Prevalence and Predictors of Mental Health Disorder Among the Adolescent Living in the Slums of Lucknow, India: A Cross-Sectional Study.

India is the home of more than 253 million adolescents, which account for almost 21% of the country's population. In the recent past, there has been a rise in the prevalence of mental illness and maladaptive behaviours among adolescents living in slum populations, which are increasing at an alarming rate in many developing countries, mainly due to rural-urban migration, are characterized by poverty, poor housing, overcrowding, poor environment, and high prevalence of communicable diseases. This neglected population has become a major reservoir for a broad spectrum of adverse health conditions. Studies on the mental health status among adolescents in India are relatively scarce. The main objective of the study was to estimate the prevalence of mental health disorder and its determinants among adolescents in slum settings in Lucknow, India; by using GHQ-12. The study used cross-sectional primary data which was collected in 2015-2016 from the adolescents living in various slums of Lucknow city. About 590 adolescents whose parents gave consent to participate were included in the study. Descriptive statistics, Chi square test and ordered logistic regression analysis (OLR) technique were used to assess the mental health. Reliability of GHQ-12 was assessed before performing the analysis which was found to be 0.79. Approximately, 33% of adolescents were found to suffer from severe level of mental disorder. The results of this study depicts that adolescents of age 12-15 years had more severe mental health problems compares to 16-19 years of adolescents. Females were more likely to suffer from severe mental health problems compared to moderate/normal mental health problems (OR 1.72; p < 0.001). Odds of severe mental health problems was significantly higher among Muslims (OR 1.66; p < 0.001) than Hindus. Thus, it was found that age, gender, education, caste, household economic status, media exposure and religion to be significantly associated with mental health problem. Government should provide a wide range of adolescent friendly health services (clinical, mental, nutritional, including counselling) in these slums for a better adolescent health outcome.

Morbidity transition at the national and sub-national level and their determinants over the past and contemporary period in India.

The study delves into the epidemiological transition, examining the intricate changes in health status patterns and their connection to morbidities. Specifically, it assesses morbidity transition at both national and subnational levels in India and their determinants from 1995 to 2018. This study examines self-reported morbidities in India by utilising four rounds of National Sample Survey Organisation (NSSO) data (52nd, 60th, 71st, and 75th) from 1995-2018. We estimated prevalence by conducting descriptive analysis on socio-demographic determinants and morbidities such as: Infectious and Communicable Diseases (In&CDs), Non-communicable diseases (NCDs), Disability and other diseases. Moreover, we employed pooled regression analysis to explore morbidity risk transitions over the past decades. The study revealed a steady upsurge in morbidity prevalence in India, doubling from 56 (per thousand) in 1995 to 106 in 2014. However, a considerable decline was observed in the most recent round in 2018 (79 per thousand). From 1995 to 2018, NCDs gained a prominent share in morbidity trends. Kerala in the southern region reported the highest rates, followed by states like Lakshadweep, Andhra Pradesh, Karnataka, West Bengal, Punjab, and others. Age, sex, residence, education, caste, religion, and wealth are pivotal factors in determining the severity of different disease burdens in different sections of the population in India. Over the study period (1995, 2004, 2014, and 2018), the odds of reported morbidities risk transition significantly increased over successive decades: 1.81 times in 2004 (95% CI: 1.78-1.84), 2.16 times in 2014 (95% CI: 2.12-2.2), and 1.44 times in 2018 (95% CI: 1.41-1.46), compared to 1995 (52nd round). The study reveals significant disparities in morbidity reporting across Indian states from 1995 to 2018, attributed to distinct demographic, social, and economic determinants. India continues to grapple with the dual burden of diseases, but the NCDs burden is mounting at a faster pace than CDs.

Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis.

BACKGROUND: Tobacco use is associated with early, intermediate and long-term complications throughout the life course. With an influx of newer products containing nicotine, poly-tobacco use is slowly emerging as a public health concern, that is defined as existing tobacco users currently using two or more tobacco or nicotine products. While many studies have investigated single use tobacco, there is a paucity of research on regional patterns and socio-demographic factors associated with poly-tobacco use in India. OBJECTIVES: To assess prevalence of poly-tobacco use and determine the socio-demographic factors associated with poly-tobacco use in India. METHODS: Data from the Global Adult Tobacco Survey 2 (GATS, 2016-17) was analysed, which included information on tobacco use among people aged >15 years. The pattern of current tobacco status was described using descriptive statistics. Multiple logistic regression models were estimated to determine factors associated with poly-tobacco use. RESULTS: The prevalence of poly-tobacco use in India was found to be 9.8%. Among the current tobacco users, the prevalence was 33%. Significant socio-demographic factors associated with poly-tobacco use included younger age, male gender, religion and backward caste. North-eastern region reported highest prevalence of poly-tobacco use in the country, followed by the central region. CONCLUSION: The number of poly-tobacco users in India is considerably high and a matter of concern, more so in north east and central regions of the country. There is a need to create awareness about dangerous effects of all types of tobacco products and strengthen implementation of tobacco control policies with special focus on regions with high burden.

A study of deterioration of pulmonary function parameters among smokers and recovery among ex-smokers in bus depot workers.

Smoking has deleterious effects on Pulmonary Function Test (PFT) parameters; however, evidences about recovery in ex-smokers are ambiguous. Therefore present study was conducted to quantify relative deterioration of PFT parameters and to assess reversibility of the same. A cross-sectional study was conducted on 84 bus-depot workers consisting of equal number of smokers, ex-smokers and non-smokers. PFT observations were obtained using Medspiror following standard methods and precautions. Comparisons among three groups were performed employing one-way ANOVA and post-hoc tests. There were substantial effects of smoking on PFT parameters (deterioration was up-to half). Partial recovery was found in all the parameters of ex-smokers. Frequency and duration of smoking were negatively correlated with some of the parameters. In conclusion, present study has demonstrated considerable deterioration of PFT parameters in smokers and indications of recovery in ex-smokers. Further detailed study with larger sample size and stricter definition of ex-smokers is recommended.

Blood pressure responses to steady treadmill exercise in overweight and obese young adults.

Overweight and obesity are major risk factors for chronic diseases. There exists an autonomic imbalance in these persons. The blood pressure response to exercise is an useful method to evaluate cardiac status. Hence this project was undertaken to study the blood pressure responses to steady treadmill exercise in overweight and obese persons. The study was carried out on 85 young healthy adults (Normal weight = 30, Overweight = 25 and Obese = 30) in the age group of 18-22 yrs. Steady dynamic exercise test was done on treadmill for 5 mins. Blood pressure and Pulse rate were recorded before, during 3rd min of exercise, immediately after cessation of exercise and after 5 mins of recovery. Statistical analysis was done using one way ANOVA followed by post-hoc tests for between group comparisons. The resting blood pressure was higher in overweight and obese group when compared to normal group. There was increased systolic pressure response to exercise in study groups where as the diastolic pressure decreased during exercise. Heart rate response was also higher in study groups. Over weight and obese young adults had elevated resting blood pressure and showed increased response to steady exercise which could be due to alterations in the autonomic activity in these persons.

Is Video Podcast Supplementation as a Learning Aid Beneficial to Dental Students?

INTRODUCTION: Podcasting has recently emerged as an important information technology tool for health professionals. Podcasts can be viewed online or downloaded to a user computer or a handheld multimedia device like a portable MP3 player, smart phone and tablet device. The principal advantage of the podcast is that the presentation of information need not be linked with any particular time or location. Since students are familiar with newer technology tools and may be using it on a regular basis, video podcast could serve as a convenient tool for students to help remember both conceptual and factual information. AIM: The purpose of this study was to assess the attitude of first year dental students towards video podcast supplementation and to assess the efficacy of video podcast as a teaching aid in comparison to text book reading. MATERIALS AND METHODS: First year dental students were recruited for this study. A didactic lecture class was conducted for the students (n=100). The students were then randomly divided into two groups. Students present in group A (n=46) underwent a video podcast session followed by a multiple choice question test. This was followed by student feedback to assess the usefulness of video podcast. Students belonging to group B (n=54) had a study session for 20 minutes followed by the MCQ test. Students then underwent the video podcast session followed by feedback to assess the utility of video podcast. Mann-Whitney U test was applied to compare the difference in the median MCQ score between the two groups. RESULTS: The findings revealed a significant gain in the median MCQ score in the intervention group (group A) when compared to control group (Group B). In the feedback form, 89% of students agreed that the video podcast might be useful as it would enable them to view slides and hear the lectures repeatedly. CONCLUSION: Students who underwent the video podcast session performed significantly better in the MCQ test compared to students who underwent text book reading alone. This demonstrates an advantage of video podcasts over text book reading. Majority of students accepted the benefits of video podcast supplementation.

Some basic aspects of statistical methods and sample size determination in health science research.

A health science researcher may sometimes wonder "why statistical methods are so important in research?" Simple answer is that, statistical methods are used throughout a study that includes planning, designing, collecting data, analyzing and drawing meaningful interpretation and report the findings. Hence, it is important that a researcher knows the concepts of at least basic statistical methods used at various stages of a research study. This helps the researcher in the conduct of an appropriately well-designed study leading to valid and reliable results that can be generalized to the population. A well-designed study possesses fewer biases, which intern gives precise, valid and reliable results. There are many statistical methods and tests that are used at various stages of a research. In this communication, we discuss the overall importance of statistical considerations in medical research with the main emphasis on estimating minimum sample size for different study objectives.

Team-based learning as a teaching strategy for first-year medical students.

BACKGROUND: Teaching programmes in medical education are now routinely employing active learning strategies to enhance the learning process and engage students in higher levels of learning. Team-based learning (TBL) is one active learning strategy that builds on individuals' strengths by allowing them to collaborate and work as a team to achieve a common learning objective. AIMS: The present study aims to evaluate the impact of TBL on student performance. It also aims to assess students' attitudes towards TBL and the feasibility of its incorporation into the course curriculum. METHODS: From a class of 241 students, 128 who agreed to participate in the study underwent two sessions of TBL each consisting of Individual and Group Readiness Assurance Tests (IRATs and GRATs). The readiness assurance tests each had 13 multiple choice questions (MCQ). To analyse the impact of TBL supplementation, the median sessional MCQ scores of students who underwent TBL supplementation (group 1) were compared with those who did not undergo the session (group 2). Students' experiences with TBL and their attitudes towards incorporation of TBL into the course curriculum were analysed using a feedback questionnaire that was given to students who underwent TBL. RESULTS: Students belonging to the TBL group performed significantly better than the students who did not undergo TBL (p<0.001). The median sessional MCQ score of the TBL group was seven and non-TBL group was six. The overall mean attitude score obtained from feedback questionnaires was 3.57, which indicates a positive attitude towards TBL. CONCLUSION: The team-based learning session improved student engagement with course content. The majority of the students felt that TBL supplementation enhanced their understanding of course content and believe that it will help them perform better in their exams.

Discovery of the CCR1 antagonist, BMS-817399, for the treatment of rheumatoid arthritis.

High-affinity, functionally potent, urea-based antagonists of CCR1 have been discovered. Modulation of PXR transactivation has revealed the selective and orally bioavailable CCR1 antagonist BMS-817399 (29), which entered clinical trials for the treatment of rheumatoid arthritis.

Expansion of Masood's cytologic index for breast carcinoma and its validity.

BACKGROUND: The incidence of breast carcinoma is increasing in developing countries due to adoption of western life-style. Fine-needle aspiration cytology is the initial method to evaluate the palpable breast lesions. The neoadjuvant therapy is helpful in treating high grade rather than low grade breast carcinomas. Masood cytologic index (MCI) delineates all the breast lesions into four groups. The carcinoma group is not graded further. AIM: The present study proposes a method for the expansion of carcinoma group into three grades. MATERIALS AND METHODS: A total of 50 breast carcinoma cases were prospectively studied by comparing expansion of MCI with modified bloom Richardson (MBR) grading over a period of 3 years. RESULTS: Altogether 43/50 cases (86%) had concordance with histopathological grading. The analysis revealed a R2 value of 60%, which was significant. The P value of anisonucleosis, nucleoli and chromatin pattern were 0.001, 0.049 and 0.02 respectively, which were significant. CONCLUSIONS: The present study with the expansion of carcinoma category of MCI into three grades similar to MBR will help the treating surgeon to plan the management accordingly. The results obtained in this study need to be subjected to multicentric study with a large number of cases.

Efficacy and perceived utility of podcasts as a supplementary teaching aid among first-year dental students.

BACKGROUND: The advent of newer technology and students' growing familiarity with it has enabled information providers to introduce newer teaching methods such as audio podcasting in education. Inclusion of audio podcasts as a teaching aid for undergraduate medical or dental students could serve as a useful supplement to make reviewing more convenient and to enhance understanding and recall of the subject matter. AIMS: To assess the efficacy of podcasts as a supplementary teaching and learning aid for first-year dental students of Manipal.To study students' attitudes towards audio podcasts and perceived utility of podcasts. METHOD: This study was conducted at the Manipal College of Dental Sciences, India. The participants were first-year dental students. Live lecture classes were conducted for the students (n=80). The students were then divided randomly into two equal groups of 40 each. Group 1 students (n=40) had a study session followed by a multiple choice question (MCQ) test. This was followed by a podcasting session. Group 2 students had a study session along with an opportunity to listen to a podcast, followed by the test. Following this both groups completed a feedback form intended to assess their perceived utility and attitude towards podcasts. The performance score was analysed using SPSS and an independent sample t test was used to test the significance of differences in the mean score between the two groups. RESULTS: Our analysis revealed a significant difference (p = 0.000) in the mean score between the two groups. Group 1 scored a mean of 7.95 out of 13 and group 2 scored a mean of 6.05 out of 13. Analysis of the feedback forms showed that 91.3 per cent of the students found the podcasts useful, as they could listen to lecture content repeatedly and at their own convenience. Sixty-three per cent of the students, however, felt that the absence of images and diagrams in podcasts was a disadvantage. CONCLUSION: Students benefited when podcasts were used to supplement live lectures and textbook content. This was indicated by better student performance in the podcast group. Also, students showed a favourable attitude for podcasts being used as a supplementary teaching and learning aid.

Introducing physiology practical demonstration in course curriculum for the first year nursing students.

INTRODUCTION: Combination of didactic lecture, practical demonstration and performing experiments by students is followed in medicine, dentistry and bachelor of pharmaceutical sciences. The purpose of this study was to assess the attitudes of nursing students towards practical demonstration in physiology. MATERIAL AND METHODS: Seventy three nursing students of the first year underwent practical demonstration of Physiology experiments. Students indicated their agreement or disagreement with the 8 items by ticking one of the five alternative responses. Mean attitude scores were calculated for each item and for the total scale. RESULTS: The overall mean attitude score of 3.76 was towards the favourable side. Eighty seven percent of students agreed that practical demonstration reinforces concepts. Eighty nine percent of students found practical demonstration is a good form of learning experience. CONCLUSION: The introduction of practical demonstration in addition to didactic lectures may help the students in understanding concepts in Physiology.

Health status of the prisoners in a central jail of South India.

BACKGROUND: Health care in prisons is one of the neglected health areas in our country. Looking into the health problems of prisons will show us a way for the approach in providing the heath care for prisoners. OBJECTIVES: To assess the health status of convicted inmates of prison and to study their sociodemographic profile. MATERIALS AND METHODS: A cross-sectional study was conducted among the inmates of central prison over a period of 1 year. Study population comprised of 300 convicted life-term prisoners. The inmates were interviewed using predesigned and pretested proforma. Sociodemographic data were analyzed by frequencies and percentages along with 95% confidence interval using statistical package SPSS18. RESULTS: In health status, 29 (9.6%) inmates suffered from acute upper respiratory tract infections and 15 (5%) from acute lower respiratory tract infections. A total of 54 (18%) inmates had ascariasis. Diseases of musculoskeletal system and connective tissue contributed to 26 (8.7%) of inmates. A total of 252 (84%) prisoners had anemia. In sociodemographic profile, it was found that rural people, unmarried, illiterates, lower socioeconomic status people were more likely to have committed the crime resulting in the conviction for life. CONCLUSIONS: As there is an increase in number of prisoners and morbidities among them, there is an urgent need for prison health care services in developing countries like India and provide training to the health care providers to manage the commonly existing health problems among prisoners in the prisons.

Manual liquid based cytology in primary screening for cervical cancer--a cost effective preposition for scarce resource settings.

Conventional pap smear (CPS) examination has been the mainstay for early detection of cervical cancer. However, its widespread use has not been possible due to the inherent limitations, like presence of obscuring blood and inflammation, reducing its sensitivity considerably. Automated methods in use in developed countries may not be affordable in the developing countries due to paucity of resources. On the other hand, manual liquid based cytology (MLBC) is a technique that is cost effective and improves detection of precursor lesions and specimen adequacy. Therefore the aim of the study was to compare the utility of MLBC with that of CPS in cervical cancer screening. A prospective study of 100 cases through MLBC and CPS was conducted from October 2009 to July 2010, in a Medical College in India, by two independent pathologists and correlated with histopathology (22 cases). Morphological features as seen through MLBC and CPS were compared. Subsequently, all the cases were grouped based on cytological diagnosis according to two methods into 10 groups and a subjective comparison was made. In order to compare the validity of MLBC with CPS in case of major diagnoses, sensitivity and specificity of the two methods were estimated considering histological examination as the gold standard. Increased detection rate with MLBC was 150%. The concordance rate by LBC/histopathology v/s CPS/histopathology was also improved (86% vs 77%) The percentage agreement by the two methods was 68%. MLBC was more sensitive in diagnosis of LSIL and more specific in the diagnosis of inflammation. Thus, MLBC was found to be better than CPS in diagnosis of precursor lesions. It provided better morphology with increased detection of abnormalities and preservation of specimen for cell block and ancillary studies like immunocytochemistry and HPV detection. Therefore, it can be used as alternative strategy for cervical cancer prevention in limited resource settings.

Validity of different cytological grading systems of breast carcinoma--a hospital-based study in South India.

INTRODUCTION: With increase in the incidence of breast carcinoma, fine needle aspiration cytology (FNAC) has began to play a major role in diagnosing and grading. The study was aimed at validating the different cytological grading systems like Hunt's cytological grading (HCG), modified black grading (MBG), Robinson's cytological grading (RCG) and Masood's cytology index (MCI) in comparison with a modified Bloom-Richardson (MBR) histopathological grading. METHODS AND MATERIAL: Fifty breast carcinoma cases were prospectively studied by comparing various cytological grading methods with histopathological grading over a period of three years. All statistical analyses were carried out with the Epi-info package. RESULTS: The concordance rate of RCG was 82% which is highest of all, while that of MBG was 68%. HCG and MCI were not comparable with MBR due to insufficient grading. CONCLUSIONS: RCG for breast carcinoma is validated. A consensus for a standard cytological grading method similar to the gold standard MBR histological grading must be arrived at based on conducted comparative studies and has to be inculcated in routine cytology reports.

Population based studies of cancer survival: scope for the developing countries.

Survival refers to the life of a person after diagnosis of disease, and survival studies have the objective of evaluating the overall performance of a group of patients in terms of quality and quantity of life after the diagnosis or treatment. Potentially there are two approaches for the study of population-based survival; direct (classical) and indirect. The direct approach refers to defining a cohort of patients and collecting follow-up information, whereas the indirect approach uses current data on incidence and mortality for estimating various segments of life. In general, there are numerous difficulties in the conduct of population-based survival studies by the classical method, especially in the set-up of developing countries. These include time and finance required for the conduct of the study, the problem of loss to follow-up and also the time gap between the year of diagnosis of patients and the availability of results on their survival. In fact the problem of time gap is recognized even in the developed world. There have been many studies highlighting these problems and suggesting potential solutions. Generally they have focused on three directions: viz, improving the address information and thereby reducing the loss to follow-up; development of methodologies to deal with the losses to follow-up and indirect studies of cancer survival, thereby obviating the follow-up process. This commentary covers the potential approaches of population-based survival studies, classical survival studies, problems in the same, and methods adopted for their solution. A summary of the conceptual and methodological developments on these concepts, highlighting the scope for the developing countries, is also presented.

An indirect study of cancer survival in the context of developing countries.

With classical approaches, survival refers to the life of a person after diagnosis of disease, and survival studies deal with measurement of the same to evaluate overall performance of a group of patients in terms of quality and quantity of life after diagnosis/treatment. There are numerous difficulties in the conduct of a population-based survival study in the context of developing countries, including India. Loss to follow-up is a typical problem encountered, causing biased estimates. In view of this difficulty with the classical approach, the objective of this study was to propose an indirect methodology for the study of survival. The proposed methodology is based on life table techniques and uses current data on incidence and mortality from the disease. It involves the estimation of person years free of disease (PYFD), person years with disease (PYWD), person years of life lost (PYLL) and average duration of disease (ADD) and their comparison over a time period. Empirical application was carried out for mouth and lung cancers in males and cancers of breast and cervix in females as well as for all sites combined together in each sex. Cancer incidence and mortality data by age and sex for the years 1989, 1993, 1997 and 2001 were obtained from published reports of Mumbai Cancer Registry, India. All causes of deaths for these years were obtained from Mumbai Municipal Corporation. Three life tables were constructed by applying various attrition factors: (a) risk of death from all causes; (b) risk of incidence and that of death from other causes; and (c) risk of death from other causes only. The expectation of life from the second life table gave PYFD. PYWD and PYLL were calculated by suitable subtractions among three expectations of life. ADD was calculated by dividing person years lived with disease by number developing the disease. It was noted that during 1993-2001, PYFD for all sites increased from 59.4 to 62.1 and from 63.8 to 66 years in males and females respectively. PYLL was about 0.8 year in males and 1 year in females. Similarly, PYWD was 0.6 and 1 year in males and females. ADD for all sites varied from 4 to 4.7 years in both sexes. It was about 6 years for mouth cancers and 2 years for lung cancers in males and 4-5 years for breast and cervical cancers in females. Validation of the ADD was carried out by comparison with published data for calculating median duration of disease. Given the difficulties in conduct of classical survival studies, the proposed method may provide a useful tool for having a regular audit of prognostic factors in the community.

Study of social loss or gain from a particular cause: scope for the developing countries - a review with reference to cancer.

Incidence rates have long been used to assess the burden of different diseases in a population, whereas loss due to occurrence of diseases is studied using the death rates. Death rates however, are based on and therefore describe, only number of lives lost. There have been two approaches to arrive at the actual loss or gain from a particular cause viz. Person years of life lost (PYLL) approach and cause elimination life table (CELT) approach. This review covers these approaches and the competing risk theory and models focusing on the methodological developments. A summary of the conceptual and methodological developments on these concepts has also been presented. There are eight possible approaches in dealing with the loss in the presence or gain in the absence of a particular cause of death depending upon the preferences related to PYLL/CELT approach, modeling/descriptive approach, considering or without considering competing causes. A close look at the two basic approaches reveals that PYLL and cause elimination are just different terminologies used to address the same quantity, loss in the presence or gain in the absence. As far as descriptive vs. modeling approaches are concerned, all the descriptive procedures can be put in the form of models and all the models can be presented in a descriptive way. Regarding results using different models, no practical difference exists in the results based on different models for competing risks. However, exclusion of the competing risks may result in a considerable bias in the developing countries where general mortality is relatively higher. This review study suggests freedom in the selection of a modeling or a descriptive approach without any considerable loss of accuracy but at the same time emphasizes the consideration of the competing risks. An empirical study may be recommended to confirm the conclusions of this study.