Exploring Knowledge of Cognitive Disposition to Respond in Clinical Decision-Making among Early Clinical Learners

Introduction: Background: Errors in clinical medicine are a constant occurrence leading to litigations. Cognitive disposition to respond (CDR) was considered the underlying cause of errors in the decision-making process. The rapid thinking system used by early clinical learners leads to cognitive errors. The scenario gets compounded by a limited awareness and lack of exposure to cognitive dispositions to respond (CDRs) in the formal medical graduate curriculum. Variation in the frequency of occurrence in a real-life context, contradictory claims over the influence of clinical expertise, specialty, and methods of teaching about cognitive biases led to this exploratory study among early clinical learners. Methods:In the present research, subjects' recruitment was based on voluntary participation of medical graduates, interns, and residents, who were assigned to equal groups of 30. All study groups were first exposed to six commonly occurring CDRs as role-play-based videos, followed by a case scenario-based exposure to 13 uncommon CDRs in the clinical setting. Participants were then asked to reflect on the experience. Data was analyzed by descriptive and thematic analysis. Results:Among the 19 tested biases, 75.6% of participants identified Hindsight bias. The sunk cost was found out by 34.4% of participants only. Information processing bias was identified more frequently than psychological processing bias. Intergroup variability showed that residents were not identifying biases as frequently as medical graduates and interns. The role play video with reflective writing was voiced as the suitable training method for cognitive bias. Conclusion:The study concludes that medical graduates must be sensitized to CDRs using role-play-based reflection methods.

Vaccination and associated factors among tribal children of 1 year age in nine Indian districts: A cross-sectional study

OBJECTIVE

To report on vaccination status by 12 months of age among tribal children from nine districts of India.

METHODS

Cross-sectional study of 2631 tribal women having a child aged 12 months or below from nine Indian districts with a considerable proportion of the tribal population. Socio-demographic details, reception of various vaccines by 12 months of age, mother's antenatal care utilisation and health system-related details were collected through a pre-tested, interviewer-administered questionnaire from mothers. Multiple logistic regression analysis was used to identify the factors associated with complete vaccination by 12 months of age.

RESULTS

Only 52% of children were fully vaccinated by the age of 12 months among the tribal populations; 11% did not receive any vaccine, and 37% of the tribal children received some vaccines. The age-appropriate vaccination was unsatisfactory as only 75% of the infants received all birth dose vaccines, and only 60.5% received all doses by 14 weeks. Only 73% were vaccinated against measles. Illness of the child, home births and communication gaps concerning vaccination were the main reasons for an infant not being vaccinated appropriately. Frequency of health worker's visits to the village, hospital birth, reception of advice on vaccination and educational status of the head of the households were significantly associated with full vaccination status.

CONCLUSION

A relatively low proportion of children were fully vaccinated among the tribal populations. Health systems factors, mainly the outreach services and advice by the health workers, were positively and significantly associated with a child being fully vaccinated by 12 months of age. Improving outreach services is crucial to improve vaccination coverage in tribal areas, and there is a need to address the social determinants in the long run.

An analysis of the dynamic role of lipids in the progression and development of cardiovascular disease

The main cause of mortality around the globe is cardiovascular disease (CVD). There are several indications followed by experimental validation that dysfunctional lipotoxicity is one of the primary causes of cardiovascular illnesses such as atherosclerosis, “coronary heart disease”, (CHD), and hypertension. Obesity and diabetes raise the number of circulating lipids, which may enhance the production of harmful intermediates and cause issues related to cardiovascular disorders. Effective and affordable medicines to lower cardiovascular risk are desperately required. Lipids or lipoprotein particles play a critical role in atherosclerosis, the pathophysiology behind CVD. They also have an effect on inflammatory processes, vascular or cardiac cell function, leukocyte activity, and ultimately the health of the heart and blood arteries. In this paper, an attempt was made to identify the cause of lipid buildup that led to the pathophysiology of cardiovascular disorders as well as the processes behind lipotoxicity. A summary of current and developing treatment approaches to decrease the incidence of lipid-induced cardiovascular disease is also compiled through previous studies.

Social isolation, social support, and psychological distress among the elderly during the COVID-19 pandemic: A cross-sectional study from central India

Background

In the present COVID-19 pandemic, social distancing measures have been advised to protect elderly from infection which might have led to poor mental health state.

Objective

A cross-sectional study was carried out to assess the magnitude of social isolation, social support, and psychological distress among the elderly during the COVID-19 pandemic in Central India.

Methods

The estimated sample size was 1535. The sample was equally distributed among rural, semiurban, and urban strata of districts. Social isolation was measured using Lubben's Social Network Scale-Revised, and psychological distress was assessed using Kessler K10 Psychological Distress Scale. Other parameters such as a history of COVID-19 illness and COVID-19 vaccination were assessed.

Results

The prevalence of social isolation was higher at 23.6% during the COVID-19 pandemic compared to before the pandemic period (15.0%). The majority perceived a high level of social support during the pandemic (55.3%) and 39.9% received moderate support. Overall, 18.4% of the respondents had psychological distress. Out of them, 56.2% had mild distress, 20.1% had moderate distress, and 23.7% had severe distress. Significant predictors of psychological distress were female gender, lower socioeconomic status, history of COVID-19 disease among the participants, social isolation, and lack of social support.

Conclusion

Social isolation and lack of social support were significant predictors of psychological distress among the elderly during the pandemic.

Is rule of halves still an occurrence in South India: Findings from community-based survey in a selected urban area of Puducherry

Background:

The objective of the present study was to assess the applicability of the rule of halves in an urban population of Puducherry, South India. We also aimed to find the correlates associated with undiagnosed hypertension to facilitate targeted screening.

Methodology:

We derive our observation from a community-based cross-sectional study conducted using the World Health Organization STEPwise approach to surveillance in urban slum of Puducherry during 2014–15. Blood pressure (BP) was measured for all the study subjects (n = 2399), and the subjects were classified as hypertensive using Joint National Committee 8 criteria, systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mmHg and/or known hypertensives and/or treatment with antihypertensive drugs. Controlled hypertension was defined as SBP <140 mmHg and DBP <90 mmHg.

Results:

Of 2399, 799 (33.3%; 95% confidence interval [CI]: 31.4%–35.2%) adults were found to have raised BP by any means (known and unknown hypertensives). Of the 799, 367 (15.3%; 95%CI: 13.9%–16.8%) of study participants were known hypertensives. Of the known hypertensives, 74.7% (274/367) were put on treatment (drugs and or lifestyle modification), and 80% (218/274) were on regular treatment. Higher proportions of men were found to have undiagnosed hypertension compared to women (26.1 vs. 19.8%, P < 0.001). Similarly, adult from below poverty line (23.8 vs. 20%, P < 0.001), unskilled laborer (26.6 vs. 20%, P < 0.001), and literacy less than middle school (12.3 vs. 23%, P < 0.001) had more undiagnosed hypertension.

Conclusion:

In the selected urban area of Puducherry around one-third of the adult populations are having hypertension, including the 54% of undiagnosed hypertension. Adults from the vulnerable subgroups such as lower level of literacy, below poverty line, and unskilled work are found to have higher proportions of undiagnosed hypertension.

Prevalence of under-nutrition, associated factors and perceived nutritional status among elderly in a rural area of Puducherry, South India

BACKGROUND

Under-nutrition among elderly goes undetected, despite their nature of vulnerability to it. Majority of the available literature assessed under nutrition in the facility based settings. We aimed to determine the prevalence of under-nutrition and its associated factors among elderly, in a rural setting.

METHODS

A community based cross sectional survey was conducted among elderly in one of the randomly selected sub centre catchment area in rural Puducherry, south India. Information on socio demographic characteristics, morbidities and perception on their nutritional status were obtained. Anthropometric measures such as weight and arm span were measured by trained medical graduate as per the standard guidelines. Bodymass index (BMI) less than 18.5kg/m(2) was considered as under-nutrition.

RESULTS

Of total 296 elderly in the study setting, 271 (92%) participated in the study. The prevalence of under nutrition among the elderly was 24.8% (95% CI: 19.7-30.3). More than half of the elderly (58.7%) perceived their nutritional status as poor; of them 28.9% were actually under-nourished. Mean (SD) BMI scores were higher for elderly women compared to that of men [elderly women vs men: 22 (4.6)kg/m(2) vs 21 (3.8)kg/m(2), p=0.03]. In multivariate analysis, being an elderly male, age more than 70 years and per capita income less than 1000 INR were found to be significantly associated with under-nutrition.

CONCLUSION

In this rural area, one fourth of elderly were under nourished. Urgent inter-sectoral measures including food security programs are required to address this huge nutritional problem in this vulnerable group.

Development and implementation of healthy workplace model in a selected industry of Puducherry, South India

Background:

The workplace is increasingly being used as a setting for health promotion and preventive health activities; not only to prevent occupational injury, but to assess and improve people's overall health.

Objective:

This study aims at developing and implementing a healthy workplace model in a software industry of Puducherry.

Methods:

Operations research was carried out in a purposively selected industry in Puducherry. The study was planned in four phases-baseline assessment and risk profiling, intervention, final evaluation and dissemination of results. Baseline evaluation of employees (n = 907) was done by a self-administered questionnaire to collect sociodemographic variables and risk factor profile using noncommunicable diseases (NCDs) LITE Proforma.

Results:

Healthy workplace committee comprising of several stakeholders was formed, and a formal launch of the health awareness campaign was organized. Broad themes for health education sessions and support activities were identified. Risk profiling of employees showed high levels of risk factors and morbidity-more than 15% were found to be hypertensive and around 55% were obese. Stress and back ache were reported by almost half of the respondents. Modifications in the workplace targeting physical and psychosocial work environment were suggested to the committee, as part of the initiative. This study has demonstrated the feasibility of developing and implementing a healthy workplace model in South India. This model can be replicated or adapted in other industries for health promotion and prevention of NCDs.

Conclusion:

Dedicated and concerted efforts of the management consistent with the requirements of safety, health and environment at work place with appropriate support from the health system can improve the quality of work and working life.

Adriamycin induced spermatogenesis defect is due to the reduction in epididymal adipose tissue mass: a possible hypothesis

Adriamycin is an anthracycline antibiotic used as anticancer drug since past few decades. Though effective against cancer, it is cardiotoxic, nephrotoxic, hepatotoxic and also toxic for reproductive system. Although a number of potential toxic mechanisms have been identified following exposure to adriamycin, the major pathogenic mechanism appears to be the generation of toxic reactive oxygen species (ROS). Animals treated with adriamycin have shown a decrease in total sperm count. This implies that adriamycin impairs the process of spermatogenesis. Epididymal white adipose tissue (EWAT) is necessary for normal spermatogenesis, and decrease in the EWAT causes disturbance in spermatogenesis. Factor X is an unknown molecule synthesized by EWAT that plays crucial role in spermatogenesis. Adriamycin inhibits Kruppel-like factor 4 (KLF-4) and thus downregulates the adipogenesis process needed to maintain the EWAT mass. Apart form adipocytes, KLF-4 and peroxisome proliferator-activated receptor gamma (PPAR-γ) are also found in spermatogonium and testis, implying its vital role in spermatogenesis. Adriamycin treatment inhibits KLF-4 and thus PPAR-γ in EWAT and spermatogonium. Reduction of EWAT might cause a decrease in Factor X level. Declining of Factor X level, KLF-4 and PPAR-γ together will lead to disturbance in spermatogenesis process.