Effect of life skills education on socio-emotional functioning of adolescents in urban Puducherry, India: A mixed-methods study.

BACKGROUND: We wanted to assess the effect of life skills education (LSE) and regular curriculum on the self-esteem, self-efficacy, adjustment, and psychosocial functioning of students from co-educational government schools, compared to those receiving only the regular curriculum. The secondary objectives were to study the feasibility of such sessions and identify the factors affecting the effectiveness of the sessions. MATERIALS AND METHODS: We conducted a mixed-methods study in government schools of urban Puducherry, India in 2018-2019. The quantitative component was a cluster-randomized trial with activity-based learning methods delivered over 10 sessions in the intervention arm (IA). Differences in outcome variables (self-esteem, self-efficacy, adjustment, psychosocial behavior) between baseline and after intervention in each of the groups were calculated, and the difference-in-differences (DID) technique was applied to account for any natural change in scores over time. Qualitative data were collected through focused group discussions (FGDs) among students and teachers. Analysis was founded on a positivist paradigm with inducto-deductive methodology. RESULTS: The mean (SD) age of 258 participants was 13 (1) years in both arms. The mean (SD) difference between baseline and end-line for IA and control arm (CA) was 0.3 (4.4) and - 0.1 (4.0), for self-esteem (P = 0.38), 0.03 (6.0) and - 1.1 (6.1) for self-efficacy (P = 0.12), and - 0.04 (3.5) and - 0.05 (4.3) for adjustment (P = 0.73), respectively. Similarly, the median (interquartile range [IQR]) difference in the conduct problems scale of the Strengths and Difficulties Questionnaire was - 1 (-2, 1) and 0 (-1, 1) (P < 0.01). Five FGDs revealed multiple positive effects on anger management, conduct, self-awareness, and responsible behavior. All 10 teachers viewed life skills education (LSE) positively. CONCLUSIONS: LSE positively affects adolescents' socio-emotional functioning, but more extended periods of exposure are needed to demonstrate discernible change. The feasibility of implementation depends on the syllabus and based on health policies.

Influence of Religious Affiliations on Attitudes Toward Homosexuality Among Physicians: A Cross-Sectional Study From India.

Objective: To examine the attitudes among practicing physicians of various specialties toward homosexuality and its association with participants' religious affiliations in India.Methods: A cross-sectional descriptive study was conducted among physicians about their attitudes toward homosexuality between December 2018 and January 2019. Participants completed a survey anonymously in hardcopy form or online. The survey was developed based on the Attitude Toward Homosexuality Scale for Indians (AHSI). A higher AHSI score indicates less homonegativity. It was modified by adding demographic details, career status, and personal experience with homosexual individuals.Results: The study results showed that among 106 respondents, 81 were men with a mean (SD) age of 32.2 (7.3) years. Of the participants, 40 (37.7%) were MBBS graduates with no specialization, while 34 (32.1%) and 32 (30.2%) respondents were from medical and surgical specialties, respectively. The majority of the respondents were Muslim (43.4%), followed by Hindu (35.8%), Christian (10.4%), those not conforming to any religion (5.7%), and other religions (4.7%). The mean ± SD total score on the AHSI was 69.6 ± 17.7, which was higher than the mean neutral score of 60. The AHSI total score was significantly higher among women (P < .001). The total AHSI score was highest among the no religion category followed by Hindus, with the lowest for biblical religions; the difference was statistically significant (P < .001). No significant difference was seen between Muslims and Christians.Conclusions: This study showed an overall positive attitude among the respondents toward homosexuality; however, those belonging to Abrahamic religions, especially Muslims, had more negative attitudes. The results highlight the need for antistigma campaigns and educational interventions targeting the physician population of India to reduce negative attitudes toward homosexuality and improve their knowledge of this topic.

Comparison of thoracolumbar interfascial plane block with local anaesthetic infiltration in lumbar spine surgeries - A prospective double-blinded randomised controlled trial.

Background and Aims: Posterior lumbar spine fusion surgeries are associated with severe postoperative pain necessitating a multimodal analgesic regime. Wound infiltration with local anaesthetic is an accepted modality for postoperative analgesia in spine surgeries. Thoracolumbar interfascial plane (TLIP) block is a novel technique being evaluated for providing analgesia in lumbar spine surgeries. This study aimed to compare the analgesic efficacy of TLIP block compared to that of wound infiltration with local anaesthetic in terms of time to request the first dose of rescue analgesic. Methods: Seventy-one patients scheduled for posterior lumbar spine fusion under general anaesthesia were included in this double-blinded randomised controlled trial. Preoperatively, patients were randomly allocated to receive either a TLIP block (TLIP group) or wound infiltration (LI group). The primary endpoint was the time of the first request for rescue analgesia. Secondary endpoints were the total tramadol consumption and pain and comfort scores measured at various time points in the 48-h postoperative period. The trial was terminated after second interim analysis as the analgesic benefit of TLIP was evident both clinically and statistically. Results: The median (interquartile range) duration of the time of the first request for rescue analgesia was 1440 (1290, 2280) min in the TLIP group and 340 (180, 360) min in the infiltration group; P value <.001. The mean tramadol consumption was significantly higher in the infiltration group compared to the TLIP group, with a P value <.001. Conclusion: TLIP block provided better postoperative analgesia than that provided by wound infiltration with local anaesthetic.

Age-Period-Cohort Analysis of Trends in Mental Health Mortality in India from 2001 to 2015.

The current study was done to examine the trend of mental health mortality in India using age-period-cohort (APC) analysis. We have conducted a secondary data analysis by using the data on mental health mortality from WHO Global Health Estimates. We performed APC analysis by weighted least squares regression with assumption that data follows Poisson distribution.Annual increase in the age adjusted mortality rate due to mental health problems was 1.52%. Rate ratio (RR) increased consistently across all the age groups from 15-19 to 80-84 years. RR of period effects also showed increase from 2001-2005 to 2011-2015 periods. RR of cohort effects showed consistent increase from 1921-1925 to 1986-1990 cohorts and then decreasing from 1991-1995 to 1996-2000. To summarize, we found that mental health mortality shows increasing trend in India over the past decade with maximum increase among older population.

Patient and Provider's Experience and Perspective in Addressing Barriers to Medication Adherence Among Noncommunicable Disease Patients in Rural Puducherry, South India-A Qualitative Study.

BACKGROUND: Trend in morbidity and mortality due to noncommunicable diseases (NCDs) is rising because of poor control status. Medication nonadherence is one of the most common and modifiable causes of inadequate control status. OBJECTIVES: To examine the barriers in drug adherence among NCD patients in rural Puducherry. METHODS: This qualitative study includes in-depth and key informant interview conducted among 6 NCD patients and 4 health-care providers. Interviews were audio-recorded, and transcript was prepared in verbatim format. Thematic content analysis was done to derive the categories and themes. RESULTS: Major barriers for nonadherence to medications found were stress, substance abuse, forgetfulness, lack of family support, and high case load of health facilities. Corrective measures suggested to address the barriers were to provide health education to patients and family members, awareness campaigns in community, and health education sessions at the clinic. CONCLUSION: Psychological factors such as stress, social isolation, and negligence are major barriers for drug adherence. Health education session at community and health system is needed to improve the adherence.

Effectiveness of Workplace Intervention for Reducing Alcohol Consumption: a Systematic Review and Meta-Analysis.

AIMS: To review the effectiveness of workplace interventions in reducing alcohol consumption among employees. METHODS: Systematic search of science databases from inception till May 2018 for trials where an intervention was tested against a control and data presented as amount of alcohol consumed per week. Quality of trials was assessed by Cochrane risk of bias tool. Meta-analysis was performed with random-effects model and pooled mean difference (MD) was reported with 95% confidence interval. Publication bias was assessed using Egger's test. RESULTS: Seven trials with 1291 participants could be included. No outcome assessments were blinded. There was positive effect of workplace intervention on reduction of alcohol consumption with pooled MD of -2.25 [95% CI: -4.20 to -0.30]. The effect was only seen where subjects had a baseline alcohol consumption of over 15 standard drinks per week. There was no heterogeneity across the trials (I2=0%). Funnel plot was symmetrical shaped and Egger's test confirmed that there was no publication bias. Two studies found no advantages to intervention on differences on the AUDIT test. CONCLUSION: There is weak evidence for workplace interventions (varying modes) as a way of facilitating reduction in the consumption of alcohol among employees but only among the heavier consumers.

Effectiveness of peer led intervention in improvement of clinical outcomes among diabetes mellitus and hypertension patients-A systematic review and meta-analysis.

Peer-led intervention allows the patients to develop knowledge, skills and confidence in managing their own conditions. Hence this review was done to assess the effectiveness of peer-led intervention in improving the clinical outcomes of DM and HTN patients. We conducted systematic search in Medline, CENTRAL, Sciencedirect and Google-Scholar from inception till May 2018 and retrieved 3654 citations. Meta-analysis was performed using random-effects model and pooled mean difference (MD) was reported with 95% CI. Publication bias was assessed using Egger's test. 29 trials (26 DM and 3 HTN) with 6363 participants were included. There was positive effect of peer led intervention on DM and HTN with pooled MD of -0.28% [95%CI: -0.45 to -0.11] and -7.52mmHg [95%CI: -14.39 to -0.66]. There was significant heterogeneity and publication bias in both DM and HTN trials. Sensitivity analysis showed only little improvement in the final estimate. Peer support intervention is effective and causes statistically significant reduction in HbA1C and systolic blood pressure among DM and HTN patients.

Impact and cost effectiveness of pneumococcal conjugate vaccine in India.

BACKGROUND: World Health Organization has recommended the introduction of pneumococcal conjugate vaccine (PCV) in the childhood immunisation programme of all the countries in the world. In lieu of its introduction in India, there is a need to generate evidence on cost-effectiveness of this vaccine. The current study looks into the impact and cost-effectiveness of PCV vaccine in India. METHODS: We evaluated the cost effectiveness of implementation of PCV 13 vaccination program at national level by comparing with no vaccination program for a period of 10 birth cohorts from 2018 to 2027. UNIVAC, a deterministic static cohort model is developed by giving the conservative estimates of vaccine program related to mortality, disease event rates, vaccine efficacy and coverage projections, system and health care costs for the first five years of life. Cost effectiveness is reported as Incremental Cost Effectiveness Ratio (ICER). Further scenario and sensitivity analysis were done. Probability of PCV intervention to be cost effective at a willingness to pay (WTP) threshold equal to per capita gross domestic product (GDP) is calculated using the government perspective. RESULTS: We found that the introduction of PCV vaccination program can cost an additional $467 (INR 31,666) for averting per DALY which is less than one time GDP per capita of India. Even with the most unfavourable scenario for PCV vaccine, cost per DALY averted is found to be $2323 (INR 1,57,520) which is still a cost effective intervention in India. Probabilistic sensitivity analysis found the ICER for PCV to be $649 (INR 44,008) with 95% CI: $374-$1161. CONCLUSION: This study shows that the PCV program is a highly cost effective intervention and justifies the introduction of PCV into routine immunisation schedule in some of the states and recommends introducing it throughout the country to reduce morbidity and mortality among the under-five children.