Mapping the Consequences - An Exploratory Study on the Use of Body Mapping Technique to Assess Perceptions of Health-care Workers on the Effects of Uncontrolled Diabetes Mellitus and Hypertension.

Knowledge of the consequences of uncontrolled diabetes mellitus and hypertension on various body organs among health workers is necessary to educate patients. Body mapping is a tool used for exploring perceptions as a part of qualitative research. This study assesses the perceptions of health-care workers on the effects of uncontrolled diabetes mellitus and hypertension on the human body using the body mapping technique. All 19 staff members of an Urban Primary Health Center were asked to draw a human body and map the parts affected by uncontrolled diabetes mellitus and hypertension. The mean age of the participants was 35.42 ± 10.54 years, and median years of work experience were 4 (3, 7) years. Fourteen (74%) participants had mapped kidneys and 11 (58%) participants had mapped head/brain indicating stroke to indicate damage due to uncontrolled diabetes mellitus and hypertension. Only 7 (37%) and 4 (26%) participants perceived that feet and eyes could be affected.

COVID-19-related Fears and Practices among Postnatal Women Availing Services at a Rural Maternity Hospital in South Karnataka.

SUMMARY: The postnatal period is a critical phase indeed, in which, owing to the pandemic, an added apprehension being the safety and well-being of both, mother and child. This study was mainly done to assess the attitude and practices regarding postnatal care during the Covid-19 pandemic among women availing services at Snehalaya hospital, Solur. It was a hospital based cross- sectional study done among post-natal mothers and data were collected using an interview schedule following sections such as- socio-demographic details, questions assessing the attitudes towards postnatal care during the pandemic followed by questions assessing the practices in the same period. It was found that of the total interviewed, nearly half mothers reported to have a fear of getting infected with Covid-19 and few reported to have a fear of deaths due to Covid-19. Fear of dying from Covid-19 was an evident finding seen more among the gainfully employed and those with bad obstetric history. The socioeconomic status did have a bearing on the perceptions towards the pandemic influence on the maternal and child health during the puerperal period.

Community perceptions and individual experiences of breast cancer in communities in and around Bangalore, India: a qualitative study.

Breast cancer is the most common cause of cancer mortality in India, yet breast cancer literacy remains poor. This study aimed to assess community perceptions and experiences with breast cancer in order to identify and address the gaps in our understanding of the socio-cultural barriers to awareness and care-seeking for breast cancer.Qualitative focus group discussions and in-depth interviews were conducted among breast cancer survivors and caretakers, health workers, and general population individuals in a tertiary care facility, urban underprivileged community, and rural setting around Bangalore city. Data was thematically analyzed using inductive approach.Breast cancer awareness was commonly gained through interpersonal relationships or self-experiencing breast cancer, mass media, and medical personnel. The most significant barriers to seeking care for breast cancer were cost of care, lack of female doctors, fears of diagnosis, and death. Stigma of breast cancer was attributed to possible isolation by the community members and misconception that cancer is infectious thereby delaying care-seeking.This study provides an understanding of what individuals perceive about breast cancer and highlights some important anecdotes from breast cancer survivors who have experienced the full extent of a breast cancer diagnosis in India. The institutional and social barriers brought out by this study may be taken into consideration when planning targeted interventions for breast cancer in India.

Postnatal depression among women availing maternal health services in a rural hospital in South India.

BACKGROUND AND OBJECTIVE: Postnatal depression, with an estimated prevalence of 13-19%, causes significant impairment of mental health among women worldwide and has long term consequences. However, more than half of all cases are not detected by healthcare providers. Screening for postnatal depression has not been given importance in maternal health programs in India. Our objective was to screen for postnatal depression among women attending a rural hospital in India, immediately postpartum and at 6-8 weeks post-delivery, and to study associated factors. METHODS: A cross sectional study was done on 123 postnatal women attending a rural maternity hospital in Karnataka, South India, of whom 74 women were interviewed within one week of childbirth, and 49 women at 6-8 weeks post-delivery. The Edinburgh Postnatal Depression Scale was used to screen for postnatal depression. RESULTS: About 45.5% of the women screened positive for postnatal depression (44.6% of all subjects within one week of delivery and 46.9% at 6-8 weeks after delivery). Postnatal depression was significantly associated with mood swings during antenatal period, staying with the family of birth during pregnancy and away from their husbands, and was significantly higher among women who perceived their life as stressful and having a low self-esteem (P<0.05). CONCLUSIONS: This study found a high prevalence of postnatal depression in women in rural Karnataka. This underlines the need for incorporating screening for postnatal depression in the routine care of women during pregnancy and delivery.

Diabetes, hypertension, and other cardiovascular disease risk factors among adults in an urban underprivileged community in Bangalore city, India.

Aim: Diabetes and hypertension are major risk factors of cardiovascular disease, which is known to be the leading cause of global mortality in the world today. Studies have shown that the prevalence of these risk factors is on the rise, with the burden of diabetes alone increasing by 80% in the last two decades. Complications of diabetes and hypertension result in huge public health challenges for the country and catastrophic medical expenditures for families among the urban poor. Our study aims to estimate the prevalence of diabetes, hypertension, and other cardiovascular risk factors among adults in an urban underprivileged community of Bengaluru city. Objectives and Methods: A cross-sectional study was conducted over a period of 6 months where 2245 individuals aged 30 or older were interviewed using a structured interviewer-administered questionnaire used to capture sociodemographic details that assessed modifiable risk factors for diabetes and hypertension. Inclusion criteria for diabetes were considered if the random blood sugar reading was ≥200 mg/dL, whereas a diagnosis of hypertension was taken into consideration if the systolic blood pressure reading was ≥140 mmHg and/or diastolic blood pressure was ≥90 mmHg. Results: Among the 2245 participants that took part in the study, 15.5% were diabetics and 17.2% were hypertensive. There was a strong association of diabetes among consumers of alcohol, with more than one-third having a high prevalence of the disease (odds ratio (OR): 2.09, 95% confidence interval (95% CI): 1.1-3.9). More than half the population were consumers of junk food; the prevalence of diabetes in this group was 1.35 times higher than that in their counterparts (OR: 1.35, 95% CI: 1.0-1.8). A significant association of diabetes was also seen among those identified with central obesity (OR: 1.83, 95% CI: 1.4-2.5). One-third of the population who consumed alcohol were found to be diagnosed with hypertension (OR: 3.08, 95% CI: 1.6-5.9), and one-fifth of individuals who were regular consumers of junk food had a higher prevalence of hypertension (OR: 1.41, 95% CI: 1.1-1.8). A higher prevalence of hypertension was also seen among individuals with central obesity or a body mass index (BMI) of >30 (OR: 1.59, 95% CI: 1.2-2.1; OR: 1.92, 95% CI: 1.4-2.6). Conclusion: The findings from our study conducted in an urban underprivileged area of Bengaluru city shed light on the significant associations between diabetes and hypertension and various demographic and lifestyle factors. Specifically, male gender and lower educational status were found to have a significant association with diabetes, whereas being unmarried and having a high BMI status were strongly linked to hypertension. In addition, the study revealed that elderly individuals, alcohol consumers, junk food eaters, and those with central obesity demonstrated an increased risk for both diabetes and hypertension. By identifying these risk factors, targeted interventions can be developed to address the unique challenges faced by this vulnerable section of society. Strategies can be designed to raise awareness, encourage healthier lifestyle choices, and improve access to healthcare services to effectively prevent and manage diabetes and hypertension in this community.

Needs assessment study for management of menopause in the community.

Menopause is an inevitable phase in every woman's life. Women may suffer from unpleasant symptoms during perimenopause. Understanding the health needs of the community during this period will help in developing menopause management programs that can improve quality of life. Aim: To study the symptoms of menopause and perception of women in relation to menopause in order to understand their needs. Settings and Design: A cross-sectional, multi-centric study was undertaken at three institutions (called DH, SJ, and SK) at two cities in India. The study population comprised women between the ages of 40 and 60. Institutional Ethics Committee approval and consent of participants were ensured. Material and Methods: Two instruments, a pilot-tested, peer-reviewed, validated, structured questionnaire and the Menopause Rating Scale (MRS) were utilized for the study. The minimum sample size was calculated to be 385 per site. Statistical analysis was conducted using the IBM Statistical Package for Social Sciences. Results: A total of 1297 forms were analyzed. MRS scores showed psychological symptoms to be most prevalent. Joint and muscular pains were the most common somatic symptoms. Hot flashes and urogenital symptoms were experienced by a lower number. Our MRS scores were significantly higher than those seen in other regions. Urban women, site SJ, those with irregular menstrual cycles, and lower incomes scored higher than their counterparts. Awareness about menopause was patchy, especially regarding medication or support services available. Conclusions: The high MRS scores emphasize the need to institute awareness programs, providing information on choices available for care (hormone replacement therapy, medications, or counseling) and information on where to access services. Primary care physicians can play a vital role in fulfilling this need by ensuring timely knowledge to the community, providing correct diagnosis and treatment. This will help improve the quality of life and sense of well-being of this community.

The impact of health education intervention on perceptions of menstrual cup among college going female students in peri-urban Bangalore.

OBJECTIVES: To assess the impact of health educational intervention on perceptions of menstrual cup usage among female students enrolled in a degree college in Bangalore district. METHODS: An interventional study was conducted among female students studying in a degree college in peri-urban Bangalore. Universal sampling was followed and a prior face validated questionnaire was administered to the students after to assess their perceptions, followed by a health education intervention. The subjects were followed up after a period of one month, to assess the impact of health education in changing their perception towards menstrual cups. RESULTS: Among 83 study participants with mean age 19.5±0.95 years, post intervention we found a 42 % increase in the total awareness score and a 35 % increase in total attitude score towards menstrual cup use. There was an increase by 36.1 % (p<0.001) among participants who considered menstrual cup better than sanitary napkins. A reduction by 27.7 % (p=0.024) of reported fear of pain and discomfort while using menstrual cup was noted. CONCLUSIONS: There was a significant improvement in the overall awareness about how to use a menstrual cup, advantages, and attitude towards the usage of menstrual cups following the health educational intervention. Health education was found to have a positive impact on perceptions of menstrual cup.

Immunogenicity of SARS-CoV-2 vaccines BBV152 (COVAXIN®) and ChAdOx1 nCoV-19 (COVISHIELD™) in seronegative and seropositive individuals in India: a multicentre, nonrandomised observational study.

Background: There are limited global data on head-to-head comparisons of vaccine platforms assessing both humoral and cellular immune responses, stratified by pre-vaccination serostatus. The COVID-19 vaccination drive for the Indian population in the age group 18-45 years began in April 2021 when seropositivity rates in the general population were rising due to the delta wave of COVID-19 pandemic during April-May 2021. Methods: Between June 30, 2021, and Jan 28, 2022, we enrolled 691 participants in the age group 18-45 years across four clinical sites in India. In this non-randomised and laboratory blinded study, participants received either two doses of Covaxin® (4 weeks apart) or two doses of Covishield™ (12 weeks apart) as per the national vaccination policy. The primary outcome was the seroconversion rate and the geometric mean titre (GMT) of antibodies against the SARS-CoV-2 spike and nucleocapsid proteins post two doses. The secondary outcome was the frequency of cellular immune responses pre- and post-vaccination. Findings: When compared to pre-vaccination baseline, both vaccines elicited statistically significant seroconversion and binding antibody levels in both seronegative and seropositive individuals. In the per-protocol cohort, Covishield™ elicited higher antibody responses than Covaxin® as measured by seroconversion rate (98.3% vs 74.4%, p < 0.0001 in seronegative individuals; 91.7% vs 66.9%, p < 0.0001 in seropositive individuals) as well as by anti-spike antibody levels against the ancestral strain (GMT 1272.1 vs 75.4 binding antibody units/ml [BAU/ml], p < 0.0001 in seronegative individuals; 2089.07 vs 585.7 BAU/ml, p < 0.0001 in seropositive individuals). As participants at all clinical sites were not recruited at the same time, site-specific immunogenicity was impacted by the timing of vaccination relative to the delta and omicron waves. Surrogate neutralising antibody responses against variants-of-concern including delta and omicron was higher in Covishield™ recipients than in Covaxin® recipients; and in seropositive than in seronegative individuals after both vaccination and asymptomatic infection (omicron variant). T cell responses are reported from only one of the four site cohorts where the vaccination schedule preceded the omicron wave. In seronegative individuals, Covishield™ elicited both CD4+ and CD8+ spike-specific cytokine-producing T cells whereas Covaxin® elicited mainly CD4+ spike-specific T cells. Neither vaccine showed significant post-vaccination expansion of spike-specific T cells in seropositive individuals. Interpretation: Covishield™ elicited immune responses of higher magnitude and breadth than Covaxin® in both seronegative individuals and seropositive individuals, across cohorts representing the pre-vaccination immune history of most of the vaccinated Indian population. Funding: Corporate social responsibility (CSR) funding from Hindustan Unilever Limited (HUL) and Unilever India Pvt. Ltd. (UIPL).

Polyfunctional CD4 T-cells correlating with neutralising antibody is a hallmark of COVISHIELDTM and COVAXIN® induced immunity in COVID-19 exposed Indians.

Detailed characterisation of immune responses induced by COVID-19 vaccines rolled out in India: COVISHIELDTM (CS) and COVAXIN® (CO) in a pre-exposed population is only recently being discovered. We addressed this issue in subjects who received their primary series of vaccination between November 2021 and January 2022. Both vaccines are capable of strongly boosting Wuhan Spike-specific neutralising antibody, polyfunctional Th1 cytokine producing CD4+ T-cells and single IFN-γ + CD8+ T-cells. Consistent with inherent differences in vaccine platform, the vector-based CS vaccine-induced immunity was of greater magnitude, breadth, targeting Delta and Omicron variants compared to the whole-virion inactivated vaccine CO, with CS vaccinees showing persistent CD8+ T-cells responses until 3 months post primary vaccination. This study provides detailed evidence on the magnitude and quality of CS and CO vaccine induced responses in subjects with pre-existing SARS-CoV-2 immunity in India, thereby mitigating vaccine hesitancy arguments in such a population, which remains a global health challenge.

Incidence of Postpartum Depression and Its Association With Antenatal Psychiatric Symptoms: A Longitudinal Study in 25 Villages of Rural South Karnataka.

Background: Postpartum depression (PPD) is the commonest mental health disorder post-childbirth, yet there is a paucity of data in rural areas regarding the actual incidence of PPD, which excludes pre-existing or antenatal depression. To estimate the incidence of PPD among rural women of south Karnataka and identify predictors of PPD, including antenatal psychiatric disorders. Methods: A longitudinal study in 25 villages in south Karnataka among 150 pregnant women in the third trimester of pregnancy using simple random sampling. Baseline data collected and revised Clinical Interview Schedule used to screen antenatal psychiatric disorders. Participants followed-up 6-8 weeks postpartum, end-line data collected, and Edinburg Postnatal Depression Scale administered. Chi-square and Fischer's exact tests for association between PPD and covariates. Logistic regression to calculate adjusted odds ratios. Results: Prevalence of antenatal psychiatric disorders was 15.3%. The incidence of PPD was 11%. A significantly higher proportion of PPD was found among women with adverse events in the last year, low socioeconomic status, and perceived lack of care/support at home. Predictors of PPD were antenatal psychiatric disorders (AOR = 4.3, 95% CI = 1.22-5.11; P = 0.028), mothers reporting worry about their infant's health (AOR = 7.7, 95% CI = 1.22-48.32; P = 0.012) and mothers receiving postpartum care by caregivers other than their own mother (AOR = 4.0, 95% CI = 1.13-8.09; P = 0.030). Conclusions: Our study found that one in ten rural women is developing PPD and there is a strong link between PPD and antenatal psychiatric disorders and family factors. This calls for capacity building of general physicians and village-level workers and strengthening of the Home-Based Newborn Care Program, where weekly postpartum home visits by ASHA are an opportunity for screening and counselling mothers.

Are rural women aware of breast cancer and do they practice breast self-examination? A cross-sectional study in a rural hospital in South India.

Background: Breast cancer is the most common cancer among Indian women. Breast self-examination (BSE) remains a feasible screening method in resource-poor settings, yet diagnosis in advanced stages remains common. We aimed to assess the awareness of breast cancer and the practice of BSE among women in a rural area of south India. Methods: A cross-sectional hospital-based study in rural Ramanagara district, Karnataka, with 416 adult women who were interviewed using the Breast Cancer Awareness Measure. Results: Less than one in ten women knew that lump in the breast is a symptom of breast cancer. Majority 338 (81.2%) were not able to state even a single symptom of breast cancer and 365 (87.7%) not able to state even one risk factor of breast cancer. Majority 354 (85.1%) of the women in the study had never heard of BSE. None of the women in the study performed monthly BSE. Only 40 (9.6%) of the women actually performed BSE within the last 6 months. Women with higher education and those who reported a history of a lump in the breast in self or family were significantly more likely to state at least one symptom of breast cancer and were more likely to practice BSE. Conclusion: The rural women in this study had poor awareness regarding breast cancer and poor practice of BSE. Awareness of at least one symptom of breast cancer was associated with an 18 fold increase in the practice of BSE. This study has revealed an urgent need to focus on health awareness regarding breast cancer and BSE among rural women.

Cardiovascular Disease Risk Factors and 10 Year Risk of Cardiovascular Events among Women over the Age of 40 Years in an Urban Underprivileged Area of Bangalore City.

BACKGROUND: Cardiovascular disease (CVD) is one of the leading causes of death among Indian women but not a focus of current strategies to improve women's health. OBJECTIVES: To assess 10-year CVD risk and estimate the prevalence of CVD risk factors among underprivileged women. METHODS: A cross-sectional study among women aged 40-79 years in an urban underprivileged area of Bangalore city, using nonlaboratory-based World Health Organization and the International Society of Hypertension risk prediction chart and INTERHEART list of CVD risk factors. Blood pressure, random blood sugar, height, weight, and waist circumference were measured. The Chi-square test was done for the association between CVD risk status and risk factors. Multiple logistic regression performed to calculate adjusted odds ratios (ORs). RESULTS: Of 1027 women, 11% women had high risk of CVD (≥20% risk of fatal/nonfatal cardiovascular event within next 10 years). The prevalence of CVD risk factors was high with 20.2% diabetes, 53.7% hypertension, 77% overweight/obesity, and 92% central obesity. Majority were physically inactive with unhealthy diet, lacking daily fruits and vegetables, excess consumption of salty food, junk food, red meat, and excess oil. Significantly higher CVD risk found among women who were sedentary during leisure time (P = 0.028), single/separated/widowed women (OR = 1.84 [1.26-4.29] P = 0.002), and women who did not walk or cycle as a regular means of transport (OR = 1.47 [1.98-2.19] P = 0.041). CONCLUSION: High risk of CVD among underprivileged women reveals an urgent need for community-based interventions for prevention of CVD. Screening and management of diabetes and hypertension must include weight reduction and health education strategies. Policy-makers need to initiate efforts toward improving affordability of healthy diets for the urban underprivileged.

Secondhand Smoke Exposure during Pregnancy and its Effect on Birth Outcomes: Evidence from a Retrospective Cohort Study in a Tertiary Care Hospital in Bengaluru.

CONTEXT: The effect of maternal smoking on birth outcomes is well-established, but the effect of maternal secondhand smoke (SHS) exposure is less clear, especially among Indian women. AIM: To evaluate the effect of SHS exposure during pregnancy on birth outcomes such as gestational age at birth, neonatal anthropometry, and Apgar score. SETTING AND DESIGN: Retrospective cohort study at a tertiary hospital in Bengaluru. METHODS: 208 postnatal mothers: 104 each in "exposed" and "nonexposed" group, based on the history of SHS exposure during pregnancy. Sociodemographic and obstetric details were obtained by interview schedule and birth outcomes were obtained from patient charts. STATISTICAL ANALYSIS: Association of SHS exposure with birth outcomes was analyzed using inferential statistics such as Chi-square, t-test, and Mann-Whitney U-test, whereas the strength of association was expressed as relative risk with 95% confidence intervals. P < 0.05 was considered statistically significant. RESULTS: SHS exposed and nonexposed groups were comparable with regard to potentially confounding socioeconomic and obstetric covariates. Babies born to SHS-exposed mothers had significantly lower mean birth weight, mean birth length, and mean birth head circumference by 172.5 g (P = 0.027), 1.6 cm (P = 0.001), and 1.1 cm (P = 0.001), respectively. CONCLUSION: Mothers exposed to SHS during pregnancy were twice likely to deliver low birth weight babies (relative risk [RR] = 1.9 [1.0-3.6], P = 0.02) and babies of low birth length (RR = 2.64 [1.4-4.6], P = 0.001) than unexposed mothers. With a significant risk of adverse birth outcomes found among mothers exposed to SHS during pregnancy, it is important that a "no tobacco smoke" environment at home should be recommended for pregnant women and their families.

Experience and Perceptions Regarding Menopause among Rural Women: A Cross-Sectional Hospital-Based Study in South Karnataka.

BACKGROUND: There is a culture of silence around menopause in India, more so among rural women. This study was conducted to assess the prevalence of menopausal symptoms, factors associated with the severity of menopausal symptoms, and perceptions regarding menopause among rural perimenopausal women. METHODOLOGY: A cross-sectional study was conducted at a rural hospital, among women aged 40 years or more, having experienced at least one menstrual cycle in the past 1 year. Structured interview schedule was administered to capture perceptions of menopause. Symptoms of menopause and severity were assessed using the Menopause Rating Scale (MRS) and participants screened for depression using patient health questionnaire-9. RESULTS: Among 200 women, the prevalence of symptoms of menopause was 70%. Commonly reported symptoms were somatic symptoms: Joint/muscular pain, hot flushes, and psychological symptoms: Physical/mental exhaustion, anxiety. Median overall MRS score was low (4 [interquartile range = 1, 7]), pointing out to lesser severity. Significant association was found between MRS score and higher body mass index (P = 0.007), tobacco-chewing (P = 0.023), and depression (P < 0.001). Perception of menopause was generally positive, but we also documented some myths and misconceptions regarding menopause that indicate a need for health awareness in this population. CONCLUSION: This study found high prevalence but low severity of menopausal symptoms. Our findings point to a need for mitigating symptoms of menopause through diet, physical activity, tobacco cessation, and counseling for depression. Targeted interventions using community women's groups and village-level health workers are recommended to provide not only awareness regarding menopause but also an opportunity to screen for comorbidities with appropriate referrals.

Impact of a Residential Rural Community-Based Training Program for Medical Students on Cognitive and Affective Domains of Learning in Community Medicine: A Mixed Methods Study.

INTRODUCTION: As part of undergraduate training in community medicine, students of 1st-year MBBS at our medical college in South India undergo rural residential community-based training called Rural Orientation Program (ROP). OBJECTIVE: The objective was to study the impact of ROP at a medical college in South India. METHODOLOGY: Short-term impact was studied immediately before and after ROP using a 30-item questionnaire administered to 142 students. Medium-term impact was studied among 23 students in 2nd-year MBBS. Quantitative component consisted of objective structured practical examination scores and qualitative component documented reflections on learnings. Long-term impact was studied by surveying 287 alumni (batches of 1979 onward) to explore the impact of ROP on their career. RESULTS: We found a significant (P < 0.001) improvement in the median posttest score (21, interquartile range [IQR]: 20-23) when compared to pretest (12, IQR: 10-16). The mean OSPE score was 19.34 ± 3.19 (maximum score = 25) with 54.55% obtaining a score ≥20. Thematic analysis of reflections depicted that students gained insights on factors influencing health and social organizations in rural areas. ROP helped develop empathy toward patients and a holistic approach toward health, in understanding rural dynamics and improved communication skills. CONCLUSION: ROP increases subject knowledge and plays a role in molding attitudes of students toward the care of people in rural areas and improves communication skills. This time-tested model can be replicated in other medical colleges across the country.

Public perceptions on Controlled Human Infection Model (CHIM) studies-a qualitative pilot study from South India.

Research using Controlled Human Infection Models is yet to be attempted in India. This study was conducted to understand the perceptions of the lay public and key opinion makers prior to the possible introduction of such studies in the country. 110 respondents from urban and rural Bangalore district were interviewed using qualitative research methods of Focus Group Discussions and In-depth Interviews. The data was analyzed using grounded theory. Safety was a key concern of the lay public, expressed in terms of fear of death. The notion of infecting a healthy volunteer, the possibility of continued effects beyond the study duration and the likelihood of vulnerable populations volunteering solely for monetary benefit, were ethical concerns. Public good outcomes such as effective treatments, targeted vaccines and prevention of diseases was necessary justification for such studies. However, the comprehension of this benefit was not clear among non-medical, non-technical respondents and suggestions to seek alternatives to CHIMs repeatedly arose. There was a great deal of deflection-with each constituency feeling that people other than themselves may be ideally suited as participants. Risk takers, those without dependents, the more health and research literate, financially sound and those with an altruistic bent of mind emerged as possible CHIM volunteers. While widespread awareness and advocacy about CHIM is essential, listening to plural voices is the first step in public engagement in ethically contentious areas. Continued engagement and inclusive deliberative processes are required to redeem the mistrust of the public in research and rebuild faith in regulatory systems.

Do Low Self-Esteem and High Stress Lead to Burnout Among Health-Care Workers? Evidence From a Tertiary Hospital in Bangalore, India.

BACKGROUND: Low self-esteem can be an issue among health-care workers due to the hierarchical medical system. Health-care workers are also in a high pressure environment that can lead to stress and burnout. This study was conducted to estimate the proportion of health-care workers with low self-esteem, high stress, and burnout and the factors associated with these in a private hospital in Bangalore city. METHODS: This cross-sectional study included a random sample of health-care workers of various cadres - doctors, nurses, nursing aides, technicians, and workers in ancillary departments such as laundry, dietary, central sterile supply department, and pharmacy, with probability proportional to size. Rosenberg Scale for Self-esteem, Cohen's Perceived Stress Scale, and Shirom-Melamed Burnout Measure were used as study tools. RESULTS: Among the 306 health-care workers, there were high levels of low self-esteem (48.4%), stress (38.6%), and burnout (48.7%), with the lowest levels being among doctors. Those aged younger than 30 years had significantly lower self-esteem and greater stress. CONCLUSIONS: Health-care workers with low self-esteem were nearly thrice more likely to suffer high stress, Odds Ratio (OR) = 2.84 (1.36-5.92), and those who were stressed had more than three times higher chance of experiencing burnout, OR = 3.6 (2.02-6.55). Path analysis showed that low self-esteem among health-care workers had a direct effect on burnout, as well as an indirect effect through stress (mediator variable). This study indicates the need for screening and counseling for low self-esteem, stress, and burnout as part of a periodic medical examination of all cadres of health workers.

Development of a Comprehensive Antenatal Risk Assessment Tool to Predict Adverse Maternal and Perinatal Outcomes in Rural Areas: An Exploratory Study.

Objective: To develop a comprehensive antenatal risk assessment tool to predict adverse maternal and early perinatal outcomes in a rural setting. Materials and methods: Cross-sectional study among women admitted for delivery in a rural maternity hospital, south India. Risk factors from Rotterdam Reproductive Risk Reduction (R4U) scorecard and social factors relevant to Indian rural context were included in questionnaire. Maternal and perinatal outcomes were obtained from in-patient records. Logistic regression of risk factors associated with adverse outcomes and weighted scores assigned using beta-coefficients. Cut-off score to predict adverse outcome was derived using Receiver Operator Characteristic Curve (ROC Curve) and Likelihood ratios. Results: Adjusted odds for adverse outcome highest for small for gestational age by ultrasound scan [OR=7.4 (1.4-36.5)], tobacco chewing [OR=5.6 (1.8-28.5)] and hypertensive disorders of pregnancy [OR=3.5 (1.9-9.6)]. After assigning weighted scores, the 74-item antenatal risk assessment tool had a maximum possible score of 86. Risk score was calculated for all subjects. Cut-off score to predict adverse outcome was 4, using ROC curve, with a sensitivity of 98%, a specificity of 21% and positive likelihood ratio of 1.23 (1.10-1.37). Conclusion: This comprehensive antenatal risk assessment tool is easy to administer, specific to rural areas and can help community-level workers to screen, monitor, and refer high risk pregnancies for further management to prevent adverse maternal and perinatal outcomes. This may be considered a prototype towards developing more robust antenatal risk screening and outcome prediction in rural settings.

Barriers to Healthy Lifestyle among College-Going Students in a Selected College in Bengaluru Urban District.

CONTEXT: Cardiovascular diseases (CVDs) are influenced by factors acting at all stages of life. Healthy lifestyle practices among adolescents and youth are crucial in preventing CVDs in the later years. Many barriers prevent young people from practicing healthy lifestyles. AIMS: The aim of this study is to identify barriers to healthy lifestyle among college-going students in Bengaluru Urban District. SETTINGS AND DESIGN: A cross-sectional study was conducted among 722 students aged 15-25 years, in a degree college in Bengaluru Urban district. SUBJECTS AND METHODS: A structured interview schedule with good internal consistency (Cronbach's alpha = 0.887), consisting of 50 questions scored on a 5-point Likert scale with five domains (diet, physical activity, tobacco use, alcohol consumption, and stress) was administered. The total score was classified into high-, moderate-, and low-barrier categories using percentiles. The barrier score for each domain and for each individual question was computed by multiplying the weight of the responses by their frequencies. STATISTICAL ANALYSIS USED: Barriers to healthy lifestyle and its association with sociodemographic variables were analyzed using inferential statistics such as t-test and ANOVA. Significant factors were entered into a multiple linear regression model. RESULTS: The domain of stress emerged as the topmost barrier followed by diet. The main factors responsible for stress among college students were examinations (74.9%), long hours of the study (71.1%), and lack of time (69.6%). CONCLUSIONS: Barriers to healthy lifestyle are common among adolescents and youth. The topmost barriers identified were stress- and diet-related barriers.

Fear of Childbirth among Pregnant Women Availing Antenatal Services in a Maternity Hospital in Rural Karnataka.

BACKGROUND: Pregnancy, though joyful, may be a time of fear and anxiety. Twenty percent of pregnant women in developed nations report a fear of childbirth, and 6%-10% describe a severe fear that is crippling. This could lead to adverse maternal and fetal outcomes. Data on fear of childbirth among pregnant women are lacking in India and would help in incorporating measures to enhance routine antenatal care. METHODOLOGY: With the objective of documenting fear of childbirth and associated factors, a cross-sectional study was conducted in rural Karnataka among women availing antenatal care services, using a face-validated 30 item questionnaire developed by the authors which was then scored to determine fear of childbirth. RESULTS: Of 388 women studied, 45.4% (176) had a fear of childbirth. The commonest fears documented were: not feeling confident about childbirth, being afraid or tense about the process of childbirth, fear of labor pains, and fear of cesarean section. Teenage pregnancy, nulliparity, primigravida status, and having no living child were significantly associated with fear of childbirth. CONCLUSION: Overall, 45.4% (176) of women had a fear of childbirth. It is important to identify and address the various fears of childbirth that women may have, as revealed by this study, with a view to providing information and reassurance to the mother, with the aim of improved maternal and fetal outcomes.