Indian Journal of Community Medicine最新文献

Background: The relationship between students and teachers in medical education is crucial for developing future healthcare professionals. This study explores the evolving dynamics of this relationship and its impact on educational outcomes, considering technological integration, societal changes, and competency-based medical education (CBME).

Materials and methods: This qualitative study was conducted using focus group discussions with undergraduate medical students and in-depth interviews with medical faculty members at a medical college, from December to January 2024. Participants included faculty with at least 10 years of teaching experience and undergraduate students aged 18-30 years, selected via purposive sampling. Data were transcribed and analyzed using thematic analysis, with codes generated de novo and in vivo.

Results: The thematic analysis identified six major themes: Evolving Student-Teacher Dynamics, Perceptions about Learning, Perceptions about Teaching, What's Working and What's Not, Emotional and Psychological Aspects, and Institutional Policies and Infrastructure. Key findings include a noticeable decline in the authority of teachers, increased reliance on online learning resources, significant stress and burnout among students and faculty, the need for improved support systems, and the crucial role of infrastructure in effective teaching and learning.

Conclusions: Medical education is at a transformative stage, necessitating the continuous adaptation of teaching methods and institutional policies. Emphasizing psychological well-being, flexible institutional policies, and improved infrastructure are essential for fostering a supportive and effective learning environment. Ongoing research and stakeholder dialogue are vital to keeping medical education responsive to both technological advancements and the human aspects of learning and professional development.

Background: The prevalence of child undernutrition is significantly high in India, prompting a study to evaluate the effectiveness of a crèche combined with community-based nutrition promotion interventions aimed at reducing undernutrition among children aged 6-36 months in two Indian states. This study also assessed the cost-effectiveness of this intervention for optimal resource allocation.

Method: Using a provider's perspective, the study analyzed project costs associated with the intervention, which was compared to a control group. The effectiveness was measured through the Composite Index of Anthropometric Failure (CIAF), with costs gathered from project accounts and outcomes analyzed through baseline and endline surveys. To assess the cost-effectiveness of the intervention, the incremental cost-effectiveness ratio was calculated, taking the difference in total costs of intervention and control areas against the Disability-Adjusted Life Years (DALYs) averted through the intervention. Costs were adjusted for inflation and converted to 2023 US Dollars. To assess the robustness of the results, sensitivity analyses were conducted.

Results: The incremental cost per CIAF case averted was US$2791, while the incremental cost per DALY averted stood at US$514. This cost-effectiveness was aligned with WHO recommendations, considering it below India's GDP per capita threshold of US$2610.

Conclusion: In conclusion, the study found that integrating a crèche with community nutrition promotion significantly addresses child undernutrition effectively and affordably. Implementing such interventions into the existing health system is vital for reducing the burden of undernutrition in India.

The number of diabetic patients has tripled over the past 20 years. To address diabetes, multicomponent intervention may prove to make a significant difference. This study was conducted to assess the effectiveness of telemedicine in diabetes management at Primary Care Centres in the Asian population and to compare the effectiveness of different strategies of telemedicine interventions. Randomized controlled trials conducted in primary health care settings examining the effectiveness of telemedicine interventions in the management of diabetics were included in this review. The search strategy included MeSH terms related to Diabetes, Telemedicine, Diabetic management, Effectiveness, and Asia to find relevant studies. The published literatures were searched on the electronic database search engines, namely, Pubmed, Embase, Scopus, and Cochrane Library. The outcomes assessed for this study were HbA1c, FBG, Psychological Distress, and Quality of Life. For metaanalysis, Cochrane's Q statistic and inconsistency index (I2) were used to compute the statistical heterogeneity. The different types of telemedicine strategies were compared and ranked by the surface under the cumulative ranking curve. Nine articles were selected based on the inclusion and exclusion criteria. Our meta analysis of eight trials indicated a significant reduction of HbA1c of 0.19% (95% CI: 0.37, 0.01; P = 0.04) compared with the control groups. The effect of telemedicine intervention favored toward the intervention group compared with the usual care group. Telemedicine can be seen as a favorable approach to manage diabetes in primary care settings.

Socioeconomic status (SES) is an important determinant of health and utilization of health care services. Though there are various criteria used to construct an SES scale (method of social classification), income is used as the sole or major criterion in some situations. Dr. B.G. Prasad (India), in 1961, constructed the SES scale using income as the criterion. This scale is still being used by researchers and students by updating it using consumer price index and linking factors released by the Government of India from time to time. This paper seeks to describe a seven-step process to update Dr. B.G. Prasad's SES scale based on Consumer Price Index for Industrial Workers in India. The rationale behind the process and relevant concepts are explained in detail.

Background: Coronary artery diseases (CADs) require chronic treatment, and recurrent coronary events can be prevented by adhering to secondary prevention guidelines. This study was conducted to determine the adherence to secondary prevention strategies and its associated factors among adults with CAD in a rural cohort in South India.

Materials and methods: A community-based cross-sectional study was conducted within the ENDIRA (Epidemiology of Non-communicable Diseases In Rural Areas) Cohort in the rural part of Aluva municipality of Ernakulam district, Kerala, India, which comprises five adjacent panchayats with a population of approximately 100,000 individuals. CAD patients aged 35 to 80 years from this cohort who have had an event of myocardial infarction in the past decade as confirmed by medical records were included. The primary outcome measured was the adherence to secondary prevention strategies across six domains as per the guidelines of the American Heart Association. A multivariable logistic regression model was used to determine the independent predictors of inadequate adherence to secondary prevention strategies.

Results: The study included 436 participants with a mean (± SD) age of 65.20 (±8.37) years, and 69% were males. The medication adherence among patients with CAD was 56.4% (95% CI 51.77-61.08), the blood pressure control was 77.3% (95% CI 73.36-81.23), the ideal body mass index was maintained by 48.9% (95% CI 44.16-53.54), the recommended physical activity was followed by 64.9% (95% CI 60.43-69.39), the smoking cessation rates were 61.8% (95% CI 52.33-71.19) and 72.5% (95% CI 68.29-76.67), and there was adequate mental health.

Conclusion: The study reveals moderate adherence among CAD patients to the secondary prevention strategies in a resource-limited setting. Ensuring community access to high-quality follow-up care after CAD is crucial.

A public health professional is expected to come up with quick, single and definitive answers. These answers impact health and wellbeing of many beneficiaries. The skill of critical thinking helps in drawing right conclusions from available information and prevent misperception, various types of biases, blind spots, preconception, distortion and other flaws. Critical thinking is self-guided, self-disciplined thinking in a fair-minded way. Ennis (1993) defined it as," Critical thinking is reasonable reflective thinking focussed on deciding what to do." The opposite of critical thinking is selective thinking. Selective thinking involves taking quick, biased decisions without much thinking, analysis, objectivity, reinforcement of one's own pre-conceived ideas. Lack of critical thinking leads to mistakes, missed opportunities, and failure. In today's world, full of uncertainty, ambiguity, fast-changes, incessant distraction and information overload, critical thinking is an essential skill for public health leaders. This skill can be acquired by consciously practising it till it becomes a habit. The public health leaders need to create a culture of critical thinking in their organization by setting an example and facilitating it in routine work. This article summarises the actions public health professionals need to take to practice and promote critical thinking.

Background: India, with its growing population and demographic changes, confronts substantial problems in addressing oral health inequities, particularly among the tribal population's older adults aged 60 and above. The purpose of this study is to explore oral hygiene practices and dental treatment-seeking behavior among older members of the Irula tribal people in Tamil Nadu.

Methods: A total of fifty-six participants aged 60 and above were interviewed, revealing diverse oral hygiene practices including the use of traditional remedies and limited access to professional dental care. A convenient sampling technique was employed to recruit the study participants set of 7 Focus Group Discussions was made, with 8 in each group. The samples were conveniently chosen after checking for their eligibility criteria.

Results: Older adults of the Irula tribal population primarily rely on toothbrushes, neem twigs, or traditional remedies like charcoal for oral hygiene. Common dental issues include gum bleeding and caries. Many have limited awareness of oral cancer risks. Participants often relied on self-medication for dental pain due to barriers such as cost and accessibility to healthcare facilities. Many older adults suffer in silence due to the rural locations of these villages and a paucity of dental services.

Conclusion: The results highlight the need for oral health programs to tribal cultural beliefs and socioeconomic constraints, requiring collaboration among public health agencies, tribal governments, and healthcare providers. Incorporating traditional knowledge, enhancing accessibility, and fostering community outreach can achieve long-term oral health improvements and overall well-being in tribal communities.

Background: The Indian Diabetes Risk Score (IDRS) is a cost-effective and noninvasive screening tool that plays an important role in the early detection and risk-stratification of diabetes, and thus immediate referrals to health centers for further assessment and management of the individuals.

Methods: The study involved 422 urban adults, aged 30 and older, who came under the field practice area of a tertiary hospital. Using a prevalidated questionnaire, data on sociodemographics, anthropometrics, physical measurement (like blood pressure), biochemical measurement (random blood sugar), and IDRS components were obtained. Univariate and multivariate logistic regression analyses were performed to identify the predictors. The cut-off for the risk score for undiagnosed diabetes risk assessment was evaluated using the area under the curve (AUC) and the receiver-operating characteristic (ROC).

Results: The average age of participants in this study is 46.1 years (±11.8). Out of the total participants, 50.7% were females, while 49.3% were males. According to IDRS, 20.3% of participants were found to be at high risk of diabetes, 56.2% at moderate risk, and 23.5% at low risk. Among the factors that significantly predicted increased diabetes risk according to IDRS were age, high salt consumption, female gender, and higher body mass index. With a 0.68 AUC, the IDRS exhibited an 86.6% sensitivity at a cut-off value of ≥30 and a 28.1% specificity. The study observed maximum sensitivity (60.6%) and specificity (69.5%) at a cut-off of 45, as further shown by evaluating Youden's index (30.1%).

Conclusions: With optimal performance at a cut-off of ≥45, the IDRS reasonably identified 76.5% of urban adults with moderate-to-high risk for diabetes. Integration of routine IDRS screening in primary healthcare in resource-limited settings, along with counseling on lifestyle modification, can increase its utility in risk stratification and referral.

Introduction: Although from the beginning of first human life, menstruation has been there; still it has never been discussed as openly as it should have been. There have been some religious festivals where menstruation is celebrated, yet menstruation has always been a topic of closed-door discussion. It is a "women's-topic." Educated Indian men feel uncomfortable during conversations on menstruation. They tend to avoid such discussions. To know what goes wrong from the beginning of an adolescent boy's life that leads to such awkwardness surrounding the topic of menstruation, this qualitative study was designed.

Methods: Five Focused group discussions (FGDs) were conducted among adolescent boys of a co-ed school. Methodological framework of content analysis was employed to obtain themes and sub-themes. For this inductive coding was performed.

Results: A total of 50 male students of 9^th class were included in the study with mean age of 13.5 years. Four themes and eight sub-themes emerged from the FGDs. One interesting finding was that some of the participants acquired knowledge from television advertisements and movies. Most of them did not perceive menstruation as a normal phenomenon and considered it a diseased state or a sin. Most of the boys wanted that menstruation be taught to them.

Conclusion: Overall, there is a lack of perception regarding menstruation among the school going adolescents. The source of information is very informal and lacks clarity. Providing proper sex education is the way forward.

[This retracts the article on p. S58 in vol. 49.].