National Journal of Community Medicine

Anxiety Unveiled: A Cross-Sectional Study on High School Students in Rural Tamil Nadu

Rajan Edward Daniel Thomas — 2024-12-01

Background: Adolescence is a unique phase of human growth, marked by rapid cognitive, psycho-social, and physical development. Despite being a period of resilience, mental illnesses often begin during this stage. This study aimed to determine the prevalence of anxiety disorders among high school students in rural Tamil Nadu.

Methodology: A community-based cross-sectional study was conducted in high schools in the rural areas of Chengalpattu district, Tamil Nadu. High school students aged 12 to 15 years of both genders were included using a systematic random sampling method. A total of 234 students were interviewed using the Spence Children’s Anxiety Scale (SCAS-Child) questionnaire to assess anxiety levels. Qualitative variables were described using mean and standard deviation, and ANOVA was applied to explore associations between anxiety and determining factors.

Results: Panic/agoraphobia emerged as the most common anxiety disorder. Obsessive-compulsive disorder and social phobia were higher in girls, while panic/agoraphobia, fear of physical injury, general, and separation anxiety were more prevalent in boys. Children with fathers in white-collar jobs showed higher panic/agoraphobia and general anxiety (Mean±SD: 12.13±4.5, p < 0.02), while those from lower socioeconomic classes had more separation anxiety (Mean±SD: 6.86±2.7, p < 0.02). Anxiety disorders were higher among children from joint or three-generation families.

Conclusion: There is a significant prevalence of anxiety among adolescents, with clear correlations to sociodemographic factors. Enhancing protective factors and addressing modifiable risks at the school level is crucial to improving adolescent mental health services.

Accuracy of Aneroid Versus Digital Sphygmomanometer in Community-Based Screening for Hypertension in Hubballi, Karnataka, India - A Cross-Sectional Study

Mahesh D Kurugodiyavar — 2024-12-01

Background: Hypertension is a significant global health issue, responsible for approximately 7.5 million deaths annually. Even a modest increase of 5 mm Hg in systolic blood pressure (BP) can elevate the risk of fatal stroke and infarction by about 25%. Hence this study aimed to assess the accuracy of aneroid and digital sphygmomanometers relative to the mercury sphygmomanometer.

Methodology: This community-based cross-sectional study was conducted in the urban slums of old Hubballi among 270 participants aged 30 years and above. Participants were selected using Probability Proportion to Size from 3 wards. Blood pressures were measured with all three sphygmomanometers and Bland Altman plot analysis was done.

Results: The results revealed that the mean difference in systolic blood pressure compared to mercury was -0.57 mmHg for the aneroid and -4.63 mmHg for the digital (p <0.05). For diastolic blood pressure, the mean difference was -0.39 mmHg for the aneroid and -3.43 mmHg for the digital (p <0.05). Bland-Altman analysis showed agreement limits of 66.3% for systolic and 75.2% for diastolic blood pressure with the aneroid sphygmomanometer.

Conclusion: The aneroid sphygmomanometer provides more reliable BP readings compared to the digital sphygmomanometer for both systolic and diastolic measurements.

AI-Enhanced Strategies for COVID-19 Vaccination and Booster Prioritization: A Comprehensive Framework

Sara AlShaya — 2024-12-01

Background: Distributing vaccines efficiently during the COVID-19 pandemic presented significant logistical challenges. To address the need for identifying populations at risk of breakthrough infections and those requiring booster shots, Emirates Health Services (EHS) developed a framework utilizing AI-driven digital solutions. Objective: To develop a machine learning (ML) model to identify individuals at risk of breakthrough infections and in need of booster doses, aiming to prioritize booster administration and reduce repeated infections among fully vaccinated individuals in the Northern Emirates of the UAE.

Methods: A monitoring dashboard was developed using the EHS Intelligence (PaCE) platform. The study, conducted in three phases, created models to predict infection risk, COVID-19 severity in ICU patients and breakthrough infection risk, using data from the Wareed EMR system.

Results: The AI models accurately identified high-risk individuals and predicted ICU mortality, achieving AUCs of 75% and 74% for infection risk, 94% and 91% for ICU mortality in training and validation datasets, observed 79% AUC with 85% accuracy for identifying high-risk groups for booster vaccination.

Conclusion: The integration of AI in vaccination prioritization demonstrated its potential to enhance public health initiatives and improve pandemic management in the UAE.

Assessment of Dysmenorrhea and its Associated Factors among Females of District Ghaziabad

Priyanka Verma — 2024-12-01

Background: Dysmenorrhea is a very common problem and a large number of females in our society are suffering from it. This study aims to determine the prevalence of dysmenorrhea and its associated lifestyle and other factors.

Methodology: This was a cross-sectional study which was conducted among females aged between 15 to 45 years in urban population of district Ghaziabad through a house-to-house survey, using a pre-designed, semi-structured questionnaire.

Results: The prevalence of dysmenorrhea was 67.8%. Out of the participants having dysmenorrhea, 36.5% females were experiencing mild pain, 44.3% were experiencing moderate pain and 19.1% were experiencing severe pain. The chances of dysmenorrhea were significantly more in participants of 15 to 25 years of age, participants who had attained early menarche, those having pre-menstrual symptoms and those who had passage of clots during menstruation, participants consuming refined flour, fried food, preservatives, soda and those who were skipping meals. Participants doing physical exercises showed less chance of menstrual pain.

Conclusions: The prevalence is dysmenorrhea is quite high in our society. It may be related to factors which are modifiable, such as diet and exercise. An improvement of lifestyle is recommended.

A Study of The Quality of Life in Patients with Schizophrenia: A Cross-Sectional Study in A Tertiary Care Hospital, Mumbai, India

Prasad Tagad — 2024-12-01

Background: There are limited recent Indian studies assessing the quality of life in patients with schizophrenia. This study evaluated the socio-demographic data, psychopathology, quality of life, and their associations in patients with schizophrenia.

Methodology: Fifty outpatients with schizophrenia, meeting ICD-10 DCR criteria, were assessed using Kuppuswamy’s socioeconomic status scale, the Positive and Negative Syndrome Scale (PANSS), and the Quality-of-Life Scale (QLS).

Results: The mean patient age was 36.3 years, with a male-to-female ratio of 1.6:1. Most patients were married, unemployed, educated up to middle school, and belonged to the upper-lower socioeconomic class. Clinically, they had mild psychopathology with a mean PANSS total score of 62.36. Quality of life assessment revealed that 12% had severe impairment, 64% had mild to moderate impairment, and 24% had no impairment. Occupational status was significantly associated with QLS scores. PANSS scores negatively correlated with QLS scores, with stronger correlations in the general psychopathology and negative symptom domains.

Conclusion: The findings emphasize the need for personalized and holistic approaches to managing schizophrenia, addressing both clinical symptoms and socio-demographic challenges.

Assessment of Thyroid Function Status and Thyroid Antibody Levels Among Tribal Population of Jarugumalai Hills of Salem District, Tamil Nadu, India

Vijayakarthikeyan M — 2024-12-01

Background: Tribal population not only suffers from malnutrition and communicable diseases but also from non-communicable diseases. Globally, one of the most frequent metabolic disorders include thyroid disorders. The study was conducted to estimate the prevalence of Thyroid disorders using Thyroid Function Test, to determine the Anti-Thyroid Peroxidase Antibody levels among the tribal population, and also to determine the factors associated with thyroid disorders among the tribal population.

Materials and Methods: It is a community based analytical cross-sectional study conducted among 375 tribal residents of Jarugumalai hills. Data was collected using a pre tested semi-structured questionnaire. Categorical variables were described using frequency and percentage. Variables significantly associated with thyroid disorders were identified using univariate and multivariate analysis.

Results: Nearly 32% had any form of thyroid disorders. About 18% and 7% respectively had subclinical hypothyroidism and overt hypothyroidism. Also, 12% of the study participant blood samples were positive for Anti Thyroid Peroxidase antibody (ATPO). Female gender Usage of inadequately iodised salt and presence of ATPO were significantly associated with thyroid disorder on multivariate analysis.

Conclusion: Thyroid status assessment showed a high prevalence (32%) among the marginalized population. Multi-pronged approach involving educational, administrative and legal measures must be implemented to curb this problem.

Clinico-Epidemiological Profile of Women with High-Risk Pregnancies Attending Pradhan Mantri Surakshit Matritva Clinic in A Rural Block of Purba Bardhaman District, West Bengal

Arif Hossain — 2024-12-01

Background: High-risk pregnancies (HRPs) significantly contribute to maternal and neonatal morbidity and mortality in India. However, many pregnancies remain unclassified as high-risk. To address this, the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) was launched to improve the quality and coverage of antenatal care (ANC). This study aimed to estimate the proportion of HRPs and their correlates among PMSMA beneficiaries in a rural block of Purba-Bardhaman district, West Bengal.

Methodology: A cross-sectional study was conducted over six-month period at Pradhan-Mantri- Surakshit-Matritva (PMSM) Clinic among 190 women were selected by simple random sampling. Data were collected by reviewing records as well as from selected study subjects using a pre-designed schedule and analysed using Jamovi v-2.4.8.

Results: Data analysis revealed that 65.3% of pregnancies were high-risk, with 75% of these involving a single high-risk factor and 25% having multiple factors. The leading contributors were hypothyroidism (19.6%), previous Caesarean-section (14.2%), and pregnancy-induced hypertension (13.7%). Statistically significant associations were found between HRPs and caste, occupation, and ANC-registration status.

Conclusions: The findings highlight the importance of improving antenatal care by enhancing screening and interventions. Future research and healthcare policies should focus on comprehensive strategies to identify and manage risks, improving maternal and infant health outcomes.

Determinants of Gynaecological Morbidities and Treatment-Seeking Behaviour among Women in Eastern India: A Study Based on NFHS 4 And 5

Nilanjana Gupta — 2024-12-01

Background: Gynaecological morbidities are key components of reproductive health and contribute considerably to the disease burden among women in eastern India. Societal stigma and socio-cultural beliefs often prevent women from reporting and seeking treatment for these morbidities. The objective was to explore the scenario and associated factors of gynaecological morbidity and treatment-seeking behaviour among women in eastern India.

Methodology: The analysis is based on two rounds of National Family Health Survey (NFHS 4 and NFHS 5), including women from 15-49 years who reported or sought treatment for any gynaecological morbidity. Bivariate and binary logistic regression analysis were used to analyse regional variations and the factors associated with gynaecological morbidity treatment-seeking behaviour.

Results: The prevalence of gynaecological morbidities India increased from 25.68% in NFHS 4 to 28.74% in NFHS 5, having the highest prevalence in Bihar. Women seeking treatment increased from 35.05% to 38.16, with more preference for private healthcare facilities than the public. Socioeconomic factors like wealth index, age, age at marriage and first birth, educational attainment, working status, awareness about STI significantly influences gynaecological morbidities and treatment-seeking.

Conclusion: The findings of the study emphasised the need of awareness, health education and economic support to overcome the barriers of treatment seeking behaviour of gynaecological morbidities.

Evaluating Post-Treatment Quality of Life in Cervical Cancer Patients in Tripura, India

Sarada Sutradhar — 2024-12-01

Background: In India, cervical cancer (CC) is the most common gynecological cancer. This harms the patient's physical and psychological health, lowering their quality of life (QOL). The study aimed to compare QOL of healthy women and cervical cancer survivors in Tripura, India.

Materials and Methods: With a propensity score matching system, this cross-sectional study compared 384 healthy women with 384 cervical cancer survivors. In order to assess sexual functioning and quality of life, we administered three questionnaires: the EORTC QLQ-C30, the EORTC QLQ-CX24 (the cervical cancer module), and the sociodemographic and clinical record form.

Result: Cervical cancer patients had a 64.67±2.68 overall quality of life and global health status. We discovered no statistically significant differences in age, education, economic position, marital status, first pregnancy, or residency between cervical cancer survivors and controls (p 0.05). Cervical cancer survivors reported higher lymphoedema scores than healthy women (p = 0.04). The EORTC QLQ-C30 and CX24 showed significant differences in cognitive ability (p = 0.01) and constipation (p = 0.03) between the two groups.

Conclusion: Research indicates that many cervical cancer survivors can maintain an acceptable quality of life despite their condition. Chemoradiotherapy significantly impaired the sexual functioning of cc survivors in comparison to a healthy control group.

Evaluating India’s Position in Pragmatic Clinical Trial for Public Healthcare: A Key to Real World Healthcare Solutions

Smruti Besekar — 2024-12-01

Pragmatic Clinical Trials (PCTs) are valuable tools for evaluating interventions in real-world settings, providing insights for clinical practice. Unlike traditional randomized controlled trial (RCTs), PCTs generate real-world evidence for better decision-making. With 615 reported globally between 1967 and 2017, a 58% increase from 2013 to 2017, India has only one registered PCT, indicating a gap in its adoption. This review examines national clinical trial registries, PubMed database for PCTs till 2024, comparing data across different nations. The study reveals a significant shortage of PCTs in India and a lack of awareness of frameworks like Pragmatic Explanatory Continuum Indicator Summary 2. India faces challenges in implementing PCTs due to low awareness, inadequate infrastructure, and logistical hurdles. However, with regulatory reforms, international collaboration, and infrastructure improvements, India can become a key player in advancing PCTs. Increased awareness and researcher training will contribute to better healthcare outcomes both domestically and globally.

Recent and Advanced Trends in Cancer Treatments

Chithra RA — 2024-12-01

Background: Cancer treatment remains a critical area of clinical research, with numerous approaches developed depending on tumor type and stage. Recent advances in genetic and immunotherapy, bioinformatics, and genetic science have revolutionized cancer diagnosis and treatment. Emerging technologies such as gene delivery, oncolytic virotherapy, suicide gene therapy, and CRISPR/Cas9 offer promising therapeutic avenues.

Methods: This review provides a detailed analysis of the latest techniques of Gene therapy, artificial intelligence, Nanocarrier Delivery Systems, Immunotherapy, CAR T-Cell Therapy, Epigenetics, Vaccines, and Clinical translation and assessing their therapeutic potential in cancer treatment. A review of early critical studies focused on the integration of immunotherapy, nanotechnology, and artificial intelligence (AI) in cancer therapies with emphasis on targeted delivery systems and precision medicine.

Results: The review highlights the synergistic effects of combining targeted therapies with immunotherapy, particularly immune checkpoint inhibitors and CAR-T cell therapy. Therapies such as CRISPR/Cas9 demonstrate significant potential in cancer targeting, while advancements in nanocarrier delivery systems offer enhanced precision with reduced side effects. AI's role in improving cancer diagnosis and personalized treatment is also underscored.

Conclusion: This comprehensive analysis of recent therapeutic approaches and technological advancements addresses gaps in previous reviews and offers updated insights into cutting-edge cancer treatments. The review emphasizes the evolving role of immunotherapy, nanotechnology, AI, and nanotechnology, providing clinicians and researchers with the most current and relevant information for optimizing cancer treatment strategies.

Empathy Assessment Among Medical Students Towards Patients - A Cross-Sectional Study

Subha Lakshmi — 2024-12-01

Background: Empathy is the student’s understanding of the patient’s experience and ability to convey the feeling. Empathy is teachable and measurable, and proper teaching to students about ethics, humanity, and professionalism can improve patient care.¹ This study tries to determine the empathy levels among medical college students towards patients and the variation in empathy levels among medical college students towards patients each year.

Methodology: The sample size was 400, undergraduate students from 1^st year to compulsory rotating medical internship were selected.

Results: There was a significant association between empathy levels and year of education and as the year of study increases the empathy level decreases and this is statistically significant.

Conclusion: The empathy level of medical students is at good levels. Still, the empathy level is declining as the year of studies increases because of the stress in studies and increased patient load.

Prevalence of Perceived Stress Among Polypharmacy Patients: A Cross-sectional Study

Ghazwan Alhashem — 2024-12-01

Background: The concurrent use of 5 or more medications is the most recognized definition of polypharmacy. Many physical and mental consequences could be associated with polypharmacy, and stress is no exception. The objective of the current study is to investigate the prevalence of perceived stress among polypharmacy individuals and its association with sociodemographic factors.

Method: A cross-sectional study was carried out between September and December at 6 major hospitals and several private clinics in Iraq. Study participants were required to have at least 2 chronic diseases and be using 5 or more drugs for at least 90 days, aged 50 years or older. Sociodemographic data and the Perceived Stress Scale 10 (PSS-10) were completed by participants. The Mann-Whitney test was used to compare the median PSS-10 scores for different sociodemographic factors.

Results: Among the 235 polypharmacy participants, the median PSS-10 score was 20. Moreover, the median PSS-10 score was significantly higher among female participants, those with an increased number of chronic diseases, the presence of adverse effects, and participants with financial issues related to healthcare (P <0.05).

Conclusion: The present findings indicate a moderate perceived stress score among polypharmacy participants, highlighting the need for strategies to alleviate stress alongside personalized medication management.

Beyond The Social Lens: The Critical Call to Integrate Gender-Based Violence into Healthcare, Medical Education and Research

Namratha Kulkarni — 2024-12-01