Improving adolescents' dietary behavior through teacher-delivered cancer prevention education: a school-based cluster randomized intervention trial in urban Rajasthan.

BACKGROUND: Dietary practices are one of the most common modifiable risk factors for cancers. Foods rich in dietary fibers are considered protective, meanwhile fast & junk foods are risk for common cancers. Adolescence period is marked by habit formation and is thus suited for delivering behavioral intervention. Schools offer an optimal setting for planning and executing these interventions to a large number of adolescents. OBJECTIVE: To assess the effectiveness of a teacher-delivered cancer-prevention education in changing dietary behaviors of school going adolescents. METHODS: A cluster randomized trial was conducted in government secondary and senior secondary schools with schools as clusters. A minimum required sample of 1032 students was estimated from 16 schools with 1:1 allocation in intervention and non-intervention groups. Dietary behaviors were recorded as dichotomous variable. The determinants were recorded as per theory of planned behavior framework using Likert-scale. Two teachers from each intervention school were trained to deliver cancer prevention education with focus on role of dietary behavior. Pre-post training assessment of teachers' knowledge towards common cancers was done using a self-administered questionnaire. Gender adjusted difference-in-difference analysis was done to assess intervention effect on both healthy and unhealthy behaviors. RESULTS: In selected schools all students from classes 8 to 10 were approached and a total of 1224 students were enrolled, of whom 1096 completed the study. The study recorded significant improvement in scores of students from intervention group compared to non-intervention group for their attitude, subjective norms, perceived behavioral control and intention towards consuming healthy and avoiding unhealthy foods. The intervention was effective in significantly improving the proportion of students limiting fried/fast/packed food & sugar sweetened beverages (OR:1.51, 95%CI:1.08,2.12,p:0.017), and consuming fruits & vegetables daily (OR:1.55, 95%CI:1.08,2.22, p:0.017) while adjusting effect of gender. CONCLUSION: Classroom-based cancer prevention education delivered through teachers during regular working hours is effective in improving dietary behaviors and its determinants among adolescent students. Thus, we recommend integrating a section focusing on the role of diet in cancer prevention and other lifestyle diseases in the existing school curriculum. TRIAL REGISTRATION: The trial was registered under Clinical Trial Registry-India with registration number CTRI/2018/12/016586, dated-10/12/2018.

Recalibrating the Non-Communicable Diseases risk prediction tools for the rural population of Western India.

BACKGROUND: The aim of the present study was to recalibrate the effectiveness of Indian Diabetes Risk Score (IDRS) and Community-Based Assessment Checklist (CBAC) by opportunistic screening of Diabetes Mellitus (DM) and Hypertension (HT) among the people attending health centres, and estimating the risk of fatal and non-fatal Cardio-Vascular Diseases (CVDs) among them using WHO/ISH charts. METHODS: All the people aged ≥ 30 years attending the health centers were screened for DM and HT. Weight, height, waist circumference, and hip circumferences were measured, and BMI and Waist-Hip Ratio (WHR) were calculated. Risk categorization of all participants was done using IDRS, CBAC, and WHO/ISH risk prediction charts. Individuals diagnosed with DM or HT were started on treatment. The data was recorded using Epicollect5 and was analyzed using SPSS v.23 and MedCalc v.19.8. ROC curves were plotted for DM and HT with the IDRS, CBAC score, and anthropometric parameters. Sensitivity (SN), specificity (SP), Positive Predictive Value (PPV), Negative Predictive Value (NPV), Accuracy and Youden's index were calculated for different cut-offs of IDRS and CBAC scores. RESULTS: A total of 942 participants were included for the screening, out of them, 9.2% (95% CI: 7.45-11.31) were diagnosed with DM for the first time. Hypertension was detected among 25.7% (95% CI: 22.9-28.5) of the participants. A total of 447 (47.3%) participants were found with IDRS score ≥ 60, and 276 (29.3%) with CBAC score > 4. As much as 26.1% were at moderate to higher risk (≥ 10%) of developing CVDs. Area Under the Curve (AUC) for IDRS in predicting DM was 0.64 (0.58-0.70), with 67.1% SN and 55.2% SP (Youden's Index 0.22). While the AUC for CBAC was 0.59 (0.53-0.65). For hypertension both the AUCs were 0.66 (0.62-0.71) and 0.63 (0.59-0.67), respectively. CONCLUSIONS: IDRS was found to have the maximum AUC and sensitivity thereby demonstrating its usefulness as compared to other tools for screening of both diabetes and hypertension. It thus has the potential to expose the hidden NCD iceberg. Hence, we propose IDRS as a useful tool in screening of Diabetes and Hypertension in rural India.

Identifying psychological antecedents and predictors of vaccine hesitancy through machine learning: A cross sectional study among chronic disease patients of deprived urban neighbourhood, India.

COVID-19 vaccine hesitancy among chronic disease patients can severely impact individual health with the potential to impede mass vaccination essential for containing the pandemic. The present study was done to assess the COVID-19 vaccine antecedents and its predictors among chronic disease patients. This cross-sectional study was conducted among chronic disease patients availing care from a primary health facility in urban Jodhpur, Rajasthan. Factor and reliability analysis was done for the vaccine hesitancy scale to validate the 5 C scale. Predictors assessed for vaccine hesitancy were modelled with help of machine learning (ML). Out of 520 patients, the majority of participants were female (54.81%). Exploratory factor analysis revealed four psychological antecedents' "calculation"; "confidence"; "constraint" and "collective responsibility" determining 72.9% of the cumulative variance of vaccine hesitancy scale. The trained ML algorithm yielded an R2 of 0.33. Higher scores for COVID-19 health literacy and preventive behaviour, along with family support, monthly income, past COVID-19 screening, adherence to medications and age were associated with lower vaccine hesitancy. Behaviour changes communication strategies targeting COVID-19 health literacy and preventive behaviour especially among population sub-groups with poor family support, low income, higher age groups and low adherence to medicines may prove instrumental in this regard.

Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS).

BACKGROUND: The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18). METHODS: NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) - Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises. RESULTS: Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3-3.3) in rural public to 9.0% (95% CI; 6.2-13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities. CONCLUSION: Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.

Physicians' Total Burden of Occupational Stressors: More than Threefold Increased Odds of Burnout.

OBJECTIVES: To assess the relation between total job stressor burden and physician burnout, identifying potentially contributory modifiable stressors, using a comprehensive, theory-based instrument created for physicians by physicians. METHODS: From 2018 to 2019, we conducted a cross-sectional study in a public teaching hospital in India. Of 305 clinically active physicians, 293 were reached and 42.7% participated. Job stressors were assessed via the physician-specific Occupational Stressor Index (OSI) and burnout by the Copenhagen Burnout Index (CBI). RESULTS: The 76 fully participating physicians were 68% male, 84% residents, and 70% age 30 or younger, from various specialties. Mean scores for total OSI: 87 ± 7.8; personal burnout: 46.6 ± 18.2; work-related burnout: 41.4 ± 20.7; and patient-related burnout: 31.7 ± 22.4. Total OSI scores were significantly associated with personal and work-related burnout, adjusting for working-years as physicians and sex. Total OSI scores >88 showed adjusted odds ratios (±95% confidence intervals): 3.99 (1.31, 12.1) and 6.50 (1.85, 22.8) for personal and work-related burnout, respectively. The high demands aspect of the OSI showed significant multivariate relations to personal, work-related, and patient-related burnout. Patient-related burnout was significantly more likely among male physicians in these multivariate analyses. Physicians outside preventive/diagnostic areas, with heavier burdens and more emergency cases were less likely to fully participate. CONCLUSIONS: The total burden of job stressors is powerfully associated with personal and work-related burnout. The clinically defined total OSI cutpoint >88 warranting urgent intervention is corroborated by >3-fold odds of personal and work-related burnout. Lowering total OSI scores is an immediate priority, starting with potentially modifiable stressors that are already maximum/near-maximum (inadequate rest breaks, nightshifts, work hours, insufficient work-free vacation time, and infection hazards). These issues affect patient care.

Measuring medical graduate behavioral intention for administering on-site care to road traffic accident victims: Development and validation of a questionnaire.

BACKGROUND: Prehospital trauma care skills are often taught and assessed in undergraduate medical curricula but the intention to voluntarily offer these skills in out of hospital or primary care settings is poorly understood. OBJECTIVES: The objective is to develop and validate a questionnaire measuring behavioral intention among medical graduates for administering on-site care to road accident victims. METHODS: A cross-sectional study was conducted from September 2018 to February 2019, among medical graduates of an academic institution in Jodhpur, Rajasthan. Items for "Measure of Intention to help road accident victim (MIHRAV) instrument" were framed as per the constructs of theory of planned behavior. A total of 150 candidates undergoing internship were approached for informed consent and a link for online questionnaire was shared. STATISTICAL ANALYSIS: Exploratory factor analysis (EFA) and tests for convergent, discriminant, and predictive validity was done using IBM SPSS version 23.0 for psychometric validation of scale. RESULTS: Original version of MIHRAV included 29 items which were reduced to 18 items. EFA identified five factors which explained 72% of cumulative variance with high Cronbach's α (0.920). Discriminant validity showed adequate correlations ranging from 0.283 to 0.541. Predictive validity demonstrated that model was significantly able to predict "behavioural intention to help" (F (4128) = 24.139, P = 0.0001) and explained 43% of variance. CONCLUSION: The findings reveal that developed instrument "MIHRAV" is a reliable and valid scale for predicting behavioral intention among medical graduates for administering onsite care to road accident victims.

Essential Yet Neglected Role of Primary Care Physicians in Palliation Team.

Quality home-based care for patients with the end-stage disease is increasingly being preferred. Responding to disease associated symptoms and complications may pose an array of challenges in evolving palliative care systems, as no formal institutional mechanism exists to respond to patient and caregiver's wishes. Family and primary care physicians can play an instrumental role in such scenarios by bridging the gaps between cancer specialists and patient and caregivers expectations.

Prehospital care training in a rapidly developing economy: a multi-institutional study.

BACKGROUND: The trauma pandemic is one of the leading causes of death worldwide but especially in rapidly developing economies. Perhaps, a common cause of trauma-related mortality in these settings comes from the rapid expansion of motor vehicle ownership without the corresponding expansion of national prehospital training in developed countries. The resulting road traffic injuries often never make it to the hospital in time for effective treatment, resulting in preventable disability and death. The current article examines the development of a medical first responder training program that has the potential to reduce this unnecessary morbidity and mortality. METHODS: An intensive training workshop has been differentiated into two progressive tiers: acute trauma training (ATT) and broad trauma training (BTT) protocols. These four-hour and two-day protocols, respectively, allow for the mass education of laypersons-such as police officials, fire brigade, and taxi and/or ambulance drivers-who are most likely to interact first with prehospital victims. Over 750 ATT participants and 168 BTT participants were trained across three Indian educational institutions at Jodhpur and Jaipur. Trainees were given didactic and hands-on education in a series of critical trauma topics, in addition to pretraining and post-training self-assessments to rate clinical confidence across curricular topics. Two-sample t-test statistical analyses were performed to compare pretraining and post-training confidence levels. RESULTS: Program development resulted in recruitment of a variety of career backgrounds for enrollment in both our ATT and BTT workshops. The workshops were run by local physicians from a wide spectrum of medical specialties and previously ATT-trained police officials. Statistically significant improvements in clinical confidence across all curricular topics for ATT and BTT protocols were identified (P < 0.0001). In addition, improvement in confidence after BTT training was similar in Jodhpur compared with Jaipur. CONCLUSIONS: These results suggest a promising level of reliability and reproducibility across different geographic areas in rapidly developing settings. Program expansion can offer an exponential growth in the training rate of medical first responders, which can help curb the trauma-related mortality in rapidly developing economies. Future directions will include clinical competency assessments and further progressive differentiation into higher tiers of trauma expertise.

An assessment of facilities and services at Anganwadi centers under the Integrated Child Development Service scheme in Northeast District of Delhi, India.

OBJECTIVE: The current study was aimed to assess the facilities and services being provided at the Anganwadi Centres (AWCs) by the Anganwadi workers with regards to the norms laid down by Integrated Child development Service (ICDS) scheme, with special emphasis on the children of 0-6 years of age. DESIGN: Cross-sectional study. SETTING: A resettlement colony of North-West District of Delhi, having a population of hundred thousand. PARTICIPANTS: A total of 41 AWCs were present in the study area and were included in our study. The Anganwadi workers at these AWCs were interviewed. MAIN OUTCOME MEASURES: The outcome measures were the facilities present at the AWCs and knowledge of Anganwadi workers regarding the services to be provided and revised supplementary nutrition norms laid down by ICDS. RESULTS: The AWCs in the area were covered under three projects namely Project A, B and C consisting of 18, 9 and 14 AWCs, respectively. The mean room size for all the AWCs was 108.97 ± 62.18 square feet. A weighing machine was present in 29 (70.7%) of the AWCs. Growth charts for growth monitoring of children were present in 28 (68.3%) of AWCs. A drug kit was not present in 14 (34.1%) of the 41 AWCs. The mean number of children of 0-3 years enrolled per AWC was 45.78 ± 14.07. However, the mean number of children present at the time of the visit at the AWCs was 6.24 ± 5.39. Knowledge of Anganwadi workers regarding revised norms for calorie and protein for beneficiaries was found to be poor. CONCLUSION: This study showed a lack of facilities at the AWCs and poor knowledge of Anganwadi workers. Thus a regular training and supportive supervision of the Anganwadi workers is recommended along with the availability of adequate facilities and infrastructures.

Job stressors in relation to burnout and compromised sleep among academic physicians in India.

BACKGROUND: Burnout among physicians, especially in the academic setting, is an urgent concern, with adequate sleep one of the key focal points. OBJECTIVE: To identify job stressors contributing to burnout and compromised sleep among academic physicians, using a comprehensive, theory-based instrument, the Occupational Stressor Index (OSI), whose specific form was created 'for physicians by physicians'. METHODS: This parallel mixed-methods cross-sectional investigation was conducted among 109 physicians employed in a public teaching hospital, Jodhpur, India. Work conditions were evaluated by the physician-specific OSI (part I). The Copenhagen Burnout Index and Pittsburgh Sleep Quality Index (PSQI) were the outcome instruments (part II). Seventy-six physicians completed parts I and II. RESULTS: The physicians were from wide-ranging specialties, and 82% of the cohort were residents. Mean total OSI scores were 87.4±8.1, with unit-change yielding adjusted odds-ratios (95% confidence-intervals) for personal (1.10 (1.02-1.18)) and work-related burnout (1.12 (1.04-1.22)), and PSQI (1.09 (1.01-1.17)). Significant multivariable associations with burnout and/or sleep indices included: working 7 days/week, lacking work-free vacation, insufficient rest breaks, interruptions, many patients in intensive-care, no separate time for non-clinical duties, pressure to publish, injury/suicide attempts of colleagues/staff, performing pointless tasks. The latter were described as administrative/clerical. Lacking genuine rest breaks was mainly patient-related, further compromised by emergency work and lacking separate time for non-clinical duties. Long workhours and exhausting schedule were cited as most difficult parts of work, while reducing workhours, improving work schedule, and hiring more staff most frequently recommended. CONCLUSION: Specific working conditions potentially contributory to burnout and compromised sleep among physicians working in academic medicine are identified using a methodologically-rigorous, in-depth approach. These findings inform evidence-based interventions aimed at preserving physician mental health and work capacity.

An Ambispective Community-Based Survival Study of Common Cancers in Rural Jodhpur, Rajasthan, Western India.

Background Cancer is the leading cause of death globally. Information on cancer patterns and survival is essential for the effective planning and implementation of cancer control interventions. Objective This study aimed to identify various factors associated with the survival estimates of common cancers. Methods A community-based ambispective study was conducted in a rural population. Data were collected from individuals diagnosed with cancer or relatives of individuals who died of cancer. The total population covered was 82,983. All cancer cases diagnosed since 2005 and followed until the year 2020 were included. Survival analysis and five-year survival rates were estimated. A Cox proportional hazard model was used. Results A total of 146 cancer patients were included in the study. Five-year survival estimates for breast cancer, head and neck cancer, and GI cancer were 72%, 28%, and 0%, respectively. The median survival time was lowest for GI cancers (1 year), and for head and neck and breast cancers, it was 3 and 6 years, respectively. Multivariate Cox regression was performed, adjusting for age, type of hospital, alcohol use, tobacco use, opium use, gender, treatment sought, GI cancer, frequency of changing hospitals, and frequency of follow-up. After adjustment, changing hospitals ≥3 times, being lost to follow-up, receiving no treatment, tobacco abuse, and the presence of GI cancers were significantly associated with survival estimates. Conclusions The five-year survival estimate for GI cancers was the lowest compared to other cancers. Study participants who were lost to follow-up or who took no treatment were significantly associated with lower survival estimates.

Minimal clinically important difference in maxillofacial trauma patients: a prospective cohort study.

The present study estimated the minimal clinically important difference (MCID) for pain on a visual analogue scale - numerical rating scale (VAS-NRS) and mean bite force (MBF) in patients treated for maxillofacial trauma (MFT). This cohort study included 120 MFT patients treated according to AO principles. Preoperative and four-week postoperative pain on the VAS-NRS, and MBF were measured to calculate MCIDs as indicators of functional rehabilitation. The patient's perspective of the treatment was assessed using a four-item anchor question. The MCID was determined by two anchor-based approaches, namely, the change difference (CD) method and receiver operating characteristic (ROC) curve method. According to the CD method, the MCID for pain was 2.4 and the MBF was 147.9 N. Based on the ROC curve, the MCID for pain was 2.5 (sensitivity 91.7%, specificity 47.2%) and MBF was 159.1 N (sensitivity 71.4%, specificity 61.1%). This study demonstrated a high sensitivity (>70%) for MCID, which implies that pain reduction of 2.4-2.5 points on the VAS-NRS and a gain in MBF of 147.9-159.1N are clinically relevant for patients treated for MFT.

Untapped potential of commercial drivers in providing post-crash care to road traffic accident victims: A cross-sectional study from fast urbanizing city of Jodhpur, India.

Objectives: Most road traffic accident (RTA) deaths occur before victim reaches a definitive trauma care facility. The aim of the study was to determine the role of commercial drivers toward providing post-crash care to RTA victims in Jodhpur, Rajasthan. Materials and Methods: This cross-sectional study assessed the role of commercial auto-rickshaw and cab drivers for providing post-crash care in urban Jodhpur during 2019-2020. Eligible participants volunteering for the study were included from taxi and auto stands in urban Jodhpur. A pre-tested questionnaire was administered by a trained interviewer. Data analysis was done using SPSS v23.0. Summary measures in terms of frequencies, means, and range are reported. Chi-square test, Fisher's Exact test, and Multivariate Logistic Regression analysis were done for statistical associations. Results: Two hundred male participants completed the study with a mean age of 37.74 (8.96) years having an average work experience as commercial drivers of more than 10 years. Over 70% of participants witnessed RTA in the past year and 52% provided care to victims. The knowledge of post-crash care was most affected by their education level (adjusted odds ratio [aOR]: 1.778, 95% confidence interval [CI]: 0.958, 3.301), whereas the intended post-crash care practices were significantly better among participants with previous training (aOR: 15.376, 95% CI: 2.149, 110.017). Conclusion: The current study establishes the role of commercial drivers as first responders at accident sites in the fast urbanizing city of Jodhpur, Rajasthan. Systematic capacity building initiatives of commercial drivers to salvage RTA victims have potential to strengthen pre-hospital trauma care continuum in non-metro districts of India experiencing high burden of accidents.

Application of Indian Diabetic Risk Score (IDRS) and Community Based Assessment Checklist (CBAC) as Metabolic Syndrome prediction tools.

BACKGROUND: Indian Diabetic Risk Score (IDRS) and Community Based Assessment Checklist (CBAC) are easy, inexpensive, and non-invasive tools that can be used to screen people for Metabolic Syndrome (Met S). The study aimed to explore the prediction abilities of IDRS and CBAC tools for Met S. METHODS: All the people of age ≥30 years attending the selected rural health centers were screened for Met S. We used the International Diabetes Federation (IDF) criteria to diagnose the Met S. ROC curves were plotted by taking Met S as dependent variables, and IDRS and CBAC scores as independent/prediction variables. Sensitivity (SN), specificity (SP), Positive and Negative Predictive Value (PPV and NPV), Likelihood Ratio for positive and negative tests (LR+ and LR-), Accuracy, and Youden's index were calculated for different IDRS and CBAC scores cut-offs. Data were analyzed using SPSS v.23 and MedCalc v.20.111. RESULTS: A total of 942 participants underwent the screening process. Out of them, 59 (6.4%, 95% CI: 4.90-8.12) were found to have Met S. Area Under the Curve (AUC) for IDRS in predicting Met S was 0.73 (95%CI: 0.67-0.79), with 76.3% (64.0%-85.3%) sensitivity and 54.6% (51.2%-57.8%) specificity at the cut-off of ≥60. For the CBAC score, AUC was 0.73 (95%CI: 0.66-0.79), with 84.7% (73.5%-91.7%) sensitivity and 48.8% (45.5%-52.1%) specificity at the cut-off of ≥4 (Youden's Index, 2.1). The AUCs of both parameters (IDRS and CBAC scores) were statistically significant. There was no significant difference (p = 0.833) in the AUCs of IDRS and CBAC [Difference between AUC = 0.00571]. CONCLUSION: The current study provides scientific evidence that both IDRS and CBAC have almost 73% prediction ability for Met S. Though CBAC holds relatively greater sensitivity (84.7%) than IDRS (76.3%), the difference in prediction abilities is not statistically significant. The prediction abilities of IDRS and CBAC found in this study are inadequate to qualify as Met S screening tools.

Minimal clinically important difference of mouth opening in oral submucous fibrosis patients: a retrospective study.

Objectives: The purpose of this study was to estimate the minimal clinically important difference (MCID) of mouth opening (MO) and patient satisfaction in surgically treated oral submucous fibrosis (OSMF) patients. Materials and Methods: The status of MO was collected preoperatively (T0), postoperatively at 3 months (T1), and at a minimum of 6 months postoperatively (T2). MCID was determined through the anchor-based approach with the change difference method, mean change method, and receiver operator characteristic curve (ROC) method. Results: In this study, 35 patients enrolled and completed postoperative follow-up (T2) averaging a duration of 18.1 months. At T1, using the change difference method, MO was 14.89 mm and the ROC curve exhibited a 11.5 gain in MO (sensitivity 81.8% and specificity 100%, area under the curve [AUC] of 0.902) and was classified as MCID as reported by patients. At T2, MCID of MO was 9.75 mm using the change difference method and 11.75 mm by the mean change method. The ROC curve revealed that the MCID of MO at T2 was 10.5 mm with 73.9% sensitivity and 83.3% specificity (AUC of 0.873). The kappa value was 0.91, confirming reliability of the data. Conclusion: This study demonstrated MCID values that indicate the clinical relevance of surgical treatment of OSMF if the minimum possible gain in MO is approximately 10 mm.

Adherence to healthy behavioral practices promotes COVID 19 preventive behavior among chronic disease patients: A cross-sectional study from urban Rajasthan, India.

Background: The coronavirus disease-19 (COVID-19) pandemic has led to unprecedented morbidity and mortality across the world. Chronic disease patients of urban poor neighbourhoods are one of the most vulnerable population subgroups as the number of cases and deaths increase exponentially in India. The study aims to explore the factors associated with desirable health behaviours among chronic disease patients availing care from a primary health facility and examine their association with the COVID-19 preventive behaviour. Material and Methods: A cross-sectional study was conducted among chronic disease patients attending a health centre in an urban area of Jodhpur, Rajasthan. A interviewer administered semi-structured questionnaire was pilot tested and validated prior to initiation of data collection. A total of 520 patients were enrolled for the study. Results: Poor adherence to health behaviour was observed among a majority of the respondents (infrequent physical activity: 72.0%, one or less fruit serving per day: 96.5%, one or less vegetable serving per day: 88.8%). A factor analysis revealed three domains of COVID-19 preventive behaviour: sanitisation, preventive hygiene and social distancing. Multiple regression revealed respondents opting for COVID-19 screening and those with lower salt intake followed the overall and individual COVID-19 preventive behaviour. Conclusion: The health behaviour assessment and inter-personal counselling by the health care providers at the primary health facilities may contribute to the increasing adherence for the COVID-19 preventive behaviour among chronic disease patients.

Parents' Perceptions and Intention to Vaccinate Their Children Against COVID-19: Results From a Cross-Sectional National Survey in India.

Background: Despite the success of adult vaccination against COVID-19, providing vaccines to children remains a challenge for policymakers globally. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination in India. Methods: A cross-sectional web-based study was designed, parents or caregivers (N = 770) were recruited through snowball sampling using Google form. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with sociodemographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of child vaccination intention among Indian parents. Results: Seven hundred and seventy parents across the country have completed the survey. Of the 770 participants, 258 (33.5%) have shown intent to vaccinate their children. The stated likelihood of child vaccination was greater among parents who had a bachelor's degree or higher education (aOR: 1.98, 95% CI: 1.15-3.51); as well as among parents who intended to vaccinate themselves (aOR: 2.35, 95% CI: 1.30-4.67). Parental concerns centered around vaccine safety and side effects. Conclusion: Indian parents reported high knowledge of the COVID-19 virus and were aware of the development of a vaccine. However, about one-third of parents intended to vaccinate their children, and about half of them were not sure whether to vaccinate their children or not against the COVID-19 virus. The study highlighted the need for health promotion strategies that promote vaccine uptake among parents.

Sociodemographic Determinants of Willingness and Extent to Pay for COVID-19 Vaccine in India.

Background: Responding to the fast transmission rates and increasing fatality rates, countries across the world expedited the development and deployment of the vaccine for coronavirus disease 2019 (COVID-19). Evaluation of individuals' willingness to pay (WTP) would provide pertinent information regarding future demand and financing preferences, which shall help to devise the effective payment strategy for COVID-19 vaccination. Methods: A nationwide, cross-sectional, and self-administered online survey using a structured questionnaire was conducted to identify the sociodemographic determinants of willingness and extent to pay for COVID-19 vaccine in India. A non-probability convenience sampling followed by snowball sampling was employed to recruit participants (n = 3,341). The likelihood of sociodemographic determinants to predict willingness and extent to pay was modeled using the multivariate binary logistic regression analysis. Results: Out of 3,341 participants, 68% (n = 2,271) were willingness to pay for COVID-19 vaccine. Results showed significantly higher odds for willingness to pay among participants who were single [adjusted odds ratio (aOR) = 1.394, p < 0.01] and having a family size of 4 members (aOR = 1.346, p < 0.01). The adjusted odds ratio sizably increased from 1.396 for participants whose monthly income was between INR 10,000 and 20,000/month to 2.240 for participants whose monthly income was above INR 50,000/month. Further, out of 2,271 of those participants who were willingness to pay for COVID-19 vaccine, majority (n = 1,246, 54.9%) of participants were willingness to pay below 50% of COVID-19 vaccine cost. This study found that those who are single (aOR = 0.688, p < 0.01), having an income between INR 20,000 and 50,000/month (aOR = 0.686, p < 0.05), and those who belonged to socially disadvantaged category (aOR = 0.450, p < 0.01) were estimated to have significantly lower odds of willingness to pay more than 50% of COVID-19 vaccine cost. Conclusion: This study observed that majority of those participants who willingness to pay for COVID-19 vaccine were willingness to pay only up to 50% of COVID-19 vaccine and income was observed as a precursor predictor of the willingness and extent to pay for COVID-19 vaccine. The understanding on the willingness and extent to pay for COVID-19 vaccine and its sociodemographic determinants will be helpful for making the strategic decisions related to the financing of COVID vaccine in India.

Community health workers willingness to participate in COVID-19 vaccine trials and intention to vaccinate: A cross-sectional survey in India.

Background: Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. This study aims to determine factors associated with community health workers' willingness to participate in clinical trials of COVID-19 vaccine, and their vaccination intention, in India. Methods: A cross-sectional study was conducted among 377 community health workers using self-administered anonymous questionnaire during the lockdown periods in India. Participant's socio-demographics, willingness-to-participate in COVID-19 vaccine trials, intention to accept COVID-19 vaccine were recorded in a Likert scale. Data were analysed descriptively, and a multivariate logistic regression model was used to investigate factors associated with willingness to participate and accept the vaccine. Results: Among 377 CHWs, 70 (19%) intended to participate in COVID-19 vaccine trial, 151 (40%) responded positively regarding their intention to get vaccinated. Those with knowledge on development of COVID-19 vaccine [aOR 3.05 (95% CI: 1.18-7.88), p = 0.021], and men [aOR 3.69 (95% CI: 1.51-8.97), p = 0.004] were more willing to participate in clinical-trial, while an undergraduate degree, and trust in domestic vaccines were identified as deterrents for the same. Perceiving COVID-19 as risk [aOR 2.31 (95% CI: 1.24-4.31), p = 0.009], and male gender [aOR 2.39 (95% CI: 1.17-4.88), p = 0.017] were factors associated with intention to get vaccinated. Respondents who had knowledge about COVID-19 virus were less likely to uptake the hypothetical vaccine [aOR 0.32 (95% CI: 0.12-0.88), p = 0.027]. Conclusions: Increasing knowledge regarding COVID-19 is not enough to improve vaccine acceptance rates. Targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance.

Trends in willingness to receive COVID-19 vaccines among healthcare workers in India: Findings from repeated cross-sectional national surveys.

Background: COVID-19 vaccination of the healthcare workers (HCWs) is a key priority in the fight against the SARS-CoV-2 pandemic. India launched its COVID-19 vaccination program in January 2021. We aimed to understand the trends in willingness to receive COVID-19 vaccines and its associated factors among HCWs in India. Methods: Using a repeated cross-sectional survey design, we collected information from HCWs in three critical time points: before (n = 937, October 2020), during (n = 1346, January 2021); and after (n = 812, May 2021) the introduction of COVID-19 vaccines in India. The third survey coincided with the peak of the second wave of COVID-19 pandemic in India. Findings: Of the study participants, 43.7, 60.2, and 73.2% were willing to receive COVID-19 vaccines during the first, second and third rounds of surveys, respectively. In multivariable logistic regression analysis, participants who trusted the health care system were more likely to report willingness to receive a COVID-19 vaccine; medical trust emerged as a significant factor in all the three rounds of surveys (First survey-aOR: 2.24, 95% CI: 1.67-2.99; Second survey-aOR: 3.38, 95% CI: 2.64-4.33; Third survey-aOR: 2.54, 95% CI: 1.65-3.91). Having confidence in domestic vaccines (Second survey-aOR: 2.21, 95% CI: 1.61-3.02; Third survey-aOR: 2.05, 95% CI: 1.24-3.37); and high perceived risk of contracting COVID-19 (Second survey-aOR: 1.48, 95% CI: 1.13-1.93; Third survey-aOR: 2.02, 95% CI: 1.31-3.13) were found to be associated with willingness to receive vaccines. Among socio-demographic characteristics, being married (aOR: 1.71, 95% CI: 1.08-2.71) and having high socio-economic status (aOR: 3.01, 95% CI: 1.65-5.51) emerged as significant factors associated with willingness to receive COVID-19 vaccines in the third round of the surveys. Interpretation: Willingness to receive COVID-19 vaccine increased with time, as the severity of the pandemic increased. To increase COVID-19 acceptance and coverage among HCWs, it is important to instill confidence in domestic vaccines and assist in accurate assessment of risk toward contracting COVID-19 infection.