Extension for Community Healthcare Outcomes Based Telementoring of Physicians for Dementia-Effectiveness in India.

Objective: The study aimed to evaluate the effectiveness of a program based on the telementoring model [Extension for Community Healthcare Outcomes (ECHO)] for primary care physicians in diagnosing and treating patients with dementia. Method: The ECHO model was adapted through 12 live sessions of 2 h every 2 weeks consisting of a didactic presentation by the expert, peer-led new case discussions, and follow-up discussions. In addition, there were 10 h of self-paced e-learning and interim assignments. The impact was examined by noting participation, session ratings, monthly clinical reports, and comparing knowledge and competency scores before and after the course. Results: Among the 63 participants, 39.7% attended at least 80% of the sessions; completing the program successfully. The ratings for all sessions ranged from "good" to "excellent." The paired sample t-test revealed a statistically significant improvement (p < 0.001) in self-rated skills and confidence in diagnosing and treating dementia with an effect size of 1.25 and 1.37, respectively. No change in the knowledge score was observed throughout the course. A considerable increase in dementia-related clinical practice was observed during four monthly summary of clinical cases. Due to the limited data of monthly reports during the COVID pandemic, no statistical analysis was attempted. Conclusion: The ECHO model appears to have a positive immediate impact on the clinical ability of primary care physicians to diagnose and treat dementia. Its direct impact on patient health and at the community level should be aimed at in future studies.

Impact of Plantation Induced Forest Degradation on the Outbreak of Emerging Infectious Diseases-Wayanad District, Kerala, India.

The world has been facing a pandemic owing to COVID-19. We have also seen the geographic expansion and outbreaks of other emerging infectious diseases (EID) in recent years. This paper investigates the direct and indirect effects of land use land cover change (LULCC) on EID outbreaks in the context of Wayanad District of Kerala, India. Wayanad is in the vulnerable tropical forested region, and it is named as one of the four environmental change hotspots. The focus of this project is mainly three EIDs prevalent in this region: Kyasanur forest disease (KFD), Dengue and Leptospirosis. Our results, based on topographical map, remote sensing and extensive field work, show that the natural forest in Wayanad was replaced with agriculture and forest plantation during 1950-2018. This paper further suggests that encroachment of forest by forest plantation causes the human-animal conflict resulting in the outbreak of KFD cases. Our analysis reveals that a high number of Dengue cases is found in the forested regions of the district and over the adjacent human-made agriculture plantation areas. High and medium number of Leptospirosis cases contain a high portion of land area devoted to paddy cultivation and agricultural plantation. In summary, the results clearly show the linkage between the outbreak of above mentioned EIDs and LULCC in the context of Wayanad district, Kerala. We also discuss in detail the causal pathway involving human-environmental dynamics through which plantation leads to the outbreak of KFD. Replacing forests with plantations poses an alarming threat of disease outbreak in the community.

Postgraduate Physiotherapy Training in a Quandary - Ramifications of Corona virus pandemic Lockdown: A Survey-based Study.

INTRODUCTION: Coronavirus disease-2019 (COVID-19) has disrupted clinical services and postgraduate training across the world. Hence, this survey was conducted to understand the impact of pandemic on Physiotherapy post-graduate (PG) education. METHODS: It was a cross-sectional, observational study. A total of 254 Physiotherapy PG trainees were recruited through snowball sampling from Physiotherapy colleges across the state of Maharashtra. A 34-item structured questionnaire was developed, based on available literature, to evaluate the impact of COVID-19 pandemic on four domains: academic training, clinical training, research activities, and concerns faced by a PG trainee. The face validity of this questionnaire was assessed by six academicians and their suggestions were examined. Subsequently, it was piloted on five PG trainees before administering it to the participants. The validated questionnaire was then circulated via various social media platforms and personal contacts using Google form. Descriptive statistics were summarized as frequencies/ percentages. McNemar's test was used to determine the differences on a dichotomous dependent variable between the two related groups using SPSS software. RESULTS: Overall 131 trainees provided complete responses. Although 85% (n=111) of them claimed they attended PG teaching activities through online mode, almost 67% (n=101) disagreed to have achieved their learning objectives. A vast majority (91%, n=119) of them felt that their specialty related practical training was severely affected, and 98% (n=129) reported that reduced caseload had impacted their clinical learning. Also, 70% (n=54) of final year PGs had difficulty in recruiting new participants for their dissertation. Spread of infections to family (98%), commuting in public transport (98%), uncertainty about exam dates (91%), and competency development in specialty areas (96%) were some of their concerns. CONCLUSION: COVID-19 pandemic had impacted various domains of Physiotherapy PG program such as academic, clinical and research areas. Regulatory authorities should take serious consideration and devise strategies to overcome it.

Acceptance of e-consult for Substance Use Disorders during the COVID 19 pandemic: A study from India.

OBJECTIVES: The COVID 19 pandemic has created challenges in providing timely care for patients and families with Substance Use disorders (SUDs). With the difficulties in face-to-face consultations because of social distancing measures, telepsychiatry services can be beneficial. The study proposes implementing an e-consult for SUD management and measuring its acceptability among the health care providers (HCPs) in India. METHODS: The mobile-based e-consult for SUD, connecting HCPs with addiction specialists, was implemented during the COVID lockdown period in India from 25 March to 31 May (71 days). A total of 153 HCPs, i.e., doctors, nurses, counselors, consulted for 110 cases of SUD. Sixty-eight provided feedback by filling the survey form derived from the Service User Technology Acceptability Questionnaire (SUTAQ). RESULT: More than 60% of HCPs reported overall high satisfaction. More than 98% providers reported high acceptability concerning"access to specialist care," "trusted to work appropriately", "saving time," "would like torecommend to others," easier to get touch with a specialist." The doctors reported significantly high acceptability about "access to specialist care," "satisfied with recommendations,"recommend to others" compared to other HCPs. CONCLUSION: During COVID 19 pandemic lockdown in India, e-consult was an acceptable tool in managing SUDs. The majority of HCPs could discuss their cases with addiction experts. There is a need to expand this further in other mental health conditions.