Impact of COVID-19 pandemic on online medical education - An online survey of students' perspective.

Introduction: The year 2020 brings in a paradigm shift in medical education with the emergence of the COVID-19 pandemic. Since the government of India initiated the first countrywide lockdown, educational institutions, including medical colleges, have adopted online mode for undergraduate teaching. Medical education is virtually incomplete without appropriate practical exposure. This study was conducted to understand the opinion of the medical students towards online classes as an impact of this pandemic on medical education. Materials and Methods: A descriptive online survey was conducted using a google form among medical undergraduate students from across India. Snowball sampling was used to recruit study participants. The responses were analyzed using numbers and percentages. Continuous variables were expressed as the mean and standard deviation of the mean. Results: The mean age of the 1426 respondents was 20.46 years. The majority of the responses were from Karnataka (412), followed by Odisha (167). While fairly a good number of respondents agreed that online classes provided a conducive environment and independence in learning, a large proportion disagreed or remained neutral in terms of its usefulness. This could be attributed to several reasons, which may be categorized into three important groups: the technical competence of the students, the provision of an enabling environment and the ability of the teachers. Conclusion: Students had varying opinions on online classes, but most emphasized the need for redoing the lessons taught online.

Prevalence and Assessment of Knowledge, Attitudes, and Practices of Tobacco Use Among Medical and Dental Students in Bhubaneswar, Odisha.

Background Tobacco use remains a significant global public health concern, causing millions of preventable and premature deaths annually and imposing substantial economic burdens. India, the second-largest producer and consumer of tobacco products worldwide, bears a significant burden of tobacco-related morbidity and mortality. Medical and dental students represent the future healthcare workforce and role models; hence, their tobacco consumption and attitude would play a vital role in tobacco control. This study aims to estimate the prevalence and assess the knowledge, attitudes, and behaviors regarding tobacco use among medical and dental students in Bhubaneswar, Odisha. Methods A descriptive cross-sectional study was conducted using the Global Health Professional Students Survey (GHPSS) questionnaire. The study included third-year Bachelor of Medicine and Bachelor of Surgery (MBBS) and Bachelor of Dental Surgery (BDS) students from two private medical and two dental colleges in Bhubaneswar, Odisha. Data were collected from February to April 2019 through anonymous self-administered questionnaires, and descriptive and bivariate analyses were performed. Results A total of 400 students were surveyed, with 16% reporting being current smokers (24.3% males, 8.7% females). Furthermore, 36.8% had tried cigarettes and other tobacco products. Nonsmokers demonstrated stronger support for comprehensive tobacco control policies, such as banning advertising and smoking in public places, compared to current smokers. Most students acknowledged the importance of recording tobacco use history and providing educational materials; however, only around 40% had received formal training on smoking cessation. Conclusion The findings highlight the need for targeted intervention among medical and dental students for tobacco cessation. It is vital to foster a positive attitude toward tobacco control among future healthcare professionals. Health professional institutions should take proactive steps to prevent tobacco use among students and develop initiatives to motivate successful cessation training. Investing in tobacco control education for healthcare professionals is crucial to empower them in tobacco cessation efforts and promote healthier societies.

Socioeconomic gradient of lean diabetes in India: Evidence from National Family Health Survey, 2019-21.

Diabetes is a global public health challenge, particularly in India, affecting millions. Among diabetic patients, lean type 2 diabetes is a severe subtype with higher microvascular complication risks. While studies on the prevalence, variations and risk factors of diabetes are increasingly available, there has been limited research on the prevalence, variations, and socioeconomic disparities of lean diabetes in India. This study used NFHS-5 microdata, and lean diabetes is defined as those with a BMI level of under 25 and random blood glucose levels of over 200 or under diabetic medication. Descriptive and multivariate analyses were conducted to understand lean diabetes variations and related factors. Socioeconomic disparities were measured using concentration curves and the concentration index. The study unveiled important insights into lean diabetes in India. 8.2% of men and 6.0% of women had elevated blood glucose levels, indicating a significant diabetes burden. Notably, 2.9% of men and 2.4% of women were diagnosed with lean diabetes. Among type 2 diabetics, 52.56% of males and 43.57% of females had lean type 2 diabetes. Lean diabetes prevalence varied from 11.6% in the poorest quintile to 1.1% in the richest. The odds of lean type 2 diabetes among those in the poorest quintile was 6.7 compared to the richest quintile. The concentration index of lean type 2 diabetes was -0.42 for men and -0.39 for women, suggesting a disproportionate impact on lower socioeconomic groups. This study advances our understanding of the complex interplay between socioeconomic factors and lean type 2 diabetes in India. To address the rising burden of lean diabetes among lower socioeconomic strata, policymakers and healthcare professionals must prioritise initiatives enhancing healthcare access, promoting healthy lifestyles, and ensuring effective diabetes management. By addressing socioeconomic disparities and implementing interventions for vulnerable populations, India can reduce diabetes-related mortality and enhance its citizens' overall health.

Prevalence and Risk Factors of Iron Deficiency Anemia among the Tribal Residential Adolescent School Students of Odisha: A Cross-Sectional Study.

Background: Globally, anemia is one of the biggest public health challenges. The highest prevalence of anemia is seen among adolescents. Tribal communities are especially at a disadvantage, with several studies documenting a high prevalence of anemia among tribal adolescents. We investigated the prevalence of anemia and its associated risk factors among the tribal residential adolescent school students in Odisha. Material and Methods: In a cross-sectional survey, the prevalence of anemia was estimated by spectrophotometry among adolescents of residential schools in three predominantly tribal districts of Odisha. The severity of anemia was defined as per the World Health Organization classification for adolescents. Results: The mean age of 953 subjects was 13.07 ± 1.48 years. The prevalence of anemia was found to be 37.3%. As per the World Health Organization classification, 19.9% had mild anemia, 16.3% had moderate, and 1% had severe anemia. Consumption of Iron Folic Acid (IFA) was associated with the level of hemoglobin at a statistically significant level. Conclusion: We found that the prevalence of anemia was lower than in similar studies conducted in other parts of the country. Despite poor coverage of beneficiaries with iron and folic acid at the national level, our study showed better compliance and was associated with a significantly higher level of hemoglobin among those who consumed IFA.

Operational Feasibility of Hospital-Based Cancer Registries in Low- and Middle-Income Countries: A Systematic Review.

Cancer registration is crucial for any country's cancer surveillance and management program. However, there is a lack of systematic evidence on the operational feasibility of hospital-based cancer registries (HBCRs) in low- and middle-income countries (LMICs). We systematically reviewed and described the challenges and prospects of HBCRs in LMICs. We reported the study according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Electronic databases such as MEDLINE, EMBASE, Web of Science, ProQuest, and CINAHL were searched. Peer-reviewed studies published between January 1, 2000 and June 30, 2021 were included. We used thematic analysis to synthesize the findings discussing barriers and enablers of HBCRs. Thirteen studies were eligible for the analysis after eliminating duplicates, screening of title and abstract, and full-text review. The determinants, registry functionality, data management and abstraction, data security, data quality, organizational readiness, and perception of registry staff influence the implementation of HBCRs. In LMICs, many registries lacked functional documentation and data management systems due to a shortage of skilled professionals. However, in many instances, physicians and patients communicated via digital media, which helped obtain accurate data. The HBCR completeness rate was high in Ethiopia, China, Thailand, and Tanzania. Qualification and capacity building of the data managers was linked to the completeness and accuracy of the registry data, which led to sustainability. In addition, a few registries implemented new worksheets to enhance documentation. This review highlights the need for additional digitalization of the cancer registry to improve its functionality, completeness, follow-up, and output. Further, physicians and data managers require regular training to address cancer registry completeness and reduce errors.

Gendered Pattern and Predictors of Tobacco use in India: Evidence from the Second Round of Global adult Tobacco Survey.

Background: India has completed the second round of the Global Adult Tobacco Survey (GATS) to monitor adult tobacco use and progress in tobacco control efforts. This study assesses the gendered pattern of tobacco use and its predictors in the second rounds of GATS. Material and Methods: Publicly available GATS-2 (2016-2017) data was analyzed which contains self-reported tobacco use information of ≥15 years Indians (n = 74,037). The independent predictors of "smoking only," "smokeless only," and "dual use" among current male and female tobacco users were assessed using the multinomial regression model. Results: The burden of "smoking only," "smokeless only," and "dual-use" of tobacco were 8.9% (8.74-9.15), 16.69% (16.42-16.96), and 3.89% (3.75-4.03), respectively, in the second round with wide regional variation as well as male dominance in use. Region, age, education, caste, and religion were significantly and consistently associated with different types of tobacco use in both genders. Other contextual predictors of tobacco use were residence, marital status, occupation, awareness, and wealth index (WI). Conclusions: Tobacco use predictors and their gendered patterns are contextual. Monitoring the predictors for tobacco use, which may change over time, should be given priority in the national tobacco control program.

Survival of Gastric Cancer Patients at a Tertiary Care Hospital in Eastern India: A Retrospective Data Analysis.

Background Gastric cancer is one of the most common cancers and a leading cause of death worldwide. Most cases of gastric cancer are diagnosed at an advanced stage when no definitive treatment is available leading to an overall declined survival rate. In this study, we aimed to investigate the survival rate of gastric cancer patients admitted to our tertiary care center and determined the relationship between sociodemographic and clinicopathological characteristics with mortality. Methodology Gastric cancer patients treated between January 2019 and December 2020 were included in this retrospective study. The clinicopathological and demographic data of 275 gastric cancer patients were analyzed. The Kaplan-Meier method was used to calculate the overall survival of gastric cancer patients. The Kaplan-Meier log-rank test was used to calculate the difference. Results The mean survival of gastric cancer patients was 20.10 months (95% confidence interval = 19.20-21.03). Deaths were higher among stage III (42.6%) and stage IV (36.1%) patients compared to stage I (1.6%) and stage II (19.7%) patients. Mortality was significantly higher (70.5%) in patients without surgery. Conclusions The mean survival in our study setting is lower and is associated with the pathological stage of the disease, surgical intervention, and patients presenting with other gastrointestinal symptoms. A lower survival rate can be attributed to late diagnosis.

Performance of the Heaviness of Smoking Index in Indian Settings.

Background and objective The heaviness of smoking index (HSI) is a popular tool to assess nicotine dependence in clinical and community settings. Low cigarette consumption and concurrent use of other tobacco products raise concerns about its validity in Indian settings. This study explores the performance of HSI in Indian settings. Methods This study analyzed daily manufactured cigarette smoker data from the cross-sectional Global Adult Tobacco Surveys (GATS) from its first (GAST-1, 2009) and second waves (GATS-2, 2016), both of which were available in the public domain. The HSI scores were calculated based on the number of cigarettes smoked per day (CPD) and time to first smoke (TTFS) after waking up among the current daily cigarette users. This study examined the utility of the HSI scale in Indian settings by estimating the predictability of low dependence on quit attempts and quit intentions using the likelihood ratio parameter. Results About nine in 10 cigarette users in India consumed less than 10 cigarettes per day, yielding a low score on the HSI scale for most of the daily cigarette users. The majority of daily cigarette smokers scored ≤ 1 (low dependence) on the HSI scale both in GATS-1 and GATS-2, irrespective of their exclusive cigarette use status. The absolute value and the 95% confidence limit of positive likelihood ratios (falling below and above one) suggest that the predictability of low dependence on quit attempts and quit intention in the Indian setting is limited. Conclusions The utility of the HSI scale in assessing nicotine dependence among cigarette users in India is limited. This may be attributed to low average cigarette consumption, concurrent use of various tobacco products, and the sociocultural milieu of Indian smokers. This highlights the need for a new rapid nicotine dependence scale tailored to the specific patterns of tobacco use behavior prevalent in the Indian context.

Health Warnings on Tobacco Packages: A Compliance Assessment Study Around Educational Institutions in Bhubaneswar, India.

Background Graphic health warning labels (HWLs) on tobacco product packaging have been identified by the World Health Organization (WHO) as a cost-effective policy intervention to warn consumers about the health risks of tobacco. Compliance with HWLs shields young individuals from tobacco marketing influences and exposes users to health warnings. Assessing compliance with health warning labels would provide insights into the state of law implementation. The study assessed health warning labels on tobacco packages as per the Cigarettes and Other Tobacco Products (COTPA) (Packaging and Labelling) Amendment Rules of 2020, specifically assessing their availability around educational institutions in Bhubaneswar, Odisha, India. Materials and methods From August 2022 to January 2023, a protocol was employed to collect information on the sale of tobacco products around educational institutions including packages of cigarettes, beedis, and smokeless tobacco (SLT) from Bhubaneswar City. Using multistage random sampling 18 schools were selected in Bhubaneswar City. Areas within 100 yards (91.44 meters) of each school were mapped using a map tool. All prospective tobacco vendors within 100 yards of each school were included in the study. The data on compliance with HWLs were summarized using descriptive statistics. The health warnings compliance assessment of the tobacco products available with the vendors was conducted using three major indicators, including analysis of the font content, size and element of the graphics, and textual health warnings. In addition, the surface area occupied by these warnings was measured using a calibrated ruler. Results Within 100 yards of 18 schools in Bhubaneswar city, 57 vendors were found selling tobacco. About 48 distinct brands and 791 unbranded tobacco products were identified from 2135 packets collected from 57 vendors. Out of the 48 branded product packets examined, 25 brands were for smoking (cigarettes, bidis), while 23 were for SLT products such as khaini, gutkha, and pan masala containing tobacco. Only six brands out of 17 cigarette packs complied with HWL provisions. None of the eight unique bidi packs and 302 unbranded bidi packs were compliant with any HWL compliance indicators. Other compliance-related issues included incomplete health warning labels, out-of-rotation pictorial health warnings, distorted printing (blurry, heavy tint, and faded), and split warnings. Conclusion Tobacco products were sold within 100 yards of educational institutions in clear violation of the COTPA Section 6 provisions. Furthermore, the tobacco products sold were also not in compliance with the health warning label laws under section 7 of COTPA. There is an urgent need for strict enforcement of the provisions relating to the ban on sale within 100 yards of educational institutions and health warning label rules in Bhubaneshwar.

HER 2/neu Overexpression in Oral Squamous Cell Carcinoma and Its Clinico-Pathological Association at a Tertiary Care Center in Eastern India.

Human epidermal growth factor receptor 2/neu (HER2/neu) is known to serve as a prognostic and predictive biomarker in several cancers such as breast, gastric and ovarian cancers. In head and neck squamous cell carcinoma, HER2/neu expression is seen but in a fluctuated manner. Hence, its role as a prognostic factor in oral squamous cell carcinoma (OSCC) needs evaluation. To determine the HER 2/neu overexpression in OSCC patients and its association with clinical and pathological parameters. 74 patients of OSCC treated between 2016 and 2018 were included in the study. Immunohistochemistry was done on tissue samples from these patients and HER2/neu expression was measured. Both biopsy and resected specimens were considered for the study. Out of 74 patients, 47.3% (35) were operated and 52.7% (39) were not operated due to loss to follow-up. No significant association was found (p = 0.636, OR = 0.68, CI = 0.14-3.34) between lymphovascular invasion (LVI) and HER2/neu expression. Similar results were seen for perineural invasion (PNI) (p = 0.490, OR = 0.53, CI = 0.88-3.24), depth of invasion (p = 0.21), grade of tumor (p = 0.214), clinical-stage (p = 0.511) and pathological stage (p = 0.091). No significant association existed between HER2/neu expression and LVI, PNI, clinical-stage, the grade of tumor and the pathological stage of oral squamous cell carcinoma.

Gender dimensions of youth vulnerability toward access to cigarettes in South-East Asia: Evidence from global youth tobacco survey.

Background: Youths are lured to smoking to make them tobacco customers. Limiting access to tobacco products by youths is a proven strategy to reduce youth tobacco use. This study aimed to examine the burden of cigarette smoking and access to tobacco by youth in South-East Asia (SEA). Methods: The burden along with the physical (methods of obtaining cigarettes), financial (cigarette affordability by pocket money), and illegal (sale to minors) access to cigarettes among school-going boys and girls were examined by analyzing the Global Youth Tobacco Survey (GYTS) data (2013-2016) from seven SEA member countries. Descriptive statistics using country-specific GYTS sample weight was used to estimate parameters with 95% confidence intervals. Results: The proportion of youths reporting cigarette smoking was highest in East Timor [boys: 55.57 % (51.93-59.21) and girls: 11.35% (9.12-13.59)] and lowest in Sri Lanka [boys: 2.96% (2.91-3.0) and girls: 0%]. Smoking prevalence was higher among boys than girls. Smoking among boys and girls was positively correlated (r = 0.849, p = 0.032). The most common method of obtaining cigarettes was "buying it from a store/kiosk/street hawker" and "other sources." Except in Indonesia, financial access was limited for most youths. Financial access had a positive but negligible influence on cigarette smoking. Despite legal restrictions on sales to minors, students could obtain cigarettes from vendors. Conclusion: Contextual cigarette smoking and access to cigarettes by youths despite the legal ban and unaffordability is a concern. Country-specific socio-cultural-economic and legal dimensions need to be examined to limit cigarette use among youths.

Prevalence, Patterns, and Predictors of Physical Inactivity in an Urban Population of India.

Physical inactivity (PI) is a risk factor for mortality and morbidity. PI and its predictors among the urban population in Bhubaneswar, India, were unknown. Finding out the contribution of PI as a cause of existing noncommunicable diseases (NCD) is difficult without following up with a cohort. The study was hence done to find out the prevalence, patterns, and predictors of physical inactivity in an urban population, and simultaneously investigate its causal relationship with NCD from this cross-sectional study. Cluster random sampling was used with a sample size of 1203 with a design effect of three. Socio-demographic, health profile, physical activity levels, and stage of change for physical activity behavior were collected. Logistic regression and marginal structural model analysis (by inverse probability of treatment weighting {IPTW} using a generalized estimating equation {GEE} to investigate the relationship between physical activity and prevalence of NCDs) were done using IBM SPSS v20 software (Armonk, NY: IBM Corp.). Statistical significance was tested at p=0.05. A total of 1221 subjects participated. The mean age was 35.25 years and 71.9% were physically inactive. General caste, presence of NCD, and being in a static stage of change influenced physical activity positively. PI was found to be a risk factor for NCD with 1.54 times higher odds in this population. The study concluded that the prevalence of physical activity was low and PI was a causative factor for NCD.

Medication Adherence Among Patients of Type II Diabetes Mellitus and Its Associated Risk Factors: A Cross-Sectional Study in a Tertiary Care Hospital of Eastern India.

BACKGROUND: Type 2 diabetes mellitus is a major public health problem. Adherence to anti-diabetic medications improves glycaemic control, which in turn prevents complications as well as reduces out-of-pocket expenditure. The World Health Organization highlights that the impact of interventions directed to improve adherence has far greater implications than specific medical interventions. There are several factors that contribute to poor adherence. Not many studies have been conducted to explore adherence to diabetes medications in eastern India. OBJECTIVES: To measure medication adherence among patients suffering from diabetes. To determine the various risk factors influencing adherence to medication. To find out the association of health-related quality of life with adherence to medication. METHODOLOGY: A hospital-based cross-sectional study was conducted in the outpatient Department of General Medicine and Endocrinology of a tertiary care hospital in eastern India from January to March 2020. Adult subjects, who were diagnosed with type 2 diabetes mellitus for at least six months, were interviewed using a pretested, structured questionnaire containing 8-item Morisky Medication Adherence Scale (MMAS-8) to determine adherence to diabetic medications. Data were analysed in SPSS version 27 (IBM Corp., Armonk, NY, USA). RESULTS: The mean age of the 331 participants interviewed was 53.40 (SD 11.0) years and the majority were males (57.1%). Medication adherence of 34.14% (n=113) was found among the subjects. Having any comorbidity, positive family history of diabetes and the habit of current alcohol intake increased the odds of poor adherence by 3.26 times, 1.88 times, and 2.35 times respectively in binary logistic regression analysis. Those following a diabetic diet had a protective effect, decreasing poor medication adherence by 79.6%. Poor medication adherence increased by 1.077 times with every one-day increase in unhealthy days. CONCLUSION: The medication adherence was 34.14% and as compared to other similar studies medication adherence in the study population was poor and was associated with unhealthy days.

An ethnographic approach to understand cultural perspectives of tribes on branding practice for sick children in Odisha, India.

Background & objectives: Traditional beliefs on child healthcare at time lead to potentially harmful practices like branding. However, there is a gap in people's perceptions, attitudes and beliefs about branding practice. Therefore, the present study was undertaken to document the cultural motivation, ability and opportunity for branding practice in a tribal district of Odisha, India. Methods: Initially, such practices were observed in the tribal community for three months. Then, 18 in-depth interviews were conducted - ten among women having under-five children, and eight among traditional healers. Six focus group discussions were conducted with community health workers as well. The responses were digitally recorded, transcribed and translated and were further used for thematic framework analysis. Results: The primary determinants of branding practice were cultural beliefs compounded with low-health literacy, proximity to conventional care and influence of family and friends. The key driver for branding practices was traditional cultural beliefs on child healthcare decisions and health-seeking behaviours. Opportunities in the health system - availability and quality of health services - frequently drive them to seek healthcare from the system structure and routine health communication improves their ability to make better healthcare decisions. Interpretation & conclusions: Culture significantly affects the conceptualisation of illness and care-seeking pathways in a society. The indigenous community used to consult local traditional healers for their health concerns. While the government has made efforts to increase community health literacy through various platforms and multiple stakeholders' engagements, the doorstep availability of modern care and health promotion interventions remains critical for meeting the health needs of the indigenous community.

Prevalence, Patterns, and Predictors of Yoga Practice Among Adults in an Urban Population in Eastern India.

The objective of this study was to determine the prevalence and predictors of yoga practice. This cross-sectional study was conducted as a part of a larger study that included yoga as a form of physical activity. Data were collected during April and August 2019 from the adult urban population of Bhubaneswar, India. This study was conducted using a cluster random sampling method. A representative sample (n = 1,203) of adults aged 18-59 years, irrespective of gender, was interviewed using a questionnaire adapted from the 2012 U.S. National Health Interview Survey, with the Epicollect5 handheld data-collection tool. Predictors of yoga practice were explored using multivariable logistic regression. The mean age of the participants was 35.19 ± 10.67 years, with 55.3% males. The majority were Hindu (93.62%) and belonged to the unre s e rved category (65.60%), people generally of higher relative socioeconomic status. The lifetime prevalence of yoga was 16.9%. Prevalence of any form of yoga (yoga, pranayama, or meditation), all forms of yoga (yoga, pranayama, and meditation), pranayama, and meditation was 17.0%, 10.7%, 14.3%, and 11.4%, respectively. After adjusting for confounders, female gender, Hindu religion, minimum of higher-secondary or graduate-level education, and having received advice from professionals for yoga practice had significantly higher odds of practicing yoga, and those of higher socioeconomic status had significantly lower odds of practicing yoga. We found a low prevalence of yoga. Sociodemographic characteristics like gender, religion, education, socioeconomic status, and other factors like learning yoga from professionals may be important predictors of continued yoga practice.

Challenges in Detection of Adolescent Anaemia: Validation of Point-of-Care Device (Mission® plus) for Haemoglobin Measurement among Tribal Residential School Children of Selected Districts of Odisha, India.

BACKGROUND: Screening for anemia among tribal school children has been a challenge. OBJECTIVES: To validate a point-of-care (POC) device (mission® plus hemoglobinometer) to the gold standard method, spectrophotometry. STUDY DESIGN: Cross-sectional study. PARTICIPANTS: The representative sample of 953 tribal adolescents from the residential schools of Odisha. METHODS: Hemoglobin was measured simultaneously by the POC and gold standard method during January to July 2019. The validity of the POC device was measured by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The area under the curve was calculated using receiver operating characteristic (ROC) analysis. Concordance of the POC device with the gold standard method was determined by the Bland-Altman plot. The intraclass correlation coefficient (ICC), precision (⍴), a bias correction factor (Cb), and the concordance correlation coefficient were also calculated. Deming regression analysis was performed, and a linear equation was established. RESULTS: The mean age of the study participants was 13.07 (±1.48) years. The prevalence of anemia was 45.54% by the gold standard method. The sensitivity and specificity of the POC device were 94.9% and 56.1%, respectively. PPV and NPVs were 64.4% and 93.0%, respectively. The area under the ROC curve was found to be 0.856. The ICC was 0.887 (95% confidence interval: 0.872-0.901). CONCLUSIONS: Very good reliability/absolute agreement for hemoglobin measurements existed between the POC device and the gold standard method making it suitable as a screening device.