Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

BACKGROUND

The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa.

OBJECTIVE

Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups.

OUR APPROACH

Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel.

ONGOING ACTIVITIES

Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality.

CONCLUSION

There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.

Tuberculosis in the era of COVID-19 in India

BACKGROUND AND AIMS

Tuberculosis (TB) still continues to be endemic in various regions of the world, including in India and needs surveillance, clinical assessment, testing, contact tracing, confirmation of diagnosis with supervised or in-supervised treatment regimens for an effective eradication. We assess the challenges due to COVID- 19 pandemic on management of Tuberculosis and current strategies adopted to mitigate them.

METHODS

We carried out a comprehensive review of the literature using suitable keywords such as 'COVID-19', 'Pandemics', 'Tuberculosis' and 'India' on the search engines of PubMed, Scopus, Google Scholar and Research Gate in the month of May 2020 during the current COVID-19 pandemic to assess the impact of COVID-19 on management of Tuberculosis.

RESULTS

We found considerable disruption in Tuberculosis service provisions both in the primary care and hospital settings. Lockdown, social distancing, isolation strategies and public health guidelines to prevent viral transmission impacted the delivery of all aspects of Tuberculosis care.

CONCLUSIONS

COVID-19 pandemic has had a significant impact in the delivery of various tuberculosis prevention, surveillance, and treatment programmes. Lockdown and public health guidelines have resulted in tough challenges in traditional management of tuberculosis and has required reconfiguration of methods to support patients including wider use of remote consultations.

Preparedness, perceived impact and concerns of health care workers in a teaching hospital during coronavirus disease 2019 (COVID-19)

Objective:

Coronavirus Disease 2019 is a new threat to human lives worldwide. Preparedness of institutions during epidemic outbreak has a pivotal role in saving lives and preventing further spread. At the same time, these pandemics impact badly on professional and personal life of Health care workers. The objective of this study is to find the opinion of Health care workers regarding their level of preparedness, concerns and perceived impact related to this pandemic outbreak.

Materials and Methods:

In this study, random samples of doctors and nurses was provided with a self-administered questionnaire regarding their preparedness, work and non-work related concerns and impact on their lives during Covid-19 outbreak.

Results:

Most of the Health Care Workers believed that their institute preparation to fight Covid-19 pandemic is better than prior to onset of this crisis (P < 0.001). Work related stress was seen more commonly in nurses whereas higher frequency of non-work related stress was observed among doctors. Nurses (75.55%) faith in their employer was more than doctors faith (46.66%) regarding their medical needs. There was more acceptance of hydroxychloroquine as a prophylactic drug for Covid-19 in doctors compared to nurses (P < 0.01).

Conclusions:

Though this institute was more prepared at the time of pandemic spread, substantial opportunity of improvement remains. The consistency of work and non work related anxiety and stress in health care workers is very high in present study group. Concerns and risks of Health Care Workers should be addressed ethically and adequately by strengthening safety measures and building trust in the system they work.

Mutation density changes in SARS-CoV-2 are related to the pandemic stage but to a lesser extent in the dominant strain with mutations in spike and RdRp

Since its emergence in Wuhan, China in late 2019, the origin and evolution of SARS-CoV-2 have been among the most debated issues related to COVID-19. Throughout its spread around the world, the viral genome continued acquiring new mutations and some of them became widespread. Among them, 14408 C>T and 23403 A>G mutations in RdRp and S, respectively, became dominant in Europe and the US, which led to debates regarding their effects on the mutability and transmissibility of the virus. In this study, we aimed to investigate possible differences between time-dependent variation of mutation densities (MDe) of viral strains that carry these two mutations and those that do not. Our analyses at the genome and gene level led to two important findings: First, time-dependent changes in the average MDe of circulating SARS-CoV-2 genomes showed different characteristics before and after the beginning of April, when daily new case numbers started levelling off. Second, this pattern was much delayed or even non-existent for the "mutant" (MT) strain that harbored both 14408 C>T and 23403 A>G mutations. Although these differences were not limited to a few hotspots, it is intriguing that the MDe increase is most evident in two critical genes, S and Orf1ab, which are also the genes that harbor the defining mutations of the MT genotype. The nature of these unexpected relationships warrants further research.

Coronaviruses pathogenesis, comorbidities and multi-organ damage - A review

Human coronaviruses, especially COVID-19, is an emerging pandemic infectious disease with high morbidity and mortality. Coronaviruses are associated with comorbidities, along with the symptoms of it. SARS-CoV-2 is one of the highly pathogenic coronaviruses that causes a high death rate compared to the SARS-CoV and MERS. In this review, we focused on the mechanism of coronavirus with comorbidities and impairment in multi-organ function. The main dysfunction upon coronavirus infection is damage to alveolar and acute respiratory failure. It is associated with the other organ damage such as cardiovascular risk via an increased level of hypertension through ACE2, gastrointestinal dysfunction, chronic kidney disease, diabetes mellitus, liver dysfunction, lung injury, CNS risk, ocular risks such as chemosis, conjunctivitis, and conjunctival hyperemia, cancer risk, venous thromboembolism, tuberculosis, aging, and cardiovascular dysfunction and reproductive risk. Along with this, we have discussed the immunopathology and coronaviruses at a molecular level and therapeutic approaches for the coronavirus infection. The comorbidities and multi-organ failure of COVID-19 have been explained at a molecular level along with the base of the SARS-CoV and MERS-CoV. This review would help us to understand the comorbidities associated with the coronaviruses with multi-organ damage.

Increasing cardiovascular medication adherence: A medical research council complex mhealth intervention mixed-methods feasibility study to inform global practice

AIMS

To evaluate a mHealth intervention to increase medication adherence among Iranian coronary heart disease patients.

DESIGN

Quantitative-dominant mixed-methods study.

DATA SOURCE

Iranian coronary heart disease patients' responses and most recent clinical documents as well as responses from Iranian cardiac nurses who participated in this study.

METHODS

The study was conducted between September 2015-April 2016 drawing on the Medical Research Council's Framework. Phase one comprised of a patients' survey and focus groups with cardiac nurses. The automated short message service reminder was piloted in phase two. We recruited 78 patients and randomized to receive either 12-week daily reminders or usual care. The primary outcome was the effect on medication adherence; secondary outcomes were self-efficacy, ejection fraction, functional capacity, readmission rate and quality of life.

RESULTS

Feasibility was evidenced by high ownership of mobile phones and high interest in receiving reminders. Participants in the intervention group showed significantly higher medication adherence compared with the control group.

CONCLUSION

The mHealth intervention was well accepted and feasible with early evidence of effectiveness that needs to be confirmed in a fully powered future randomized clinical trial.

Cancer awareness and attitude towards cancer screening in India: A narrative review

Cancer awareness is the key to early detection and better health-seeking behaviour. Cancer is quite common in both developing as well as developed countries, but awareness is yet poor among the general population. Poor awareness may lead to poor uptake of screening modalities and delay in diagnosis. One factor that has been consistently shown to be associated with late diagnosis and treatment is a delay in seeking help for cancer-like symptoms. This paper reviews the literature on cancer awareness among the general population and attitude towards screening modalities. The poor awareness level among the Indian population shows the need for health education and sensitisation regarding cancer and its different aspects. This will be helpful in the successful implementation of health programmes related to cancer.

Smartphone use and the quality of life of medical students in the Kumaun Region, Uttarakhand

Background:

Once a device for telecommunication, now a powerful device bringing the whole world in one's palm, smartphones are increasingly becoming a common commodity among the medical students. Smartphones foster social interaction and facilitate multitasking and learning, but they also have some adverse effects. Young people, especially students, who are always inquisitive towards new technology, are likely to be affected by both these positive and negative impacts.

Objective:

To assess smartphone use and its association with the quality of life (QOL) of medical students.

Materials and Method:

A cross-sectional study was conducted among the undergraduate medical students of Government Medical College (GMC), Haldwani. All the students enrolled in MBBS course in GMC, Haldwani, who gave consent for participation and were present on the day of questionnaire administration, were included in the study. Smartphone addiction scale (SAS-SV), and WHO-BREF questionnaires for QOL were used for assessing smartphone use, and QOL of the medical students, respectively.

Results:

A total of 395 medical students were included in the study; out of them, 42% considered themselves addicted to the smartphone. According to SAS-SV, smartphone addiction was found among 43.8% medical students. It was seen that the junior-most and senior-most batches were significantly less addicted to the smartphone (p-value < 0.001). Male students were more addicted (OR = 1.45, CI = 0.962–2.174) to the smartphone as compared to females. The QOL of the students was significantly affected by smartphone use in all domains assessed (p-value ranging from < 0.001 to 0.002).

Conclusions:

Smartphone addiction is high among medical students and it has a significant negative impact on their QOL.

How India is dealing with COVID-19 pandemic

India, which has the second-largest population in the world is suffering severely from COVID-19 disease. By May 18th, India investigated ∼1 lakh (0.1million) infected cases from COVID-19, and as of 11th July the cases equalled 8 lakhs. Social distancing and lockdown rules were employed in India, which however had an additional impact on the economy, human living, and environment. Where a negative impact was observed for the economy and human life, the environment got a positive one. How India dealt and can potentially deal with these three factors during and post COVID-19 situation has been discussed here.

The potential impact of the COVID-19 response related lockdown on TB incidence and mortality in India

India has the highest burden of incident tuberculosis (TB) cases and deaths globally. TB is strongly associated with poverty and this risk is largely mediated by undernutrition in India. COVID-19 response related lockdown has resulted in an economic crisis which may double levels of poverty, has exacerbated food insecurity, and disrupted TB services. These developments may have serious implications for TB progression and transmission in India. The nutritional status of a population is a strong determinant of the TB incidence, and undernutrition in adults alone accounts for 32-44% of TB incidence in India. A systematic review has shown that a 14% increase in TB incidence can occur per one unit decrease in body mass index (BMI), across the BMI range of 18.5-30 kg/m2. We believe that one unit decrease in BMI (corresponding to a 2-3 kg weight loss) may result in the poor in India as a result of the lockdown and its aftermath. This may result in an increase in estimated (uncertainty interval) incident TB by 185 610 (180 230, 190 990) cases. A 59% reduction in TB case detection between end March and May 2020, may result in an estimated (uncertainty interval) additional 87 711 (59 998, 120 630) TB deaths [19.5% increase (14.5, 24.7)] in 2020. Disadvantaged social groups and those living in states with higher levels of poverty, under-nutrition,and migrant workers are at particular risk. We suggest enhanced rations including pulses through the public distribution system and direct cash transfers to the poor pending restoration of livelihoods. TB services should be resumed immediately with enhanced efforts at case detection including active case finding. To prevent deaths among TB detected within the national TB programme, systemic identification, referral and management of severe disease at notification should be considered.

Caring for older adults during the COVID pandemic and beyond: experience from a specialized tertiary facility for the care of older persons in a low resource setting

The ongoing Coronavirus disease (COVID-19) pandemic has markedly changed health care provisions and arrangements for patient care. Older adults are most susceptible to worse outcomes. The public health impact of the disease in terms of morbidity and mortality has necessitated the evolution of management protocols for effective care of older persons. This review describes our experience during this period attending to the healthcare needs of both the acutely ill and clinically stable patients at the first purpose-built facility for the care of older persons in Nigeria, the Chief Tony Anenih Geriatric Centre (CTAGC), University College Hospital, Ibadan. A major strategy recommended by the World Health Organization was a lockdown with restricted movements and laid down rules for engagement. As such, the CTAGC also embarked on steps to ensure patient safety as well as effective care. Prior to the lockdown, targeted activities included fumigation of the centre as well as health education and promotional activities. Measures were put in place to care for up to 95% of our patients at home. Thus, a "Care in Place" approach was adopted to enable them to take ownership of their care. Ambulatory older patients were seen on an out-patient basis following scheduled appointments after a telephone consultation through the hospital's designated lines. Clients were managed for their routine health conditions which were mostly non-communicable diseases (NCDs). Also, acutely ill older patients were admitted for acute exacerbation and/or complications of their chronic morbidities. Importantly, 60% of admitted patients presented with COVID like symptoms but they all tested negative for COVID 19. Based on our experience at the CTAGC, older persons can be successfully managed through a "Care in place" approach in a resource-poor setting during pandemics with high infectivity rates such as COVID 19. The information hereby generated is beneficial for future practice.

Diabetes self-management amid COVID-19 pandemic

BACKGROUND AND AIMS

COVID-19 pandemic has challenged the physician-centered approach of diabetes care in India that is primarily based on routine clinic visits. We aim to review the various aspects of patient-centered care via diabetes self-management education based on available literature.

METHODS

This is a narrative review using Pubmed, EMBASE and Google Scholar search till March 29, 2020. Search terms were "COVID-19", "diabetes self-care", "diabetes self-management education", "DSME", "diabetes self-management in India", "diabetes self-care in India" and "DSME in India".

RESULTS

We have discussed an educational plan on diabetes self-management that can be adopted for people with diabetes mellitus in our country amid the ongoing pandemic. We have also identified the barriers to diabetes self-management in the current scenario and suggested possible solutions to overcome those.

CONCLUSIONS

We have reemphasized the need for a simultaneous patient-centered approach in routine diabetes care that has to be coordinated by a multidisciplinary team amid the ongoing COVID-19 pandemic.

Cost of Management of Diabetes Mellitus: A Pan India Study

Background:

Diabetes mellitus is a major noncommunicable disease. While mortality rates are increasing, the costs of managing the disease are also increasing. The all-India average monthly expenditure per person (pppm) is reported to be ₹ 1,098.25, which translates to an annual expenditure of ₹13,179 per person.

Purpose:

While a number of studies have gone into the aspect of the cost of disease management, we do not find any study which has pan-India reach. We also do not find studies that focus on differences (if any) between rural and urban areas, age or on the basis of gender. We planned to report the cost of illness (COI) in diabetes individuals as compared to others from the data of a pan-India trial.

Methods:

Government of India commissioned the Indian Yoga Association to study the prevalence of diabetes mellitus in India in 2017. As part of the questionnaire, the cost of treatment was also captured. Data collected from 25 states and union territories were analyzed using the analysis of covriance (ANCOVA) test on SPSS version 21.

Results:

There was a significant difference (P < .05) between the average expenses per person per month (pppm) of individuals with self-reported known diabetes (₹1,357.65 pppm) and others (unknown and/or nondiabetes individuals–₹ 999.91 pppm). Similarly, there was a significant difference between rural (₹2,893 pppm) and urban (₹4,162 pppm) participants and between those below (₹1,996 pppm) and above 40 years (₹5,059 pppm) of age.

Conclusion:

This preliminary report has shown that the COI because of diabetes is significantly higher than others pointing to an urgent need to promote disease-preventive measures.

Trends & treatment outcomes of multidrug-resistant tuberculosis in Delhi, India (2009-2014): A retrospective record-based study

BACKGROUND & OBJECTIVES

The increase in the burden of multidrug-resistant tuberculosis (MDR-TB) is a matter of grave concern. The present study was undertaken to describe MDR-TB treatment outcome trends in Delhi and their epidemiological correlates, to assess the adequacy of treatment records and to also generate evidence towards influencing and improving practices related to the MDR-TB control programme.

METHODS

A retrospective record-based study (2009-2014) was conducted in three major drug resistance TB treatment centres of Delhi. Treatment outcomes and adverse effects were extracted from the existing programme records including patients' treatment cards and laboratory registers.

RESULTS

A total of 2958 MDR-TB patients were identified from the treatment cards, of whom 1749 (59.12%) were males. The mean (±standard deviation) age was 30.56±13.5 years. Favourable treatment outcomes were reported in 1371 (53.28%) patients, but they showed a declining trend during the period of observation. On binomial logistic regression analysis, patients with age ≥35 yr, male sex and undernourishment (body mass index <18.5) at the time of treatment initiation had a significantly increased likelihood of unfavourable MDR-TB treatment outcome (P <0.001).

INTERPRETATION & CONCLUSIONS

The study showed an increasing burden of MDR-TB patients, especially in the young population with increased risk of transmission posing a major challenge in achieving TB elimination targets.

Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study

BACKGROUND

Primary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial.

OBJECTIVE

The aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India.

METHODS

We conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care.

RESULTS

A total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49%), inadequate ventilation (n=29, 57%), and negligible airborne infection control measures (n=38, 75.5%). N95 masks were available at 26 (50.9%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5% (n=12) and 27.4% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P<.001) during the COVID-19 pandemic.

CONCLUSIONS

Existing PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies.

Audit of diabetic care in family practice center in Abha City, Aseer region: CBAHI standards application

OBJECTIVE

The objectives of this study is to assess the quality of diabetic care at AlManhal PHCC based on CBAHI standards.

METHODS

This audit was conducted during 2018 at Al_Manhal PHCC through assessment all aspects of DM care ( structures, processes and outcomes) using CBAHI standards . Data entry and analysis were managed used SPSS.

RESULTS

Most of DM structures were available at the PHCC , however, health educational program , lab relevant facilities were partially met the standards. Records of 429 patients were assessed for process of care which were satisfactory except for laboratory investigations and eye examination which were partially met . Good DM metabolic control was (28%) , HTN control (71%) and lipid control( 54%), good compliance with appointment was 85% . The most common documented complications were retinopathy( 14%), nephropathy (4.5%) and CHD( 4%).

CONCLUSION AND RECOMMENDATIONS

This audit revealed that using of CBAHI standards for DM care at PHCC is simple and practical and could help to identify the weak areas that needs improvement. The present care of DM in our PHCC has acceptable infrastructures except for health education program , laboratory and referral system which should be scaled up to improve the processes and outcomes. DM control is still a big challenge and needs more collaborative effort between health care providers and patients.

Primary Non-Adherence to Antihistamines-Conclusions From E-Prescription Pilot Data in Poland

Background

In allergic conditions such as allergic rhinitis and urticaria, orally administered H₁-antihistamines belong to first-line therapy and therefore, are widely prescribed. Due to the frequent, and often chronic, course of allergic diseases, adherence is of great importance. In 2018 a novel, nationwide e-prescription system was piloted in Poland, which allowed to analyze primary non-adherence to orally administered H₁ antihistamines.

Objectives

To assess the primary non-adherence to orally administered H₁-antihistamines in Poland, defined as not redeeming the drug issued on a particular e-prescription within its validity period.

Methods

The study was based on all e-prescriptions issued in Poland in 2018, issued for 119.880 drugs. The analysis included nine major orally administered H₁ antihistamines available in Poland.

Results

Out of 2280 analyzed e-prescriptions on orally administered antihistamines, 1803 (79.1%) of them were redeemed. Therefore, the level of primary non-adherence reached 21%. Among women it reached 19.9%, but it was not significantly lower than among men (23.4%, p=0.064). The highest non-adherence (31.3%) was observed in the age group 19-39, whilst the highest adherence rate (84.6%) was observed in those 75 years or older. The most frequently prescribed second-generation antihistamine was bilastine—596 e-prescriptions with 23.7% primary non-adherence.

Conclusions

More than 1 out of 5 e-prescriptions on orally administered H₁-antihistamines were not redeemed in Poland in 2018. Age, but not gender, significantly influenced the degree of primary non-adherence to these drugs. To authors knowledge, this is the first real-life study on primary non-adherence to H₁-antihistamines in Poland and one of the very few on this subject worldwide.

Problematic Mobile Phone and Smartphone Use Scales: A Systematic Review

The popularity of smartphones is undeniable in nearly all facets of society. Despite the many benefits attributed to the technology, concern has grown over the potential for excessive smartphone use to become problematic in nature. Due to the growing concerns surrounding the recognized and unrecognized implications of smartphone use, great efforts have been made through research to evaluate, label and identify problematic smartphone use mostly through the development and administration of scales assessing the behavior. This study examines 78 existing validated scales that have been developed over the past 13 years to measure, identify or characterize excessive or problematic smartphone use by evaluating their theoretical foundations and their psychometric properties. Our review determined that, despite an abundance of self-report scales examining the construct, many published scales lack sufficient internal consistency and test-retest reliability. Additionally, there is a lack of research supporting the theoretical foundation of many of the scales evaluated. Future research is needed to better characterize problematic smartphone use so that assessment tools can be more efficiently developed to evaluate the behavior in order to avoid the excessive publication of seemingly redundant assessment tools.

An institution-based study to assess the prevalence of Nomophobia and its related impact among medical students in Southern Haryana, India

BACKGROUND

Inappropriate usage of mobile phones is very hazardous for school and college students as it results in poor academic performance due to the poor concentration during classes or lectures over use of mobile phones, accidents due to reduced concentration while driving, and poor social relations due to preference for mobile usage and avoiding nearby people.

AIM

Considering the above facts, the present study was conducted with an aim to estimate the prevalence of nomophobia among students and interns of medical college and its negative impacts on their sleep quality, and academic performance.

METHODS

The present study was conducted at SHKM GMC, Nalhar, Nuh from November to December 2018 among 600 MBBS students and interns who were using mobile phones using a pretested, predesigned, and standardized questionnaire. Test results with P value less than 0.05 only were considered statistically significant.

RESULTS

Nearly two fifth of the study subjects (40.1%) were found to have nomophobic, with scores more than twenty-four. The Pearson's chi square analysis reflected that most of the academic performance variables such as decline in study habits and grades, reduced concentration, and coming late for classes have a statistically significant (P = 0.000) association with nomophobe score.

CONCLUSION

In conclusion, a significant burden of mobile phone addiction and a tendency for impaired control that compromises the health and wellness were prevalent in medical students. Measures need to be taken to address this challenge in view of the current era of growing information technology.

Nomophobia: impact of cell phone use and time to rest among teacher students

Nomophobia is one of the modern pathologies that has been born as a consequence of the impact that portable technologies have had on society and the dependence generated among citizens, especially towards smartphones. This phobia manifests itself and is intensified by the loss of immediate access to information, to the network of contacts, as well as by the impossibility of contacting or being contacted by other people. All this ends up interfering with the development of the person's daily life (physical, physiological, psychological, social problems, among others). Although the research is in an incipient phase, the problem has not been studied with the teaching population, so we present a pioneering study with this group, the main objective being to analyze the prevalence of nomophobia in future teachers of Early Childhood and Primary Education, as well as to check the incidence of rest time in the levels of nomophobia. The study follows a descriptive, correlational, transversal and predictive design and a quantitative methodology. The standardized nomophobia questionnaire NMP-Q was used on a sample of n = 849 future teachers. The results show average levels of nomophobia in most of the variables. However, the higher levels of nervousness, fear or anxiety stand out due to the inability to communicate instantaneously. Also, a higher prevalence of the problem is observed in the sector of the sample that claims to sacrifice rest time due to the use of their mobile phone. Although these numbers are not alarming, we must take into account that in some variables the prevalence is slightly higher, making it necessary to make educational interventions in this regard and to promote education for the responsible and critical use of media and technologies.

Mobile Phone Dependence among Undergraduate Students of a Medical College of Eastern Nepal: A Descriptive Cross-sectional Study

INTRODUCTION

Mobile phones are becoming increasingly indispensable in daily life of the students which has resulted in mobile phone dependence. The objective of the study was to find the prevalence of mobile phone dependence among undergraduate students of a medical college of Eastern Nepal.

METHODS

A descriptive cross-sectional study was conducted from October 2016 to March 2017 on a total of 390 undergraduate students aged between 17 and 25 years using stratified sampling technique. Students using mobile phones for more than one year was included in the study. Students were requested to complete a pretested self-administered questionnaire which comprised their socio-demographic characteristics, pattern of mobile phone usage and mobile phone addiction index developed by Leung.

RESULTS

The prevalence of mobile phone dependence among the undergraduate students was found to be 85 (21.8%). Mobile phone dependence was found to be related with time spend on mobile; calls per day, money spend on recharge per month and years of ownership of mobile phone. There was no difference between males and females with regard to mobile phone dependence.

CONCLUSIONS

The present study found that mobile phone dependence was common among the undergraduate medical students. These results suggest the need to develop educational programme to educate the students to use mobile phone meaningfully.

Cardiovascular disease risk assessment and treatment among person with type 2 diabetes mellitus at the primary care level in rural central India

INTRODUCTION

Despite evidence in support of assessment and treatment of risk factors to prevent cardiovascular disease (CVD) among people with type 2 diabetes mellitus (T2DM), studies have shown gaps in practises at the primary care level. The study was undertaken to find out the prevalence and management of risk factors for CVD in patients with T2DM from rural area India.

METHODOLOGY

A crosssectional study was conducted in a tertiary care hospital in rural India. Around 192 persons with T2DM over 35 years of age were interviewed and examined using a structured questionnaire to determine the presence of CVD risk factors, previous assessment and management of these risk factors.

RESULTS

The mean age was 58.91 (SD 11.30) years. Tobacco use and harmful consumption of alcohol were reported by 67.7% and 27%, respectively. Nearly 43.8% were doing moderateintensity physical activity, 2.1% were consuming more than 6 servings of green leafy vegetables/fruits per week, 22.9% were overweight and 5.2% were obese. A family history of CVD was present in 12.5%. About 75% of participants were having one or more risk factors for CVD, and a comprehensive CVD risk assessment was done by 15%. The most commonly assessed risk factor was blood pressure (84.3%) and blood sugar (40%). Around 30% were advised for weight reduction and 23.4% were advised to quit tobacco. Dietary counseling and diet plan were prepared for 17 (8.9%) participants.

CONCLUSION

Nearly threefourths were receiving treatment for hypertension. The majority of people with T2DM in rural areas had one or more CVD risk factors; however, very few were assessed and treated for CVD risk factors at the primary care level. Patient education and training of the diabetes care providers at the primary care level may be useful for comprehensive CVD risk assessment and treatment to prevent CVD complications in patients of T2DM.

Awareness and perspectives on expansion of latent TB management among public-sector physicians and medical trainees in Delhi, India

More than one in two healthcare workers (HCWs) in developing countries have latent tuberculosis infection (LTBI), an asymptomatic condition signifying persistent tubercular infection in absence of disease.

OBJECTIVE

to evaluate the physician attitude towards LTBI preventive therapy and their perspectives regarding the potential expansion of latent TB management under the RNTCP.

MATERIAL AND METHODS

We conducted a cross-sectional analysis among 60 participants of a continuing medical education program during October' 2019 in a medical college in Delhi, India.

RESULTS

We enrolled a total of 30 medical officers, 15 resident doctors and 15 medical interns, comprising 27 (45%) males and 33 (55%) females. Only 9 (15%) participants were aware of existing RNTCP guidelines for programmatic management of LTBI. The median (IQR) self-rated willingness of the participants in receiving treatment for LTBI after confirmation of diagnosis on a 10 point continuous rating scale was 6 (5.8). The principal reason attributed to the treatment hesitancy were concerns over drug side effects 19 (31.7%), emergence of drug resistance 11 (18.3%) and the likelihood of reinfection 4 (6.7%). Support for expansion of preventive therapy among household TB contacts was varied, with maximum (41.2%) participants wanting it only for the comorbid patients.

CONCLUSION

LTBI preventive treatment is associated with considerable side effects and lack of long-term benefits by a majority of Indian physicians despite significant personal health concerns in treating pulmonary TB cases.

The determinants of out-of-pocket health-care expenses for diabetes mellitus patients in India: An examination of a tertiary care government hospital in Delhi

OBJECTIVE

To assess the determinants of out-of-pocket (OOP) expenses on diabetes-related treatment incurred in patients attending outpatient clinics in a tertiary care hospital in Delhi, India.

STUDY DESIGN

A cross-sectional analysis of baseline data from a quasi-experimental study was conducted over 8 months in 2016 in a major tertiary care hospital in Delhi.

METHODS

The study included 375 diabetes patients up to 65 years of age on treatment for at least a year without significant complications. Data were collected through a patient interview schedule.

RESULTS

Of the previous six scheduled appointments, at least two missed appointments were seen in 267 (71.2%) patients. The average patient's OOP expenditure on diabetes-related medicines was ₹63.5 a month, a similar amount was spent on traveling to and from health facilities. Sixty-four (17.1%) patients took antidiabetic medication for <85% of the days in the previous 3 months.

CONCLUSION

There exists a high burden of missed clinic appointments among diabetes patients in tertiary care government health settings in India. This appears to be related to the high cost in terms of both time and money involved in attending appointments for the modest benefit of a dispensation of a 15-day drug refill. Health policy measures focused on strengthening medication coverage need to explore the balance of costs and benefits when determining the frequency of clinical appointments in these settings.

Translation of the Chinese Version of the Nomophobia Questionnaire and Its Validation Among College Students: Factor Analysis

Background

Nomophobia or phobia of no mobile phone is the fear of being without a mobile phone or being unable to contact others via a mobile phone. It is a newly emerging psychiatric disorder among mobile phone users.

Objective

There are no psychometric scales available in China for examining nomophobia, although China has become the largest mobile phone handset consumer market in the world. Therefore, this study aimed to translate the original English version of a psychometric scale into Chinese and further examine its reliability and validity among Chinese college students.

Methods

The original version of the Nomophobia Questionnaire (NMP-Q) was first translated into Chinese using the backward and forward translation procedure. An exploratory factor analysis (a principal component analysis plus varimax rotation) and a confirmatory factor analysis (CFA) were performed to examine the underlying factor structure of the translated questionnaire. The internal consistency reliability of the scale was determined by computing the Cronbach alpha coefficient, the test-retest reliability, and the corrected item-total correlation. A multivariate regression analysis was used for examining associations between nomophobia and independent variables among the college students.

Results

A total of 2000 participants were included in the study. Their ages ranged from 16 to 25 years, with 51.95% (1039/2000) being male participants. The Chinese version of NMP-Q retained 18 items. The eigenvalues, total variance explained, and scree plot jointly support a 4-factor structure of the translated questionnaire. The CFA reached the adaptive standard, and the discriminant validity of the scale was good. The Cronbach alpha coefficient of this scale was .925, and the Cronbach alpha coefficients of the subscales were .882, .843, .895, and .818. The test-retest reliability was 0.947. Corrected item-total correlation ranged from 0.539 to 0.663. The significant predictors for each of the dimensions of nomophobia and total score of the questionnaire were the average number of hours spent on a mobile phone daily and gender.

Conclusions

The Chinese version of the NMP-Q exhibited satisfactory psychometric properties.

Fat taxation in India: A critical appraisal of need, public health impact, and challenges in nationwide implementation

National Nutritional Monitoring Bureau survey (2017) has found that more than half of the adults in India were overweight and obese. To halt this rising epidemic, development of various policy measures has been suggested in National action plan for prevention and control of noncommunicable diseases. One such measure is the introduction of fat tax which is a surcharge or tax placed on food and beverages containing high amounts of fat. Government of India has made various direct budgetary initiatives for boosting the sectors related to the production of items rich in fat, sugars and salt without realizing the potential public health consequences. Hence, increasing the taxes for unhealthy junk foods should encourage the people to take healthier food options which in turn lead to positive impact on health. However, fat taxationfaced several challenges during implementation in countries like Denmark, Hungary, France and United States. Major challenges were the taxation debate, setting tax limit and encroaching into the autonomy rights of people. Evidences have shown that taxation alone cannot bring down the burden of non-communicable diseases but should be combined with measures like subsidies and access to healthy food items, public health education campaigns and programmes.

Nomophobia: An Individual's Growing Fear of Being without a Smartphone-A Systematic Literature Review

This review examines the current literature focused on nomophobia (objectives, methodological design, main variables, sample details, and measurement methods) in the Scopus and Web of Science databases. To this end, we conducted a systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. The initial sample consisted of 142 articles, of which 42 met the inclusion criteria and were analyzed in detail. The findings show that the current research is in an exploratory phase, with a greater predominance of descriptive, nonexperimental, and cross-sectional studies that explore the prevalence of nomophobia mainly in adolescents and university students. The most widely used measurement instrument is the Nomophobia Questionnaire (NMP-Q) proposed by Yildrim and Correia. In addition, the research suggests that nomophobia negatively affects personality, self-esteem, anxiety, stress, academic performance, and other physical and mental health problems. We are therefore faced with a health problem, which negatively affects a person, causing psychological problems and physical and behavioral changes.

Behaviour model for diabetic ulcer prevention

Purpose

Diabetic ulcers are one of the complications that often occur in patients with DM. The aim is to develop a behaviour model for diabetic ulcer prevention by integrating Lawrance Green Theory and the Theory of Planned Behaviour.

Methods

An explanative observational design was used with a cross-sectional approach. The population consisted of DM patients who had underwent treatment at the internal medicine clinic of Sidoarjo District Hospital. The sample size of 133 respondents was obtained through purposive sampling. The data analysis used Partial Least Square.

Results

Predisposing factors (knowledge), supporting factors (availability of health facilities and accessibility of health resources) and driving factors (the role of health workers and family support) significantly influence the main factors (attitudes toward behaviour, subjective norms and perceptions of self-control) with a statistical T value>1.96. The main factor influences intention (T = 48.650) and intention influences behaviour (T = 4.891).

Conclusion

Intention is influenced by the attitudes toward behaviour, subjective norms and self-control perceptions. Good intentions can increase the preventive behaviour related to diabetic ulcers. Increasing the diabetic ulcer prevention behaviour can be done by providing regular education to both the patients and their families about diabetic ulcers and their prevention through the appropriate management of DM, lifestyle modification and regular foot care that requires active involvement from the family and health care workers.

COVID-19 and Child Vaccination: A Systematic Approach to Closing the Immunization Gap

The COVID-19 pandemic threatens to set back major successes that have been achieved in global vaccine initiatives. We conducted a rapid review and synthesis of the literature on immunization provision and Utilization since the onset of the COVID-19 pandemic. A total of 11 papers comprising peer-reviewed articles and key policies and guidelines, published between January 1 and June 15, 2020, were analyzed. Widespread disruptions of routine immunization and vaccination campaigns were reported leaving millions of children worldwide at risk of measles outbreaks. We present an expanded model of the World Health Organization's Global Routine Immunization Strategic Plan (GRISP) action areas as a tool to help countries quickly adapt to immunization challenges in the presence of COVID-19 and close the emerging immunization coverage gaps.

Adaptation and Validation of the Polish Version of the 10-Item Mobile Phone Problematic Use Scale

Pathological use of smartphones may be the biggest non-drug addiction of the 21st century. Therefore, rapid screening tools designed for easy identification of people with problematic mobile phone use are needed. The main aim of the present study was to validate a short version of the Mobile Phone Problematic Use Scale (MPPUS-10) in the Polish population. The study comprised 640 university students aged 18-38 years. We used a self-report questionnaire that included questions regarding socio-demographic variables and Polish versions of the Mobile Phone Problem Use Scale (MPPUS-10), Mobile Phone Addiction Assessment Questionnaire (MPAAQ in Polish KBUTK), and Internet Addiction Test (IAT) by Kimberly Young. The analysis showed high reliability for the final Polish version of MPPUS-10 (Cronbach's α = 0.78) and confirmed a significant correlation between the MPPUS-10 and the MPAAQ, which was previously used in Poland (rho = 0.56; p < 0.001). Due to the poor correlation of item number 10 with other items, we suggest dropping this item and using the nine-item Polish version. Our result also confirmed significant correlation between the MPPUS-10 and the IAT (rho = 0.54; p < 0.001). The contribution of the study is the Polish validation and adaptation of the MPPUS-10 scale with confirmed psychometric values. It provides a quick and convenient screening tool to assess problematic mobile phone use. Our results also indicate the need for a revision of available diagnostic tools in Poland.

Awareness about breast cancer and mammogram among women attending outpatient clinics, Ain Shams University Hospitals, Egypt

BACKGROUND

Breast diseases in women, whether benign or malignant, are very commonly encountered. The breast is the commonest site for female cancer in Egypt (38.8%). Breast cancer screening can reduce morbidity and mortality and improve the survival rate for this malignancy. Mammogram can be used as a screening technique beside its role as diagnostic, especially in women over 40 years of age.

OBJECTIVES

To assess knowledge, attitude and practice regarding breast cancer and awareness about mammogram as a screening method among a group of females attending Ain Shams University outpatient clinics.

METHODS

A cross-sectional study was performed from August to September 2017. A systematic random sample was taken from attending females (18-70 years) in Ain Shams University outpatient clinics (Internal Medicine, Surgery, Pediatrics Hospital, and Maternity hospital). They were interviewed using a questionnaire inquiring about sociodemographic background, participants' knowledge, attitude, and practice towards breast cancer and its screening.

RESULTS

The mean age ± SD of attending females (18-70 years) was 37 ± 11 years. Most study participants had correct information about mammography. They showed poor knowledge level about risk factors. Mass media such as TV and internet were identified as the main source of information on breast cancer by 43% and 23.9%, respectively. In general, participants had positive attitude towards breast cancer screening by mammography. Around 90% agreed that mammogram was the best way to find a very small lump in the breast, and 91.4% agreed that women who have regular screening by mammogram have better disease outcome than those who do not screen. Regarding mammography practice rate, a small percent of participants (8.1%) was advised by their doctors to conduct a screening mammography. The level of knowledge was significantly and positively correlated with their attitude towards breast cancer screening.

CONCLUSION

The poor knowledge and practices of women illustrate the need for health education program directed to Egyptian females to improve their knowledge about breast cancer-especially its risk factors-and its screening. Using TV and Internet as media for spreading information about this disease is crucial.

Medication adherence and glycemic control among diabetes patients in developing countries

The potential interconnectedness of medication adherence, glycemic control, and clinical inertia in resource-constrained settings of the developing world needs further evaluation.

Prevalence and Correlates of Excessive Smartphone Use among Medical Students: A Cross-sectional Study

BACKGROUND

Increasing smartphone use has led to the introduction of smartphone addiction as a behavioral addiction with detrimental effects on health. This phenomenon has not been widely studied in the Indian context. This study assessed the rate of smartphone addiction in a sample of medical students, with a focus on its correlation with sleep quality and stress levels.

METHODS

A cross-sectional study was conducted between November 2016 and January 2017 in 195 medical students. Their smartphone use, level of smartphone addiction, sleep quality, and perceived stress levels were measured using the Smartphone Addiction Scale-Short Version (SAS-SV), the Pittsburgh Sleep Quality Index (PSQI), and the Perceived Stress Scale (PSS-10), respectively.

RESULTS

Of the 195 students, 90 (46.15%) had smartphone addiction as per the scale. A self-reported feeling of having smartphone addiction, use of the smartphone right before sleeping, PSS scores, and PSQI scores were found to be significantly associated with the SAS-SV scores. Significant positive correlations were observed between the SAS-SV and PSS-10 scores, and the SAS-SV and PSQI scores.

CONCLUSIONS

There is a high magnitude of smartphone addiction in medical students of a college in Western Maharashtra. The significant association of this addiction with poorer sleep quality and higher perceived stress is a cause for concern. The high self-awareness among students about having smartphone addiction is promising. However, further studies are required to determine whether this self-awareness leads to treatment seeking. Further studies are required to explore our finding of the association of smartphone addiction with using the smartphone before sleeping.

The effects of medication adherence on study outcomes in randomized clinical trials: A role for cognitive dysfunction?

Medication nonadherence is common and has been associated with poor health outcomes. Older adults are especially likely to be non-adherent to their medications, as they often have more medications to manage and are at greater risk for cognitive dysfunction. Though less frequently examined, the association between cognitive dysfunction and nonadherence also likely extends to clinical trials research. The current study used archival data to examine the potential impact of cognitive dysfunction on adherence to a nutritional supplement as part of a 90-day randomized clinical trial in neurologically healthy middle-aged and older adults. Results showed overall cognitive performance was predictive of adherence to capsule intake when controlling for polypharmacy [F(1,157) = 6.53, p < .01]. These results suggest that cognitive dysfunction may impact findings from RCTs through its adverse impact on adherence to study protocol, possibly leading to greater treatment variance, artificially reduced treatment effects, lower study power, and distorted study outcomes and conclusions. A better understanding of methodological and statistical approaches to account for these unwanted effects are needed.

Diabetes self-care in primary health facilities in India - challenges and the way forward

India has approximately 73 million people living with diabetes and another 37 million with prediabetes while nearly 47% of the diabetes cases are undiagnosed. The high burden of poor glycemic control and early onset of complications with associated economic costs indicates a high prevalence of poor self-management practices. It is well-established that achieving patient-centered primary care consistent with a chronic care model ensures optimum diabetes self-management support and improves long-term clinical and health outcomes in diabetes patients. The public sector primary care system in India provides services free of cost to beneficiaries but lacks patient-centered care that undermines diabetes self-management education and support. Furthermore, factors like poor patient knowledge of diabetes, suboptimal medication adherence, persistent clinical inertia, lack of data for monitoring and evaluation through clinical audit worsens the standards of diabetes care in primary care settings of India. There is a need for government initiatives to be directed towards the provision of comprehensive outpatient care that is inclusive of uninterrupted supply of drugs, provision of essential laboratory investigators, training and availability of qualified diabetes educators and availability of specialist support when required. Furthermore, the integration of depression screening and smoking cessation services at the primary care level is warranted.

Factors influencing diabetes self-care practice among type 2 diabetes patients attending diabetic care follow up at an Ethiopian General Hospital, 2018

INTRODUCTION

Diabetes mellitus is a global public health emergency in the twenty-first century. Diabetes patients who had to adhere to good self-care recommendation can prevent the complication associated with diabetes mellitus. Self-care management of diabetes mellitus in Sub-Saharan Africa was poor including Ethiopia. The aim of this study was to assess factors influencing diabetes self-care practice among type 2 diabetes patients at Debre Tabor General Hospital, Northwest Ethiopia diabetes clinic follow up unit.

METHODS

An institutional based cross-sectional survey was conducted on systematically sampled 405 type 2 diabetes patients at Debre Tabor General Hospital diabetes clinic from June 02/2018 to June 30/2018. Bivariate and multivariable logistic regression was fitted to identify independent predictors of diabetes self-care practice. A p value of less than 0.05 was used to declare statistical significance.

RESULTS

A total of 385 type 2 diabetes patients participated with a response rate of 95%, of which 243 (63.1%) study participants had good self-care practice. The mean ± SD age of the respondents and the duration of diagnosed for diabetes mellitus was 52.28 ± 12.45 and 5.09 ± 3.80 years respectively. Type 2 diabetes patients who had a glucometer at home (AOR = 7.82 CI (3.24, 18.87)), getting a diabetes education (AOR = 2.65 CI (1.44, 4.89)), and having social support (AOR = 2.72 CI (1.66, 4.47)) were statistically associated with good self-care practice.

CONCLUSION

Despite, the importance of diabetes self-care practice for the management of diabetes and preventing its complications, a significant number of type 2 diabetes patients had poor diabetes self-care practice. So, to enhance this poor practice of diabetes self-care, provision of diabetes self-care education and counseling on self-monitoring blood glucose should be promote by health care providers during their follow up.

Problematic smartphone use associated with greater alcohol consumption, mental health issues, poorer academic performance, and impulsivity

BACKGROUND

This study sought to examine the occurrence of the problematic use of smartphones in a university sample and associated physical and mental health correlates, including potential relationships with risky sexual practices.

METHODS

A 156-item anonymous online survey was distributed via e-mail to a sample of 9,449 university students. In addition to problematic smartphone usage, current use of alcohol and drugs, psychological and physical status, and academic performance were assessed.

RESULTS

A total of 31,425 participants were included in the analysis, of whom 20.1% reported problematic smartphone use. Problematic use of smartphones was associated with lower grade point averages and with alcohol use disorder symptoms. It was also significantly associated with impulsivity (Barratt scale and ADHD) and elevated occurrence of PTSD, anxiety, and depression. Finally, those with current problems with smartphone use were significantly more sexually active.

CONCLUSIONS

Problematic use of smartphones is common and has public health importance due to these demonstrable associations with alcohol use, certain mental health diagnoses (especially ADHD, anxiety, depression, and PTSD), and worse scholastic performance. Clinicians should enquire about excessive smartphone use as it may be associated with a range of mental health issues. Research is needed to address longitudinal associations.

Impact of pharmaceutical care in the improvement of medication adherence and quality of life for COPD patients in Vietnam

BACKGROUND

Medication adherence is an important factor in the management of chronic obstructive pulmonary disease (COPD). However, the rate of non-adherence to medications is high in COPD and is associated with worsened clinical outcomes and health-related quality of life for patients.

OBJECTIVES

Our study aimed to evaluate the impact of a pharmaceutical care program led by pharmacists in the improvement of medication adherence and quality of life for COPD patients in Vietnam.

METHODS

A pre- and post-intervention study was conducted over 12 months. Pharmacists provided brief counselling which focused on the role of COPD medications and the importance of adherence. Morisky Medication Adherence Scale was used to evaluate patients' adherence. Quality of life was assessed using the EQ-5D-5L questionnaire and clinical outcomes were evaluated by symptom scores. These outcomes were reassessed at baseline (T0), after 3 months (T1), 6 months (T2) and 12 months (T3).

RESULTS

Study participants consisted of 211 COPD patients (mean age: 66.6 ± 8.2 years). The percentage of patients with good adherence significantly increased from 37.4% to 53.2% (p < 0.001) after the program. Mean medication adherence scores improved from 6.7 (T0) to 7.4 (T2) and 7.4 (T3) (p < 0.001). EQ-5D-5L index values also increased from 0.47 (T0) to 0.59 (T3) (p < 0.001). There was no significant change in symptom scores across the duration of the study.

CONCLUSIONS

Medication adherence and quality of life of COPD patients improved considerably after implementation of a pharmaceutical care program, thus supporting a vital role for pharmacists alongside physicians in the management of COPD.

Improving the assessment of medication adherence: Challenges and considerations with a focus on low-resource settings

Improving patient survival and quality of life in chronic diseases requires prolonged and often lifelong medication intake. Less than half of patients with chronic diseases globally are adherent to their prescribed medications which preclude the full benefit of treatment, worsens therapeutic outcomes, accelerates disease progression, and causes enormous economic losses. The accurate assessment of medication adherence is pivotal for both researchers and clinicians. Medication adherence can be assessed through both direct and indirect measures. Indirect measures include both subjective (self-report measures such as questionnaire and interview) and objective (pill count and secondary database analysis) measures and constitute the mainstay of assessing medication adherence. However, the lack of an inexpensive, ubiquitous, universal gold standard for assessment of medication adherence emphasizes the need to utilize a combination of measures to differentiate adherent and nonadherent patients. The global heterogeneity in health systems precludes the development of a universal guideline for evaluating medication adherence. Methods based on the secondary database analysis are mostly ineffectual in low-resource settings lacking electronic pharmacy and insurance databases and allowing refills without updated, valid prescriptions from private pharmacies. This significantly restricts the choices for assessing adherence until digitization of medical data takes root in much of the developing world. Nevertheless, there is ample scope for improving self-report measures of adherence. Effective interview techniques, especially accounting for suboptimal patient health literacy, validation of adherence questionnaires, and avoiding conceptual fallacies in reporting adherence can improve the assessment of medication adherence and promote understanding of its causal factors.

Vitamin D status, determinants and relationship with biochemical profile in women with Type 2 Diabetes Mellitus in Delhi, India

OBJECTIVE

To determine the burden of vitamin D deficiency and its determinants and to assess the relationship of 25 hydroxycholecalciferol (25-OHD) levels with biochemical parameters linked to health outcomes in women with Type 2 Diabetes Mellitus (T2DM).

MATERIAL AND METHODS

This was a hospital based cross-sectional study in the diabetes out-patient department clinic of a major tertiary care hospital in Delhi, India. Adult women with T2DM on treatment for at least 6 months were included in this study. The women who have been given Vitamin D supplementation during the past 6 months were excluded. We assessed Serum 25-OHD, HbA1c, lipid profile and fasting plasma glucose in the patients through standardized laboratory methods.

RESULTS

One hundred women with T2DM were enrolled of which 22 (22%) had good glycemic control (HbA1c < 7%). Vitamin D deficiency was seen among 77 (77%) and insufficiency among 16 (16%) of the recruited subjects. Younger age group (31-45 years) and illiteracy was significantly associated with vitamin D deficiency (p < 0.05). No association was found between Vitamin D deficiency and HbA1c levels.

CONCLUSION

Vitamin D deficiency is highly prevalent among women with T2DM. Illiteracy and young age were major determinants of vitamin D deficiency indicating they need special attention and Vitamin D supplementation.

Achieving TB elimination in India: The role of latent TB management

The elimination of Tuberculosis (TB) in settings with a high dual burden of active and latent TB is one of the most important public health challenges of the 21st century. India has the highest TB burden in the world and nearly 40% of the population being infected with TB. There also exist large often overlapping socially and medically vulnerable populations like the PLHIV, pediatric TB contacts, children with protein-energy malnutrition, homeless people, workers in silica industry and adults with low BMI. A significantly higher risk of progression into active tubercular disease exists in those with compromised immune or nutritional status. It is uncertain if global TB elimination targets can be achieved in the absence of aggressive LTBI treatment strategies for interrupting the chain of transmission of the disease. India hence needs to accelerate and prioritize capacity building in latent TB research. A research agenda is outlined for generating evidence towards the evolution of critical evidence-based policy for LTBI management under Indian health settings.