Hypertension treatment cascade among men and women of reproductive age group in India: analysis of National Family Health Survey-5 (2019-2021).

Background: Only a proportion of adults with hypertension are diagnosed and receive recommended prescriptions despite the availability of inexpensive and efficacious treatment. We aimed to estimate the prevalence of different stages of hypertension treatment cascade among the reproductive age groups in India at the national and state levels. We also identified the predictors of different stages of the hypertension treatment cascade. Methods: We used the nationally representative data from National Family Health Survey (NFHS)-5. We included all the males (15-54 years) and females aged 15-49. Socio-demographic factors, anthropometric measurements, habits, comorbid conditions, and healthcare access stratified the stages of the hypertension treatment cascade among hypertensives. We used multinomial logistic regression to identify the determinants of the treatment cascade levels. Findings: We had data from 1,267,786 individuals. The national prevalence of hypertension was 18.3% (95% CI: 18.1%-18.4%). Men (21.6%, 95% CI: 21.5%-21.7%) were found to have a higher prevalence as compared to women (14.8%, 95% CI: 14.7%-14.9%). Among hypertensive individuals, 70.5% (95% CI: 70.3%-70.7%) had ever received a BP measurement ("screened"), 34.3% (95% CI: 34.1%-34.5%) had been diagnosed prior to the survey ("aware"), 13.7% (95% CI: 13.5%-13.8%) reported taking a prescribed anti-hypertensive drug ("under treatment"), and 7.8% (95% CI: 7.7%-7.9%) had their BP under control ("controlled"). Males, illiterates, poor, never married, residents of rural areas, smokers/tobacco users, and alcoholic users were less likely to be in any of the treatment cascades. Interpretation: The prevalence of hypertension in India is high. The "Rule of half" of hypertension does not apply to India as the proportion of people screened, aware of their hypertension status, treated, and controlled are lower than 50% at each stage. Program managers must improve access to hypertension diagnosis and treatment, especially among men in rural areas and populations with lower household wealth. Funding: None.

Analysis of YouTube content on substance use disorder treatment and recovery.

BACKGROUND AND AIM: Emerging literature suggests the role of social media in substance use disorders (SUD). This study aimed to explore the content of YouTube videos for persons on SUD treatment/recovery, describing the users' exposure and engagement metrics and understanding viewers' perspectives. METHODS: We generated a set of 10 key phrases to search on YouTube. Eighty eligible videos were analyzed using a mixed-methods approach. Content analysis of all videos and thematic analysis of 30 videos were done using the three most viewed videos from each key phrase. The reliability of videos was assessed using a modified DISCERN. The total number of views, likes, dislikes, and comments were noted and created engagement metrics. The linguistic analysis of viewers' comments was done to assess their perspectives. RESULTS: Sixty-three (78.8%) videos were from the US, and 59 (73.8%) were intended for persons or families with substance misuse. Persons in recovery uploaded 23 (28.7%) videos. We identified five themes - reasons for using drugs, symptoms of addiction, consequences of drug use, how to stop drug use, and expressed tone in the language. The positivity and relative positivity ratios were highest for videos developed by persons in recovery. There was a negative correlation between the relative positivity ratio and content fostering internalized stigma. Words with negative emotional experiences dominated the viewers' comments. CONCLUSION: YouTube content on SUD treatment and recovery is popular and revolves around the biopsychosocial understanding of addiction. There is an urgent need for a language policy and regulation of non-scientific content.

High risk and low prevalence diseases: Thyroid storm.

INTRODUCTION: Thyroid storm is a rare but serious condition that carries a high rate of morbidity and even mortality. OBJECTIVE: This review highlights the pearls and pitfalls of thyroid storm, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION: Thyroid storm is a challenging condition to diagnose and manage in the ED. It is characterized by exaggerated signs and symptoms of thyrotoxicosis and evidence of multiorgan decompensation, usually occurring in the presence of an inciting trigger. Clinical features of thyroid storm may include fever, tachycardia, signs of congestive heart failure, vomiting/diarrhea, hepatic dysfunction, and central nervous system disturbance. There are several mimics including sympathomimetic overdose, substance use disorders, alcohol withdrawal, acute pulmonary edema, aortic dissection, heat stroke, serotonin syndrome, and sepsis/septic shock. Ultimately, the key to diagnosis is considering the disease. While laboratory assessment can assist, there is no single laboratory value that will establish a diagnosis of thyroid storm. Clinical criteria include the Burch-Wartofsky point scale and Japan Thyroid Association diagnostic criteria. ED treatment focuses on diagnosing and managing the trigger; resuscitation; administration of steroids, thionamides, iodine, and cholestyramine; and treatment of hyperthermia and agitation. Beta blockers should be administered in the absence of severe heart failure. The emergency clinician should be prepared for rapid clinical deterioration and employ a multidisciplinary approach to treatment that involves critical care and endocrinology specialists. CONCLUSIONS: An understanding of thyroid storm can assist emergency clinicians in diagnosing and managing this potentially deadly disease.

Prevalence and determinants of isolated systolic and isolated diastolic hypertension in India: Insights from the national family health survey (NFHS)- 4.

Background: Isolated Systolic Hypertension (ISH) and Isolated Diastolic Hypertension (IDH) are often the ignored forms of hypertension and are determinants of future cardiac and neurological events and contribute to mortality. However, the nationally representative estimates of both these forms of hypertension remain unknown from India. Aim: To estimate the ISH and IDH from a nationally representative survey of India. Material and Methods: The present study used data from 7,23,181 people (15-54 years), recorded during the fourth round (2015-2016) of the National Family Health Survey (NFHS), India. The prevalence of ISH and IDH was calculated for state comparison, while multilevel logistic regression analysis was done to assess the correlates of both types of hypertension. Results: The prevalence of ISH and IDH was found to be 1.2% (95% CI 1.0-1.4) and 5.7% (95% CI 5.2-6.2), respectively. The prevalence of both ISH and IDH increased with age, with a more significant increase in systolic pressure towards the higher age. Northeastern states of India (Assam, Meghalaya, and Arunachal Pradesh) had the highest prevalence of both forms of hypertension. On multilevel logistic regression, male gender, increasing age groups (highest odds ratio (OR) being in 45-49 year age group), alcohol, and diabetes positively predicted both ISH and IDH. Urban residence, literacy, and tobacco were positive predictors of IDH, whereas urban residence, smoking, and literacy negatively predicted ISH. Conclusion: ISH and IDH have a significant presence among the population of India. This data provides insights to formulate strategies at the primary and primordial prevention levels.

Is the rule of halves in hypertension valid uniformly across India? A cross-sectional analysis of national family health survey-4 data.

Background: Hypertension is widely prevalent across India. The rule of halves is commonly used to describe the attrition and gaps in the care cascade of hypertension management across detection, availing treatment, and having controlled blood pressure (BP) on treatment. Objectives: Using nationally representative data, we aimed to assess the rule of halves in hypertension management in different states of India and across sociodemographic, health system, and personal factors. Methods: A descriptive analysis of secondary data from the National Family Health Survey-4 was conducted. We included 770,662 individuals (112,122 men and 658,540 nonpregnant women) of 15-49 years of age. The proportion of individuals not aware of hypertension status among those with high BP, known hypertensives not availing of treatment, and uncontrolled BP among those on treatment were expressed as percentage with a 95% confidence interval (CI). Results: Of those with high BP, 48.5% (95% CI: 47.8%-49.3%) were not aware of their hypertensive status. Among known hypertensives, 72% (95% CI: 71.2%-72.8%) had not availed treatment for hypertension. Among those on treatment, 39.8% (95% CI: 38.7%-40.9%) had uncontrolled hypertension. Conclusion: The rule of halves of India shows that the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke has made relatively good progress with the detection of hypertension and achieving BP control among those on treatment. However, with three-fourth of known hypertensives not availing treatment, more dividends from the detection of hypertension efforts could be realized. The program needs to especially focus on ensuring the treatment for those detected with hypertension.

Design and Evaluation of Interprofessional Training Program for Healthcare Students from Collectivistic Culture.

Background: Healthcare is team-based, and with increased mobility of healthcare workers, most of them will work with team members from all over the globe. Interprofessional education (IPE) research has mostly focused on specially designed programs in academic health institutions to prepare students for multidisciplinary work. Few IPE programs aim to integrate students with mixed disciplines from collectivist cultures. Methods: This mixed-methods study was conducted between June and August 2019. Surveys and an e-portfolio were recorded of 33 final-year and graduated health professional students' participation in an 8-week IPE summer program at a medical school in Ireland. Survey results are described, and the content of portfolios was analyzed based on the deductive analysis of qualitative data derived from questions. Results: Students reported the greatest improvement in presentation skills (63.6%), followed by communication (54.5%), team working skills (93.9%), and interprofessional learning (42.4%), respectively. Qualitative findings highlighted challenges for students from a collectivist culture adapting to an IPE: uncomfortable verbally expressing themselves in problem-based learning (PBL) and how to work with other sex. Positive themes about IPE that emerged were enjoyment in sharing ideas and building trust with PBL groups. We learned that the program had to be flexible enough to meet the educational requirements of a target community with mixed English language ability and adaptability to IPE. Conclusion: The authors propose that an international PBL-based summer program is effective in improving healthcare students' attitudes towards IPE. This study provides valuable insights to facilitate the development of further IPE programs to increased collaboration between students across various healthcare disciplines. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01536-7.

Do online media adhere to the responsible suicide reporting guidelines? A cross sectional study from India.

BACKGROUND: The content and nature of media reports could influence suicide prevention measures. AIM: To evaluate contemporary online media reports' compliance with guidelines for responsible reporting of suicidal acts from Indian resources. METHODS: We included English and Hindi articles for reports concerning suicide, published by local and national media sources for 30 consecutive days from the day of death of a celebrity by alleged suicide. The search was performed in Google News with predefined search queries and selection criteria. Two independent investigators did data extraction. Subsequently, each news report was assessed against guidelines for the responsible reporting of suicide by the WHO and the Press Council of India. RESULTS: We identified 295 articles (Hindi n = 172, English n = 123). Results showed more than 80% of the media reports deviated from at least one criterion of the recommendations. A maximum breach was seen in the news article's headlines, sensational reportage and detailed suicide methods description. Significant differences were seen in the quality of English and Hindi reporting and reporting celebrity and noncelebrity suicide. Additional items revealed were reporting suicide pacts, linking multiple suicides in a single news report, allowing user-generated threads and linking Religion and suicide. CONCLUSION: Measures are required to implement reporting recommendations in the framework of a national suicide prevention strategy.

Development and validation of education materials to reduce childhood blindness due to retinopathy of prematurity.

BACKGROUND: Timely and appropriate follow-up appointments for infants at risk for retinopathy of prematurity (ROP) are very important to prevent blindness. Caregivers are important members of the ROP team, and their involvement is essential in ensuring optimal visual outcomes. This paper aimed to develop health information materials on ROP by a systematic process for better comprehensibility by the target audience of low literacy. MATERIALS AND METHODS: It was a methodological study conducted at the neonatal intensive care unit of a tertiary care hospital, North India. The development and validation of educational materials was conducted in six steps. The study focused on both the knowledge of the target audience and on the validation of the educational materials by experts and caregivers of ROP eligible infants. RESULTS: Most of the items (content, language, layout, motivation, and cultural appropriateness) were in either a suitable or adequate category. Only one item illustration was in the nonsuitable category. The mean final score of the leaflet after revision by experts was 9 (maximum score = 10). Regarding readability, The Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and gunning fog index were found to be 72.5, 7.4, and 6.2, respectively. The leaflet was found to be suitable for the seventh grader. The mean knowledge score of the parents was 4 (maximum score-5). CONCLUSION: The study showed satisfactory acceptance of the developed ROP information materials by caregivers and experts. A similar approach could be adopted for the development of other health information materials.

Improving handover competency in preclinical medical and health professions students: establishing the reliability and construct validity of an assessment instrument.

BACKGROUND: As part of the worldwide call to enhance the safety of patient handovers of care, the Association of American Medical Colleges (AAMC) requires that all graduating students "give or receive a patient handover to transition care responsibly" as one of its Core Entrustable Professional Activities (EPAs) for Entering Residency. Students therefore require educational activities that build the necessary teamwork skills to perform structured handovers. To date, a reliable instrument designed to assess teamwork competencies, like structured communication, throughout their preclinical and clinical years does not exist. METHOD: Our team developed an assessment instrument that evaluates both the use of structured communication and two additional teamwork competencies necessary to perform safe patient handovers. This instrument was utilized to assess 192 handovers that were recorded from a sample of 229 preclinical medical students and 25 health professions students who participated in a virtual course on safe patient handovers. Five raters were trained on utilization of the assessment instrument, and consensus was established. Each handover was reviewed independently by two separate raters. RESULTS: The raters achieved 72.22 % agreement across items in the reviewed handovers. Krippendorff's alpha coefficient to assess inter-rater reliability was 0.6245, indicating substantial agreement among the raters. A confirmatory factor analysis (CFA) demonstrated the orthogonal characteristics of items in this instrument with rotated item loadings onto three distinct factors providing preliminary evidence of construct validity. CONCLUSIONS: We present an assessment instrument with substantial reliability and preliminary evidence of construct validity designed to evaluate both use of structured handover format as well as two team competencies necessary for safe patient handovers. Our assessment instrument can be used by educators to evaluate learners' handoff performance as early as their preclinical years and is broadly applicable in the clinical context in which it is utilized. In the journey to optimize safe patient care through improved teamwork during handovers, our instrument achieves a critical step in the process of developing a validated assessment instrument to evaluate learners as they seek to accomplish this goal.

Portrayal of mental illness in Indian newspapers: A cross-sectional analysis of online media reports.

BACKGROUND: Media portrayal of mental illness may influence public stigma and service utilization. AIM: This study aims to explore the overall tone and content of the news articles on mental illnesses in India. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted on online English and Hindi news portals for articles which made reference to mental illness, published by local and national media sources between September 2019 and August 2020. The search was performed using location and news-only filters in the "Google" search engine; we used predefined search queries and selection criteria. A previously published checklist was used for the content analysis; it was done by two independent investigators. RESULTS: A total of 273 news reports met inclusion criteria (Hindi n = 164, English n = 109). Results showed that more than half (54.9%) had a positive tone. Nearly a third (30.8%) of these articles were stigmatizing in tone. Persons with mental illness were portrayed as violent, unreliable, and unpredictable. Uses of blanket terms (33.3%) such as mentally ill, mentally unstable, mentally retarded, and stigmatizing photographs (36.9%) were also common. Overall, Hindi media had a significantly better quality of reporting than the English language media. National media reports had a less negative and stigmatizing tone than local articles. CONCLUSION: There is a need for a concerted attempt to improve the quality of media reporting of mental illness in India.

The health information seeking behaviour and needs of community health workers in Chandigarh in Northern India.

This article represents two-firsts for the feature--it is the first to report on a study outside the UK and the first to examine the health information needs of community health workers. Sonika Raj is pursuing PhD at the Centre for Public Health, Panjab University, Chandigarh, in India and she conducted her research in Chandigarh. The article outlines the important role that health workers at community level play in determining health outcomes in the developing world, including Chandigarh. It demonstrates that while those workers recognise their information needs, there are many issues affecting their ability to access health information effectively, not least their limited access to appropriate technology and training. AM.

Assessment of health-promoting behavior and lifestyle of adolescents of a north Indian city.

BACKGROUND: Several health-compromising behaviors (e.g., smoking, alcohol) as well as health-enhancing behaviors (e.g., physical exercise, nutrition) are adopted in adolescence and they often persist into adulthood. Thus, there is a definite need to investigate the health behavior of adolescents rather than focus on adults since it will be far more difficult for adults to change their unhealthy habits adopted in their youth. Therefore, the present study was conducted to ascertain health-promoting behavior and lifestyle of university graduates of Chandigarh. METHODS: The present cross-sectional pilot study was conducted in Chandigarh during 2009 among university graduates of Chandigarh aged 17-20 years. A semi-structured, pretested questionnaire comprising of 28 items was used to get information from students regarding their involvement in diet, physical exercise, spirituality and philanthropy. Height, weight, waist and hip circumference of the respondents were measured using standardized equipments and procedures. RESULTS: Mean score of health-promoting lifestyle profile of university graduates was found to be 67.5 ± 12.1 (maximum attainable score = 106). Fourteen students were found to be overweight. Frequent intake of fast food and less consumption of fruits and vegetables was reported by the students. Majority of students exercised as part of their daily routine. CONCLUSIONS: The result of the study showed that North Indian students had reasonably good orientations toward health behaviors, with a mean score of 67.5. The topics related to diet, physical exercise, spiritual growth and philanthropy promotion should be incorporated within the curriculum of students for their all round personality development.

Short-term impact of oral hygiene training package to Anganwadi workers on improving oral hygiene of preschool children in North Indian City.

BACKGROUND: Globally, dental caries is categorized in the list of public health problems in preschool children. In India, lack of availability and affordability of oral health enhances the cost of treatment and care. Empowering community workers like Anganwadi workers (AWWs) in oral health, and providing basic oral health awareness to the mothers through them can be feasible model. So, the present study was conducted to evaluate the short-term impact of Oral Hygiene Training Package (OHTP) to AWWs on improving oral hygiene of preschool children. METHODS: This before and after comparison field trial was done in Anganwadi centres (AWCs) of Chandigarh city, India. 534 children aged 36-72 months attending 21 AWCs were examined before and after imparting trainings to AWWs. OHTP was administered to AWWs, which consisted of power-point presentation and demonstrated the skills like proper brushing technique, plaque disclosure, flossing technique, gum massaging etc. The AWWs later imparted training to mothers in their respective AWCs. Post intervention data was collected after three months.Outcome measures were improvement in oral health status (plaque, debris, gingival health), oral habits (brushing, rinsing) and decrease in caries activity (Snyder test). RESULTS: Prevalence of dental caries was found to be 48.3%. Only 4.1% of the population reported brushing twice which increased significantly to 9.9% post-intervention (p = 0.000). There was a significant decrease in debris (78.3% to 54.1%), and stage-1 plaque (75.5 to 66.5%) in the oral cavity. Caries activity by Snyder's test decreased from 48.2% to 31.2% (p = 0.01) post-intervention. CONCLUSIONS: Controlled trials of using AWWs to improve oral hygiene appear to be justified. TRIAL REGISTRATION: CTRI/2012/07/002786.