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    Table of Contents - Current issue
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April-June 2021
Volume 46 | Issue 2
Page Nos. 173-362

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EDITORIAL  

Strengths, weaknesses, opportunities, and threats analysis of competencies and building skill pyramid in the subject of community medicine Highly accessed article p. 173
Sunder Lal
DOI:10.4103/ijcm.IJCM_963_20  
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Role of public health ethics for responsible use of artificial intelligence technologies Highly accessed article p. 178
Sudip Bhattacharya, Md y Hossain, Ruchi Juyal, Neha Sharma, Keerti Bhusan Pradhan, Amarjeet Singh
DOI:10.4103/ijcm.IJCM_62_20  
Recent advancements in artificial intelligence (AI) technologies have shown promising success in optimizing health-care processes and improvising health services research and practice leading to better health outcomes. However, the role of public health ethics in the era of AI is not widely evaluated. This article aims to describe the responsible approach to AI design, development, and use from a public health perspective. This responsible approach should focus on the collective well-being of humankind and incorporate ethical principles and societal values. Such approaches are important because AI concerns and impacts the health and well-being of all of us collectively. Rather than limiting such discourses at the individual level, ethical considerations regarding AI systems should be analyzed enlarge, considering the complex socio-technological reality around the world.
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Medical biostatistics as a science of managing medical uncertainties Highly accessed article p. 182
Abhaya Indrayan
DOI:10.4103/ijcm.IJCM_763_20  
Biostatistics is generally understood as the branch of statistics that deals with data relating to biological processes. While this remains the core of biostatistics activities, medical biostatistics has additional features. It is rarely realized that the ultimate function of medical biostatistics is to manage medical uncertainties, particularly those that are data based. We propose to define medical biostatistics as the science of managing empirical uncertainties in health and medicine. This definition describes the subject more appropriately and has the potential to put it on a pedestal it deserves because of its focus on medical aspects. This note provides the rationale for this proposal.
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REVIEW ARTICLES Top

Behavior change communication: Past, present, and future p. 186
S Nancy, Amol R Dongre
DOI:10.4103/ijcm.IJCM_441_20  
Behavior change communication (BCC) aids in the prevention of both communicable and noncommunicable diseases in clinical settings and public health. Emerging and re-emerging infectious diseases in the future need to be tackled by developing behavioral immunity through effective BCC strategies. Health education and Information Education and Communication gradually evolved to BCC primarily focusing on creating a conducive environment for promoting behavior change. Various theories/models operating at the individual, inter-personal, and community levels were put forward to explain the core constructs of behavior change. Each theory/model has its own strengths and weaknesses in its applicability. In practice, no theory is perfect and each has certain limitations. Hence, a battery of theories may be needed to develop a BCC strategy. This review article critically appraises the evolution of BCC, the strengths and weaknesses of BCC theories/models and it's applicability from the past to the future. This review will benefit postgraduates and public health workers in understanding the concepts of BCC and applying the same in their practice.
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Efficacy of tetravalent dengue vaccine: A systematic review and meta-analysis p. 191
Ashish Wasudeo Khobragade, Dilip D Kadam
DOI:10.4103/ijcm.IJCM_608_20  
Dengue is one of the neglected tropical diseases caused by flavivirus. Live-attenuated tetravalent vaccine is launched for the age group of 9–45 years. It is given in three doses schedule. Eleven studies were included in meta-analysis by following PRISMA guidelines. Healthy persons in the age group of 2–45 years were included in these studies. Statistical analysis was done by “R” software. Pooled relative risk among vaccinated versus control group was calculated using random-effect model. Pooled dengue vaccine efficacy was calculated from relative risk. Heterogeneity and publication bias were assessed using Baujat and funnel plot, respectively. Adverse effects following immunization were reviewed. Pooled vaccine efficacy is 58% (95% confidence interval 46%-67%). I2 statistics is 81.4%.
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ORIGINAL ARTICLES Top

Decision-making skills: An assessment among adolescents in surat city p. 195
Rutu Sanjaybhai Buch, Mohua Moitra, Rahul Damor, Naresh Chauhan
DOI:10.4103/ijcm.IJCM_512_19  
Introduction: This study assessed the process of decision-making among adolescents and the factors affecting it and also explored the styles of decision-making among adolescents. Methodology: A cross-sectional study using purposive sampling was carried out involving 1177 college-going students aged between 17 and 19 years. General Decision-Making Style (GDMS) and semi-structured questionnaire was used to collect data. Data were analyzed with the help of SPSS and AMOS. Exploratory and confirmatory factor analyses were run. Results: Good decision-making process was seen among 76.9% of the students. Kaiser–Meyer–Olkin verified that sampling adequacy was 0.8. Scree plot and Monte Carlo parallel analysis were suggestive of four factors which were logically intuitive, avoidant, dependent, and spontaneous styles of making decisions. Cronbach's alpha was 0.7 for GDMS. Staying arrangement, paternal education, fantasy scale score, perspective-taking score, personal distress score, problem-solving, self-esteem, creative thinking, and coping with stress were found statistically significant with decision-making process. While, on confirmatory factor analysis, a five-factor model was found to be fit with minimum discrepancy/degrees of freedom value of 2.68, root mean square error of approximation: 0.038, Comparative Fit Index (CFI): 0.927, Normed Fit Index (NFI): 0.890, parsimony CFI: 0.66, and parsimony NFI: 0.634. A high correlation was observed between rational and intuitive styles. Conclusion: The process of decision-making was found to be good, but styles of making decisions were overlapping
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Perceptions of frontline workers, female health workers, and school teachers in menstrual hygiene promotion among adolescent girls of Delhi, India: A qualitative study p. 201
Suneela Garg, Mongjam Meghachandra Singh, Saurav Basu, Nidhi Bhatnagar, Yomri Dabi, Falak Azmi, Indu Bala, Yamini Marimuthu, Amod Borle
DOI:10.4103/ijcm.IJCM_137_20  
Background: Government schemes for the promotion of Menstrual Hygiene Management (MHM) among adolescent girls in India are underpinned by crucial implementation efforts from the frontline health workers, community health workers, and school teachers. Aim: The aim of the study is to identify the perspectives on menstrual health and hygiene management with regard to government schemes for sanitary pad distribution to adolescent girls among the frontline workers and the government school teachers located in urban resettlement colonies in Delhi. Methods: In-depth interviews were conducted with 30 accredited social health activisits, 30 Anganwadi Workers (AWW), and 30 auxiliary nurse midwives (ANMs) and five focus group discussions among 28 government school teachers from the middle, high, and secondary standard. Results: Most participants recognized the phenomenon of menstruation-related problems in adolescent girls and were aware of some of the common sociocultural, religious, and hygiene-related menstrual restrictions prevalent in their communities. All the participants believed that the pad distribution scheme was highly beneficial. However, in spite of inclusion of menstrual health promotion in the school curriculum, teachers often lacked self-efficacy in discussing challenges and health concerns related to MHM with their students. Conclusions: Despite their potential as community resources for adolescent girls, FHWs, ANMs, and school teachers often fail to impart crucial menstrual hygiene information and skills-building needed toward achieving effective, safe, and optimal MHM.
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Perceptions regarding climate change and its health impact: Reflections from a community-based study in India p. 206
Vinay Tripathi, Rais Akhtar, GS Preetha
DOI:10.4103/ijcm.IJCM_120_20  
Background: In the climate change discourse, a body of scholarship focusing on how people perceive climate change and its impact is increasing. However, in the Indian context, such scholarship is limited. Objective: This paper aims to describe the perceptions of people on climate change and its health impacts, which were captured as part of a larger study. Methodology: A cross-sectional study was conducted in randomly selected 983 households in four districts spread across Madhya Pradesh and Jammu and Kashmir. A semi-structured questionnaire was used to collect the data. Results: For 72% of respondents, the perception was not related to climate change per se. Their perceptions were contextual and were based on the anomalies which are observed in the immediate weather conditions. The health impacts of climate change were also not understood at the first place, but with probing 64% of respondents were able to report seasonal diseases. Conclusion: Perceptions of the people regarding climate change are more linked to their own experiences with their local weather conditions rather than the overall concept. This also explains their lack of comprehension about the health impact of climate change, but a sound understanding of seasonal diseases.
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Determinants of compliance to population-based oral cancer screening program among low socioeconomic women in Mumbai, India p. 210
Gauravi A Mishra, Heenakauser A Shaikh, Sharmila A Pimple, Aanchal A Awasthi, Vasundhara Y Kulkarni
DOI:10.4103/ijcm.IJCM_190_20  
Background: The use of tobacco, especially smokeless variety, is common and culturally accepted among Indian women. Hence, oral cavity cancers rank as the fourth most common cancers among Indian women. Objectives: The objectives of this study were to study factors determining compliance of women for oral cancer screening in a population-based program in Mumbai and to create awareness among women regarding ill effects of tobacco and importance of oral cancer screening. Materials and Methods: This is a community-based organized service program for awareness and screening of oral cavity cancers among women residing in low socioeconomic areas of Mumbai, India. Screening was conducted by oral visual inspection by trained primary health workers (PHWs). Univariate and multivariate logistic regression analyses were conducted to identify predictors of participation in oral cancer screening. Results: 138,383 population was surveyed, out of which 13,492 eligible women were enlisted for oral cancer screening. Among these, 12,495 were contacted and 11,895 (95.12%) women participated in a cancer awareness program and 11,768 (94.18%) participated in oral cancer screening. According to results of multivariate logistic regression analysis, women belonging to Hindu religion 94.57%, with mother tongue Marathi 94.76%, and with family history of cancer 95.84% complied significantly higher to oral cancer screening as compared to other women. Conclusion: This program has assisted in identifying predictors of compliance to oral cavity screening. Furthermore, it demonstrates that good compliance can be achieved through multiple household visits, personal invitation during camps, organizing well-planned Health Education Program, and the use of simple, low-cost visual inspection test performed by trained PHWs.
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Factors associated with intention and attempt to quit: A study among current smokers in a rural community of West Bengal p. 216
Aparajita Dasgupta, Pritam Ghosh, Bobby Paul, Soumit Roy, Sauryadripta Ghose, Akanksha Yadav
DOI:10.4103/ijcm.IJCM_214_20  
Context: Tobacco smoking is one of the preventable causes of death. Global Adult Tobacco Survey 2 report showed that 19% Indian males were current smokers. It is important to find out factors which help smokers on smoking cessation, ultimately to prevent of lung and other morbidities. There are few community-based studies on intention and attempt to quit smoking in rural area. Aims: The present study aimed to determine the factors associated with intention and attempt to quit smoking among current smokers. Settings and Design: A cross-sectional study was conducted from June to September 2019 among 198 male daily smokers residing in the rural field practice area of AllH and PH, Kolkata. Subjects and Methods: After cluster sampling, data were collected by predesigned schedule by the face-to-face interview. Results: 151 (76.3%) study subjects intended to quit smoking. 63 (31.8%) study subjects attempted to quit in last 1 year. Thirty-one (47.5%) showed high-to-medium nicotine dependence. There was a significant association of intention to quit with agriculture as occupation (acquisitive crime [AOR]-2.17, confidence interval [CI]-1.01–4.63), low nicotine dependence (AOR-2.98, CI-1.43–6.21), doctor's advice (AOR = 2.84, CI-1.27–6.33), and family pressure (AOR = 2.16, CI-1.07–4.38). Attempt to quit was significantly associated with low nicotine dependence (AOR = 5.85, CI-2.85–12.00), family pressure (AOR = 2.94, CI-1.47–5.91). Conclusion: Along with counseling to reduce nicotine dependence, comprehensive approach both from family members as well as health care providers, is vital to escalate the quitting behaviour in smoking habit.
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Randomized controlled trial on the promotion of sexual health using “self-care interventional package” in men who have sex with men p. 221
Anjali Sharma, Karobi Das, Sushma Kumari Saini, Sandhya Ghai, Sandeep Mittal, Manmeet Kaur
DOI:10.4103/ijcm.IJCM_225_20  
Purpose: Men who have sex with men (MSM) is a vulnerable group, who have been neglected and discriminated. Such discrimination decreases their access to health care and increases the spread of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Aims and Objective: The objective is to evaluate the effectiveness of “self-care interventional package” on the promotion of sexual health, among MSM. Materials and Methods: A randomized controlled trial was conducted on MSM from two nongovernmental organization centers of Chandigarh, which were randomized by simple random sampling into a control and experimental group. Over a period of 1 month, a total of 115 MSM were found eligible; 55 in control group and 60 in experimental group. Data were collected by a personal interview, after taking consent, in a comfortable and private environment. The Self-Care Interventional Package on the promotion of sexual health was developed in the form of flash book and booklet, and delivered by one-to-one interaction. Three follow-ups were done weekly for motivation in both the groups. Postintervention assessment was conducted after 1 month. Results: There was a statistically significant (P < 0.01) improvement in knowledge about prevention and management of STIs and HIV, getting vaccinated for Hepatitis B and regular self check-up. Statistically significant reduction in unsafe sexual practices was noted among the MSM of experimental group. Conclusion: The self-care interventional package for the promotion of sexual health was effective in improving the sexual heath of the MSM population.
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Survival rate and cost-effectiveness of conventional and atraumatic restorative treatment restorations among anganwadi preschool children in Bengaluru city: A follow-up study p. 226
KB Shilpashree, V Chaithra, Archana Bhat, Archana Krishnamurthy
DOI:10.4103/ijcm.IJCM_226_20  
Background: Atraumatic restorative treatment (ART) approach helps reduce barriers to restorative care for the patients. This study was done to compare the survival rate and cost-effectiveness of conventional and ART restorations at time-intervals of 6, 12, and 18 months among anganwadi preschool children in Bengaluru city. Materials and Methods: 133 children aged 3–5 years attending anganwadi centers in Bengaluru city based on inclusion and exclusion criteria were recruited for the present study. A split-mouth technique was used in which the participants received two types of carious cavity excavation techniques (conventional and ART) followed by restoration using glass ionomer cement. Comparison and evaluation were made at the end of 6 months, 12 months and 18 months intervals to check for the survival rate and cost-effectiveness. Results: The survival rates of ART when compared to conventional restorations were higher at 6 months and 12 months 97.7% and 93.07%, respectively, and at 18 months survival rate of conventional restorations were higher. The cost-effectiveness ratio (CER) of the ART restoration was lower when compared to conventional restorations. Conclusion: The carious cavities restored using ART techniques had a better survival rate at 12 months and lower CER when compared to the conventional technique.
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Prevalence of emotional and behavioral problems among school-going adolescents: A cross-sectional study p. 232
U Harikrishnan, Grace Lalhlupuii Sailo
DOI:10.4103/ijcm.IJCM_451_20  
Background: Adolescence is a period of several emotional, mental, and behavioral changes, and many adolescent problems are manifested in the form of emotional problems, conduct problems, hyperactivity, and peer-related problems. The objectives of the current study are to assess the prevalence of emotional and behavioral problems across gender and location. It analyzes the Strengths and Difficulties Questionnaire (SDQ) total score with sociodemographic details among school-going adolescents in Kollam district. Materials and Methods: A cross-sectional study of 600 school-going adolescents between Class VIII to XII from the rural and urban areas in Kollam district was carried out using a cluster sampling method. A self-reported SDQ was administered to the respondents. Results: The findings indicate that a little more than a tenth of school-going adolescents had emotional and behavioral problems and multiple regression analysis revealed a significant association in SDQ total score with the type of schools, settings, and socioeconomic status. Conclusion: Early detection, periodical assessment, and intervention in the schools with the aid of mental health professionals can help adolescents in coping with different issues and for a healthy transition into adulthood.
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Prevalence and determinants of cognitive impairment and depression among the elderly population in a rural area of North India p. 236
Rashmi Kumari, Bhavna Langer, Rajiv Kumar Gupta, Rakesh Bahl, Najma Akhtar, Heena Nazir
DOI:10.4103/ijcm.IJCM_475_20  
Background: Demographic transition has resulted in population aging, which has led to advancement in multiple geriatric problems including cognitive impairment (CI) and depression. Objectives: The objective was to find the prevalence and determinants of CI and depression in the rural elderly population. Materials and Methods: This was a community-based cross-sectional study conducted in a rural area. The prevalence of CI was measured using the Mini-Mental State Examination scale and depression was assessed using the Geriatric Depression Scale. The data so collected were analyzed using PSPP software. Results: The mean age of the study participants was 67.47 ± 6.43 years. The prevalence of CI and geriatric depression was found to be 36% (153/425) and 29.1% (124/425), respectively. Variables which were found to have independent significant association on multivariate analysis with CI were literacy, memory complaints, and depression. For geriatric depression, an independent association was seen with literacy, socioeconomic status, memory complaints, stress in the family, and presence of CI. CI and geriatric depression were found to be strongly correlated with each other (r = −0.252, P < 0.001). Conclusions: Almost one-third of the geriatric population is suffering from depression (29.1%) and CI (36%). This necessitates for accurate and timely diagnosis, so as to ensure proper care and support to the elderly population with emphasis on geriatric mental health care.
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Screening and management of maternal malnutrition in nutritional rehabilitation centers as a routine service: A feasibility study in kalawati saran children hospital, New Delhi p. 241
Tashi Choedon, Konsam Dinachandra, Vani Sethi, Praveen Kumar
DOI:10.4103/ijcm.IJCM_491_20  
Background: In India, Nutrition Rehabilitation Centers (NRCs) established at public health facilities provide residential medical nutrition therapy for severe acute malnutrition (SAM) children with complications. A large proportion of their mothers are also malnourished. NRCs do not provide services to such mothers as part of routine practice. However, technical algorithm for delivering Maternal Nutrition (MN) services in facility settings is available. Objectives: To test the practical feasibility of layering the MN services in NRC as a routine service. Methods: The MN services were delivered by a nutrition counselor using a triage approach (assess, classify, supplement/counsel/treat). All mothers received diet, micronutrients, and group counseling, those at nutritional risk received individual counseling and SAM mothers also received catch-up diet during their stay. Program data were collected from mothers during January 1 to August 31, 2019 at the NRC in Kalawati Saran Children Hospital. To gain operational insights, a structured interview with nutrition counselor was conducted. Results: Out of 168 mothers, 8% were found to be pregnant and 89% were at nutrition or medical risk. The prevalence of short stature was 18%, severe/thin 21%, overweight/obese 34%, and anemic 72%. Feedback from the nutrition counselor indicated no operational challenges, however, further efforts to ensure that mothers keep coming back for follow-up visits is needed. Conclusion: The findings indicated that existing staffs were able to deliver the MN services within the time, cost, and regime of the routine NRC. This paper provides four recommendations for layering the MN services in NRCs.
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Impact of a residential rural community-based training program for medical students on cognitive and affective domains of learning in community medicine: A mixed methods study p. 247
Farah Naaz Fathima, Avita Rose Johnson, Pretesh Rohan Kiran, S Ratnakumari, Bobby Joseph
DOI:10.4103/ijcm.IJCM_545_20  
Introduction: As part of undergraduate training in community medicine, students of 1st-year MBBS at our medical college in South India undergo rural residential community-based training called Rural Orientation Program (ROP). Objective: The objective was to study the impact of ROP at a medical college in South India. Methodology: Short-term impact was studied immediately before and after ROP using a 30-item questionnaire administered to 142 students. Medium-term impact was studied among 23 students in 2nd-year MBBS. Quantitative component consisted of objective structured practical examination scores and qualitative component documented reflections on learnings. Long-term impact was studied by surveying 287 alumni (batches of 1979 onward) to explore the impact of ROP on their career. Results: We found a significant (P < 0.001) improvement in the median posttest score (21, interquartile range [IQR]: 20–23) when compared to pretest (12, IQR: 10–16). The mean OSPE score was 19.34 ± 3.19 (maximum score = 25) with 54.55% obtaining a score ≥20. Thematic analysis of reflections depicted that students gained insights on factors influencing health and social organizations in rural areas. ROP helped develop empathy toward patients and a holistic approach toward health, in understanding rural dynamics and improved communication skills. Conclusion: ROP increases subject knowledge and plays a role in molding attitudes of students toward the care of people in rural areas and improves communication skills. This time-tested model can be replicated in other medical colleges across the country.
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Operational barriers in providing comprehensive emergency obstetric care by task shifting of medical officers in selected states of India p. 252
Vikash Ranjan Keshri, Bishan Swarup Garg
DOI:10.4103/ijcm.IJCM_563_20  
Background: A network of first referral unit (FRU) is set up to improve the availability and accessibility of comprehensive emergency obstetric care (CEmOC) services. To fill the gap of the scarcity of obstetricians and anesthetists at FRU, two short-term trainings in CEmOC and anesthesia were started for in-service medical officers. Objective: This study aimed to assess the operational status of FRU in providing CEmOC services by task shifting of trained medical officers in selected states of India. Materials and Methods: The study was done in seven states of India. A team of experts assessed conveniently selected health facilities designated as FRU by using a semi-structured, predesigned, and pretested checklist for CEmOC functionality status. A total of 50 designated FRUs were assessed and data were systematically analyzed. Results: We documented the availability of five key elements for the operationalization of CEmOC services at FRU. Out of 50 facilities, 9 (18%) reported conducting operative delivery and 11 (22%) of the facilities were fully operational with all elements available. At 9 (18%) facilities, one element and, at 17 (34%) facilities, two elements were missing. The blood storage unit was the most important missing element (68%) followed by operative facilities (36%). The challenges of FRUs remained uniform across states. Barriers identified to operationalize FRU were the availability of trained doctors in cesarean section and anesthesia together, lack of operative facilities, and blood storage units. Conclusions: To operationalize the network of FRU for CEmOC services by task shifting of medical officer, it is important to ensure the availability of all five key elements together at all facilities.
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Factors predisposing to burnout syndrome among medical staff participating in complex surgical processes p. 258
Jakub Dobroch, Marta Baczewska, Alicja Szylejko, Karolina Chomicz, Pawel Knapp
DOI:10.4103/ijcm.IJCM_625_20  
Background: Burnout syndrome is a serious manifestation of distress among health-care professionals. Objective: Due to the specific nature of work in operating theaters, factors that affect the staff performance and therefore predispose to burnout syndrome were assessed. Methods: Based on the original questionnaire, 254 respondents working in the operating theaters of the university hospital, appraised levels of work satisfaction, sources of stress, and psychosocial burden. Work-related mental stress was assessed using the Meister's questionnaire. Burnout levels were evaluated in the group extended to 316 employees with Maslach Burnout Inventory. Results: Work satisfaction analysis indicated unsatisfactory management and remuneration as the negative agents. The majority of the respondents emphasized the maintenance of medical records as a prominent stress factor. A large number of participants (n = 221; 87%) described work as emotionally burdensome. The results showed that the highest burden was related to the following variables: time pressure, responsibility, problems, and conflicts. The examined group was qualified to the second degree of mental load related to the work. Similarly, the entire group reached a high level of emotional exhaustion. Conclusions: Presented data indicate the need of evaluation to minimize occupational burnout problem.
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An assessment of the risk factors and concerns of postpartum depression among mothers seeking health care in North Central Trinidad p. 263
Shivananda B Nayak, Sheneel Jaggernauth, Ariana Jaggernauth, Priyankaa Jadoo, Nirdosh Jagmohansingh,, Vanessa Jaggernauth, Rayhaan Hosein, Britnee Issarie, Jessica Jaikaran
DOI:10.4103/ijcm.IJCM_628_20  
Background: Postpartum depression (PPD) is a debilitating mental disorder which affects mainly females usually after giving birth. Objectives: We aimed to study the risk factors and concerns of PPD among mothers seeking health care at regional health authority hospitals in Trinidad. Materials and Methods: The cross-sectional study consisted of 360 mothers from the postnatal and neonatal clinics of the North Central Regional Health Authority, Trinidad. Data were collected via a questionnaire using convenience sampling to study the risk factors and concerns of PPD among mothers. Participants were asked to sign a consent form before filling out the questionnaire. The questions were geared toward obtaining mother's perspective on predisposing factors of PPD, identifying if they are at risk for perinatal depression, the outcomes of having PPD, and determining if they were screened and treated for it. Results: This study comprised 360 postnatal women among which 4.7% were diagnosed with postpartum while 40% scored ≥10 in the Edinburgh Postnatal Depression Scale which indicated a risk for PPD. This research revealed seven significant predictors of PPD: family history of mental illness, baby blues, mood swings during period, use of oral contraceptives, emotional support, life stress, and being diagnosed with depression (P < 0.05). Other characteristics like sociodemographics were not remarkably correlated but marginally indicative of depressive signs. Conclusion: The study shows that many risk factors of PPD exist, and screening and treatment should be used to avoid the consequences of PPD.
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Beedi rollers' perception toward alternative means of livelihood amid economic benefits p. 268
Praveen Kumar, Asha Kamath, Radhika Nayak, Muralidhar M Kulkarni, Veena G Kamath, Somya Mullapudi, Rohith Bhagawath
DOI:10.4103/ijcm.IJCM_629_20  
Background: Beedi rolling is one of the principal occupations of women residing in coastal Karnataka. The beedi worker's welfare fund consists of a combination of schemes to improve the living conditions of beedi workers and their families. On the other hand, the government is introducing several anti-tobacco policies, which could lead to insecurity among beedi rollers about their future. As a result, majority of the trade unions believe that alternate livelihood must be provided to the workers. In the midst of economic benefits and stringent tobacco control policies, this study explores the perception of beedi rollers to quit tobacco rolling and engage with an alternative livelihood. Objectives: The objectives of this study were as follows: (1) to explore the opinion of beedi workers toward alternate means of livelihood and (2) to identify the benefits availed by the beedi workers. Methodology: The study was conducted with a semi-structured questionnaire by interview method in all the seven blocks of the Udupi district of Karnataka with a total of 381 respondents through convenience sampling. The interviewer administered the survey with the help of a predesigned user application which was developed through Kobo Toolbox, and the analysis was carried out using IBM SPSS version 26. Results: Although 69% of the respondents believed that beedi rolling is not a secured job, three-fourth of the respondents were not ready to quit the beedi rolling job due to low education, higher age, and lack of financial support to invest in other occupations. Conclusion: Our study showed that most of the participants were full-time beedi rollers and most of them were not ready to shift to other jobs due to old age, lack of experience with other vocations, and benefits availed. There is a need to focus on strengthening skill development programs and introduce sustainable economic alternatives to the beedi rollers.
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Menopause-specific quality of life of rural women p. 273
Harmeet Kaur Kang, Arshdeep Kaur, Aarti Dhiman
DOI:10.4103/ijcm.IJCM_665_20  
Background: Menopause is a natural process, but it causes hormonal and biological changes in the body, which can result in drastic effects on quality of life (QOL) of women. Objective: The study was conducted to assess the menopause-specific QOL (MENQOL) of rural women. Subjects and Methods: A descriptive cross-sectional design was used to assess MENQOL of rural women of the selected villages of Punjab. A total of 150 menopausal women were selected using simple random sampling technique. The MENQOL questionnaire was administered to assess the QOL in relation to menopausal symptoms. Results: The mean score of overall QOL was 3.4274 ± 0.99, which revealed a moderate impact of menopausal symptoms on the QOL. Stepwise linear regression revealed the significant impact of 16 out of 29 menopausal symptoms on QOL. Furthermore, MENQOL was found to be significantly associated with education, marital status, and sleep pattern of women. Conclusions: There is a significant effect of menopausal symptoms on QOL of women which emphasizes the need to create awareness among menopausal women regarding menopausal symptoms and management to improve their QOL.
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A quasi-experimental study to assess the effectiveness of a structured training program on newborn care based on asha module 7 - “Skills that saves lives” in terms of reported practice among asha workers in a selected community of Delhi p. 277
Anu Gauba, Maharaj Singh
DOI:10.4103/ijcm.IJCM_722_20  
Background: Newborn health and survival depend on the care given to the newborn, although newborn care is a very essential element in reducing child mortality, it often receives less than optimum attention. Objectives: The objective of this study was (1) to develop a structured training program for ASHA workers on newborn care based on ASHA module 7 “Skills that saves lives.” (2) To compare the reported practices of ASHA workers with regard to newborn care before and after the administration of structured training program. (3) To determine the association between the practice scores and the selected demographic data, i.e., age, years of experience, and education. (4) To assess the acceptability of ASHA workers about training programs regarding newborn care. Materials and Methods: Quantitative research approach was selected with one group pre- and posttest design. A random sampling technique was used for the selection of ASHA workers. A structured practice questionnaire on newborn care was prepared to assess the practices of ASHA workers and a structured opinionnaire to assess the acceptability of the training program. Result: The findings revealed that the mean of posttest scores (25.6) was higher than the mean of pretest scores (14.5) with a mean difference of 11.1. There was no association between practice scores and selected demographic variables, i.e., age, years of experience, and educational status of ASHA workers. Conclusion: The structured training program on newborn care was effective in improving the practices of ASHA workers.
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Utility of the interferon-gamma release assay for latent tuberculosis infection screening among indian health-care workers p. 281
Sunita Girish, Aarti Kinikar, Geeta Pardesh, Sangita Shelke, Anita Basavaraj, Ajay Chandanwale, Dileep Kadam, Samir Josh, Gauri Dhumal, Nilima Lokhande, Andrea Deluca, Nikhil Gupte, Amita Gupta, Robert C Bollinger, Vidya Mave
DOI:10.4103/ijcm.IJCM_761_20  
Background: The utility of interferon-gamma release assays (IGRAs) for latent tuberculosis infection (LTBI) screening among health-care workers (HCWs) in low- and middle-income countries (LMICs) remains unclear. Methods: This was a prospective cohort study among HCW trainees undergoing annual LTBI screening via tuberculin skin test (TST) and QuantiFERON® TB Gold Test-in-tube (QFT-GIT) in Pune, India. TST induration ≥ 10 mm and QFT-GIT ≥ 0.35 IU/ml were considered positive. Test concordance was evaluated at entry among the entire cohort and at 1 year among baseline TST-negative participants with follow-up testing. Overall test agreement was evaluated at both timepoints using the kappa statistic: fair (k < 0.40), good (0.41 ≥ k ≤0.60), or strong (k > 0.60). Results: Of 200 participants, prevalent LTBI was detected in 42 (21%) via TST and 45 (23%) via QFT-GIT; QFT-GIT was positive in 27/42 (64%) TST-positive and 18/158 (11%) TST-negative trainees. Annual TST conversion was 28% (40/142) and included 11 trainees with baseline TST-/IGRA+; QFT-GIT was positive in 17/40 (43%) TST-positive and 5/102 (5%) TST-negative trainees. Overall test concordance was 84% (k = 0.52; 95% confidence interval [CI]: 0.38–0.66) and 80% (k = 0.44; 95% CI: 0.29–0.59) at baseline and 12 months, respectively. Conclusions: We observed good overall agreement between TST and QFT-GIT, and QFT-GIT detected additional LTBI cases among TST-negative trainees with possible early detection of LTBI conversion. Overall, our results support the use of IGRA for annual LTBI screening among HCWs in a high burden LMIC setting.
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Period of sun exposure and vitamin d status among the rural elderly women of West Bengal, India p. 285
Joyeta Ghosh, Debnath Chaudhuri, Indranil Saha, Aditi Nag Chaudhuri
DOI:10.4103/ijcm.IJCM_764_20  
Introduction: Vitamin D deficiency has been found to be prevalent among Indian elderly women. Aging has a significant association with decreased concentration of 7-dehydrocholesterol, the precursor of Vitamin D3 in the skin. Objective: The aim is to find out the association between the period of sun exposure and serum 25(OH) D level among rural elderly women of West Bengal, India. Subjects and Methods: The present study was conducted among 236 elderly women aged between 60 and 70 years residing at Amdanga Block, North 24th Parganas district of West Bengal, India. They were assessed for their period of sun exposure and serum 25(OH) D level. Results: The sun exposure index was low from sufficient to deficient Vitamin D status groups, but they were insignificant (P = 0.09). Spearman's correlation test revealed significant positive relationship (0.183 [P = 0.005]) between sun exposure and serum 25(OH) D level. Conclusion: Therefore, for maintaining optimum serum 25(OH) D level, adequate sun exposure for this population is needed, particularly for the individuals having suboptimal Vitamin D status.
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SHORT COMMUNICATIONS Top

Menstrual hygiene practices and constraints in availing government sanitary pad provision among adolescents in rural Puducherry: A mixed method study p. 288
Gayathri Surendran, Mamta Gehlawat, Shanthosh Priyan, Sonali Sarkar
DOI:10.4103/ijcm.IJCM_243_20  
Context: Although free and subsidized sanitary pads are provided by the government, proportion of adolescents availing this service remains low. Aims: The aim of the study was to determine the proportion of adolescent girls availing supply of sanitary napkins from a rural health training center (RHTC) in Puducherry; to assess the level of satisfaction with government supply; and to identify reasons for not accessing the same. Subjects and Methods: The mixed-method cross-sectional study done in July 2017 included 240 adolescent girls living in the RHTC service area of a tertiary care institute. Quantitative data were collected house to house with a pretested semi-structured questionnaire and qualitative data from a focused group discussion. Results: Sanitary pads were used by all of the participants who achieved menarche. Of them, 87 (40.2%) used pads purchased outside and 127 (58.8%) used both government supply and private purchase. Reasons for not availing government supply were insufficient quantity and low quality, lack of information about the government provision, and accessibility issues. Conclusions: Ensuring better quality and adequate quantity of sanitary pads supplied by the government along with increased awareness about the government provision can increase the utilization of the same by rural adolescents.
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Estimation of baseline widal antibody titers among apparently healthy urban population of district Jammu p. 292
Saransh Bahl, Sandeep Dogra, Rakesh Bahl, Amit Sachdeva, Bella Mahajan
DOI:10.4103/ijcm.IJCM_347_20  
Introduction: Definitive diagnosis of Enteric fever is by blood culture for Salmonella enterica serotype Typhi, Paratyphi A, and Paratyphi B which takes long turnaround time and is costly, whereas Widal test is simple, rapid, and cost-effective test whose interpretation depends on the baseline Widal titers among healthy individuals in a defined population. Objectives: To determine the baseline Widal titers among apparently healthy urban population of district Jammu (J&K). Materials and Methods: 302 individuals in the age group of 18–50 years were recruited. A pretested questionnaire was used to collect demographic and clinical details. The Widal testing was done using commercial Salmonella antigen kit. Results: A total of 302 samples were screened by Widal test. 138 samples (45.69%) were reactive for TO antigen and 64 (21.19%) tested reactive for TH antigen, 3 (0.01%) samples showed agglutination for AH antigen and 3 (0.01%) were positive for BH antigen. Majority of seropositive samples were in dilutions of 1:40 for both TO and TH antigens. Conclusions: Hence, next higher dilutions showing positivity for both TO and TH antigens, i.e., ≥1:80 may be considered diagnostic for enteric fever in the urban population of Jammu district.
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Self-referral to the university hospital resulting in unnecessary patient expenses: A prospective descriptive study in a super-tertiary hospital p. 295
Sasirintra Phankitiya, Varisara Luvira
DOI:10.4103/ijcm.IJCM_422_20  
Context: Thailand subsidizes health-care costs, allowing citizens access to health care without out-of-pocket expenses. However, some citizens still spend large amounts of money on treatment provided at tertiary care hospitals. Aim: To identify the proportion of patients whose visits are not covered by national health insurance at the tertiary hospital and their reasons for visiting. Settings and Design: Prospective, descriptive study in patients visiting Srinagarind hospital outpatient department from July to September 2019. Subjects and Methods: We gathered and analyzed the data regarding demographics, hospital visits, and illness severity using a questionnaire. Statistical Analysis Used: Descriptive analyses and logistic regression were performed as appropriate. Results: Of the 700 participants, 40% (95% confidence interval 36.3–43.7) was not covered for their visits. The three common reasons visiting this hospital were desire of treatment from a specialist (42.9%), the reputation of the hospital (31.4%), and service satisfaction (26.6%). Conclusions: Although the national health-care system provides a gratis service pathway, some people still pay out-of-pocket unnecessarily. Officials should work to better raise the level of public confidence in the primary and secondary care units.
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Gap Analysis in workforce and infrastructure in the subcenters for upgradation to health and wellness center in a community development block of purba Bardhaman district, West Bengal p. 300
Prosun Goswami, Amitava Chakraborty, Dilip Kumar Das, Soumalya Ray
DOI:10.4103/ijcm.IJCM_552_20  
Context: The government of India has recently decided to upgrade subcenters (SCs) to health and wellness centers (HWCs) for providing comprehensive quality services. Aims: The present study was undertaken to determine workforce- and infrastructure-wise gaps in the SCs for upgradation to HWCs and assess knowledge of the auxiliary nurse midwives (ANMs) regarding services to be delivered through HWCs. Settings and Design: This cross-sectional study was conducted in Bhatar block of Purba Bardhaman district between August and October 2019. Subjects and Methods: Workforce and infrastructure availability was assessed using a checklist in 38 SCs and knowledge was assessed using a questionnaire among ANMs. Statistical Analysis Used: Data entry and analysis was done in Microsoft™ Excel™. Results: No Subcentre had Community Health Officer and 23.7% of Subcentre were without second ANM. 28.9% of the ANMs had adequate knowledge about services to be delivered through HWCs. Infrastructurally, lack of staff residential facility (76.3%), water supply (34.2%), and inadequate civil construction (34.2%) were major barriers. Conclusions: Adequate recruitment of HCWs, infrastructure upliftment, and proper training of HCWs in the SCs are the need of the hour.
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Family psychoeducation as an intervention tool in the management of schizophrenia and the psychological wellbeing of caregivers p. 304
Meenu Sharma, Shikha Srivastava, Abhijit Pathak
DOI:10.4103/ijcm.IJCM_683_20  
Background: Caregivers need to be imparted with specialized skills to retain their psychological well-being and to manage the patient with schizophrenia effectively. Aim: This study aims to understand the role of family psychoeducation (FPE) in the management of schizophrenia and the well-being of caregiver. Materials and Methods: The sample included 40 caregivers and patients, 20 each assigned randomly in treatment group (psychoeducation given) and the control group. Pre and post assessment of psychological wellbeing (PWB), symptoms of the patient, and emotional regulation was done through the scales mentioned in the study and analyzed through analysis of variance. Results: Statistically significant improvement in emotional regulation of caregivers and patient (P = 0.05) and improvement of PWB in caregivers (P = 0.01) as well as significant reduction in symptoms of patients (P = 0.01) found in the treatment group. Conclusion: FPE was found to be effective in improving PWB of caregivers and effective management of a patient with schizophrenia.
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Depression among rural stroke survivors: A cross-sectional study p. 309
Soumya Sadanandan, Fatima DSilva, Vishnu Renjith
DOI:10.4103/ijcm.IJCM_875_20  
Background: Depression is a major neuropsychiatric complication of stroke. Poststroke depression (PSD) can lead to inadequate functional recovery, social withdrawal, poor quality of life, and suicidal ideations. Objective: The study explored the PSD among stroke survivors. Materials and Methods: A cross-sectional survey was conducted among 151, purposively selected rural stroke survivors of Kozhikode district, Kerala, India. Patient health questionnaire-9 (PHQ-9) was used to assess PSD. Results: The age of participants ranged from 28 to 80 years with a mean (standard deviation) age of 64.58 (10.3) years. The majorities of the participants were males (53.6%), had an ischemic stroke (76.2%), and had left-sided brain lesions (75.5%). The median (interquartile range) depression scores on PHQ-9 were 9 (12–6). Most of the participants had either mild (47%), moderate (21.2%), or moderately severe depression (11.9%). Low energy, sleep disturbances, low self-esteem, and anhedonia were the common depressive symptoms experienced by the stroke survivors. Conclusions: High prevalence of undiagnosed depression remains as a significant challenge to primary care.
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Spirometric measurement among polyurethane foam mattress-making workers of India p. 313
Rajnarayan Ramshankar Tiwari, Sampathraju Raghavan
DOI:10.4103/ijcm.IJCM_909_20  
Background: The polyurethane foam (PUF) mattress-making workers are exposed to isocyanates which are known respiratory toxicants and cause effect on pulmonary volumes and flows. Thus, the study was with a rationale to measure the changes in pulmonary flow and volumes due to isocyanates among PUF mattress-making workers. Materials and Methods: The study included 183 male workers from seven PUF making units of western and northern India. Using the interview technique as a tool for data collection, demographic and occupational details of the subjects were recorded on the predesigned and pretested pro forma. The mean of spirometric parameters was compared using one-way ANOVA and t-test. The relation between spirometric parameters and anthropometric parameters was analyzed using the correlation coefficient. Results: The spirometry showed that out of 183 participants, 165 (90.2%) subjects had normal spirometry, 13 (7.1%) had restrictive impairment, and 4 (2.2%) had obstructive impairment. All the mean spirometric values showed a declining trend with increasing age, while only forced expiratory volume in first second and forced vital capacity25%–75% showed a declining trend with increasing duration of employment. The spirometric measurements had a negative correlation with age and positive correlation with height. Conclusion: The spirometric values representing the airway flow were affected. The associated factors include age and duration of exposure.
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Abdominal obesity is associated with physical activity ndex in indonesian middle-aged adult rural population: A cross-sectional study p. 317
Eka Prasetya Budi Mulia, Kartika Afrida Fauzia, Atika Atika
DOI:10.4103/ijcm.IJCM_947_20  
Background: Obesity is one of the significant health problems. Physical activity includes a potential modifier in the development of abdominal obesity. Objective: The objective of the study is to analyze the association between physical activity and abdominal obesity in middle-aged adults in the Indonesian rural population. Methods: A community-based study was conducted in a rural area of Malang, Indonesia. Data were collected using interviews to obtain sociodemographic and physical activity index (PAI). Waist circumference was measured using a tape measure. Data were analyzed using one-way ANOVA and logistic regression. Results: A total of 75 adults (62.7% were female) was included in this study. Mean waist circumference was 88.18 ± 9.21 cm. Total prevalence of abdominal obesity was 69.3%. Among the total of participants, 29.3% were inactive. A significant association was found between physical activity and abdominal obesity. Participants with inactive PAI have a higher risk of suffering from abdominal obesity than those with active PAI with odds ratio = 7.04; 95% confidence interval: 1.55–31.99. Conclusion: In middle-aged adults living in a rural area of Indonesia, physical activity was associated with a lower risk of abdominal obesity. Strategies for preventing and reducing abdominal obesity in rural areas should consider improving physical activity.
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CASE STUDY Top

Importance of day-care centers in dementia care: A case study from India p. 321
Pallerla Srikanth, Sojan Antony, S Manjunatha, A Thirumoorthy
DOI:10.4103/ijcm.IJCM_699_20  
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LETTERS TO EDITOR Top

Acute rise in the incidence of chickenpox due to temperature variation in a specific locality of gwalior city p. 323
Vaibhav Misra, Deepak Gawali, Abhishek Kumar Jain, Rishika Khetan, Savita Bharat Jain
DOI:10.4103/ijcm.IJCM_156_20  
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Patient empowerment by uploading health education materials through medical/research institutions social media websites p. 325
Sudip Bhattacharya, Amarjeet Singh
DOI:10.4103/ijcm.IJCM_191_20  
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A survey of visual impairment in children attending a blind school in South India p. 327
Sabyasachi Chakrabarty, Rishabh Desai, Meenakshi Ravindran, Shivkumar Chandrashekharan, Neelam Pawar, Fathima Allapitchai
DOI:10.4103/ijcm.IJCM_209_20  
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Nonelastic compression stockings for the reduction of lymphedema and the maintenance of the results for 2–3 years p. 329
Jose Maria Pereira de Godoy, Lívia Maria Pereira de Godoy, Henrique Jose Pereira de Godoy, Maria de Fatima Guerreiro Godoy
DOI:10.4103/ijcm.IJCM_230_20  
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Prevalence of modifiable cardiovascular risk factors among coffee estate workers in rural South India (CARE) p. 331
Sitarah Mathias, Akhil Xavier Joseph, Tanvi Jadhav, Denis Xavier
DOI:10.4103/ijcm.IJCM_237_20  
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Fixed time alarm bell technique as a method to improve hand hygiene compliance p. 334
Jins George, Lijo Kurian, Shubhadeep Das, Pradeep Narayan, Nilanjan Dutta, Das Debasis
DOI:10.4103/ijcm.IJCM_268_20  
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Are clinicians responsible for the development of antibiotic resistance at a tertiary health care hospital? A qualitative study from outlook of doctors p. 336
Ankit Kumar, Uttam Kumar Pal, Dilip Kumar Pal
DOI:10.4103/ijcm.IJCM_286_20  
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Work addiction in the community: A trend for India p. 338
Manoj Kumar Sharma, Nitin Anand, Ashwini Tadpatrikar, K Thennarasu, Girish N Rao, Vivek Benegal, Rajkumar Lenin Singh, Divya Thomas, Hemant K Gupta
DOI:10.4103/ijcm.IJCM_390_20  
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Impact of new collecting instruments on satisfactory cervical cytology in a diagnostic reference center at mexico city p. 340
Carlos Manuel Ortiz-Mendoza
DOI:10.4103/ijcm.IJCM_397_20  
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A qualitative study on health and lives of spinal cord injury patients due to road traffic accidents in Madurai district, Tamil Nadu, India p. 342
Vigneshwaran Subbiah Akkayasamy, Sigamani Panneer
DOI:10.4103/ijcm.IJCM_459_20  
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Status of mandatory tuberculosis case notification among pharmacy outlets in urban Puducherry: A cross-sectional descriptive study p. 344
R Revathy, Swaroop Kumar Sahu, Tanveer Rehman
DOI:10.4103/ijcm.IJCM_499_20  
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Effect of nocturia on quality of life among clients with benign prostatic hyperplasia p. 346
Susamma Varughese, TP Rajeev, Devina E Rodrigues
DOI:10.4103/ijcm.IJCM_599_20  
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Is telemedicine a feasible tool? – Experiences and challenges faced by the team during COVID-19 home care program p. 348
G Rakesh Maiya, Timsi Jain, G Shiny Chrism Queen Nesan, P Preeti, Yogesh Mohan, G Dinesh Kumar
DOI:10.4103/ijcm.IJCM_705_20  
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Changing trends of accidental poisoning in children over the last two decades p. 350
Machinary Puthenpurayil Jayakrishnan, Padinharath Krishnakumar, Madathil Govindaraj Geeta, Biju George
DOI:10.4103/ijcm.IJCM_723_20  
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Retraction rates of research articles addressing COVID-19 pandemic: Is it the evolving COVID epidemiology or scientific misconduct? Highly accessed article p. 352
Komal Shah, Jaykaran Charan, Anish Sinha, Deepak Saxena
DOI:10.4103/ijcm.IJCM_732_20  
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Detection and management of a COVID-19 hotspot within a tertiary care hospital p. 355
Gajanan D Velhal, Niharika Pant, Aditi Dey
DOI:10.4103/ijcm.IJCM_877_20  
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BOOK REVIEW Top

Till we win: India's fight agnainst the COVID-19 pandemic p. 357
Rashmi Sharma
DOI:10.4103/ijcm.ijcm_604_21  
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OBITUARY Top

Obituary p. 358

DOI:10.4103/0970-0218.317188  
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IAPSMíS EFFORTS Top

IAPSM's efforts towards eliminating tuberculosis by 2025 p. 359

DOI:10.4103/0970-0218.317187  
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MINUTES OF THE MEETING Top

Minutes of the Meeting of IAPSM General Body p. 360

DOI:10.4103/0970-0218.317102  
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