Barriers to Cancer Diagnosis and Treatment: A Pilot Qualitative Study of Patient and Practitioner Perspectives in Rural India.

Introduction Cancer remains a critical global health issue, particularly in developing countries, where timely diagnosis and effective treatment are often hindered by numerous barriers. These obstacles exacerbate the cancer burden and contribute to disparities in care. This study explores the barriers to cancer diagnosis and treatment from the perspectives of patients and healthcare providers in rural India, aiming to inform targeted interventions and improve outcomes. Methods This qualitative study was conducted from April to May 2024 at a tertiary cancer hospital in rural Western Maharashtra, India. Nine semi-structured interviews were conducted with five cancer patients and four healthcare practitioners. Participants were selected through purposive sampling until information saturation was achieved. Interviews were conducted in local languages and analyzed using thematic analysis to identify key barriers and themes. Results The study identified several major themes related to barriers to cancer diagnosis and treatment. Patients highlighted a lack of awareness and understanding of cancer, significant financial burdens, challenges in accessing healthcare facilities, and emotional distress. Healthcare practitioners noted systemic issues, including inadequate diagnostic capabilities, insufficient healthcare infrastructure, and a shortage of specialized providers. Both groups emphasized the impact of cultural beliefs and stigma, as well as the limited support systems available to patients. Conclusion The findings highlight the complex interplay of factors contributing to delays in cancer diagnosis and treatment in rural India. Addressing these barriers requires multifaceted interventions, including increasing public awareness, improving healthcare infrastructure, and enhancing support systems for patients. Policy development should focus on these areas to reduce disparities and improve cancer care outcomes in resource-limited settings.

Exploring the Determinants of Tobacco Usage Among Adolescents: A Cross-Sectional Study in Western Maharashtra.

Introduction The widespread use of tobacco is a major global health threat, causing significant morbidity and mortality. The World Health Organization (WHO) estimates that annually, millions of people die prematurely due to tobacco use, with this number projected to increase significantly in the future. Developing countries, including India, bear a substantial burden of tobacco-related deaths, often beginning during adolescence. This study estimated the prevalence of tobacco use among adolescents in the 13-19 years age group, identified the types of tobacco products used, explored the reasons for initiation, and examined the influence of family, peers, and socio-demographic factors on tobacco use. Methods A community-based cross-sectional study was conducted from August 2022 to June 2024 in a medical college's urban and rural field practice areas in Pune district, Maharashtra. A total of 310 adolescents were surveyed using convenience sampling. Data were collected using a pre-designed, pre-tested questionnaire, and statistical analysis was performed using Jamovi software version 2.3.28. Chi-square and Fisher's exact tests were applied to assess associations between variables. Results Out of 310 participants, 94 (30.32%, 95% CI: 25.25%-35.77%) reported using tobacco. Among these 94 participants, 82 (87.23%) used smokeless tobacco, 19 (20.21%) used the smoked form of tobacco, and seven (7.45%) used both forms. The mean age of initiation was 15.94 years for smoking and 15.59 years for smokeless tobacco. The data indicate a higher percentage of tobacco use among females (50%) compared to males (24.8%). However, in terms of absolute numbers, more males (60) than females (34) reported using tobacco due to the larger number of males in the study sample. The most common reasons for initiation included curiosity (43.74%) and peer pressure (53.99%). Specifically, 49 individuals (42.6%) aged 13-15 were using tobacco, compared to 23 individuals (30.3%) aged 16-17, and only 22 individuals (18.5%) aged 18-19. Participants from urban areas reported higher tobacco use (48%) compared to those from rural areas (46.7%). Among those from joint families, about 24 (31.6%) reported tobacco use, while in nuclear families, it was slightly lower at about 70 (29.9%). Conclusion Factors such as peer pressure and curiosity played significant roles in the initiation of tobacco use, with more than half of the participants citing peer influence as the primary reason for starting. This study revealed differences in tobacco usage patterns across age groups, with younger participants showing higher usage rates. The findings highlight the need for targeted interventions, such as health education and anti-tobacco media campaigns, to reduce tobacco use among adolescents.

The Plight of Healthcare Providers in Managing and Preventing Sexually Transmitted Infections (STIs)/Reproductive Tract Infections (RTIs): A Qualitative Study.

Background Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) pose significant public health challenges globally, particularly in resource-limited settings. This study aimed to investigate the challenges faced by healthcare providers in managing and preventing STIs/RTIs in India. Materials and methods In-depth interviews were conducted with eight healthcare providers, including counselors, gynecologists, and dermatologists, working in government settings. A semi-structured interview guide was used to explore challenges related to patient care and healthcare system resources. Results The study revealed significant gaps in patient knowledge and awareness about STIs/RTIs, with misconceptions affecting treatment-seeking behavior. Social stigma and cultural barriers were identified as major obstacles to open communication and timely care. Gender-specific challenges in healthcare-seeking behavior and partner notification were noted. Healthcare providers reported inconsistent availability of treatment kits and medications, as well as challenges in ensuring patient compliance. The need for improved healthcare infrastructure, including specialized clinics and better interdepartmental coordination, was highlighted. Conclusion Addressing STI/RTI management challenges requires a multifaceted approach, including enhancing public awareness, ensuring consistent medication supply, establishing specialized clinics, and improving interdepartmental coordination. These findings provide valuable insights for developing targeted interventions to improve STI/RTI management and prevention in resource-limited settings.

A Cross-Sectional Study on Sedentary Lifestyle Among Budding Doctors: Silent Killer?

Background Internship is the time period when young doctors learn to balance between professional and personal lives. If they have good awareness and practice of any kind of physical activity during this period, it will help them to continue it forward. This enables them to educate and inspire people and patients around them. The main objectives of this study were to assess patterns of physical activity among medical interns and to understand the factors preventing physical activity among them. Methodology This cross-sectional survey was carried out among interns of a tertiary care hospital in western Maharashtra from July 2022 to September 2022. Ethical clearance was obtained before starting data collection. The survey was administered to those who fulfilled the inclusion criteria. The questionnaire was adopted from the Global Physical Activity Questionnaire. The data collected were entered into Microsoft Excel (Microsoft Corporation, Redmond, WA) and analysis was done using MedCalc v.18.2.1 (MedCalc Software Ltd, Ostend, Belgium). Results A total of 220 interns were enrolled in the survey, of which 13 were removed due to incomplete data and 28 interns did not participate in the study. Finally, 179 interns were included for analysis in the study. The response rate was 87.27%. The mean age of participants was 23.12 years. The study population consisted of 72 (40.22%) males and 107 (59.78%) females. Among participants, 33 interns (18.44%) were involved in vigorous activity during work, and 108 interns (60.34%) were involved in moderate physical activity during work. The median time of a sedentary lifestyle was 300 minutes per day and was more common among males. Cumulatively busy working schedules and exam preparation were the important reasons for reduced physical activity. Conclusion There is a gap in the practice of physical activity among interns. A sedentary lifestyle was more prevalent among male interns than in female interns. The main constraints were demanding working hours and the pressure of competitive exams. Medical students will become doctors in the future who can advise their patients on healthy lifestyle habits. We recommend that it is necessary to promote physical activity in medical schools and to reinforce the importance of physical exercise in the medical curriculum.

Quantification of COVID-19 Vaccine Coercion in India: A Survey Study.

INTRODUCTION: Informed consent is the cornerstone of medical ethics, enshrined in the constitution of most countries, as well as in international documents. However, mandates for coronavirus disease 2019 (COVID-19) vaccination as well as coercion were prevalent in many places in the world, including in India. Against this background, we did a cross-sectional study to assess and quantify the extent of COVID-19 vaccine coercion in India. METHODS: A cross-sectional study was conducted after obtaining ethical clearance from the Indian Institute of Technology Bombay (IITB). This survey was conducted using a pretested questionnaire anonymously amongst college students and adults in Mumbai from October 2022 to December 2022. The questionnaire contained details of why the vaccine was taken, and if the participant was a student. Descriptive analysis was conducted and frequencies, percentages along with 95% confidence intervals were used to summarize the findings. RESULTS: A total of 483 participants responded, which included both students and non-students, of which 470 participants reported having taken the vaccine. A total of 106 (21.95%, 95% CI 18.48%-25.85%) reported to have been pressured into taking the vaccine. The level of coercion was similar among college students (78, 21.61%, 95% CI 17.67%-26.14%) and non-student adults (28, 22.95%, 95% CI 15.82%-31.43%).  Conclusion: A significant proportion was coerced into taking the vaccines, violating the requirement for informed consent. These results are of paramount importance for future policies as well as for posterity.

Prevalence of Vitamin D Deficiency in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study.

Background Type 2 diabetes mellitus (T2DM) is one of the most common non-communicable diseases, causing a high mortality rate globally. Vitamin D deficiency has been reported as a rising pandemic. Vitamin D levels have been found to be associated with obesity and insulin resistance. However, there is not much research done to study the various factors associated with the association between vitamin D levels and diabetes mellitus in the Indian population. Objective The objective of this study is to estimate the prevalence of vitamin D deficiency in T2DM patients and find the factors associated with vitamin D levels among type 2 diabetes mellitus patients. Materials and methods A cross-sectional analytical study was planned and done in the Urban Health Training Centre of Dr. D.Y. Patil Medical College. The sample size was calculated using published data on prevalence. Data from 116 T2DM patients were collected using a questionnaire about their socio-economic status, dietary patterns, outdoor activities, exercise, drug and supplement intake, occupation, and symptoms, which was filled out by the participants after written informed consent. Levels of serum vitamin D were estimated from the blood samples taken from the participants. Statistical analysis was done using MedCalc software. Results Vitamin D deficiency was found in 86 (74.14%) out of 116 diabetic patients. There were 63 males, and 71.43% of them had lower-than-normal vitamin D levels. The number of female participants was 53, and 77.36% were found to suffer from vitamin D deficiency. There were 88 obese participants, and only 22.73% were found to have sufficient levels of vitamin D. Conclusion The results depict a high prevalence of vitamin D deficiency in type 2 diabetes mellitus patients. Regular supplementation of vitamin D for diabetic patients can prevent them from developing any further complications. Increasing awareness about a healthy lifestyle, a proper diet, adequate sunlight, and exercise can help keep most non-communicable diseases at bay. Additional studies should be done to understand the pathophysiology better, which can aid in preventing diseases in the beginning stages of development.

Impact of COVID-19 pandemic on mental health of general population: A comparison study between rural and urban population.

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted the mental health of the population globally with the increase in cases of depression, suicide, and self-harm. According to the World Health Organization, there has been an increase of 28% and 26% in major depressive disorders and anxiety, respectively, during 1 year of the COVID-19 pandemic. Only a few studies had been conducted in India assessing mental health, especially the post hoc effect of a pandemic. Therefore, the current study was conducted to estimate the prevalence of depression, anxiety, and stress in rural against urban populations as well as the contributing factors viz age, gender, socioeconomic class, change in occupation, and income. Materials and Methods: A community-based cross-sectional study was conducted from July 2021 to February 2022 among participants residing in the area covered by the Urban Health Training Centre (Ajmera, Pimpri, Pune) and Rural Health Training Centre (Alandi, Pune) of a medical college in Pune. One hundred fifty-four participants (total of 308) above 18 years of age who were not diagnosed or under treatment for psychiatric illness were interviewed using the Depression Anxiety Stress Scale - 21 (DASS-21) to screen for anxiety, depression, and stress in each setting. Results: Overall prevalence of mental distress was 35.71% (n = 110). In the rural area, it was 29.2% (n = 45) as compared to 42.2% (n = 65). in the urban category. The prevalence of depression was significantly higher in urban areas (33.1%) compared to rural areas (19.4%), with an overall prevalence of 26.3%. The net prevalence of anxiety and stress was 35.7% and 15.6%, respectively, which were also higher in urban areas (Anxiety OR = 1.769, P = 0.018*; Stress OR = 2.262, P = 0.013). The upper middle class had the least psychological problems. Overall, 11% of participants had lost their jobs; 48.75% in rural and 37% of urban participants had a decrease in their income. Conclusion: The COVID-19 pandemic has resulted in an increased burden of mental illness. The prevalence of mental health problems is alarmingly high, especially in urban communities. To combat the global mental health pandemic, the interventions that mediate psychological distress must be quickly implemented. Due importance should be given to mental healthcare in the community.