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Background: The implementers of the tobacco control policy in the field have been neglected by the policymakers. They are the ones who have first-hand knowledge and their experiences in the field are not being used to bring about changes in the area of tobacco control. Objective: The objective of this paper is to critically examine how Michael Lipsky's concept of street-level bureaucracy can be used to address tobacco control in the health department in district Jalandhar of Punjab. Methods: Semi-structured interview schedules were used to interview Senior Medical Officers/Nodal Officers and Health Supervisors/Sanitary inspectors in four out of ten Community Health Centers and District hospital in Jalandhar. Data so collected were subjected to the process of inductive analysis and themes developed within the framework given by Lipsky. Results: The street-level bureaucrats (SLBs) were not given adequate training, and various organizational resources for tobacco control are missing in the district. There are threats and challenges which are faced by them in the field, and they do not exercise decision-making power to handle these barriers for effective implementation of the tobacco control program. Conclusion: The government needs to be inclusive in the process of policymaking meaning that it can be more accommodative of the suggestions given by the SLBs and provide them with discretionary powers to exercise their role efficiently. [ABSTRACT FROM AUTHOR]

Background: Interactive teaching methods aid post graduate students in learning qualitative research. Four academic researchers from the United Kingdom had an opportunity to teach qualitative research methods, specifically consensus methods, to the Master of Public Health students (MPH) during a visit to India. This teaching formed part of a work package with All India Institute of Medical Sciences Rishikesh, India exploring the concept of family resilience among families with children under 6 years. Aims: To use the experiences of the MPH students to gain knowledge and create meaning about using the consensus methods. Participants: The participants were the MPH students. Methods: We used the workshop method to introduce the concept of family resilience by using the question, ‘What will be the three top public health priorities in India to support family resilience in the 21st century?’ as a central theme for all the workshops. Furthermore, we introduced qualitative research methods and hands on experience of consensus methods to the students. The students were introduced to Delphi and Group Concept Mapping (GCM) methods during workshop 1. Workshop 2 introduced Nominal Group Technique (NGT) through a short presentation followed by a practical hands on session using GCM data from workshop 1. The last workshop (3) focused on the World Café method. Results: The students evaluated the workshops highly and asked for online sessions on GCM, NGT, and World Café which will be planned in the future. Conclusion: We concluded that the post graduate curriculum for master’s in public health studies would benefit from teaching using interactive research methods which will enhance their critical thinking and autonomy. Second, although the MPH curriculum had quantitative methods in place, introducing qualitative consensus methods will open new avenues into future research. Finally, teaching using practical demonstration gives students a voice and makes learning effective and enjoyable. [ABSTRACT FROM AUTHOR]

Background: Though numerous variables affect academic performance in children, one of the primary underlying causes is poor nutrition. Nutritional status determines how the body develops, how the mind works, and how one behaves and hence should be given sufficient priority in growing children. The likelihood of acquiring type 2 diabetes is becoming more common in children and adolescents with poor nutrition and unhealthy eating habits. Aim: This study aimed to determine the nutritional status of girls and boys studying in grade 9 and the influence of nutritional status with respect to achievements in academics. Materials and Methods: This was a descriptive study done based on the permission obtained in a private school located in North Chennai. The sample of 210 children of grade 9 was selected based on their academic performance, socioeconomic status, age, type of school, sex, family size (siblings order), and parent’s educational status randomly. Data were collected in the form of questionnaire to understand the impact of nutritional status influencing academic achievements. Results: Of the 210 participants studied, the nutritional status among boys and girls was perceived differently (P < 0.01). The nutritional status with respect to parental education and sibling order also had a significant difference (P < 0.01). There was a positive correlation between academic achievement in the quarterly and half-yearly exams and the nutritional status of the students. Conclusions: The study report clearly indicates that there is a relationship between the nutritional status of the children and their academic achievement. The nutritional status of children has also an impact on their risk of developing diabetes. [ABSTRACT FROM AUTHOR]

Background: Previously, we had a course in epidemiology for medical undergraduates that was based on traditional lecture methods with no formal formative assessment (FA). We found poor uptake of our course in terms of learning and attendance by students. Objective: The objective was to assess the effect of improved course (interactive lectures and formal FA) in epidemiology on student learning and attendance. Materials and Methods: It was a triangulation type of mixed-methods program evaluation, where both quantitative (quasi-experimental design) and qualitative (open-ended responses) analysis was done. This study was carried out in the department of community medicine in a tertiary care teaching hospital, Puducherry. We improved the quality of the course material, interaction in lectures and included formal structured FA in the last course. Kirkpatrick's framework was used for the course evaluation. We compared the performance of three batches to check the effect of our revisions on students' learning and their attendance. Results: Student's learning outcome was measured using end-of-course assessment scores (Level-2). The percentage of students successfully completing the course improved from 39% to 81% and attendance status of ≥90% improved from 50% to 57%. Learner's immediate reactions (Level-1) were captured using open-ended questions, and content analysis was done. Students appreciated the course material, FAs, and in-class activity. Conclusions: Little improvement in a traditional epidemiology course for undergraduates in the form of interactive lectures and formative feedback and providing the student with course material led to significant gains in students' knowledge and attendance. [ABSTRACT FROM AUTHOR]

Imparting a positive attitude toward social determinants of health among medical students has remained a challenge in medical education. This pedagogical exercise attempted to use a toxic tour with participant photography technique to impart environmental health education as part of the community medicine curriculum for medical students. In collaboration with a local environmental health nongovernmental organization, faculty from two medical colleges took a set of 13 medical students to Ennore thermal power plants as a part of a toxic tour to view the air and water pollution caused due to the operation of the power plants. The students were instructed to capture photographs of the environmental hazards using their mobile phone cameras and share them on a social media platform. Immediately after the tour, the students discussed their experiences with the faculty. Two weeks after the toxic tour, the students engaged in a focus group discussion in which they discussed their experiences, advantages, and disadvantages of the toxic tour and participant photography method and their attitudes toward environmental health. This pedagogical exercise led to the active engagement of the students with the environmental hazards in the area. They shared 70 photographs on the social media platform. In reflection, students described that they found the method very useful to actively engage with the environment, look for and find the hazards, revisit, and reflect on the photos, and use the photos to share the knowledge and experience. They also demonstrated a positive social determinants and public health attitude during the discussions. Participant photography technique during a toxic tour can impart affective domain of learning related to environmental health among medical students. [ABSTRACT FROM AUTHOR]

Background and Rationale: Patients suffering with head and neck cancers are observed to have a relatively high risk of developing emotional disturbances after diagnosis and treatment. These emotional concerns can be best understood and explored through the method of content analysis or qualitative data. Though a number of qualitative studies have been conducted in the last few years in the field of psychosocial oncology, none have looked at the emotions experienced and the coping by head and neck cancer patients. Materials and Methods: Seventy-five new cases of postsurgery patients of head and neck cancers were qualitatively interviewed regarding the emotions experienced and coping strategies after diagnosis. Results: Qualitative content analysis of the in-depth interviews brought out that patients experienced varied emotions on realizing that they were suffering from cancer, the cause of which could be mainly attributed to three themes: 1) knowledge of their illness; 2) duration of untreated illness; and 3) object of blame. They coped with their emotions by either: 1) inculcating a positive attitude and faith in the doctor/treatment, 2) ventilating their emotions with family and friends, or 3) indulging in activities to divert attention. Conclusion: The results brought out a conceptual framework, which showed that an in-depth understanding of the emotions — Their root cause, coping strategies, and spiritual and cultural orientations of the cancer survivor — Is essential to develop any effective intervention program in India. [ABSTRACT FROM AUTHOR]

Introduction: Systematic reviews and meta-analyses of well-designed and executed randomized controlled trials have the potential to provide the highest levels of evidence to support diagnostic and therapeutic interventions in urology. Materials and Methods: The role of systematic reviews in the urological literature is described. A three-step appraisal of the validity, magnitude and applicability of results will permit an evidence-based approach to incorporating findings of systematic reviews and meta-analyses into practice. Results: The validity of systematic reviews depends on a focused clinical question that generates specific inclusion and exclusion criteria for identifying studies through an exhaustive literature search. The primary studies must be of high methodological quality and assessments should be reproducible. Informed consumers of the urological literature should be aware of the consistency of results between trials in a review, as well as the magnitude and precision of the best estimate of the treatment effects. When making decisions about implementing the results, urologists should consider all patient-important outcomes, the overall quality of the evidence and the balance between benefits, potential harms and costs. Conclusion: This framework will lead to a more evidence-based application of systematic reviews within the urological literature. Ideally, utilization of an evidence-based approach to systematic reviews will improve the quality of urological patient care. [ABSTRACT FROM AUTHOR]

Purpose: Clinical practice guidelines play a critical role in guiding the evidence-based clinical practice of urology. We describe a systematic approach to critical appraisal of urology guidelines. Materials and Methods: Based on a focused clinical question derived from a clinical scenario, we identified a relevant clinical practice guideline that we critically appraised using the Users' Guide to the Medical Literature framework as to whether the results are valid, what are the results, and can they be applied to the care of an individual patient. Results: A clinical practice guideline by the National Institute for Clinical Excellence on the use of sunitinib as the first line treatment for patients with metastatic renal cell carcinoma was identified. The guideline development process was found to be appropriately rigorous and included an explicit rating of the quality of evidence. The recommendations were clearly stated and appeared applicable to the specific patient in the clinical scenario. Conclusions: Clinical practice guidelines should be developed using rigorous evidence-based methodology. Urologists should have the skills and knowledge to critically appraise a guideline before applying it to the care of their patients. [ABSTRACT FROM AUTHOR]