Alcohol and Tobacco Use Among Undergraduate and Postgraduate Medical Students in India: A Multicentric Cross-sectional Study

Background: Substance use among medical fraternity is a well-known phenomenon among both undergraduate (UG) and postgraduate (PG) medical students. Yet, there have been very few multi-centric studies to estimate the actual burden of this problem in this important population group in India. This study was conducted to estimate the prevalence of alcohol and tobacco use, assess the knowledge and attitudes towards this issue, and identify factors associated with substance use among UG and PG medical students in India.Methods: A pre-tested, self-report, anonymous questionnaire was administered to medical undergraduates and post graduate medical residents of eight medical colleges across India. This study used a convenience sample of medical colleges with random selection of study participants within each college for each group, UG and PG.Results: Prevalence of alcohol and tobacco use among UG students was 16.6%, 95% CI [14.5, 18.9] and 8.0%, 95% CI [6.4, 9.6], respectively, whereas prevalence was 31.5%, 95% CI [26.3, 37.0] and 14.5%, 95% CI [10.7, 18.9], respectively for PGs. For both substances, males had a higher prevalence of use compared to females in both groups (p < 0.001). Positive family history of substance use (p < 0.001 for both groups) and early age of initiation (p = 0.011 for tobacco; p > 0.05 for alcohol) were associated with a greater difficulty to quit the habit. Over 90% of study participants felt that substance use adversely affected their skills and reported not using substances prior to managing their patients.Conclusions: Since substance use is a relatively common phenomenon among UG and PG medical students in India, future prospective studies and interventions are required to better understand the pattern of substance use and reduce its prevalence.

Community based cross sectional study: to assess the prevalence of arthritic symptoms in an army garrison in large city of North India

Background: Arthritis affects almost 350 million people globally and is one of the leading causes of disability in the world. The prevalence in India is like that in developed countries. Symptoms of arthritis have been found to be influenced by alcohol intake, smoking, obesity and type of diet which lead to aggravation in pain, exacerbation in disease activity and deterioration in general health.Methods: Present community-based cross-sectional study was conducted in a large military station in North India over a period of one month. Armed Forces personnel and their family members aged 18 yrs and above residing in military station and consenting to the study were included. A sample of 1475 was studied.Results: The age of participants ranged from 18 to 70 yrs (median 32±7.4 yrs) with 20.54% females and 79.46% males. The prevalence of symptoms suggestive of Gout, RA, OA and Spondyloarthritis was 8.95% (95% CI, 7.54, 10.52), 3.25% (2.41, 4.29), 11.32% (9.75, 13.05) and 14.17% (12.43, 16.05), respectively. Symptoms suggestive of RA were found to be significantly associated with female gender, those of Gout and Spondyloarthritis with male gender, while OA did not have any gender predisposition.Conclusions: The population with symptoms of arthritis needs to be identified early by early symptomatic diagnosis and measures instituted for appropriate management to prevent future complications and associated morbidity

Access to medicines in the Indian Public Health System – what works and what does not? A review of the National Health Mission Common Review Mission Reports (2007-2021)

Since the inception of India's flagship "National Health Mission" (formerly known as the National Rural Health Mission), considerable efforts have been made to ensure access to quality and affordable healthcare, including medicines. Over time, there has been a differential, yet noticeable improvement in the availability and access to medicines across states. This underscores the need to review and analyse various state-specific practices in India supported or recommended by the NHM, to identify key enablers and barriers. Consequently, a review of NHM’s Common Review Mission (CRM) reports between 2007 and 2021 was undertaken. All findings relevant to medicines were identified, retrieved and analysed. Core themes pertaining to medicines included: mechanisms adopted by states for procurement and supply chain management, health system factors influencing the supply chain, the convergence of national health programs, the rollout of the Free Drugs Service Initiative and Comprehensive Primary Health Care, and awareness among the healthcare providers and community. The article further expounds on these themes in the Indian context, highlighting the determinants of access to medicines as well as their interlinkages. In conclusion, it underscores the need to strengthen the overall health system to accelerate universal access to free essential medicines at public health facilities

Why should we invest in health? Evidence from the lens of second-order benefits of health

Life expectancy and access to health care have both increased globally in recent decades, and these innovations have significantly improved well-being. As a result, health reforms are increasingly becoming a top concern in all countries in order to address/increase accessibility, affordability, and availability of quality services, as well as improve spending efficiencies. There are many evidenced benefits which are secondary to the health benefits of those programmes. However, second-order benefits of health schemes have received little attention and are rarely discussed in mainstream policy and practice. The paper intends to contribute to broader initiatives to recognise health schemes as vital in achieving equitable and inclusive development that benefits the entire community. The logical framework technique was used to analyse the health schemes' second-order benefits. The primary and secondary objectives, methods, outcomes, and impacts were compared. Apart from the health programmes’ own objectives, the analysis revealed extensive benefits such as employment opportunities, local partnerships with communities, decreased inequalities and population-level impacts on socio-economic development, women empowerment, increase in literacy and school completion rates, and decrease in out-of-pocket expenditure. The economic impact of investing in health systems by creating high-quality jobs and purchasing goods and services from local businesses is highlighted by the second-order health advantages, which are in relation to the primary benefits. Not only do healthcare systems play an important role in the economies of the nation, but also in the social lives of these communities

Innovations in teaching/learning methods for medical students: Research with mentoring

In this era of evidence-based medicine, innovative teaching learning methods coupled with appropriate mentoring are required to make the undergraduate medical students interested in the speciality of Community Medicine. Teaching research methodology to medical students by a hands-on approach along with mentoring by involving them in small, feasible, sustainable, and replicable studies on a topic of interest clearly showed renewed interest among students toward the subject

Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices

The rapid uptake of the hypodermic syringe as a medical technology by physicians in Europe and America since its introduction in the middle of the 19th century has led to a level of medical and public acceptance seldom reached by other therapeutic techniques. Presently, the developed world has clear guidelines regarding injection use and safety; in contrast, developing countries are facing the brunt of risks associated with the use of this technology, which was introduced into their societies during the early 20th century. There is now a popular demand for injections, and an alarming number of unnecessary and unsafe injections are being administered. The problem of unsafe injections is not restricted to curative injections, but includes immunizations too. The association of unsafe injections and infection transmission is quite clear, and there is an urgent need to reduce the number of required injections and make them safe. An understanding of the determinants of current injection practices in the socio-cultural-economic context is necessary in order to plan relevant and effective interventions.Injections Determinants Magnitude Safety Research Policy

Correspondence article on the research protocol titled ‘Towards Health Equity and Transformative Action on tribal health (THETA) study to describe, explain and act on tribal health inequities in India: A health systems research study protocol’ published in Wellcome Open Research in December 2019 [version 1; peer review: 2 approved]

Research on indigenous (Tribal) populations is a step towards understanding the various tribal health issues and challenges and paves the way for addressing these issues. However, such populations are categorised as vulnerable and marginalised according to National ethical guidelines by Indian council of medical research. Hence, adequate measures are needed to be ensured by researchers while undertaking any research involving tribal populations to safeguard the rights of research participants. The purpose of this correspondence is to initiate a discussion among the researchers to give due consideration to research ethics especially when the research is being conducted on vulnerable populations and take adequate safeguard measures as suggested by National ethical guidelines to protect the rights of study participants

Effectiveness of evaporative desert cooler mounted with fabricated metal mesh in preventing Aedes mosquito breeding in a North Indian City

Context: We modified conventional metal body evaporative desert coolers by covering the water sump with fabricated metal mesh. Aedes mosquito breeding in these modified desert coolers was then tested during dengue transmission season. Aim: This study was carried out with the aim of providing an effective modification which can be carried out locally in evaporative metal body desert room coolers, to prevent Aedes mosquito breeding. The authors also compared the effectiveness of such desert coolers mounted with fabricated metal mesh against the standard National Centre for Disease Control, mosquito proof coolers (NCDC-MPC). Settings and Design: This study was carried out from October 2015 to 2016 in a large military cantonment area of North India. The data collection for larval breeding was done during late summer and monsoon months, namely May–October 2016. Subjects and Methods: Conventional metal body evaporative desert cooler was modified by covering its sump water tank with a fine mesh. These modified coolers were then monitored for larval breeding and compared with the NCDC-MPC, and conventional nonmodified routinely used desert coolers. Statistical Analysis Used: A database was created in MS Excel and observations were recorded analyzed and tabulated. Results: No breeding was detected in the NCDC coolers and the coolers mounted with fabricated metal mesh. Conclusion: The conventional desert cooler locally modified by mounting a fabricated metal mesh to cover sump water tank of the cooler, was found to be effective in preventing Aedes breeding. It offers the advantage of simplicity, low cost, and improved availability

Hydroxychloroquine/chloroquine prophylaxis among health-care workers: Was it really preventive? – Evidence from a multicentric cross-sectional study

Background: Despite the low level of clinical evidence in hydroxychloroquine (HCQ) favor, it was prescribed for pre- and post-exposure prophylaxis in India and worldwide. In absence of a large randomized control trial, the evidence needs to be generated through observation study, hence the study was conducted to find the evidence for prophylaxis of HCQ. Materials and Methods: A multi-centric cross-sectional study involving government hospitals was chosen for serosurvey conducted from August 21, 2020, to November 20, 2020. Questionnaire was adopted from WHO. Data about chloroquine (CQ) use among health-care workers (HCWs) were added and the duration of CQ intake was also noted. Results: A total of 2,224 HCWs were recruited. The mean duration of time of taking HCQ was 7.1 weeks (standard deviation ± 6.1 weeks, median = 4 weeks with IQR, 3–10 weeks). Training on personal protective equipment (PPE), knowledge of handwashing, direct care to the patient, availability of alcohol hand rub, close contact with the patient, duration of contact, and usage of PPE were associated with HCQ intake. The antibody formation in group taking HCQ was 16.9% compared to 19.8% not taking it (P = 0.08). The Chi-square for linear trend for weeks of HCQ intake and antibody formation. However, the same was not statistically significant (Chi-square = 3.61, P = 0.06). Conclusion: Our study did not find a statistically significant association in the large multicentric study. The absolute difference of 2.9% in the two groups may not be sufficient to warrant its widespread use for prophylaxis