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Background and Aims: With the implementation of the COVID-19 lockdown, conventional teaching had to be replaced with online teaching, to ensure the continuity of medical education. This has impacted the clinical training of medical undergraduates. We aimed to explore their perceptions and differences before and during the COVID-19 lockdown. Methods: A cross-sectional online survey using a self-administered, retrospective pre-post questionnaire, was conducted among students from pre-final and final year between December 2020 and March 2021. Agreement scores with 15-items about the various domains of clinical training were recorded. Open-ended question was asked to know about the reasons for the students’ preferences. Chi-square test and Wilcoxon signed rank test were used to compare the proportion and medians respectively. Results: We received 1000 responses from students of 191 medical colleges {Median (IQR): 6 (2,10) per college}. Most (81.6%) opined that their experience with clinical training was better before COVID-19 lockdown, irrespective of the mode of teaching in clinical skills (P

In this population-based study, the authors constructed age-specific and sex-specific hemoglobin percentiles from values reported for a defined healthy population in the Comprehensive National Nutrition Survey (CNNS). Age-specific and sex-specific 5th percentiles of hemoglobin derived for this healthy population was used as the study cut-off to define anemia. These were compared with the existing WHO cut-offs to assess significant differences between them at each year of age and sex for quantifying the prevalence of anemia in the entire CNNS sample. From the CNNS survey 41210 participants had a hemoglobin value, 8087 of whom were included in this study and comprised the primary analytical sample. Compared with existing WHO cut-offs, the study cut-offs for hemoglobin were lower at all ages, usually by 1–2 g/dL, but more so in children of both sexes aged 1–2 years and in girls aged 10 years or older. Anemia prevalence with the study cut-offs was 19·2 percentage points lower than with WHO cut-offs in the entire CNNS sample with valid hemoglobin values across all ages and sexes (10·8% with study cut-offs vs 30·0% with WHO cut-offs). The authors concluded that these findings support the re-examination of WHO hemoglobin cut-offs to define anemia.

CONTEXT: Currently, self-directed learning (SDL) is emphasized in medical institutions all over the world. The skills of SDL enable one to be a lifelong learner, a necessity to cope up with fast-expanding medical knowledge. AIMS: This study aims to develop and implement an “SDL” module for medical undergraduates and find out their perception about the same. SETTINGS AND DESIGN: A cross-sectional study using a mixed-method design (having both qualitative and quantitative components) was conducted in the Department of Community Medicine, UCMS, Delhi, India. METHODS: A module was developed following an extensive literature review and focus group discussions with the teaching staff of the institute. First-semester undergraduate students were invited to participate in the study and asked for feedback using a semi-structured questionnaire. STATISTICAL ANALYSIS: Quantitative data were expressed in mean, range, and frequency. For qualitative data, thematic analysis was performed. RESULTS: The module was implemented with 160 students, in November for 10 hour distributed over 5 weeks. Feedback could be obtained from 130 students. Sixty-seven percent of students were satisfied and 66% reported as motivated to study the allotted topic further. Qualitative analysis showed that though the students liked the learning process based on this module, they also felt facilitators could have been more active in imparting knowledge and skills. CONCLUSIONS: To make learners equipped with the ability to learn throughout a professional learning course, SDL as a learning tool should be introduced in the medical undergraduate curriculum.

Background Disability competencies were included, for the first time, in India's new undergraduate competency-based curriculum as a result of physician-led advocacy in 2019; the regulatory body also recommended the use of the humanities in medicine. Objective To use tools from the health humanities to impart disability competencies and help students appreciate the social and human rights issues associated with disability. Methods A module was developed and piloted in the foundation course on the new cohort of students. The tools included storytelling, visual art, poetry, narratives, and Forum Theatre; many facilitators were doctors and patients with disabilities. Learners were introduced to the concept of universal design through a field visit. Quantitative and open-ended feedback was taken from learners after module delivery; reflections were sought after four months. Results The data revealed that the humanities tools used in the module had the potential to help learners explore struggle and oppression and to expose discriminatory attitudes. Learners were able to think beyond the hegemony of normalcy, and show an understanding of diversity, dignity, autonomy, disableism, social inclusion, equity, and universal design. They admitted to the misconceptions they carried and showed keenness to advocate for change. Conclusion This study piloted a novel disability competencies module using tools from the health humanities and found that learners were able to engage with and show an understanding of the social and human rights issues associated with disability. Conversations by, for, and with people with disabilities must be part of such interventions in developing and delivering disability courses.

Introduction: Internet addiction (IA) is an emerging phenomenon among the youth of India. It has been found to be associated with mental health problems. This study was therefore conducted to find out the burden of IA among college students in Delhi, its risk factors and association with depression, anxiety, and stress. Methods: A cross-sectional study was conducted, with face-to-face interviews, among the nonprofessional college students of the University of Delhi. Simple random sampling was used to select the students from the list obtained from the three colleges. Young's IA test scale and depression, anxiety, and stress short scale were used to measure IA and the mental health correlates, respectively. Chi-square tests were applied for testing the association of IA with the sociodemographic variables, the variables related to internet usage patterns, and the mental health variables. Independent predictors were determined using logistic regression modeling. Results: The prevalence of IA was 25.3%. The mean (standard deviation) age of the participants was 19.1 (1.02) years and 62.1% were males. The median family income was INR 50,000. IA was significantly associated with higher family income, greater screen time, always online status, and greater duration of internet use per week. The independent predictors of IA were greater duration of internet use per week and always online status, depression, anxiety, and stress. Conclusion: The burden of IA among the college students was high. depression, anxiety, and stress were found to be independent predictors of IA.

Background: In spite of the decline observed in total fertility rate (TFR) in India during the last few decades, the unintended pregnancy rates continue to remain the same. With increasing employment levels of women, there has been an increase in the contraceptive usage rates, but evidence among the working women regarding the emergency contraceptive pills is lacking. The Objectives of the study was to assess, among the working women regarding the emergency contraceptive pills (ECP). Methods: A cross sectional survey was conducted among the reproductive age group working women attending the obstetrics and gynecology outpatient department clinic of a private hospital in Delhi. Face to face interviews were conducted using a sem-structured questionnaire. Results: Out of the 206 participants studied, around one-third (35.0%) were not aware about ECPs. Amongst the aware, 81.3% and 44.8 % did not know about the correct indication and correct timing of ECP use respectively. Amongst those who were aware about ECPs, 91.8% had never used it. Conclusions: Even though the awareness about ECPs is not low, the correct knowledge about its indications and correct timing is poor. More emphasis on increasing the awareness about ECPs is required to increase its correct use thereby reducing TFR further.

Zoonotic diseases are an important public health problem. Keeping this in way, a panel reviewed the discussion around “one health” strategy of the WHO in combating zoonotic diseases during Seventh annual conference of Consortium Against Rabies (CAR) with the theme of “Zoonoses: Thinking beyond Rabies” held on 14th and 15th June 2019. The panel came out a manuscript discussing the need, background, and rationale for basic framework of possible roadmap for one health. Background —About CAR: CAR has been established with the aim to serve as a platform for the control of the rabies menace in India. It will evolve into a full fledged struggle against rabies in the country. The association comprises of medical professionals, veterinary doctors, and public health persons. The idea behind CAR is to bring the best minds in the country for research and information dissemination in the field of rabies. About Academy of Family Physicians of India (AFPI): AFPI is the official association of family physicians in India. Dedicated to provide professional leadership, conduct healthcare advocacy, policy development and a change in health system within the domain of family medicine, and larger public health system in the country, the academy is the recipient of the Healthcare Leadership Award 2012 in the category of Healthcare Governance and Public Administration. The white paper development Process: More than 100 medical experts, veterinary doctors, and public health persons from across the country and belonging to the fields of internal medicine, family medicine, public health, veterinary sciences, nursing science and environmental science and representing reputed medical institutions, government funded research institutions, and policy making bodies participated in discussions on topic of “one health” made during 7th Annual national conference of CAR with the theme of “Zoonoses: Thinking beyond Rabies” held on 14th and 15th June 2019. The panel steering the discussion included leading expert from ICMR, medical colleges, veterinary college, family medicine, private practitioners, and health program managers. The panel committee had prepared a draft document well in advance of the conference, which was communicated to all participants for feedback and comments. The panel was steered by ICMR expert. The discussion of the panellist was presented to the consensus group and unanimously adopted. A writing group worked on the manuscript, which was again circulated by email to all for any comments and suggestions before final publication.

Janani Suraksha Yojana (JSY) was launched in April 2005, to promote institutional deliveries through provision of cash assistance, transport, escort, and referral services. An observational cross-sectional study was conducted to assess the antenatal registrations, postnatal checkups, and institutional deliveries, and to compare the various social groups. Married women of the reproductive age group, having at least two children, were interviewed regarding antenatal care, delivery, and postnatal care in both pregnancies, latest as well as previous. Post JSY implementation, antenatal registrations increased from 61.79 to 96.34%, Deliveries at the Government Health Facility increased from 25.20 to 53.25% and postnatal check-ups increased from 45.93 to 69.51%. In the post-JSY-implementation phase, the Government Health Facility was preferred more by Scheduled Castes (SC), Scheduled Tribes (ST), Other Backward Classes (OBC) (SC/ST = 56.87%, OBC = 60.2%, and general = 43.68%), educated (Illiterate = 17.39%, Primary = 88.14, and Middle or above = 81.94%) and the lower socioeconomic classes (Lower SEC 71.83% and Upper lower and above = 45.71%) for their deliveries. It appears that the socially backward groups have benefited more from JSY.

Background India is highly endemic for rabies. Although fatal, rabies is a preventable disease. Several factors interfere with the timely utilization of post exposure prophylaxis (PEP) in the population. There is a need to explore the factors leading to delay in PEP initiation. Objective To study the factors associated with delay in initiation of PEP among animal bite cases attending anti-rabies clinic in the out-patient department (OPD) of a hospital in Delhi. Materials and methods A cross-sectional hospital based study was conducted among 200 patients attending the anti-rabies clinic. After obtaining informed consent, the patients were interviewed using a pre-tested, semi-structured questionnaire to find out the delay in initiation of PEP and the factors associated with it. Results Most common biting animal was found to be dog (96%). Out of the studied subjects ( n = 200), 134 (67%) were males, 123 (61.5%) were from rural areas and 61 (30.5%) were illiterate. Delay in initiation (vaccine initiation in more than or equal to 48 h) of PEP was found among 41% of the studied subjects. The mean time spent during each visit by the study subjects were 3.46 h (SD 1.60). Delay was more likely in people living at a distance of more than 10 km from the vaccination centre ( p p = 0.004). Delay showed an increasing trend with age ( p = 0.041). Most commonly cited reasons by the respondents ( n = 82) for the inability to come early for vaccination included work related barriers (42.68%), anti-rabies clinic being closed on Sundays/national holidays (36.59%) and unawareness about timely PEP (31.71%). Conclusion Accessibility and lower economic status were the major factors associated with delay in initiation of PEP for rabies prevention.

Medical research does not deal with only medical sciences; it is also dependent on other disciplines, and statistics is an integral part in its conduct. It is challenging for a medical researcher to grasp the importance of statistics and also to decide the types of statistical issues in the various phases of his/her medical research. There are inherent variations within and between the human/animal subjects used in medical research and these uncertainties can only be grasped using statistical tools. Initiating a medical research while taking into account the statistical aspects right at the planning stage is one of the best ways to conduct better evidence-based research. The validity of the results of a medical research depends not only on the methodology of conducting the study but also on the analysis of data collected. As opposed to the general perception, statistics not only deals with analysis of data but is also intricately interwoven with the methodology section of the research where sample sizes, inclusion/exclusion criteria, and others are mentioned. Although statistical softwares simplify the computational aspect of statistics, the confusing conceptual aspects make interpretation of the outputs difficult and incorrect. Seemingly simple terms such as population, sample, parameters, and variables have been explained keeping the medical researchers' perspective in mind. This first article in the series Statistics in Medical Research makes an attempt to facilitate the medical researcher to overcome the initial questions that challenge him/her with regard to statistics.