Traffic Noise Assessment in Urban Puducherry, South India.

Background Noise pollution is an emerging global problem that can affect people's well-being and mental and physical health. In India, six percent of people suffer hearing loss, and prolonged exposure leads to irreversible noise-induced hearing loss. Objective To assess the noise levels at selected residential, commercial, industrial, silence zones, traffic junctions, and related noise indices in urban Puducherry and compare them with Central Pollution Control Board (CPCB) standards. Methods The study was conducted using a cross-sectional noise survey based on the 2015 study sites in urban Puducherry using a sound level meter, analyzed the results with limits set by the CPCB standards, and calculated the various noise indices. Results In urban Puducherry, the noise level showing silence zones is more hazardous than industrial, residential, commercial, and traffic junctions. Out of the 36 sites surveyed, 33 locations are above the prescribed daytime limit by CPCB. Conclusions The noise assessment at selected sites in urban Puducherry shows that around 92% of study sites are well above the daytime standards of CPCB, highlighting an urgent need to curb noise levels. The findings revealed that increased noise at study sites could be due to the increased number of vehicles and transportation systems.

Determinants of respectful maternity care at a tertiary care teaching institute in South India: A mixed-methods study.

OBJECTIVE: To determine the proportion of women who experienced disrespect and abuse (D&A) and the type of D&A during labor and postpartum, and to determine the factors significantly associated with D&A. METHODS: A cross-sectional mixed-methods study undertaken in tertiary care teaching institute South India. After ethical approval, 380 postpartum women within 72 h of delivery were recruited for the study. The determinants of respectful maternity care (RMC) were assessed quantitatively and qualitatively. For quantitative assessment, they were interviewed using questionnaires adopted from the United States Agency for International Development- Maternal and Child Health Integrated Program (USAID-MCHIP) protocol, which has verification criteria for RMC. As a second method for quantitative assessment, they were asked to rate the care from their perspective on a 10-point score. For the qualitative component, they were asked to identify the healthcare workers associated with D&A by their designation and to answer three open-ended questions. IBM SPSS Statistics 25 (IBM Corporation, Statistical Package for Social Sciences, version 25) was used for analysis. D&A as per RMC standards I-VII and its severity were expressed as frequencies and percentages with 95% confidence interval. Univariate analysis was used to determine the associated factors, and severity was determined by χ2 test. RESULTS: The prevalence of D&A was high (85%) according to the RMC standards of the USAID-MCHIP questionnaire, whereas it was only 33% according to women's perspective. The most common type of D&A was non-dignified care. The factors significantly associated with D&A were women over 25 years, those admitted as an emergency referral, having a recommendation letter, and relatives working at the same healthcare facility. CONCLUSION: The prevalence of D&A was high as measured by the USAID-MCHIP questionnaire, and the most common type was non-dignified care followed by physical abuse.

Role of specific nutritional biomarkers in predicting post-operative complications among patients undergoing elective abdominal surgery.

PURPOSE: Nutritional biomarkers like serum prealbumin, transferrin, retinol-binding protein (RBP), C-reactive protein (CRP), leptin, and insulin-like growth factor 1 (IGF1) have the inherent ability to diagnose undernutrition objectively before it is clinically manifested. The primary objective of the study was to evaluate the diagnostic efficacy of the specific nutritional biomarkers in predicting post-operative complications. METHODS: A prospective cohort study was conducted in the department of surgery and included all patients aged 18 years and above who underwent elective abdominal surgery. Demographic details and clinical and surgical details were documented from the case records. Nutritional biomarker assay was done at admission. The post-operative complications occurring until discharge were graded using the Clavien-Dindo classification. The diagnostic accuracy of the specific nutritional biomarkers in predicting post-operative complications was assessed. RESULTS: A total of 320 patients were included in the study. Of these, 126 (39.38%) developed post-operative complications. Major complications accounted for 19.05% of the complications, while 80.95% were minor complications. Patients with blood prealbumin level less than 17.287 mg/dL had a higher incidence of complications (p < 0.001). Serum transferrin levels less than 168.04 mg/dL and IGF1 levels less than < 44.51 ng/ml showed increased incidence of complications (p < 0.001). The AUC was found to be the highest for serum IGF1 with 0.7782. Sensitivity was equally high for IGF1 and serum transferrin, with 76.98% for the former and 76.19% for the latter. CONCLUSION: Specific nutritional biomarkers, like serum prealbumin and transferrin, were efficient in predicting postoperative complications of patients before undergoing elective abdominal surgeries even after adjusting for confounders. This can facilitate preoperative corrective measures to lower the overall postoperative complications.

Perception of Noise Pollution Among Youths and Adults in Urban Puducherry, South India.

Objective The study seeks to assess the perceptions of people on evaluating the sources of noise, noise-induced health issues, and noise regulation awareness among the exposed population present in the study site of urban Puducherry, South India. Methods A cross-sectional survey using a pre-tested semi-structured questionnaire was conducted between July and August 2021 in 32 study sites in urban Puducherry to evaluate how adults and youth perceive noise pollution. The questionnaire gathered details on their sociodemographic characteristics, knowledge of the problems associated with noise pollution, source of noise pollution, effects of noise on health, and awareness of regulations related to noise pollution. Results Half of the study participants perceive that noise pollution is a problem in their localities; the majority feel disturbed by that noise; and the most prevalent reason given for noise pollution is traffic noise. Most of the participants reported that trouble paying attention to work or conversations was the most frequent health impact of noise pollution. Participants who are employed, have formal education, belong to families above the poverty line, and reside near the main road and sub-main road (less than 200 meters) showed a significant association (p-value <0.05) with perceived noise pollution problems. Conclusion Based on the findings, it can be concluded that respondents in urban Puducherry perceive traffic noise as the most common source of noise pollution. The majority of the participants felt that the excessive noise made it difficult for them to focus on their work. Individuals who reside or work close to a major highway and outdoor workers believe noise pollution is a big problem.

Continued tobacco use among tobacco-related head and neck cancer patients seeking care in a tertiary care facility, South India.

INTRODUCTION: Continued tobacco use in cancer patients leads to decreased treatment efficacy and safety, decreased survival, decreased quality of life, and an increased risk of cancer recurrence and primary tumours at other sites. OBJECTIVE: To determine the prevalence of continued tobacco usage during the first 6 months of diagnosis among tobacco-related head and neck cancer patients seeking care from a tertiary care centre and the factors associated with it. METHODS: A facility-based cohort study was conducted at a tertiary care centre in Puducherry, India. Newly diagnosed head and neck cancer patients aged > 18 years with a history of tobacco use were interviewed to gather information on their socio-demographic, clinical characteristics, and tobacco usage. All participants were interviewed again at the 3rd month and at the 6th month during their follow-up visit. The data were entered in EpiData v3.1 and analysed using STATA v14. Multivariable logistic regression analysis was done with continued tobacco use as the dependent variable and variables that were found significantly associated with continued tobacco use in univariate analysis. RESULTS: Out of 220 study participants at baseline, 157(71 %; 95 % CI: 65.1-77.1) were using tobacco at the time of diagnosis. Out of these 157 participants, 80(50.9 %; 95 % CI; 43.1-58.7) continued to use tobacco at the 3rd month, 63(40.1 %: 95 % CI: 32.6-47.9) continued to use tobacco at the 6th month. The characteristics significantly associated with continued tobacco use are age (less than 39 years and more than 70 years), primary school education, nuclear family, and living alone, smoking tobacco, and increased duration of tobacco use. CONCLUSION: Two-fifths of head and neck cancer patients with a history of tobacco use continued to use tobacco at the 6th month after diagnosis of cancer. Awareness of effects of tobacco use and the benefits of tobacco cessation needs to be created among cancer patients.

Developing Script Concordance Test Items in Otolaryngology to Improve Clinical Reasoning Skills: Validation using Consensus Analysis and Psychometrics.

Background: Script concordance testing is widely practiced to foster and assess clinical reasoning. Our study aimed to develop script concordance test (SCT) in the specialty of otolaryngology and test the validation using panel response pattern and consensus index. Materials and Methods: The methodology was an evolving pattern of constructing SCTs, administering them to the panel members, and optimizing the panel with response patterns and consensus index. The SCT's final items were chosen to be administered to the students. Results: We developed 98 items of SCT and administered them to 20 panel members. The mean score of the panel members for these 98 items was 79.5 (standard deviation [SD] = 4.4). The consensus index calculated for the 98-item SCT ranged from 25.81 to 100. Sixteen items had bimodal and uniform response patterns; the consensus index improved when eliminated. We administered the rest 82 items of SCT to 30 undergraduate and ten postgraduate students. The mean score of undergraduate students was 61.1 (SD = 7.5) and that of postgraduate students was 67.7 (SD = 6.3). Cronbach's alpha for the 82-item SCT was 0.74. Excluding the 22 poor items, the final SCT instrument of 60 items had a Cronbach's alpha of 0.82. Conclusion: Our study revealed that a consensus index above 60 had a good item-total correlation and be used to optimize the items for panel responses in SCT, necessitating further studies on this aspect. Our study also revealed that the panel response clustering pattern could be used to categorize the items, although bimodal and uniform distribution patterns need further differentiation.

Effects of web-based training for carers in old age homes using WHO-iSupport for dementia, as a training tool - A mixed-method study.

WHO recognized Dementia as public health priority and developed iSupport, a knowledge and skills training program for carers of people living with Dementia. This Mixed-Method study assessed the effectiveness of web-based training sessions among carers at old age homes in and around Puducherry, India, using WHO-iSupport for dementia hardcopy manual as a training tool. We registered the clinical trial protocol with Clinical Trial Registry-India (CTRI), CTRI/2020/11/029154. We determined the change in 35 carer's knowledge and attitude following the training sessions using pre and post-test questionnaires quantitatively. Further, we explored their learning experience by conducting eight descriptive one-to-one telephonic interviews. Due to the COVID-19 pandemic, we conducted this study online. i.e., obtained virtual consents, pre and post-test using Google forms, and training sessions through a webbased platform. We divided carers into groups where each carer attended two training sessions, and each session lasted for 2 h. Training sessions improved the carer's knowledge from a pre-test score of Median (IQR) 12 (9, 15) to a post-test score of 17 (16, 20) and attitude score from 30 (27.3, 34.8) to 33.5 (30.3, 39) in post-test. They perceived that the training sessions were helpful as they gained knowledge on dementia care, and their attitude has changed optimistically towards people living with Dementia. These findings suggest that web-based training has an effect and indicates the need for training among carers in various old age homes for betterment in providing care.

Geographical Information System-Aided Noise Pollution Mapping of Urban Puducherry, South India.

Context: Noise pollution and its influence on environmental and quality of human life are a major concern and hot topic of scientific research in the twenty-first century. Aims: Spatial analysis of noise pollution in urban Puducherry, South India. Settings and Design: Cross-sectional study conducted in 36 locations of urban Puducherry. Methods and Material: Noise measurements were taken using a calibrated NOR 132 digital sound level meter using the prescribed parameters set by the Central Pollution Control Board. Geo coordinates were taken using Garmin Oregon 550 GPS. Noise measurements were classified according to the Bureau of Indian Standards for town planning into five zones. Statistical Analysis Used: Noise pollution map of urban Puducherry for three time points of the day was generated using ArcGIS Desktop v10.3 with Geo-statistical module and Inverse Distance method. Results: Seventeen percent of the sites are high noise sources (80-90 dB), two thirds (65%) of the study sites fall into concentrated average noise zones (70-80 dB), and less than one fifth (18%) of the study sites are in relatively quiet zones across different measurement time slots. Conclusions: Long-term strategy for noise control should be incorporated in the development of new townships and other infrastructures in accordance with the noise control norms. Implications for future research include monitoring noise pollution levels in rural areas and health effects of noise pollution in bystanders and drivers.

The Need for Nicotine De-addiction Services among Newly Diagnosed Tobacco-Related Head and Neck Cancer Patients, South India.

OBJECTIVES: This study aimed to determine the proportion of tobacco-related head and neck cancer patients in need of nicotine de-addiction services at the time of diagnosis and factors associated with it. METHODS: Facility-based cross-sectional study was conducted in a tertiary care center. Tobacco-related head and neck cancer patients with a past and present history of tobacco usage registered in cancer clinic from March 2016 to February 2017 were recruited. Participants were interviewed using a pretested and semi-structured questionnaire to gather information on the socio-demographic, clinical characteristics, and tobacco usage. Data were entered in EpiData v3.1 and analyzed using STATA v14. RESULTS: Among 220 participants recruited in the study, 83% were males, 47% were >60 years of age, and 40% had no formal education. Around 49% were smoking tobacco during the treatment period, 41% used smokeless tobacco, and 10% used both smoking and smokeless. The majority (56%) of them had stage T4 tumors. Around 71% of participants required de-addiction services. Those of age more than 70 years (aRR (95%CI) 1.43 (1.1-1.9)), currently employed (aRR (95%CI) 1.5 (1.2-1.9)), living alone (aRR (95%CI) 1.6 (1.0-2.5)) or in a nuclear family (aRR (95%CI) 1.5 (1.2-2)), who initiated tobacco use at a younger age (aRR (95%CI) 1.5 (1.0-2.2) were in higher need of de-addiction services. CONCLUSION: The majority of tobacco-related head and neck cancer patients required nicotine de-addiction treatment. Hence de-addiction services should be established as an integral unit of cancer clinics.

Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India.

BACKGROUND: In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India. METHODS: We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model. RESULTS: Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45-59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM. CONCLUSIONS: Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.

'Shifting from anxiety to the new normal': A qualitative exploration on personal protective equipment use by otorhinolaryngology health-care professionals during COVID-19 pandemic.

Background: The novel coronavirus pandemic has influenced the working practice of health-care professionals who come across symptomatic and asymptomatic COVID patients in their day-to-day practice. Especially, among HCWs in otorhinolaryngology, with the risk of exposure being high, hence were mandated to use personal protective equipment (PPE). Materials and Methods: The change in perceptions and patterns of PPE use throughout the COVID-19 pandemic was studied in detail through interviews conducted among 15 key informants, and the data were analyzed using health belief model in our study. Results: A health belief model explains the trajectory of PPE use by otorhinolaryngology health care providers during the COVID-19 pandemic. The course of usage of PPE by otorhinolaryngology health-care professionals during the COVID-19 pandemic was explained through the health belief model. During the initial days of the COVID-19 pandemic, intense perceived severity and susceptibility to COVID infection led to PPE use, and otorhinolaryngology HCWs resorted to higher grade PPEs which gave optimal protection; but in course of time with a better understanding of the natural course of illness, minimal PPEs without compromising HCW safety were used with minimal discomfort. Perceived severity of COVID infection on self and family, health knowledge, influence of peers, and support from the institution encouraged them in using PPEs. Conclusion: We found that various aspects of health belief model such as the perceived susceptibility, perceived severity of the disease, perceived barriers and benefits in PPE use, self-efficacy, health-related knowledge, and the cues to action influence PPE use among otorhinolaryngology HCWs. The key findings can be applied in behavior change models to promote the use of PPE in the hospitals, especially during the time of pandemic.

Medicine Storage and Dispensing Facilities in Public Healthcare Pharmacies of Puducherry, India.

Background Large amounts of medicines are wasted during procurement, storage, distribution, and utilization. Proper procurement, storage, dispensing, and documentation of medicines are important aspects of pharmacy management. The World Health Organization (WHO) and the Indian Pharmaceutical Association (IPA) have developed guidelines for the storage and dispensing of medicines by pharmacists. This study was conducted to assess the storage and dispensing facilities of medicines in public healthcare pharmacies of Puducherry province in south India. Methodology A one-time survey was conducted in 10 public healthcare pharmacies by filling the checklist which was prepared based on the WHO and IPA guidelines. Results Facilities such as adequate surface area, storage area, reception area, and availability of water supply in dispensing area were available in 90% of surveyed pharmacies. The most common system used for the arrangement of medicines was alphabetical order (70%). In 80% of pharmacies, a sufficient number of shelves was available for storage of medicine, and in 90% of pharmacies, shelves were properly labeled. None of the pharmacies had separate storage facilities for expired medicines and narcotic drugs. Conclusions In Puducherry, pharmacy services are provided by qualified and experienced pharmacists. Although most of the surveyed pharmacies had all the required infrastructure and equipment facilities, few pharmacies need to improve their facilities to promote good drug-dispensing practices.

Development and Validation of Scale Assessing the Preparedness of Objective Structured Clinical Examination in Undergraduate Competency based Medical Education.

Background: Formative assessments methods such as objective structured clinical examination (OSCE) are reliable and valid assessment tools employed under the competency-based medical education (CBME) curriculum. However, there was no uniform scale to assess the attributes of OSCE for any of the medical subjects. Hence, this study was done to develop and validate a scale to assess the attributes of OSCE and make sure that the intended objectives of the OSCE are achieved. Methods: The scale was developed using literature review and expert opinion. It consisted of 10 questions and response to these items was based on a 5-point Likert scale ranging from "strongly agree" to "strongly disagree." The final version was administered among 30 students undertaking survey community diagnosis (CD) posting during their third semester. Exploratory and confirmatory factor analysis was performed to validate the scale. Results: Two-factor structures were obtained with eigenvalues of 4.32 and 1.90. Factor 1 consisted of seven items (positively faced questions) accounting for 42.84% of the variance, whereas Factor 2 had the remaining three items (negatively faced questions) explaining 19.36% of the variance. Thus, together, the two factors explained 62.20% of the variance. Goodness-of-fit indices revealed good Comparative fit index (CFI) s of 0.90, Tucker Lewis index (TLI) of 0.87, and acceptable Standardized Root Mean Square Residua (SRMR) of 0.13. The reliability coefficient (Cronbach's alpha) for the scale was 0.81. Conclusion: This study develops and validates a scale that can be used universally for assessing the attributes of OSCE across all disciplines and in medical education institutes in India.

Assessment of medicine use based on WHO drug-use indicators in public health facilities of the South Indian Union Territory.

OBJECTIVE: To assess medicine use based on World Health Organization (WHO) core drug-use indicators in selected public health facilities of the South Indian Union Territory. METHODS: A prospective cross-sectional study was conducted for period of one year (from March 2019 to February 2020) in 10 selected public health facilities based on the WHO document How to investigate drug use in health facilities. Total 900 prescriptions were analysed to study prescribing, patient care and health facility indicators. The results were compared with the WHO standard measures. RESULTS: The overall average number of drugs per prescription was 3.2. Percentage of prescriptions with antibiotics and injections were found to be 36.6 and 11.4%, respectively. Percentage of drugs prescribed by generic name was 74.6%. Percentage of drugs prescribed from the National List of Essential Medicine was 93.3%. Average consultation and dispensing time were found to be 3.9 minutes and 49.3 seconds, respectively. The percentage of drugs dispensed in this study was 98.5 and 61.6% of medicines were properly labelled; 76.7% of patients had correct knowledge of each medicine dispensed to them. Mean availability of key essential medicine was 73.4%. CONCLUSION: Indicators such as percentage of drugs prescribed from the National List of Essential Medicine, availability of copy of essential medicine list and percentage of drugs dispensed were found to be as per WHO optimal value. Indicators such as average number of drugs per prescription, average consultation and dispensing time and percentage of medicines labelled were found below optimal value and need to be improved.

An initiative to limit screen-time in children aged between 6 and 18 years in an urban area in Puducherry: a qualitative study.

BACKGROUND: Recently television viewing and use of computers have increased considerably and has become a necessary evil in the society. The amount of Screen Time (ST) exposure of a child largely depends on the views of their parents. Screen time among adolescents have resulted in multiple problems. OBJECTIVE: To explore the perceptions of parents of children aged 6-10 years and adolescents of 11-18 years residing in an area of urban Puducherry regarding screen-time and develop health education material to decrease ST. MATERIALS AND METHODS: A community-based, Qualitative study was conducted during April 2018 in Urban Puducherry. Two FGDs among the adolescents t and one FGD among the mothers of 6-10 years old children to capture their perceptions on ST. RESULTS AND CONCLUSION: The three FGD included 30 participants. The main categories that evolved among the adolescents were Benefits, barriers and influencing factors of ST and ways to reduce them. Mothers expressed their concerns regarding screen time and efforts taken to reduce it. Our study showed that curtailing ST is possible by friendly parenting.

'People listen more to what actors say': A qualitative study of tuberculosis-related knowledge, behaviours, stigma, and potential interventions in Puducherry, India.

India has made substantial advancements in reducing the burden of tuberculosis (TB), but persons living with active TB (PLWATB) still face myriad challenges in seeking and receiving care, including TB-related stigma. To meet the END TB targets, it is critical that PLWATB engage in care and are able to adhere to treatment. This qualitative study aimed to understand TB-related stigma (perceived, enacted, and internalised) and possible interventions to reduce stigma in Puducherry and Tamil Nadu, India. We conducted 47 in-depth interviews with PLWATB and household members and eight focus group discussions: two each with PLWATB, their household members, healthcare workers, and key informants. We found varying TB-related knowledge: the vast majority of interview participants reported incorrect modes of transmission, although most were also aware that TB is curable. Participants reported high levels of perceived stigma, with nearly two-thirds of PLWATB choosing to hide their disease to avoid being stigmatised in their community. Participants supported interventions including celebrity advocacy and school-based programming to increase community knowledge and reduce enacted stigma as well as support groups and counselling to reduce internalised stigma in PLWATB. This study has the potential to inform future interventions to reduce TB-related stigma in India.

Economic Burden of Cancer Treatment in a Region in South India: A Cross Sectional Analytical Study.

INTRODUCTION: The rising cost of cancer diagnosis and treatment has imposed a huge financial burden on the affected households. Understanding the nature of this burden will help us to formulate plans to avoid financial distress among the same. OBJECTIVE: The study aims to estimate the Out of Pocket Expenditure (OOPE) for the management of selected solid cancers among the Out-Patient Department (OPD) of Regional Cancer Centre in South India and to determine the proportion of families experiencing Catastrophic Health Expenditure (CHE) due to the same. METHODS: A hospital based cross sectional analytical study was undertaken in the authors' institute in South India. 474 solid cancer patients were interviewed in OPD of Radiation Oncology by a trained data collector. Sociodemographic variables, costs incurred under various headings and expenditure details of participants were obtained. Direct Medical and Direct Non-Medical costs were calculated, and its total was used as the OOPE. Costs were presented as mean with its standard error. Incidence of CHE was calculated using the 40% threshold on the Capacity to pay and was expressed as proportions with 95% confidence interval. Appropriate statistical tests were used to look for statistically significant differences in the study groups. RESULTS: The average OOP expenditure incurred by a cancer patient was INR 35,817 (USD 523.6) for male and INR 20,496 (USD 299.6) for female. Males had a significantly higher OOPE than females. The prevalence of catastrophic health expenditure (CHE) was 61.6% at the 40% CTP threshold. Patients who used insurance schemes had higher prevalence of CHE than those who did not use insurance schemes (65.5% vs 60.7%, p value 0.351). CONCLUSION: Cancer care provided through public institutions had a low direct medical cost, but the indirect cost seemed to be extremely high. Public based financial assistance is the need of the hour to help the cancer affected families.

Target Volume Delineation Training in Radiation Oncology in India : A Survey Evaluating Its Status, the Need for Educational Programs and the Utility of Virtual Teaching.

INTRODUCTION: The complexity of modern-day radiotherapy techniques calls for greater accuracy in target volume delineation which requires intensive training and expert guidance. In this study, we intend to evaluate the status of training in target delineation across radiation oncology curriculums in India and utility of webinars in teaching it. METHODOLOGY: We organized daily webinars on the topics of radiological anatomy and target volume delineation in common sites of cancer over a period of 2 weeks. At the end of the program, a 35 item survey questionnaire was shared with the participants. The responses were analysed and are reported here. RESULTS: Out of the 797 participants that registered for the course, 356 radiation oncologists responded to the survey questionnaire. Majority (96%) of our respondents believe that there is a need for additional training in target volume delineation. Ninety percent of the participants felt that radiation oncology curriculum requires a formal radiology training but only 6.7% reported that their training consisted of a dedicated rotation and regular lectures in radiological anatomy. Majority (97%) responded that they were  likely to incorporate the points learnt from the webinar sessions in their daily practice. Forty eight percent of respondents opted for attending a webinar to an in-person event in the future while 34% would like to have the option to choose between the two. Ninety four percent agreed that online webinars should be conducted routinely even after the pandemic ends. CONCLUSION: Our survey results suggest that target volume delineation training in India is deficient and virtual teaching programs can be a practical and effective way to improve it.

Emotional intelligence and perceived stress among undergraduate students of arts and science colleges in Puducherry, India: A cross-sectional study.

BACKGROUND: The concept of emotional intelligence has gained great popularity in the last few decades. With significant rise in stress and other emotional disturbances among students, it becomes necessary to determine whether high emotional intelligence could help manage perceived stress better. This study aims to assess emotional intelligence and perceived stress among undergraduate students of Arts and Science colleges, to determine the association of emotional intelligence with perceived stress, academic performance, and selected socio-demographic factors. METHODS AND MATERIAL: Using multistage sampling, 720 students aged 18 years and above were selected from four colleges in Puducherry. Emotional intelligence and perceived stress were assessed using standard self-administered questionnaires "The Schutte Self-Report Emotional Intelligence Test (SEIT)" and "Perceived Stress Scale (PSS-14)," respectively. RESULTS: The median (IQR) Emotional Intelligence score and Perceived Stress score were 127 (114-137) and 43 (39-47), respectively. The study was not able to establish a significant association between emotional intelligence and perceived stress. A weak significant correlation existed between emotional intelligence and academic performance. Multiple variable analysis revealed gender, year of study, volunteering with youth organizations, and mother's occupation to be significantly associated with emotional intelligence (p < 0.05). CONCLUSIONS: Women, final year students and those who volunteered with youth organizations had higher emotional intelligence. Children of mothers who were employed in knowledge-intensive occupations were more emotionally intelligent. Academic performance had a weak positive significant correlation with emotional intelligence.

Diagnostic delay for head and neck cancer in South India: A Mixed-methods Study.

BACKGROUND: Early diagnosis is an important aspect of quality of cancer care.Analysis of the diagnostic delays and the reasons for delay helps to plan strategies to improve cancer care. OBJECTIVES: To determine the primary, secondary, and total diagnostic delay of patients diagnosed with head and neck cancer and to explore the reasons for the delay from the patient perspective. METHODS: Explanatory mixed method design was used. Two hundred persons with a confirmed diagnosis of head and neck cancer attending the ENT (ear, nose, throat) cancer clinic in a teaching hospital before the initiation of treatment were included in the study. The median delay and the association of the delay with the various factors were analyzed. Sixteen one-to-one interviews of patients were done to identify the reasons for the delays from the patient perspective. RESULTS: Median primary, secondary, and total diagnostic delays were 30 days, 30 days, and 73 days, respectively. Statistically, primary delay was found significantly longer among ever users of smokeless tobacco and significantly longer secondary delay was found among those with age less than 60 years. The reasons for the delay were grouped in the categories (i) Symptom appraisal delay due to low perceived seriousness and (ii) health-seeking behavior delay. CONCLUSIONS: The diagnostic delay was considerable. Measures to enhance symptom appraisal by improving health literacy, opportunistic screening, and strengthening the referral system would decrease diagnostic delay.