Indian journal of public health最新文献

Background: In tuberculosis (TB) care and management, there are practical challenges existing at the patient-provider level leading to implementation barriers at the primary care level.

Objectives: The objective of the study is to explore the challenges and barriers faced by people with TB and health-care workers in TB care and management.

Materials and methods: This study was done as a part of a community intervention study between November 2021 and December 2022. Twenty interviews were taken with treatment for TB (n = 7) and health-care personnel (n = 13). Health-care personnel include nursing staff, medical officers, laboratory technicians, community health workers, and medical personnel from tertiary care hospital. Participants were recruited across all levels of health-care systems. Interviews were carried out in the Hindi language, audio recorded, and translated to English. Participants were asked about their experiences of challenges and barriers faced during TB care and management. Qualitative data were coded, and thematic analysis was done manually.

Results: The challenges and barriers at the level of people with TB were issues with communication between providers and people with TB, out-of-pocket expenditure, poor adherence to medicines, lack of proper diet, gender issues, and stigma. The challenges and barriers at the level of health-care providers were a lack of infrastructure and logistics, lack of awareness, COVID-19-related issues, lack of workforce, and technical issues.

Conclusion: Communication between providers and people with TB must be improved to improve the drug adherence and satisfaction of the end user. Proper funding must be provided for the TB programs. People with TB must be counseled properly regarding the free health care services available near their homes to prevent out-of-pocket expenditure. These will help in fast-tracking the elimination of TB.

Background: Adolescents are exposed to various psycho-physiological stressors due to rapid changes in their bodies along with increased academic pressure, peer pressure, and pressures from other sources of society. Group health education sessions in schools could have a positive outcome in not only the way they perceive stress but also tackle it efficiently.

Objective: The objective of the study was to assess the effectiveness of group health education intervention on "perceived stress" among the high school children of Kolar.

Materials and methods: An open-label cluster randomized controlled trial was conducted among high school students (8th, 9th, and 10th standard) in selected English Medium Schools of Kolar Taluk. The study was conducted in three phases spanning 5 months of duration. Phase I included baseline data collection wherein "perceived stress" level was captured using the Perceived Stress Scale (PSS) 10 questionnaire. Phase II was the interventional phase in the form of group health education sessions. Phase III was end-line assessment.

Results: Before the intervention, 6.2%, 92.4%, and 1.5% of the students had mild, moderate, and severe stress, respectively, in the intervention group. After the intervention in the intervention group, about 57.9% had mild stress, 42.1% had moderate stress, and none had severe stress. The difference in difference analysis (DID) showed that the mean PSS scores in the intervention group changed by -8.84 while in the control group by 0.40.

Conclusion: Group health education delivered was effective in reducing the perceived stress levels among high school children and it is a feasible and acceptable intervention for stress in school-going adolescent children.

Knowledge of the consequences of uncontrolled diabetes mellitus and hypertension on various body organs among health workers is necessary to educate patients. Body mapping is a tool used for exploring perceptions as a part of qualitative research. This study assesses the perceptions of health-care workers on the effects of uncontrolled diabetes mellitus and hypertension on the human body using the body mapping technique. All 19 staff members of an Urban Primary Health Center were asked to draw a human body and map the parts affected by uncontrolled diabetes mellitus and hypertension. The mean age of the participants was 35.42 ± 10.54 years, and median years of work experience were 4 (3, 7) years. Fourteen (74%) participants had mapped kidneys and 11 (58%) participants had mapped head/brain indicating stroke to indicate damage due to uncontrolled diabetes mellitus and hypertension. Only 7 (37%) and 4 (26%) participants perceived that feet and eyes could be affected.

The impact of COVID-19 on human life has been catastrophic. It is the greatest crisis that humankind has ever faced. It already caused over 21 million confirmed cases and 758,000 deaths as of July 2021. Modeling frameworks, underlying assumptions, available datasets, and the region/time frame being modeled, predictions are possible, but the projections might vary widely, making it difficult to rely on one model universally way. This article presents the prediction and forecasting technique for COVID-19, using the widely adopted susceptible-exposed-infected-recovered (SEIR) model. The modified SEIR model is presented to model the pandemic to represent an open system where the mass movement of the population is considered. Spreading patterns of the pandemic over time, in actual and as per the model, are compared to check the authenticity of the model.

Background: There are several leadership training programs for health researchers in India. However, there is a need to develop context-tailored leadership and mentoring approaches.

Objective: The objective of the study is to critically analyze the available leadership training programs in India for health researchers and service providers, for the leadership domains incorporated and overall training approaches.

Materials and methods: We used an exploratory-descriptive design to identify and review leadership training programs for health researchers and service providers/managers that had been offered by Indian institutions between 2013 and 2018. Our analytic approach was based on "transformational leadership" and "leader-member exchange" theories of leadership, curricula of popular leadership training programs worldwide, and the International Clinical Epidemiology Network model for leadership in health research in India based on a nationwide primary study.

Results: We identified and reviewed 20 leadership training programs. These were heterogeneous in aim, scope (broad-based/thematic), course content, design, target participants and class profile, mode of delivery and training method, duration, frequency, and fund arrangements. The programs infrequently included topics on soft skills, mentoring, risk mitigation, collaboration for research, funding dynamics, institutional transformation, self-view and peer perception, and personal well-being. The programs insufficiently addressed contextual challenges of career exploration and risk mitigation, project management, strategic planning, and decision-making, ethics and integrity, negotiations, networking and collaboration, understanding funding dynamics, and mentoring. Only three programs linked to the training to the participants' ecosystem.

Conclusions: There is a need to develop customized course contents and training strategies that address the requirements of the local context vis-à-vis globally connected research ecosystems.

Background: The medical devices industry plays a critical role in public health and requires attention in research and policy. The COVID-19 pandemic exposed a lack of resilience in areas of drugs and vaccines but also in medical products.

Objectives: The study analyzes India's strengths and weaknesses in the trade of medical devices and identifies specific devices where India can attain self-sufficiency and areas where trade is still beneficial.

Materials and methods: A set of critical products traded during the COVID-19 pandemic were identified from the World Integrated Trade Solution website at the 6-digit Harmonized System code level. A detailed analysis of exports and imports of medical products at disaggregated 8-digit codes was carried out.

Results: During the pandemic, India had a trade surplus in some low-technology-based products such as suture needles, catheters, and cannulae along with X-ray apparatus and electrocardiographs among the medium-tech products. The imports of high-tech devices like in vitro diagnostics almost doubled to meet the surge in demand. The requirement of pulse oximeters, ventilators, and other monitoring devices jumped, and their imports reported an 800% increase from $134 million in 2019-2020 to $1162 million in 2021-2022. Most of India's imports of medical devices come from the top five exporting countries, with the share of the USA and China at 39%-40%.

Conclusion: There is a need to expand the manufacturing capacity of surgical instruments, consumables and disposables, apart from some high-tech products. The public health care facilities should procure domestically manufactured medical devices and trade with neighbouring countries to reduce import concentration must be prioritised.

We conducted the study to assess the effect of patient-tailored diet counseling on the nutritional status of chronic respiratory disease (CRD) patients under the pulmonary rehabilitation program from June 2021-May 2022. These patients completed 2 months of patient-tailored diet counseling sessions under the pulmonary rehabilitation program, which consisted of 4-5 interactive diet counseling sessions fortnightly. The pre- and postassessment was done using standardized outcomes: Malnutrition Universal Screening Tool (MUST), body mass index (BMI), and ideal body weight. The study enrolled 110 CRD patients. There was a statistically significant improvement in pre- and postassessment in MUST score, appetite, and unintentional weight loss (P < 0.001). Most of the patient's BMI normalized. In prenutritional assessment, most of the patients were malnourished and in postassessment, the number of malnourished and anemic patients was reduced. This study concludes that nutritional counseling effectively improves nutritional status and anemia.

Learning disabilities (LDs) are a group of neurodevelopmental deficits that negatively affect the acquisition, organization, retention, comprehension, or application of age appropriate knowledge. Persons with LD lead a subsidized quality of life, especially in academic/vocational and psychosocial domains. A certificate issued by the medical boards at a state or district level is required to avail benefits such as scribes or relaxations. This may be done through a series of assessments by psychologists, special educators, or other health-care professionals. The authors aim to understand if uniformity exists in the assessment methods used for the diagnosis of LD globally and to prepare a gap analysis for the same. A systematic review was performed on English literature articles published from January 2005 to August 2023. Full-text studies reporting assessment and diagnostic methods of LD were included. A total of 1246 records were identified through a manual search of an electronic database. Seven duplicates were removed and 1174 studies were excluded based on the relevance by screening titles, abstracts, and full texts. Sixty-five studies were included and analyzed. The authors found a lack of uniformity in this diagnostic protocol, leading to uncertainty in disability certification, doctor shopping, and additional stress for the patients, as well as added burden on the government. Identification of LD requires a multistep assessment process with culturally relevant tools and norms and the participation of a multidisciplinary team of experts.

Evidence on the association of chronic illnesses with depression among adolescents in the Indian community setting is limited. A simple random sample of 583 adolescents, comprising 56.6% of boys and 43.4% of girls, were interviewed on home visits. Self-reports on chronic illnesses were elicited, followed by administration of Patient Health Questionnaire-9 (PHQ-9) questionnaire to screen for depression, and for confirmation of diagnosis by age-appropriate Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI Kid), or MINI. The prevalence of chronic illnesses was 8.4% (95% confidence interval [CI]: 6.3-11.0). Of these participants, 42.8% screened positive for depression. The prevalence of depression was 10.2% (95% CI: 3.4-22.2) among adolescents with chronic illness. The prevalence of physical-mental multimorbidity was 0.8% (95% CI: 0.3-2.0). The presence of chronic illness was associated with depression identified using both PHQ-9 (adjusted odds ratio [AOR] =3.1 [95% CI: 1.7-5.8], P < 0.001) and MINI Kid/MINI (AOR = 3.2 [95% CI: 1.1-9.4], P = 0.037). Adolescents with chronic illnesses can be targeted for mental morbidity screening in a bid to improve functional outcomes.

Background: Obesity has reached an alarming rate affecting all categories of the population. A tremendous rise in obesity has been observed in children and adolescents. In India, the prevalence of adolescent obesity is more than 30% of the population. Advanced glycation end products (AGEs) are a diverse group of compounds formed by the amalgamation of glucose and a protein moiety. These glycated compounds are found in processed foods subjected to high-temperature cooking techniques contributing to the formation of dietary AGEs (dAGEs). The enormous consumption of dAGE attributes to the development of metabolic diseases.

Objectives: The objective of this study was to develop and validate a food frequency questionnaire (FFQ) among obese adolescents aged 10-19 years to gauge their dAGE consumption.

Materials and methods: This questionnaire was developed from previous literature (15 articles), validated using the content validity ratio (CVR) by Lawshe, and estimated for reliability using the test-retest method. A pilot study was done among 50 obese adolescents aged 10-19 years, who completed the questionnaire twice, with a gap of 15 days.

Results: A total of 54 items were validated (CVR ≥0.99) from the 60 food items. A reliability score >0.7 was observed, and a significant correlation (P ≥ 0.01) between the test and retest results was determined.

Conclusion: Hence, this FFQ is reliable and can be used for future research studies to elicit dAGE consumption among obese adolescents.