Prevalence and sociodemographic determinants of common mental disorders (CMDs) symptoms in a rural adult population of Haryana, North India.

Objectives: Common mental disorders (CMDs), including depression, anxiety, and somatoform disorders, affect all stages of life and impact individuals, families, and communities. This study aimed to determine the magnitude of CMDs and their sociodemographic determinants in the adult population of a rural block in North India. Material and Methods: A cross-sectional, quantitative, community-based study was conducted among adult residents of a rural block in Haryana, North India, using a multistage random sampling technique. The Hindi version of the General Health Questionnaire (GHQ-12), a well-validated tool, was used to screen participants for CMDs. Scores of 4 or above denoted the presence of CMDs. Bivariate analyses were performed to determine the associations between CMDs and sociodemographic characteristics. Results: Of the 180 residents selected for the study, most were women (60.0%) and aged between 31 and 50 years (52.3%). The prevalence of CMDs symptoms in the study population was 20.0%. The presence of CMDs symptoms was significantly higher among those who were aged 60 years or older [OR=12.33, 95% CI 3.21-47.38], widowed, divorced or separated [OR=7.50, 95% CI 1.09-51.52], illiterate [OR= 6.25, 95% CI 2.84-13.77], had monthly family income below 10,000 INR [OR=3.33, 95% CI 1.54-7.20], had any chronic physical illness [OR=8.28, 95% CI 3.70-18.56] and had a family history of any psychiatric illness [OR=5.56, 95% CI 1.52-19.42]. Conclusion: The burden of CMDs was quite high among adults in rural North India. The presence of CMDs was closely associated with sociodemographic characteristics. Primary care and community-based settings need to screen for, diagnose, and manage CMDs to address this growing problem.

Relation of Primary Fingerprint Patterns With Gender and Blood Group: A Dermatoglyphic Study From a Tertiary Care Institute in Eastern India.

Background Identification of an individual plays a vital part in any medicolegal investigation. The fingerprint is one of the oldest and most reliable biometric methods and is taken as legitimate proof of identification of an individual. Positive relationships between the fingerprint pattern and blood group and the fingerprint pattern and gender were demonstrated in some of the previous studies but weren't consistent across them. Objectives (a) To study the distribution of fingerprint patterns among the study participants by gender and ABO and Rh blood groups and (b) to find an association between the fingerprint pattern and gender and blood group. Methods A cross-sectional observational study was carried out in the year 2021 on 800 healthcare students and workers of All India Institute of Medical Sciences, Patna, Bihar, Eastern India having different ABO and Rh blood groups. Healthy individuals i.e., those who were not suffering from any illness which can affect the fingerprints, aged 18 years or above were included and individuals having hand or finger deformities or missing fingers, having an allergy to the ink pad, and having blood group diseases were excluded. Rolled imprints of all the 10 digits of the participants were taken on a white A4 size Performa and were classified into loops, whorl, arches, and composite. The distribution of the fingerprint patterns was then compared by gender, ABO and Rh blood group. Chi-square/Fischer exact tests were applied to compare two groups and find the association. P-value<0.05 was taken as statistically significant. Results The majority (66.0%) of the participants in the study were males with a male: female ratio of 1.9:1. Most common blood group was blood group B (37.7%) followed by O (29.8%), A (23.0%), and AB (9.5%). Rh-positive cases constituted around 96% of all the studied cases with the rest being Rh-ve. The general distribution of the fingerprint pattern showed a high frequency of loops registering 55.9%; followed by whorls (34.9%), arches (6.0%), and composite (3.1%). The distribution of fingerprint patterns among the male and female gender was found to be similar with no significant difference (p=0.11). However, the distribution of the finger patterns across the ABO blood groups showed a statistically significant difference (p=0.0003) whereas it was non-significant across the Rh blood groups (p=0.08). Conclusion This study concludes that the distribution of the primary fingerprint patterns relates to the "ABO" blood group but not to gender and Rh blood group. An individual's fingerprints may be used to predict his/her blood group and vice versa.

Universalization of Healthcare for Non-Communicable Diseases in India - Promise of Health and Wellbeing, Insurance for Universal Health Coverage.

SUMMARY: Noncommunicable diseases (NCDs) pose a significant global health and economic burden, necessitating universal health coverage (UHC). Out-of-pocket (OOPs) payments for healthcare, particularly in low- and middle-income countries lacking social protection and health insurance, contribute to impoverishment and catastrophic expenditure. This scoping review aimed to assess the state of UHC for NCDs in India, including the progress made, coverage of government health insurance schemes, challenges faced, and their potential solutions. A literature search was performed in major databases such as PubMed, Ovid, Web of Science, Embase, Cochrane Library, and Google Scholar using appropriate keywords. Findings indicated that UHC remains a distant dream in India with a disproportionately high NCD burden and a substantial portion of health-care expenses (80% outpatient, 40% inpatient) relying on OOP expenditures, causing financial hardship. Limited universal social security exacerbates health-care access challenges. The coronavirus disease-2019 pandemic has further hindered NCD services and UHC progress. The Ayushman Bharat program, featuring health and wellness centers and the Pradhan Mantri Jan Arogya Yojana, aims to address primary health-care needs and provide NCD coverage in India. Despite this, challenges persist, including inadequate availability of essential medicines and technologies in health-care facilities, as well as gaps in rural health-care access. Telemedicine services like "eSanjeevani" have been implemented to improve access in remote areas. To achieve UHC for NCDs in India, it is crucial to strengthen primary health-care, ensure medicine availability, enhance human resources, establish a referral system, address social determinants, and implement social protection.

Effectiveness of a collaborative model in improving maternal and child health outcomes among urban poor in Chandigarh, a North Indian city.

BACKGROUND: To ascertain the effectiveness of a collaborative model between the Department of Community Medicine and state health department to improve MCH outcomes among the urban poor in Chandigarh. MATERIALS AND METHODS: A quasi-experimental study was conducted from 2011-12 to 2015-16 in the intervention and control areas. A collaboration was established between the state health department and the Department of Community Medicine of an autonomous institute. The intervention and control areas were mainly inhabited by the poor migrant population. Critical elements of an efficient collaboration such as the early engagement of partners, clearly stated purpose with common goals, effective communication, and no financial conflict were implemented in the intervention area. MCH program's implementation was strengthened through supportive supervision, enhanced community engagement, male partner involvement, tracking of high-risk pregnant women, and identification of problem families. Trend analysis of MCH indicators was done. The difference-in-difference (DID) analysis was done to measure the net effect of the intervention. RESULTS: All the MCH indicators improved significantly in the intervention area compared to the control area (P < 0.05). DID analysis depicted a net increase in the early registration of pregnancies by 18%, tetanus toxoid immunization by 9.2%, and fully immunized children by 8.6%. There was also an improvement in the maternal mortality ratio by 121.1 points, infant mortality rate by 2.2 points, and neonatal mortality rate by 2.6 points in the intervention area. CONCLUSION: An innovative, collaborative model between the state health department and the Department of Community Medicine effectively improved the MCH outcomes in Chandigarh.

Assessment of APACHE II Score to Predict ICU Outcomes of Patients with AKI: A Single-center Experience from Haryana, North India.

Background: The acute physiology and chronic health evaluation (APACHE) II severity score has shown a good calibration and discriminatory value across a range of disease processes and remains the most widely used source of prognostic information on the risk for death in patients admitted to intensive care units (ICUs). Objectives: To study APACHE II scores in patients of acute kidney injury (AKI) admitted in the ICU and to find its association with outcome. Materials and methods: One hundred patients with AKI aged 18 years or above were admitted in the ICU, department of general medicine, of a tertiary care institute in Haryana, North India, from October 2019 to September 2020, were studied. Patients who had known causes of chronic kidney disease (CKD), on maintenance hemodialysis, and those who underwent renal replacement therapy (RRT) or nephrectomy were excluded. All required investigations were performed, and data were collected. The patients were followed till discharge or in-hospital mortality. Results: The mean age of the patients was 55.92 ± 18.18 years. Male-female ratio was 1.5:1. Thirty-five percent of the admitted patients had an in-hospital mortality. Sepsis (47%) was the most common cause of AKI, and 83% of the patients had underlying comorbid conditions. The mean APACHE II score of the expired patients on admission, i.e., 24.80 ± 13.65, was found to be significantly higher compared to the mean APACHE II score (17.25 ± 10.12) of the discharged patients (p-value <0.001). APACHE II score was found to have 57.14% sensitivity, 86.15% specificity, 69% PPV, 78.9% NPV, and 76% diagnostic accuracy to predict mortality among the AKI patients. Conclusion: APACHE II scoring system has a good discrimination and calibration when applied to ICU-admitted AKI patients and is a good predictor of prognosis in them. How to cite this article: Patel P, Gupta S, Patel H, Bashar MDA. Assessment of APACHE II Score to Predict ICU Outcomes of Patients with AKI: A Single-center Experience from Haryana, North India. Indian J Crit Care Med 2022;26(3):276-281.

Incidence, Pattern and Severity of Adverse Events Following Immunization (AEFIs) Associated With Chadox1 nCOV-19 Corona Virus Vaccine (Recombinant) Among the Healthcare Workers of a Tertiary Care Institute of Eastern Uttar Pradesh, India.

Background In January 2020, the Government of India based on the recommendation of the Drugs Controller General of India (DCGI) and National Technical Advisory Group on Immunization (NTAGI) started the rollout of the COVID-19 vaccine in the country. Two vaccines, ChAdOx1 nCoV-19 coronavirus vaccine (recombinant), i.e., COVISHIELD produced by Serum Institute of India and COVAXIN developed indigenously by Bharat Biotech, were given emergency use authorisation (EUA) by the DCGI. Methods In this cohort study, we assessed the incidence, pattern and severity of adverse events following immunization (AEFI) observed among the healthcare workers of a large tertiary care institute in eastern U.P., India vaccinated with ChAdOx1 nCoV-19 Coronavirus vaccine (recombinant) within 30 minutes of vaccination by direct observation. Results Out of the total 836 healthcare workers who were vaccinated with the first dose of the vaccine, around 10% experienced any AEFI within the directly observed period. The most common AEFI was pain/tenderness at the injection site experienced by 59.3% of those who experienced any AEFI followed by headache/dizziness (35.3%), itching/rashes at the injection site (8.1%), nausea/vomiting (5.8%) and fever/chills (4.7%). The majority (95.3%) of the AEFIs observed were of minor severity with no serious AEFIs observed as per the WHO severity classification. Conclusion ChAdOx1 nCoV-19 Coronavirus vaccine (recombinant) is proven to be safe based on our findings as the majority of AEFIs observed were of minor grade only. However, the vaccine beneficiaries should be strictly observed for a minimum of 30 minutes at the vaccination site to look for any serious AEFI with arrangements to manage the same.

Is it the Right Time to Introduce the Hepatitis B Booster Vaccine in National Immunization Schedule? An Analysis from the Available Evidence.

Hepatitis B virus (HBV) infection is a global health concern, and it is considered one of the deadliest infections in the world, having nearly 1.2 million deaths annually. Around 75% of all global HBV carriers live in the Asia-Pacific region. In this regard, India has a prevalence ranging between 2% and 7% with exposure rates of 10%-60%. Hepatitis B is a vaccine-preventable disease. In India, the World Health Organization protocol for hepatitis B vaccination has been followed, and it is given free of cost in public health facilities under the National Immunization Schedule. Despite the free hepatitis vaccination program in India, coverage and awareness are low. Low awareness, followed by low coverage of hepatitis vaccination, can prove dangerous for the Indian population in the long run. A majority of chronic hepatitis cases progress silently to end-stage liver disease without having many signs and symptoms. Once occurred, a complete cure is not possible with currently available drugs. The studies from neighboring countries such as China and Taiwan documented that the impact of single-dose booster for children of 10 years has made a significant difference from the cost-effectiveness perspective. They have also included the booster dose in their national vaccination program. Considering the low level of vaccination awareness, small coverage, high disease burden, and high treatment cost, now, it is high time for India to introduce hepatitis B booster vaccine.

Evaluation of Data Quality of Four New Population Based Cancer Registries (PBCRs) in Chandigarh and Punjab, North India- A Quality Control Study.

BACKGROUND: Population based Cancer Registries(PBCRs) are hallmark of cancer surveillance and cancer control activity .The value of cancer registries rely heavily on underlying quality of their data. Current study assessed data quality of four new PBCRs of Chandigarh, SAS Nagar, Mansa and Sangrur covering a total population of 4.5 millions on three quality parameters i.e. comparability, validity and completeness as recommended by International Agency of Research on Cancer(IARC), Lyon, France. METHODS: For assessing comparability, data of the registries were reviewed in terms of system of classification and coding, definition of incidence date and rule for multiple primaries. For assessing validity (Accuracy) four different methods i.e. re-abstraction and re-coding, percentage morphologically verified cases (MV%), percentage of death certificate only (DCO%) cases and percentage of cases with other and unspecified sites (O and U%) were used. For assessing completeness of coverage, different semi-quantitative methods were used. RESULTS: Re-abstraction done for 10% of the total incident cases yielded overall percentage agreement of 97.4%, 97.2%, 95.4% and 94.9% for PBCR Chandigarh, SAS Nagar, Mansa and Sangrur respectively. MV% was found to be 96.3% for PBCR Chandigarh, 92.8% for PBCR SAS Nagar , 89.3% for PBCR Mansa and 82.9% for PBCR Sangrur. Percentage of DCO cases and O and U cases were 1.4% and 2.8% for PBCR Chandigarh, 3.9% and 5.3% for SAS Nagar, 6.4% and 16.4% for Mansa and 6.3% and 8.3% for Sangrur. Completeness assessed through the various methods showed good level of completeness at PBCR Chandigarh and SAS Nagar and somewhat lower but acceptable level of completeness at PBCR Mansa and Sangrur. CONCLUSIONS: All the four PBCRs are comparable internationally. PBCR Chandigarh and SAS Nagar, predominantly urban registries, have higher accuracy of their data and good completeness levels as compared to predominantly rural registries of Mansa and Sangrur. Cancer estimates given by all the four registries are reliable and data from these registries can be utilized for planning cancer prevention and control activities in the region.

Prevalence and determinants of diabetic peripheral neuropathy/foot ayndrome in the rural population of North India

Introduction: Diabetic peripheral neuropathy (DPN), a common and troublesome complication of diabetes mellitus (DM), leads to a higher risk of diabetic foot ulcers and lower limb amputation. This study aimed to assess the prevalence of DPN among patients of type 2 DM from rural North India and associated risk factors for the condition. Materials and Methods: A facility-based cross-sectional study was carried out among type 2 diabetic patients attending the Non-Communicable Diseases (NCD) clinic of a secondary care hospital in rural North India. A questionnaire that included sociodemographic details, clinical and laboratory parameters, and the Michigan Neuropathy Screening Instrument (MNSI) for detecting peripheral neuropathy was administered to 100 consecutive eligible patients. Statistical Package for Social Sciences (SPSS) version 25.0 was used for entering and analyzing data. Bivariate analysis was performed to determine the factors significantly associated with the presence of DPN. Results: The prevalence of DPN was found to be 42.0%. Male gender, advancing age (≥60 years), longer duration of diabetes (>10 years), smoking, physical inactivity, obesity, uncontrolled blood pressure, poor glycemic control and altered lipid profile were found to be significantly associated with the presence of DPN. Conclusions: The prevalence of DPN among type 2 diabetes patients from rural northern India is alarmingly high. There is a need for essential screening of all diabetic patients by their primary care provider for early detection of DPN, particularly in rural India (AU)

Factors causing early maternity discharge of uncomplicated normal delivery cases at government health facilities in Northern India: An exploratory study.

INTRODUCTION: Most of the neonatal and maternal deaths occur within the first 48 hours post-delivery. Hence, this time period is very crucial for the survival of newborns and mothers both. As per maternal and child health program guidelines in India, it is clearly mentioned that all the government health facilities should discharge the mother and baby only after 48 hours of delivery in case of normal delivery and after 7 days in case of delivery conducted by cesarean sections. AIM: The aim of the study was to find the various factors responsible for early maternity discharge (<48 h) of normal vaginal deliveries (NVDs) conducted at government health facilities. MATERIAL AND METHODS: The study was conducted in a rural block of Haryana, North India, from May to June, 2015. Postnatal women with NVD within 6 months of duration from initiation of the study were included after taking proper informed consent. A questionnaire was developed by the investigators to interview the women. The questionnaire consists of 26 items which included the socio-demographic details and questions on various factors affecting postnatal stay at the health facility. RESULTS: A total of 40 postnatal women consented and participated in the study. Their mean age was 23.46 ± 5.63 years. Majority of them (24, 60.0%) were having their first child. Out of them, 12 delivered at primary health centers (PHCs), 18 at community health centers, and the rest at the district hospital. A total of 24 (60%) of them were discharged early (<48 h) as per laid guidelines. It was observed that primiparity, delivery at PHC, normal birth weight of baby, and term deliveries were significantly associated with early discharge. Among those who had NVD and stayed beyond 48 h, most of them mentioned that the round-the-clock availability of doctors/nurses was the main reason for their staying at the health facility. CONCLUSION: The proportion of postpartum women discharged early is high and alarming. There is a need for essential counseling to be imparted to the mothers by doctors/nurses at all the health facilities for staying till 48 hours and by health workers during the antenatal period of the importance of the stay at the facility post delivery.

Epidemiological investigation of an outbreak of Acute Viral Hepatitis A and E in a semi-urban locality in Chandigarh, North Indian Union Territory, 2016-17.

CONTEXT: During ongoing passive surveillance in Burail, Chandigarh an unexpected rise in number of acute viral hepatitis (AVH) was reported during December 2016. AIMS: An outbreak of AVH was investigated in an urbanized village, Burail, in Chandigarh, India with an objective of describing its epidemiological features. SETTINGS AND DESIGN: A house-to-house survey was conducted in Burail (population 51,958). SUBJECTS AND METHODS: WHO's standard case definition for AVH was used to identify cases. Suspected cases were tested for hepatitis A virus (HAV) and E virus (HEV) using enzyme-linked immunosorbent assay. Drinking water samples were tested for fecal contamination. Control measures were implemented to contain the outbreak. STATISTICAL ANALYSIS USED: Descriptive analysis was done as per time, person, and place. RESULTS: Out of 141 confirmed cases of AVH, 85.1% were positive for HEV, 12.8% for HAV, and 2.1% for both HAV and HEV. The attack rate was 27.1 per 10,000 in a population. Males were affected more than females (P < 0.05). One of the areas reported a leakage in drinking water pipeline and had highest attack rate (36.8/10000 population). Drinking water samples were found negative for contamination. Around 27% of confirmed cases reported history of taking food from local vendors in Burail 2-6 weeks prior to the onset of symptoms. CONCLUSION: This study described the epidemiological features of dual hepatitis outbreak due to HAV and HEV from Chandigarh, Union Territory, north India.

How effective is the virtual primary healthcare centers? An experience from rural India.

INTRODUCTION: Virtual clinic is a new concept in India. This summary describes that how a virtual clinic is transforming the healthcare scenario in rural India. Virtual clinic is based on a social business model, which may involve diverse stakeholders to promote primary care. AIM: This virtual e-clinic aims to expand health outreach in rural and hard-to-reach areas of India and provide primary health care services by connecting local practitioners and health workers visiting patients with qualified allopathic doctors in city through video conferencing technologies. METHODOLOGY: This was a cross-sectional study evaluating the feasibility and acceptance of virtual primary care. A convenient sampling method was used. Data on demographic profiles, morbidity patterns, and referrals were collected with proper consent. This virtual clinic comprises of smartphones, monitors, and assistive devices so that patient can interact with the doctors through video-conferencing and can have authenticated prescriptions with standardized protocols. The private organization who initiated the virtual care program had two centers at the beginning and gradually expanded them to 20 in Uttar Pradesh. Consultations charges were kept minimum to no-profit, no-loss. Data were collected from January 2019 to June 2010. RESULTS: Total number of consultations made was 800. Out of 800 patients, 157 patients belonged to age group of ≥60 years. Mean age the patient was 56 ± 1.56 years, among them 421 (52.62%) were male. The participants actively engaged in clinical interactions and completed full sessions of consultations, which highlight the acceptability of the virtual care system and feasibility of effective patient-provider communication and service delivery using digital technologies. CONCLUSION: The concept of virtual primary care is becoming very popular in rural region where no qualified doctors are available. The initial results of this technological startup appears to be promising; however, it is necessary to evaluate the quality of care, health outcomes, potentials to integrate such innovations in existing primary care, and the legal as well as ethical issues in the future research.

Salutogenesis: A bona fide guide towards health preservation.

Preserving health requires a holistic approach involving the component of physical, mental, social, and spiritual well-being as stated by World Health Organisation. Salutogenesis concept focuses on the factors responsible for well-being rather than the disease pathogenesis in contrary to pathogenesis concept. This evidence-based summary tries to shed a light on existing concept called salutogenesis which is much required in the current scenario.

Clinical, sociodemographic profile and stressors in patients with conversion disorders: An exploratory study from southern India.

BACKGROUND: Patients present with "conversion disorder" as a response to any underlying stressful situation. It is clinically important to evaluate the presence, type, and temporal relation of the stressors, resulting in conversion. Further, knowing the sociodemographic and psychological profile of the conversion patient helps in better management. AIM: The aim of the study was to study the clinical presentations, sociodemographic characteristics, and underlying stressors associated with conversion disorder. MATERIALS AND METHODS: Fifty patients admitted to the Department of Psychiatry, NRI Medical College and Hospital, Guntur, Andhra Pradesh, from January 2013 to December 2014, who fulfilled the inclusion criteria of the study were evaluated for sociodemographic characteristics, clinical presentations, and stressor on a semi-structured pro forma. RESULTS: Majority of the patients with conversion symptoms were children and young adults (74.0%), females (62.0%), students (46.0%), married (54.0%), and those from nuclear families (78.0%) and rural background (62.0%). Socioeconomic status wise, majority (66.0%) of the patients belonged to middle class. Majority of the patients (92.0%) had a recognizable precipitating factor, of which family-related/marital (36.0%) and education/school-related (18.0%) problems accounted for the major types. Purely motor symptoms were the predominant presentation (84.0%) with unresponsiveness/syncopal attack and pseudo seizure being the commonest. CONCLUSION: Conversion disorders are commonly seen in females, children and young adults, students, and in those belonged to middle class in socioeconomic status and rural areas. They are mostly preceded by identifiable psychosocial stressors.

Psychological impact of COVID-19 pandemic on health care professionals and workers.

The outbreak of a novel coronavirus starting from December 2019 and reaching pandemic proportions has raised concerns as to the ability of the current protective measures and the health-care system to handle such a threat. Health-care workers may experience considerable psychological distress as a result of the coronavirus disease-19 pandemic due to providing direct patient care, vicarious trauma, quarantine, or self-isolation.

Artificial intelligence enabled healthcare: A hype, hope or harm.

In this paper, we have described the health care problem (maldistribution of doctors) in India. Later, we have introduced the concept of artificial intelligence and we have described this technology with various examples, how it is rapidly changing the health care scenario across the world. We have also described the various advantages of artificial intelligence technology. At the end of the paper, we have raised some serious concerns regarding complete replacement of human based health care technology with artificial intelligence technology. Lastly, we concluded that we have to use artificial intelligent technology to prevent human sufferings/health care problems with proper caution.

NOMOPHOBIA: NO MObile PHone PhoBIA.

The term NOMOPHOBIA or NO MObile PHone PhoBIA is used to describe a psychological condition when people have a fear of being detached from mobile phone connectivity. The term NOMOPHOBIA is constructed on definitions described in the DSM-IV, it has been labelled as a "phobia for a particular/specific things". Various psychological factors are involved when a person overuses the mobile phone, e.g., low self-esteem, extrovert personality. The burden of this problem is now increasing globally. Other mental disorders like, social phobia or social anxiety, and panic disorder may also precipitate NOMOPHOBIC symptoms. It is very difficult to differentiate whether the patient become NOMOPHOBIC due to mobile phone addiction or existing anxiety disorders manifest as NOMOPHOBIC symptoms. The signs and symptoms are observed in NOMOPHOBIA cases include- anxiety, respiratory alterations, trembling, perspiration, agitation, disorientation and tachycardia. NOMOPHOBIA may also act as a proxy to other disorders. So, we have to be very judicious regarding its diagnosis. Some mental disorders can precipitate NOMOPHOBIA also and vice versa. The complexity of this condition is very challenging to the patients' family members as well as for the physicians as NOMOPHOBIA shares common clinical symptoms with other disorders. That's why NOMOPHOBIA should be diagnosed by exclusion. We have to stay in the real world more than virtual world. We have to re-establish the human-human interactions, face to face connections. So, we need to limit our use of mobile phones rather than banning it because we cannot escape the force of technological advancement.