Vol 10, Issue 4, Oct-Dec, 2020

Novel coronavirus infection or COVID-19 has become a major challenge and a matter of concern not only for India but for the whole world. This viral infection has been recognized in almost whole world and clinically represented with dry cough, fatigue, coughing sputum, shortness of breath. This article is an attempt to throw light on coronavirus infection and enumerates certain preventive measures to be taken in a periodontal set up for prevention of the same. Key words: Novel coronavirus, Infection, Aerosol production, Periodontist, Prevention.

Background: Settings based approach for health promotion at workplaces is surveillance of employees for CVD risk factors, which will help to estimate the prevalence of CVD risk factors and monitor CVD risks among the employees. It was planned to calculate the prevalence of CVD risk factors among group C employees of tertiary care hospital in south India. Materials and Methods: A hospital based cross-sectional survey was conducted among 324 group C employees aged ≥18 years as per the WHO “STEP wise approach to surveillance of non-communicable diseases” (STEPS) methodology. Standardized international protocols were used to measure behavioural risk characteristics (smoking, alcohol consumption, fruit and vegetable consumption, physical activity) and physical characteristics (weight, waist circumference, height and blood pressure). Multivariate analysis was done to know the factors, which carry independent risk of hypertension. Risk factor profiling of the employees was done using WHO/ISH risk prediction chart to estimate the 10 year risk of a fatal or nonfatal major cardiovascular events (myocardial infarction or stroke), according to age, gender, blood pressure, smoking status and presence or absence of self-reported status of diabetes mellitus. Data entry was done using Epi-data version 4.4.2.1. Data cleaning and analysis was done using Statistical Package of Social Sciences (SPSS) version 20. Results: Mean age in years was 34.3 (±8.26) and men contributed 79.3% of study participants. Prevalence of major cardiovascular risk factors was as follows: Current smokers 25.3% men, regular alcohol intake 29.01% between men, overweight (≥23 kg/m2) 26.4%, central obesity 16%, hypertension 13.7% and a past history of diabetes mellitus 15.6%. Almost 3/4th of the participants were following unhealthy diet and living sedentary life style. The relationship between sociodemographic factors and selected risk factors of CVD (tobacco use, alcohol use, unhealthy diet and physical activity) was found significant associated with gender, age, educational status and years of work experience. Around four percent participants had a >10% risk of developing CVD in next 10 years. Conclusion: The prevalence of CVD risk factors is high in the sample population. Employee health and wellness program must be regulated and implemented in the institute, to overcome the burden of cardiovascular diseases. Key words: Employee, Cardiovascular disease, Risk factor profile, Prevalence, Tertiary Health Care.

Background: Low rates of professional help seeking are observed in college youth despite high prevalence of common mental health problems. Perceptions regarding social norms related to help seeking can be one of the factors that influence help seeking inclination. Aim: The present study examined perceived peer norms related to help seeking for depressive symptoms and their relationship to one’s own help seeking inclination in urban Indian college youth. Methods: A cross- sectional survey design was used. College youth (N=300) in a metropolitan Indian city constituted the study sample. A modified version of the General Help Seeking Questionnaire was used. This incorporated two depression vignettes; one described depressive symptoms in the context of a life event and another one depicted similar depressive symptoms without any life event. The likelihood of oneself as well as one’s peers seeking help from different sources was inquired into, for both the vignettes. Results: Friends were rated as the most likely source of seeking help for depressive symptoms. Seeking help from a professional by self and by one’s peers was rated as less likely when depression was preceded by a life event than when it was not. College youth rated their own likelihood of seeking professional help to be higher when they perceived their peers’ likelihood of seeking professional help to be higher. Conclusion: Perceived peer norms about help seeking for depression can play an important role in influencing inclination to seek help from professional sources in college youth. Implications for designing interventions to improve help seeking in youth are highlighted. Key words: Help seeking, Social norms, Depression, Youth, Treatment gap.

Since their inception in 2012, accountable care organizations (ACOs) have yielded inconsistent and unpredictable financial results. These outcomes may be related to an individual ACO’s participant mix of primary care physicians (PCPs) and specialists. We analyzed ACO performance data to better understand the cooperative roles of PCPs and specialists in financially successful ACOs. The dataset included several variables reflecting different quantitative and qualitative characteristics of ACO performance. The analyses of variance and covariance (ANOVA and ANCOVA) were used as the primary statistical tool. The obtained results provided the evidence that a larger number of PCPs in an ACO can help to achieve quantitative goals related to immediate financial effect. In contrast, ACOs with a higher relative share of specialists tend to improve the healthcare quality and profitability in the longer term. The results provide a solid basis for further investigation that may help future ACOs to design the strategies resulting in efficient quality care and sustainable profitability. Key words: Healthcare, Triple Aim, Medicare, Statistical Testing, Analysis of Variance.

Introduction: Certain professions predispose individuals to obesity and musculoskeletal disorders. Banking is one such sector where working involves sitting for prolonged times along with exposure to physical and psychosocial risk factors. Very few studies have been conducted in India in public sector bank settings, concerning these chronic conditions. This study intends to encourage further research in these areas. Objectives: This study aimed to determine the prevalence of obesity and MSDs. Its objectives were to determine the association of these conditions with socio-demographic characteristics and lifestyle factors. Materials and Methods: A cross-sectional study was conducted among 487 employees working in PSU banks of Mangaluru region. WHO STEPS and modified Nordic questionnaire were used for this study. The participants were measured for their height and weight, using a portable stature meter and a digital weighing scale respectively. Results: The aggregate prevalence of overweight and obesity was 65.5% (20.9% for overweight and 44.6% for obesity). The prevalence of musculoskeletal discomfort within the past 12 months was 57.3%. Most of the complaints were reported for the lower back (27.1%) and neck (26.9%). Conclusion: The aggregate prevalence of overweight/obesity and MSDs among the public sector bank employees of Mangaluru region was very high. Action needs to be taken at policy level. The cost of treating these chronic conditions can be very high. Risk factors need to be modified which will help to control the prevalence of obesity and MSDs. Key words: Obesity, Overweight, Sedentary, BMI, Musculoskeletal disorders, Public sector bank.

Background: The current Coronavirus pandemic has infected more than 15 million people worldwide and has been responsible for more than 630,000 deaths worldwide, a significant number of which has been healthcare professionals. Povidone-iodine (PVP-I) has been known as microbicidal agent since the past few decades and it has also demonstrated better anti-viral activity than other antiseptics in a few in vitro studies against other coronaviruses (SARSCoV and MERSCoV). Povidone iodine has also been found to be a safe and effective solution to be used as a gargle or intranasally. Aim and Objectives: Through our study, we would like to propose the application of PVP-I in appropriate and safe concentration through nasal application and oropharyngeal wash to limit the spread of the virus from infected patients to healthcare workers and thus reduce the transmission of COVID-19. Methods: This application is to be done according to the proposed protocol, which has been devised keeping in mind the feasibility, safety and efficacy of PVP-I application. This should be used regularly by patients with a suspected or confirmed COVID-19 infection to not only prevent the spread, but also by healthcare workers prior to treating such patients, or performing perioral or nasal procedures during the pandemic, regardless of the status of the patient. Patients undergoing such procedures should also be treated with PVP-I. The total iodine exposure according to the proposed protocol has been found to be within previously recorded safe limits. Conclusion: We hypothesize that usage of PVP-I as a personal protective equipment at the portal of entry would help decrease the rates of transmission of the SARS-CoV-2 infection. Key words: Betadine, Coronavirus, Gargle, Povidone Iodine, Pandemic.

Introduction: More than 16% morbidity among adolescent age group is caused by mental health disorders. The early occurrence of psychiatric disorders like anxiety and depression in adolescent age is associated with mental, physical and social squeal in future life. Thus, early detection of mental health disorders and their prompt treatment will help the adolescents to lead a socially and economically productive life. In this background the present study was conducted to assess the influence of child friendliness on prevalence of depressive disorders among adolescents in selected JSS Schools in Mysuru and Chamarajanagara districts of Karnataka. Methodology: A cross-sectional study was conducted among 18 randomly selected upper primary and high schools from July to December 2019. A total of 400 students aged between 11 to 16 years were included in the study. The mental health status, demographic details, and child-friendliness of schools were assessed using validated self-administered questionnaires and checklists. Results: The prevalence of depressive disorders among adolescent children was 4%. The presence of depressive disorders among respondents was associated with the location of the school, current scholastic year, father’s occupation, relationship with siblings and child-friendliness of the respective schools. Conclusion: The major modifiable factor associated with the depressive disorder was childfriendliness of the schools according this study. Hence more attention has to be paid and collective efforts have to be made by managements, governments and the community to improve the child-friendliness of schools and thereby mental health status of its students. Key words: Depressive disorder, School health, School child-friendliness.

Background: The SARS-CoV-2 led to a nationwide lockdown in India from 24th March, 2020. It became important to identify people’s attitudes and practices to allow rapid change in health policies to alleviate stress factors. Objectives: To evaluate the attitudes, practices and sources of information and their perceived reliability from people residing in India. Methods: An online-based survey which asked respondents about the change in their practices due to the pandemic and their opinions on the measures taken to prevent spread of the virus. was conducted on 29th March, 2020. 995 individuals (Average age – 42.8 years) responded from 24 states of India. Participants were invited to respond through the survey through dissemination of a link through online social media platforms. Only people who were residing in India were included in the study. Results: 58.6% were highly concerned about contracting the virus. 51.9% had stepped out during the lockdown period, most commonly to buy groceries (37.2%). 45% respondents faced mask shortages leading to prolonged use of the same mask (average 6.74 hours). 29.3% paid above the maximum retail price for their masks. Although people favored laws making self-isolation (95.2%) and mask wearing in public (81.5%) compulsory, support fell on introduction of a jail term for violating the law. Health care professionals were considered the most reliable source of information (4.42/5) followed by public health officials (4.03/5). However, 60.4% of the population used newspapers, magazines, etcetera for their information. Conclusion: People seem to rely on information sources that they themselves claim to be of inferior reliability. People generally support laws with fines to ensure prevention of virus transmission but do not support jail terms to these laws. Key words: Coronavirus, India, Quarantine, Attitudes (Source: MeSH:NLM).

Introduction: Scrub typhus is very common re-emerging Rickettsia infection in India and many other South East Asian countries. The unplanned urbanization, deforestation and easy transportation leads to changes of place of occurrence of scrub typhus from hilly and forest terrains to plan land with different clinical manifestation. Aim: This study was conducted to identify the regional characteristic of clinical sign, symptom and treatment outcome of scrub typhus patients admitted in a tertiary level hospital of Murshidabad district of West Bengal. Methods: An observational cross sectional study was conducted among 82 hospitalized scrub typhus patients during September, 2019 to March, 2020. Patients were selected by purposive sampling procedure. Data were analyzed in descriptive statistic. Results: All study participants presented with acute febrile illness with other symptoms like headache, cough, dyspnea, nausea, generalized weakness, abdominal pain and myalgia. On examination, patients had hepatosplenomegaly (21%), lymphadenopathy (7%), pedal edema (14%), Icterus (12%) and eschar (4%). On investigation, elevated ALT (37%), elevated AST (36%), Low platelet count (25%), low Hb% (52%), elevated WBC count (37%) levels were the most common findings. Interestingly few patients diagnosed with co-morbid infections eg: enteric fever (12%), Urinary tract infection (12%), respiratory tract infection (27%), dengue fever (5%) and malaria (2%). Low mortality rate (4%) was observed due to tertiary level health care services and increased awareness among local medical fraternities on scrub typhus apart from lower virulence or indigenous resistance as host or environment factor. Conclusion: Scrub typhus is an important zoonotic disease of variable presentation with low fatality if diagnosed and treated early. It is necessary to include scrub typhus serology test as routine blood test for all acute febrile illness patients for this area. Key words: Scrub typhus, Complications, Observational Study, Murshidabad.

Context: Government efforts are being made for the reduction of child mortality through the facility and community-based strategies. Studies have indicated that several other factors also have an impact on child survival. This calls for researches to be directed efforts and understanding of the local causes and factors associated with it. Aim: To analyze the sociodemographic, programmatic and clinical profile of neonates’ admitted in SNCUs. Settings and Design: A cross sectional study amon 43 SNCUs during year 2017-18. Methods and Materials: The data was recorded from the pre-defined case record registers and analyzed using simple proportions. Statistical Analysis used: Chi-square test and multivariable logistic regression analysis were carried out for finding the association between survival rate of neonates and other variables. Results: Out of 48,775 neonates admitted at selected SNCUs across the State, 68.5% were successfully discharged, 6.7% referred to higher centers, 10% left against medical advice and 15.2% died during the study period. Survival Rate was observed to be significantly associated with the Place of Delivery, Mode of Transport, Type of Admission, Maturity of child admitted, weight of a child during admission and Indications of admission. Key words: SNCU, Child Survival, Regression, NMR, U5MR, Gujarat state. Key Messages: Several factors influence the new-born survival which must be given attention along with the programme interventions. These factors must be studied more indepth and may be given due weightage by the programme managers to enhance new-born survival.

Introduction: Health authorities across the world have implemented non-pharmaceutical interventions (NPIs) such as social distancing measures and hand hygiene campaigns in response to COVID-19. However, the adoption of health-protective behaviour by individuals in alignment with these interventions, although effective, is variable. Results: Evidence suggests that increases in perceived disease severity, disease susceptibility and intervention efficacy correlate with the adoption of protective behaviours. Additionally, external cues from select, credible sources promote behavioural adoption whilst barriers to behavioural change, such as the opportunity cost faced by the employed, dissuade adoption. Lastly, demographic and socioeconomic factors play a role with men, the young, those with lower educational status and those less socially connected being less likely to adopt protective behaviours. Conclusion: For health authorities, an understanding of these correlates can better inform efforts to increase adherence to NPIs and stem novel viral transmission. Approaches such as risk personalisation, the communication of evidence-based effects of interventions and education regarding lesserused behaviours (e.g., mask-wearing) are discussed. Also highlighted is the importance of consistent communication via local actors such as General Practitioners and the role of multilevel social networks. Lastly, the need for tailored efforts to enhance protective behaviour adoption in specific sub-populations is considered. Key words: Behaviour, Health belief model, Preventative, COVID-19.

Background: Diabetes Mellitus is a major public and clinical health concern. It is a basic knowledge that T2DM causes a serious decline in normal Quality of Life, where late identification in later ages is the major challenge. The main motive of this study was to evaluate a pre-existing multivariate risk factors for the development of Type 2 Diabetes Mellitus in youth. Objectives: To predict and assess the risk and risk factors for Type 2 Diabetes Mellitus. Methods: The study was designed to be a cross-sectional epidemiological study. It was conducted in the students of graduation and under graduation courses in Guntur District, Andhra Pradesh over 6 months from 1st September 2019 to 1st February 2020 which includes 2524 students with a response rate of 92.5%. Students are enrolled based on Inclusion and exclusion criteria. Specially designed data collection form used to obtain the data required for the study. Results: In our study we have collected data from 2524 students where, 1088 students (34.50%) were males and 1435 (65.49%) were females. Diabetes risk was assessed using validated tool, Indian Diabetes Risk Score. Conclusion: We came to a conclusion that most of the students have moderate to low risk of diabetes mellitus, with significantly contributing risk factors like family history, low PA. Key words: Andhra Pradesh, Diabetes risk, Family history, IDRS, India, Students, Youth.

Background and Objectives: Presently world is facing Corona virus disease pandemic. This disease was first identified in Wuhan city of China which spread rapidly to more than 200 countries including India. Rajasthan is a state affected badly with this disease. So this present study was conducted to find out the status of COVID-19 in state and to find out the effects of containment measures taken. Materials and Methods: This record base case series type of study was conducted from reports received of confirmed COVID-19 cases and reported to the IDSP, DMHS from March 2nd 2020 to May 25th 2020, from various reporting units of Rajasthan. Desired information’s were collected, compiled and analyzed. Interpretation and Conclusion: There were 7351 laboratory-confirmed case including 4061 recovered cases and 166 deaths. Recovery rate and Case Fatality Rate were found 55.24% and 2.26% respectively. (2.4%) reported. Although patients of all ages were affected with this disease but majority (81.99%) were in 16-60 years of age group. In these positive cases male predominance was also observed with M:F ratio 2.11. Majority of district of Rajasthan were affected with this pandemic having about half of cases in three districts v.i.z. in Jaipur, Jodhpur and Udaipur districts. Average Doubling time has increased from 4 days to 18 days as a result of containment measures undertaken in Rajasthan. So these containment measures like social distancing, masking, washing hand frequently etc. Should be taken care of even after lockdown to prevent the COVID-19 infection. Key words: COVID-19, PHEIC, SARS CoV-2, Lockdown, Containment Measures, Effect of Lockdown.

Background: Responses to perceived-stress trigger toxic emotions of anger. Uncontrolled anger outburst enhances aggressiveness, disrupts personal relationships and social harmony; impairing quality of life. Development of cost-effective preventive strategies to reduce levels of stress, anger and violence is vital for public health. Objectives: To (i) quantitatively investigate relationships between perceived-stress, anger and quality of life; (ii) identify vulnerable individuals using stress-anger reactivity and (iii) explore the effectiveness of Preksha-Meditation practice as a preventive strategy. Methods: In a single-arm pre- and postintervention study, healthy adults recruited from 7-day residential Preksha-Meditation training camps were administered Preksha-Meditation. Pre- and post-intervention levels of variables, measured by validated and reliable self-report questionnaires, from 50 subjects could be analyzed and compared using t-test. Results: Despite heterogeneous scores, perceivedstress and anger correlated positively. Quality of life correlated negatively with both stress and anger. Assessment of individual’s stress-anger reactivity can identify vulnerable persons who develop uncontrollable anger. Post Preksha-Meditation, average scores of perceivedstress and anger declined significantly. Stress-anger-reactivity was reduced in majority (70%) of subjects, indicating enhancement of coping capacities. Interestingly, males displayed larger reductions in levels of perceived-stress-anger and in stress-anger reactivity leading to better quality of life. Conclusion: Intense PM training in short-term retreats is a feasible and costeffective approach to reduce stress-induced anger. Comprehensive longitudinal studies on larger samples to verify and extend the present preliminary findings are warranted before undertaking large-scale applications to prevent increased domestic violence during stressful events, like infectious disease pandemics. Key words: Stress-anger reactivity, Uncontrolled anger, Violent behaviour, Quality of life, Preksha-Meditation, Pandemics, Preventive strategy.

Background: Bullying in childhood and adolescence has pervasive negative impacts in adulthood in both victims and bullies. There are few studies describing the prevalence of bullying in Indian schools, and few which have documented the various forms of bullying prevalent in our country. This study is being carried out with working hypothesis that various forms of bullying perpetration and victimisation exists in Indian urban schools. Objectives: To study the prevalence of bullying perpetration/ victimization, forms of bullying/victimization in Indian high school students. Methods: A cross sectional study conducted in 2 urban schools in Bangalore. A cohort of 435 adolescents (13-18yrs) were administered a pre validated 8 item questionnaire, part of the Student School Survey to assess bullying perpetration/ victimization. Results: 435 students in all, with 242 girls (55.6%), 170 boys (39.1%), 23 not revealing gender were studied. Total prevalence of bullying perpetration was 70.74%, and victimization was 74.94%. Verbal bullying was the most prevalent (55.17%) with physical bullying (40.46%) and cyber bullying (15.86%) being less frequently reported. Similarly verbal victimization (65.75%) was most prevalent followed by physical victimization (40.23%) and cyber victimization (14.48%). Conclusions: The information revealed by our study sensitizes doctors to the existing prevalence of bullying. Paediatricians and adolescent physicians should enquire about bullying from their adolescent patients and offer anticipatory guidance. Assessment of bullying can be implemented routinely in schools. A multi-targeted approach at individual/family level, school level, community level, State level and National level to make the school a safer environment for children can be adopted. Key words: Urban high school children, Physical bullying, Verbal bullying, Cyber bullying, Cyber victimization.

The paper presents a quantitative and qualitative dimensions of congenital heart defect (CHD) research output in India, based on publications data (1335) indexed in Scopus database during 2000-19. CHD research registered 10.0% growth, averaged 7.07 citations per paper, contributed 3.04% share to the global output and constitute 13.48% share of India’s research as international collaborative. CHD research is skewed as top 10 countries account for 83.23% of global output. India ranks as the 10th most productive country in the world. The distribution of CHD research by type of research reveal that Tetralogy of Fallout accounted for the highest share (34.31% share), followed by Aortic Stenosis (30.41%), Atrial Septal Defects (28.16%), Ventricular Septal Defects (26.22%), etc. AIIMS - New Delhi, Amrita Institute of Medical Sciences, Coimbatore and PGIMER - Chandigarh lead the country as the most productive organizations (with 222, 73 and 64 papers). Besides, Amrita Institute of Medical Sciences, Coimbatore (33.88 and 4.79), SCTIMST - Trivandrum (30.73 and 4.35) and Institute of Medical Sciences, BHU, Varanasi (17.20 and 2.43) lead the country as the most impactful organizations in terms of citation per paper and relative citation index. B. Airan, A. Saxena and S. Talwar have been the most productive authors (with 63, 63 and 59 papers) and P. Khairy (16.31 and 2.31), B. Vaidyanathan (14.3 and 2.03) and R.K. Kumar (10.53 and 1.49) have been the most impactful authors. Indian Heart Journal, Annals of Pediatric Cardiology (84 papers) and Annals of Cardiac Anaesian (53 papers) topped the list of most productive journals (with 110, 84 and 53 papers). International Journal of Cardiology (18.62), Catheterization and Cardiovascular Interventions (16.64) and Journal of Cardiothoracic and Vascular Anesthesia (11.65) leads in ranking in terms of citation per paper. Key words: Congenital Heart Defects, Indian publications, Scientometrics, Bibliometrics.

Background: The COVID-19 pandemic in India has become the biggest public health challenge. If we go by the number of confirmed cases and casualties, the situation seems to be a matter of grave concern. The lock-down measures and social-distancing practices have played an important role in impeding the spread of COVID-19. However, accurate forecasting is required to prepare the healthcare-system for future plan-of-action. Objectives: The present study aims to predict the trends in the outbreak of COVID-19 in India, by forecasting on the basis of publicly-available data. Methods: The data has been obtained from https://www. covid19india.org, https://www.worldometers.info/coronavirus and ICMR reported publiclyavailable information on COVID-19. The number of confirmed cases are growing exponentially as per the real-time-data. For forecasting the trends in terms of confirmed, active, recovered, and death cases by using the autoregressive-integrated-moving-averages (ARIMA) model. Results: Findings reveal the estimated value of the point-forecast for total confirmed, active, recovered, and death cases. Estimates indicate that the total confirmed cases were increasing at the rate of 3.48%, active cases at 2.92%, recovered cases at 4.09% and death cases at the rate of 3.51% daily across the country. It was also observed that the death rate was lower for the states and union territories with a higher detection rate. Conclusion: Substantial public health interventions were implemented immediately by the Government of India to control the spread of COVID-19. Due to the shortage of healthcare resources in the country, early detection is imperative along with accurate forecasting. It will help in reducing the associated cost of acute care for the majority of infected cases and unnecessary burden on the healthcare system. Key words: Coronavirus Disease (COVID-19), Forecasting, ARIMA, Public-health, Emergency-preparedness, India.

Mixed malaria infections often go unrecognized and are therefore under reported. We hereby report the first described case of mixed infection due to P. malariae and P. vivax from most backward region of country emphasizing possibility of change in epidemiological pattern of malaria in the region. Also present case report highlight the increasing importance of Polymerase Chain Reaction in diagnosing malaria especially mixed malaria. Key words: Malaria, Plasmodium malariae, Plasmodium falciparum, Polymerase Chain Reaction in diagnosing.