Predicting suicidal behavior among Indian adults using childhood trauma, mental health questionnaires and machine learning cascade ensembles

Among young adults, suicide is India's leading cause of death, accounting for an alarming national suicide rate of around 16%. In recent years, machine learning algorithms have emerged to predict suicidal behavior using various behavioral traits. But to date, the efficacy of machine learning algorithms in predicting suicidal behavior in the Indian context has not been explored in literature. In this study, different machine learning algorithms and ensembles were developed to predict suicide behavior based on childhood trauma, different mental health parameters, and other behavioral factors. The dataset was acquired from 391 individuals from a wellness center in India. Information regarding their childhood trauma, psychological wellness, and other mental health issues was acquired through standardized questionnaires. Results revealed that cascade ensemble learning methods using a support vector machine, decision trees, and random forest were able to classify suicidal behavior with an accuracy of 95.04% using data from childhood trauma and mental health questionnaires. The study highlights the potential of using these machine learning ensembles to identify individuals with suicidal tendencies so that targeted interinterventions could be provided efficiently.Comment: 11 pages, presnted at the 4th International Conference on Frontiers in Computing and Systems (COMSYS 2023), Himachal Pradesh, October 202

Are people at high risk for diabetes visiting health facility for confirmation of diagnosis? A population-based study from rural India.

BACKGROUND: India is witnessing a rising burden of type 2 diabetes mellitus. India's National Programme for Prevention and Control of Diabetes, Cancer, Cardiovascular diseases and Stroke recommends population-based screening and referral to primary health centre for diagnosis confirmation and treatment initiation. However, little is known about uptake of confirmatory tests among screen positives. OBJECTIVE: To estimate the uptake of confirmatory tests and identify the reasons for not undergoing confirmation by those at high risk for developing diabetes. METHODS: We analysed data collected under project UDAY, a comprehensive diabetes and hypertension prevention and management programme, being implemented in rural Andhra Pradesh, India. Under UDAY, population-based screening for diabetes was carried out by project health workers using a diabetes risk score and capillary blood glucose test. Participants at high risk for diabetes were asked to undergo confirmatory tests. On follow-up visit, health workers assessed if the participant had undergone confirmation and ask for reasons if not so. RESULTS: Of the 35,475 eligible adults screened between April 2015 and August 2016, 10,960 (31%) were determined to be at high risk. Among those at high risk, 9670 (88%) were followed up, and of those, only 616 (6%) underwent confirmation. Of those who underwent confirmation, 'lack of symptoms of diabetes warranting visit to health facility' (52%) and 'being at high risk was not necessary enough to visit' (41%) were the most commonly reported reasons for non-confirmation. Inconvenient facility time (4.4%), no nearby facility (3.2%), un-affordability (2.2%) and long waiting time (1.6%) were the common health system-related factors that affected the uptake of the confirmatory test. CONCLUSION: Confirmation of diabetes was abysmally low in the study population. Low uptake of the confirmatory test might be due to low 'risk perception'. The uptake can be increased by improving the population risk perception through individual and/or community-focused risk communication interventions

Development and psychometric testing of an abridged version of Dundee Ready Educational Environment Measure (DREEM)

Abstract Background Dundee Ready Educational Environment Measure (DREEM) is a 50-item tool to assess the educational environment of medical institutions as perceived by the students. This cross-sectional study developed and validated an abridged version of the DREEM-50 with an aim to have a less resource-intensive (time, manpower), yet valid and reliable, version of DREEM-50 while also avoiding respondent fatigue. Methods A methodology similar to that used in the development of WHO-BREF was adopted to develop the abridged version of DREEM. Medical students (n = 418) from a private teaching hospital in Madurai, India, were divided into two groups. Group I (n = 277) participated in the development of the abridged version. This was performed by domain-wise selection of items that had the highest item-total correlation. Group II (n = 141) participated in the testing of the abridged version for construct validity, internal consistency and test-retest reliability. Confirmatory factor analysis was performed to assess the construct validity of DREEM-12. Results The abridged version had 12 items (DREEM-12) spread over all five domains in DREEM-50. DREEM-12 explained 77.4% of the variance in DREEM-50 scores. Correlation between total scores of DREEM-50 and DREEM-12 was 0.88 (p < 0.001). Confirmatory factor analysis of DREEM-12 construct was statistically significant (LR test of model vs. saturated p = 0.0006). The internal consistency of DREEM-12 was 0.83. The test-retest reliability of DREEM-12 was 0.595, p < 0.001. Conclusion DREEM-12 is a valid and reliable tool for use in educational research. Future research using DREEM-12 will establish its validity and reliability across different settings

Bi-directional screening for COVID-19, tuberculosis and diabetes in flu, DOTS and NCD clinics in a rural hospital in Northern India

Introduction: To assess the status of bi-directional screening for COVID-19, tuberculosis and diabetes among people attending Non-communicable Disease (NCD), Directly Observed Treatment Short-course (DOTS), and flu clinics of a secondary care hospital in rural northern India. Material and Methods: A cross-sectional, analytical study was conducted among the eligible (aged ≥18 years) population who attended the study clinics in a rural sub-district hospital. In the flu clinic, consecutive patients were assessed for screening for TB (symptom-based) and diabetes (random blood sugar) and status of referral to DOTS and NCD clinics. Similarly, the screening for diabetes and COVID-19, Reverse Transcription-Polymerase Chain Reaction (RT-PCR) in the DOTS clinic, and TB and COVID-19 in the NCD clinic were assessed. The independent association of factors with COVID-19 positivity were assessed by calculating the adjusted prevalence ratios (aPR) at 95% confidence interval (CI). Results: Of the 405 people assessed, 279 (68.9%), 102 (25.2%), and 24 (5.9%) were from flu, NCD, and DOTS clinics, respectively. 26 (25.5%) and 22 (91.7%) of NCD and DOTS clinic patients underwent RT-PCR for COVID-19. TB screening in NCD and flu clinics was done among 4 (3.9%) and 7 (12.5%), respectively. A total of 23 (9.0%) were found positive for COVID-19, and no factors other than the presence of COVID-19 symptoms (aPR: 2.89; 95% CI: 1.33–6.29) had any independent association with COVID-19 positive status. Conclusion: The low screening for TB in NCD and flu clinics indicates the need to strengthen the implementation the TB-DM and TB-COVID-19 bidirectional screening. Similarly, the low screening or testing for COVID-19 in the NCD clinic can be improved by the implementation of systematic screening strategies like TB-DM bidirectional screening

Perception of global participants of ITEC nations on country's preparedness and response to COVID-19 pandemic

Background: The Coronavirus disease 2019 (COVID-19) pandemic has exposed the public health preparedness and response system across the world. The current study was conducted to gauge the perception of public health professionals of Indian Technical and Economic Cooperation (ITEC) countries regarding the preparedness and responses of their countries in mitigating the COVID-19 pandemic. Methodology: Three capacity-building programs, namely “Managing COVID-19 Pandemic–Experience and Best practices of India” were conducted by PGIMER, Chandigarh, for public health professionals from ITEC countries from April to May 2021 in which 97 participants from 13 countries have participated. The tools used in the study were adapted from WHO’s COVID-19 Strategic Preparedness and Response (SPRP), Monitoring and Evaluation Framework, interim guidelines for Critical preparedness, readiness and response actions for COVID-19, and a strategic framework for emergency preparedness, and finalized using Delphi technique. The overall preparedness ofmanaging COVID-19 was rated using five-point Likert scale, whereas the overall score for the country in combating the COVID-19 pandemic was assessed using 10 point scale. Results: We found that the perception of public health professionals to government response regarding COVID-19 for fostering improvement on COVID-19 situation was “moderate” with respect to transmission and surveillance mechanism, uniform reporting mechanism, and availability of adequate personal protective equipment (PPE) for health workers. However, the participants rated government response as “poor” in the availability of multisectoral national operational plan, human resource capacity, availability of trained rapid response team (RRT), preparedness in prevention and clinical management, training of healthcare workers, communication and community engagement strategies, facilities to test samples of patients, and transparent governance and administration. Conclusion: A poor level of preparedness of countries in diverse domains of managing the COVID-19 pandemic was observed. As the global threat of COVID-19 is still looming, great efforts on building a robust preparedness and response system for COVID-19 and similar pandemics are urgently required. </p

Challenges in management of tuberculosis under programmatic conditions: Perceptions of health care providers from four states of India

Background: Among the global estimation of 10.4 million new cases of Tuberculosis (TB) in 2015, 27% of cases are contributed by India. Revised national TB control program (RNTCP) started in 1993, and now heading towards for universal access. Despite its achievements, the program faces number of implementation challenges. This qualitative study explored ‘what is healthcare providers take on it?’. Material & Methods: A total of 28 in-depth interviews were conducted in Uttarakhand, Chhattisgarh, Delhi and Maharashtra from October 2014 to January 2015, under the thematic areas of finance, human resource, and communications. Participants included senior level policy makers like principal secretaries of health, National Health Mission Directors, Director Health Services, state TB officers and district TB officers, medical officers, community volunteers and TB consultants from international agencies. Analytic induction method was used for data analysis. Results: Participants identified many barriers in the overall management and implementation of RNTCP. Convergence of RNTCP needs to be more effective. Inadequate Human resources, issues in public private partnership, insufficient budget allocation and interrupted fund flow, inefficient Information Education and Communication strategy are a few. Conclusion: This study could gather the perspectives of senior health officials, implementers and other stakeholders on challenges in implementation of TB control programme in four states. Challenges perceived by them are vital in strategic revisions of RNTCP

Trends and patterns of second-hand smoke exposure amongst the non-smokers in India-A secondary data analysis from the Global Adult Tobacco Survey (GATS) I & II.

ObjectivesThe primary objective of the present study was to compare the prevalence and patterns of second-hand smoke (SHS) exposure in the home, workplace, public places, and at all three places amongst the non-smoker respondents between the two rounds of Global Adult Tobacco Survey (GATS) in India. The secondary objectives were to assess the differences in various factors associated with SHS exposure among non-smokers.Study designThis secondary data analysis incorporated data generated from the previous two rounds of the cross-sectional, nationally representative GATS India, which covered 69,296 and 74,037 individuals aged 15 years and above. Exposure to the SHS at home, workplace, and public places amongst the non-smokers were the primary outcome variables. Standard definitions of the surveys were used.ResultsThe overall weighted prevalence of exposure to SHS amongst the non-smokers inside the home and public places reduced. In contrast, the prevalence in the workplace increased marginally in round II compared to I. The proportion of adults who were exposed to SHS at all three places did not change much in two rounds of surveys. A decrease in the knowledge of the respondents exposed to SHS at home and public places was observed about the harmful effects of smoking in round II. Age, gender, occupation, place, and region of respondents were found to be significant determinants of SHS exposure at all the three places on multinomial logistic regression analysis.ConclusionsThe study calls for focused interventions in India and stringent implementation of anti-tobacco legislation, especially in the workplaces for reducing the exposure to SHS amongst the non-smokers and to produce encouraging and motivating results by next round of the survey

Smoking cessation interventions for pulmonary tuberculosis treatment outcomes.

Main results: There were no randomised controlled trials that met the eligibility criteria. A number of potentially eligible studies are underway, and we will assess them for inclusion in the next update of this review. Authors' conclusions: There is a lack of high-quality evidence, i.e. RCTs, that tests the effectiveness of cessation interventions in improving TB treatment outcomes. There is a need for good-quality randomised controlled trials that assess the effect of SCIs on TB treatment outcomes in both the short and long term. Establishing such an evidence base would be an essential step towards the implementation of SCIs in TB control programmes worldwide