The Covid-19 effect on medical students’ perceptions of their profession: A mixed methods study from South India

Covid-19 has devastated human lives and stretched the limits of the medical profession and health systems. Using the mixed methods of online survey and online focus group discussions, we assessed how medical students and interns of two medical colleges in South India viewed the profession they had chosen. Of the 900 participants, 571(63.4%) had a positive perception of the medical profession, 77(8.6%) a negative perception and 252(28%) were undecided. The year of study in medical school was significantly associated with their perception of the medical profession, with interns more likely to have a negative perception (p<0.001). An overwhelming 823(91.4%) participants remained confident of their career choice, but a higher proportion of interns were less confident or regretful about their choice of profession compared to first to fourth year students (p<0.001). Most participants experienced moral distress; they acknowledged a duty to care but were troubled by personal risk, inadequate protection, and limited resources. Gaps were identified in medical and ethics training particularly regarding uncertainties and coping with deficiencies of the health system as encountered in the pandemic. The essential role played by doctors with its required competence, care and ethics cannot be assumed or expected without investment in the making of the future doctor through more socially embedded medical education imparting the skills of understanding the public, responding to them and being the advocate for their equitable and optimal care. An ethics of responsiveness emerges as important for healthcare, also for medical education in preparation for future health crises.

Potential Factors Related to Waist Circumference in Urban South Indian Children.

Objectives: To identify important factors (linked to lifestyle, eating and sedentary behaviors) relating to waist circumference among urban South Indian children aged 3 to 16 years. Design: Cross sectional. Setting: Urban schools of Bangalore, from August 2008 to January 2010. Participants: 8444 children; 4707 children aged 3-10 years and 3737 children aged 10-16 years. Methods: Data were collected on the frequency of consumption of certain foods, physical activity patterns, sedentary habits at home, sleep duration and behaviors such as habits of snacking, skipping breakfast, eating in front of television and frequency of eating out. Simple linear regression analysis of waist circumference on various food items, physical activity, behavior and parental BMI were performed. A path model was developed to R E S E A R C H P A P E R identify potential causal pathways to increase in waist circumference. Results: Increased consumption of bakery items, non vegetarian foods, increased television viewing, decreased sleep duration, eating while watching television, snacking between meals, family meals, skipping breakfast (in older children), and parental BMI were found to be related to waist circumference. Older children possibly underreported their intake of “unhealthy” foods, but not behaviors. Conclusions: This study identified potential behaviors related to waist circumference in urban school children in India. Longitudinal studies with better measures of morbidity and adiposity are warranted in order to derive casual relationships between various determinants and waist circumference.

Waist Circumference and Waist for Height Percentiles in Urban South Indian Children Aged 3-16 Years.

Objectives: To develop age and gender specific waist circumference references for urban Indian children aged 3 -16 years. Design: Cross-sectional study. Setting: Urban preschools and schools of Bangalore. Participants: 9060 children (5172 boys and 3888 girls) in the age group of 3-16 years. Methods: Weight, height, and waist circumference were measured using standard anthropometric methodology. Percentiles for waist circumference and Waist/height ratio (W/Ht) for each age and gender were constructed and smoothed using the LMS method. Results: Mean waist circumference increased with age for both girls and boys. The upper end of curve in boys continued to increase, whereas in the girls it tended to plateau at 14 years. The waist circumference of the Indian children from the present study was higher than age and sex matched European children. The proportion of children with W/Ht ratio greater than 0.5 decreased as their age increased. Conclusions: These curves represent the first waist and waist height ratio percentiles for Indian children and could be used as reference values for urban Indian children. We suggest that for a start, the 75th percentile of waist circumference from this study be used as an “action point” for Indian children to identify obesity (as a tautological argument), while retaining the cut-off of 0.5 for the W/Ht ratio; however this underlines the need to derive biologically rational cut-offs that would relate to different levels of risk for adult cardiovascular disease.

Maternal and child health services utilization in married women of age 15- 45 years.

A house-to-house survey was carried out in Edavanakad Panchayat in Ernakulam district of Kerala to study the utilization and satisfaction from the MCH services provided by the Government and private hospitals. In all 92 women of age 15-45 were selected for the study. The use of private hospital for delivery increased with education. Younger women (age <20 years) used equally both the Government and private hospitals. Overall Government hospital was preferred over private. Antenatal practices were very good with 99% of the women having visited a doctor at least 3 times during pregnancy and women who received TT injection (99%) & IFA tablets (98%) respectively were also very good. More housewives used Government services as compared to the workingwomen and found them convenient and satisfying. The further satisfaction in services may be increased by encouraging community participation.

Self reported morbidity and awareness regarding common cancers in elderly women.

A study based on 198 women above 45 years of age was undertaken using interview methods in a house to house survey, to find the self reported morbidity and awareness regarding common cancers and screening tests. In this study the most commonly reported morbidity was due to reproductive system and related problems. Among reported problems the most common was visual (66.5%) followed by joint pains(58.9%).There was a highly significant relationship between Hypertension, Diabetes and age and also highly significant relationship between education and reported morbidity like low back ache, easy fatiguability, Hypertension and Diabetes. Women in the age group (45-55years) had a significantly better awareness about common cancers. 29.7% women were aware of breast self examination (BSE) and 20.6% practicing BSE. It was also found that women belonging to nuclear families were significantly more likely to practice BSE. Two thirds of the respondents did not know about the screening test for Breast Cancer and 83.7% were unaware of the test for cervical cancer.

Trends of head and neck cancers in urban and rural India.

BACKGROUND: The sub-site predilection of head and neck squamous cell carcinoma (HNSCC) reflects the risk profile of a community and there are suggestions that these are changing over time. OBJECTIVE: To determine the change in head and neck cancer in rural and urban populations in India. METHODS: Cancer registry data of an urban and a rural population were reviewed over a period of 13 and 11 years, respectively. Age adjusted rates (AAR) and age specific incidence rates were used for data analysis. RESULTS: Oral cancers formed the majority of the head and neck cancers with a predilection for tongue, except in rural males, in whom the pharynx was the predominant sub-site. Overall there was a reduction in the incidence of HNSCC, which was more pronounced in urban females and rural males (p< .001). Among the sub-sites, oral cavity cancers showed a decreasing trend in urban females (p< .01) and rural males (p< .01). However, the trend was towards increase of incidence of tongue cancers. Pharyngeal cancer showed reduction in urban females (p< .01), whereas it increased in rural females. The recent increase in incidence of young adults with HNSCC reported in developed countries was not observed. CONCLUSIONS: Overall, incidence of HNSCC is reducing. This may be attributed to the decreased prevalence of tobacco use.The increase in incidence of tongue cancer may suggest factors other than tobacco and alcohol in its genesis.

Adsorption of anionic dyes on to waste Fe (III)/Cr (III).

Waste Fe (III)/Cr (III) hydroxide was investigated for the removal of anionic dyes, namely acid brilliant blue (acidic dye) and procion red (reactive azo dye) from aqueous solution. In batch experiments, parameters studied include contact time, adsorbate concentration, pH, adsorbent dose and temperature. Adsorption followed Langmuir isotherm with adsorption capacity of 10.37 and 3.28 mg/g for acid brilliant blue and procion red, respectively. Adsorption kinetic studies showed second order with respect to acid brilliant blue and first order with respect to procion red. Thermodynamic parameters such as free energy, enthalpy and entropy of adsorption were also evaluated.

Bacteriology of diabetic foot lesions.

Clinical grading and bacteriological study of 107 patients with diabetic foot lesions revealed polymicrobial aetiology in 69 (64.4%) and single aetiology in 21 (19.6%). Among 107 patients 62 had ulcer. Of these 31 had mixed aerobes. Twenty six patients with cellulitis and 12 with gangrene had more than 5 types of aerobes and anaerobes such as E.coli, Klebsiella spp., Pseudomonas spp., Proteus spp., Enterobactor spp., Enterococci spp., Clostridium perfringens, Bacteroides spp., Prevotella spp. and Peptostreptococcus spp. It was noted that 50 out of 62 patients with ulcer, and all the patients with cellulitis and gangrene were given surgical management and treated with appropriate antibiotics based on antimicrobial susceptibility testing.