Development and Validation of a Symptom Scale for Indian Patients With Medically Unexplained Physical Symptoms.

Introduction Patients with medically unexplained physical symptoms (MUPS) account for a substantial proportion of patients visiting the outpatient department. Diagnosis of MUPS is a challenge for most physicians. An accurate diagnosis relies on obtaining a detailed history from patients regarding the nature of their symptoms, their onset, and any associated aggravating or relieving factors. This study aims to develop a symptom scale for Indian patients with MUPS. Methods The study had a mixed-method study design. Phase 1 involved designing the questionnaire using qualitative techniques, such as literature reviews, focus-group discussions, expert evaluation, and pre-testing of a Hindi and English language Likert-rated interviewer-administered scale. In phase 2, the construct validity of the questionnaire was established using quantitative approaches among 116 patients diagnosed with MUPS. Results The final questionnaire consists of 38 items, with good internal consistency (Cronbach 𝛂 = 0.916). Confirmation sampling adequacy for factor analysis was done using the Kaiser-Meyer-Olkin test (KMO value = 0.792) and Bartlett's test of sphericity (p < 0.001). The newly developed scale showed a Pearson correlation coefficient of 0.568 (p < 0.001) with Patient Health Questionnaire (PHQ)-15 scores. Conclusion A reliable and valid tool has been developed to assess patients' symptoms with MUPS in English and Hindi languages. This questionnaire can be used for assessment, screening, and diagnostic purposes as well as to chart longitudinal changes in patients with MUPS.

A qualitative phenomenological exploration of prolonged grief in New Delhi, India.

Prolonged grief disorder (PGD) is a condition characterized by difficulty in coping effectively with the loss of loved ones. The proposed diagnostic criteria for PGD have been based predominantly on research from developed Western nations. The cultural variations associated with experience and expression of grief and associated mourning rituals have not been considered comprehensively. The current study aimed to understand the experience of prolonged grief in India through a qualitative enquiry with mental health professionals (focus group discussions) and affected individuals (key informant interviews). Several novel findings diverging from the current understanding of manifestation and narratives of PGD emerged from the study, including differences in the social contexts of bereavement and culture-specific magico-religious beliefs and idioms of distress. The findings point to limitations of existing diagnostic systems for PGD. The results of this study suggest that the assumption of content equivalence for psychiatric disorders across cultures may not be justified and that there is a need to develop culturally sensitive diagnostic criteria and assessment scales for PGD.

Perspectives of patients, caregivers, and healthcare professionals in Indian context: A qualitative study on Medically Unexplained Physical Symptoms (MUPS).

BACKGROUND: Approximately one-fourth of individuals who seek treatment in outpatient medical settings have Medically Unexplained Physical Symptoms (MUPS), a prevalent medical ailment. Patients with MUPS have a considerable functional impairment, and a lower quality of life, and may also have co-occurring psychiatric conditions. MATERIALS AND METHODS: Eleven Focus Group Discussions (FGDs) (four virtual and seven face-to-face) were conducted with patients, caregivers, and healthcare professionals in 2021 in a tertiary care hospital in New Delhi. Thematic analysis was carried out using QSR Nvivo software. RESULTS: A total of 36 participants were recruited in the study, including patients with MUPS (n = 12), caregivers (n = 10), and healthcare professionals (n = 14) dealing with the patients of MUPS. Three themes were identified: burden of MUPS, symptom profile of patients with MUPS, and psychological profile of patients with MUPS. These were further categorized into eight sub-themes: prevalence, symptoms, course of illness, improvement with treatment, duration of symptoms, attribution of symptoms, psychological impact, and coping strategies. CONCLUSION: The study helped us to gain insight into the characteristics and experiences of patients, caregivers, and healthcare professionals dealing with MUPS in an Indian setup. Greater awareness of MUPS and training of care providers about the occurrence, management, and referral of MUPS can be beneficial.

Development of Home-Based Intervention Module for Specific Learning Disorder Mixed Type: A Qualitative Study.

Background: Despite significant prevalence of specific learning disorder (SLD) in India, insufficient efforts have been taken to deal with its burden. Currently, the workforce is limited and resources are expensive and difficult for families to access. Consequently, developing an alternative remedial program in the form of a home-based intervention (HBI) is imperative. This article describes the development phase of a manualized HBI program for 7 to 12-year-old children with SLD. Methods: Extensive literature search, 7 focus group discussions with parents of children with and without SLD and teachers/counselors (n = 44), and 22 in-depth interviews with SLD children (n = 9) and professionals (n = 13) were conducted. A thematic analysis was done. Intervention strategies were identified based on themes. Experts' feedback about the content and structure of HBI was also taken. Results: The design and application of the HBI program integrate several intervention areas, including psychoeducation, learning strategies, cognitive, social, and behavioral techniques, and therapy for parents. HBI comprised 14 parent training sessions, the duration being 45 to 60 min per session, over six months. Parent training consisted of four steps. (a) The researcher/clinician describes the steps of reading, writing, or math strategies to the parents/caregivers; (b) the researcher/clinician implements the strategies with or without the presence of the child and observation by the parent; (c) the parent practices the strategies in front of the researcher/clinician; and (d) the researcher/clinician observes parents' practice and corrects them if required. Conclusion: HBI manual for children with SLD-mixed type has been developed, keeping with all stakeholders' perspectives. Further study is on the way to assess its acceptability, feasibility, and effectiveness.

A systematic review and meta-analysis of substance use among medical students in India.

Background and Aims: Substance use among medical students may have consequences like poor academic performance and impaired patient care. There is a growing literature on substance use among medical students in India. This systematic review and meta-analysis were done to synthesize the literature on substance use among medical students in India. Methods: Medline and Google Scholar were used as search engines to ascertain the literature that reported substance use among Indian medical students from January 2000 to January 2022. The pooled prevalence of tobacco, alcohol, other substance, and overall substance use was computed. Results: A total of 65 studies were included. The pooled prevalence of tobacco use was 21.9% (95% confidence intervals [CI] 18.5% to 25.3%, n = 20,165, k = 51), while the pooled prevalence of alcohol use was 27.1% (95% CI of 23.0% to 31.1%, n = 11,823, k = 31). The overall pooled prevalence of substance use was 40.3% (95% CI of 25.5% to 55.2%, n = 4960, k = 10), while pooled prevalence of cannabis was 8.2% (95% CI of 4.9% to 11.5%, n = 2418, k = 7). The use of tobacco was about 10 times higher in males than females, while the odds of alcohol use were about five times higher in males. Conclusion: Substance use is common among medical students, with rates of substance use being generally higher in males as compared to females. Targeted interventions may help to reduce substance use and prevent the development of substance use disorders in this population.

Development of IgM-ELISA for diagnosis of recent infection of Japanese encephalitis virus in equines.

Japanese encephalitis (JE) is a re-emerging mosquito borne disease, for which equines are most susceptible amongst all animals. Detection of specific immunoglobulin 'M' (IgM) is considered as an ideal way to diagnose recent JE virus infection in equines due to low virus load and short-term viremia. The present study was undertaken to develop a sensitive and specific recombinant NS1 protein based indirect IgM-ELISA and IgM capture (MAC) ELISA to diagnose recent infection of JEV in equines. Indirect IgM ELISA was standardized with relative diagnostic sensitivity and specificity of 100% and 88.5%, respectively. The validation of indirect IgM-ELISA in different laboratories revealed excellent reproducibility with Cohen's kappa value ranging between 0.84 and 1. The standardization of MAC ELISA was attempted using checker board titration method and non-specific binding of polyclonal anti-equine IgM capture antibody with anti-porcine IgG conjugate and with hyperimmune serum raised in swine against the antigen was observed. Hence, the MAC ELISA was standardized with monoclonal capture antibody; however, its diagnostic performance could not meet the satisfactory limit. Due to better sensitivity and less turnaround time, indirect IgM-ELISA was employed to screen 821 equine serum samples revealing 33.73% positivity of IgM antibodies against JEV in equine population of India. The high JEV sero-positivity warrants the need for vaccination in Indian equine population along with the demand for research focused towards anti-viral therapy. The indirect IgM-ELISA developed in the present study could be useful to diagnose acute or recent infection of JEV in equines as well as in sero-epidemiological studies.

Sero-positivity of Japanese Encephalitis Virus in Equine Population of India Using IgG ELISA: Unraveling the Need for Vaccination.

Japanese encephalitis (JE) is a mosquito borne flaviviral zoonoses, causing fatal disease in equines and humans. JE is endemic in most of the states of India with occurrence of human cases every year. The horses are not vaccinated against JE in India and thus they are at more risk of acquiring the disease. Due to nonavailability of indigenously developed ELISA and high cost of imported kits, regular sero-surveillance is not being carried out to assess the true picture of JE virus in equine population of India. Therefore, a recombinant NS1 protein based indirect IgG ELISA was developed with the objective to assess the sero-positivity of JE virus in equine population of India. The diagnostic sensitivity and specificity of developed ELISA was 84.73% and 86.70%, respectively. The validation studies revealed good reproducibility of ELISA with kappa value ranging from 0.75 to 1 between the results of different laboratories. A total of 2,069 horse serum samples were screened using the developed ELISA and 401 samples were positive for IgG against JEV with an overall sero-positivity of 19.38% in equine population of India. A sero-positivity of 25.90% and 12.22% was recorded in Himachal Pradesh and Jammu-Kashmir, both hill states of North zone of India for the first time, revealing the spread of virus to the nonendemic parts of the country. The high sero-positivity of JE virus recorded in equine population warrants the need for initiation of vaccination of horses in India to prevent the morbidity and mortality.

Psycho-social and behavioral impact of COVID-19 on middle-aged and elderly individuals: A qualitative study.

BACKGROUND: COVID-19 may seem to have an impact on middle-aged and elderly people. However, not much is known about the lived experiences of middle-aged and elderly people during this pandemic. The study aims to explore psychosocial and behavioral impact of COVID-19 on the lives of these individuals. MATERIALS AND METHODS: Three focus group discussions and seven in-depth interviews were conducted. A format to guide discussions and interviews was made to bring uniformity across groups and participants. Participants were recruited through purposive and snowball sampling techniques. Discussions were recorded and transcribed verbatim. Thematic analysis method was used to extract key conceptual themes. RESULTS: There were 12 male and 10 female participants included, with a mean age of 62.2 years. Five subcategories identified were: Fear and anxiety, household confinement, lifestyle modification, preventive practices, and coping strategies. These sub-categories formed three major categories-psychological, social, and behavioral which ultimately led to the emergence of the main theme that is, COVID-19 effects on the life of middle-aged and older individuals. CONCLUSION: Middle-aged and elderly people are affected in many ways due to COVID-19. Addressing the psycho-social and behavioral problems can help in the better adjustment to tide over the pandemic.

Comprehensive Treatment Module for Medically Unexplained Physical Symptoms - A Guide for General Practitioners.

PURPOSE: This study was aimed to develop a comprehensive treatment module that the general physician can use to manage patients with Medically Unexplained Physical Symptoms (MUPS) at a primary care level.  Methods: This comprehensive module was developed after a literature review followed by its validation by a two-step Delphi technique with experts from internal medicine, psychiatry, and clinical psychology. RESULTS: The developed module for the patients with MUPS includes case diagnosis, initial evaluation, strategy for referral, and a comprehensive treatment module. The comprehensive treatment module includes symptom discussion, rapport establishment, physical health counselling, stress management, cognitive strategies for symptom control, comorbidities treatment, and medical management.  Conclusion: The developed module has unique features, such as intensive sessions with these patients, a patient-specific treatment strategy, and a holistic approach incorporating pharmacological and non-pharmacological interventions. General Practitioners across the world can use this comprehensive treatment module for the management of patients with MUPS.

Memory changes following adjuvant temporo-parietal repetitive transcranial magnetic stimulation in schizophrenia.

OBJECTIVE: The use of repetitive transcranial magnetic stimulation (rTMS) in schizophrenia has shown improvement as well as deficits in memory. Though most studies had focused on dorsolateral prefrontal cortex only, but impact of rTMS on cognitive functions remain inconclusive. The need of the study is to assess the impact of rTMS on memory in schizophrenia. MATERIALS AND METHODS: Forty right-handed male patients with schizophrenia were included by purposive sampling and rated on Positive and Negative Syndrome Scale (PANSS) before starting the rTMS treatment with the experimental group. Low frequency 1 Hz rTMS including 1200 stimulations were given over temporo-parietal cortex for 20 min as add on to medications. At the end of 10 session treatment (5 days a week for 2 weeks), the patients were re-evaluated. RESULTS: A total of 39 patients (20 for experimental group and 19 for control group) with mean age of 29.70 ± 9.05 and 31.26 ± 7.78 years, respectively, shows significant difference to pre- and post-treatment mean PANSS score in positive, negative and general psychopathology domains. The pre- and post-treatment mean Postgraduate Institute Memory Scale Scores with multivariate repeated measures analysis of variance revealed significant improvements in all memory domains (P < 0.01) except remote memory in both experimental and control groups. CONCLUSION: RTMS in combination with antipsychotics has shown improvement in psychopathology in patients of schizophrenia without any deterioration of memory.

Tools for the evaluation of the psychological impact of COVID-19: A practical guide for Family physicians and Primary Care Practitioners.

The COVID-19 pandemic has affected the global population significantly and has resulted in physiological, psychological, social, and behavioral changes among the individuals. The prominent mental health effects of COVID-19 on the general and clinical populations have been well recognized. The family physicians and primary care practitioners from various disciplines are likely to encounter patients who are experiencing psychological distress manifested in the form of anxiety, depression, stress, insomnia, increased substance use, or other symptoms. This narrative review is aimed to present a bird's eye view of the psychological impact of COVID-19 on the general population and the various tools that are used to evaluate them. Besides, we intend to suggest a set of tools/questionnaires that can be used by the family physicians and primary care practitioners for generating data on the psychological impact of this pandemic.

Development and validation of a questionnaire to assess preventive practices against COVID-19 pandemic in the general population.

Coronavirus Disease 2019 (COVID-19) pandemic has affected millions of people worldwide with far-reaching socio-economic implications in society. The adoption of preventive practices by the public remains the mainstay in reducing the spread of COVID-19 but there is a dearth of validated tools to assess such infection prevention practices related to pandemics. This study was conducted to develop and validate a questionnaire for the assessment of preventive practices against COVID-19 in the general population. It was done following a standardized protocol involving questionnaire development through literature review, focused group discussions, in-depth interviews, expert opinion, and pre-testing. This was followed by the validation of the questionnaire through a cross-sectional survey on 108 individuals from diverse backgrounds in New Delhi, India in July 2020. Exploratory factor analysis was used to evaluate construct validity. Internal consistency was assessed by Cronbach's alpha coefficient. The developed questionnaire for assessing preventive practices consists of two sections: the first section of 18 items to evaluate preventive practices and the second section of 19 items for assessing various reasons for deficiencies in the preventive practices. The first section has good content validity (CVR = 0.81 and S-CVI/Av = 0.97) and internal consistency (Cronbach's alpha coefficient 0.82). Thus, this questionnaire is a valid and reliable tool for the comprehensive assessment of preventive practices and barriers related to the COVID-19 pandemic. It will be useful in assessing the preparedness of the public and will be helpful to policymakers in designing appropriate interventions for protection against COVID-19.

Development and validation of a questionnaire to assess socio-behavioural impact of COVID-19 on the general population.

BACKGROUND AND AIM: The aim of the study is to develop a valid and reliable tool to assess sociobehavioural changes due to COVID among the general population. METHODS: This mixed method study has two phases. Phase I for questionnaire development (literature review, focus group discussion, expert evaluation and pilot testing). Phase II for establishing construct validity via factor analysis and internal consistency via Cronbach's ɑ by administering the questionnaire on 179 participants. RESULTS: A questionnaire comprising 33 questions and five domains was developed having Cronbach's α of 0·82. CONCLUSION: The developed questionnaire is a concise, easy to administer and valid tool to assess socio-behavioural changes.

Psycho-social and behavioural impact of COVID 19 on young adults: Qualitative research comprising focused group discussion and in-depth interviews.

A qualitative study comprising eight focus group discussions and two in-depth interviews were conducted to explore the social and behavioural changes in young adults during COVID pandemic. Common themes identified were changes in interpersonal and intrapersonal relationships, changes in health-related behaviour, lifestyle modifications and impact on academic and professional life.

Impact of COVID-19 on psychosocial functioning of peripartum women: A qualitative study comprising focus group discussions and in-depth interviews.

OBJECTIVE: Peripartum is a period of profound hormonal changes in the body and COVID-19 seems to have an additional impact on these women's psychosocial functioning. This calls for a need to address the psychosocial and behavioural impact of COVID-19 on peripartum women's lives. METHODS: Three focus group discussions and ten in-depth interviews were conducted. A format to guide discussions and interviews was made to bring uniformity across groups and participants. Participants were recruited through purposive sampling. In verbatim transcription was done, followed by thematic analysis to extract key conceptual themes. RESULTS: Fourteen pregnant and eleven postpartum women were included. The mean age was 28.5 years. Two major domains were identified: 1) the psychological domain including the categories of thoughts, emotions, and behaviour, and 2) the social domain comprising categories of relationships with family members and friends, perceived loss of social support, doctor-patient relationship, and social determinants of health. CONCLUSION: The pandemic has indeed affected the psychosocial functioning of peripartum women. The study results might prove to be helpful for clinicians and mental health specialists who can suggest and develop different coping strategies for peripartum women during this pandemic.

Development and validation of a questionnaire to evaluate the impact of COVID-19 on lifestyle-related behaviours: eating habits, activity and sleep behaviour.

OBJECTIVE: This study was conducted to develop and validate a questionnaire to assess the impact of COVID-19 pandemic on lifestyle-related behaviour related to eating, activity and sleep pattern. DESIGN: Indexed study used a mixed method design. Phase I employed qualitative methods for development of questionnaire including literature review, focus group discussion, expert evaluation and pre-testing. Phase II used quantitative methods for establishing construct validity of the questionnaire via parallel factor analysis. PARTICIPANTS: Phase 1 involved participation of experts from different fields (Departments of Medicine, Nutrition and Clinical Psychology) and general adult population. For phase II, data were collected from 124 adult respondents (female = 57·26 %); mean age (36 ± 14·8 years) residing in an urban setting. RESULTS: The questionnaire consisted of three sections: (A) socio-demographic and anthropometric parameters, (B) twenty-four items each for investigating the changes in eating, activity and sleep behaviour before v. during COVID-19, (C) six items assessing COVID-19 specific reasons for lifestyle change. The Cronbach's α value of the questionnaire is 0·83 suggesting its good internal consistency. CONCLUSIONS: This appears to be a valid tool to assess the impact of COVID-19 on lifestyle-related behaviours with potential utility for public health researchers to identify these changes at community level and develop strategies to reinforce corrective behaviours.

A short questionnaire to assess changes in lifestyle-related behaviour during COVID 19 pandemic.

BACKGROUND AND AIMS: The lasting impact of COVID 19 pandemic and associated restrictions are bound to be significant on lifestyle-related behaviour including diet, physical activity and sleep which is one of the important components in the management of diabetes mellitus and metabolic syndrome. This study was conducted to develop and validate a questionnaire to assess changes in individual's lifestyle-related behaviour during COVID 19 pandemic. MATERIALS AND METHODS: The questionnaire was developed through a standardised methodology including literature review, focus group discussion, expert evaluation, pre-testing and validation. The face validity and content validity of the questionnaire were analysed. A cross-sectional survey was carried out on 103 participants to validate the questionnaire that used a 5-point Likert scale for the response option. Exploratory factor analysis was performed to establish construct validity. Cronbach's alpha was calculated to test the internal consistency of the whole questionnaire. RESULTS: A questionnaire with 20 items to assess the lifestyle-related behaviour of people was developed. The questionnaire shows a satisfactory validity and a good internal consistency with the Cronbach's alpha value of 0.72. CONCLUSION: The developed tool is valid and reliable to assess the changes in lifestyle-related behaviour of individuals during COVID 19 pandemic.

Association of Somatic Symptom Severity With Sociodemographic Parameters In Patients With Medically Unexplained Physical Symptoms: A Cross-Sectional Study From a Tertiary Care Center in India.

Background There is a paucity of studies assessing the severity of somatic symptoms in medically unexplained physical symptoms (MUPS) from Medicine outpatient department (OPD). Methodology This cross-sectional study was conducted in Medicine OPD of a tertiary care hospital in India, in which 245 MUPS-diagnosed patients out of 976 consecutive screened patients were evaluated for the severity of somatic symptoms (by administering the Patient Health Questionnaire-15) and its sociodemographic correlates. Results Out of 245 recruited patients, three-fourth had a significant severity level of somatic symptoms. High level of somatic symptom severity was more common in females (p ≤ 0.001), married patients (p = 0.011), rural dwellers (p = 0.035), less educated (p = 0.003), and those with lower socioeconomic status (p = 0.001). Conclusions Patients with MUPS have a high level of somatic symptom severity with certain sociodemographic correlates. Further research should be conducted to investigate the reasons for this and to formulate a cost-effective treatment strategy.