The Rising Scourge of Mental Illness and Infodemic: An Outcome of Social Media and COVID-19.

COVID-19 was accompanied with the increasing broadcast of fake news, misinformation and excessive information via social media platforms. This phenomenon has been termed "infodemic", to describe an overwhelming amount of mostly fake, false or inaccurate information which spreads rapidly and impacts negatively on achieving a solution. It would therefore be desirable to use a cautious approach which utilizes culturally sensitive and country specific measures to deal with this occurrence. We aim to raise awareness, likewise draw the attention of global scientific community on this topic of public and mental health concern and it calls for further comments on this issue.

Knowledge, attitude, and practices related to COVID-19 pandemic among social media users in J&K, India.

BACKGROUND: A series of measures have been suggested to reduce Covid-19 infection, including knowledge training for prevention and control, isolation, disinfection, classified protections at different degrees in infection areas, and protection of confirmed cases. OBJECTIVES: We conducted this study with an aim to assess the knowledge, attitude and practice among the general population regarding COVID-19. METHODS: This was a cross-sectional study carried out by the Department of Community Medicine, Government Medical College, Srinagar in the month of April 2020. The questionnaire had four segments to collect data regarding social-demographic details, knowledge regarding Covid-19, attitude and practice based questions. The questionnaire was shared via social media applications like face book and Whatsapp to reach the target population. Continuous variables were summarized as frequency and percentage. All the analysis was done using Microsoft Excel 2016. Among participants who responded, 1252 (82%) were in the age group of 18-40 years and 912 (60%) from urban areas. RESULTS: A total of 934 (61%) respondents had heard details on COVID-19 from the social media, 1358 (89%) knew all ways of coronavirus transmission, 602 (40%) felt that COVID-19 is a serious disease, 1184 (78%) responded that they totally agree with the lockdown decision, and 1296 (85%) responded that lockdown is helping in reducing the number of cases. The majority, i.e. 1318 (87%), followed advisories and reported washing hands with soap and water regularly, 1108 (73%) reported regularly wearing masks, 1344 (89%) reported following lockdown guidelines, and 1306 (87%) reported maintaining social distancing. The respondents exhibited good knowledge, positive attitude, and sensible practices regarding COVID-19. CONCLUSION: Our study showed that the respondents have exhibited good knowledge, positive attitude and sensible practices regarding covid-19 during the pandemic.

Prevalence of Mental Disorders Among Patients with Multimorbidity Visiting Primary Care Settings in Slums of Karachi, Pakistan.

BACKGROUND: Anxiety and depression often exacerbate multimorbidity conditions, leading to increased disability rates among affected individuals. OBJECTIVE: The study aimed to assess the mental health status of individuals with multimorbidity belonging to the marginalized population of Karachi, Pakistan. Specifically, the prevalence of anxiety and depression was investigated. METHODS: A multicenter cross-sectional study was conducted between July 2022 and June 2023 in 10 primary healthcare clinics located in 4 peri-urban areas of Karachi. A total of 9331 participants were included in the study. The Patient Health Questionnaire 4 (PHQ-4), Generalized Anxiety Disorder 7 (GAD-7), and Patient Health Questionnaire 9 (PHQ-9) were used to assess symptoms of anxiety and depression. The data collected were analyzed using the statistical analysis system (SAS) version 9.4. RESULTS: Among the study participants, 2894 (31%) were men and 5534 (59.3%) were women. The prevalence of moderate to severe anxiety was 31% among men and 59.3% among women. The age group between 41 and 60 years exhibited the highest rates of moderate to severe anxiety, 19.3% as evaluated by GAD-7 and 34.6% by PHQ-9. The Pathan ethnic group had the highest prevalence of anxiety (11%) and depression (28.3%) in the neighborhoods. Unemployed participants showed moderate to severe anxiety in 21.3% of the cases and moderate to severe depression in 25.5% of the cases. CONCLUSION: The study revealed a significant cooccurrence of anxiety and depression among individuals with multimorbidity in the marginalized population of Karachi, Pakistan. Furthermore, the presence of anxiety symptoms in multimorbidity patients with depression indicates a more unfavorable health state. It is essential to explore the implementation of screening measures and therapeutic interventions for comorbid anxiety and depression in this population to improve clinical outcomes.

Navigating the infodemic: strategies and policies for promoting health literacy and effective communication.

The COVID-19 pandemic, with its vast impact illustrated by 770 million confirmed cases and 6.9 million deaths as of September 21, 2023, has exposed a critical challenge: the infodemic. Effective communication and health literacy are pivotal in addressing this crisis. This article emphasizes the urgency of combating health misinformation, highlighting its tangible impact on public health and social well-being. Trustworthy sources, especially government agencies and public health officials, played a central role in shaping public behavior. Clear, accurate, and consistent messaging became vital. Health literacy, a fundamental determinant of pandemic response, empowered individuals to understand and act upon health information. Approximately 36% of adults exhibited basic or below-basic health literacy skills, emphasizing its crucial role. Improving health literacy emerged as a strategic imperative, enabling informed choices and proactive health protection. The pandemic underscores the vital role of effective communication and health literacy in combating health misinformation, fostering informed decision-making, and safeguarding public health.

"Taste modification" strategy for prevention and control of hypertension in India: need for robust clinical trials.

Hypertension is an important modifiable risk factor for cardiovascular disease (CVD). Among normotensives, excessive dietary salt elevates the blood pressure and thereby increases the risk of CVD events. Despite such solid evidence, there is no effective approach to address excessive salt intake in India. Instead of just encouraging patients to lower their salt intake, we must provide an alternative technique by fostering an environment that facilitates this behaviour change. In this Viewpoint, we propose 'Taste Modification' strategy, i.e., a salt-reduction technique in which individuals are informed that adding spices/herbs to meals will reduce their salt intake. We hypothesise that a gradual reduction in salt intake can aid in the treatment of hypertension over time. The goal is to progressively substitute salt with spices for effective salt reduction. However, the 'Taste Modification' strategy must be first validated using multicentric clinical trials.

Sputum Testing as the New Mass Screening Method for COVID-19 Patients in India - A Public Health Perspective.

In December 2019, an unusual form of pneumonia of unknown origin was identified in Wuhan and soon expanded into an intercontinental pandemic that affected nations all over the world. The unusual pneumonia was subsequently named COVID-19. The management of COVID-19 disease has been highly dependent on the early identification of patients who are positive for SARS-CoV-2 infection. For detecting the SARS-CoV-2 virus in upper or lower respiratory tracts, the Centers for Disease Control and Prevention (CDC) recommend strategic sampling approaches. Most countries collect nasopharyngeal swabs and oropharyngeal swabs for rapid viral testing by experienced healthcare workers. Due to the increase in single-day cases, the high cost of RT-PCR, and the requirement for greater coverage in order to detect COVID-19 infections, the screening method has been changed to the Rapid Antigen Test during this phase of the pandemic in India. Considering the limited sensitivity of the fast antigen test compared to the sputum test, and the benefit of having additional resources available from an already established TB network, policymakers should consider implementing COVID-19 with sputum testing. For India, which has 1.3 billion people and limited resources, contemplating a community level sample collection of COVID-19 samples will be an effective decision if scientific data is used for this purpose will be an effective choice for the country with more than 1.3 billion population and limited resources.

Non-communicable diseases, type 2 diabetes, and influence of front of package nutrition labels on consumer's behaviour: Reformulations and future scope.

BACKGROUND AND AIM: Non-communicable diseases (NCDs) had an inverse impact on the economic stability of many nations all over the globe. We describe and recommend food policy measures to improve food package labelling and global eating patterns for the population to measure secondary prevention and behavioural change. METHODS: A Literature search was done on standard search engines using key terms like diabetes, food package labelling, labelling laws, etc. RESULTS: Consumption of unhealthy ultra-processed foods is on the rise because of variable choices at the supermarkets, restaurants, marts, and supermarkets. People who had a 10% increase of ultra-processed foods (UPF) in their diet had a 15% greater chance of developing T2D. This translates to roughly four portions of processed food per day. In India, the consumption of UPF is on the rise, and the related industry is mounting by 40% each year, placing India at 10th place in the fast-food per capita spending figures. Many labelling systems have been proposed and well-designed but with advantages. A trustworthy and helpful FOPL is one that most people will understand clearly and know what is in the food they are buying. It simply discourages the consumers from consuming high-energy, calorie-dense products as they can quickly and effectively identify products that are high in salt, sugar, saturated fats, trans fats, or total fats. CONCLUSION: Many countries such as Chile, China, Thailand, Malaysia, Singapore have initiated steps to include food labels, especially FOPL, on the food packets. It's the right opportunity for India to introduce an identical replica of the Chilean model.

Prevention of childhood obesity through appropriate food labeling.

BACKGROUND AND AIM: The prevalence of childhood obesity has increased across the globe and millions of the school children are either obese or overweight. This has happened due to rapid nutritional transition over the past few decades. As childhood obesity is multi-factorial in origin and unhealthy foods, packaged foods, high calorie foods are considered as important behavioral risk factors. The aim of this article is to opine whether appropriate food labeling is one of the preventable methods in prevention of childhood obesity. METHODS: A thorough literature search on childhood obesity articles on well-known search engines like Cochrane Library, PubMed, Google Scholar and Embase electronic data base was done to reach an opinion and derive a conclusion. RESULTS: Among many interventions to prevent NCDs, it is evident that effective FPL can reduce the burden of NCDs, including childhood obesity. Additionally, it was found that during purchasing any food items, consumer knowledge/information plays a crucial role for food purchasing which is commonly recognized by food labels. The problems with the existing food labels are-these are misleading/not completely understandable/not clearly visible to the consumers due to multiple reasons like low literacy levels, diverse languages, small font size and many more. Globally, there exists multiple food labeling system which are consumer friendly. It is the right time for us to join other countries in experimenting with creative food labelling systems. The Chilean system being the gold standard in this regard. CONCLUSION: It is evident that good food labeling can effectively reduce the burden of non-communicable disease/childhood obesity (indirect evidence) by empowering customers to buy the right/healthy foods. In a country like India, where literacy among consumers is competitively high and languages are diverse, the same approach should be replicated in order to prevent or halt the rising trend of childhood obesity.

Mental health services in conflict areas - An experience from Libya.

The Libyan mental health system has long been seen as inefficient and insufficient for the demands of the country. Thousands of Libyans require mental health therapy now more than ever before. Libya's Ministry of Health has worked to improve access to mental health services. Despite international assistance, Libya continues to face issues due to stigma and a shortage of competent psychiatrists. The majority of Libyan individuals are unable to obtain private psychiatric care. This places the burden on the public sector to care for the majority's psychological pain and suffering and this needs to be addressed.

Let There Be Light-Digital Eye Strain (DES) in Children as a Shadow Pandemic in the Era of COVID-19: A Mini Review.

Introduction: Digital eye strain, which is often ignored by the public, has emerged as a "Shadow Pandemic" in the era of the COVID-19 pandemic. Aim: The current paper is aimed at discussing the ill effect of digital screens on eyes in the wake of the COVID-19 pandemic. Methodology: A literature search was done using "PubMed," "Google scholar", and "Scopus" using key terms like "Digital Eye Strain," "Eyestrain," or "Computer Vision Syndrome." Relevant articles were identified and included to support the argument for this narrative review. Results: Studies conducted in the UK reported that 68% of children extensively use computers, while 54% undertake online activities after the age of 3. Similar studies estimated 4 h and 45 min per day of screen exposure time among adults in the UK. Indian studies reveal that the prevalence of DES is 69% in adults and 50% in children respectively. Indian ophthalmologists found that computer-using and specialized ophthalmologists were more informed of symptoms and diagnostic signs but were misinformed about treatment modalities. The use of social media and multitasking is particularly prominent among younger adults, with 87% of individuals aged 20-29 years reporting the use of two or more digital devices simultaneously. It has been observed that the use of computer glasses corrects refractive errors and helps in the reduction of symptoms, while precision spectral filters help in reducing symptoms of micro-fluctuation of accommodation. Conclusion: We concluded that DES is emerging globally as a "Shadow Pandemic" and it is high time to respond. Community ophthalmologists, public health authorities, and educational sectors especially should be involved to prevent this.

Neurocysticercosis presenting as psychosis: A case report and a brief literature review.

Patients with neurocysticercosis, a common infection of the central nervous system caused by Taenia solium, have been reported to develop neuropsychiatric complications. We report a unique case of recurrent psychosis caused by neurocysticercosis in a 37-year-old El Salvador immigrant woman and discuss the underlying pathophysiological mechanisms of the complications. We reviewed published case reports of neurocysticercosis that presented with psychotic features and compared their diagnostic evaluation, the underlying pathophysiology of complications and treatment regimen with our case. This review concludes that neurocysticercosis should be considered in the differential diagnosis of patients presenting with psychosis with a history of residence in an endemic area.

Dengue outbreak in the times of COVID-19 pandemic: Common myths associated with the dengue.

With the sharp rise in dengue cases across the state and the ongoing COVID-19 pandemic, it is crucial to pay attention to the common misbelieves among the population about dengue. It should be considered to actively spread awareness about the disease to bust the common myths associated with it. A few common myths include that it is a contagious disease, or it is a milder infection than COVID-19, so it's not taken more seriously, or that one cannot be coinfected with both dengue and COVID-19 at one time. We propose that accurate information about dengue can be spread through community education through televisions and social media to cater to the targeted audience. In addition to that, awareness campaigns in rural areas should be planned to help the masses understand the pathogenesis of the diseases and play a role in limiting the transmission.

Geospatial epidemiology of hypertension and its risk factors in India: Findings from National Family Health Survey (2015-2016).

Background: The fourth round of National Family Health Survey (2015-2016) measured blood pressure for the first time and provided a unique opportunity of exploring trends in hypertension prevalence across states and districts for the first time. Aim: This study will be the first in India to estimate the geospatial variation of hypertension among those in the 15-49 years age group in India. Materials and Methods: Out of a total of 616,346 selected occupied households, 601,509 were successfully interviewed, giving a response rate of 98%. We adjusted the proportion of hypertension obtained by using national sample weights. We built a multivariable logistic regression model to assess the determinants of hypertension. Results: The overall weighted prevalence of hypertension was 11.7%, and the prevalence was 11.1% in females and 11.0% in males. Urban areas had a higher prevalence (13.0%) compared to rural areas (11.0%). Those with no education (14.4%) and those who reported smoking (16.5%) had hypertension. Consumption of alcohol, fruits, and eggs was also found to be significantly related to hypertension. Conclusion: Hypertension epidemic is spreading alarmingly in India across rural and urban populations. Disturbingly, the hypertension prevalence is now becoming more concentrated among the poor. This phenomenon has serious implications for the country's social and economic well-being. Urgent preventive measures need to be taken at a multidisciplinary level.

Dietary salt consumption pattern as an antecedent risk factor for hypertension: Status, vision, and future recommendations.

Multiple salt reduction strategies have been devised from time to time, addressing the issues of hypertension without considering the other essential factors, like the variability of salt sensitivity from the person to person. In this paper, we discuss how high salt consumption is one modifiable risk factor associated with hypertension among Indians, and there needs to be updated cut-off values. A thorough literature search on salt consumption articles on well-known search engines like Cochrane Library, PubMed, Google Scholar and Embase electronic database revealed a paucity of data in this field for India. Several studies revealed that the mean salt intake among the Indian populations ranges between 5.22 and 42.30 g/day. Moreover, among other risk factors analysed, salt intake (≥ 5 gm/day) was significantly associated with the development of hypertension. Although the need to address reduced salt intake for primordial prevention of hypertension and related cardiovascular diseases (CVDs) in India is well acknowledged by the key stakeholders, social and cultural beliefs, unorganized food retail sector and lack of existing food policing are some of the potential barriers that affect the progress and employment of such effective strategies. Some multinational food companies have already research is warranted to evaluate the contextual barriers and facilitators and to adopt effective strategies to improve awareness among consumers, to encourage the endorsement of salt reduction by the food industry, and to facilitate the adoption of countrywide consumer-friendly food labelling. We concluded that salt consumption is high in India, although this assessment has been done primarily by subjective methods in India. People all across are recommended the same cut-off value of dietary salt consumption regardless of the diversity in dietary patterns and environmental conditions across the country. There is an urgent need to address these issues through evidence-based population research.

Reducing the infectious diseases burden through "life course approach vaccination" in India-a perspective.

The burden of vaccine-preventable diseases is increasing day by day across all age groups. However as per the universal immunization programme, we vaccinate only under-fives and antenatal mothers, a large portion of the vulnerable population remain unvaccinated and the concept of "life course approach" regarding vaccination is missing. It increases the overall burden to the already constrained Indian health care system. As India, now has become the largest manufacturer of multiple vaccines, we have continuous chain healthcare points (primary-tertiary level), with dedicated manpower in the public health sector that is why in this paper we are proposing to expand the horizon of the vaccination process using a "life course approach". It will not only directly benefit the vulnerable populations (individual level), but also it can benefit the nation, indirectly. Although we may face challenges at multiple phases (conception to implementation), they can be overcome by multisectoral and multipronged innovations.

Imposing COVID-19 lockdown and reported dog bite cases: An experience from a tertiary antirabies center of North India.

The world was taken aback after the corona pandemic started from China and soon engulfed the whole of the world. Strict restrictions were in place since the beginning, and people were confined to their homes; only emergency services were allowed to work. The study's objectives were to see the effect of lockdown on the number of dog bite cases being reported to our antirabies clinic. The study was conducted in the antirabies clinic of the Department of Community Medicine, Government Medical College, Srinagar, Jammu & Kashmir. This study involved a dog bite victim who approached the said clinic during the lockdown, which was implemented in the wake of COVID-19 from March 21, 2020 to June 03, 2020. We included all the dog bite victims living in the Srinagar city and from the adjoining districts who had been bitten by the street dog during the lockdown phase. Over 5 years, 4,670 (73.6%) dog bites among males were reported. The proportion of dog bites among males varies from 72% to 81% in the 5 years. It can be observed that a maximum of 783 (81.1%) dog bites were reported from males during the lockdown period in 2020. Moreover, 2,847 (44.9%) bites were category II dog bites, while 3,392 (55.1%) were category III dog bites. There were fewer dog bites reported at the first, fourth, seventh, eighth, and ninth weeks while there was a little surge in cases on the 2nd, 3rd, 5th, 6th, and 10th week. Lockdown had indirectly reduced the number of dog bite cases reported to the clinic during different lockdown phases than the previous year's data.

Role of vaccine science diplomacy in low-middle-income countries for eradicating the vaccine-preventable diseases: Targeting the "LAST MILE".

The meaning of "vaccine diplomacy (VD)" is defined as "the use of vaccines to increase a country's diplomatic relations and influence over other nations." The golden era of vaccine science diplomacy started during the time of Cold War between the United States (US) and the Union of Soviet Socialist Republics (USSR) with the development of a prototype of oral polio vaccine by the US Scientist Dr Albert Sabin working along with his Soviet counterparts. The foundation stone was already laid down by Edward Jenner when he shared his technique of the smallpox vaccine with other major countries to curb the spread of smallpox. Eventually, such a step led to the eradication of such a deadly disease. Only time has changed, not the tide. Even today, vaccines continue to remain as one of the important tools for achieving Millennium Developmental Goals (MDGs) and other targets in developing countries like India. During the wake of the Corona Virus Diseases-19 (COVID-19) pandemic, India's role in developing its vaccine science diplomacy has been a point of attraction. The phase-3 trial of Covaxin being developed by Bharat Biotech started in Lucknow and Gorakhpur in October 2020, and it is widely considered as the forerunner for the Indian vaccine market. As per the Union Health Ministry of India- "The Union Government is working on at least five distinct ways, ranging from free vaccines to guaranteed supply, in which it can help its immediate neighbours and countries in West Asia, Africa and even Latin America-officials familiar with the plan said on conditions of anonymity. The idea is to leverage the country's standing as the world's vaccine factory to merge diplomatic ties. Historically, it is observed that by the development and introduction of newer vaccines from time to time, many dismaying hurdles to vaccine science diplomacy (VSD) arise from ongoing wars and political instability. The current scenario is that both VSD and VD are at crossroads, and there is a possibility of getting a good direction if we make a piggyback policy approach of vaccine diplomacy along with the foreign policy. The lessons learned from the past must be followed now and, in the future, to make a better world for all. We acknowledge that the COVID-19 episode has again highlighted the dire need for VSD, and we assume that not only COVID-19 but in future, emerging and re-emerging diseases will occur so we have to prepare ourselves for combatting those future emerging and re-emerging diseases.

Lessons learnt from alcoholism and substance use disorders (SUDs) during the COVID-19 pandemic in India.

SUD is a widespread non-communicable disease (NCD) with biological, social, or psychological foundations which policymakers have given less attention during the COVID-19 pandemic. People with alcohol dependence went into withdrawal as a result of the lockdown and acute lack of alcohol availability, which led to black marketing and, in extreme cases, suicide. On the other hand, De-addiction services in India were not adequately equipped for the SUD pandemic, and as a result, most services could not cope with lockdown problems. To generate revenue and to get out of this Catch-22 situation, the Government opened liquor shops and sold alcohol while people purchased it as usual because of excess stress, lack of social contact, loneliness and boredom. We recommend that during COVID-19 pandemic, national, state, and local governments, as along with organisations such as Alcoholics Anonymous, develop and support networks to address the needs of patients with SUD.

Colour coded client segmentation (CCCS) public health approach to educate the community to deal with problem of hypertension: A pilot study.

INTRODUCTION: We know that risk communication is equally important as risk identification, which is usually not communicated properly to the patients and resulting in poor outcomes, especially in hypertensive patients. OBJECTIVE: Our study objective was to evolve and test a colour coded client segmentation based public health approach to educate the community to deal with problem of hypertension. METHODOLOGY: This cross-sectional pilot study was done in March 2020 among purposively approached in a primary health centre to 100 people aged above 18 years, among them 41 gave written consent for the study and their demographic information was noted. They were given colour coded cards as per the current blood pressure level and previous history of hypertension. On each colour coded card, specific advice was written for that category. For all the participants, blood pressure and treatment seeking behaviour was noted. For hypertensive patients, adherence to medication and non-pharmacological measures was noted. RESULTS: Mean age of the participants was 46.5 ± 13.06 years. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the participants were 135 ± 16.85 mm Hg and 86 ± 11.42 mm Hg, respectively. Among the participants, 10 (24.39%) had a known history of hypertension. Among them, as per the blood pressure levels measured on the day of the study 50% (5) had their blood pressure levels under control. Interestingly 16 (39%) participants were found hypertensive incidentally. DISCUSSION: It is evident from the studies that colour coded approach is used in multiple ways, in multiple settings, for multiple diseases. To our knowledge, little focus has been given for hypertensive disorders in the community level. We merely bother about making their risk profiling, even in the digital age. Sometimes physicians in emergency become puzzled whenever patients collapsed in front of them and we missed the "Golden Hour" for the treatment by searching patients' medical details. CONCLUSION AND RECOMMENDATIONS: The above problem can be solved by risk profiling of chronic patients by colour coded OPD/Health cards.