Endolichenic fungal diversity associated with some lichens of the Western Ghats.

A total of 389 strains of fungi belonging to 38 species were isolated from 10 lichen species of the Western Ghats, southern India. All the lichens screened, irrespective of their growth forms or location, harboured endolichenic fungi. Most of the fungi belonged to the Ascomycotina. Chaetomium sp. 1, Hypoxylon investiens, Nemania bipapillata, Nodulisporium sp., Paecilomyces sp., and Sporormiella intermedia were the most common ones and were present in 5 or more lichen species. Of the 28 sporulating fungi, 7 belonged to Xylariales, and their total colonization frequency in all the lichens was also high. This observation further substantiates the high ecological amplitude of Xylariales, possibly due to overlapping ecological niches and their ability to inhibit co-occurring endolichenic fungi.

Development and Validation of a Symptom Scale for Indian Patients With Medically Unexplained Physical Symptoms.

Introduction Patients with medically unexplained physical symptoms (MUPS) account for a substantial proportion of patients visiting the outpatient department. Diagnosis of MUPS is a challenge for most physicians. An accurate diagnosis relies on obtaining a detailed history from patients regarding the nature of their symptoms, their onset, and any associated aggravating or relieving factors. This study aims to develop a symptom scale for Indian patients with MUPS. Methods The study had a mixed-method study design. Phase 1 involved designing the questionnaire using qualitative techniques, such as literature reviews, focus-group discussions, expert evaluation, and pre-testing of a Hindi and English language Likert-rated interviewer-administered scale. In phase 2, the construct validity of the questionnaire was established using quantitative approaches among 116 patients diagnosed with MUPS. Results The final questionnaire consists of 38 items, with good internal consistency (Cronbach 𝛂 = 0.916). Confirmation sampling adequacy for factor analysis was done using the Kaiser-Meyer-Olkin test (KMO value = 0.792) and Bartlett's test of sphericity (p < 0.001). The newly developed scale showed a Pearson correlation coefficient of 0.568 (p < 0.001) with Patient Health Questionnaire (PHQ)-15 scores. Conclusion A reliable and valid tool has been developed to assess patients' symptoms with MUPS in English and Hindi languages. This questionnaire can be used for assessment, screening, and diagnostic purposes as well as to chart longitudinal changes in patients with MUPS.

Effectiveness of cognitive retraining intervention on weight loss and lifestyle-related behaviours among adults: A systematic review and meta-analysis.

INTRODUCTION: The review explores the potential benefits of cognitive retraining interventions in improving healthy lifestyle-related behaviours, and its possible use as an alternative or complementary approach to traditional weight loss interventions. METHOD: Studies were selected using different electronic databases (PubMed, Web of Science, Scopus, Embase), to identify RCTs published in the last 23 years on cognitive retraining interventions for weight loss. A total of 12 studies were finalized for systematic review and six for meta-analysis based on the inclusion criteria. The risk of bias was assessed by the two reviewers independently using the criteria outlined in the Joanna Briggs Institute Critical Appraisal Tool for RCTs. The R software was used to perform meta-analysis. RESULT: The overall effect estimates slightly favoured the intervention group, with a standardised mean difference (SMD) of -0.26 [95% CI (-0.58- 0.06) P < 0.05; I2 = 0.00%]. This suggests that although the effect was not statistically significant, cognitive retraining interventions may have a small effect on weight loss. The findings of the systematic review revealed that cognitive retraining interventions may be effective in modifying lifestyle behaviours and these changes may contribute in achieving and maintaining weight loss in the long run. CONCLUSION: Interventions exhibited a positive effect on weight loss. These interventions demonstrated promise in modifying lifestyle behaviours, suggesting a potential role in achieving and sustaining long-term weight loss. Further research is warranted to refine and validate these findings.

Evaluation of Tools to Assess Symptoms and Symptom Severity in Patients With Medically Unexplained Physical Symptoms: A Systematic Review and Narrative Synthesis.

A substantial portion of patients presenting to healthcare settings exhibit physical symptoms lacking clear, demonstrable organic causes. Accurate assessment of symptom severity is crucial for documenting outcomes and establishing treatment efficacy. This systematic review and narrative synthesis aims to provide researchers with insights into available and validated tools for assessing medically unexplained physical symptoms (MUPS). It involved comprehensive searches across electronic databases, including PubMed, Wiley, and Cochrane, adhering to PRISMA and COSMIN guidelines. The study comprised two phases: Phase 1 systematically reviewed tools for assessing MUPS symptoms and severity, while Phase 2 conducted a narrative synthesis of their measurement properties, focusing on validity and reliability. Out of 14,459 records, 191 articles were identified, leading to the recognition of 16 validated tools for assessing MUPS symptoms and severity. Most tools demonstrated excellent internal consistency and structural validity. However, the majority lacked cross-cultural validity. The choice of tools for the assessment of MUPS will assist clinicians and researchers in determining the severity of MUPS and developing a tailored treatment plan to improve the physical and psychological functioning of these patients.

Diversity of arbuscular mycorrhizal fungi in seleniferous soils and their role in plant growth promotion.

The present study aimed to investigate the molecular diversity of arbuscular mycorrhizal fungi (AMF) in natural seleniferous soils and their role in protecting plants from Se toxicity. The genomic DNA extracted from maize roots grown in seleniferous and non-seleniferous regions was amplified using AMF-specific primers by nested PCR. The 1.5 kb amplicon spanning pSSU-ITS-pLSU of 18S rRNA of AMF was deciphered using the Illumina Miseq Next Generation Sequencing (NGS) technique. A total of 17 AMF species from the seleniferous region and 18 AMF species from the non-seleniferous region were identified. The number of reads of Glomus irregularis, G. custos, and G. intraradices was higher in seleniferous soil than in non-seleniferous soil, indicating their tolerance to Se. A consortium of Se-tolerant AMF inoculum was prepared and inoculated to maize plants, grown in natural seleniferous soils. AMF-inoculated plants had healthy growth with higher root, shoot, and grain biomass than non-AMF-inoculated plants. AMF inoculation leads to higher Se accumulation in roots but lesser Se accumulation in shoots and seeds of inoculated maize plants as compared to control plants. Present study results suggest that AMF species from seleniferous soils have the potential to be used as biofertilizers to improve plant growth and tolerate Se toxicity in seleniferous soils.

Perspectives of patients, caregivers, and healthcare professionals in Indian context: A qualitative study on Medically Unexplained Physical Symptoms (MUPS).

BACKGROUND: Approximately one-fourth of individuals who seek treatment in outpatient medical settings have Medically Unexplained Physical Symptoms (MUPS), a prevalent medical ailment. Patients with MUPS have a considerable functional impairment, and a lower quality of life, and may also have co-occurring psychiatric conditions. MATERIALS AND METHODS: Eleven Focus Group Discussions (FGDs) (four virtual and seven face-to-face) were conducted with patients, caregivers, and healthcare professionals in 2021 in a tertiary care hospital in New Delhi. Thematic analysis was carried out using QSR Nvivo software. RESULTS: A total of 36 participants were recruited in the study, including patients with MUPS (n = 12), caregivers (n = 10), and healthcare professionals (n = 14) dealing with the patients of MUPS. Three themes were identified: burden of MUPS, symptom profile of patients with MUPS, and psychological profile of patients with MUPS. These were further categorized into eight sub-themes: prevalence, symptoms, course of illness, improvement with treatment, duration of symptoms, attribution of symptoms, psychological impact, and coping strategies. CONCLUSION: The study helped us to gain insight into the characteristics and experiences of patients, caregivers, and healthcare professionals dealing with MUPS in an Indian setup. Greater awareness of MUPS and training of care providers about the occurrence, management, and referral of MUPS can be beneficial.

Workplace Violence in Healthcare Settings: A Cross-Sectional Survey among Healthcare Workers of North India.

Background: Workplace violence (WPV) is a significant problem in both developed and developing countries, especially among healthcare workers. It has widespread implications for their overall health and well-being. Objective: The study was conducted to assess the problem of violence among doctors and other healthcare workers in healthcare settings. Material and Methods: A cross-sectional survey was conducted using a validated questionnaire from August 21 to September 18, 2021, based on purposive and snowball-sampling techniques for data collection. Appropriate statistical methods were applied to study the association between sociodemographics and characteristics of violence. Results: A total of 601 responses were analyzed. The results showed that approximately 75% of the participants experienced violence in some form at their workplace. These episodes lead to a significant impact on the physical and mental health of these workers. Around one-third of the participants felt uncomfortable reporting these incidents. Some of the most common risk factors and mitigation strategies were also reported by the participants. Conclusion: The findings of this study can be used by the legislators, administrators, and policymakers to develop strategies that can help in mitigating these episodes of violence for the better functioning of the healthcare system.

Psychological interventions for medically unexplained physical symptoms: A systematic review and meta-analysis.

OBJECTIVE: Individuals seeking treatment for physical symptoms having unknown etiology are common in the primary healthcare setup. Factors such as biomedical, environmental, social, and psychological ones are expected to play an important role in the treatment of Medically Unexplained Physical Symptoms (MUPS). Therefore, this systematic review and meta-analysis aimed to investigate the efficacy of psychological interventions for the treatment of MUPS. METHOD: Studies were selected using different electronic databases (PubMed, Wiley, Cochrane), to identify RCTs published in the last 11 years on psychological interventions to treat MUPS. A total of 12 studies were finalized for systematic review and 7 for meta-analysis based on the inclusion criteria. The risk of bias was assessed by the two reviewers independently using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. OpenMeta[Analyst] was used to perform meta-analysis. RESULTS: The findings revealed that psychological interventions can possibly be effective in treating patients with MUPS. Somatic symptom severity and depression improved in the intervention groups as compared to controls, while anxiety, and physical and mental component summary of Short-Form General Health Survey 36 did not significantly improve in the intervention group. CONCLUSION: A tailored module including psychological interventions to deal with these patients in primary care may be useful in improving the overall functioning of the individuals.

Counselling and Behaviour Modification Techniques for the Management of Obesity in Postpartum and Midlife Women: A Practical Guide for Clinicians.

Behaviour change is the basic foundation in the management of obesity. Such behaviour change is difficult to achieve due to several psychosocial and behavioural barriers that often remain unidentified and unaddressed in a weight management programme. This is even more challenging in postpartum and midlife women because of several biopsychosocial factors. The non-availability of psychologists or trained healthcare counsellors further complicates the attainment of behavioural changes. Therefore, clinicians, who are often the first point of contact for treating these population groups, are hamstrung by the lack of a multidisciplinary approach for weight reduction. Some of the common psychological, social and behavioural barriers have been identified in this article, and evidence-based techniques such as goal setting, stimulus control and cognitive restructuring are presented in a step-wise approach, to help clinicians cater to these population groups in a holistic manner.

Identifying Predictors of Workplace Violence Against Healthcare Professionals: A Systematic Review.

Understanding the predictors of workplace violence amongst healthcare professionals is important to develop and implement prevention and mitigation strategies. We conducted a systematic review to synthesize the recent evidence on predictors of workplace violence across healthcare settings. The review has been done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two electronic databases (PubMed and Google Scholar) were used to search peer-reviewed studies published for the year 2009-2020 to identify studies reporting predictors of workplace violence. The significant predictors were analyzed using descriptive statistics such as proportions in most of the studies and some studies used inferential statistics such as logistic regression analysis, Chi-square test, ANOVA and Student's t-test. A total of 46 studies were identified and overall evidence was graded using an adapted GRADE approach. Some of the moderate quality predictors associated with workplace violence were the patient with a history of mental health disease, psychiatric setting, professional's gender and work experience and evening shift workers. Being a nurse was the only high-quality predictor. Healthcare professionals and administration can identify the predictors relevant to their setting to mitigate episodes of violence against healthcare personnel.

Interventions for workplace violence against health-care professionals: A systematic review.

BACKGROUND: Workplace violence (WPV) against health-care professionals has been a concern worldwide as it strains the relationship between the patient and healthcare professionals. Implementing mitigation interventions to help the healthcare professionals to prevent and manage these violent episodes might make the workplaces more secure. OBJECTIVE: This study aimed to synthesize the recent evidence on intervention strategies for workplace violence. METHOD: Four electronic databases (PubMed, Wiley, Cochrane and Google Scholar) were searched for peer-reviewed intervention studies published in the last 11 years to mitigate workplace violence. A qualitative synthesis of the findings from included studies was done. RESULT: A total of 17 studies were identified based on prevention and management of workplace violence. The interventions were mainly educational in nature based on a workshop format. These interventions were found to be effective in improving the perceived ability to deal with situations that lead to violence. CONCLUSION: Strategies to mitigate violent episodes could be helpful to health-care professionals and administrators in their attempts to make safer workplaces in the health-care settings.

A cross-sectional evaluation of communication skills and perceived barriers among the resident doctors at a tertiary care center in India.

BACKGROUND: The study was conducted to assess the different components of communication skills and barriers to practicing good communication skills among resident doctors in a health care setting. MATERIALS AND METHODS: A web-based cross-sectional survey was performed, and data were collected using a pre-validated questionnaire with a Cronbach's alpha (0.88). A total of 431 responses were statistically analyzed. Chi-square test was used to associate the socio-demographics and communication skills. Regression analysis was conducted to analyze the association between various communication domains and barriers, which were adjusted for potential confounders such as age and gender. RESULTS: Resident doctors have differential levels of competencies in each domain of communication skills. Around two-thirds of the residents did not practice good communication skills while breaking the bad news and reported poor para-verbal skills. Some of the most common barriers to practicing good communication skills were found to be an infrastructural deficit, lack of time, and long working hours. These barriers significantly affected the communication skills such as para-verbal skills {[-0.32; P < 0.01; C.I (-0.54 to -0.09), [-0.27, P < 0.05, C.I (-0.54 to. 004)], [-0.32, P < 0.01, (0.07-0.56)]}, the ability to break bad news {[-0.42, P < 0.01, (-0.73 to -0.11)], [-0.35, P < 0.05, (-0.75 to -0.35)], [0.48, P < 0.01, (0.12-0.84)]}, and communication with patients/attendants {[0.39, P < 0.01, C.I (-0.71 to -0.06)], [-0.88, P < 0.001, C.I (-1.2 to -0.48)], [-0.88, P < 0.001, C.I (-1.2 to -0.48)]} after adjustment for confounding such as age and gender. CONCLUSION: There is a scope for improvement in practicing good communication skills with patients, among the residents doctors in India. Structured modules for training and evaluation should be implemented in the medical curriculum.

Executive summary of evidence and consensus-based clinical practice guideline for management of obesity and overweight in postpartum women: An AIIMS-DST initiative.

INTRODUCTION: Postpartum obesity is a public health concern. There is a need to counsel women about their postpartum weight management, accounting for various barriers they face. Limited literature in the Indian context underscored the need to develop the clinical practice guideline to be used by healthcare providers in Indian healthcare settings. METHODS: The guideline was formulated by following the standardised methodology proposed by the National Health and Medical Research Council. Various steps such as identification of the patient population, assembly of the guideline development groups, identification of the key clinical questions, guideline development methods, grading the quality of evidence and recommendations and guideline translation were carried out to develop and validate the clinical practice recommendations. RESULTS: The evidence and consensus-based clinical practice guideline has been developed, providing recommendations for key topics of interest for first-line treatment of obesity (lifestyle-related management). Recommendations focus on screening and initiating discussion with overweight and obese postpartum women as well as those who had normal pre-pregnancy body mass index but have retained excessive weight in the postpartum period. Recommendations highlight the evaluation and management of dietary, physical activity and breastfeeding behaviour. Recommendations also account for behavioural modification techniques to improve adherence to the prescribed weight management advice. Duration and frequency of follow-ups as well as the advice to be disseminated have also been discussed in the recommendations. CONCLUSION: The guideline provides clinical practice points that can be used by healthcare providers, postpartum women and policymakers for opportunistic screening and management of postpartum obesity.

Effect of camel milk on glucose metabolism in adults with normal glucose tolerance and type 2 diabetes in Raica community: a crossover study.

BACKGROUND: To investigate effects of camel milk consumption on insulin sensitivity and glycemic control in normal and type-2 diabetics of Raika and Non-Raika community. METHODS: 28 raika and non-raika male were enrolled in study, categorized in 2 groups, non-diabetic and diabetic after one month stabilization. Non-diabetics were supplemented with cow milk and diabetics with camel milk; followed by one-month washout period. Afterwards regimen was interchanged for 3 months. Biochemical and anthropometric data was recorded at baseline, after stabilization, before and after washout and at end of study. RESULTS: An improving trend was observed in both the groups for camel milk effect (FBS 203.86 +/- 24.09 to 161.43 +/- 11.39 mg/dl; p<0.05, OGTT 320.86 +/- 25.34 to 213.79 +/- 15.96 mg/dl; p<0.05 in diabetics and FBS 101.79 +/- 3.06 to 96.79 +/- 2.56 mg/dl, OGTT 114.36 +/- 7.99 to 100.36 +/- 6.74 mg/dl in control). HbAlc improved due to camel milk consumption (8.39 +/- 0.64 to 7.27 +/- 0.67%) whereas deteriorated in the case of cow milk (7.36 +/- 0.66 to 8.26 +/- 0.60%) in diabetic group. The HOMA-IR reduced from 13.21 +/- 4.88 to 4.38 +/- 0.75, AUC-glucose from 37253.57 +/- 2859.08 to 30724.29 +/- 3677.33 and AUC-insulin from 5871.86 +/- 1210.73 to 3301.86 +/- 629.98 in the camel milk group. CONCLUSIONS: In type-2 diabetics camel milk reduces FBS, post-prandial glucose and HbA1c. AUC-insulin and AUC-glucose also decreased significantly along with HOMA-IR. It shows hypoglycemic effect of camel milk reducing insulin resistance. (www.actabiomedica.it).

Tools for the evaluation of the psychological impact of COVID-19: A practical guide for Family physicians and Primary Care Practitioners.

The COVID-19 pandemic has affected the global population significantly and has resulted in physiological, psychological, social, and behavioral changes among the individuals. The prominent mental health effects of COVID-19 on the general and clinical populations have been well recognized. The family physicians and primary care practitioners from various disciplines are likely to encounter patients who are experiencing psychological distress manifested in the form of anxiety, depression, stress, insomnia, increased substance use, or other symptoms. This narrative review is aimed to present a bird's eye view of the psychological impact of COVID-19 on the general population and the various tools that are used to evaluate them. Besides, we intend to suggest a set of tools/questionnaires that can be used by the family physicians and primary care practitioners for generating data on the psychological impact of this pandemic.

Comprehensive Treatment Module for Medically Unexplained Physical Symptoms - A Guide for General Practitioners.

PURPOSE: This study was aimed to develop a comprehensive treatment module that the general physician can use to manage patients with Medically Unexplained Physical Symptoms (MUPS) at a primary care level.  Methods: This comprehensive module was developed after a literature review followed by its validation by a two-step Delphi technique with experts from internal medicine, psychiatry, and clinical psychology. RESULTS: The developed module for the patients with MUPS includes case diagnosis, initial evaluation, strategy for referral, and a comprehensive treatment module. The comprehensive treatment module includes symptom discussion, rapport establishment, physical health counselling, stress management, cognitive strategies for symptom control, comorbidities treatment, and medical management.  Conclusion: The developed module has unique features, such as intensive sessions with these patients, a patient-specific treatment strategy, and a holistic approach incorporating pharmacological and non-pharmacological interventions. General Practitioners across the world can use this comprehensive treatment module for the management of patients with MUPS.

Development and Validation of a Comprehensive Questionnaire to Assess Interpersonal Discord (Bullying, Harassment, and Discrimination) at the Workplace in a Healthcare Setting.

Objective This study was conducted to develop and validate a comprehensive questionnaire to assess bullying, discrimination, and harassment in healthcare settings. Methodology A mixed-method study design was used to develop and validate the questionnaire. In phase I, qualitative approaches were used for the development, which included literature search, focus group discussions (FGDs), following which the construct was developed. In phase II, face validity and construct validity were established using quantitative approaches. Results The final questionnaire consists of 25 items divided into five sections addressing the burden, impact, reasons for underreporting, risk factors, and mitigation strategies. The questionnaire has very good consistency with a Cronbach's alpha score of 0.86. Conclusion This is a comprehensive tool with appropriate psychometric properties with potential use for evaluating the problem of interpersonal discord in the form of bullying, harassment, and discrimination in a healthcare setting.

Development and Validation of a Questionnaire to Evaluate Workplace Violence in Healthcare Settings.

Introduction This study aims to develop and validate a questionnaire to assess workplace violence (WPV) domains in the healthcare setting. Methods  The study used a mixed-method design. In Phase 1, qualitative methods for developing the questionnaire were employed, including literature review, focus-group discussion, expert evaluation, and pre-testing. During Phase 2, quantitative methods were employed for establishing the construct validity of the questionnaire. In Phase 1, experts from departments like emergency medicine, medicine, obstetrics and gynecology, psychiatry, trauma, anesthesia, and critical care unit participated. For Phase 2, data were collected from 213 participants; mean age (30.48±5.95) in metropolitan cities. Results The questionnaire consists of 37 items in five domains: (A) Forms of violence, (B) Impact of violent incidences, (C) Reporting of incidence, (D) Mitigation strategies, and (E) Risk factors. The Cronbach's alpha value of the questionnaire is 0.86, suggesting an excellent internal consistency. Conclusion A reliable and valid tool for gathering information regarding WPV in the healthcare system from around the world has been developed. The tool can be used to study the elements that may contribute to violence and its consequences, which will help policymakers curate various mitigation methods to safeguard WPV victims.

Psycho-social and behavioural impact of COVID 19 on young adults: Qualitative research comprising focused group discussion and in-depth interviews.

A qualitative study comprising eight focus group discussions and two in-depth interviews were conducted to explore the social and behavioural changes in young adults during COVID pandemic. Common themes identified were changes in interpersonal and intrapersonal relationships, changes in health-related behaviour, lifestyle modifications and impact on academic and professional life.

Socio-behavioural impact of COVID-19 on general population: A cross-sectional survey of one thousand seventy-nine participants across India between the first and the second wave of pandemic.

BACKGROUND AND AIMS: COVID-19 is expected to have a significant impact on the socio-behavioural aspect of citizens' lives, although the effects are expected to manifest differently in different population groups. The current study was conducted to assess the socio-behavioural impact of COVID-19 among the general population across India between the first and the second wave of pandemic. METHODS: A web-based cross-sectional study was conducted from 15th March -25th March 2021 using a pre-validated validated questionnaire upon the general population using e-survey, telephonic and face-to-face interview. The participants were recruited from the different regions of India by the purposive and snowball sampling technique following the principle of maximum diversity. Appropriate statistical tests were applied to study the association between the various sociodemographic variables and different behaviours. RESULTS: A total of 1079 responses were analysed for the study. Almost half of the participants feared contracting the COVID-19 infection. Overall, female participants, elderly people (more than 60 years of age) and urban dwellers reported a greater fear in the survey. More than half of the participants (53.39%) reported significant difficulties due to home confinement. People have become more inclined to adopt healthy lifestyles. There are mixed responses in the area of following preventive practices. CONCLUSION: People have a significant amount of fear and anxiety related to the pandemic, leading to several social and behavioural changes that might have a considerable impact on their everyday lives.