Development and Validation of an Interprofessional Community-Based Teaching-Learning Module for a Family Adoption Programme for Indian Medical Undergraduates.

INTRODUCTION: Medical education aims to prepare graduates to address society's health requirements effectively. The majority of assessments are summative and provide a minimal chance for feedback. The evaluation techniques and teaching-learning activities place a greater emphasis on knowledge than on attitude and abilities. They might also lack soft skills, including professionalism, ethics, doctor-patient relationships, and communication, as they are a hidden part of the traditional curriculum. Learning activities that take place in a specific setting, like a community, are referred to as community-based education. OBJECTIVES: To develop and validate the Interprofessional Teaching-Learning Module for the Family Adoption Program for medical undergraduates.  Method: This was an educational observational study to develop a module for a family adoption program for Bachelor of Medicine and Bachelor of Surgery (MBBS) students, which began from the first professional year and extended to the second and third professional years. Experts from different health professions were identified, and a preliminary meeting was called to discuss the purpose of the module and the role and responsibilities of each. Institutional Ethics Committee clearance was obtained after the submission of the synopsis. RESULTS: An interprofessional team was formed and communicated regarding the purpose of the module, and the initial draft was prepared with their contribution. The panel of experts for relevancy validated the module, and the content validity index derived, which was 0.92, was considered good and relevant. CONCLUSION: The Interprofessional Teaching-Learning Module for the Family Adoption Program is a comprehensive and collaborative approach for equipping students' necessary knowledge and skills to facilitate successful adoption and support families effectively.

Exploring the hidden mental health consequences of malaria beyond the fever.

Malaria morbidity has various presentations and the focus now shifts to uncommon signs and symptoms of malaria infection such as cognitive impairment to address the morbidity when the mortality declines. About 50% of children admitted to hospitals due to malaria experience neurological complications due to factors like low blood sugar, inflammation, elevated pressure, decreased oxygen levels, and excitotoxicity. Malaria during pregnancy negatively also impacts children's cognitive, behavioral, and executive function leading to neurodevelopmental delay due to increased susceptibility which can significantly affect maternal and child health, leading to higher rates of underestimated factors like anxiety, depression, and PTSD. Despite having the world's second-largest tribal population, India's indigenous and tribal communities and their mental health are less explored and less understood. Western psychological tools and neurocognitive assessment tools are not universally applicable, thus necessitating the development of tailored tools to investigate psychological or neurocognitive impairment. This paper has illuminated the hidden mental health consequences of malaria infection, emphasizing the prevalence, nature, and implications of psychological distress among affected individuals. The findings underscore the importance of recognizing and addressing these psychological consequences in the holistic management and prevention of malaria and its mental health consequences.

Interprofessional Modules for Teaching Skills in Skill Labs.

Clinical skills laboratories are educational facilities that have the potential benefit for undergraduate and postgraduate medical students and medical staff. They provide a safe and protected environment in which the learner can practice clinical skills before using them in real clinical settings. These skills laboratories help to ensure that all students acquire the necessary techniques and are properly assessed before practicing on real patients. In addition, they support the acquisition, maintenance and enhancement of the clinical skills of students in the healthcare profession. Teaching skills in skill lab require a standardized module for each skill that can be applied to all the students universally. The study was started with the aim to solve a problem that has arisen as National Medical Council (NMC) has announced implementation of Competency based medical education (CBME) a new syllabus for medical education from 2019 MBBS batch that includes skill teaching. Faculty in various Medical colleges is not trained in developing modules and teaching skills to students in skill lab. There are no standardized teaching modules for skills training in skill laboratories. As part of the project we decided to develop modules for the two competencies to be taught in the skill lab for the subject Otorhinolaryngology i.e. Otoscopy and Anterior Nasal packing; NMC guidelines being the benchmark in developing these modules. Later modules were also to be implemented on sample students to get a feedback on the structure of the module for further improvement. These modules developed as part of the project will help as a baseline tool for developing other modules in different subjects by various Institutes. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04568-0.

Exploring the Darkverse: A Multi-Perspective Analysis of the Negative Societal Impacts of the Metaverse.

The Metaverse has the potential to form the next pervasive computing archetype that can transform many aspects of work and life at a societal level. Despite the many forecasted benefits from the metaverse, its negative outcomes have remained relatively unexplored with the majority of views grounded on logical thoughts derived from prior data points linked with similar technologies, somewhat lacking academic and expert perspective. This study responds to the dark side perspectives through informed and multifaceted narratives provided by invited leading academics and experts from diverse disciplinary backgrounds. The metaverse dark side perspectives covered include: technological and consumer vulnerability, privacy, and diminished reality, human-computer interface, identity theft, invasive advertising, misinformation, propaganda, phishing, financial crimes, terrorist activities, abuse, pornography, social inclusion, mental health, sexual harassment and metaverse-triggered unintended consequences. The paper concludes with a synthesis of common themes, formulating propositions, and presenting implications for practice and policy.

Prevalence and risk factors of recurrent aphthous stomatitis among college students at Mangalore, India.

Background: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases affecting an approximate 25% of the world's population. Some common etiological factors are genetics, nutritional deficiencies, stress and immune dysfunction. There is currently no specific medication to treat the condition but RAS tends to heal by itself within a week or two. We aimed to explore about the prevalence and related risk factors of recurrent aphthous ulcers among college students aged 18-30 years who had been affected within the preceding six months prior to the study duration. Methods: A questionnaire survey was conducted among 681 students from four colleges in Mangalore, Karnataka, India after obtaining the approval for the same from the respective colleges. Consenting participants returned a survey containing various questions. The collected data was then analyzed using descriptive statistics. The study was approved by the Institutional Ethics Committee. Results: Of the 681 participants, 322 (47.2%) were affected with RAS in the past six months which included 131 (40.6%) males and 191 (59.3%) females. Single mouth ulcers were the most common presentation seen among the study participants (74.2%). Factors showing statistically significant association were: family history of RAS (P < 0.001), known diabetics (P < 0.001), history of smoking (P < 0.001), oral trauma (P < 0.001), history of wearing braces/dentures (P < 0.001) as well as those using toothpastes containing sodium lauryl sulphate (P < 0.001), stress and lack of sleep (P < 0.001). The most common form of medication used were topical agents (43.1%) (P < 0.001). Conclusions: There was a statistically significant association between the occurrence of RAS and family history of RAS, diabetes, smoking, history of braces/dentures, oral trauma, sodium lauryl sulphate toothpastes, lack of sleep, stress, menstruation, consumption of particular foods and beverages. Further research is needed in this field to truly understand the prevalence and risk factors of RAS and to help in discovering a treatment modality for this condition.

Knowledge, attitude and practices towards COVID-19 among Indian medical undergraduates: a questionnaire-based study.

Background: The Coronavirus disease-19 (COVID-19) infection of severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) has emerged as a recent pandemic, increasing the need for epidemiological studies and studies on public health. Only some studies have evaluated the awareness of medical undergraduates in India and other countries, leading to a lack of literature. Methods: This study is a descriptive cross-sectional questionnaire-based study conducted in Kasturba Medical College, Mangalore, India, between June to August 2020. An online survey using Google Forms was circulated among undergraduate medical students in India by a convenient sampling method for data collection. Descriptive analysis was derived based on frequencies and percentages, and the association with age, gender, and year of undergraduate training medical course was derived using the chi-square test. Results: Altogether, 630 students from India responded to the survey, with a maximum response from students studying in the second year (38.7%). Nearly 63.85% of responders identified themselves as females. Knowledge regarding the human-to-human transmission of the virus, symptoms, complications, definition of "close contact, quarantine, and its indications was adequate among the students, with more than 70% correct responses. However, one-fourth of the students needed to gain more knowledge about masks. Respiratory hygiene was poor among 24.8%. Nearly 40% of students were unaware of the management of patients with COVID-19. Conclusion: There is a need for regular quality training and institutional programs on infection control of COVID-19 and other infectious diseases across all Indian medical colleges to educate undergraduate medical students, who are future healthcare professionals, thus minimizing the risk of transmission and providing standardized care for patients.

Assessment of the factors that affect the selection of a dentifrice among a population of 18-24-year-old students in Mangalore: A questionnaire survey.

Introduction: Bacterial plaque accumulation is the primary etiological factor for periodontal disease; hence, prevention of its accumulation is the cornerstone to any oral hygiene practice. Mechanical tooth cleaning by means of toothbrush and a dentifrice remains the most reliable and common method for controlling supragingival plaque. The objective of the study was to evaluate the factors considered while choosing a dentifrice and also to assess the role of socioeconomic status in determining these factors. Materials and Methods: This was a questionnaire study carried out among undergraduate students from the business and mass communication background of two private degree colleges in Dakshina Kannada, India. Two hundred and fifty-five students were included in the study. The questionnaire consisted of 24 close-ended questions. Results and Conclusion: The parameters of brand name, availability, and the flavor of the dentifrice are among the most accepted factors that a consumer takes into consideration in selecting a dentifrice. Parameters of influence (parents, colleagues, and celebrities), advertisement, and dentist recommendations of a dentifrice were also found to have a major influence on the consumer in selecting a dentifrice.

Preventing Early Childhood Caries through Oral Health Promotion and a Basic Package for Oral Care: A Pragmatic Trial.

Introduction: Untreated caries in mothers is one of the common risk factors for early childhood caries (ECC). Aim: The aim of the study was to investigate the impact of an oral health promotion program on ECC. Methodology: We conducted a pragmatic trial at 12 primary health centers in a rural community of India with 311 pregnant women using fluoride toothpaste, oral health information through pamphlets, and referral to urgent dental care or atraumatic dental treatment as the test intervention. Data were collected through structured interviews at baseline and oral examination of the children at 2 years of age. Results: Of the 311 women who participated, 274 children were followed up with at 2 years of age. ECC was low and comparable in both groups. When compared with the control group, significantly, more children from the intervention group were breastfed for over 6 months of age (P = 0.012) and consumed less sugar (P < 0.001). The number of mothers' decayed teeth (P = 0.01), children's sweet scores (P < 0.001), and the age at which brushing commenced for children (P = 0.04) increased the likelihood of tooth decay in children. Conclusion: The oral health promotion program had some beneficial effects in preventing caries in children when provided to pregnant women.

Overweight and Obese Status Is Not Associated With Disease Activity for Children and Adolescents With Newly Diagnosed Inflammatory Bowel Disease.

INTRODUCTION: Despite the high prevalence of pediatric obesity, its impact on Crohn's disease (CD) and ulcerative colitis (UC) activity remains poorly characterized. The aim of this study was to evaluate disease-related outcomes in overweight and obese children with CD and UC. METHODS: We conducted a retrospective cohort study using the ImproveCareNow Network, a multicenter registry of children with inflammatory bowel disease. We included children with newly diagnosed CD and UC enrolled in ImproveCareNow Network from September 2006 to December 2018 who had at least 1 follow-up visit 12-18 months after diagnosis. Patients were stratified into normal weight, overweight, or obese categories. Primary outcome was remission at 1 year based on physician's global assessment (PGA); key secondary outcomes included short pediatric CD activity index and pediatric UC activity index. RESULTS: There were 4,972 children included (70% CD). Compared with normal weight, obese and overweight children with CD did not have worse disease activity at 1 year based on PGA. However, obese children did have modestly worse disease activity based on short pediatric CD activity index (inactive 43% vs 58%, mild 48% vs 36%, and moderate-severe 9% vs 7% for obese vs normal weight, P < 0.01). For children with UC, there were no differences in disease activity at 1 year based on PGA or pediatric UC activity index. Logistic regression mirrored these findings. DISCUSSION: Obese and overweight children with newly diagnosed inflammatory bowel disease do not seem to have worsened disease activity at 1 year after diagnosis compared with normal weight children.

Single-Cell Analysis Reveals Unexpected Cellular Changes and Transposon Expression Signatures in the Colonic Epithelium of Treatment-Naïve Adult Crohn's Disease Patients.

BACKGROUND & AIMS: The intestinal barrier comprises a monolayer of specialized intestinal epithelial cells (IECs) that are critical in maintaining mucosal homeostasis. Dysfunction within various IEC fractions can alter intestinal permeability in a genetically susceptible host, resulting in a chronic and debilitating condition known as Crohn's disease (CD). Defining the molecular changes in each IEC type in CD will contribute to an improved understanding of the pathogenic processes and the identification of cell type-specific therapeutic targets. We performed, at single-cell resolution, a direct comparison of the colonic epithelial cellular and molecular landscape between treatment-naïve adult CD and non-inflammatory bowel disease control patients. METHODS: Colonic epithelial-enriched, single-cell sequencing from treatment-naïve adult CD and non-inflammatory bowel disease patients was investigated to identify disease-induced differences in IEC types. RESULTS: Our analysis showed that in CD patients there is a significant skew in the colonic epithelial cellular distribution away from canonical LGR5+ stem cells, located at the crypt bottom, and toward one specific subtype of mature colonocytes, located at the crypt top. Further analysis showed unique changes to gene expression programs in every major cell type, including a previously undescribed suppression in CD of most enteroendocrine driver genes as well as L-cell markers including GCG. We also dissect an incompletely understood SPIB+ cell cluster, revealing at least 4 subclusters that likely represent different stages of a maturational trajectory. One of these SPIB+ subclusters expresses crypt-top colonocyte markers and is up-regulated significantly in CD, whereas another subcluster strongly expresses and stains positive for lysozyme (albeit no other canonical Paneth cell marker), which surprisingly is greatly reduced in expression in CD. In addition, we also discovered transposable element markers of colonic epithelial cell types as well as transposable element families that are altered significantly in CD in a cell type-specific manner. Finally, through integration with data from genome-wide association studies, we show that genes implicated in CD risk show heretofore unknown cell type-specific patterns of aberrant expression in CD, providing unprecedented insight into the potential biological functions of these genes. CONCLUSIONS: Single-cell analysis shows a number of unexpected cellular and molecular features, including transposable element expression signatures, in the colonic epithelium of treatment-naïve adult CD.

A task-based learning strategy in preclinical medical education.

Preclinical task-based learning (TskBL) is a simulated learning approach in which the focus for students is a real task done by a medical professional. TskBL includes standardized patient encounters and is helpful to provide early clinical exposure. Our study aimed at planning, implementing, and assessing TskBL among first-year medical students and comparing it to the conventional method of tutorials in the physiology MBBS curriculum. This is a nonequivalent group quasi-experimental study approved by the institutional ethics committee. TskBL was conducted for seven topics among first-year medical students of Kasturba Medical College, Mangalore for three academic years. Participants were divided into a TskBL group and a control group. Both groups attended the theory classes in physiology, practical sessions, and clinical examinations concerning the tasks. After this, the TskBL group underwent TskBL, and the control group underwent tutorials. Pretest and posttest assessments were conducted by using a multiple choice question (MCQ) test and objective structured clinical examinations (OSCEs).The mean TskBL scores for MCQ (exception: hypertension, myasthenia gravis, and chronic obstructive pulmonary disease) and OSCE (exception: anemia and hypertension) were significantly higher than the tutorial group. Pretest and posttest scores revealed significantly higher MCQ and OSCE scores for TskBL (exception: MCQ score for hypertension and chronic obstructive pulmonary disease). The tutorial group did not show a significant improvement in test scores for all the tasks. The TskBL strategy could be used for topics that are likely to be encountered by the students during clinical attachments. Small group teaching can include TskBL in preference to tutorials to provide early clinical exposure in medical schools.

Integrating Research into Undergraduate Medical Education Curriculum: A 20-year Experience from a Medical School in Coastal South India.

Research is the key to advancement in medical science. Medical school can nurture the skill of research right from the under graduation. Research forms an integral part of the medical curriculum in western countries. We attempted the same in our medical school in India. We developed a structured research methodology program, which was implemented in the undergraduate (UG) curriculum in two phases. Phase I focuses on research methodology and Phase II on manuscript writing. With the implementation of a competency-based medical education curriculum (CBME), we have extended the research methodology program with manuscript writing and introduction to systematic reviews, which is being offered as electives to UG medical students in the third professional year. Our experience in training students at an UG level has been immensely satisfying. We hope that this article will help other medical schools to adopt a similar method of training UG medical students in research methodology and scientific medical writing.

Evaluation of Preclinical Task Based Learning program in Medical Education.

The conventional curriculum in preclinical medical education has a need for early clinical exposure programs that help in correlation of basic science data with clinical skills. This is helpful to develop clinical reasoning skills, problem-solving abilities, team work, communication skills and overall attitudes and behaviour relevant for a healthcare provider. Preclinical task based learning (TskBL) is an active learning strategy in which the focus for the first year medical student is a real task done by a doctor. In this strategy the student-doctors undergo a standardized patient encounter and discuss the learning issues related to the task in the first year of medical school. The current study is focussed on the student perception of the effectiveness of task based learning module.The TskBL was conducted among first year medical students for nine topics that are commonly encountered in the clinics. After TskBL was planned and implemented the evaluation of the modules was done using focus group discussions. The students highlighted the importance of standardized patients in the TskBL strategy in providing early clinical exposure in preclinical medical education. They reported its usefulness gaining essential knowledge, skills and attitudes for medical learning. They reported positive outcomes of module design and processes and activities in TskBL. Based on the negative aspects of the modules, future improvement was suggested in improving the usefulness of standardized patient encounter. This study showed the novice learners' outlook of the potency of TskBL for several other topics of clinical relevance to provide early clinical exposure in medical schools.

The Effect of Socioeconomic Factors and Indoor Residual Spraying on Malaria in Mangaluru, India: A Case-Control Study.

India faces 0.5 million malaria cases annually, including half of all Plasmodium vivax malaria cases worldwide. This case-control study assessed socioeconomic determinants of urban malaria in coastal Mangaluru, Karnataka, southwestern India. Between June and December 2015, we recruited 859 malaria patients presenting at the governmental Wenlock Hospital and 2190 asymptomatic community controls. We assessed clinical, parasitological, and socioeconomic data. Among patients, p. vivax mono-infection (70.1%) predominated. Most patients were male (93%), adult (median, 27 years), had no or low-level education (70.3%), and 57.1% were daily labourers or construction workers. In controls (59.3% male; median age, 32 years; no/low-level education, 54.5%; daily labourers/construction workers, 41.3%), 4.1% showed asymptomatic Plasmodium infection. The odds of malaria was reduced among those who had completed 10th school grade (aOR, 0.3; 95% CI, 0.26-0.42), lived in a building with a tiled roof (aOR, 0.71; 95% CI, 0.53-0.95), and reported recent indoor residual spraying (aOR, 0.02; 95% CI, 0.01-0.04). In contrast, migrant status was a risk factor for malaria (aOR, 2.43; 95% CI, 1.60-3.67). Malaria in Mangaluru is influenced by education, housing condition, and migration. Indoor residual spraying greatly contributes to reducing malaria in this community and should be promoted, especially among its marginalised members.

Health Maintenance Consensus for Adults With Inflammatory Bowel Disease.

BACKGROUND: With the management of inflammatory bowel disease (IBD) becoming increasingly complex, incorporating preventive care health maintenance measures can be challenging. The aim of developing these updated recommendations is to provide more specific details to facilitate their use into a busy clinical practice setting. METHOD: Fifteen statements were formulated with recommendations regarding the target, timing, and frequency of the health maintenance interventions in patients with IBD. We used a modified Delphi method and a literature review to establish a consensus among the panel of experts. The appropriateness of each health maintenance statement was rated on a scale of 1 to 5 (1-2 as inappropriate, and 4-5 as appropriate) by each panelist. Interventions were considered appropriate, and statements were accepted if ≥80% of the panelists agreed with a score ≥4. RESULTS: The panel approved 15 health maintenance recommendations for adults with IBD based on the current literature and expert opinion. These recommendations include explicit details regarding specific screening tools, timing of screening, and vaccinations for adults with IBD. CONCLUSIONS: Patients with IBD are at an increased risk for infections, malignancies, and other comorbidities. Given the complexity of caring for patients with IBD, this focused list of recommendations can be easily incorporated in to clinical care to help eliminate the gap in preventative care for patients with IBD.