Integrating Narrative Medicine Through Story-Telling: A Feasibility Study in a Community Medicine Curriculum for Undergraduate and Postgraduate Students.

Introduction The routine curriculum of community medicine includes clinico-social case-taking with a focus on the physical, biological, and psychosocial determinants of health. There is an opportunity to integrate narrative medicine with this for undergraduate and postgraduate medical students using story-telling. The objective of the current study was to assess its feasibility, challenges, and opportunities. Methods We conducted a need assessment cross-sectional survey of the teaching faculty of community medicine across India using Google Forms. Considering an 80% positive response in a pilot within the department, a relative error of 10%, and a 20% non-response rate, the sample size was 120. The questionnaire included closed-ended questions with a Likert scale that dealt with affective, cognitive, and communication domains and open-ended questions for insights into opportunities and challenges. The results of the former were expressed as descriptive statistics, in frequencies and proportions. Open-ended questions were summarized to guide the refinement of further implementation. Results Of the 120 participants, 92 (77%) quoted low/medium empathy quotient in students, and 107 (89.2%) felt that the listening skills of students can improve with the introduction of story-telling. A hundred and twelve (93.4%) participants felt that their history-taking skills can improve with story-telling, and all agreed that the language of medicine can be improved. One hundred nine (90.8%) felt that it will lead to better student-patient interaction. Opportunities included a better understanding of social determinants, patient-/family-centered care, improved communication skills, and better mental health. The key challenges included time, motivation, the need for training/capacity building, and streamlining of assessment metrics. Conclusion We conclude that story-telling may help medical students investigate various social determinants of health, disease, and lived environments that create vulnerabilities.

Prevalence of Metabolic Syndrome and its Risk Factors among Adults in a Rural Area of Dakshina Kannada District.

Background: Metabolic syndrome (MS) consists of interconnected factors responsible for increased risk of cardiovascular diseases and development of type 2 diabetes mellitus. Early identification and treatment of components of MS leads to improved cardiovascular outcomes. Aims: To determine the prevalence of metabolic syndrome among adults >18 years of age and to study the various socio-demographic and behavioral factors associated with MS. Methods and Material: This was a cross-sectional study conducted among 280 adults of >18 years in a rural area of Dakshina Kannada district. Probability proportional to size and random sampling was used to select the study participants. Data was collected by interviews, anthropometry, blood investigations. Results: Prevalence of MS was 33.9% and majority were females (71.8%). The mean age was 49.35 (±15.22) years. The prevalence (raised levels/on treatment) of hypertension, hyperlipidemia and hyperglycemia were 56.79% (systolic), 38.93% (diastolic), 38.57% (raised triglycerides), and 45% respectively. Majority of the subjects were obese (52.9%). Participants of 18-49 years age group had 2.30 times higher odds of having MS than ≥50 years age group (P value < 0.001). Female gender and low socio-economic status had 1.49- and 1.31-times higher odds of having MS respectively. Family history of diabetes and presence of co-morbidities had 1.20- and 1.02-times higher odds of developing MS. Conclusion: There is a high prevalence of MS in rural areas. Intervention based on lifestyle modifications needs to be developed.

Experience of Workplace Incivility and Its Impact on Stress and Turnover Intention among the Nurses Working at a Hospital: Cross-Sectional Survey Approach.

BACKGROUND: Incivility in the workplace drowns the mental health of the nurses and hampers the daily routine. The majority of the nurses working at hospitals were experiencing incivility. It affects the physical and psychological health of the nurses. Experience of workplace incivility and its impact on stress and turnover among nurses was discussed in this study. MATERIALS AND METHODS: Cross-sectional survey approach was used to select 50 nurses by simple random sampling technique. Standard scales for incivility, stress, and pre-tested scale for the turnover intention was used to collect the data. RESULT: Nurses experience incivility in their workplace almost from all the sources. The majority (64%) of the staff nurses had a moderate level of stress and 30% had average intention to leave the present job. There was a positive relationship found between the experience of incivility and stress (r = 0.43, p < 0.002), stress, and turnover intention (r = 0.40, p < 0.004). CONCLUSIONS: Experience of incivility provokes stress among the nurses, and this may influence turnover intention.

Treatment success rates among tuberculosis patients notified from the private sector in West Bengal, India.

In India, an estimated 50% of tuberculosis (TB) patients are diagnosed and managed by private providers (PPs). However, there is limited information on treatment outcomes among those treated by PPs largely because of a lack of systems for patient follow-up and documentation of the outcomes. Tuberculosis Health Action Learning Initiative (THALI) project implemented in six districts of West Bengal, supported PPs in managing TB patients and systematically documented the TB treatment outcomes of such patients. This provided us an opportunity to describe the treatment outcomes and assess factors associated with 'unsuccessful outcomes' among TB patients notified by PPs from January to April 2018. This was a retrospective cohort study using routinely collected data. During the study reference period, 2347 patients were notified from 389 PPs. The patient's mean (SD) age was 39.9 (17.2) years and 61% were males. Of the total, about 86% had pulmonary TB, 95% were new cases, and 23% were microbiologically confirmed (either on sputum smear microscopy or Xpert assay). Among 2347 patients, 19% received free drugs from the National Tuberculosis Program (NTP) under the supervision of PPs while the rest purchased anti-TB drugs from the private pharmacies. The 'successful outcomes' (cured and treatment completed) were seen in 86.1% (95% confidence interval (CI), 84.6%-87.4%) patients and 8.6% were 'not evaluated'. The patients who received free NTP drugs (adjusted relative risk-4.0 (95% CI: 3.1-5.0)) had a higher risk of 'unsuccessful outcomes' than those who availed of drugs from private pharmacies. The high 'successful outcomes' among TB patients treated by PPs are promising. However, higher 'unsuccessful outcomes' among patients on free NTP drugs need to be explored, and suitable corrective actions have to be taken.

Epidemiological profile and mapping geographical distribution of road traffic accidents reported to a tertiary care hospital, Mangaluru using quantum geographic information system (QGIS).

BACKGROUND: The worldwide annual average of road traffic accident (RTA) is approximately 7,00,000 and out of that 10% occur in India. It is estimated that in India, by 2020 RTA would have its fatal effect on about 5,50,000 people annually. This study was conducted to describe the epidemiological profile and spatial distribution of RTAs using quantum geographic information system (QGIS) software reported to a tertiary care hospital in Mangaluru. METHODS: It was a record based descriptive study conducted in a tertiary care hospital of Mangaluru. The complete enumeration of all RTAs reported to Yenepoya Medical College Hospital (YMCH) during January 2018 to June 2018 was followed. QGIS software was used to depict spatial distribution of the road traffic accident on open street map. RESULTS: A total of 180 cases of RTA was reported to the hospital during the study period, of which 86.1% were males. The mean age of the study participants was 33.99 years. The lower limb was the most common site of injury (48.3%) and fractures were the most common type of injury (55.6%). As per the type of RTA majority (55.6%) was motorbike accidents and drivers (47.8%) were the most common RTA victims. Predominantly RTAs occurred during evening hours of the day (40%). QGIS plotting revealed clustering of RTAs in Dakshina Kannada district, North Karnataka and neighboring districts of Kerala. CONCLUSION: QGIS can be used at the health care system level as an important tool to plan preventive measures and early intervention measures at the site of RTA.

Spatiotemporal analysis of drug-resistant TB patients registered in selected districts of Karnataka, South India: a cross-sectional study.

BACKGROUND: Tuberculosis (TB) depicts heterogeneous spatial patterns with geographical aggregation of TB cases due to either ongoing person-to-person transmission or reactivation of latent infection in a community sharing risk factor. In this regard, we aimed to assess the spatiotemporal aggregation of drug-resistant TB (DR-TB) patients notified to the national TB program (NTP) from 2015 to 2018 in selected districts of Karnataka, South India. METHODS: This was a cross-sectional study among DR-TB patients notified from Dakshina Kannada, Udupi, and Chikamagalur districts of the state of Karnataka. Clinico-demographic details were extracted from treatment cards. The registered addresses of the patients were geocoded (latitude and longitude) using Google Earth. Using the QGIS software, spot map, heat maps and grid maps 25 km2 with more than the expected count of DR-TB patients were constructed. RESULTS: Of the total 507 patients studied, 376 (74%) were males and the mean (standard deviation) age of the study participants was 41.4 (13.9) years. From 2015 to 2018, the number of patients increased from 85 to 209 per year, the area of aggregation in square kilometers increased from 113.6 to 205.7, and the number of rectangular grids with more than the expected DR-TB patients (> 1) increased from 12 to 47. CONCLUSIONS: The increase in the number of DR-TB patients, area of aggregation, and grids with more than the expected count is a cause for concern. The NTP can use routine programmatic data to develop maps to identify areas of aggregation of disease for targeted TB control activities.

Enablers and Challenges in the Implementation of Active Case Findings in a Selected District of Karnataka, South India: A Qualitative Study.

BACKGROUND: Active case finding (ACF) for tuberculosis (TB) is a promising tool to enhance early case detection among marginalized populations. As opposed to passive case finding, it involves systematically searching for TB in individuals who would not spontaneously present for care. The National TB Program (NTP) of India has initiated ACF for TB through the existing general health system since the end of 2017. However, prior to scale-up, there is need for exploring the implementation challenges and solutions to improve the efficiency of this program. OBJECTIVES: (1) To explore the enablers and challenges in the implementation of ACF for TB by NTP in the Bengaluru rural district of Karnataka, South India, and (2) to explore the perceived solutions to improve the efficiency of ACF activity. METHODS: A qualitative descriptive study was conducted in the Bengaluru rural district during July 2018. In-depth interviews using purposively selected health care providers involved in active case finding (n = 9) and presumptive TB patients (n = 9) and presumptive TB patients (. RESULTS: The challenges in conduct of ACF were as follows: inadequate training of health care workers, shortage of staff, indifferent attitude of community due to stigma, lack of awareness about TB, illiteracy, inability to convince patients for sputum test, and delay in getting CBNAAT results. The field staff recommended the installation of mobile CBNAAT machine, involvement of general health staff in activity, training of health workers on counseling of patients, and issue of identity cards for community health workers/volunteers so that people recognize them. CONCLUSION: The health system challenges in conduct of ACF need to be addressed by training the health staff involved in activity and also improving the access to TB diagnostics.

Strategy to sensitize private practitioners on RNTCP through medico-social workers in urban field practice area of a Medical College in Bengaluru, Karnataka.

BACKGROUND: India accounts for 25% of global TB burden and majority of TB patients seek care from private practitioners. It becomes imperative to involve private practitioners with newer strategies to strengthen the Revised National Tuberculosis Control Program (RNTCP). A study was conducted to assess the knowledge, attitude and practices among private practitioners with regards to tuberculosis case detection and referral and to demonstrate the feasibility of utilizing existing medico-social worker of a medical college in sensitizing the private practitioners. METHODS: An intervention study was conducted during 2017. In an urban field practice area of a medical college, 34 allopathic private practitioners (PP) from six slums formed the study population. The RNTCP trained Medico social workers (MSW) of medical college provided repeated sensitization to private practitioners on case referrals. The data of KAP among private practitioners was collected. The output of repeated sensitization was measured by comparing the number of cases referred by Private Practitioners to DMC during the pre and post intervention period. RESULTS: Only 1 in 2 practitioners were aware about the duration of cough in presumptive TB cases. Nearly 44% of them were not aware about the first investigation of choice under RNTCP; 53% of the doctors did not know about the total number of sputum samples to be collected. After the sensitization of PPs by MSWs the number of presumptive pulmonary cases was increased by more than two folds. CONCLUSION: The strategy of utilizing the services of medico-social workers employed in a medical college to sensitize the private practitioners is feasible and has demonstrated the increase in number of presumptive TB case referrals to DMCs.

An epidemiological study on fluorosis in an urban slum area of Nalgonda, Andhra Pradesh, India.

Fluorosis is an important public health problem in certain parts of India. Nalgonda is one of the fluorosis endemic districts of Andhra Pradesh. A cross-sectional study was undertaken to assess the prevalence of dental and skeletal fluorosis in Panagal, one of the urban slum areas of Nalgonda town of Andhra Pradesh. 265 individuals residing in 92 households of five colonies of Panagal were selected by multi-stage random sampling. Fluorosis was assessed by standard clinical methods and water samples were tested for fluoride level. It was observed that mean fluoride level in ground water samples in the area was 4.01 mg/l and that of Nagarjunsagar water was 0.74 mg/l. The mean age of the study subjects in the area was 34.73 years. The overall prevalence of skeletal fluorosis was 24.9% and that of dental fluorosis was 30.6%. The prevalence increased with age. Skeletal and dental fluorosis is endemic in the study area.