Screen Time Among Medical and Nursing Students and Its Correlation With Sleep Quality and Attention Span: A Cross-Sectional Study.

BACKGROUND:  Screen time is increasing among students and is also known to affect their lifestyle and health. The study investigated the correlation of screen time with sleep quality and attention span. METHODS: A cross-sectional study was conducted among undergraduate medical and nursing students in November 2021. A total of 192 students were selected randomly and investigated using a structured questionnaire. Sleep behavior was assessed using the Pittsburg Sleep Quality Index. Screen time and attention span were measured for each participant. The screen time data was reported as the median with an IQR. Pearson's correlation was performed to assess the correlation between screen time and sleep behavior and screen time and attention span. RESULTS:  The median screen time for 28 days was 260 (192.2-326.7) hours, and the median non-academic screen time was 250.0 (172.3-328.0) hours. Subjective sleep quality was good among 163 (84.9%) of the study participants. Global sleep quality was poor among 91 (42.2%) participants. The median score of the digit span forward was 6.00 (IQR: 5.00-7.00), and the median score of the digit span backward was 5.00 (IQR: 4.00-6.00). The global sleep score had a strong positive correlation with screen time, with a Pearson's correlation coefficient of 0.86. Forward and backward attention spans were not correlated with sleep scores, with correlation coefficients of 0.037 and 0.071, respectively. CONCLUSION:  Screen time is increasing significantly among medical and nursing undergraduate students, and their sleep is also getting affected. Emphasis should be given to the balance between digitalization and health.

Utilization of Untied Fund and Factors Affecting the Utilization at Sub-Centers of Rural Odisha: A Mixed-Method Study.

Introduction: The untied funds at sub-centers provided flexibility for local action at block and down below levels. Effective utilization of untied fund can strengthen the healthcare. So, our study aims at assessing the knowledge of health workers, male/female (HWF/M), and effectiveness of utilization of untied funds at the sub-center (SC) level. Material and Methods: A mixed method (cross-sectional study and qualitative study) was conducted at Tangi Block, Khordha district, Odisha, in the year 2020. Health workers, male and female in sub-centers, and local stakeholders were interviewed using a structured interview schedule. The tool comprises financial records, a semi-structured questionnaire, and an in-depth interview guide. Universal sampling was adopted. For the cross-sectional study, 24 health workers were male/female, and for the qualitative study, all local stakeholders and 24 health workers female/male were interviewed. The study was conducted as a part of an academic program, and ethics approval was approved by AIIMS Bhubaneswar Institute Ethics Committee. Results: Seven out of 24 sub-centers did not spend any money, with a median unspent amount of 4260 INR (Q1-0, Q3-17300). As many as 36.8% of sub-centers had a delay of 9 months to get the untied fund, which significantly affected the utilization of funds. 37% of HWF/M utilized the fund inappropriately. None of the health workers had complete knowledge regarding the appropriate usage of untied fund. Communication gap, multiple engagements, non-cooperation from officials, delay in technical processing, and irregular Garam Sabha meetings were found to be barriers. Conclusion: Our study found out under-utilization of money in untied fund. Communication gap, non-cooperation form village leaders, poor knowledge, overburdened health workers, improper reporting, and lack of felt need were found to be barriers for prompt utilization.

Development and Validation of the ScAbIeS Tool for Diagnosing Scabies by Community Healthcare Workers in Resource-Limited Settings.

Introduction Scabies can lead to community outbreaks if not diagnosed early. Developing and validating a relevant tool for diagnosing scabies at the community level is essential to bridging the early diagnosis and treatment gap. Objective The objective of this study is to develop and validate a newer tool to diagnose scabies at the community level by Community Healthcare Workers (CHWs) in resource-limited settings. Methods The developed "ScAbIeS" tool comprised five items divided into two major and three minor criteria. After its development, a longitudinal descriptive study validated the "ScAbIeS" tool. The eligible participants were included in the study through active screening in villages under the Rural Health Training Center (RHTC) Mendhasala. Those villages' Accredited Social Health Activists (ASHS) were included as CHWs for diagnosing scabies using the "ScAbIeS" tool. The participants with skin lesions and/or itching were diagnosed with scabies by CHWs using the "ScAbIeS" tool. The diagnosis of CHWs using the "ScAbIeS" tool was compared with those of physicians, including expert dermatologists, to determine the sensitivity and specificity. Results Kappa's agreement is found to be 0.896 for CHWs and trained physicians regarding the diagnosis of scabies by the "ScAbIeS" tool. Cronbach's alpha is 0.738 for major criteria and 0.565 for minor criteria. 0.778 is found to be Cronbach's alpha for the total scale. The "ScAbIeS" tool is 85% sensitive and 100% specific to diagnose scabies when used by CHWs. Conclusion The "ScAbIeS" tool can be used to diagnose scabies at the community level by CHWs with appropriate training. It will lead to the prevention of complications and community outbreaks of scabies.

Depression and quality of life among elderly: Comparative cross-sectional study between elderly in community and old age homes in Eastern India.

BACKGROUND: Depression among elderly is an emerging public health concern. Along with other comorbidities, depression affects the quality of life and functional ability of the geriatric population. This study aimed to assess the depression and quality of life among elderly and compare these parameters among the inhabitants of old age home and in the community. MATERIALS AND METHODS: A cross-sectional study was conducted among the elderly of the community and old-age homes in the urban areas of Raipur, Chhattisgarh between March and July 2016. Hundred elderly (50 in each group) participated in the study. Geriatric Depression Scale 15 (GDS-15) and Older People Quality of Life (OPQoL)-35 scale were used to assess the geriatric depression and quality of life, respectively. Association between depression and demographic variables were analyzed by Chi-square/Fisher's exact test. Pearson's correlation coefficient was calculated between GDS-15 and OPQoL-35 scale. RESULTS: The prevalence of geriatric depression was 59%. Quality of life was better among the old-age home elderly participants than that of community elderly when compared for score of life over all (11.78 vs. 13.56), health (12.8 vs. 14.0), social relationship (10.48 vs. 13.9), control over life (11.92 vs. 14.08), home and neighborhoods (9.38 vs. 12.36), psychological and emotional wellbeing (10.96 vs. 13.7), financial circumstances (14.5 vs. 16.7), and leisure and activities (13.86 vs. 15.28). Moderate positive correlation was observed between depression and quality of life. CONCLUSION: The higher prevalence in our study emphasizes the need to delineate the actual burden in the elderly population and provide necessary supportive measures. It needs to be addressed adequately through a coordinated primary care approach and community and social support. Timely and adequate management of depression can improve the quality-of-life outcomes.

Prevalence of Anxiety Disorder in Adolescents in India: A Systematic Review and Meta-Analysis.

Anxiety is one of the most common mental disorders in the adolescent age group due to both physiological and psychological changes along with substance use in this age group. Generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and social phobia (or social anxiety disorder) constitute anxiety disorders as per the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria. In India, the National Mental Health Survey was conducted to estimate the burden of different mental health disorders, but the adolescent age group was not included in that survey. A comprehensive search strategy was used to find out articles from PubMed and ProQuest, along with a risk of bias assessment using two components of the Quality in Prognosis Studies (QUIPS) tool. The 13 articles included in the meta-analysis were divided into two groups depending on sampling strategy and outcome measurement. Due to more than 99% heterogeneity, the random effect model is used to find the pooled estimate. The pooled prevalence of anxiety disorder among adolescents in India is found to be 0.41 (CI: 0.14-0.96) for studies with more than low risk and 0.29 (CI: 0.11-0.46) for studies with low risk. The Begg and Mazumdar rank correlation test revealed no publication bias in the included studies. One study was found to be an outlier using the Baujat test, but pooled estimate and heterogeneity did not change significantly after its removal from analysis. The weight of individual studies calculated using the random effect model did not show any gross difference. A significant burden of anxiety was found in adolescents in India. Effective intervention should be planned to reduce this burden.

A Cross-Sectional Study to Correlate Serum Complement C3 and C4 Levels With Clinical and Pathological Severity in Cutaneous Small-Vessel Vasculitis.

Introduction The role of serum C3 and C4 levels as a marker of disease activity in cutaneous small-vessel vasculitis (CSVV) has been sparsely studied, especially in India. The primary objective was to determine the correlation between clinico-histopathological severity and serum C3 and C4 levels in CSVV. The secondary objective was to determine the association between direct immunofluorescence (DIF) findings and serum C3 and C4 levels and clinico-histopathological findings. Method This prospective cross-sectional study included all the clinically diagnosed cases of CSVV that satisfied the pathological criteria for CSVV. A clinical disease activity grade and a histopathological severity grade were calculated in all patients (N=50). Results Serum C3 and C4 levels (n=44) were diminished in 4.5% of cases. There was no significant correlation between the serum C3 and C4 levels and the clinical and histopathological severity. DIF was positive in 60.0% of cases (n=45), and IgA was the predominant immune deposit (46.7%). No significant association was detected between the DIF findings and the serum C3 and C4 levels, histopathological severity, and clinical disease activity grade. Positive DIF findings were significantly associated with palpable purpura and cutaneous necrosis. A significant association was detected between gastrointestinal involvement and IgA positivity. Conclusion In CSVV, serum C3 and C4 may not be used as markers of disease severity, and a positive DIF finding may indicate an underlying gastrointestinal involvement.

Comparison of Clinical Presentation and Vaccine Effectiveness Among Omicron and Non-omicron SARS Coronavirus-2 Patients.

Introduction The rapidly mutating Omicron SARS-CoV-2 variant has replaced the previous dominant SARS-CoV-2 variants like alpha, and delta resulting in the amplification of coronavirus disease 2019 (COVID-19) cases. The present study was conducted to compare the clinical profile and vaccination status in patients infected with Omicron and non-Omicron SARS-CoV-2 variants. Methods All patients who tested positive for coronavirus disease 2019 (COVID-19) during the study period (January 2022 to February 2022) were further tested for detection of SARS-CoV-2 Omicron variant by using Omisure kit (TATA MD CHECK RT-PCR, TATA MEDICAL AND DIAGNOSTICS LIMITED, Tamil Nadu, INDIA). Clinico-demographic factors and vaccination status were compared between both Omicron and non-Omicron groups. Results A total of 1,722 patients who tested positive for COVID-19 were included in the study, of which 656 (38.1%) were Omicron and 1,066 (61.9%) were non-Omicron SARS-CoV-2 variants. Blood group and vaccination status were the major predictors for Omicron. The proportion of male patients was 58.4% in the Omicron group and 57.9% in the non-Omicron group. Maximum cases (86.2%) belonged to >18-60 years age group, 7.3% to >60 years age group, and least to 0-18 years (6.5%). The average age of the study participants was 35.4 ± 14.5 years. Vaccinated participants had less chance of having Omicron than the unvaccinated participants (p-value - 0.003). Fever and loss of smell were found to be significantly associated with the non-Omicron SARS-CoV-2 variant. (p-value < 0.05). Conclusion The present study reflects that the clinical course of the disease is milder in Omicron as compared to the non-Omicron variant. However rapid rise in cases can badly affect the healthcare system demanding good preparedness to tackle all the predicaments. Good Vaccination coverage should be of utmost priority irrespective of the variant type.

Anti-Rabies Vaccine Compliance and Knowledge of Community Health Worker Regarding Animal Bite Management in Rural Area of Eastern India.

Background Rabies is a public health problem in developing countries like India accounting for the second-highest number of rabies-related deaths worldwide. Anti-rabies vaccine (ARV) is the only proven and effective way of preventing death in this 100% fatal disease. However, compliance is a real concern. This study aims to assess the compliance of ARV and rabies immunoglobulin (RIG) among the ARV-clinic beneficiaries and also the knowledge of the health workers regarding animal bite management. Methods A cross-sectional study was conducted in an ARV clinic of a community health centre in a rural Odisha (Eastern India) between February and April 2019. All the beneficiaries attending the ARV clinic were followed up for 28 days to assess their ARV and RIG compliance. Data were collected using a pre-designed semi-structured questionnaire and analysis was performed using SPSS v.22 (IBM Corp, Armonk, NY, USA). Proportion was calculated for categorical variables and mean for continuous variables. Chi-square test was applied to test for significance of categorical variables. Results A total of 468 beneficiaries were followed up. More than half (59.8%) of the animal bite victims had a category-II bite, followed by 33.4% having category-III, and 6.8% having a category-I bite. Around three-fourth were exposed to dog bite. Only 52.3% of the patients were compliant with ARV, and 49.4% were compliant with RIG. Knowledge of the health workers regarding wound management was found to be sub-optimal. Conclusion Poor ARV compliance was seen among the beneficiaries. Awareness activities need to be strengthened further to improve health-seeking behaviour. The significant gap in knowledge of the health workers indicates the need for professional training at regular intervals.

Adherence of Doctors to Standard Diarrhoeal Management Guideline During Treatment of Under-Five Diarrhoeal Episodes: A Study From Eastern India.

Introduction Diarrhoea is one of the major preventable causes of childhood death in tribal areas of India. Most acute diarrhoea in childhood can be managed with oral rehydration salt (ORS) and zinc. This study aimed to assess the adherence of doctors to standard diarrheal management guidelines while treating under-five diarrhoeal episodes. Methods The cross-sectional study was conducted in 10 blocks of Kandhamal district in southern Odisha, India. The under-five childhood diarrhoea prescriptions from July to August 2018 were audited during September 2018. One health facility from each block and 15 prescriptions from each health facility were selected randomly. Data were collected and entered in Epicollect5 and analyzed using Statistical Packages for Social Sciences Version 22.0 (IBM Corp., Armonk, NY). Categorical variables were presented as proportions. Results A total of 150 under-five acute diarrhoea prescriptions were audited from 10 health facilities. One hundred ten prescriptions were from the out-patient department and 40 prescriptions were from the admitted diarrhoeal patients. The majority of them included ORS (77.3%) and zinc (75.3%) in the prescription, however, only half of the prescriptions (52.7%) had recommended dose and duration of zinc. All admitted patients received intravenous fluids. Most prescriptions (89.3%) did not document the hydration status of the patient. All prescriptions were silent about the severe acute malnutrition status of the children before administering fluid therapy. Antibiotics were prescribed in 80% of the prescriptions. Prebiotics, probiotics and anti-spasmodic were prescribed in 37.3% of the prescriptions. Conclusion Adherence of doctors to acute diarrheal management guidelines for the management of under-five diarrhoea was poor in our study. Further researches and training are required to improve childhood diarrhoea management in health facilities of tribal areas of India.

Community perception regarding diarrhoea management practices in a tribal predominant aspirational district of Odisha: A mixed-method study.

CONTEXT: Childhood diarrhea is still a major problem in developing countries, and the condition is worse in tribal areas. AIMS: The study aims to assess the community perception related to diarrhea management in an aspirational district of Odisha, India. SUBJECTS AND METHODS: A mixed-method study was conducted in Kandhamal, an aspirational district of Odisha, Eastern India, from June to October 2018. An in-depth interview was conducted among community health workers, and a cross-sectional survey was done for the household interview. The data were collected in a mobile-based application, Epicollect5, and in-depth interviews were recorded digitally. STATISTICAL ANALYSIS USED: The data were analyzed in the Statistical Package for Social Sciences (SPSS) version 22.0. Categorical variables are presented in proportions. Force-field analysis was conducted to assess the driving and restraining forces of diarrhea. Content analysis was done for the digitally recorded data. RESULTS: Nine out of ten people were aware of the benefit of breastfeeding during diarrheal episodes in children aged under 5 years, and <50% were aware of zinc benefit. Poor sanitation, lack of safe water, poor hygiene practices, socioeconomic status, and illiteracy are the major challenges in diarrheal control in the tribal area. CONCLUSIONS: Improving the demand by creating community awareness regarding management of diarrhea, availability of essential drugs (ORS and zinc) at the community level, and capacity building of community health workers for management of diarrhea can reduce diarrhea-related morbidity and mortality in tribal areas of India. Handwashing, hygiene practices, and availability of safe water need to be promoted in the tribal region. In the long term, the socioeconomic determinants have to be addressed.