National Journal of Community Medicine

Closing the Gap: Addressing Challenges in Telemedicine Acceptance and User Experience

Payal Kapoor — 2024-10-01

Possible Connection Between Non-Alcoholic Fatty Liver Disease and Type-2 Diabetes Mellitus

Rajdeep Ghosh — 2024-10-01

Restriction of Mobile Phone Usage at Bed Time: Effect on Sleep Quality, Mood and Cognitive Function

Priyadharshini Sivagurunathan — 2024-10-01

Introduction: Mobile phones are integral to modern life, but excessive use, particularly at night, can lead to disrupt well-being. Limiting mobile phone use before bedtime may improve individual well-being. This study aimed to evaluate whether restricting mobile phone use at bedtime enhances sleep quality, mood, and cognitive function.

Methodology: Undergraduate students from a selected engineering college were assessed for bedtime mobile phone use. Sixty-eight students were chosen via simple random sampling. A self-reported questionnaire including the Pittsburgh Sleep Quality Index, Positive and Negative Affect Scale, and Montreal Cognitive Assessment Scale evaluated sleep quality, mood, and cognitive function before implementing restrictions. The "Lock My Phone" app was used to enforce these restrictions. Post-intervention assessments were conducted on the 15th and 30th days.

Results: Before the intervention, all students reported poor sleep quality, 80.8% had reduced positive affect, 91.1% experienced high negative affect, and only 23.5% had normal cognitive function. Significant improvements were observed in sleep quality, mood, and cognitive function post-restriction (p<0.001).

Conclusion: Restricting mobile phone use before bedtime significantly improved sleep quality, mood, and cognitive function among undergraduate students.

Enhancing Latent Tuberculosis Infection Treatment Adherence with Mobile Health Intervention: A Quasi-Experimental Study

Rohitashwa Kumar — 2024-10-01

Introduction: While detecting active TB is central to public health efforts, modelling indicates that reducing latent TB through preventive therapy is crucial. Current regimens mitigate risk but are lengthy and have side effects, necessitating support for uninterrupted treatment. This paper presents the development and evaluation of a digital health platform designed to enhance adherence among LTBI patients.

Methods: A Quasi-experimental study was conducted among LTBI patients in Delhi. A total of 163 participants were allocated to intervention (n=82) and control (n=81) groups. Participants were followed up for 6 months post recruitment. Effectiveness of mobile application was evaluated through quantitative tools.

Results: Intervention group participants showed slightly higher treatment completion rates (65.91%), in comparison to participants in control group (63%). The analysis demonstrated no co-relation of gender, age, education and employment with treatment completion rates in intervention group. While text and video-based interventions have shown success, there remains a need for more user-centric digital health interventions in this area, given the limited number of studies to date.

Conclusion: The mobile health applications can be useful for LTBI care. However, there is a need of involving users during development so that continued interest of users can be ensured.

Depression and its Association with Insomnia among Geriatric Population of Selected Slums of Bankura Municipality, West Bengal

Atanu Biswas — 2024-10-01

Background: While depression is a major health concern among older people, sleep disorders are also very common among them and often persist simultaneously. The study was conducted to assess the prevalence of depression and insomnia, and any correlation of association between them, in the geriatric people living in study area.

Methodology: A cross-sectional analytical study was conducted among 186 older people living in three selected slums of Bankura Municipality, West Bengal, India. A pre-tested, structured interviewer-administered-questionnaire including Geriatric Depression Scale-Short form and Insomnia Severity Index were used for data collection.

Results: The prevalence of geriatric depression and insomnia in the study setting were 54.3% and 37.6% respectively. While illiteracy, complete financial dependency and taking sedative were associated with geriatric depression, history of smoking was associated with insomnia among participants. Geriatric depression was significantly associated with insomnia. There was statistically significant positive correlation between GDS-S score and ISI score.

Conclusions: A significant proportion of elderly population suffers from depressive disorders and sleep disorders. Early detection and management of these conditions will provide the society with healthy ‘senior citizens.

Neck Circumference: A Novel Anthropometric Tool for Screening Obesity Among Young Adults

Mouna Hogalagere Sriramappa — 2024-10-01

Background: Obesity is a global health concern characterized by excessive fat accumulation, posing significant health risks that affect all age groups. Particularly among young adults, including medical students, obesity can lead to physical and psychosocial consequences, emphasizing the need for effective screening. The study was conducted to evaluate the effectiveness of using neck circumference as a screening tool for detecting obesity among young adults by assessing its correlation with other anthropometric measurements and determining the appropriate cut-off points

Methodology: A cross-sectional study was conducted among 146 medical students at the Apollo Institute of Medical Sciences and Research, Chittoor, Andhra Pradesh. Data were collected using a semi-structured questionnaire and various anthropometric measurements, including neck circumference.

Results: Neck circumference was higher among males, with a mean of 34.4±2.1cm for males and 30.2±1.9cm for females. Neck circumference showed significant positive correlations with height, weight, Body Mass Index, waist-hip ratio, hip and waist circumference. Neck circumference is proposed as a screening tool for assessing obesity among young adults, with cut-off values of 34cm for males and 30cm for females.

Conclusions: Neck circumference is an effective screening tool for obesity among young adults, correlating with conventional anthropometric measures.

Knowledge and Practices Among Livestock Owners Regarding Brucellosis- A Cross-Sectional Study

Kalluru Arjun Reddy — 2024-10-01

Background: Brucellosis is one of the earliest identified and most prevalent zoonotic diseases of bacterial origin with 5, 00, 000 human cases every year globally. Cases reported are only the tip of the iceberg because of the non-specificity in clinical manifestations and chronicity in complications. The study was conducted to determine the knowledge and practices regarding brucellosis among livestock owners and to determine the sero-prevalence of brucellosis in livestock owners.

Methods: A cross-sectional study was conducted among 256 livestock owners. Knowledge and practices were assessed using two-point assessment. Anti-brucellosis IgG and IgM antibodies were tested by slide agglutination test and in turn, were confirmed by standard tube agglutination test.

Results: Almost 70% of participants had poor knowledge and followed poor practices. Participants with intermittent fever (aOR: 0.2465), joint pains (aOR: 0.1418), and a history of abortions in their animals (aOR: 0.2303) were less likely to have poor knowledge. Illiterate participants (aOR: 11.9512) and those without a cowshed (aOR: 7.1445) were more likely to have poor knowledge about brucellosis. Participants with low socio-economic status (aOR: 17.3726), those who had heard about brucellosis through radio/television (aOR: 3.7746), those with primary-level education (aOR: 13.9779), and illiterate participants (aOR: 43.9506) more likely to follow poor practices. Participants with a history of symptoms like intermittent fever (aOR: 0.1338) and a history of abortions in their animals (aOR: 0.052) were less likely to follow poor practices related to brucellosis. (p< 0.05).

Conclusion: The study participants had a poor understanding of brucellosis and high levels of risky practices, all of which contributed to the risk of contracting brucellosis.

Pre-Hospital Care and Effect of Cardiopulmonary Resuscitation (CPR) On Survival Rate of Out-Of-Hospital Cardiac Arrest (OHCA) Victims, Telangana (India)

Amreen Aijaz Husain — 2024-10-01

Introduction: OHCA is among the leading causes of mortality worldwide. India lacks a comprehensive database of cardiac arrests and an efficient emergency medical system. The treatment of cardiac disease has improved, yet the outcomes of OHCA remain poor.

Methods: This is an observational 1-year prospective, single center, cohort study conducted on cohorts of OHCA victims. “Utstein Resuscitation Template” was followed for gathering the information starting location of arrest till the final resuscitation outcome. The information on OHCA patient treatment and current knowledge gaps is the aim of this study.

Results: The study was conducted in the Warangal region of Telangana, India. The research comprised 1167 OHCA patients with a suspected cardiac etiology who were taken to the Mahatma Gandhi Memorial Hospital between June 1, 2022, and June 30, 2023. CPR attempts were recorded. Findings suggested if an individual was aware of the risk factors for CVD, they were more likely to report symptoms before OHCA.

Conclusion: OHCA survival rate can be increased if the chain of survival is maintained by offering awareness and CPR training programs to the general public or bystanders, as well as efficient emergency ambulance services with qualified emergency medical staff.

Implementation of Respect for Autonomy in Hospital Services Within the Indonesia National Health Insurance System

Desdiani Desdiani — 2024-10-01

The principle of patient autonomy forms the foundation of medical ethics. However, its exploration within the context of national health insurance systems in developing countries remains under-researched. This study aimed to evaluate respect for patient autonomy within Indonesia's National Health Insurance (NHI/JKN) system. The study using a qualitative research interview analyzed thematically. Conducted in Depok, West Java, the study involved in-depth semi-structured interviews with 18 participants, encompassing patients from first-level health facilities (FLHF), general practitioners at FLHF, specialist doctors, and management of referral hospital (RH) officers, and staff members of the JKN. The data were transcribed and analyzed using a thematic approach. The study revealed substantial underutilization of respecting patient autonomy within medical contexts under the JKN. Five themes emerged: challenges in the referral system, knowledge and information dissemination, decision-making and autonomy, quality of healthcare services, and systemic constraints and impact. These themes highlight the lack of patient awareness, restricted medical choices, the dominant role of paternalism (a system in which the government or a person in a position of authority makes decisions for other people) in healthcare decisions, and improper informed consent process. The findings suggest that the principles of beneficence and paternalism often overshadow respect for patient autonomy in the JKN system. This raises concerns about the ethical aspect of patient treatment, particularly the need for greater focus on patient autonomy and shared decision-making to align more closely with global medical ethics practices. This study contributes to understanding autonomy in national health insurance systems in developing countries. It highlights the need for systemic reforms to enhance healthcare efficiency and effectiveness while respecting patient autonomy.

Prevalence and Determinants of Uncontrolled Diabetes Mellitus: A Community-Based Study from Karnataka, India

Imaad Mohammed Ismail — 2024-10-01

Background: Uncontrolled diabetes mellitus is a significant health challenge, especially in developing countries. Factors contributing to it vary by region, making it crucial to understand them for effective blood sugar control. The study’s objectives were to estimate the prevalence of uncontrolled diabetes mellitus and its determinants among residents of selected areas of Dakshina Kannada, Karnataka.

Methodology: This study was conducted from October 2021 to May 2023 among adult diabetics residing in the Jokatte and Madani Nagar areas of Dakshina Kannada. The required sample size was estimated at 180 and 90 diabetic patients were randomly selected from each study area. Data were collected by field workers using a pre-tested questionnaire, and a lab technician obtained blood samples for HbA1c. Data analysis was performed using SPSS Ver 27.

Results: The study enrolled 180 diabetics with a mean (± S.D) age of 56.9 (±10.3) years. Uncontrolled diabetes was noted in 75.6% of diabetics. Significant determinants for uncontrolled diabetes were longer duration of diabetes, poor knowledge of blood sugar tests, irregular testing and insufficient physical activity.

Conclusion: The study observed an alarming prevalence of uncontrolled diabetes and identified its key determinants. Healthcare providers must implement targeted interventions addressing these factors to achieve effective diabetes control.

Prevalence and Predictors of Fear of Childbirth Among the Pregnant Women Attending a Tertiary Care Hospital in Imphal-East District Manipur, North-East India: A Cross-Sectional Study

Bishwalata Rajkumari — 2024-10-01

Background: Fear of childbirth (FOC) is a feeling of uncertainty and anxiousness before, during or after delivery which may increase the risk of various physical problems and mental disorders thereby affecting maternal and infant morbidity and mortality. Objectives: To estimate the prevalence of fear of childbirth and to determine its associated factors among pregnant women.

Methodology: A hospital-based cross-sectional study was conducted among pregnant women attending ante-natal clinic of a tertiary-care hospital in Imphal-East District of Manipur. A 30-item questionnaire was used for data collection. Descriptive statistics, univariate and multivariate logistic regression analysis were performed to test for association taking all variables with p < 0.2 for model building for the adjusted analysis. A p value <0.05 was taken as level of significance. Ethical approval was obtained from the Institutional Ethics Committee.

Results: Out of 431 participants, fear of childbirth was seen in 36%. Increasing age of the respondent (AOR: 0.877) and residing in urban area (AOR: 0.548) showed a protective effect but respondents having past history of abortion (AOR: 2.054) and being in the third trimester of pregnancy (AOR: 1.964) were found to have an increased risk of having ‘Fear of childbirth’ (p<0.005).

Conclusions: Overall, 155 (36%) of women had fear of childbirth. It is important that healthcare professionals to be aware of fear of childbirth and ensure that pregnant women receive adequate health education, counselling during regular ANC checkups.

The Influence of Personal Listening Devices on Hearing in Egyptian University Students: A Cross-Sectional Study

Nabila Mohammed Raouf — 2024-10-01

Background: Improper use of personal listening devices (PLDs) is associated with an increased risk of hearing loss. The purpose is to investigate the use of PLDs among university students and their impact on hearing.

Methodology: A study involved 310 University students, surveyed on their PLDs habits. They shared their daily PLD use, volume level, and duration of use. Participants also discussed PLD-related hearing issues and other risk factors for hearing loss. Screening used the Five-minute hearing test (FMHT) and the “Hear WHO” app. Positive cases in both tests received diagnostic pure-tone audiometry (PTA).

Results: About 70% used in-earpiece PLDs for studying, 53% used them for over 5 years. Also 83% used PLDs for over 60 mins daily, and 72% used them above volume level 6. Most (74%) were low-risk users. 10.6% tested positive for hearing loss in both screenings, with 1.6% confirmed by PTA. A shift in the 4 kHz average hearing threshold was noted. Tinnitus was reported by 49%, and ear pain by 42% of students. Higher risk PLD use predicted tinnitus, ear pain and excessive ear wax in multivariable analysis.

Conclusions: Students' high-volume PLD use is linked to auditory problems like tinnitus and ear pain. Regular hearing screenings are recommended.

Transforming Healthcare Communication in India: A Strategic Paradigm

Urvish Joshi — 2024-10-01

Epidemiological Analysis of Cancer Patients Diagnosed With Cranial Metastasis at Initial Presentation

Ercan Kaya — 2024-10-01

Introduction: Metastatic lesions are the most common brain tumors, comprising 52% of all cases. Early diagnosis is crucial to improve patient outcomes, but many cases remain undiagnosed until advanced stages. This study aimed to investigate the characteristics of patients diagnosed with brain metastasis concurrently with their primary malignancy, examine prognostic factors, and compare these findings with brain metastases of known primary origins.

Method: A retrospective analysis was conducted on 184 patients between 18-80 years diagnosed with brain tumors between January 2018 and January 2019. Patient data were collected from clinical records, and statistical analyses were performed using SPSS 26.0.

Results: Out of the total patients, 43% were diagnosed brain metastases. Among these, 33% had no known primary malignancy at diagnosis. In this group, 92.3% were over 50 years old, and 77% were male. The most frequent primary cancer was lung cancer (81%). Males had an average time to metastasis diagnosis approximately twice as long as females. A higher incidence of metastasis correlated with a lower Karnofsky Performance Score, indicating reduced operability and quality of life.

Conclusion: Early diagnosis is critical to improving outcomes. Routine cranial imaging for patients over 50 may aid in early intervention.

Prevalence of Depression, Anxiety, Stress and Suicide Ideation Among Undergraduate Medical Students in India: A Systematic Review and Meta-Analysis

Harpreet Kaur — 2024-10-01

Background: Studies reported significant levels of psychological morbidity from across the globe among undergraduate medical students. Present meta-analysis aimed to provide a most up to date comprehensive insight into the prevalence of depression, stress, anxiety and suicidal ideation among undergraduate medical students in India.

Material and Methods: A systematic search was conducted in three databases PubMed, Scopus and Google Scholar from July 2023 to August 2023. Quality of included studies (43 studies, N=15557) was assessed using modified Newcastle-Ottawa scale and data was analyzed using MetaXL version 5.3. Pooled estimates with 95% confidence intervals were determined using the random-effects model.

Results: The pooled prevalence of depression, anxiety, stress and suicide ideation was 48% (95% CI: 41-55%) (P 0.000, I² = 98%), 54% (95% CI 42-58%) (P =0.00, I² = 98%), 50% (95% CI 45-63%) (P =0.001, I² = 99%) and 21% (95% CI: 9-35%) (P =0.000, I² = 98%) respectively. Subgroup analysis showed more females than males students were affected from depression, anxiety, stress and suicide ideation.

Conclusion: High prevalence of psychological disorders in medical students in India emphasize the need for the counselling services to control this morbidity and implement long term policies and programs at institutional level.