Electronic nicotine delivery system: a narrative review on growing threat to tobacco control and health of the young Indian population.

The electronic cigarette (EC) was developed as an alternative to cigarette smoking. In less than a decade, the prevalence of past-month EC usage increased from 1.5 to 27.5 % among US high-school students. In the coming years, Asia-Pacific countries will have the highest sales of electronic nicotine/non-nicotine delivery systems (ENDS/ENNDS) after Western Europe. Based on the World Health Organization and Indian Council of Medical Research recommendations, India approved a complete ban on EC in 2019. Even though it has been three years since the ban, EC is still being sold in India's grey markets, where marketing is not regulated. In this narrative review, we discuss that vaping is not just a harm reduction strategy for tobacco smoking cessation but poses a serious threat to India's existing tobacco control efforts as well as the health of the country's young people.

Inter-observer agreement among specialists in the diagnosis of oral potentially malignant disorders and oral cancer using store-and-forward technology.

OBJECTIVES: Oral cancer is a leading cause of morbidity and mortality. Screening and mobile Health (mHealth)-based approach facilitates early detection remotely in a resource-limited settings. Recent advances in eHealth technology have enabled remote monitoring and triage to detect oral cancer in its early stages. Although studies have been conducted to evaluate the diagnostic efficacy of remote specialists, to our knowledge, no studies have been conducted to evaluate the consistency of remote specialists. The aim of this study was to evaluate interobserver agreement between specialists through telemedicine systems in real-world settings using store-and-forward technology. MATERIALS AND METHODS: The two remote specialists independently diagnosed clinical images (n=822) from image archives. The onsite specialist diagnosed the same participants using conventional visual examination, which was tabulated. The diagnostic accuracy of two remote specialists was compared with that of the onsite specialist. Images that were confirmed histopathologically were compared with the onsite diagnoses and the two remote specialists. RESULTS: There was moderate agreement (k= 0.682) between two remote specialists and (k= 0.629) between the onsite specialist and two remote specialists in the diagnosis of oral lesions. The sensitivity and specificity of remote specialist 1 were 92.7% and 83.3%, respectively, and those of remote specialist 2 were 95.8% and 60%, respectively, each compared with histopathology. CONCLUSION: The diagnostic accuracy of the two remote specialists was optimal, suggesting that "store and forward" technology and telehealth can be an effective tool for triage and monitoring of patients. CLINICAL RELEVANCE: Telemedicine is a good tool for triage and enables faster patient care in real-world settings.

Role of verbal autopsy in cancer registration: A mixed-methods study from the population-based cancer registry of Northern India.

OBJECTIVES: To describe utilisation of verbal autopsy as one of the data collection approaches in cancer registration in an Indian setting. We aimed to estimate the proportion and epidemiological characteristics of malignancies identified by the Varanasi population-based cancer registry (PBCR) using verbal autopsy between 2017 and 2019 and to develop a thematic network for implementing verbal autopsy. METHODS: This was a cross-sectional mixed-methods study. Quantitative methods were applied to analyse information from PBCR proforma of the verbal autopsy-confirmed cancers; qualitative methods were applied to evaluate verbal autopsy conducted by field staff from key informants. In-depth interviews of field staff for the challenges and potential solutions during verbal autopsy were assessed. RESULTS: Of 6466 registered cancers, 1103 (17.1%) were verbal autopsy-confirmed cancers, which had no other source of information. The majority of verbal autopsy cases were from vulnerable populations who were aged >50 years (721, 65.4%), female (607, 55.1%), from rural backgrounds (853, 77.3%), illiterate or just able to read and write (636, 57.7%), and from lower and middle-income groups (823, 74.6%). Verbal autopsy helped provide information about symptoms and site of disease, diagnostic and treatment details, and disease status. Major challenges during verbal autopsy described by field staff were incomplete cancer treatment, destruction of medical records and non-cooperation by the community and lack of support from the local workforce as cancer is not notifiable. CONCLUSION: Verbal autopsy helped identify cancers that would have been missed during active case finding from available resources. The majority of verbal autopsy-confirmed patients belonged to vulnerable populations. Non-cooperation from community and local health systems was major challenge during verbal autopsy. Developing robust cancer awareness, patient navigation, and social support programmes will strengthen verbal autopsy. Integration of standardised and reproducible methods of verbal autopsy in cancer registry and digitalization of health information, especially in limited-resource settings with weak vital registration, will facilitate completeness in cancer registration.

Inter-observer agreement among specialists in the diagnosis of Oral Potentially Malignant Disorders and Oral Cancer using Store-and-Forward technology.

Oral Cancer is one of the most common causes of morbidity and mortality. Screening and mobile Health (mHealth) based approach facilitates remote early detection of Oral cancer in a resource-constrained settings. The emerging eHealth technology has aided specialist reach to rural areas enabling remote monitoring and triaging to downstage Oral cancer. Though the diagnostic accuracy of the remote specialist has been evaluated, there are no studies evaluating the consistency among the remote specialists, to the best of our knowledge. The purpose of the study was to evaluate the interobserver agreement between the specialists through telemedicine systems in real-world settings using store and forward technology. Two remote specialists independently diagnosed the clinical images from image repositories, and the diagnostic accuracy was compared with onsite specialist and histopathological diagnosis when available. Moderate agreement (k = 0.682) between two remote specialists and (k = 0.629) between the onsite specialist and two remote specialists in diagnosing oral lesions. The sensitivity and specificity of remote specialist 1 were 92.7% and 83.3%, whereas remote specialist 2 was 95.8% and 60%, respectively, compared to histopathology. The store and forward technology and telecare can be effective tools in triaging and surveillance of patients.

Status and Determinants of Early Detection of Oral Premalignant and Malignant Lesions in India.

It has been over four decades since the launch of the National Cancer Control Programme in India, yet the cancer screening rates for oral cancer remain unremarkable. Moreover, India is bracing a large burden of oral cancer with poor survival rates. An effective public health programme implementation relies on a multitude of factors related to cost-effective evidence-based interventions, the healthcare delivery system, public health human resource management, community behaviour, partnership with stakeholders, identifying opportunities and political commitment. In this context, we discuss the various challenges in the early detection of oral premalignant and malignant lesions and potential solutions.

A Cross Sectional Assessment of the Profile of Risk Factors of Non-Communicable Diseases Among Health Care Staff of a Tertiary Cancer Hospital.

Background: Non-communicable disease (NCD) is the leading cause of death, accounting for 70% of total death globally, and posing a major public health challenge. In India, nearly 5.8 million people (WHO report, 2015) die from NCDs every year. The basic element of NCD prevention is the identification of the associated risk factors and risk modification. The objective of the current study was conducted to assess the prevalence of risk factors for NCDs among healthcare staff of the two units of a Tertiary Cancer Hospital in Varanasi, India, using WHO STEPS approach. Methods: This cross sectional study was conducted among 528 participants who were willing to participate in the study, from among 967 healthcare staffs of the two units of the Tertiary Cancer Hospital. The participants were interviewed and the anthropometric and biochemical parameters were measured. Results: The prevalence of risk factors, associated with NCD, tobacco use, alcohol use, extra salt in diet, less than 5 servings of fruits/vegetables, physical inactivity and self-perceived high stress score was found in 34 (6.43%), 90 (17.04%), 461 (87.3%), 412 (78.03%), 409 (77.4%) and 159 (30.11%) respondents, respectively. Multiple logistic regression revealed that Diabetes was significantly associated with male sex, high BMI and physical inactivity. Hypertension was found significantly associated with male sex, increasing age, tobacco and or alcohol consumption, high BMI and high stress. Dyslipidemia was also found significantly associated with high BMI, male sex, physical inactivity and high stress levels. Conclusion: A high prevalence of risk factors for NCDs was found among the healthcare staff and it is the need of the hour to take preventive measures to reduce the prevailing burden of NCD.

Incorporation of Storytelling as a Method of Oral Health Education among 3-6-year-old Preschool Children.

PURPOSE: To find the effectiveness of storytelling as a method of oral health education among 3-6-year-old preschool children. DESIGN: A non-randomized experimental pre-post study design. SETTING: Preschools located in urban Bengaluru. SUBJECTS: Two hundred, 3-6 years, preschool children. INTERVENTION: An age-appropriate story with oral health messages was delivered using hand puppets during the storytelling session in preschool. MEASURES: A self-administered 11-item picture-based, closed-ended questionnaire assessed children's knowledge and attitude at baseline and post-intervention. A 1-week audit sheet to monitor the brushing, eating, and mouth rinsing pattern was administered for the parents to measure the change in behavior post-intervention. ANALYSIS: Change in KAP mean scores was assessed using the "Wilcoxon Sign Rank test" at p < 0.05. "Cohen's d" was used to calculate the "Effect size". RESULTS: Significant improvement was observed in mean KAP score (pre 7.52 ± 1.95 post 8.60 ± 1.55, p = 0.0001) with effect size 0.2. There was a significant increase in the knowledge and attitude and practice score, knowledge (pre 2.97 ± 1.02, post 3.63 ± 0.78, p = 0.0001, effect size: 0.3), attitude (2.27 ± 0.81, 2.77 ± 0.60, p = 0.000, effect size: 0.3), and practice (2.04 ± 1.07, 2.28 ± 0.60, p = 0.0001, effect size: 0.1). CONCLUSION: The storytelling method was effective in improving the oral health-related KAP of children aged 3-6 years. SIGNIFICANCE: This study attempts to inculcate good oral hygiene practices at a very early stage by targeting 3-6-year-old preschool children. Storytelling being humankind's oldest form of teaching and motivating change, can not only address the prevailing oral disease burden but also the oral health inequality by reaching out to every community. HOW TO CITE THIS ARTICLE: Shruti T, Govindraju HA, Sriranga J. Incorporation of Storytelling as a Method of Oral Health Education among 3-6-year-old Preschool Children. Int J Clin Pediatr Dent 2021;14(3):349-352.

Beta Testing an Oral Health Edutainment Card Game Among 12-13-Year-Old Children in Bangalore, India.

BACKGROUND: Card games are easy, cost effective, culturally acceptable, as well as sustainable and require minimal infrastructure over other edutainment approaches in achieving health and oral health promotion goals. Therefore, we wanted to conceptualize, develop, and beta test an innovative oral health edutainment card game for preadolescent children in Bangalore, India. MATERIALS AND METHODS: An innovative oral health card game, titled "32 warriors" was conceptualized and developed to incorporate age appropriate, medically accurate oral health information. The card game aimed at empowering children to take appropriate care of their oral health. The card game was beta tested on 45 children, aged between 12 and 13 years. Using prepost design, a 32-itemed, closed-ended questionnaire assessed children's oral health knowledge, attitude, and feedback on the game. Change in mean scores for knowledge and attitude was assessed using "Wilcoxon Sign Rank test" at P < 0.05. "Effect size" was calculated. Feedback was categorized in terms of type of response and its frequency. RESULTS: Statistically significant improvement was observed in group mean overall score, mean knowledge, and attitude scores, respectively (pre 14.7 ± 2.91 and post 18.6 ± 4.35, P = 0.003; 11.8 ± 2.73, 14.76 ± 4.0, P = 0.000; 2.93 ± 1.09, 3.84 ± 1.02, P = 0.000), with mean effect size 0.5. Participants reported that they enjoyed the game and learned new things about oral health. CONCLUSION: The card game is appealing to children and improves their oral health knowledge and attitude as evidenced by beta test results. We need to further explore the demand, feasibility, and cost effectiveness of introducing this game in formal settings (school based)/informal settings (family and other social settings).