate, or severe illness. In severe cases, pneumonia, acute respiratory distress syndrome, sepsis, and septic shock can occur. Individuals above 60 years and people with preexisting comorbidities are at higher risk for developing serious complications. The incubation period of this new pathogen ranges from 1 to 14 days and there is no preexisting immunity to the disease. Countries across the globe have adopted various prevention and control measures to minimize negative health impacts. India has adopted various public health measures which include social distancing measures, nationwide lockdown to reduce risk of exposure, widespread IEC messaging regarding hand-washing, usage of masks, and recommending avoidance of unnecessary travel to combat the spread of disease. This manuscript reviews the global situation, contextualizes India's disease control efforts, and outlines the possible way forward by identifying specific actions under the following headings: enhancing district preparedness, enabling care for patients, and broadening community and stakeholder engagement for India.
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Accountability in Healthcare in India Highly accessed article p. 125
Manish Priyadarshi, Sanjiv Kumar
DOI:10.4103/ijcm.IJCM_224_19  
Today, health is a human right in India, and the government is working hard for universalization of health services provision till the grassroots. Health without accountability is a challenging task in hand, and recently, state governments drafted a bill toward public health system to move in the strengthened direction of accountability mechanism. Accountability is the quality or state of being accountable, and it is an important component of the health-care reforms in India. This article provides more nuanced understanding of accountability which includes the specification of accountability, conceptual framework of accountability, and its potential approaches for how accountability is viewed today in India with reference to the Central, State, District, and other stakeholders. It examines the role of accountability in making accountable health plans, and its relationship governance/ownership structures as a key component of health-care reforms as improved accountability is a major element in improving the health system performance. The article elaborates on the definition of accountability in terms of answerability and sanctions and distinguishes the three types of accountability, namely financial, performance, and political/democratic. The article describes three accountability-enhancing strategies, namely reducing the pilferage, assuring acquiescence with procedures and standards, and improved learning from the past experience. The recent events in Indian health care put forward a serious issue on how accountability can be fixed if health mishaps happened and how we can make our health plans accountable to the needs and aspiration for the people of India. Overall, the accountability is discouraging and more needs to be done to enhance the accountability compliance in India.
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ORIGINAL ARTICLES Top

Psychometric validation of a nutrition knowledge questionnaire among parents of 3–6-Year-Old Asian Indian children in east Barddhaman district, West Bengal, India p. 130
Nilita Das, Arnab Ghosh
DOI:10.4103/ijcm.IJCM_347_19  
Background: In India, virtually, no study was aimed to develop a psychometrically valid and reliable questionnaire to assess the nutrition knowledge and practice among parents of children aged between 3 and 6 years. Objective: The present study describes an evaluation of validity and reliability measures in a questionnaire designed for the assessment of nutrition knowledge among parents of children participating in a study finding relationship between physical growth and development and nonverbal intelligence quotient development being undertaken in a semi-urban area. Design: This was a cross-sectional school-based reliability and validity study. Setting: This study was conducted in seven primary schools within the limits of Purba (East) Barddhaman district legislation, West Bengal, India. Participants: One hundred and thirty-four parents of children aged 3–6 years were included in the study. Results: The final questionnaire consisted of 32 questions that were selected on the basis of content validity. Questions included closed-ended and multiple-choice items which could be answered correctly by 5%–95% of the target population with a difficulty index of 0.33–0.87, discrimination index of 0.12–0.44, and validity index of 0.10–0.86. Internal reliability of each item as measured by Cronbach's α of 0.87 was also significant. Conclusions: The test comprises basic psychometric criteria of a valid and reliable 32-item knowledge questionnaire which further forms an instrument for measuring current scenario and interpreting changes associated with intervention work aiming improvement of dietary and nutrition knowledge-practice in the middle-to-low socioeconomic community.
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What lessons should pradhan mantri jan arogya yojana learn from the shortfalls of rashtriya swasthya bima yojana: The case of rashtriya swasthya bima yojana in Chhattisgarh p. 135
P Shirisha
DOI:10.4103/ijcm.IJCM_95_19  
Context: Publicly funded health insurance has been rolled out by many states as well central government. As it is being seen as a way of protection against catastrophic health expenditure. Rashtriya Swasthya Bima Yojana (RSBY) has been one such attempt succeeded by the recent scheme Ayushman Bharat, which provides coverage of 5 lacs for each family per year. Aims: To assess RSBY on issues of equity across the state of Chhattisgarh. Materials and Methods: The district-wise secondary data for Chhattisgarh were obtained from the official state website of RSBY maintained by the Government of Chhattisgarh. The data were utilized to estimate the claim ratio (procedure wise as well as district wise), enrollment pattern, rate of hospitalization, and average costs of hospitalization across the district to compare the change in trends since 2011 till 2017. Results: There is an overall increase in enrollment, utilization, and number of empanelled hospitals. Also, a higher conversion ratio (i.e., increased proportion of the below poverty line households enrolled) shows a positive sign of improved coverage. All the districts faired on an average, barring Sukma with lowest enrollment rate (55%) probably due to poor accessibility and political disturbances. Conclusions: Although there has been an increase in the overall utilization, procedure-wise claims, and enrollment, there are signs of inequity, namely the skewed distribution of empanelled hospitals. Therefore, good or bad, RSBY offers important lessons to be learned for Ayushman Bharat.
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Socioeconomic inequalities in clustering of health-compromising behaviours among Indian adolescents p. 139
Manu Raj Mathur, Ankur Singh, Vijay Kumar Mishra, Priyanka Parmar, Deepti Nagrath, Richard G Watt, Georgios Tsakos
DOI:10.4103/ijcm.IJCM_349_19  
Background: The simultaneous occurrence of health-compromising behaviors can accentuate the risk of noncommunicable diseases (NCDs). This study aimed to examine the existence and patterns of clustering of four NCD risk behaviors among adolescents and its association with social position. In addition, socioeconomic inequalities in the occurrence of clustering of NCD risk behaviors were also assessed. Methods: A cross-sectional study was undertaken among 1218 adolescents (14–19 years old) in the city of New Delhi, India. An interviewer-administered questionnaire was used to assess health-compromising behaviors (tobacco and alcohol use, fruit/vegetable intake, and physical inactivity). Clustering was assessed using pairwise correlations, counts of clustering of health-compromising behaviors, comparison of observed/expected ratios, and hierarchical agglomerative cluster analysis. Multivariable logistic regressions were used to test the associations of clustering with social position (education and wealth). The relative and slope indices of inequalities in the presence of clustering of behaviors according to education and wealth were estimated. Results: Three major clusters of health behaviors emerged: (a) physical inactivity + lower fruit and vegetable intake, (b) tobacco + alcohol use, and (c) lower fruit and vegetable intake + tobacco + alcohol use. Pronounced clustering of health-compromising behaviors was observed with lower educational attainment and wealth. Conclusion: The presence of clustering of health-compromising behaviors was considerably higher among adolescents with lower educational attainment and wealth. The area of residence has an important influence on socioeconomic inequalities in clustering of NCD risk factors.
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Comparison of mental health status of married and unmarried girls of late adolescent age in an urban slum of Delhi p. 145
Sujata Gupta, Neha Taneja, SK Kapoor, Amod Kumar
DOI:10.4103/ijcm.IJCM_204_19  
Introduction: Late adolescence age (16–19 years) is organized around central task of achieving an identity. In India, age at marriage for girls has been legally declared as 18 years, but many girls are married much before this age. Early marriage for girls can have profound psychological and emotional impacts. Aims and Objectives: The aim was to study the impact of marriage on mental health of married girls of late adolescent age and to compare them with unmarried girls of the same age. Materials and Methods: A comparison study was conducted among girls of late adolescent age in an urban slum of North East Delhi. Background information was collected through oral questionnaire method. The mental health of the study participants was assessed using validated tool “General Health Questionnaire-12” and “Symptom Checklist-90.” Results: Education and economic status of participants and parents were significantly associated with early marriage. Majority of married girls were found to be associated with risk of developing mental health disorders.
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Impact of health education intervention on breast cancer awareness among rural women of Tamil Nadu p. 149
B Nisha, Ramachandran Murali
DOI:10.4103/ijcm.IJCM_173_19  
Background: The most common cancer among Indian females is breast cancer. Limited access to early detection and treatment is responsible for more than half of the deaths, primarily in rural areas, where organized mammography screening is neither affordable nor feasible. Therefore, imparting awareness on breast health and breast self-examination (BSE) is highly recommended. This study aimed to assess the impact of a health education interventional program on breast health awareness and BSE among rural women of Tamil Nadu. Methodology: A quasi-experimental study was conducted among 266 women. A preinterventional survey was done using a pretested validated questionnaire. A multipronged breast health education intervention was administered and its effectiveness was measured after 3 months using the same tool. Results: There was a statistically significant (P = 0.0001) improvement in the knowledge of breast health, perceived susceptibility, and reasons for practice and proficiency of BSE practice of the interventional group from pre- to post-test. After the interventional program, 71.8% of increase in knowledge about breast health and BSE was observed. In addition, 64.7% of the women practiced BSE compared to 7.14% pretest. Conclusion: This study highlights the awareness needs by the women and application of extensive strategies to increase the acceptance of cancer screening programs.
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Determinants of myocardial infarction in saurashtra region, Gujarat: A case–control study p. 154
Rajan Upadhyay, Bharatkumar M Gohel, Rajesh K Chudasama
DOI:10.4103/ijcm.IJCM_219_19  
Background: Myocardial infarction (MI) is a multifactorial noncommunicable disease. The study was conducted with an objective to assess the role of various sociodemographic and clinicoepidemiological determinants of MI. Materials and Methods: The cases and controls were selected in the ratio of 1:1 and were group matched for age, sex, and type of residence. Cases of MI were selected from the intensive coronary care unit of the medicine department at a tertiary care hospital, Rajkot, for 1 year. Controls were selected from the general population of Rajkot district. Information was collected in pretested pro forma using the interview technique. Results: A total of 406 cases and equal number of controls were enrolled in the study. Several risk factors identified for MI included illiteracy, upper socioeconomic class, family history of MI, Type A personality, hypertension, diabetes mellitus, obese or overweight, high waist–hip ratio, low intake of leafy vegetables, low intake of fruits, and history of acute life event for the past 1 year. On applying logistic regression model, these factors were also identified as independent determinants for MI. Conclusion: The findings confirm the role of conventional risk factors for MI and also highlight the role of sociodemographic factors such as illiteracy, higher social class, low intake of leafy vegetables and fruits, and history of acute life event.
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Determinants of home delivery among mothers in urban and rural Vadodara district, Gujarat, India p. 159
Nitin Agrawal, Anjana Tiwari
DOI:10.4103/ijcm.IJCM_289_19  
Background: Maternal health is severely affected by home deliveries because it contributes to maternal mortality, especially if home births are not made safer. Objectives: The present study aimed to assess the determinants of home delivery among mothers in urban and rural Vadodara district, Gujarat. Materials and Methods: This community-based, cross-sectional study was carried out during April 2017–July 2017. The mothers who delivered at home and hospital in urban and rural Vadodara district between April 15 and March 16 were included in the study. A semi-structured questionnaire was used for interviewing all the mothers. Information regarding sociodemographic and obstetrics characteristics of mothers was recorded. The study finding was presented in the form of frequencies and percentages, and the association was found with Chi-square test.P ≤0.05 was considered statistically significant. Results: The present study was carried out among 138 mothers, of them, 71.7% were in the age group of 20–25 years. The mean age of mothers was 24.5 ± 4.4 years. The analysis of sociodemographic and obstetric factors revealed that mothers age more than 25 years, mothers from nuclear family, illiterate mothers, late antenatal care registration by mothers, mothers not registered in Janani Suraksha Yojna/Chiranjeevi Yojana scheme, and prior experience of home delivery by mothers were significantly associated with home delivery (P < 0.05 each). Conclusions: This study highlighted that several sociodemographic and obstetrics determinants related to mother were associated with home delivery in the study setting. Taking these findings into consideration, it is recommended that appropriate maternity services should be designed with a special focus on poor, uneducated, and multiparous women as well as it should ensure early registration of pregnancy for every pregnant woman. Institutional delivery should be encouraged and advocated among mothers having all previous deliveries at home.
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A case–control study on the role of deer fly in the transmission of hepatitis B in Kerala, South India p. 164
Sangeetha Merrin Varghese, Manju Koshy, AL Sheeja
DOI:10.4103/ijcm.IJCM_431_19  
Background: The sudden increase in the number of Hepatitis B-positive cases between December 2018 and June 2019, in Pathanamthitta District of Kerala in South India, aroused fear both among the government and the people. Some earlier studies postulated that deer flies act as vectors for the transmission of Hepatitis B. Deer flies were found to be in plenty in the concerned area and their bite was also considered part and parcel of everyday life. Hence, it was considered necessary to prove whether deer flies played a role in the transmission of Hepatitis B. Aims and Objective: The aim of this study is to investigate the role of deer fly in the transmission of Hepatitis B. Materials and Methods: A case–control study design was adopted to test the hypothesis concerning the possible role of deerfly in disease transmission. Cases were those who were picked up by the routine surveillance system (Integrated Disease Surveillance Project) and found to be positive for Hepatitis B surface antigen (HBsAg). Controls were age- (±5 years) and gender-matched neighborhood individuals negative for HBsAg. Data was collected with the help of a pretested interview schedule. Results: There was no significant association between bite of deer flies and acquisition of Hepatitis B. Conclusion: This study concluded proving the deer fly hypothesis to be false.
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Factors to overcoming barriers affecting electronic medical record usage by physicians p. 168
Ankit Singh, Sammita Jadhav, MR Roopashree
DOI:10.4103/ijcm.IJCM_478_19  
Background: Hospitals are adopting electronic medical records (EMRs) in larger numbers; however, the barrier to derive its full utility is the low acceptance by physicians. Aims and Objectives: This study is done with an objective to identify the factors to overcome the barriers preventing the adoption of EMR by physicians. Materials and Methods: This study is cross sectional in natures and a self-administered questionnaire is developed based on the Technology Acceptance Model. Results: The four identified factors are positive attitude toward EMR, reliability, difficulty to use, and adaptability, these factors together, have explained 62.54 percent variance in the data set. Conclusion: The physician's acceptance for EMRs can be improved by focusing on the identified four factors, which are “positive attitude toward electronic medical records,” reliability of electronic medical records,” “difficulty level of use,” and “adaptability of electronic medical records.”
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Stress and coping strategies among undergraduate nursing students: A descriptive assessment from Western Rajasthan p. 172
Mamta Nebhinani, Ashok Kumar, Aashish Parihar, Raj Rani
DOI:10.4103/ijcm.IJCM_231_19  
Background: Nursing is a very challenging profession, which requires very stringent training since initial years of nursing education. Throughout the training period, students are exposed to various stressful situations. Inability to cope up with varied stressors may lead to psychological distress and impede students' pursuits of nursing career. Objectives: The aim of the present study is to assess stress and coping strategies among nursing students of Western Rajasthan. Materials and Methods: Two hundred and twenty-one undergraduate nursing students were recruited for the study through total enumeration. Standardized Student Nurse Stress Index and brief cope scale were used to assess stress and coping strategies. Results: Nearly 82.4% of the students reported moderate level of stress. Interface worries (mean score 17.88 ± 4.9) and academic load (mean score 17.6 ± 4.78) were the major source of perceived stress. Students considered attitude of other professionals toward nursing, lack of free time, and fear of examination as most likely reasons of their distress. Active coping was the most commonly used coping strategies. Level of stress was found to have significant association with the interest of students in nursing. Conclusions: Interface worries and academic-related concerns emerged as major source of stress. A positive trend was evident in the use of adaptive coping strategies over succumbing meekly. However, there is a great need to plan and implement stress management programs so that these budding health professionals could be better equipped and trained to face various challenges of the profession.
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A preliminary study of real-time capturing and sharing of routine health data among the public health professionals p. 176
Raghavendra Ganiga, Radhika M Pai, MM Manohara Pai, Rajesh Kumar Sinha
DOI:10.4103/ijcm.IJCM_258_19  
Context: Electronic health record (EHR) has the potential to make available the real-time data of the patient to the healthcare professionals by connecting all levels of the public health system, irrespective of their geographical boundaries. Aim: This study aims to test the capturing and sharing of real-time patient data at primary, secondary, and the tertiary level. Settings and Design: The cloud-based EHR system developed earlier was used to capture real-time data of the patient visiting a primay health center (PHC) in Udupi District of Karnataka. Subjects and Methods: About 100 patient records including laboratory and pharmacy data have been captured into the EHR system. The confidentiality of patient data is assured. Results: The result of the study indicated no errors while capturing and sharing the patient data in real time. The system also evidenced the availability of vital statistics about the patient visiting PHCs. The system also allowed the professionals at referral level to view patient data for providing quality healthcare. Conclusion: EHR plays a vital role in capturing, storing, and sharing patient data for providing quality healthcare and it should be made mandatory by the central health agencies in the provision of patient care and reporting of notifiable communicable diseases at all levels.
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Association of vitamin D levels in coal miners: A case–control study p. 181
Sanjay Dash, Sandhya Gupta, Venkatarao Epari, Priti Yugma Patra
DOI:10.4103/ijcm.IJCM_269_19  
Introduction: Coal miners working underground are likely to be at greater risk of developing Vitamin D deficiency due to reduced sunlight exposure. To date, only three studies have been reported, with no significant risk of Vitamin D deficiency among coal miners. None were conducted in the tropical region, where sunlight is ample. Objective: The present study estimated Vitamin D levels among underground coal miners in a tropical region and determined their associated factors. Methods: Serum calcium, 25-hydroxyvitamin D, and bone turnover markers among underground and surface workers were estimated in a matched case–control study. Binary logistic regression analysis was performed using case/control as the dependent variable to estimate odds ratios and 95% confidence intervals of variables which significantly (P < 0.1) differed among the cases and controls. Results: The mean Vitamin D level among both coal miners (22.12 ng/dl) and surface workers (23 ng/dl) were low. No significant difference was noted for all biochemical parameters after adjusting for other covariates except the parathyroid hormone (PTH), which was marginally higher among the surface workers. Conclusions: Even in the absence of statistically significant evidence of low Vitamin D level in underground workers compared to surface workers, there was indirect evidence (of differences in PTH) to indicate that Vitamin D level is lower in underground workers probably because of poor sunlight exposure.
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Quality assessment of maternal death review: A pilot study in 10 high priority districts of Odisha State, India p. 184
Sushree Samiksha Naik, Nirmal Kumar Mohakud, Abhipsa Mishra, Mirabai Das
DOI:10.4103/ijcm.IJCM_321_19  
Background: Maternal death review (MDR) is a strategy that helps in identifying gaps in the care of a pregnant mother. Objectives: The objective is to assess the quality of MDR, causes of maternal mortality, and finding corrective action in 10 high-priority districts of Odisha. Materials and Methods: MDR was undertaken by our team in 4-month timeline (August to November 2014). It included the development of tools, desk reviews, training of staffs, and data handling. The maternal deaths were estimated from the Annual Health Survey. It was compared to estimated maternal death of each district to get the under reporting/over reporting districts. A report was generated on MDR process indicators and program indicators after completion of the assessment. Results: Only 129 (52%) of the 247 deaths found suitable for community-based MDR. The proportion of maternal death reported versus estimated was 247 versus 367. Correct diagnoses were reported in 120 cases. The classification of deaths was not mentioned in 74 cases. Maximum deaths (55%) were in 18–25 years of age group (the most common cause being anemia). Majority (50%) of the deaths occurred during the postnatal period and majority (67%) at the health facility. Only 61 (47%) had received antenatal check-ups. Facility-based MDR showed, Type 1 delay (denotes about seeking care) being the most common (53%). Inaccurate and incomplete information available was also found to compound the above problems in addition. Conclusions: The present study could contribute to a larger extent to address some of the gaps in the MDR process in the Odisha state.
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Maternal health status in tribal India: A 5-year intervention program and its outcome p. 189
Amit Sengupta, Mamata Sahoo, Asif Khan, Raziya Shaikh, Rukhsar Khan
DOI:10.4103/ijcm.IJCM_158_19  
Introduction: There is poor penetration of evidence-based maternal health care provided under national health programs in resource-poor underserved regions. A well-planned locally acceptable community-driven comprehensive health promotion strategy and quality health care delivery mechanism is necessary to improve the situation. Objective: The main objective was to find the gaps in the existing system and promote health literacy and health-seeking behavior. Methodology: 80,000 tribal population living in isolated conflict zone of Bastar district was covered for 5 years between 2012 and 2017. An integrated health-care plan was developed with community leaders, panchayat, and the local government to promote and provide quality evidence-based maternal health care. Available resources were mobilized and health technologies introduced. Results: Regular home visits, point of care diagnostics, identification of high-risk mothers and their timely referral, and behavioral change communication increased the trust of the community. It resulted in higher demand for evidence-based health interventions. The adolescent pregnancy rate (<19 years) reduced to 6.8% (2016) from 13.5% (2012). Hemoglobin level >9 g% (third trimester) improved. Supervised births and high-risk referrals increased from 19.5% (2014) to 58% (2017) and 8.5% (2014) to 13.1% (2017), respectively. Although significant improvement was noted, key indicators continued to remain below rural Bastar (National Family Health Survey-4). Conclusion: Promotion of existing good practices, behavior change, health technologies, and evidence-based emergency care improved the maternal health status of the secluded and underserved tribal community, but persistent effort is needed to enable women access the quality maternal health services provided under National Health Mission.
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Importance of “telephone cardiopulmonary resuscitation” in out-of-hospital cardiac arrest in India p. 194
Jyothi Venkatesan, Rani Janumpally, Aruna Gimkala, Vimal Megavaran, Helge Myklebust, GV Ramana Rao
DOI:10.4103/ijcm.IJCM_223_19  
Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality in developing countries such as India. Most cardiac arrests happen outside the hospital and are associated with poor survival rates due to delay in recognition and in performing early cardiopulmonary resuscitation (CPR). Community CPR training and telephone CPR (T-CPR) in the dispatch centers have been shown to increase bystander CPR rates and survival. Objectives: The aim of this study is to identify the significance of T-CPR in OHCA and to discuss its implementation in the health system to improve OHCA outcomes in India. Materials and Methods: A descriptive research study methodology was adopted following a literature search. Results: The search criterion “Cardiovascular diseases” resulted in 162, “Out-side hospital cardiac arrest” in 50; For a comprehensive overview, these publications were evaluated looking for data on T-CPR incidence, criteria for detecting OHCA by emergency medical dispatchers, sensitivity and specificity, and BCPR. Conclusion: This current research stresses the scale and seriousness of the implementation of T-CPR in OHCA in India.
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Prevalence and pattern of skin diseases in tribal villages of Gujarat: A teledermatology approach p. 199
Rochit Rajesh Singhal, Kandarp Narendra Talati, Bankim Pankajkumar Gandhi, Mayur Kiran Shinde, Pragya A Nair, Ajay Gajanan Phatak
DOI:10.4103/ijcm.IJCM_76_19  
Background: The prevalence and pattern of skin diseases are influenced by the overall ecosystem of the region. There is a dearth of research about prevalence, health-care seeking, compliance, and treatment outcome in skin diseases among scheduled tribes. Objectives: The aim of this study is to understand the magnitude of skin diseases in tribal area of Dahod, Gujarat using a simple “Store and Forward” technique of teledermatology. Materials and Methods: A cross-sectional study was conducted in 10 randomly selected villages of Dahod and Jhalod blocks of Dahod district of Gujarat during June–August 2017. Trained surveyors visited households randomly in different localities (called Faliya) of each village ensuring representativeness. Survey responses were captured on mobile-based MAGPI portal, and images of skin conditions were capture on smart phones, and de-identified images were transferred over WhatsApp. Results: A total of 781 households were approached in 10 villages and 2214 participants consented. Among them, 549 were identified with suspected skin diseases, but 520 consented for photograph. The skin diseases were more prevalent among males, children, and elderly. Of 520, 44 (8.5%) could not be assess due to poor quality photograph and 35 (6.7%) did not have any clinically significant condition. Thus, of 2214 participants, 441 (20%) had skin diseases, and infections and eczema were major conditions constituting two-third of the skin diseases in the study population. The treatment-seeking behavior and compliance to treatment was poor. Conclusion: Considering the high prevalence of skin diseases in tribal villages of Dahod, Gujarat coupled with limited availability of trained dermatologist, new innovative avenues like teledermatology should be explored.
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Perceived stress and coping behavior among future nurses: A cross-sectional study in West Bengal, India p. 204
Aparajita Dasgupta, Debayan Podder, Bobby Paul, Lina Bandyopadhyay, Shamita Mandal, Arkaprovo Pal, Moumita Mandal
DOI:10.4103/ijcm.IJCM_200_19  
Background: Demanding clinical and academic environments have been potential sources of stress among nursing students. Inability to cope effectively often potentiates this stress. If not intervened early, this may have a detrimental effect on health and may eventually affect the future workforce in rendering care. Objectives: The objective of this study was to explore the levels and sources of perceived stress and coping behavior among undergraduate nursing students in West Bengal. Materials and Methods: This descriptive cross-sectional study was conducted in two nursing training institutions in West Bengal, from July to September 2018, using a validated pretested self-administered questionnaire comprising demographics, Perceived Stress Scale (PSS), and coping behavior inventory (CBI). Students having at least 6 months of clinical exposure were invited to participate. Of 256 eligible students, 182 returned completed questionnaires, giving an overall response rate of 71%. Descriptive statistics, Pearson's correlation, and multiple regression analysis were performed using SPSS 16.0 software. Results: “Stress from assignments and workload” and “problem-solving” was the most prominent stressor and coping behavior (Factor rank 1) respectively among students. Statistically significant correlation was observed between overall mean PSS and CBI score (r = 0.306, P < 0.01). Years of education, self-decision to join, increased screen time, staying at hostel significantly predicted stress (R2 = 0.248, F = 9.640, P < 0.01), and coping behavior (R2 = 0.223, F = 10.077, P < 0.01) among students. Conclusions: Stress from academics and clinics were high among nursing students. As they are the future carers, it is apt to intervene early to mitigate their stress and enhance their coping skills during professional training and practice.
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Prevalence of dental caries among smoking and smokeless tobacco users attending dental hospital in Eastern region of Uttar Pradesh p. 209
Neelam Mittal, Nidhi Singh, PG Naveen Kumar
DOI:10.4103/ijcm.IJCM_245_19  
Introduction: The relationship of tobacco use to dental caries is still unclear. The aim of this study is to assess the relationship between smoking and smokeless tobacco usage and prevalence of dental caries and its pattern in the Varanasi population. Materials and Methods: In this study, 472 elderly dentate and consenting individuals were included. Individuals were examined with the aid of mouth mirror, No. 23 explorer, and cotton rolls. The age of the study group ranged from 16 years to 75 years. Individuals were categorized as smoking tobacco users, smokeless tobacco users, and the combination of these two. Frequency and dosage of tobacco usage was recorded. Dental caries was measured using decayed, missing, and filled teeth (DMFT) index. Oral hygiene practices such as mode, material, and frequency of brushing were also recorded. Data were assessed using SPSS 17.0 using Chi-square, t-test, ANOVA test, and binary regression. Results: Caries rate was similar in both males and females (2.57 and 2.70), and the difference was not statistically significant. Caries was higher in individuals with habits when compared to those who were not having habits. There was no statistically significant association between individuals who were smokers, using smokeless tobacco, frequency, mode, and material of brushing with caries pattern. Among smokers, DMFT increased with frequency and duration of smoking, and it was statistically significant; however, in smokeless tobacco users, this was not the case. There was a positive correlation with DMFT and frequency of smoking. Conclusion: The study has shown that tobacco habit is a risk factor for increased caries activity, and it is higher in smokers as compared to smokeless tobacco chewers.
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Iodine deficiency during preconception period of adolescent girls residing in a district of Rajasthan, India p. 215
Jyoti Vijay, Sheel Sharma, Umesh Kapil, Ajeet Singh Bhadoria
DOI:10.4103/ijcm.IJCM_248_19  
Background: In India, iodine deficiency (ID) still remains a serious concern even after five decades of enormous efforts. ID during the preconception period of adolescent girls may negatively affect future neonates, resulting in neonatal hypothyroidism. Hence, the present study was conducted to assess the prevalence of goiter and associated factors among adolescent girls in a poor socioeconomic district of Rajasthan. Methodology: A cross-sectional study was conducted during January–March 2015 in Tonk district of Rajasthan. A total of 1912 adolescent girls were selected from thirty schools using population proportionate to size sampling. Adolescent girls were clinically examined for thyroid using palpation method. Casual urine (n = 344) and salt samples (n = 370) were collected from a subgroup of girls for the estimation of urinary iodine concentration (UIC) and iodine content in salt, respectively. Results: The overall goiter prevalence was 15.3% (95% confidence interval 13.6%–16.9%) and the median UIC was 266 μg/l (interquartile range: 150–300 μg/l) among 1912 adolescent girls (age, 15.7 ± 1.4 years). Around 16.8% of the families of adolescent girls were consuming salt with inadequate iodine (<15 ppm). Goiter prevalence was statistically significantly different with respect to age groups (P = 0.03). There was no statistically significant difference in goiter prevalence with respect to iodine content of salt (P = 0.98) and UIC (P = 0.41). The median UIC increased with an increase in consumption of iodine content of salt from inadequacy to adequacy (P = 0.15). Conclusion: Adolescent girls, residing in an underdeveloped district, are in the transition phase from mild ID (goiter prevalence 15.3%) to iodine sufficiency (median UIC 266 μg/l).
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Insights into disaster management scenario among various health-care students in India: A multi-institutional, multi-professional study p. 220
Gururaghavendran Rajesh, Almas Binnal, Mithun B H. Pai, S Vijayendranath Nayak, Ramya Shenoy, Ashwini Rao
DOI:10.4103/ijcm.IJCM_104_19  
Background: The frequency of occurrence of disasters is on the rise all over the world. Workforce shortage can be a major impediment toward efficient disaster management. Incorporation of other health-care workers along with conventional medical personnel might be critical for efficient and effective management of disasters. Objective: The objective of this study was to assess various aspects pertaining to disaster management among various health-care students in India. Methods: Final-year students pursuing medicine, dentistry, nursing, physiotherapy, pharmacy, Ayurveda, and homeopathy at various institutions in Mangalore, India, were the study participants. Participants' willingness to partake in disaster management and knowledge, attitude, behavior, and perceived effectiveness pertaining to disaster management was ascertained by a questionnaire method. Their previous history of training and familiarity with standard operating procedures was assessed. Results: A total of 437 students belonging to seven health-care institutions participated in the study. Overall, 98.40% of the participants were willing to partake in disaster management. The mean knowledge, attitude, behavior, and perceived effectiveness scores were 49.19%, 81.75%, 47.28%, and 66.20%, respectively. Step-wise multiple linear regression analysis revealed that course (β = 0.247, P < 0.001), attitude (β = 0.154,P = 0.001), and behavior (β = 0.284, P < 0.001) were significant predictors of perceived effectiveness. Conclusions: Participants in the present study revealed that they were willing to partake in disaster management. The participants also reported poor behavior and knowledge scores but appropriate attitude scores. The present study highlights the need for curriculum changes and policy implications for effective integration of various sectors for disaster management, particularly in developing nations such as India, which have a definite scarcity of resources.
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Estimation of the prevalence of tobacco consumption among rural women in South India using mixed methods analysis p. 225
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ijcm.IJCM_216_19  
Background: Tobacco consumption is a public health problem in Tamil Nadu. Objectives: The current study was done to estimate the prevalence of tobacco consumption among rural women and to identify the sociodemographic characteristics with high prevalence of tobacco consumption. Materials and Methods: It was a community-based cross-sectional descriptive study conducted among women ≥18 years of age. Mixed methods were employed to obtain the comprehensive picture about the substance use among women. Multistage random sampling method was used to interview 210 women using a semi-structured and pretested schedule. This was followed by key informant interviews, in which nine women were interviewed. Frequency distributions and Chi-square test were employed to study the association. In addition, manual content analysis was done to identify the reasons for the initiation of tobacco consumption and the measures to curb the practice. Results: The prevalence of tobacco consumption among the women was estimated as 15.2%. Women in the lower socioeconomic status group showed a higher prevalence of tobacco consumption than the middle and high socioeconomic status group. All 32 (100%) women were consuming tobacco products in the smokeless forms. Further, 28 (87.5%) women were not willing to quit tobacco consumption. Conclusion: The prevalence of tobacco consumption among the women was estimated to be above expectation of the national figures. Lower socioeconomic class and poor educational status were found to be major determinants for tobacco consumption among rural women.
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Perspectives about professionalism among undergraduate students in a medical college in India: A qualitative study p. 230
Prasad Tukaram Dhikale, Saurabh RamBihariLal Shrivastava, Srikanth Srinivasan
DOI:10.4103/ijcm.IJCM_238_19  
Background: Professionalism has been recognized as an important competency of a doctor by various regulatory bodies. Objectives: The purpose of the study was to explore the perceptions of medical undergraduate students and to assess their attitude on professionalism. Materials and Methods: It was a qualitative study in which four focus group discussions were conducted, one for each year of course. Results: A total of seven themes emerged after the qualitative analysis of the data, namely qualities of a good doctor, need of teaching professionalism, ways of learning professionalism by medical students, ways of teaching professionalism, assessment of professionalism, factors promoting professionalism, and factors hindering professionalism. The students perceived that a good doctor should be committed to excellence, responsive and accountable to patients, profession and community, selfless, healthy, good communicator, ethical and law abiding, practice integrity, and social justice. The students preferred to learn professionalism by role modeling by faculties and case-based scenario discussions. Conclusion: Medical undergraduate students should be briefed about the need and importance of professionalism through small-group discussions involving narratives, case scenarios, and role modeling by faculty. Professionalism of both students and faculties should be assessed and appropriate action taken.
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Evaluation of remote monitoring device for monitoring vital parameters against reference standard: A diagnostic validation study for COVID-19 preparedness p. 235
Mohit Tayal, Anirudh Mukherjee, Udit Chauhan, Madhur Uniyal, Sakshi Garg, Anjana Singh, Ajeet Singh Bhadoria, Ravi Kant
DOI:10.4103/ijcm.IJCM_317_20  
Context: Vital parameters including blood oxygen level, respiratory rate, pulse rate, and body temperature are crucial for triaging patients to appropriate medical care. Advances in remote health monitoring system and wearable health devices have created a new horizon for delivery of efficient health care from a distance. Materials and Methods: This diagnostic validation study included patients attending the outpatient department of the institute. The accuracy of device under study was compared against the gold standard patient monitoring systems used in intensive care units. Statistical Analysis: The statistical analysis involved computation of intraclass correlation coefficient. Bland–Altman graphs with limits of agreement were plotted to assess agreement between methods. P <0.05 was considered statistically significant. Results: A total of 200 patients, including 152 males and 48 females in the age range of 2–80 years, formed the study group. A strong correlation (intraclass correlation coefficient; r > 0.9) was noted between the two devices for all the investigated parameters with significant P value (<0.01). Bland–Altman plot drawn for each vital parameter revealed observations in agreement from both the devices. Conclusion: The wearable device can be reliably used for remote health monitoring. Its regulated use can help mitigate the scarcity of hospital beds and reduce exposure to health-care workers and demand of personal protection equipment.
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SHORT COMMUNICATION Top

Epidemiological correlates of psychological distress in a rural community of South India: A cross-sectional study p. 240
M Shreyaswi Sathyanath, Rashmi Kundapur
DOI:10.4103/ijcm.IJCM_129_19  
Context: Integration of mental health into primary care is essential to establish access to mental health services. Screening the community for psychological distress is the first step. Aims: The aim of the study was to estimate the burden and the determinants of psychological distress in a rural community. Settings and Design: This was a community-based cross-sectional study among adult members of a rural community of Nitte Village in Udupi district in Karnataka, South India. Methodology: Three hundred and ten households were surveyed using the World Health Organization Self-Reported Questionnaire (SRQ). A cutoff value of 8 in SRQ was taken as screening positive. Statistical Analysis Used: Descriptive data were analyzed in proportions, whereas Chi-square test and regression analysis were used to explore associations. Results: Hypertension and diabetes were the two common comorbidities. The prevalence of psychological distress was 42.4 per thousand. “Being easily tired” and “feeling tired all the time” were the two most common responses out of the SRQ checklist. Distress was significantly associated with gender, educational status, and marital status. Conclusions: The prevalence of psychological distress was 42.4 per thousand, and somatic complaints were common presentations of distress in the study population.
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LETTERS TO EDITOR Top

Yoga as an add-on therapy in the management of migraine p. 244
Sachin Kumar Sharma, Alok Singh, Shirley Telles, Acharya Balkrishna
DOI:10.4103/ijcm.IJCM_407_19  
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Rubella seroprevalence among Indian female medical and nursing students at a tertiary care teaching institute and its correlation with socioeconomic status p. 246
Shashank Shekhar, Vijaya Lakshmi Nag, Pratibha Singh, Rashmi Kaushal, Shuchita Batra, Charu Chandra
DOI:10.4103/ijcm.IJCM_319_19  
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007