A Prospective Study of the Age at Menarche in North Indian Girls, Its Association With the Tanner Stage, and the Secular Trend.

Background Menarche is an important event in a female's reproductive health. However, the age at menarche is variable and has implications on the future health of the girl. The purpose of this study was to estimate the mean age at menarche of North Indian adolescent girls and its association with the Tanner stage and to study the trend of menarcheal age in India in the 21st century. Materials & methods A longitudinal descriptive study was conducted on 470 healthy girls aged nine to 16 years in expectant menarche (Tanner stage II). They were followed for six months to check for the attainment of menarche. Those who achieved menarche were grouped in Group I and the rest in Group II. The data were analyzed using the independent t-test. Results Menarche was achieved by 263 girls in the six-month follow-up period. The mean (SD) age of menarche was 13.13 (1.23) years. Group I girls were mostly in Tanner stage IV and above. Group II girls had a mean (SD) age of 11.53 (1.1) years and were mostly in Tanner stage III or below. The estimated decline in the age of menarche in the 21st century was about 0.41 years per decade. Conclusion The girls who achieved menarche had a significantly higher age and Tanner stage of sexual maturity than girls who did not achieve menarche in the study period. Tanner stage is a better measure to estimate the pubertal onset than age. The studies on the age of menarche in the current century reveal that the declining trend in the menarcheal age is continuing in India.

Tracking Water, Sanitation, and Hygiene Practices: Waste Management and Environmental Cleaning in the Slums of North India.

Background One or more of the following five amenities is lacking in slum communities: durable housing, sufficient living area, access to clean water, access to improved sanitation facilities, and secure tenure. This study aimed to identify the gaps in water, sanitation, and hygiene conditions in the urban slums of Lucknow. Methodology A community-based, cross-sectional study was conducted among families residing in the urban slums of Lucknow, Uttar Pradesh, India for 18 months starting from April 2020. Results A total of 747 heads of families were interviewed and their families were surveyed. The proportion of kaccha slums was 37.25% and of pakka slums was 62.74%. About 98.3% of families residing in kaccha slums used indiscriminate throwing as a method of solid waste disposal. About 96.5% of families residing in kaccha slums practiced open-field defecation while those residing in pakka slums used a toilet within the premises. Kaccha slum dwellers were practicing open-field defecation 12.8 times more than pakka slum dwellers. This study showed that sanitary conditions in kaccha slums were mainly responsible for the overall burden of excreta disposal, solid waste disposal, and access to water supply for drinking and other household purposes. Conclusions Water supply and housing conditions such as dampness, floor, and the non-availability of electricity are the primary predictors of the preference for open-field defecation among slum dwellers.

Adolescent Health Academy Statement on the Care of Transgender Children, Adolescents, and Youth.

JUSTIFICATION: The transgender community has been long stigmatized, and discriminated against, and faces numerous mental and physical problems. Certain indicators of transgender personality appear during childhood and more often before puberty begins. This puts the onus on Pediatricians to identify and offer evidence-based care for their benefit. There is an urgent and deep-felt need to understand the medical, legal, and social aspects of the care of transgender children. Hence, Adolescent Health Academy decided to release a statement on the care of transgender children, adolescents, and youth. OBJECTIVES: To review the existing international and national guidelines and recommendations to formulate a statement for the Pediatricians on (a) terminologies and definitions; (b) legal status in India; and (c) implications for pediatric practice. PROCESS: A task force was convened by the Adolescent Health Academy as the writing committee to draft the guidelines. These were approved by all the members of the task force and the Executive Board of Adolescent Health Academy (2022). RECOMMENDATIONS: Gender identity develops in childhood and adolescence as a feeling of self, and it should be respected to mitigate gender dysphoria. The law permits transgenders the right of self-affirmation and it upholds their dignity in society. The transgender community is prone to victimization, and prejudice leading to a high risk of substance abuse, suicidal ideation, and mental health issues. Pediatricians are the primary care providers of children and adolescents including those with gender incongruence, so they should be abridged with gender-affirmative practices. Gender-affirmative care involves pubertal suppression, hormonal therapy, and surgery which should be done in conjugation with the social transition, by a gender-affirmative care team.

Using the Endsley Model to Evaluate Simulation-Based Situation Awareness Training for Medical and Nursing Students in India: A Qualitative Analysis.

INTRODUCTION: Situation awareness (SA) training is a vital part of healthcare training, and opportunities to provide SA training to healthcare workers are limited in low- and middle-income countries. We aimed to analyze undergraduate medical and nursing students' perception of their understanding of SA through an interprofessional obstetric neonatal emergency simulation workshop (ONE-Sim) and subsequently evaluate their perceived changes in SA understanding using the Endsley model ( Hum Factors 1995;37(1):32-64). METHODS: Feedback on SA before and after the workshop was collected through questionnaire-based surveys. Thematic analysis was performed, with themes emerging from an inductive analysis followed by a deductive analysis using the Endsley model. RESULTS: The themes emerging from the inductive analysis included environmental awareness, evolving knowledge, skill development, and applicability to practice. These aligned with the 3 levels of SA in the Endsley model in the deductive analysis suggesting that participants transformed their perception, comprehension, and projection of SA after the workshop. CONCLUSION: Simulation-based education enhanced SA perception in obstetric and neonatal emergencies for medical and nursing students in a low- and middle-income country, and the Endsley model is a feasible framework to measure learner perceived changes in SA understanding through simulation-based education.

Community of Inquiry framework to evaluate an online obstetric and neonatal emergency simulation workshop for health professional students in India.

BACKGROUND: We transitioned our obstetric neonatal emergency simulation (ONE-Sim) workshops to an online format during the COVID-19 pandemic. In this study, we evaluated key learning acquired by undergraduate medical and nursing students attending the online ONE-Sim workshops from a low- and middle-income country (LMIC). METHODS: Student perception of online workshops was collected using electronic questionnaires. Data was analysed using thematic analysis by employing the Community of Inquiry (CoI) framework. RESULTS: One hundred sixty medical and nursing students who attended the online ONE-Sim workshops completed the questionnaires. There was evidence in the data to support all three aspects of the CoI framework-social, cognitive and teacher presence. CONCLUSIONS: The use of the CoI framework helped to describe key learning from online interprofessional simulation workshops conducted for a LMIC.

Parental Perspectives on Remote Learning and School Reopening.

We conducted this online survey to assess the parental perspectives on remote learning, the associated stress, and school reopening during the COVID-19 pandemic. Of 2694 responses, 2032 (75.4%) parents perceived remote learning to be stressful for the child and 1902 (70.6%) for the family. The mean (SD) duration of remote learning was 3.2 (2.1) hours/day and 5.3 (1.0) days/week. Parents from 1637 (61.7%) families reported headaches and eye strain in children. Starting regular school was not acceptable to 1946 (72.2%) parents.

Indian Academy of Pediatrics Guidelines on School Reopening, Remote Learning and Curriculum in and After the COVID-19 Pandemic.

JUSTIFICATION: With the unprecedented COVID-19 pandemic and the resultant school closure, children all over the country are undergoing a lot of educational, psychosocial, and physical problems. There is an urgent and deep felt need to offer scientific and concrete guidance for these concerns and support children in their educational development during these testing times. OBJECTIVE: To review the guidelines and recommendations given by various international agencies and formulate guidelines in the Indian context on (a) how and when to reopen the schools; (b) ways and means of remote learning; and (c) to identify the contents of curriculum that need restructuring in context of the current situation. PROCESS: Indian Academy of Pediatrics (IAP) formed a task force of pediatricians, educationists and technological experts who connected through various video and social platforms. They gathered and exchanged information and thoughts. The writing committee drafted the guidelines and got approval of all the members of the task force. RECOMMENDATIONS: Schools can be reopened only when the local epidemiological parameters are favorable, the administration is equipped with adequate infrastructure and health care facilities, and the stakeholders (teachers, students, parents, and support staff) are prepared for the new normal. In the meanwhile, remote learning (media-based and /or otherwise) should reach to the last student to maintain uninterrupted education. The curriculum needs to be revised, with focus on revision and core contents. Informal learning of psychosocial empowerment and daily living skills should be encouraged rather than stressful formal learning.

Introduction of an undergraduate interprofessional simulation based skills training program in obstetrics and gynaecology in India.

Interprofessional simulation based education (SBE) improves core clinical skills and team training in obstetrics and gynaecology. In this innovative study, the introduction of an undergraduate interprofessional SBE program for teaching obstetrics and gynaecology skills in India was evaluated. The study attempted to evaluate the feasibility and benefit of the interprofessional skills training workshop in obstetrics and gynaecology, which was introduced for medical and midwifery students in a secondary level hospital in India. The program focuses on improving "hands-on" clinical skills and can be explained by the "skills acquisition theory". Using a survey, participants rated relevance, pitch and confidence (on a 5-point Likert scale) and described the contextualisation and teaching of core clinical skills through the workshop using free-text. Descriptive analysis of quantitative Likert scale responses and thematic analysis of the free-text data was conducted and themes identified. Ninety-five medical and midwifery students attended the inaugural workshop, in a low-resource setting. The clinical experience in obstetrics and gynaecology across both groups was minimal, neither were they exposed to any prior SBE. Both health professional groups found the workshop useful, relevant and improved their confidence in performing vaginal examination and births. The key theme, which emerged from qualitative analysis, was "getting hands-on" experience. Other themes included learning by simulation without clinical time constraints, retaining the ability to make mistakes, bridging theory to practice, valuing interprofessional experience and ensuring equal learning opportunities for all participating professional groups. The advantages of interprofessional SBE, for medical and midwifery students, are reproducible in a low-resource setting, and may be be helpful for learning intimate clinical examination, obstetric procedures and team training.

Mobile obstetric and neonatal simulation based skills training in India.

BACKGROUND: The developing world has a significantly high risk of women and babies dying during childbirth. Interprofessional simulation training has improved birth practices and outcomes by impacting clinical and non-technical skills like communication, teamwork, leadership and effective use of resources. While these programs have become a training requirement in many high-income countries, they have not been widely introduced in the low-income, low-resource settings. QUESTION: To explore the use of a structured obstetric and neonatal emergency simulation training program in India. AIM: The aim was to identify the challenges faced by birthing staff in their clinical practice and the key messages learnt from the simulation programs that are applicable to their clinical practices. METHODS: Mobile interprofessional obstetric and neonatal workshops were piloted in three locations (metropolitan, primary rural and secondary hospitals) of India for medical and midwifery staff, and students. Using a pre-post workshop survey design, participants were asked to describe their role and challenges in their birth practice and the key learning acquired by the program. FINDINGS: Eight workshops were conducted across three sites involving a total of 150 participants. Participants at all sites described maintaining safety of women and babies as their key role. Their main challenge was lack of availability of medical back up, resources, structured training and poor compliance from women. The key learning was gaining knowledge and procedural skills, non-technical skills, a systematic approach to obstetric and neonatal emergencies and learning in teams through simulation. IMPLICATIONS FOR PRACTICE: Mobile obstetric and neonatal simulation training workshops were useful for medical and midwifery staff, and students in different health settings in India and may have a role as a routine training tool for health professionals involved in childbirth.

Gingival Overgrowth Leading to the Diagnosis of Familial Tuberous Sclerosis Complex.

Tuberous sclerosis complex (TSC), a neurocutaneous syndrome, is characterized by the development of benign tumours affecting different body systems. We herein present a report of a 40-year-old female patient presenting with dental enamel pits and localized gingival overgrowth that eventually lead to the diagnosis of a case of familial TSC. Diagnosis of familial TSC by comprehensive oral examination and detection of oral manifestations proved to be inevitable as it resulted in institution of appropriate treatment strategies and genetic counselling of the affected family.