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1.
J Pak Med Assoc ; 72(12): 2565-2566, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-20245600

ABSTRACT

Adult vaccination is an accepted part of health care and diabetes care. In spite of evidence regarding the efficacy and utility of vaccination in preventing disease, we continue to encounter vaccine hesitancy and vaccine skepticism. As physicians, it is our duty to encourage the public to get vaccinated. In this article, we create a simple framework which helps assess the barriers to vaccine acceptance, and create bridges to overcome vaccine hesitancy and skepticism. We use an interesting mnemonic, NARCO, to remind ourselves, and our readers, of the appropriate hierarchy of interviewing related to vaccine acceptance.


Subject(s)
Physicians , Vaccination Hesitancy , Adult , Humans , Health Facilities , Memory , Vaccination , Primary Health Care
2.
Indian J Community Med ; 48(1): 31-40, 2023.
Article in English | MEDLINE | ID: covidwho-2272302

ABSTRACT

Oxygen support became one of the rate-limiting steps for medical care during COVID-19 pandemic in India. The primary aim of this study was to appraise the manufacturing, supply, and distribution of medical oxygen during the pandemic. The secondary objectives were to highlight the coordination of various stakeholders to mitigate the oxygen surge and to present a critical analysis of India's response to the emergent situation. Using an analytic approach, we have delineated India's response to mitigate the medical oxygen surge during the distressing second peak between March-May 2021. In the pre-COVID-19 era, of the total 6900 MT of oxygen produced in India, only 1000 MT was available for medical usage, which was increased up to 19940 MT through the strengthening of in-house oxygen manufacturing, low-cost innovations, and enhanced storage facilities. High-burden states were identified, and transport was facilitated through departments of railways, defence and civil aviation. Real-time scrutiny of the oxygen supply was provided. Essential customs duties on importing oxygen and vital equipment were exempted, along with other swift decisions. National Oxygen Stewardship Program' was initiated to build the capacity of health care workers in oxygen therapy and rational use of surplus oxygen. The pandemic overwhelmed the health system. But a coordinated multi-stakeholder approach facilitated the fight against oxygen surge. However, a comprehensive pandemic response will need more than just oxygen. This resourceful utilization offers a silver lining and facilitates the improvement of health systems and health outcomes in the long term.

3.
JMIR Public Health Surveill ; 2022 Oct 28.
Article in English | MEDLINE | ID: covidwho-2242216

ABSTRACT

BACKGROUND: Many nations swiftly designed and executed government policies to contain the rapid rise of SARS-CoV-2 cases. The government actions can be broadly segmented as movement and mass gathering restrictions (such as travel and lockdown), public awareness (such as facial covering and hand washing), emergency healthcare investment and social welfare provisions (such as poor welfare schemes to distribute food and shelter). The Blavatnik School of Government-Oxford university tracked various policy initiatives by governments across the globe and released them as composite indices. We assessed the overall government response using Oxford Comprehensive Health Index (CHI) and Stringency Index (SI) to combat the SARS-CoV-2 pandemic. OBJECTIVE: This study aims to demonstrate the utility of CHI and SI to gauge and evaluate the government responses for containing the spread of SARS-CoV-2. We expect a significant inverse relationship between policy indices (CHI and SI) and SARS-CoV-2 severity indices (morbidity and mortality). METHODS: In this ecological study, we analysed data from two publicly available data sources released between March 2020, to October 2021: Oxford Covid-19 Government Response Tracker (OxCGRT) and World Health Organization (WHO). We applied Auto-Regressive Integrated Moving Average (ARIMA) and Seasonal ARIMA (SARIMA) to model the data. The performance of different models was assessed using a combination of evaluation criteria: Adj-R2, Root Mean Square of Error (RMSE) and Bayesian Information Criteria (BIC). RESULTS: The strict implementation of policies by the government to contain the crises of SARS-CoV-2 resulted in higher CHI and SI in the beginning. Although the value of CHI and SI gradually fell--the same was consistently higher at values of more than 80% points. During the initial investigation, we found that Cases Per Million (CPM) and Deaths Per Million (DPM) followed the same trend. However, the final CPM and DPM model were SARIMA (3,2,1)(1,0,1) and ARIMA (1,1,1), respectively. The current study does not support the hypotheses that SARS-CoV-2 severity (CPM and DPM) is associated with stringent policy measures (CHI and SI). CONCLUSIONS: Our study concludes that the policy measures (CHI and SI) do not explain the change in epidemiological indicators (CPM and DPM). The study reiterates our understanding that strict policies do not necessarily lead to better compliance but may overwhelm the overstretched physical health systems. The 21st-century problems, thus, demand 21st-century solutions. The digital ecosystem was instrumental in the timely collection, curation, cloud storage and data communication. Thus, digital epidemiology can--and--should be successfully integrated into existing surveillance systems for better disease monitoring, management and evaluation.

4.
JMIR Public Health Surveill ; 7(8): e29957, 2021 Aug 30.
Article in English | MEDLINE | ID: covidwho-2141339

ABSTRACT

BACKGROUND: Association between human mobility and disease transmission has been established for COVID-19, but quantifying the levels of mobility over large geographical areas is difficult. Google has released Community Mobility Reports (CMRs) containing data about the movement of people, collated from mobile devices. OBJECTIVE: The aim of this study is to explore the use of CMRs to assess the role of mobility in spreading COVID-19 infection in India. METHODS: In this ecological study, we analyzed CMRs to determine human mobility between March and October 2020. The data were compared for the phases before the lockdown (between March 14 and 25, 2020), during lockdown (March 25-June 7, 2020), and after the lockdown (June 8-October 15, 2020) with the reference periods (ie, January 3-February 6, 2020). Another data set depicting the burden of COVID-19 as per various disease severity indicators was derived from a crowdsourced API. The relationship between the two data sets was investigated using the Kendall tau correlation to depict the correlation between mobility and disease severity. RESULTS: At the national level, mobility decreased from -38% to -77% for all areas but residential (which showed an increase of 24.6%) during the lockdown compared to the reference period. At the beginning of the unlock phase, the state of Sikkim (minimum cases: 7) with a -60% reduction in mobility depicted more mobility compared to -82% in Maharashtra (maximum cases: 1.59 million). Residential mobility was negatively correlated (-0.05 to -0.91) with all other measures of mobility. The magnitude of the correlations for intramobility indicators was comparatively low for the lockdown phase (correlation ≥0.5 for 12 indicators) compared to the other phases (correlation ≥0.5 for 45 and 18 indicators in the prelockdown and unlock phases, respectively). A high correlation coefficient between epidemiological and mobility indicators was observed for the lockdown and unlock phases compared to the prelockdown phase. CONCLUSIONS: Mobile-based open-source mobility data can be used to assess the effectiveness of social distancing in mitigating disease spread. CMR data depicted an association between mobility and disease severity, and we suggest using this technique to supplement future COVID-19 surveillance.


Subject(s)
COVID-19/epidemiology , COVID-19/transmission , Cell Phone , Geographic Information Systems , Pandemics , Travel/statistics & numerical data , Humans , India/epidemiology
5.
J Family Med Prim Care ; 11(9): 5187-5193, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2144221

ABSTRACT

Introduction: Telemedicine has emerged as an essential interface between health care providers and patients during the pandemic. The present study was done to assess this technology's level of acceptance and satisfaction amongst the patients. Methods: We did a retrospective study amongst patients >18 years (n = 300) who had availed telemedicine services in different departments of a tertiary care hospital between May and August 2020. The patients were interviewed telephonically using a pre-tested semi-structured tool that collected information about the socio-demographic and clinical characteristics of the patients, and satisfaction was measured on a 5-point Likert Scale. Results: Fifty-five percent patients received teleconsultation via a telephone call, while the others preferred video calling services on WhatsApp messenger. Overall, more than 97% of the clients depicted satisfaction with the telemedicine services in three major domains: registration/appointment services, consultation with the doctor and post-consultation services. Some of the common feedback included difficulty in getting medicine using the scanned copy of prescription slip generated by the hospital, problems faced in reimbursement of the bills, long waiting period, and poor quality of video calls due to slow internet. Conclusion: Telemedicine proved to be an efficient means of communication for many patients during the pandemic. Though patient satisfaction was high with the services received by them, timely assessment of the problems encountered in the implementation of telemedicine services will help evolve the services not just during the pandemic but even after that.

6.
BMJ Open ; 12(4): e059701, 2022 04 06.
Article in English | MEDLINE | ID: covidwho-1779382

ABSTRACT

OBJECTIVES: To assess the difficulties faced by the pregnant women in seeking appropriate antenatal care due to the restrictions imposed during the COVID-19 pandemic; assess the difficulties encountered during delivery and postpartum period; the suitability of the teleconsultation services offered; effect of COVID-19 infection on pregnancy outcomes and the effect of restrictions on the nutrition profile of the pregnant women. DESIGN: Prospective observational study. SETTING AND PARTICIPANTS: We included 1374 pregnant women from the rural areas of three districts of Punjab, India registered at government health centres before the implementation of lockdown due to the COVID-19 pandemic on 24 March 2020. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the difficulties faced by the women during their pregnancies due to restrictions imposed during the lockdown. The secondary outcomes included the effect of COVID-19 infections on pregnancy outcomes, satisfaction from the telemedicine services and restrictions on the nutrition profile of the pregnant women. RESULTS: One-third of the women (38.4%) considered their last pregnancy unplanned. Women faced difficulties due to the restrictions in getting adequate nutrition (76.5%), accessing transportation facilities (35.4%), consultations from doctors (22.4%) or getting an ultrasonography scan (48.7%). One-fifth (21.9%) of women could not access safe abortion services. Only 3.6% of respondents ever took any teleconsultation services offered by the government. Most of them felt unsatisfied compared with routine visits (77.5%). COVID-19-infected women were primarily asymptomatic (76.1%), but there was a high incidence of preterm birth (42.8%). Frontline workers could visit 64.3% of the women in the postpartum period despite restrictions. CONCLUSIONS: Lockdown compromised the antenatal care in our study area while the frontline workers attempted to minimise the inconvenience. Telemedicine services did not prove to be of many benefits to pregnant women and should only work as a supplement to the existing protocols of antenatal care.


Subject(s)
COVID-19 , Premature Birth , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Female , Humans , Infant, Newborn , Pandemics/prevention & control , Pregnancy , Prenatal Care
7.
Cureus ; 13(10): e18489, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1497844

ABSTRACT

Background The coronavirus disease 2019 (COVID-19) pandemic has aggravated the demand for diabetes care due to restrictive measures like the lockdown affecting access to healthcare services. The current study was conducted to assess the changes in medication compliance, dietary pattern, and glucose monitoring during the lockdown period as compared to the pre-lockdown period among patients living with type 2 diabetes mellitus (T2DM) attending a diabetes clinic in northern India. Methods This cross-sectional study was conducted between May and July 2020. Information regarding the sociodemographic and clinical profiles of the patients like age, sex, income, qualification, family history of diabetes, history of smoking and alcohol, type of treatment, co-morbidities, drug adherence for T2DM, changes in the pattern of diet, physical activity, blood glucose monitoring, and drug usage during and before the lockdown was collected through telephonic interviews using a structured tool. Descriptive analysis was performed, and the chi-square and Wilcoxon sign ranks tests were used to see the association between variables. Results A total of 260 patients were enrolled in the study. A higher proportion of males reported a decrease in the consumption of cereals (13.9%), eggs (56.5%), and meat and fish (92.7%) and an increase in water intake (25.8%) while a higher proportion of females reported no change in physical activity levels (77.2%) during the lockdown against pre-COVID times. There was a significant improvement in medication adherence and glycemic control during the lockdown period as compared to the pre-lockdown times. Conclusion More time for self-care, adequate counseling about glycemic goals, and knowledge of self-monitoring of blood glucose levels helped the majority of patients in adopting a healthy lifestyle and achieve better glycemic control during the COVID-19 lockdown.

8.
Indian J Med Ethics ; -(-): 1-4, 2021 Feb 23.
Article in English | MEDLINE | ID: covidwho-1239249

ABSTRACT

Diabetes Mellitus (DM) could have easily been labelled as the "black swan" of the 21st century, had Covid-19 not emerged as a pandemic. Modern diabetes care in India grapples with multiple challenges. The twin enemies of uncontrolled hyperglycaemia and unwanted hypoglycaemia pose an ethical dilemma during the decision-making process of DM management. With an unfavourable support system against this rapidly emerging public health threat, we look to the Indian Constitution for guidance. Apart from just euglycaemia (a state of normal blood glucose levels), every Indian living with DM has some requirements and rights, that can be summarised with the help of three basic principles of the Constitution, ie, justice, equality and liberty. Together, these words remind us to practise accurate and appropriate diabetes care, delivered in a patient-centred manner. Justice, equality and liberty should be incorporated into diabetes-care systems, and fraternity encouraged. This will ensure that we achieve the dreams of our founding fathers through evolution of a comprehensive disease management model.

9.
Prim Care Companion CNS Disord ; 23(2)2021 03 25.
Article in English | MEDLINE | ID: covidwho-1231533

ABSTRACT

OBJECTIVE: To examine the various psychosocial factors associated with reverse migration among migrant workers during the coronavirus disease 2019 (COVID-19) lockdown in India. METHODS: A cross-sectional multicenter study was conducted at 4 sites in Northwest India. The migrant workers were recruited from various shelter homes, and information was gathered from reverse migrant workers and controls using various tools including a sociodemographic profile; knowledge, attitudes, and practices questionnaire; and reasons for migration and reverse migration questionnaires. A total of 275 reverse migrant workers and 276 controls participated in the study. RESULTS: There was a considerable difference between reverse migrant workers and controls regarding the question of whether it was safe to travel during lockdown (76.0% vs 26.4%, respectively). The most common route of spread of COVID-19 infection was through touching and sneezing, and symptoms were fever, dry cough, and sore throat in both groups. Reverse migrant workers had low self-esteem and were reluctant to participate in customs of their migration city. A large number of reverse migrant workers reported that they had no money to survive, worried about family back home at their village, felt pressured by family members to come back to the village, and had been terminated from their job. CONCLUSIONS: Reverse migrant workers had the attitude that it was safe to travel during the lockdown. About one-fifth of the reverse migrant workers reported no place to live and fear of getting an infection. The reverse migrant workers also reported feeling low and gloomy, restless, and uncertain about the future and fear of death. Lack of jobs was a major factor driving migrant workers from their native homes.


Subject(s)
COVID-19 , Employment , Family , Health Knowledge, Attitudes, Practice , Transients and Migrants/psychology , Adolescent , Adult , Aged , COVID-19/prevention & control , Communicable Disease Control , Cross-Sectional Studies , Female , Humans , India , Male , Middle Aged , Young Adult
10.
Int J Soc Psychiatry ; 68(1): 210-215, 2022 02.
Article in English | MEDLINE | ID: covidwho-1067027

ABSTRACT

BACKGROUND: The prevalence of mental health problems and substance abuse in the migrant population is higher than the general population. AIMS AND OBJECTIVES: To assess the prevalence and pattern of mental health issues and substance use in the migrant population and highlight the association with the reverse migration of migrant workers. METHODOLOGY: The field staff visited the shelter homes for migrant population in four cities of Northern India (Chandigarh (UT), Bhatinda (Punjab), Panchkula (Haryana) and Jaipur (Rajasthan). After maintaining the social distance and wearing masks by the staff and migrants, written informed consent was taken for participation in the study. The socio-demographic details of reverse migrants were noted down and Hindi version of Patient Health Questionnaire (PHQ-9) for mental health problems and screening tool for pattern of substance abuse was administered. Geographically matched undisplaced were also administered these tools. RESULTS: A total of 275 reverse migrants and 276 undisplaced were included in the study. The prevalence of ever use for all the substances among reverse migrants was 44.4% (122/275) and among undisplaced, it was 45.3%. The prevalence of alcohol, tobacco and cannabis was higher than the general population. The prevalence of at least one diagnosis on PHQ-9 is 13.45% (reverse migrants 19.3% and undisplaced 7.6) and the prevalence of other depressive disorder is significantly higher in reverse migrants (17.1%) than undisplaced (4.0%). CONCLUSION: The study concludes that prevalence of mental health issues and substance abuse in migrant population is significantly higher than the general population and the prevalence of at least one diagnosis and other depressive disorder is significantly higher in reverse migrants than undisplaced.


Subject(s)
Substance-Related Disorders , Transients and Migrants , Humans , India/epidemiology , Prevalence , Substance-Related Disorders/epidemiology
11.
J Pak Med Assoc ; 70(Suppl 3)(5): S15-S20, 2020 May.
Article in English | MEDLINE | ID: covidwho-609352

ABSTRACT

The year 2020 started with a report about a cluster of pneumonia cases from Wuhan, China, that were later identified to be caused by the novel coronavirus. By March 11, this outbreak was designated as a pandemic by World Health Organization. So far, it has affected 213 countries and territories around the world. It is an infectious disease (R0: 2.2 to 3.3) with confirmed human-to-human transmission. The high morbidity and mortality attributed to viral infection has overwhelmed the health systems of most countries across the globe. As of now, there is no confirmed treatment or vaccine against COVID-19. The current pharmacological management relies only on supportive care. Therefore, only non-pharmacological approaches are left to protect people from infection. Established preventive methods against infection include dodging the exposure from the virus, which will break the chain of transmission and prevent further human-to-human spread. In the present paper, we discuss the various non-pharmacological approaches that have to be adopted at the personal or community level and by the healthcare providers to win against this virus.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics/prevention & control , Pneumonia, Viral , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Evidence-Based Medicine , Health Personnel , Humans , Hygiene , Patient Isolation , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Quarantine , SARS-CoV-2
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