Validation of the Indian (Hindi) version of the life-space assessment scale among community-dwelling older adults: a multicentric cross-sectional study.

BACKGROUND: The Life-Space Assessment (LSA) is an instrument that measures mobility in older adults as they reach different areas, defined as life-spaces extending from home to beyond towns or regions. The purpose of the study was to develop the Hindi version of the LSA (LSA- H) and to investigate the validity and reliability of the Hindi version as well as its cultural adaptation. METHODS: A cross-sectional study of two hundred forty-five older adults participated in the study from four different study practice areas. Following forward backwards translation, the LSA-H was developed, and the scores were correlated with those of the Activities-Specific Balance Confidence Scale Hindi (ABC- H), the Physical Health Subscale of the WHO-BREF Questionnaire and the Geriatric Depression Scale: Short Form Hindi (GDS-SFH) to test the criterion and concurrent validity. RESULTS: The mean score and standard deviation of the LSA-H questionnaire were 56.53 ± 35.99, those of the Physical Health Subscale of the WHO-BREF instrument were 18.54 ± 7.87, those of the GDS-SFH questionnaire were 6.95 ± 4.21 and those of the ABC- H questionnaire were 54.40 ± 28.96. The Pearson correlation coefficient (r) between the LSA-H score and ABC-H score was 0.707 (p value < 0.0001), that between the LSA-H score and the Physical Health Subscale of the WHO-BREF was 0.766 (p value < 0.0001), and that between the LSA-H score and GDS-SFG score was - 0.674 (p value < 0.0001). CONCLUSION: This study demonstrated that the Hindi version of the LSA is a valid and reliable instrument for assessing living space among older adults in the Hindi language in an Indian population. Furthermore, the LSA-H was significantly correlated with other health assessment tools in terms of functional mobility, general health status and mental well-being.

Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India.

Background: Acceptance of vaccines has been on a decline in recent times, with vaccine hesitancy being listed as one of the top 10 global health threats. This study analysed vaccine hesitancy and belief towards vaccination among caregivers of children aged below 5 years. Methods: In this cross-sectional study, 196 caregivers of children aged 6 months to below 5 years who had attended an immunization clinic at a tertiary care institute of Eastern India from March to May 2019 were surveyed. Consecutive sampling was used to recruit eligible study participants. The survey assessed the attitudes of parents towards childhood vaccination by using the Vaccine Hesitancy Scale and their beliefs towards vaccination. Univariate analysis was performed to assess the association of various sociodemographic factors with vaccine hesitancy. Results: Among the caregivers, most (48%) mothers were aged 26-35 years, literate and homemakers. Vaccine hesitancy was observed in 9.18% of the participants. Only the age of the child was significantly associated with vaccine hesitancy. Nearly half (48.5%) of the participants were concerned about the serious adverse effects of vaccines, and a third (30.6%) agreed that newer vaccines are associated with higher risks than the older ones. Caregivers felt that vaccines are no longer required for uncommon diseases. Conclusion: Concerns regarding vaccine hesitancy are prevalent even among caregivers attending a tertiary care institute. Thus, additional studies are required to assess hesitancy in urban, rural, remote and inaccessible areas. Policymakers ought to conduct periodic assessments and implement necessary remedial measures for the long-term sustenance of the benefits of the national immunization programme.

Cut-off of Anthropometric Measurements and Nutritional Status among Elderly Outpatients in a Tertiary Health Care Center in Telangana.

Introduction:Geriatric population is most vulnerable to various emerging communicable and noncommunicable diseases due to various socio-economic, physiological, psychological and nutritional risk factors. Adequate nutritional status is utmost important in older age as it helps in maintaining the immune response and preventing the morbidities and mortalities in this age. Thus, the opportunistic screening of malnutrition among geriatric population gives an extra edge for achievement of healthy ageing in the elderly. The objective of the present study was to assess the nutritional status among the elderly population and provide cut-off values of various anthropometric measurements for detecting the risk of malnutrition among old age people. Materials and methods:The present cross-sectional study was carried out among people aged . 60 years who visited the geriatric clinic of a tertiary health care center between May and December 2021. The nutritional status of the 468 selected elderly was assessed using the Mini Nutritional Assessment (MNA) tool and various anthropometric measurements. Receiver operating characteristic (ROC) curve and Youden index were used to determine the cut-off values of anthropometric measurements. Correlation between various anthropometric parameters was studied. Data was analyzed using SPSS vs. 20 software. Results:Out of the 468 subjects, around one third had a risk of malnutrition and 7% malnutrition as per the MNA scale. Cut-off values of triceps skinfold thickness, neck circumference and arm muscle circumference were 12.5 cm, 32.5 cm, 18.3 cm and 11.5 cm, 35.5 cm, 21.2 cm for detecting malnutrition and risk of malnutrition, respectively. Neck circumference was found to be the most suitable measurement, with a cut-off value of 32.5 cm and 35.5 cm for detecting malnutrition and risk of malnutrition, respectively, as it possessed the highest Youden index and AUC. Conclusion:The prevalence of malnutrition was found to be low in the present study setting. Our findings firmly established that the neck circumference could be used as a simple, rapid, non-invasive and valid screening tool, with high sensitivity and specificity for detecting the risk of malnutrition in geriatric clinics or primary health care settings.

Assessment of Health Status of Newborns Discharged From Sick Newborn Care Units of the Five Cyclone Fani Affected Districts of Odisha, India.

OBJECTIVE: This study was undertaken to assess the health status of newborns discharged from Sick Newborn Care Units (SNCU) of the Cyclone Fani affected districts of Odisha, which is amongst the highest neonatal mortality rate states in the country. METHODS: Cyclone Fani hit the coast of Odisha on May 3, 2019. This cross-sectional study was conducted in 5 districts and targeted the babies discharged from SNCU's from January to May 2019. A telephonic interview of the caregivers was conducted to assess the health status of the newborns. Data was collected in a web-based portal and analyzed by statistical package for social sciences SPSS (IBM Corp., Armonk, New York, USA). RESULTS: We inquired about 1840 babies during the study period but only 875 babies could be followed up, with the highest proportion of the babies from the most affected district. Out of 875 babies, 111 (12.7%) had 1 or more illnesses during follow up. Distance from the health facility and time constraints were the major reasons for not seeking health care. Of the babies, 35.7% were reported as being underweight. Poor breastfeeding (14.1%) and kangaroo mother care (31.7%) practices were reported. Only 32% of the babies were completely immunized. CONCLUSION: The health status of the babies discharged from the SNCUs was found to be poor. Newborn care can be strengthened by improving home-based and facility-based newborn care.

Factor Structure of the Telugu Version of the COVID-19 Pandemic-Related Perceived Stress Scale (PSS-10-C) Administered on Grassroots Frontline Health Care Workers of Rural Telangana.

Background: During the COVID-19 pandemic, perceived stress is an important determinant of mental health problems, especially in health care workers (HCW). By and large, regional language tools to assess perceived stress in the context of the pandemic have not been validated in India. We aim to explore the factor structure of the Telugu translated version of the COVID-19 pandemic-related Perceived Stress Scale (PSS-10-C) administered on grassroots frontline HCW of rural Telangana, India. Methods: Data relating to 311 grassroots frontline HCW consisting of accredited social health activists (ASHA), multipurpose health workers (MPHW), and auxiliary nurse and midwives (ANMs) working in rural primary health centers (PHC) in five districts of Telangana were analyzed. An exploratory factor analysis was conducted to identify latent factors. Convergent validity was assessed by computing Pearson product-moment correlations between the scores of PSS-10-C and Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Results: The principal component analysis showed that the 10 items of the scale were significantly loaded by two latent factors with eigen values of 2.792 and 2.009, respectively. Factor solution showed that six and four items correlated with each of the two factors, respectively. Significant correlations between PSS-10-C, GAD-7, and PHQ-9 scores showed convergent validity. The two factors may represent substantive factors "perceived self-efficacy" and "perceived helplessness." There may be an influence of the reverse-coded method on the factor solution. Conclusion: The Telugu translated version of PSS-10-C holds fair-to-good psychometric properties.

Factor Structure of the Telugu Version of the Insomnia Severity Index Administered to Primary Care Health Workers of Rural Telangana During the COVID-19 Pandemic.

Objective: Prevalence of insomnia has been high during the coronavirus disease 2019 pandemic, especially in health care workers. The 7-item Insomnia Severity Index (ISI) is the most commonly used tool to assess insomnia severity and its impact. The ISI has not been translated and validated for use among Telugu-speaking health care workers. The objective of this study was to explore the factor structure of the Telugu-translated version of the ISI, administered among primary care health workers in rural Telangana, India.Methods: The Telugu version of the ISI was administered to 315 grass-root primary care health workers in rural primary health centers of 5 districts of Telangana. Exploratory factor analysis was conducted to measure the factor structure of the translated version of the ISI. Data were collected in August 2021.Results: The principal component analysis showed that the 7 items of the scale significantly loaded on to 1 latent factor with an eigenvalue of 4.036, explaining 57.66% of the total variance. The factor reliability (Cronbach α) was 0.876.Conclusions: The results show that the Telugu translated version of the ISI conforms to previously found factor solutions and is valid to assess insomnia severity in primary care health workers.

Experience from a COVID-19 screening centre of a tertiary care institution: A retrospective hospital-based study.

BACKGROUND: The COVID-19 pandemic continues to be a significant public health concern across the whole world, including India. In the absence of any specific treatment or vaccine against COVID-19, the role of efficient testing and reporting has been uncontested so far as the number of cases is rising daily. In order to strengthen the screening activities and to prevent nosocomial infection, facility-based screening centres have been designed and operated at various levels of healthcare, including tertiary care institutions. METHODS: The present study has been planned with an objective to understand the patient profile and evaluate the functioning of COVID-19 screening OPD (CS-OPD) at a tertiary care hospital. In this hospital-based retrospective study, data from individuals visiting the COVID-19 screening OPD during the period from 17th March 2020 to 31st July 2020 were collected. We documented and analysed relevant demographic, epidemiological and clinical characteristics of the patients. RESULTS: A total of 10,735 patients visited the COVID-19 screening OPD during the defined study period of which 3652 individuals were tested. The majority of the patients, i.e., 65.67% (7050) were male and in the 15-59 years age group (84.68%). The most common symptoms among patients visiting CS-OPD was cough (9.86%). Of the total, 17.17% (1843) of patients reported to the CS-OPD with a contact history of COVID-19-positive patient. On the other hand, 13.49% (1448) of patients were with either domestic or international travel history. The overall testing rate and positivity rate for CS-OPD during this period were found to be 34.02% and 7.94%, respectively. CONCLUSION: The clinical, demographic and epidemiological characteristics of patients visiting CS-OPD varied across the study period depending upon the containment and testing strategy. The CS-OPD played a crucial role in preventing nosocomial infection and maintaining non-COVID care at the tertiary care hospital.

Hospital-Based Contact Tracing of Patients With COVID-19 and Health Care Workers During the COVID-19 Pandemic in Eastern India: Cross-sectional Study.

BACKGROUND: The contact tracing and subsequent quarantining of health care workers (HCWs) are essential to minimizing the further transmission of SARS-CoV-2 infection and mitigating the shortage of HCWs during the COVID-19 pandemic situation. OBJECTIVE: This study aimed to assess the yield of contact tracing for COVID-19 cases and the risk stratification of HCWs who are exposed to these cases. METHODS: This was an analysis of routine data that were collected for the contact tracing of COVID-19 cases at the All India Institute of Medical Sciences, Bhubaneswar, in Odisha, India. Data from March 19 to August 31, 2020, were considered for this study. COVID-19 cases were admitted patients, outpatients, or HCWs in the hospital. HCWs who were exposed to COVID-19 cases were categorized, per the risk stratification guidelines, as high-risk contacts or low-risk contacts. RESULTS: During contact tracing, 3411 HCWs were identified as those who were exposed to 360 COVID-19 cases. Of these 360 cases, 269 (74.7%) were either admitted patients or outpatients, and 91 (25.3%) were HCWs. After the risk stratification of the 3411 HCWs, 890 (26.1%) were categorized as high-risk contacts, and 2521 (73.9%) were categorized as low-risk contacts. The COVID-19 test positivity rates of high-risk contacts and low-risk contacts were 3.8% (34/890) and 1.9% (48/2521), respectively. The average number of high-risk contacts was significantly higher when the COVID-19 case was an admitted patient (number of contacts: mean 6.6) rather than when the COVID-19 case was an HCW (number of contacts: mean 4.0) or outpatient (number of contacts: mean 0.2; P=.009). Similarly, the average number of high-risk contacts was higher when the COVID-19 case was admitted in a non-COVID-19 area (number of contacts: mean 15.8) rather than when such cases were admitted in a COVID-19 area (number of contacts: mean 0.27; P<.001). There was a significant decline in the mean number of high-risk contacts over the study period (P=.003). CONCLUSIONS: Contact tracing and risk stratification were effective and helped to reduce the number of HCWs requiring quarantine. There was also a decline in the number of high-risk contacts during the study period. This indicates the role of the implementation of hospital-based, COVID-19-related infection control strategies. The contact tracing and risk stratification approaches that were designed in this study can also be implemented in other health care settings.

Effectiveness of a short-structured training programme on knowledge of healthcare providers and programme managers involved in maternal and child health programmes in Odisha, India: a quality improvement study.

OBJECTIVE: To evaluate the effectiveness of training programme on knowledge related to new interventions proposed under India Newborn Action Plan (INAP) and Integrated Action Plan against Pneumonia and Diarrhoea (IAPPD). DESIGN: Quality improvement study with pre-evaluation and post evaluation. SETTING: The study was conducted in 17 districts of Odisha, India. PARTICIPANTS AND INTERVENTIONS: The participants were healthcare providers and programme managers involved in maternal and child health programmes. Intervention was a short-structured (8 hours) training delivered to 127 batches with expected participation of 30 trainees in each batch. Training was divided into four modules covering new interventions related to INAP and IAPPD like causes of neonatal death, kangaroo mother care (KMC), feeding of low birthweight (LBW) infants, use of injection gentamicin, identification of possible serious bacterial infection (PSBI), identification and management of pneumonia and diarrhoea and key interventions for maternal health. Various modalities of teaching-learning method were used. OUTCOME MEASURES: Pretraining and post-training knowledge assessment was done with a pretested tool consisting of 15 items. Each item carried equal weightage in calculation of knowledge score thus maximum possible knowledge score was 15. Feedback assessment was also done after the training. RESULTS: The mean (SD) knowledge score significantly improved to 10.24 (2.24) after training as compared with 4.73 (1.94) before training, p<0.001 (n=982). There was significant improvement in knowledge for majority of the components namely causes of neonatal death (61.9% vs 28.1%), KMC (68.0% vs 54.6%), feeding of LBW infants (77.7% vs 6.9%), use of injection gentamicin (69.7% vs 11.2%), identification of PSBI (69.5% vs 59.5%). The improvement in knowledge score was more when healthcare providers and programme managers had provided a favourable response on feedback. CONCLUSION: Systematic pretest and post-test assessment coupled with feedback assessment can ensure the effectiveness of training programmes offered in programmatic settings.

Adherence of Doctors to Standard Diarrhoeal Management Guideline During Treatment of Under-Five Diarrhoeal Episodes: A Study From Eastern India.

Introduction Diarrhoea is one of the major preventable causes of childhood death in tribal areas of India. Most acute diarrhoea in childhood can be managed with oral rehydration salt (ORS) and zinc. This study aimed to assess the adherence of doctors to standard diarrheal management guidelines while treating under-five diarrhoeal episodes. Methods The cross-sectional study was conducted in 10 blocks of Kandhamal district in southern Odisha, India. The under-five childhood diarrhoea prescriptions from July to August 2018 were audited during September 2018. One health facility from each block and 15 prescriptions from each health facility were selected randomly. Data were collected and entered in Epicollect5 and analyzed using Statistical Packages for Social Sciences Version 22.0 (IBM Corp., Armonk, NY). Categorical variables were presented as proportions. Results A total of 150 under-five acute diarrhoea prescriptions were audited from 10 health facilities. One hundred ten prescriptions were from the out-patient department and 40 prescriptions were from the admitted diarrhoeal patients. The majority of them included ORS (77.3%) and zinc (75.3%) in the prescription, however, only half of the prescriptions (52.7%) had recommended dose and duration of zinc. All admitted patients received intravenous fluids. Most prescriptions (89.3%) did not document the hydration status of the patient. All prescriptions were silent about the severe acute malnutrition status of the children before administering fluid therapy. Antibiotics were prescribed in 80% of the prescriptions. Prebiotics, probiotics and anti-spasmodic were prescribed in 37.3% of the prescriptions. Conclusion Adherence of doctors to acute diarrheal management guidelines for the management of under-five diarrhoea was poor in our study. Further researches and training are required to improve childhood diarrhoea management in health facilities of tribal areas of India.

Effect of selected group of asana when used as an adjunct in management of cervical spondylosis of mild to moderate severity: An observational study.

BACKGROUND: "Cervical spondylosis" (CS) is a collective term used for non-specific neck pain post 30 age group. Management of CS is mainly non-surgical, particularly in mild to moderate severity that includes the oral anti-inflammatory drugs, exercises, manipulation, mobilization, or combination of these. OBJECTIVE: The objective of the study is to assess the possible benefit of a selected group of asana in a group of patients over a short time frame and assess their functional outcome. MATERIALS AND METHODS: An observational study of cohort of patients having mild to moderate CS, who visited the AYUSH department between May 2016 and November 2016 were included. "Selected group of Asana (SGOA)" was practiced for 30 min supervised and then home-based for a period of 8 weeks with usual standard treatment. Patients followed up fortnightly, and their degree of severity & disability assessed. RESULTS: Thirty patients with 19 males and 11 females having ages mean ± SD 45.61 ± 8.3 and 44.18 ± 9.78 having NDI score of mean ± SD 17.83 ± 4.749 at baseline (0 weeks) were included. Patients showed an improvement in NDI score to finally 7.40 ± 3.180, p-value = 0.0001. This improvement was also noted at various time intervals (p-value = 0.0001 each time), as seen in the post hoc analysis. CONCLUSION: Yogic practices "Specific Group of Asana" done for eight weeks on a home-based program could be useful in reducing pain and disability in people suffering from CS of mild to a moderate degree. However, more extensive, comparative, and multi-centric trials are required for establishing this as a treatment modality.

Fear and anxiety among COVID-19 Screening Clinic Beneficiaries of a tertiary care hospital of Eastern India.

India is one among the most affected countries in the COVID-19 pandemic. The increasing number of cases in India and the fear of COVID-19 infection is causing fear and anxiety. Fear and anxiety related to COVID-19 the community dwellers are less studied. This study was conducted to assess the fear and anxiety related to COVID-19 among the people seeking COVID-19 screening test. The cross-sectional study was conducted on a sample of 398 participants aged 18 years and above who attended the screening clinic of a tertiary care hospital of eastern India. Participants were assessed using Coronavirus Anxiety Scale (CAS) and Fear of COVID-19 scale which are validated screening scales. Result showed that 20.4 % of the participants were having anxiety due to COVID-19. The mean fear score was 17.87 ± 4.48. Females, Middle aged, housewives, less educated, symptomatic, co-morbid and people under institutional quarantine were having more fear. People with COVID-19 related anxiety faced more fear. These findings suggest the need for screening anxiety in COVID-19 screening clinics. People with high levels of COVID related anxiety and fear are at risk for developing psychiatric disorders hence need targeted approach to address their mental health.

Clinical and Metabolic Complications in patients with thalassemia undergoing transfusion therapy.

BACKGROUND: The transfusions in patients with thalassemia are a double-edged sword as the patients develop complications due to inadequate transfusions and due to multiple transfusions. These complications vary from metabolic complications such as diabetes mellitus and clinical complications such as growth retardation, transfusion-transmitted infections (TTI), and iron overload. We selected Balasore district in Odisha which is a satellite center of AIIMS Bhubaneshwar and has a huge population of hemoglobinopathy patients especially thalassemia and this district in Odisha lags in terms of healthcare and health awareness. MATERIALS AND METHOD: In all, 123 patients with thalassemia major were included in this study for the evaluation of metabolic and clinical complications. Anthropometric measurements such as height and weight with age and gender were used for evaluation of growth parameters as per World Health Organization (WHO) reference data. Children were termed wasted and stunted if the values were below 2 standard deviation of the reference WHO median. Blood samples were collected for TTI status and fasting blood sugar levels. RESULT: A total of 118 (95.9%) were detected to have under nutrition, 73 (59.3%) of the patients were HCV-positive, and 54 (48.6%) had high fasting blood sugar levels. Based on the HCV status, they were classified as HCV-positive and HCV-negative to compare the anthropometric and growth status in these patients. About 98.6% of the HCV-positive cases were undernutrition and 83.6% were stunted. CONCLUSION: There is an increasing trend of associated metabolic derangements in patients with thalassemia. The district-level health services have an urgent need for improvement in chelation regimes and screening technologies.

Effect of Vitamin D Supplementation on Thyroid Autoimmunity among Subjects of Autoimmune Thyroid Disease in a Coastal Province of India: A Randomized Open-label Trial.

OBJECTIVE: Hashimoto's thyroiditis (HT) is a variant of autoimmune thyroid disorders (AITD) which has been associated with vitamin D (vit-D) deficiency. However, whether vit-D supplementation is linked to reduction of thyroid autoantibodies and improvement of thyroid function is not well characterized. The present study was planned to evaluate the effect of vit-D supplementation on possible improvement of thyroid autoantibody titer and thyroid hormone profile in patients with AITD subjects. METHODS: Twenty-three patients of HT were given weekly supplementation of 60,000 IU vit-D for 8 weeks followed by once a month for another 4 months. After 6 months of vit-D supplementation, thyroid autoantibody titer (TPO antibody) and thyroid hormone profile was rechecked. RESULTS: Mean serum vit-D was increased significantly from 15.33 ± 5.71 to 41.22 ± 12.24 ng/mL (normal levels) after supplementation. There was significant increase in thyroid autoantibody titre (from 746.8 ± 332.2 to 954.1 ±4 59.8 IU/ml; P = 0.006) and TSH level (7.23 ± 3.16 to 3.04 ± 2.62 (mIU/L); P = 0.01) following 6 months of vit-D supplementation. CONCLUSION: Vitamin-D levels were low in AITD patients in eastern India and, its supplementation in HT patients increased thyroid antibody titer and there was significant reduction in serum TSH and increased in free T4.