Evidence of the Immunomodulatory Effects of Selective Serotonin Reuptake Inhibitors in Patients With Depression Through a Systematic Review.

Depression is a common illness, affecting >264 million people worldwide. According to the literature, depression patients have baseline subclinical inflammation. The immunomodulatory effects of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are largely unclear and poorly understood. Using evidence-based medicine, this study aimed to determine the immunomodulatory effects of SSRIs by assessing changes in immunomodulatory markers following SSRI treatment. Using the PubMed website, a literature search was conducted with various terminologies related to the treatment of depression and various markers of inflammation. Out of 387 retrieved articles, after critical appraisal and screening based on inclusion and exclusion criteria, 17 were selected. Qualitative synthesis and quantitative analysis were carried out. RevMan 5 software was used to synthesize and evaluate the data. Microsoft Word and Excel (Microsoft Corporation, Redmond, Washington, United States) were used for generating tables and figures. We extracted data from a total of 839 patients in 17 studies. A highly significant reduction in interleukins-6 (IL-6) (standardised mean difference (SMD) = 1.32 (95% confidence interval (CI): 0.58, 2.06), Z = 3.48, P = 0.0005), a significant reduction in tumor necrosis factor-alpha (TNF-α) (SMD = 1.29 (95% CI: 0.19, 2.39), Z = 2.30, P = 0.02) but no change in overall C-reactive protein (CRP) (SMD = 0.40 (95% CI: -0.26, 1.07), Z = 1.19, P = 0.23) levels were observed by using the random-effects model. There was substantial heterogeneity found between the studies. SSRIs have an immunomodulatory effect in patients with depression by significantly reducing the peripheral pro-inflammatory cytokine markers of IL-6 and TNF-α, which may contribute to ameliorating the response to antidepressant drug treatment. In contrast, no effects of SSRIs on acute-phase protein CRP were found.

Study of test anxiety amongst undergraduate medical students from the state of Gujarat.

BACKGROUND: Test anxiety is physiological and behavioral response that accompanies concerns about possible negative consequences of failure on an exam. Undergraduate medical students had their academics disrupted during COVID-19 pandemic. This study was done to assess levels of test anxiety among undergraduate medical students, its variance in relation to demography, COVID-19 pandemic, learning experiences, and individual factors. MATERIALS AND METHODS: Online questionnaire-based survey was done among undergraduate medical students from medical schools of Gujarat. Students from 1st, 2nd, and 3rd years who were about to appear in final exams from March to June 2021 and were asked to enroll on the survey. Apart from demography, COVID-19-related factors, learning experiences during lockdown, 10-item Westside test anxiety (WTA) scale was used to assess test anxiety levels and Kessler Psychological distress (K10) scale was used to assess level of psychological distress. RESULTS: Total of 370 students participated. Mean WTA Score was 3.15 ± 1; 60.2% of the respondents had moderate or higher levels of test anxiety. On bivariate analysis, WTA score was found significantly associated with year of study, coming from vernacular medium, various lockdown-related issues (poor internet connection, family financial problem, lack of information, worry about future), various learning experiences (self-rated proficiency with computers, feeling ill prepared for exams, feeling ill prepared for practical), and K10 score. Of these associations with K10 score, coming from vernacular medium and feeling ill-prepared for exams were maintained on multiple-linear regression. CONCLUSIONS: Vernacular medium of study during high school was found associated with test anxiety among medical students and can be a potential area of intervention. There may be merit in using WTA scale as a surrogate marker for distress in medical students.

Pattern of smartphone use, prevalence and correlates of problematic use of smartphone and social media among school going adolescents.

Background: Adolescents are likely to quickly adopt newer technologies and face detrimental effects of the same. Aim: This study assessed the prevalence and correlates of problematic smartphone and social media use among school-going adolescents. Methods: Cross-sectional study was conducted amongst class 8-10 students. Data were collected using an anonymous survey in English which included (a) sociodemographic information, (b) pattern of smartphone use and smartphone addiction scale-short version (SAS-SV), and (c) pattern of social media use and social media disorder (SMD) scale. Educative session on responsible smartphone use was followed by post-session data collection which included patient health questionnaire (PHQ-2), generalized anxiety questionnaire (GAD-2), hyperactivity subscale of strength and difficulty questionnaire (SDQ), and conscientiousness and emotional stability subscales of ten-item personality inventory questionnaire (TIPI) and post-session feedback. Results: Three hundred and twenty out of 325 responses were analyzed (180 male and 140 female). About 8% (n = 27) used smartphone for more than four hours. Prevalence of problematic smartphone use was 12.5% and problematic social media use was 11.9%. Problematic smartphone use was associated with duration of smartphone use per day and problematic social media use, which was in turn found to be associated with Facebook use and frequency of Instagram posts. About 80.6% (n = 256) participants agreed that such sessions should be conducted in schools. Conclusions: One in ten school going adolescents are likely to be having problematic smartphone and social media use. Awareness sessions in schools about responsible mobile phone use may be an acceptable strategy.

Effect of pre-operative communication using anaesthesia information sheet on pre-operative anxiety of patients undergoing elective surgery-A randomised controlled study.

Background and Aims: Pre-operative anxiety can affect psychological and physiological parameters during the intra-operative period. Pharmacological measures used to reduce pre-operative anxiety have their associated adverse effects. Pre-operative anaesthesia education is one of the non-pharmacological tools to reduce anxiety, but very limited literature is available in the Indian scenario. Hence, this study was designed to evaluate the effect of pre-operative counselling of patients using anaesthesia information sheet on pre-operative anxiety of patients who underwent elective surgery as the primary outcome. Secondary objectives were to assess the pre-operative anxiety for surgery, correlation of demographic data with pre-operative anxiety, and the common causes responsible for pre-operative anxiety. Methods: Total 110 patients were randomly allocated into two groups. Group-A was counselled using anaesthesia information sheet and in Group-B, conventional counselling was done during pre-anaesthesia check-up. Anxiety scores for anaesthesia and surgery were measured using visual analogue scale for anxiety (VAS-A). VAS-A score was compared pre- and post-intervention. Effect of intervention was assessed by comparing reduction in VAS-A score in both groups with paired t-test. Data were analysed using STATA (14.2) version. Results: The mean reduction in VAS-A for anaesthesia was more in Group-A compared to Group-B (16.6 ± 6.9 vs. 4.4 ± 5.8; P < 0.001). The mean reduction in VAS-A for surgery was more in Group- A compared to Group- B (14.6 ± 7.8 vs. 4.8 ± 7.3; P < 0.001). Conclusion: Pre-operative counselling using anaesthesia information sheet is helpful in reducing pre-operative anxiety more efficiently. Further trials are required to assess transferability in other settings.

Correlates of internet gaming among violent and nonviolent gamers and comparison of their psychological well-being with nongamers in a university student population.

Background: India's population has seen increasing access to the Internet and gaming mainly in adolescents and young adults. Aim: The aim of the study was to assess the prevalence and correlates of Internet gaming and its effects on the psychological well-being of gamers versus nongamers. Materials and Methods: Cross-sectional survey was done to enroll a convenient sample of nongamers, violent gamers, and nonviolent gamers. Measures included Psychological general well-being scale-short (PGWB-S), Internet Gaming Disorder-Short Form-9 (IGDS9-SF), name, frequency, and duration of game use. Results: The study enrolled 119 nongamers, 62 violent gamers, and 58 non-violent gamers. The prevalence of IGD was 0.8%. PGWB-S scores of gamers were comparable to nongamers. On multiple linear regression, lower PGWB-S score and higher frequency of use were found significantly associated with higher IGDSF-S9 scores. Violent gaming was found significantly associated with male gender (P ≤ 0.001), frequency (P = 0.012), and duration of game use (P ≤ 0.001). Conclusions: The study provides empirical evidence for the "gaming as a consequence of self-medication" hypothesis.

Scoping review of published research on medical education in India during the Covid-19 pandemic.

Background Medical educators in India made rapid adjustments to maintain continuity and integrity of medical education in the midst of disruption caused by the Covid-19 pandemic. However, there are concerns regarding achievement of competence by undergraduate medical students due to inadequate clinical exposure. We explored the focus of initiatives from medical educators in India by a scoping review of published articles on developments in medical education during the pandemic to map concepts, main sources and the literature available in PubMed. Methods We did this scoping review of published articles in PubMed database in four steps: (i) identification of research questions; (ii) identification of relevant studies; (iii) selection of studies meeting inclusion and exclusion criteria, and charting of data; and (iv) collating the summary and reporting of results. Manual content analysis was done to derive frequencies of variables. Results Of the 52 articles identified, 22 met the requirements. Most studies (68.2%) were published in 2020. Half of the studies were conducted among undergraduate students and the remaining among postgraduates (27.3%), faculty (18.2%) and interns (4.5%). All the studies were evaluations at Kirkpatrick level-1 (18; 81.8%) and level-2 (4; 18.2%). Most of the studies (9, 41%) focused on exploration of perspectives about online learning among students and faculty, 9 (27.3%) on teaching- learning, 4 (18.2%) on formative assessment and 3 (13.6%) on summative assessment. Conclusions Most studies were evaluations at Kirkpatrick level-1 and level-2 among undergraduate medical students with a focus on conceptual understanding.

Burnout and its correlates among nursing staff of intensive care units at a tertiary care center.

BACKGROUND: Burnout syndrome has been widely reported in nursing staff. It is more pronounced in intensive care setting (up to 80%). This survey was designed to assess the prevalence of burnout and its correlates among critical care nurses. METHODS: Anonymous questionnaire was distributed to all ICU nursing staff of a tertiary care teaching hospital. Questionnaire had 25 questions covering - demography, job characteristics, Visual Analogue Scale for stress, co-worker support, work-life balance, question for measuring burnout, job satisfaction, turnover intention, organizational commitment, for depression screening and psychosomatic symptoms. The burnout scale score was used to dichotomize into low burnout (<3) or high burnout (> = 3) group. These two groups were compared using Chi-square test, Fischer's exact test for categorical variables and independent t-test for continuous variables. Significant variables were entered in multivariate logistic regression analysis. RESULTS: Out of 150 ICU nurses, 125 (83.3%) gave completely filled questionnaires which were evaluated. 47 (37.6%) participants reported experiencing high burnout. Binary logistic regression model revealed that lack of specialized ICU training (OR = 4.28, 95% CI: 1.62 to 11.34, P = 0.003), performing extra duty in last month (OR = 5.28, 95% CI: 1.90 to 14.67, P = 0.001), High physical symptoms in last 12 months (OR = 4.73, 95% CI: 1.56 to 14.36, P = 0.006) and mid-level experience (1-5 years) were significantly associated with burnout. CONCLUSIONS: Burnout is significantly prevalent (37.6%) among intensive care nurses. Specialized training and limiting work hours can help in mitigating this problem. High frequency of physical symptoms could be early indicators of burnout.

Prevalence and Profile of Bullying Involvement among Students of Rural Schools of Anand, Gujarat, India.

BACKGROUND: Bullying can have short- and long-term implications on physical as well as mental health. The objective of this study was to assess the prevalence of bullying involvement (bully, victim, and bully-victim) and know profiles of bullying among students of rural schools of Anand, Gujarat, in Western India. MATERIALS AND METHODOLOGY: A questionnaire in the Gujarati language was administered to sixth to tenth graders of 12 rural schools (n = 2552) in the Anand district. The questionnaire included four questions each to screen for bullying behavior and victim experiences; Peer Interaction in Primary Schools Questionnaire (PIPSQ, a self-reported measure of individuals' levels of bullying behaviors and victimization experiences), and Strength and Difficulties Questionnaire (SDQ, to assess emotional, behavior, and interpersonal difficulties experienced), apart from demographic information. The analysis of variance (ANOVA)/Chi-square test was applied to determine associations. RESULTS: Prevalence of bullying involvement was 70% (n = 1529; 9.1% bullies, 18.6% victims, and 42.3% bully-victims). The prevalence of bullies was higher in boys (77.5%) compared with girls (58.3%). In addition, the prevalence of victims was higher in boys (67.2%) compared with girls (51%). No association was found between various categories and family type, birth order, number of friends, or grade. Bully-victim was the worst affected group as per the SDQ profile. CONCLUSIONS: There is a high prevalence of bullying-related involvement compared with earlier studies and a complete lack of bullying prevention policies at the school level. A simple screening strategy, using a few questions to identify bullying-related involvement, is valid and useful. Guidelines need to be devised to standardize future bullying-related research in India.

The Level and Sources of Stress in Mothers of Infants Admitted in Neonatal Intensive Care Unit.

BACKGROUND: Hospitalization of a new-born child is stressful for parents. This study was done to determine the level and sources of stress in mothers of infants admitted in Neonatal Intensive Care Unit (NICU) and variance in stress by infant and maternal characteristics. MATERIALS AND METHODS: Parental Stressor Scale for NICU was used as the primary outcome measure. Maternal socio-demography, maternal and infant characteristics such as gravidity, number of prenatal visits, perceived support from family members, perceived level of discomfort that the baby underwent, pregnancy and delivery complications, gestational age, sex, birth weight, length of NICU stay and ventilator support, and neonatal morbidity were also collected from maternal and infant hospital records. RESULTS: Amongst these rural and poorly educated mothers, the appearance of the baby, sights and sounds of NICU environment were major sources of stress. Higher maternal stress was found to be associated with poor family support during pregnancy, mothers' perception of the baby's discomfort, lower birth weight of the baby, baby on ventilator, post-partum depression, and moderate to severe anxiety symptoms. Mothers who had higher levels of education and those with pregnancy complications were more stressed. CONCLUSIONS: Before designing remediation programs for parents, local demography and the predominant NICU stressors need to be kept in mind. Possibility of screening at-risk mothers by questioning them about perception of baby's discomfort needs to be evaluated further.

Study on Assessment of Quality of Life and Depression in Patients of Vitiligo.

CONTEXT: Vitiligo is an autoimmune pigmentary disorder characterized by localized or generalized depigmentation of the skin. It is associated with significant stigma and has impact on patient's quality of life (QoL) and psychological wellbeing. AIMS: To see the variance in QoL and level of depression in vitiligo patients with extent of vitiligo. MATERIALS AND METHODS: Vitiligo patients aged ≥18 years attending OPD were included in the study. Impairment in QoL was assessed by administering DLQI (Dermatology Life Quality Index) and VIS22 (Vitiligo Impact Scale22). Depression was assessed by administering QIDSSR16 (Quick Inventory of Depressive Symptomatology). The Vitiligo Area Scoring Index (VASI) was calculated based on clinical examination. RESULTS: One hundred and fifty patients enrolled. Most common age group was 18-30 years. Mean DLQI, VIS22, QIDSSR16 scores were 7.02, 16.37, 5.87, respectively. QoL was affected to some extent in 85.3% and 86.7% according to the DLQI and VIS22, respectively. Depression was seen in 44%. COCLUSION: Young patients showed higher impairment in QoL and also higher levels of depression. It would be useful to offer psychiatric consult and counseling in addition to specific treatment.

Effect of Yoga-nidra on Adolescents Well-being: A Mixed Method Study.

CONTEXT: Adolescent well-being is a priority area for health-care interventions in the 21st century. Yoga-nidra is an ancient Indian method of enabling individuals to attain a positive state of deep physical, mental, and emotional relaxation. The practice produces a state of simultaneous relaxation and detachment resulting in inner awareness and release of stress on all planes of one's being. AIM: This mixed method study was carried out in adolescent students aged 13-15 years with an aim to assess effects of Yoga-nidra on various dimensions of well-being. MATERIALS AND METHODS: Thirty-six students received Yoga-nidra sessions 30 min daily for 3 days in a week for 1 month. Primary outcome measures were happiness, perceived stress, overall quality of life, and psychological general well-being. These and other experiential dimensions of well-being comprising of enthusiasm, alertness, quietude, clarity of thought, control over anger, self-confidence, and self-awareness were evaluated before and after intervention. Qualitative observations were recorded from participants, their teachers, and parents. Results of quantitative and qualitative methods were analyzed and compared. RESULTS: Yoga-nidra intervention resulted in significant improvement in all primary outcome measures. Participants reported significant improvement in the feelings of happiness, enthusiasm, quietude, being more inspired and alert, active, having clarity of thought, control over anger, and self-confidence at the end of the study period. Mixed method design of the study provided cross-validation and convergence of results obtained from quantitative and qualitative assessment tools. CONCLUSION: Yoga-nidra is beneficial in improving multiple dimensions of adolescent well-being.

Perceived need and attitudes towards communication skill training in recently admitted undergraduate medical students.

The Medical Council of India intends to implement an attitude, ethics, and communication training module for medical students. This study investigates undergraduate students' attitudes towards communication skills training (CST). Forms were distributed to 81 recently admitted undergraduates, of whom 76 responded, in an anonymous cross-sectional survey. Single questions assessed knowledge of communication skills (CS), need for formal curriculum, and importance of CST. Attitudes toward CS were measured using a modified Communication Skills Attitude Scale. While 72% participants considered CST to be important and 68.4% reported a need for formal training, 43% felt CST would have a better image if it sounded more like a science subject. Forty percent of the students were ambiguous about willingness to trust information on communication skills given by non-clinical lecturers, whereas 15.8% were not receptive. Fifty-five percent felt nobody would fail because of poor communication skills, and 46% felt that the ability to pass exams would get them through medical school. We found a high prevalence of unfavourable attitudes about CS (as a subject). Course implementers should be mindful of and address attitudes towards CST while delivering the content of the course.

Profile of Bullies and Victims Among Urban School-going Adolescents in Gujarat.

OBJECTIVE: To assess the prevalence of bullying, identifying bullies, victims and their associations. METHODS: Questionnaire having 'Peer Interaction in Primary Schools' and 'Strength and Difficulty Questionnaire' scales, and demographic information was administered to 7th, 8th and 9th graders (N=1106). RESULTS: Prevalence of bullying was 49%. Boys were more likely to be bullies (P=0.03), whereas students having less friends (P=0.001), overweight/obese (P=0.02), and boys (P<0.001) were more likely to be victims. Association between bullying behavior and poor academic performance was noted. CONCLUSION: We found high prevalence of bullying. The reasons for the same and scope of intervention needs further study.

Epidemiological survey of mental health in adolescent school children of Gujarat, India.

INTRODUCTION: Mental health problems in adolescents are inadequately researched in low-resource settings. We aimed in this study to assess the prevalence of mental health problems and correlates in school children aged 13-17 years and compare differences between urban and rural schools in Anand District, Gujarat. METHODS AND ANALYSIS: A cross-sectional study was conducted in five Gujarati medium higher secondary schools in Anand, Gujarat. Six hundred and ninety-three students with equal distribution of boys and girls belonging to 9th to 12th grades were included in the study. Strengths and Difficulties Questionnaire (SDQ) was used to assess the mental health status of the students, and total difficulties scoring was used to categorise participants into normal (0-15) and high (borderline (16-19) and abnormal (20-40)). Socio-demographic data and Teenage Screening Questionnaire-Trivandrum (TSQ) were used to assess associated medical and psychosocial factors. Clearance was obtained from the institutional ethics committee before conducting the study. RESULTS: 15% participants had a high SDQ score. Girls had more emotional problems, while the rest of the mental health problems were more prevalent in boys. Rural children were found to have more mental health issues. Having an eye problem, scoring <50% in last annual examinations, failure in examinations, difficulties in studying at home and difficulties in relationships were associated with high SDQ score. Keeping physically fit and having friends were associated with normal SDQ score. Logistic regression model revealed that age, receiving punishment in form of more homework and difficulty discussing friends with parents increased odds of high SDQ score, while having friends and after-school entertainment like watching movies decreased odds of high SDQ score. CONCLUSIONS: At least one in eight adolescents in this study was at risk of mental health problems. SDQ self-report questionnaire and TSQ survey may be used as a screening modality to identify at-risk students.

Qualitative Assessment of Learning Strategies among Medical Students Using Focus Group Discussions and In-depth Interviews.

BACKGROUND: Globally, students with top academic performance and high intellectual capacity usually opt to study medicine. However, once students get enrolled, their academic performance varies widely. Such variations appear to be determined by various factors, one of them being types of learning strategies adopted by students. The learning strategies utilized by the students with better academic performance are likely to be more effective learning strategies. AIMS AND OBJECTIVES: The objective is to identify effective learning strategies used by medical students. METHODOLOGY: This study was carried out among the MBBS students of Final Professional Part I. Students were categorized into three groups namely: high, average, and low rankers based on overall academic performance in second Professional University examination. First, a questionnaire consisting of closed- and open-ended questions was administered to students, to find their learning strategies. Subsequently, focus group discussion and in-depth interviews were conducted for high- and low-rankers. Discussions were audio-recorded, transcribed, and analyzed. Key statements were highlighted, collated, and categorized into general themes and sub-themes. RESULTS: Evident themes which emerged as effective strategies were hard work in the form of regularity of studies, meticulous preparation of notes, constructive use of time, utilization of e-learning, learning styles and deep learning approach and regular ward visits. Intrinsic motivation, family support, balancing physical activities and studies, guidance by seniors, teachers, dealing with nonacademic issues such as language barriers and stress were also identified as important strategies. CONCLUSIONS: Disseminating effective learning strategies in a systematic manner may be helpful to students in achieving better academic outcomes. Furthermore, educationists need to modulate their teaching strategies based on students' feedback.

Experience of a faculty development workshop in mentoring at an Indian medical college.

BACKGROUND: Our medical college is running a mentoring programme for undergraduate medical students since 2009. The academic leadership of the college identified the need to change the focus of the programme from mere problem- solving to professional and personal development of mentees. METHODS: A core group of faculty designed and implemented a workshop on mentoring for 28 mentors. The workshop included reflections on the participants' previous experiences about mentoring, discussion on perceptions of mentees about the existing mentoring programme, self-analysis of mentoring skills, overview of the Surrendering, Accepting, Gifting and Extending (SAGE) model and demonstration of effective mentoring skills using role plays and a film. We collected written anonymous feedback from participants at the end of the workshop to elicit their responses regarding various aspects of the programme, change in their views about mentoring and suggestions for future workshops. RESULTS: A majority of the participants (17, 60.7%) said that role plays and reflection on role plays were the most valuable part of workshop as they provided clarity on the concepts about mentoring. The most frequently identified take-home messages were: building trust with the mentee (7, 25%), balance in life and approach towards the mentee (6, 21.4%), and understanding that mentoring is a process geared towards personal and professional development of the mentee (6, 21.4%). CONCLUSION: The participants' reaction to the workshop was positive. The responses of participants suggested that the workshop was successful in changing their views regarding the purpose of the mentoring programme.