Screen Time beyond Gaming and Social Media: Excessive and Problematic Use of Over the Top (OTT) Platforms among College Students during COVID-19 Pandemic.

There is a gap in existing literature regarding Over the Top (OTT) platform use contributing to the excessive and problematic screen time. We aimed to assess OTT platform use among college students and its associations with increased screen time, mental well-being, COVID-19 related anxiety and personality traits. A total of 1039 students from a college in India were invited to participate in this web-based survey. A majority of participants used OTT platforms regularly. Subscription to paid OTT platforms, poor mental well-being were associated with problematic OTT use; whereas personality trait of conscientiousness seemed to offer protection against problematic OTT use.

Impact of lockdown following COVID-19 on the gaming behavior of college students.

BACKGROUND: The uncertainty about the impact of the lockdown in wake of COVID-19 on their future academic and carrier prospects, besides other concerns; makes college students, particularly vulnerable to stress during the COVID-19 pandemic. Gaming has been recognized as a coping mechanism against stress in the previously published literature. OBJECTIVES: The current study aimed to assess the gaming behavior of college students during the lockdown following COVID-19. METHODS: Data were collected from a cohort of students that constituted the sampling frame of an ongoing project. A total of 393 college students were enrolled. All the eligible students were subsequently contacted through E-mail and WhatsApp messenger and invited to share the details. RESULTS: About half (50.8%) of the participants reported that their gaming behavior had increased, whereas 14.6% reported a decrease in their gaming during the lockdown period. In binary logistic regression analysis, hours of gaming per day (odds ratio [OR] 1.75 [1.29-2.36]), increase in gaming due to examination related stress (OR 4.96 [1.12-21.98]), and belief that gaming helps managing stress (OR 4.27 [1.65-11.04]), were found to be independently associated with gaming behavior during lockdown period. CONCLUSION: In the lockdown period following COVID-19 pandemic, the increase in gaming behavior was associated with examination-related stress and the belief that gaming helps combat stress. These observations highlight the need to focus on the coping style of the students to ascertain the likelihood of them engaging in gaming behavior as a coping mechanism against stress.

Knowledge of schoolteachers on learning disabilities in urban Vellore - A cross-sectional study.

Background: Specific learning disability (SLD) is a cognitive neurobiological disorder caused by atypical brain functioning. SLD is recognized when the individual's achievement in school is below that expected for age, schooling, and level of intelligence. Screening millions of students with SLD by health personnel is a logistical impossibility. Awareness and knowledge about learning disorders among schoolteachers may play a major role in the early identification and management of children with these disorders. Therefore, the assessment of teachers' knowledge and perceptions about learning disabilities (LDs) is relevant. Method: A school-based cross-sectional study was conducted among teachers in government/government-aided and private schools in Vellore, India. The participants were selected by a simple random sampling method. There was a total of 80 teachers included in the study. Data capture was done using a questionnaire. A Chi-square test was done to test the association and the odds ratio test helped determine the strength of the association. A P-value of <0.05 was considered to be statistically significant. Results: The majority of the teachers (70%) had adequate general knowledge regarding LDs. When analyzed separately, 82.5% of government/aided teachers and only 57.5% of teachers were having adequate general knowledge regarding LDs. There was a significant association between the type of school and general knowledge regarding LDs. Government/aided teachers had better general knowledge regarding LDs and dyslexia than private teachers. Conclusions: Among 80 teachers, 70% (56) of them had adequate general knowledge regarding LDs. When analyzed separately, 82.5% (33) of government/aided teachers and only 57.5% (23) teachers were having adequate general knowledge regarding LDs. The government/aided schoolteachers had significantly higher levels of knowledge in most domains of the general knowledge section as compared to private schoolteachers. If teachers are having adequate knowledge regarding LDs, it will significantly increase the chances of children with LDs getting detected early and undergoing the treatment they require. Teacher education programs and workshops are needed to be conducted at regular intervals to improve the knowledge regarding SLDs among teachers.

Body image perception, eating disorder behavior, self-esteem and quality of life: a cross-sectional study among female medical students.

BACKGROUND: Eating disorders are strongly associated with body image concerns. Eating disorders tend to significantly impact the current and future health and quality of life of affected persons, their caregivers, and society. As body image is based on a social construct of ideal body image, it is essential to evaluate it in its cultural context. METHODS: The current study explored the relationship among body image perception, perceived stress, eating disorder behaviour and quality of life among female medical students (n = 777). Measurements included Body Shape Questionnaire, Body Image Quality of Life Inventory, Eating Attitudes Test-26 and Rosenberg Self-Esteem Scale. Multivariate analysis was conducted. RESULTS: There was a significant correlation between eating disorder behaviour and perceived body shape, body image, quality of life and self-esteem among our study participants. We also found eating disorder status was significantly associated with BMI, perceived body shape, quality of life and self-esteem. CONCLUSIONS: This is of clinical implication to female medical students and healthcare professionals to engage early in primary and secondary prevention of eating pathologies. Increasing awareness of these facts among female students can help identify at-risk students and help them seek timely medical help.

Eating disorders significantly impact the current and future health and quality of life of affected persons, their caregivers, and society. Young people are persistently flooded with social media conceptualizations of what beauty should look like. The current study explored the relationship between how we perceive our body, perceived stress, maladaptive eating behaviours and quality of life among female medical students (n=777). Measurements included those measuring perceived body shape and body image, quality of life, eating attitudes, and self-esteem. We found that a preoccupation with weight and food, crash diets, fasting, binge eating, and purging behaviours was related to how we perceived our body shape, our quality of life and self-esteem among the study participants. This is important for female medical students and healthcare professionals because it enables them to identify students at risk of eating disorders and assist them in obtaining timely medical help, thus promoting early prevention.

Trazodone for sleep disturbance in opioid dependent patients maintained on buprenorphine: A double blind, placebo-controlled trial.

BACKGROUND: Sleep disturbances are seen even in individuals on opioid agonist treatment (OAT). Established pharmacotherapy for sleep disturbances such as benzodiazepines have misuse potential and increased mortality risk in patients with OAT. No study has explored the role of trazodone on sleep disturbance in individuals maintained on buprenorphine. We aimed to assess the efficacy of trazodone in improving sleep disturbance among individuals maintained on buprenorphine. METHODS: The study was a double-blind, placebo-controlled, parallel, randomised trial. Adult males (18-60 years) stabilised on buprenorphine with Pittsburgh Sleep Quality Index (PSQI) score of above five, without other psychiatric comorbidity were randomised to receive either trazodone (50-150mg per day) or placebo. Sleep-50 questionnaire, Epworth Sleepiness Scale (ESS), Brief Pain Inventory (BPI), Clinical Opiate Withdrawal Scale (COWS), Depression, Anxiety and Stress Scale (DASS)-21, Visual Analogue Scale (VAS) for opioid craving, and PSQI were assessed at baseline and at the end of six weeks. RESULTS: Fifty-one patients were allocated to trazodone arm and 49 to placebo arm. Side-effects of trazodone were minimal and well-tolerated with comparable discontiuation rates between both groups. Significantly greater proportion of patients on trazodone (82%, mean dose 101.9 mg) had PSQI scores five or less than those on placebo (16%) at the end of six weeks. Sleep improvement was in various components like sleep quality, latency, efficiency, and duration of sleep. CONCLUSION: Trazodone is well-tolerated and effective in improving sleep disturbances in individuals with opioid dependence maintained on buprenorphine over a six-week period.

Cognitive dysfunction and disability in people living with schizophrenia.

Background: Schizophrenia is a major mental disorder characterized by positive, negative, and cognitive symptoms. Cognitive impairment is a central and enduring feature of schizophrenia and is associated with disability. It has a devastating consequence on the individuals, families, and the society. Our aim was to assess cognitive functioning, disability, and their association with sociodemographic and illness-related variables. Methodology: In an outpatient department of psychiatry, 82 adult patients with a diagnosis of schizophrenia were recruited. Schizophrenia Cognition Rating Scale (SCoRS), Positive and Negative Syndrome Scale (PANSS), and Indian Disability Evaluation and Assessment Scale (IDEAS) were used to assess cognitive function, psychopathology, and disability respectively. Socio-demographic and illness-related details were collected using a semi-structured questionnaire. Data were analyzed using STATA version 16.0 using appropriate statistical tests. Results: Approximately 93.9% of patients had at least one cognitive symptom even though not severe. The status of being married was associated with better cognitive outcome. No other socio-demographic factor was associated with cognitive dysfunction. Negative symptoms and general psychopathology scores of PANSS were positively correlated with SCoRS scores and IDEAS score. Cognitive dysfunction and disability were significantly associated suggesting higher the cognitive deficit in schizophrenia greater is the likelihood of patient experiencing disability. Conclusion: Cognitive deficits are commonly seen in patients with schizophrenia and are associated with disability. Therefore, treatment programs of schizophrenia should have a component to address these deficits using evidence-based cognitive remediation therapies. Family Physicians caring for those with schizophrenia should factor the cognitive deficits and simplify dosage regime and engage caregivers for supervision.

Maintenance electroconvulsive therapy: Are we clutching at straws?

Introduction: The available treatment options for patients with drug or treatment-resistant psychiatric disorders are limited. Maintenance electroconvulsive therapy (M-ECT) is an established option, but the literature available is limited. This study examined the utilization of M-ECT in a large tertiary care psychiatric facility, and its correlates with the socio-demographic and clinical profile of patients. Methods: A retrospective chart review was performed in a tertiary care psychiatry center based in semi-urban South India, and data was analyzed. Results: A total of 171 patients received ECT in the study period, of which only five patients were on M-ECT. These patients were diagnosed as treatment-resistant and were mostly suffering from schizophrenia. They were located less than 30 km from the hospital. They were on regular treatment but continued to have residual symptoms without functional recovery and required a high level of support from caregivers. Conclusion: Our study supports the effectiveness of M-ECT for the treatment of severe psychiatric disorders and highlights the profile of patients who have received this modality of treatment. It can be suggested with consideration of various psycho-social issues which seem to be related to adherence.

Wounded Healers of the Pandemic: A Qualitative Study on Mental Health and Protective Factors of Physicians Who Recovered from COVID-19.

Backgroud: Physicians are at a high risk of being infected by coronavirus disease (COVID-19). Methodology: Our aim was to understand lived experiences of physicians who recovered from COVID-19 by focusing on mental health and psycho-social protective factors through a qualitative study using a narrative approach. A semi-structured questionnaire was outlined referring to literature and seeking experts' opinions. Telephonic interviews were conducted after fulfilling the inclusion criteria. Interviews were transcribed verbatim, and narratives were written and interpreted. Results: Mental health concerns identified from the narratives of five physicians are fear of infecting others, feeling guilty of transmitting infection, stigma, loneliness, and worry about complications after recovery. Social support, faith in a higher power, sense of purpose, and resilience were their sources of strength. Conclusion: Given the vulnerability and professional commitment to serve people, there is an urgent need to address their mental health needs. Support groups and having interactions with mental health professionals during periods of isolation are some recommendations.

Weight Stigma in Patients With Obesity and Its Clinical Correlates: A Perspective From an Indian Bariatric Clinic.

Introduction Obesity being a global epidemic, currently has several adverse health outcomes. Weight stigma is a significant barrier to delivering quality services and also impairs clinical progress. We intended to study the association of stigma with demographic and clinical variables in obese patients to identify the obstacles in treatment-seeking, so stigma could be adequately addressed to improve clinical outcomes. Methods This study was a retrospective chart review in a Bariatric clinic in a tertiary care hospital. The weight self-stigma questionnaire (WSSQ) was routinely used in the clinic. Demographic and clinical data were collected for 146 obese patients.  Results Female patients (73%) had higher stigma scores. The mean total stigma score was 41.6(SD 3.83), the total self-devaluation score was 21.88(SD 2.10), total fear of enacted stigma was 21.26(SD 2.33). Multivariate analysis revealed an association between stigma with multiple dysfunctional eating patterns like bingeing, overeating, and grazing (Adjusted aOR 3.86, 95% CI- 1.66-8.96) and psychiatric diagnosis (adjusted aOR 3.00, CI- 1.25-7.17). Conclusion This study found an association between stigma and certain clinical variables that maintain and worsen obesity and comorbid psychiatric diagnoses. This highlights the importance of an assessment of mental health and stigma in general practice when dealing with patients with obesity. Treating the underlying psychiatric comorbidities and addressing unhealthy eating behaviors can help reduce self-stigma. Stigma is a barrier to treatment-seeking that needs to be addressed in the community.

Carbamazepine-induced delayed-onset agranulocytosis in a case of bipolar disorder with Kikuchi's disease.

A 48-year-old man who is a known case of bipolar disorder was maintaining well on a combination of carbamazepine and quetiapine for 3 years until he developed fever, severe leucopenia and lymphadenopathy, along with significant loss of weight and appetite. A thorough investigation revealed Kikuchi's disease as a likely histological diagnosis. Carbamazepine was discontinued and quetiapine was titrated for the management of psychiatric symptoms. The patient gradually made good recovery following discontinuation of carbamazepine and the diagnosis of drug-induced myelosuppression was retained. Clinicians need to be aware of the adverse effects of medications being used for long-term prophylaxis and other possible conditions that may change the course of drug effects.

Mental health issues and coping among health care workers during COVID19 pandemic: Indian perspective.

OBJECTIVES: We assessed mental health issues among Indian health care workers (HCWs) and their coping strategies during COVID 19 pandemic. METHODOLOGY: An online survey was conducted in 348 HCWs using PHQ-SADS and Brief-COPE inventory. RESULTS: Depression, anxiety and somatic symptoms were present in 54 %, 44.3 % and 54.6 % of HCWs and were more in those working in COVID19 areas. The nurses and female HCWs had more moderate to severe somatic symptoms. HCWs with moderate to severe symptoms used simultaneously both maladaptive and adaptive coping strategies. CONCLUSION: The HCWs during COVID19 pandemic have significant mental health issues and use multiple coping strategies.

Psychological impact of infection with SARS-CoV-2 on health care providers: A qualitative study.

BACKGROUND: Rapid increase in severe acute respiratory syndrome coronavirus 2 (SAR-CoV-2) infection has also affected many health care providers (HCPs). This study aims to understand personal stories of HCPs affected by SARS-CoV-2, which could help with insights about ways to support them. METHODS: Using a phenomenological approach and purposive sampling method, we recruited participants for semi-structured interviews through a telephone. Data saturation was achieved by the 11th participant and two more interviews were performed to confirm the same. Interviews were transcribed, and a seven-step Colaizzi method was used to identify different themes. RESULTS: The psychological impact of SARS-CoV-2 on HCPs who tested positive can be summarized into four broad themes. These are challenges faced by HCPs, social concerns, experience of quarantine period, and positive experiences. Challenges they faced were about dealing with uncertainty, fear of spreading infection, and stigma. In the social concerns theme, what featured was concerns about family, social support from friends and hospital, and stigmatizing experience in neighborhood. In the quarantine experience theme, self-care and desperation to connect prominently colored their emotional and psychological experience. There were positive experiences also, which included personal strength, sense of gratitude, growth, and professional commitment. CONCLUSION: The personal stories of HCPs highlight that while they coped effectively during the recovery process, it may be important to address psychosocial factors of well-being as they worked with patients testing positive for SARS-CoV-2.

Trabecular Bone Score and Bone Mineral Density in Postmenopausal Women with Morbid Obesity-A Clinical Paradox.

Obesity has long been considered to have a protective effect on bone, but specific complications in those with morbid obesity are known to have a detrimental impact on bone architecture. We aimed to study the bone microarchitecture (TBS-trabecular bone score) and bone mineral density (BMD) in postmenopausal women with morbid obesity compared to obese and non-obese age-matched women. Eighty-five consecutive postmenopausal women with morbid obesity (body mass index (BMI) ≥ 35 kg/m2) were enrolled and compared to age-matched obese (n = 80) and non-obese postmenopausal controls (n = 85). The BMD and TBS were assessed in all subjects using a Hologic-QDR 4500-W Discovery-A DXA scanner. The mean BMD (gm/cm2) at the femoral neck in women with morbid obesity was found to be significantly lower as compared to the age-matched postmenopausal obese controls (0.723 versus 0.762, p-value = 0.002). The BMD at the lumbar spine and hip showed similar trends but were not statistically significant. The bone microarchitecture was found to be significantly lower in those with morbid obesity (1.205) as compared to the other two groups (obesity 1.244; non-obese 1.228) (p < 0.013). Though obesity was associated with a better bone density and bone microarchitecture in postmenopausal women, a paradoxical lower value was seen in those with morbid obesity.

Activism, academic bias and argument without nuance is harmful and potentially dangerous.

Peter C Gøtzsche and Anders Sørensen in their article titled "Systematic violations of patients' rights and safety: Forced medication of a cohort of 30 patients" alleged violation of patient rights by psychiatrists with the use of force, thereby causing immense harm. In this commentary I try to understand their motivation, expose their bias, make an evidence based counterpoint, explore real life consequences of their views and make a case for nuanced discussion on complexities in mental health.

Development and validation of gaming disorder and hazardous gaming scale (GDHGS) based on the WHO framework (ICD-11 criteria) of disordered gaming.

This study aimed to develop and validate a brief psychometric scale for gaming disorder and hazardous gaming based on the WHO framework as defined in the ICD-11. The study was carried out among college students using face to face interview. A panel of mental health experts examined the face validity of the new Gaming Disorder and Hazardous Gaming Scale (GDHGS). An Exploratory Factor Analysis (EFA) using the principle component analysis (PCA) method with direct oblimin rotation on the five items of GDHGS was used for assessment of construct validity. The results of Kaiser Meyer Olkin (KMO) measure used for sampling adequacy and Bartlett's test (BT) of sphericity used to show the appropriateness of using factor analysis, confirmed the appropriateness of EFA for the present study sample. The factor analysis extracted single component with an eigenvalue of greater than one, which was further supported by the examination of scree plot. To examine the criterion related validity of the GDHGS, correlation between GDHGS and IGDS-SF scores was assessed. Spearman correlational analysis showed strong positive correlation of GDGHS score with IGDS-SF score (rs = 0.878, p < 0.01). Further, the sum of first four item score of GDHGS among participants diagnosed with GD (median: 15.00; IQR: 15.00-15.75) was significantly greater than those without GD (median: 4.00; IQR: 3.00-6.50) according to the diagnostic interview based on the ICD-11 criteria (U = 0.000, p < 0.001). The internal consistency of GDHGS as measured by the Cronbach's alpha was 0.914. Further, the GDHGS did not have its reliability increased by removal of any of the five items included in the scale. Also, the threshold for significant floor and ceiling effect was not reached. In conclusion, GDHGS is a valid measurement scale for disorders involving gaming behaviour based on the ICD- 11 construct.

The Prevalence and Predictors of Non-alcoholic Fatty Liver Disease in Morbidly Obese Women - A Cross-sectional Study from Southern India.

BACKGROUND: The prevalence of obesity is increasing rapidly in India and so are its associated comorbidities. Non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of metabolic syndrome, is commonly associated with obesity. However, limited data are available on its prevalence and clinical indicators among morbidly obese Indian women. The aim of our study was to find the prevalence of NAFLD in morbidly obese Indian women and study the clinically measurable obesity indicators that would best predict NAFLD. METHODS: This was a cross-sectional study, conducted in the Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore. Women were enrolled who were diagnosed to have NAFLD on sonography. Anthropometric variables, such as body mass index, waist circumference, hip circumference, waist-hip ratio and waist-height ratio were measured and compared between the two groups. SPSS Statistics 21.0 software was used for analysing the data. RESULTS: One hundred and six consecutive, morbidly obese women were recruited in this study. Nearly three-quarters (73.6%) of the 106 morbidly obese participants were found to have NAFLD. We found waist circumference, body mass index and waist-height ratio to be most useful in distinguishing between patients with and without NAFLD, and found waist-height ratio was the best screening tool for diagnosing NAFLD. CONCLUSION: NAFLD is present in a large proportion of morbidly obese women. Waist-height ratio could be used a surrogate screening tool to detect NAFLD in resource-constrained settings.

Metabolic Score for Visceral Fat (METS-VF) Estimation - A Novel Cost-Effective Obesity Indicator for Visceral Adipose Tissue Estimation.

BACKGROUND: Visceral adipose tissue (VAT) assessment is limited in clinical practice due to expensive, time consuming and limited availability of MRI and DXA machines. We explored the utility of a recently developed Metabolic Score for Visceral Fat (METS-VF) to assess VAT in south Asian individuals with morbid obesity. PATIENTS AND METHODS: Individuals with BMI ≥35 kg/m2 aged between 30 and 60 years were randomly selected from a database of individuals with morbid obesity, attending a multi-disciplinary bariatric clinic in a tertiary care teaching hospital in southern India. Body composition was assessed by using a Hologic Discovery A dual-energy X-ray absorptiometry (DXA) machine. METS-VF was used to estimate VAT by using a previously published algorithm. RESULTS: The mean age and body mass index of the study subjects (N=350) were 38.2 years and 40.1 kg/m2. The MET-VF score performed satisfactorily (AUC of 0.78 (95% CI 0.72-0.85)) for predicting an increased visceral adipose tissue (VAT area ≥ 163 cm2) as detected by DXA. A METS-VF value of 7.3 was found to have a good sensitivity and reasonable specificity in predicting elevated VAT in this population. CONCLUSION: This is the first study to validate the utility of METS-VF as a surrogate measure of visceral adiposity in south Indian individuals with morbid obesity. Given the simplicity, easy availability, reliability and inexpensive nature of this obesity indicator, it may find its widespread use in lower middle-income countries.

Obesity Indicators and Health-related Quality of Life - Insights from a Cohort of Morbidly Obese, Middle-aged South Indian Women.

OBJECTIVE: The global prevalence of obesity is increasing and has nearly doubled in the last decade, disproportionately impacting less-developed countries. The aim of this cross-sectional study was to analyse health-related quality of life (HRQOL) in morbidly obese women attending a bariatric clinic in India, and assess potential obesity indicators that can be utilised in under-resourced settings, to better understand HRQOL of individual patients. METHODS: Anthropometric measurements were collected, including waist circumference, hip circumference, waist-hip ratio, waist-height ratio and body mass index (BMI). HRQOL was assessed using an obesity-related quality-of-life questionnaire focused on the impact of obesity on physical distress, self-esteem, sexual life and work life. RESULTS: The average BMI of study participants was 39.6 kg/m2, with an average HRQOL of 40.2%. The strongest correlation was noted between BMI and HRQOL (R2=0.16). Exploratory analyses demonstrated that patients with higher BMI quartiles had lower scores for physical impact and psychosocial impact, and higher scores for sexual health, comfort with food, and experience with dieting compared to patients in lower quartiles. CONCLUSION: In South Indian, middle-aged, morbidly obese women, HRQOL is lower than average and is highly correlated with BMI, with different BMI levels having higher impacts in different subcategories, supporting the need for an individualised therapeutic focus for each patient.

Emergency care in rural settings: no easy solutions.

Bawaskar and Bawaskar in their paper titled "Emergency care in rural settings: Can doctors be ethical and survive?" in this journal have presented a very real problem faced by small private healthcare facilities in rural areas. They raise the important question of whether doctors can be true to ethical principles and yet survive in the marketplace, with particular reference to emergency care. This commentary seeks to examine the problem and suggest solutions.