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A diagnosis of autism typically depends on clinical assessments by highly trained professionals. This high resource demand poses a challenge in low-resource settings. Digital assessment of neurodevelopmental symptoms by non-specialists provides a potential avenue to address this challenge. This cross-sectional case-control field study establishes proof of principle for such a digital assessment. We developed and tested an app, START, that can be administered by non-specialists to assess autism phenotypic domains (social, sensory, motor) through child performance and parent reports. N = 131 children (2–7 years old; 48 autistic, 43 intellectually disabled and 40 non-autistic typically developing) from low-resource settings in Delhi-NCR, India were assessed using START in home settings by non-specialist health workers. The two groups of children with neurodevelopmental disorders manifested lower social preference, greater sensory interest and lower fine-motor accuracy compared to their typically developing counterparts. Parent report further distinguished autistic from non-autistic children. Machine-learning analysis combining all START-derived measures demonstrated 78% classification accuracy for the three groups. Qualitative analysis of the interviews with health workers and families of the participants demonstrated high acceptability and feasibility of the app. These results provide feasibility, acceptability and proof of principle for START, and demonstrate the potential of a scalable, mobile tool for assessing neurodevelopmental conditions in low-resource settings. Autism is diagnosed by highly trained professionals– but most autistic people live in parts of the world that harbour few or no such autism specialists and little autism awareness. So many autistic people go undiagnosed, misdiagnosed, and misunderstood. We designed an app (START) to identify autism and related conditions in such places, in an attempt to address this global gap in access to specialists. START uses computerised games and activities for children and a questionnaire for parents to measure social, sensory, and motor skills. To check whether START can flag undiagnosed children likely to have neurodevelopmental conditions, we tested START with children whose diagnoses already were known: Non-specialist health workers with just a high-school education took START to family homes in poor neighbourhoods of Delhi, India to work with 131 two-to-seven-year-olds. Differences between typically and atypically developing children were highlighted in all three types of skills that START assesses: children with neurodevelopmental conditions preferred looking at geometric patterns rather than social scenes, were fascinated by predictable, repetitive sensory stimuli, and had more trouble with precise hand movements. Parents' responses to surveys further distinguished autistic from non-autistic children. An artificial-intelligence technique combining all these measures demonstrated that START can fairly accurately flag atypically developing children. Health workers and families endorsed START as attractive to most children, understandable to health workers, and adaptable within sometimes chaotic home and family environments. This study provides a proof of principle for START in digital screening of autism and related conditions in community settings. [ABSTRACT FROM AUTHOR]

Background: Inadequate complementary feeding practices lead to poor cognition, stunting, and increased rate of infections. Insight into deficiencies of complementary feeding practices could help in planning and implementing newer approaches at various levels of intersection. Aims and Objectives: The aim and purpose of the study were to determine the complementary feeding practices, to identify maternal determinants of each practice, and to analyze the associations between complementary feeding practices with malnutrition. Materials and Methods: A prospective observational study was conducted at the Department of Pediatrics, of a tertiary hospital over a 14-week period. All children aged 6-23 months were included in the study. Data were collected using a pre-structured questionnaire based on the World Health Organization Infant and Young Child Feeding (IYCF) indicators for assessing IYCF practices. Results: A total of 400 mothers participated in the study. The mean age of children was 12.58 20±5.02 months, male: female = 1.6:1. The mean age of starting complementary feeding was 6.81±1.79 months. Semisolid food was introduced in 90.2% of children, minimum dietary diversity was received by 61.0%, minimum meal frequency by 83.8%, and minimum acceptable diet by 58.2%, eggs and flesh by 14.2% and 3.5% children, respectively; only 9.2% received vitamin A rich fruits and 38.5% did not receive any vegetable or fruit. Bottle feeding was present in 55.5% of population. Maternal parameters (education, employment access to media) and socioeconomic status were significantly associated with feeding practices (P<0.05). A significant difference was found in the nutritional status (wasting and stunting) of children who did not receive minimum dietary diversity (P<0.01). Conclusion: Wide gap exists in feeding practices even in urban settings and was significantly associated with child's nutritional status. [ABSTRACT FROM AUTHOR]

Introduction: Caesarean Section (CS) despite being one of the most commonly performed surgeries in the world has a wide variation in its techniques. To improve the outcomes of CS through rectification of the surgical techniques, it is imperative to assess the current practices amongst the obstetricians and analyse the rationale behind their surgical preferences. Aim: To assess the surgical techniques used for primary CS by obstetricians and review them with respect to the current evidence. Materials and Methods: The present descriptive, questionnairebased, cross-sectional study was carried out in the Department of Obstetrics and Gynaecology, Mayo Institute of Medical Sciences, Barabanki, Lucknow, Uttar Pradesh, India, in the month of May 2020. A total of 400 Obstetricians possessing diploma or degree in the speciality performing CS and willing to participate in the study were included. A pretested questionnaire majorly focused on the various surgical techniques of primary CS, performed by the obstetricians, was distributed online. A total 203 respondents completed the questionnaire and their response was recorded. Analysis of Variance (ANOVA), Independent samples t-test and Pearson's correlation coefficients were used to analyse the data. Results: Majority (n=140, 68.96%) of the respondents were between 25-40 years of age. In the study population, 8 (3.94%) were male respondents and 195 (96.06%) were female respondents. experience of <5 years. The most consistently used technique was the creation of bladder flap (187, 92.11%), while the least common was use of vertical incision (6, 2.9%) for opening the abdomen. There was a huge variation in the method of opening of the abdomen with 117 (57.6%) of obstetricians using blunt versus 86 (42.36%) using sharp dissection. The blunt extension of uterine incision was significantly associated with the increasing years of practice, whereas the preference to use Pfannensteil incision was significantly associated with the younger obstetricians. Conclusion: There was heterogeneity and variation in the CS techniques being practiced by the obstetricians. These varied practices were the result of surgeon preferences, their training and difficulty in unlearning the long used surgical techniques. These are bound to continue until strong evidence-based guidelines for the techniques of CS are formulated. [ABSTRACT FROM AUTHOR]

Background: Literature suggests that the COVID-19 pandemic has resulted in poor sleep quality, especially among the infected population. However, literature regarding the effect of COVID-19 pandemic and SARS-CoV-2 infection on occurrence of insomnia, restless legs syndrome and dream enactment behavior is either scarce or unavailable. Methods: This study was planned to assess the effect of SARS-CoV-2 infection on the occurrence of insomnia, restless legs syndrome (RLS) and dream enactment behavior (DEB). For this cross-sectional study, a questionnaire comprising of items related to demographic details, past medical history, and information related to SARS-CoV-2 infection was distributed through social media. Insomnia was diagnosed using clinical criteria. RLS, DEB, sleep quality, depression and anxiety were assessed using a validated questionnaire. Information regarding the use of hypnotic medications was also gathered. Results: Of the 1596 respondents, 37.2% reported disturbed sleep while insomnia was reported by 22.6% respondents. 27.3% of respondents reported RLS and 17.4% suffered DEB. The odds of insomnia were greater among males (OR = 1.27; 95% CI: 1.03–1.58; P < 0.02) and among those who had SARS-CoV-2 infection (OR = 1.76; 95% CI = 1.42–2.19; P < 0.001). Similarly, SARS-CoV-2 infection was also associated with increased odds of RLS (OR = 2.48; 95% CI = 1.98–3.11; P < 0.001) and DEB (OR = 1.58; 95%CI = 1.21–2.06; P < 0.001). Insomnia, RLS and DEB were more frequent among respondents who required oxygen therapy, those who experienced loss of taste and/or smell, depression and anxiety. Prevalence of insomnia, DEB and RLS was higher than said prevalence among respondents with no history of SARS-CoV-2 infection, but lower than that of those with positive history of SARS-CoV-2 infection. 5.3% of respondents reported taking hypnotic medications before infection, 7% during infection and 5.3% after infection. Conclusion: SARS-CoV-2-infection-related factors in association with environmental factors have increased the prevalence of insomnia, DEB and RLS among subjects having infection. SARS-CoV-2-associated immunological changes, hypoxia and neurotropism may play a role in occurrence of insomnia, DEB and RLS. [ABSTRACT FROM AUTHOR]

Introduction: Adolescence as a life stage is associated with physical and psychological changes with an interplay of biological, social, and environmental factors. The aim of this study was to determine the prevalence of aggression among children and the factors associated with aggression. Methods: This was an analytical cross-sectional study conducted in schools of Bhopal, Madhya Pradesh, India, between 2017 and 2019 among higher and higher secondary class children. All children from high and higher secondary classes were included, resulting in a sample of 192. Information on sociodemographic, family, psychosocial, lifestyle, addiction factors, aggression (Buss–Perry Aggression Questionnaire), self-esteem (Rosenberg self-esteem scale), and resilience (Nicholson McBride Resilience Questionnaire) were obtained. Results: The prevalence of aggression among children from Classes 9th to 12th was 49.5%; physical aggression was 42.7%, verbal aggression was 31.8%, anger was 44.3%, and hostility was 44.8%. Almost half (44.3%) of the children had self-esteem and only 1.6% of children had an established level of resilience. Of the sociodemographic factors considered, type of school, gender, parents' education; of the family factors considered, family members taking alcohol/drugs, parents having frequent arguments, parents hitting children and using abusive language; of the psychosocial, lifestyle and addiction factors considered, feeling neglected, grade, watching TV and practice of reading books were significantly associated with the presence of aggression in children (P < 0.05). Conclusion: Overall findings suggest the need for strengthening life skills education, positive immediate environment, coping at the individual level, social intelligence, and cautious approach toward boosting self-esteem. [ABSTRACT FROM AUTHOR]

Musculoskeletal disorders constitute 1,194 prevalent cases per 1,00,000 among children aged 5 to 19 years in India. School bags with a weight exceeding 10% of the bodyweight is a common cause of backache in school children. Methods: School children aged 8–15 years from four private schools of Bhopal were included, resulting in a sample of 934 participants. An author-assisted questionnaire was used for data collection. Results: The school bags were 16.5% of the average weight of students. 55.9% of the students experienced pain in the last 12 months, 41.6% in the last ten days and 21.3% had visited a doctor for the same. On analysis, bags with ≥ three compartments (AOR: 3.17), using both shoulders to carry bags (AOR: 0.10), and the absence of lockers in schools (AOR: 17.80) were significant predictors of pain in the last ten days (P < 0.05). Conclusion: Massive advocacy and orientation are required at all levels for educational administrators, teachers, parents and students. [ABSTRACT FROM AUTHOR]

Background: Quality management in healthcare is critical for hospitals and everyone in the loop —from physicians to support staff—needs to be aware of and involved in this process. Objectives: To assess the perception of employees about the quality management system (QMS) implemented at a tertiary care eye hospital in north India and to use it to identify scope for further improvement. Methods: This cross-sectional mixed-method study involved both questionnaire-based survey and an in-depth interview by a third party. The questionnaire had 12 questions to assess the changes in culture, infrastructure, environment, system, operation theatre and outpatient department. Employees shared their opinion about improvements brought by the QMS in eight years. Respondents were divided into five groups based on their job description: (i) doctors, (ii) technical staff (nursing/operation theatre/laboratory), (iii) optometrists/opticians/audiologists, (iv) patient care executives and (v) human resources/administration/others. Results: Of the 73 employees interviewed, 94.5% perceived an improved treatment and care process and 91.8% perceived improved treatment results. According to 83.6% of the employees, they were encouraged to report patient safety concerns and 71.2% saw improved incidence and adverse event management. The QMS has increased patient satisfaction according to 83%, while 91.8% felt it improved the profile of the hospital. The employees stated no negative effects of the QMS except a long waiting time of the patients and the duplication of paperwork. Conclusion: QMS has brought many positive changes across the hospital. Still, there is scope to reduce the patient waiting time and paperwork duplication. [ABSTRACT FROM AUTHOR]

Context: There is a need for a simple screening method for the detection of anemia that can be used by public health workers in the field. Aims: The aim of this study was to compare two methods for hemoglobin estimation, i.e., automated hematology analyzer and Digital Hemoglobinometer, and to find out the sensitivity and specificity of Digital Hemoglobinometer for the estimation of hemoglobin. Subjects and Methods: A hospital-based cross-sectional study was carried out for 6 months from April to September 2017 in a District Hospital of five High Priority Districts of Madhya Pradesh. Two hundred and sixty antenatal females per district were selected for the study. Results: The mean hemoglobin by autoanalyzer is 10.19, and that by Digital Hemoglobinometer device is 9.89. Overall, sensitivity of Digital Hemoglobinometer for hemoglobin estimation was calculated to be 89.4% and specificity was calculated to be 63.6%. Positive predictive value was found to be 82.6% and negative predictive value was 75.8% compared against AutoAnalyser (gold standard). Conclusions: As the Digital Hemoglobinometer device has high sensitivity and specificity and good diagnostic accuracy, it must be used at the community level in resource-poor setting for hemoglobin estimation. In primary health-care conditions, Digital Hemoglobinometer can significantly reduce misdiagnosis of anemia compared with clinical assessment alone. [ABSTRACT FROM AUTHOR]

Background: There has been little research conducted within developing nations examining the link between knowledge and diet-related perceptions and behaviors. In addition, prior investigations have rarely examined interrelationships between knowledge and other nutrition-related factors. Purpose: This study explored the relationship between nutrition knowledge, social/ informational factors, and diet-related outcomes among Indian adults with multiple chronic conditions. Methods: A snowball sampling technique was employed to recruit individuals. Hierarchical regression analysis was employed to examine mediating and moderating relationships. Results: Results from a cross-sectional survey indicated that knowledge only predicted use among those reporting greater pressure/concern from close others. Furthermore, social support and social trust were found to moderate the relationship between knowledge and diet-related perceptions and behaviors. Discussion: Results suggest that social factors may play a critical role in moderating the impact of nutrition knowledge on diet-related perceptions and behaviors. Translation to Health Education Practice: Public Health Education interventions targeting developing nations should aim to maximize consumers' nutrition knowledge while identifying valued close others who can help encourage positive health action. Furthermore, Health Educators as well as government and local communities must engage in outreach efforts to reinforce or, if necessary, change public perceptions regarding the food industry. [ABSTRACT FROM AUTHOR]

Objectives: To determine the risk of obstructive sleep apnea (OSA) for male permanent driving license (DL) applicants of Lucknow, India.Material and Methods: In this cross-sectional community based, study body mass index, waist-hip ratio, blood pressure of each subject were determined as an anthropometric parameter along with the history of habit of smoking, tobacco chewing, alcohol consumption. STOP-Bang (Snoring, Tired or sleepy, Observed apnea, high blood Pressure, Body mass index, Age, Neck, Gender) Questionnaire - a scoring risk assessment tool - was applied for assessment of OSA risk (high OSA risk defined by score ≥ 3) for 542 male DL recipients at 2 Regional Transport Office (RTO) centers in Lucknow, India. The statistical software SPSS 17.0 was applied to the testing.Results: In total 23% (N = 125) of participants were found with the risk of OSA. High blood pressure (≥ 140/90 mm Hg) was found for the maximum number of participants (40.5%) followed by neck circumference > 40 cm (17.1%), age (> 50 years old) (15.3%), snoring (12.3%) and tired/sleepy (10.5%). Mean values of age, anthropometric measurements and blood pressure were observed significantly higher (p < 0.001) for participants with the OSA risk. In this population the risk of OSA risk (STOP-Bang score ≥ 3) was observed for 6.7% of young (< 35 years old), 34% of middle (35-45 years old) and 73% of elder age adults (> 45 years old).Conclusions: In view of findings of this study a high number of male driving license applicants were observed with the risk of OSA. Therefore efforts should be made to develop a national screening guideline/protocol for the OSA risk assessment for driving license applicants in India. This may reduce the possibility of road traffic accidents due to the OSA-associated fatigue and drowsiness behind the wheels. Int J Occup Med Environ Health 2018;31(1):25-36. [ABSTRACT FROM AUTHOR]

Objective. To assess the prevalence of oral potentially malignant disorders and to determine the potential risk factors for its development in Indian population. Materials and Methods. This cross-sectional study was carried out on 1241 individuals in Indore, Madhya Pradesh. A questionnaire was designed to record information about sociodemographic characteristics, oral hygiene practices, dietary habits, and risk factors for oral potentially malignant disorders. Oral mucosal lesions were examined by a skilled person. Results. The overall prevalence of oral potentially malignant disorders was found to be 13.7% with oral submucous fibrosis (8.06%) found to be more common and erythroplakia (0.24%) found to be least prevalent. Results of Logistic Regression analysis showed that males (OR = 2.09, P value < 0.0001) who were ever consumers of tobacco (OR = 2.06, P value = 0.030) and areca nut chewing (OR = 2.64, P value = 0.004) were more likely to develop oral potentially malignant disorders compared to never consumers. Diabetic (OR = 2.21, P value = 0.014) and underweight individuals (OR = 2.23, P value = 0.007) were more likely to suffer from oral potentially malignant disorders. Conclusion. The study reinforces the association of tobacco and areca nut consumption with oral potentially malignant disorders. An association of oral potentially malignant disorders with diabetes and BMI was confirmed by this study. [ABSTRACT FROM AUTHOR]

Background: Several population based studies have demonstrated an association between hypo.or hyperthyroidism and dementia in last two decades. As a consequence, thyroid stimulating hormone has become part of the screening laboratory test for dementia. Aim: The aim of the present study was to evaluate the association between thyroid function and Alzheimer's disease (AD) and vascular dementia (VaD) and to determine the risk of AD and VaD in clinically euthyroid patients. Materials and Methods: A cross.sectional hospital based study was carried out in subjects diagnosed with AD/VaD and were assessed for thyroid status as routine screening test. Results: Free T3, free T4 and TSH were studied in 114 AD patients (mean age: 65 years), 35 VaD patients (mean age: 62 years) and 105 control subjects (mean age: 62 years). In AD group, TSH levels were significantly lower than controls (P = 0.00) and for each unit increase in TSH level, the odds of having dementia decreased by 37.1%. No such relation was seen in VaD. Conclusion: The results suggest a consistent association of subclinical hyperthyroidism and AD. [ABSTRACT FROM AUTHOR]

Background: Children with idiopathic nephrotic syndrome (INS) are at risk of hearing impairment due to nephrotoxic drugs and biochemical impairments. Methods: Forty children with INS aged 5-16 years [20 patients with frequently relapsing nephrotic syndrome (FRNS)/steroid dependent nephrotic syndrome (SDNS) and 20 with steroid resistant nephrotic syndrome (SRNS)] and 20 normal healthy controls were enrolled in this study. Pure tone audiometry was done using the ALPS AD 2000 audiometer. Sensorineural hearing loss was diagnosed when the bone conduction level was >20 dB and the difference in air to bone gap was ≤15 dB. Based on the air conduction (AC) threshold, deafness was graded into the following categories: mild (26-40 dB), moderate (41-55 dB), moderately severe (56-70 dB), severe (71-91 dB) and profound (>91 dB). Results: Children with FRNS/SDNS had a higher threshold for hearing at frequencies of 250 and 500 Hz, respectively, than the controls. Of the children in the FRNS/SDNS category, three (15 %) had mild sensorineural hearing impairment. These children had a low serum calcium level ( P < 0.03) and received higher cumulative doses of furosemide ( P < 0.04). Children with SRNS had a higher threshold for hearing at frequencies of 250, 500, 1,000, and 2,000 Hz, respectively, than the controls. Of the 20 children with SRNS, ten (50 %) had sensoineural hearing impairment (8 mild, 2 moderate). Children with SRNS with a hearing defect had received a higher cumulative dose of furosemide ( P < 0.03). Conclusions: Children with FRNS/SDNS and SRNS are at risk of sensorineural hearing impairment. The risk factors associated with this impairment were higher cumulative doses of furosemide and hypocalcemia. Larger prospective cohort studies are required to evaluate this association. [ABSTRACT FROM AUTHOR]

Background: With the introduction of antiretroviral therapy (ART), the mortality and morbidity of HIV/AIDS have decreased markedly. However, high adherence to ART (>95%) is necessary for a good therapeutic outcome. There is a paucity of data on paediatric adherence to ART and its correlates from developing countries, particularly India. Aim: To determine the rate of adherence to ART in HIV-infected Indian children and the factors associated with adherence. Methods: A cross-sectional study was conducted at an ART clinic in New Delhi, north India. Caregivers of 90 children were interviewed using a pre-designed, structured questionnaire and checklist. The primary measure of adherence was 4-day caregiver's recall. Adherence rates were correlated with 3-monthly CD4 counts. Results: Mean (SD, range) adherence was 91·4% (12·3, 75-100%). Adherence was low (<95%) in 31 (34·4%) patients. On multivariate logistic regression analysis, increasing time since ART initiation (OR 1·08, 95% CI 1·02-1·13), low caregiver educational status (OR 4·19, 95% CI 1·37-10·88), orphanhood (OR 3·57, 95% CI 1·13-9·25), efavirenz-based ART regimens (OR 3·65, 95% CI 1·05-10·69) and female gender (OR 3·15, 95% CI 1·03-7·68) were associated with lower adherence. The rise in CD4 count after ART initiation was more marked in the high adherence group, with the difference in the two groups becoming statistically significant after 6 months of ART (median CD4 count 698 vs 355, p=0·016). Conclusions: It is possible to achieve high adherence to ART in a resource-limited setting. Caregiver recall is a reliable and inexpensive tool for measuring adherence. Paediatric adherence to ART is influenced by numerous factors and larger studies are needed to address the issue in India. [ABSTRACT FROM AUTHOR]

Background: A computer-assisted interview, the Global Mental Health Assessment Tool-validation (GMHAT/PC) has been developed to assist general practitioners and other health professionals to make a quick, convenient, yet reasonably comprehensive standardized mental health assessment. GMHAT/PC has been translated into various languages including Hindi. This is the first study conducted in India, using the Hindi version GMHAT/PC of the series of studies assessing its validity in different cultures. Aim: The study aims to assess the feasibility of using a computer assisted diagnostic interview by health professionals and to examine the level of agreement between the Hindi version GMHAT/PC diagnosis and psychiatrists' ICD-10 based clinical diagnosis. Design: Cross-sectional validation study. Setting: Psychiatric clinic of a General Hospital and an out patient (Neurology) clinic in the Teaching General Hospital in Jaipur, India. Materials and Methods: All consecutive patients attending the psychiatric out patient clinic were interviewed using GMHAT/PC and psychiatrists made a diagnosis applying ICD-10 criteria for a period of six weeks. A small sample of subjects was interviewed in a similar way in a Neurology clinic for four weeks. Results: The mean duration of interview was under 17 minutes. Most patients were pleased that they were asked about every aspect of their mental health. The agreement between psychologists' GMHAT/PC interview diagnoses and psychiatrists' clinical diagnoses was excellent (Kappa 0.96, sensitivity 1.00, and specificity 0.94). Conclusion: GMHAT/PC Hindi version detected mental disorders accurately and it was feasible to use GMHAT/PC in Indian settings. [ABSTRACT FROM AUTHOR]

Background: GCK gene variants have been reported to be associated with gestational diabetes mellitus (GDM) in the Caucasian population. There are no reports exploring this association in the Indian population. Methods: This cross-sectional study included subjects from Max Super Speciality Hospital, New Delhi, India, over a span of 6 months. Females diagnosed with GDM as per the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria were enrolled. Direct gene sequencing was performed to screen all 10 exons and promoter region of GCK gene. Results: Out of the total 1000 females screened, 154 subjects had any degree of hyperglycemia. GCK gene screening was done and we observed 11 variants in 80.4% (41/51) of the GDM subset and 89.6% (43/48) of the controls. Allele frequencies of observed variants were not different between the control subjects (12.5%) and those diagnosed with GDM (8.4%). Conclusion: To the best of our knowledge, this is the first report from north India exploring association of GCK variants with GDM and we do not observe any association of GCK variants with GDM in our study population. CTRI Registration No: CTRI/2017/07/008964 [ABSTRACT FROM AUTHOR]