Background. Sleep is important for the growth, development and good health of adolescents. We assessed sleep patterns, hygiene and daytime sleepiness among school-going adolescents in 3 districts of Tamil Nadu. Methods. We conducted a cross-sectional survey among 538 school-going adolescents between the ages of 10 and 17 years, from 8 schools in 3 districts of Thiruvallur, Thiruppur and Namakkal selected through multistage sampling. A questionnaire with items focusing on demographic details, sleep patterns, sleep hygiene behaviour and daytime sleepiness was given to the students for self-administration after obtaining informed consent from their parents and school authorities. Results. Over 64% of adolescents sleep <8 hours at night with 5.6% sleeping <6 hours. About 48% of adolescents suffered from prolonged sleep-onset latency and about 43% had interrupted sleep. Over 64% of adolescents watched television (TV) in bed and >23% reported use of mobile phone in bed. About 64% of adolescents had at least one form of poor sleep hygiene behaviour. Decreasing age (0.7; 95% CI 0.582–0.843), studying while lying in bed (1.72; 95% CI 1.009–2.942), greater time gap between dinner and bedtime (0.795; 95% CI 0.650–0.972), staying awake late in the night and chatting on mobile phone (2.24; 95% CI 1.266–3.978) and watching TV (3.41; 95% CI 2.037– 5.722) significantly influenced excessive daytime sleepiness. Conclusion. A large proportion of adolescent students have abnormal sleep patterns and sleep hygiene behaviours. There is a need for concerted sleep-related education at the school level.

Background. Legislation has made organ donation after brain death (DBD) possible in India since 1994. However, no organs are donated in most parts of the country; the national organ donation rate is estimated at between 0.08 and 0.34 donors per million population—one of the lowest in the world. Methods. A 350-bedded private hospital in Kochi started its DBD programme in September 2013 with a structured approach based on counselling of family members of critically ill individuals. A counsellor trained to diagnose family dynamics, and recognize different stages of the grieving process, chose the right time, and the correct family member to whom the donation request could be made. Regular debriefing sessions of the core team consisting of a transplant surgeon, a transplant coordinator, an ICU counsellor and a unit administrator resulted in setting up systems that supported families of patients with catastrophic brain injury, and created an environment conducive to obtaining consent. Results. A total of 85 organ donations took place in the first 24 months (September 2013 to September 2015) of instituting the programme. Conclusion. It is possible with hospital-based teamwork and a structured approach to consistently elicit organ donation.

Background. Assam has the highest maternal mortality in India. It is difficult to make a precise estimate of maternal mortality because the available information from various surveys has a wide confidence interval. Biomedical causes of maternal mortality are known, but there is little information on determinants of sociocultural and health system aspects. Delays at various levels such as at home (first level), during transportation (second level) and at hospital (third level) operate in a maternal death. Information on these determinants will give a better understanding of the circumstances of death. We aimed to estimate the maternal mortality ratio of Barpeta district in Assam and to understand the sociocultural factors and delays at various levels, which contribute to maternal death. Method. We did a community-based, cross-sectional study. During the surveillance period of 1 year, all maternal deaths occurring in the district were identified from multiple sources and informants. These included all deaths occurring in the health facility or in the community. In 50% of such deaths, social autopsy was conducted. The data were analysed manually for descriptive statistics and thematic areas. Results. The maternal mortality ratio of the district is 225 per 100 000 live-births. About 95% of respondents availed antenatal services and 57% delivered in hospital. The routine maternal death surveillance system is sensitive and detected 94% of maternal deaths. However, community-based verbal autopsy is yet to be functional. Most maternal deaths occur among women from low socioeconomic conditions. Delay at the first level occurred in 10 maternal deaths, at the second level in 18 maternal deaths and at the third level in 8 maternal deaths. Conclusions. Health-seeking behaviour is favourable and 90% of mothers sought services. Improved and functioning infrastructure will ensure better transportation facilities and early referral to a secondary- or tertiary-level health facility, which can prevent many maternal deaths.

Background. With rapid urbanization and hectic lifestyle, there is a growing demand of pre-packaged food items. ‘Food label’, present on most packaged food items provides information about the contents, their nutritive value and other information that can help the consumer to make an informed choice. Few studies in India have assessed the consumer’s knowledge and practices related to information on a food label. Methods. We assessed the awareness, perceptions and practices related to the use of information on food labels among residents of an urbanized village of south Delhi. House-to-house visits were made and information gathered using a pre-designed, pre-tested, semi-structured questionnaire. Descriptive analysis was done and logistic regression performed to document the determinants of ‘reading food label’ by the study participants. Results. A total of 368 individuals were interviewed. The mean (SD) age of the participants was 29.1 (9.7) years. Around one-fourth (97/368; 26.4%) of all participants reported buying pre-packaged foods daily. A majority (222/ 368; 60%) of participants bought pre-packaged foods because they liked the taste, and also because they were easily available (153/368; 41.7%). A total of 64.1% (236/368) reported that they read food labels, but a majority checked only for the manufacture and expiry dates (203/236; 86%). Educational status, socioeconomic status and body mass index of the study participants were found to be significantly associated with reading of labels. Conclusions. The intention of promoting healthy food choices through the use of food labels is met inadequately at present. Awareness generation activities would be required to improve this behaviour.

Telemedicine was considered futuristic and experimental some years ago, but it is a reality today. It is now emerging as an important tool for convenient as well as specialized healthcare, particularly for patients in remote locations with limited access to standardized healthcare services. However, there are multiple challenges to realizing its full potential. We focus on some key medicolegal and ethical issues such as doctor–patient relationship, informed consent, rights of the patient, malpractice, and principles of confidentiality relevant to the practice of telemedicine and virtual consultation. We explore the global as well as the Indian legal perspective pertaining to the application of telemedicine. The absence of specific laws for registration and practice of telemedicine and virtual consul-tation in India acts as a deterrent for medical practitioners to engage in its potential use. Hence, there is a need for specific legislation.

Background. Medical professionals in India need to understand the concepts of molecular genetics to stay up-to-date with clinical care as well as to strengthen basic research in the biomedical sciences. Methods. We introduced a modular course on ‘Fundamentals in molecular and cellular biology’ for first-year medical undergraduate students in the second semester of the first MBBS year in 2015, as part of ‘Innovations in teaching physiology’ at St John’s Medical College. This was a voluntary, add-on course with didactic lectures, hands-on practical classes and a research paper presentation. Evaluation of students’ performance in the course took into account their performance in the research paper presentation-based group activity and their attendance for the hands-on practical sessions. Feedback on the content, delivery, evaluation and future improvements of the course was sought from the students. Results. About 65% of students regularly attended the 10-hour long course. Of the students evaluated for the course, 43% achieved the highest, and 11% achieved the lowest grade assigned. Nearly 72% of the students provided feedback on the course. Conclusion. This first outing of the modular course on ‘Fundamentals in molecular and cellular biology’ generated excitement among the students and achieved some learning for them. It also brought to light hidden challenges in conducting such a voluntary course for medical students in India. Our experience with the course will help in designing a better-integrated course for exposure of first-year medical students to advances in molecular biology and its applied aspects as they progress through the MBBS course.

Background. The educational environment perceived by students has an impact on satisfaction with the course of study and academic achievement. We aimed to analyse the perceptions of medical students about their learning environment and to provide feedback to stakeholders involved in curriculum planning and execution. Methods. We did a cross-sectional descriptive study at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry using the Dundee Ready Educational Environment Measure (DREEM) questionnaire. The DREEM inventory was administered to the undergraduate students of all semesters (n = 452). Students’ perceptions of learning, perception about teachers, academic self-perceptions, perceptions of atmosphere and their social self-perceptions were measured. The scores obtained were expressed as mean (standard deviation) and analysed using t-test and 1-way ANOVA (with post-hoc comparison using Tukey test). The difference between semesters and gender was also analysed. Results. The mean (SD) global score was 122.06 (22.27), out of a maximum possible score of 200. Our students opined that teachers were knowledgeable, with this component scoring the maximum of 3.32 and, at the same time, they felt that teaching overemphasizes factual learning (1.41). Only 6 items scored <2. ‘Students’ perception of atmosphere’ scored high among other domains (30 of 48, 62.5%). The mean global score of preclinical students (125.35 [20.43]) was better than clinical students (119.13 [23.44]; p = 0.003). Conclusion. Although the global score is more positive, we identified a few areas of concern such as overemphasis on factual learning, authoritarian teachers, the not-so-helpful existing learning strategies, vast curriculum (inability to memorize all), lack of supporting system for stressed out students and the boredom they felt in the course. These vital areas should be addressed by the stakeholders for the betterment of learning in the institute.