Work related musculoskeletal disorders among medical laboratory professionals: a narrative review

Work related musculoskeletal disorders are common health problem and increasing cause of disability. Laboratory professionals are unique group of healthcare professionals who play an essential part in diagnosis and therapy planning and often their work is associated with potential health hazards. Objective of current study was to review literature on prevalence of work-related musculoskeletal disorders among medical laboratory professionals. Electronic databases and bibliographies were searched and identified papers evaluated against inclusion criteria. The searching strategy uncovered 13 reports. Total 7 studies were included for the review. A high degree of heterogeneity among studies was observed. The overall prevalence’s ranges from 40-60%. With neck being more prevalent 18-78%. However additional high quality studies are required in this area

Prevalence of goitre and its associated factors in a coastal district of Karnataka

Context: Iodine deficiency Disorders (IDDs) are a major public health problem globally. In India more than 200 million are at risk for this disorder. It affects people of all ages and both sexes. The mental impairment caused by IDD especially in children is an important consequence of IDD. Aim: To find the prevalence of IDDs and the associated factors with it. Settings and Design: A school based cross – sectional study. Methods and Material: The study was done in Udupi district of Karnataka using a pretested, semistructured questionnaire. The villages of the three talukas (Udupi, Kundapur and Karkala) of Udupi district were sampled according to Probability Proportionate to Size (PPS).One school was chosen for the study from each of the 30 selected villages. Minimum of 90 students were selected from each school. Salt and urine samples were collected for Iodine estimation from a sub sample. Goitre was graded according to WHO/UNICEF/ICCIDD criteria. Results: A total of 3023 children were examined (M = 49.1%, F = 50.9%). The prevalence of goitre in Udupi district was 19.8%. The prevalence of goitre was found to be more amongst females compared to males (p = 0.021) and also was found to be increasing with the increasing age (p = 0.003). Of the 539 salt samples analyzed 23.7 % were inadequately iodized. Education of the father, fish consumption and occupation of the mother were found to be significant predictors of goitre. Conclusions: Goitre is a public health problem in Udupi district of Karnataka. The adequately Iodized salt coverage which should have been more than 90 % is not fulfilled. More awareness is required amongst the people about IDDs and its predictors

What predicts mental health literacy among school teachers?

Objectives: The present study aimed at assessing high school teachers’ mental health literacy (MHL) and predictors related to study outcomes.Design: Cross-sectional studyMethods: We employed 460 high school teachers who engaged with adolescents for at least six hours per week with a minimum of five years of teaching experience in southern India. Semi-structured questionnaires were used to assess their MHL. Descriptive analysis and backward logistic regression analysis were performed. A p-value < 0.05 was set as significant.Results: Teachers’ MHL on depression was less than desirable; however, they identified 288 (62.6%) adolescents with mental health problems during their career, and 172(59.72%) were referred to mental health professionals. On logistic regression analysis, teachers’ educational status, their marital status, teaching a class with an average strength of 31-60 students per class, previous mental health training and having self-efficacy concerning seeking informationon mental health, perceived ability to spread awareness and to provide referrals were found to predict MHL among teachers.Conclusion: Sociodemographic factors including teachers’ educational status, average class strength and having had previous mental health training were predictors for MHL among high school teachers. Establishing training programs and referral networks may be key in early intervention among adolescents

Quantifying audio visual alcohol imagery in popular Indian films: A content analysis

Objectives Though exposure to alcohol imagery in films is a significant determinant of uptake and severity of alcohol consumption among young people, there is poor evidence regarding the content of alcohol imagery in films in low-income and middle-income countries. We have measured alcohol imagery content and branding in popular Indian films, in total and in relation to language and age rating. Design In this observational study we measured alcohol imagery semiquantitatively using 5-minute interval coding. We coded each interval according to whether it contained alcohol imagery or brand appearances. Setting India. Participants None. Content analysis of a total of 30 national box office hit films over a period of 3 years from 2015 to 2017. Primary and secondary outcome measures To assess alcohol imagery in Indian films and its distribution in relation to age and language rating has been determined. Results The 30 films included 22 (73%) Hindi films and 8 (27%) in regional languages. Seven (23%) were rated suitable for viewing by all ages (U), and 23 (77%) rated as suitable for viewing by children subject to parental guidance for those aged under 12 (UA). Any alcohol imagery was seen in 97% of the films, with 195 of a total of 923 5-minute intervals, and actual alcohol use in 25 (83%) films, in 90 (10%) intervals. The occurrence of these and other categories of alcohol imagery was similar in U-rated and UA-rated films, and in Hindi and local language films. Episodes of alcohol branding occurred in 10 intervals in five films. Conclusion Almost all films popular in India contain alcohol imagery, irrespective of age rating and language. Measures need to be undertaken to limit alcohol imagery in Indian films to protect the health of young people, and to monitor alcohol imagery in other social media platforms in future

Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis

Background: Tobacco use is associated with early, intermediate and long-term complications throughout the life course. With an influx of newer products containing nicotine, poly-tobacco use is slowly emerging as a public health concern, that is defined as existing tobacco users currently using two or more tobacco or nicotine products. While many studies have investigated single use tobacco, there is a paucity of research on regional patterns and socio-demographic factors associated with poly-tobacco use in India. Objectives: To assess prevalence of poly-tobacco use and determine the socio-demographic factors associated with poly-tobacco use in India. Methods: Data from the Global Adult Tobacco Survey 2 (GATS, 2016–17) was analysed, which included information on tobacco use among people aged >15 years. The pattern of current tobacco status was described using descriptive statistics. Multiple logistic regression models were estimated to determine factors associated with poly-tobacco use. Results: The prevalence of poly-tobacco use in India was found to be 9.8%. Among the current tobacco users, the prevalence was 33%. Significant socio-demographic factors associated with poly-tobacco use included younger age, male gender, religion and backward caste. North-eastern region reported highest prevalence of poly-tobacco use in the country, followed by the central region. Conclusion: The number of poly-tobacco users in India is considerably high and a matter of concern, more so in north east and central regions of the country. There is a need to create awareness about dangerous effects of all types of tobacco products and strengthen implementation of tobacco control policies with special focus on regions with high burden

Exposure to tobacco imagery in popular films and the risk of ever smoking among children in southern India

Background Exposure to smoking in films is a recognised cause of smoking uptake among children. In India, in an attempt to protect children, films containing smoking are required to include tobacco control messaging including audiovisual disclaimers, on-screen health warnings when tobacco imagery is displayed and antitobacco € health spots' before and during the film. We report a study of the association between ever smoking and exposure to tobacco imagery in locally popular films among children in Udupi district of Karnataka state in southern India. Methods A cross-sectional questionnaire survey of all students in grades 6-8 in schools in the Udupi district ascertained smoking status and potential confounders of smoking uptake, and whether children had seen any of 27 locally popular films we had coded and found to contain imagery of actual or implied tobacco use. Ever-smoking status was defined as any reported smoking of cigarettes, beedis or other tobacco products currently or at any time in the past. Independent effects on ever-smoking status were estimated using multiple logistic regression. Results Of 46 706 students enrolled in grades 6-8 in 914 participating schools, 39 282 (84.1%) provided questionnaire responses sufficiently complete for analysis. Ever smoking was reported by 914 (2.3%) participants and in a mutually adjusted model was significantly related to age, male sex, living in a home where smoking is allowed, having parents or siblings who smoke, low paternal education, low levels of family wealth, low self-esteem, rebelliousness and poor school performance. After allowing for these effects, the odds of ever smoking were not increased among students who had seen any of the listed films containing tobacco imagery when included in the analysis as a binary exposure (OR 0.9, 95% CI 0.4 to 2.0), and decreased in relation to level of exposure graded into tertiles of tobacco intervals seen. Conclusions In this cross-sectional study, children in southern India who had seen films containing tobacco imagery are no more likely to smoke than those who had not, indicating that the tobacco control messaging mandated by Indian law may be attenuating the effect of tobacco imagery in films on smoking uptake

Programme and policy perspectives towards a tobacco-free generation in India: findings from a qualitative study

Objective This study explored multistakeholder perspectives on existing adolescent-specific tobacco control policies and programmes, to advance India’s transition towards a tobacco-free generation.Design Qualitative semi-structured interviews.Setting Interviews were conducted with officials involved in tobacco control at the national (India), state (Karnataka), district (Udupi) and village level. Interviews were audio recorded, transcribed verbatim and analysed thematically.Participants Thirty-eight individuals representing national (n=9), state (n=9), district (n=14) and village (n=6) levels, participated.Results The study findings highlighted the need to strengthen and amend the existing Tobacco Control Law (2003) provisions, particularly in the vicinity of schools (Sections 6a and 6b). Increasing the minimum legal age to buy tobacco from 18 to 21 years, developing an ‘application’ for ‘compliance and monitoring indicators’ in Tobacco-Free Educational Institution guidelines were proposed. Policies to address smokeless tobacco use, stricter enforcement including regular monitoring of existing programmes, and robust evaluation of policies was underscored. Engaging adolescents to co-create interventions was advocated, along with integrating national tobacco control programmes into existing school and adolescent health programmes, using both an intersectoral and whole-societal approach to prevent tobacco use, were recommended. Finally, stakeholders mentioned that when drafting and implementing a comprehensive national tobacco control policy, there is a need to adopt a vision striving toward a tobacco-free generation.Conclusion Strengthening and developing tobacco control programmes and policies are warranted which are monitored and evaluated rigorously, and where adolescents should be involved, accordingly

Prospective cohort study of exposure to tobacco imagery in popular films and smoking uptake among children in southern India

Background Exposure to tobacco imagery in films causes young people to start smoking. Popular Indian films contain high levels of tobacco imagery, but those that do are required by law to display onscreen health warnings when smoking imagery occurs and to include other health promotion messaging before and during the film. We report a prospective cohort study of incident smoking in relation to exposure to film tobacco imagery and anti-tobacco messaging in a cohort of children in southern India. Methods We carried out a one-year longitudinal follow up questionnaire survey in 2018 of a cohort of 39,282 students in grades 6, 7 and 8 (aged between 10 and 15 years) in schools in the Udupi district of Karnataka State in India who participated in a 2017 cross-sectional study of exposure to smoking in films and ever smoking status. Results We obtained usable linked data in 2018 from 33,725 of the 39,282 (86%) participants with data from 2017. Incident smoking was reported by 382 (1.1%) participants. After adjusting for age, sex and common confounders significantly associated with incident smoking there was no significant independent effect of exposure to film smoking, either as a binary (Odds Ratio 1.6, 95% Confidence Interval (CI) 0.5 to 4.9) or as a graded variable, on smoking uptake. An exploratory analysis indicated that the presence of on-screen health warnings that complied fully with Indian law was associated with a significantly lower odds of smoking uptake (Odds Ratio 0.8 (0.6 to 1.0, p = 0.031) relative to the same exposure sustained in absence of compliant warnings. Conclusion Exposure to tobacco imagery in Indian films was not associated with a significantly increased risk of incident smoking in South Indian children. While it is possible that this finding is a false negative, it is also possible that the effect of film exposure has been attenuated by the presence of on-screen health warnings or other Indian tobacco-free film rules. Our findings therefore support the wider implementation of similar tobacco-free film measures in other countries

Potential risk factors of smokeless tobacco consumption among adolescents in South India

Introduction: Although most of the disease burden is due to tobacco smoking, smokeless tobacco (SLT) use contributed to an estimated 76,000 deaths in 2017. We have studied the potential risk factors for SLT use among adolescents in South India. Methods: A cross-sectional questionnaire survey of all students in grades 6 to 8 in schools in the Udupi district of Karnataka State ascertained SLT use status and potential determinants of SLT uptake. Ever SLT use was defined as any reported consumption of any SLT products, currently or at any time in the past. Independent effects on ever-SLT use status were estimated using multiple logistic regression. Results: Of 46,706 students from 914 participating schools, 39,282 (84.1%) provided questionnaire responses sufficiently complete for analysis. Ever SLT use was reported by 775 (2.0%) participants and in a mutually adjusted model was significantly related to age, male sex, family use or friend’s use of SLT, low socio-economic status, high rebelliousness and low self-esteem. After controlling for these effects, the odds of ever-SLT use were significantly higher among students who had least awareness of the harmful effects of tobacco use [OR 3.7 95% CI (2.9,4.7)] and significantly lower among those not exposed to tobacco advertising [OR 0.7 95% CI (0.5,0.8). Conclusions: The prevalence of SLT use among children in Karnataka is relatively low as compared to other studies in India. The significant potential risk factors of SLT use include low awareness of the harmful effects of tobacco and tobacco control policies and exposure to tobacco advertising

Assessing the Validity of Adult-derived Prognostic Models for Primary Sclerosing Cholangitis Outcomes in Children

Background: Natural history models for primary sclerosing cholangitis (PSC) are derived from adult patient data, but have never been validated in children. It is unclear how accurate such models are for children with PSC. Methods: We utilized the pediatric PSC consortium database to assess the Revised Mayo Clinic, Amsterdam-Oxford, and Boberg models. We calculated the risk stratum and predicted survival for each patient within each model using patient data at PSC diagnosis, and compared it with observed survival. We evaluated model fit using the c-statistic. Results: Model fit was good at 1 year (c-statistics 0.93, 0.87, 0.82) and fair at 10 years (0.78, 0.75, 0.69) in the Mayo, Boberg, and Amsterdam-Oxford models, respectively. The Mayo model correctly classified most children as low risk, whereas the Amsterdam-Oxford model incorrectly classified most as high risk. All of the models underestimated survival of patients classified as high risk. Albumin, bilirubin, AST, and platelets were most associated with outcomes. Autoimmune hepatitis was more prevalent in higher risk groups, and over-weighting of AST in these patients accounted for the observed versus predicted survival discrepancy. Conclusions: All 3 models offered good short-term discrimination of outcomes but only fair long-term discrimination. None of the models account for the high prevalence of features of autoimmune hepatitis overlap in children and the associated elevated aminotransferases. A pediatric-specific model is needed. AST, bilirubin, albumin, and platelets will be important predictors, but must be weighted to account for the unique features of PSC in children.Peer reviewe