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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Knowledge and Attitude towards Vitiligo and Psoriasis among Undergraduate Medical Students: A Cross-sectional Observational Study
Correspondence Address :
Dr. Rajashekar Talari Srinivas,
Professor and Head, Department of Dermatology, Sri Devaraj Urs Academy of
Higher Education and Research, Kolar, Karnataka, India.
E-mail: yeshits@rediffmail.com; dr.chandrikamehta@gmail.com
Introduction: Understanding the perspective on vitiligo and psoriasis of undergraduate medical students enables us to focus on lacunae areas in their knowledge, and train them to disseminate accurate information to the public. A positive attitude towards vitiligo and psoriasis in society will reduce the psychosocial burden on the patients and deliver better clinical outcomes.
Aim: To assess medical student’s knowledge and attitudes towards vitiligo and psoriasis.
Materials and Methods: This cross-sectional, questionnaire-based, observational study was conducted on 351 undergraduate medical students (third semester onwards) at Sri Devaraj Urs Medical College, Kolar, Karnataka, India, from January 2021 to March 2021. Questionnaire consisted of 28 questions about knowledge and 18 about attitude towards vitiligo and psoriasis, presented through Google docs to the medical students. A score of 75% was considered as having ‘good knowledge’ and ‘positive attitude.’ Fischer’s-exact test was used as a test of significance for qualitative data. Analysis of Variance (ANOVA) was used as a test of significance to identify the mean difference between more than two quantitative variables. The p-value <0.05 was considered as statistically significant.
Results: The study included 351 participants, of which 171 (48.7%) were females and 180 (51.3%) were males. There were 89 (25.3%), 133 (37.9%), and 129 (36.8%) respondents from the second, third, and fourth years, respectively. Good knowledge was observed in 80.9% and 71.5%, and 87.7% and 72.4% had positive attitudes towards vitiligo and psoriasis, respectively. A statistically significant difference (p-value=0.002) was found in attitude between vitiligo and the year of MBBS. A statistically significant difference (p-value=0.004) was found in knowledge between psoriasis and the year of MBBS. Overall, 55.84% thought that psoriasis only concerns the skin. Good knowledge was directly proportional to a positive attitude.
Conclusion: The majority of the undergraduate medical students had ‘good knowledge’ and ‘positive attitude’ towards vitiligo and psoriasis. Good knowledge was highly proportional to a positive attitude. Unfortunately, a considerably high number of participants reported that they would not marry a person with vitiligo or psoriasis.
Behaviour, Education, Psychosocial, Stigma, Treatment
Vitiligo is a chronic autoimmune skin disease characterised by chalky white depigmented macules on various body parts (1). Even though vitiligo is an asymptomatic disease, it affects the psyche of the vitiligo patients, especially amongst the Indians, as most of the population is coloured (Fitzpatrick scale IV or V). Two prior studies on the psychosocial aspects have shown that vitiligo may profoundly impact patient’s self-esteem and interpersonal relationships (1),(2),(3),(4). Vitiligo patients experience stigmatisation, embarrassment, and self-consciousness (4). Psoriasis is a chronic inflammatory disease characterised by erythematous scaly plaques (5). Earlier studies have shown a heightened risk for adverse effects such as severe mental health outcomes, including anxiety, depression, substance abuse, and suicidality (6),(7). Visible lesions are a part of the social stigma perceived by these patients (8),(9),(10),(11),(12).
Biases against persons with other visible skin diseases are well documented among healthcare trainees and physicians. This adversely affects clinical care by hindering stigmatised individuals from receiving treatment (5),(13),(14). Effects of stigma on Quality Of Life (QOL) may be dependent on disease severity. Vitiligo patients are more likely to adopt alternative medicines than other cosmetic dermatoses, in which they commonly use allopathy (1). A study from India reported that 55.7% of vitiligo patients believed in the efficacy of alternative medicine compared to 51.7% having confidence in allopathy (1). Overall, uncovering medical professionals’ responses to questionnaires designed to evaluate their knowledge and attitude in persons with psoriasis and vitiligo will help promote steps in reducing stigma (5),(14),(15),(16),(17).
Assessing the knowledge and attitude of undergraduate medical students would give us a glance at their understanding of the disease. In addition, comprehending the lacuna in their knowledge would help develop educational campaigns to release appropriate knowledge and improve attitude. Medical students with sufficient knowledge about vitiligo and psoriasis will disseminate and educate the public. Adequate knowledge in public will significantly contribute to their attitude towards these patients (5),(11),(12),(13). Students will eventually counsel the patients and their families satisfactorily about the disease causes, course, prognosis, treatment options. Such modifications will reduce significant psychological stress, improving the patient’s treatment efficacy (5),(12),(13),(14),(15),(16). A cardinal feature of vitiligo and psoriasis that requires monitoring and intervention is the knowledge and attitude of society (14),(15),(16),(17).
Previous studies have concluded the public’s knowledge to be inadequate, along with negative attitude towards vitiligo and psoriasis patients (17),(18),(19). However, very few studies have approached this issue from a medical student’s perspective. The aim of this study was to explore the knowledge and attitude towards vitiligo and psoriasis amongst undergraduate medical students in a tertiary healthcare centre. A multifaceted understanding of medical student’s opinions of vitiligo and psoriasis will encourage advanced efforts to overcome stigma, enhance QOL, and improve treatment utilisation.
This cross-sectional, questionnaire-based, observational study was conducted on 351 undergraduate medical students (third semester onwards) at Sri Devaraj Urs Medical College, Kolar, Karnataka, India, from January 2021 to March 2021. The Institutional Ethics Board approved the study (Ethical clearance number- DMC/KLR/IEC/722/2020-21). Confidentiality and privacy of the participants was ensured by excluding identification details. Authors considered 75% as the anticipated good knowledge and positive attitudes in the study population.
Sample size calculation: The sample size was calculated on a hospital-based study that showed that 66.3% of participants had a good knowledge score {95% Confidence Interval (CI)} (1). By taking the expected proportion to be 0.663, 95% CI with an α-error of 5%, the required sample size was 343.
Inclusion criteria: All third semester onwards MBBS students, who consented to be a part of the study, were included in study.
Exclusion criteria: Students with vitiligo or psoriasis, students whose first-degree relatives with these diseases were excluded from the study.
Procedure
All participants were asked to fill two questionnaires-
• One to assess their knowledge (consisted of 14 questions each about vitiligo and psoriasis),
• The other questionnaire had 9 questions each to assess their attitude.
Each questionnaire was given 10 minutes to complete. The questionnaires were adapted from two studies assessing the knowledge and attitude towards vitiligo and psoriasis (20),(21). Few questions were then modified as per the study needs by the researchers and validated by two dermatologists.
Participants filled the questionnaires online through google forms as provided by the principal investigator. Incomplete questionnaires were not accepted as a part of the study.
For the knowledge component of the study instrument, a score of 1 was given for every correct answer, and for the attitude component; a score of 1 was given for a positive attitude. The total score was 14 for knowledge, and 9 for attitude in vitiligo and psoriasis each. The participant who scored 75% and above was considered as having ‘good knowledge’ and below was considered to have ‘poor knowledge’. A score of 75% and above will be scored as ‘positive attitude’ and below will be considered to have ‘negative attitude’ in this study population.
Statistical Analysis
MS Excel, Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM SPSS Statistics, Somers NY, USA) was used to analyse data. Categorical data was represented in the form of frequencies and proportions. The Chi-square test or Fischer’s-exact test (for 2×2 tables only) was used as a test of significance for qualitative data. Continuous data were represented as mean and standard deviation. Independent t-test was used as a test of significance to identify the mean difference between two quantitative variables. Analysis of Variance (ANOVA) was used as a test of significance to identify the mean difference between more than two quantitative variables. Graphical representation of data: MS Excel and MS word was used to obtain various types of graphs. The p-value <0.05 was considered as statistically significant after assuming all the rules of statistical tests.
The study included 351 participants, of which 171 (48.7%) were females and 180 (51.3%) were males. There were 89 (25.3%), 133 (37.9%), and 129 (36.8%) respondents from the second, third, and fourth years, respectively. The participant’s knowledge and attitude about vitiligo and psoriasis are summarised in (Table/Fig 1), (Table/Fig 2), (Table/Fig 3), (Table/Fig 4), (Table/Fig 5).
No statistically significant difference was found between knowledge regarding vitiligo and the year (in between second, third, and fourth years) of MBBS. However, there was a statistically significant difference (p-value=0.002) between attitude towards vitiligo and the year of MBBS (Table/Fig 6). A 73% (65/89), 84.1% (111/133), and 83.1% (108/129) of students from second, third, and fourth years, respectively, had good knowledge about vitiligo. A 79.8% (71/89), 85.6% (113/133), and 95.4% (124/129) of students from second, third, and fourth years, respectively, had a positive attitude towards vitiligo.
A 59.6% (53/89), 71.2% (94/133), and 80% (104/129) of students from second, third, and fourth years, respectively, had good knowledge about psoriasis. A 65.2% (58/89), 75% (99/133), and 74.6% (97/129) and of students from second, third, and fourth years, respectively, had positive attitude towards psoriasis. A statistically significant difference (p-value=0.004) was found between knowledge regarding psoriasis and the year of MBBS. Nevertheless, there was no statistically significant difference found between attitude towards psoriasis and year of MBBS (Table/Fig 6). Students had better knowledge and attitude scores regarding vitiligo than psoriasis.
The mean score of knowledge and attitude regarding vitiligo and psoriasis according to the year of MBBS were calculated. As per the overall mean score, p-value <0.001, therefore a statistically significant difference between knowledge and attitude regarding vitiligo among participants. The p-value <0.001; hence a statistically significant difference between knowledge and attitude regarding psoriasis among participants (Table/Fig 7).
A higher proportion of students with a positive attitude had good knowledge {90.1% (256/284)} in comparison to students with poor knowledge {77.6% (52/67)} towards vitiligo. A more significant percentage of students with negative attitude {22.4% (15/67)} had poor knowledge when compared to good knowledge {9.9% (28/284)} about vitiligo. Most of the students with a positive attitude had good knowledge {80.5% (202/251)} in comparison to students with poor knowledge {52% (52/100} towards psoriasis. A higher percentage of students with negative attitude had poor knowledge {48% (48/100)} when compared to good knowledge {19.5% (49/251)} about psoriasis.
To the best of author’s knowledge, this is the first study to evaluate the knowledge and attitude of vitiligo and psoriasis among undergraduate medical students. Only one study documented that the most frequently endorsed myths among medical students about psoriasis were that the disease is not physically painful, is not a serious disease, does not negatively affect physical health, and can be cured (19). The current study was necessary, as previous studies have reported poor public understanding and negative attitude, which affect the lives of many patients with vitiligo and psoriasis (22),(23).
Remarkably, most of the students had sufficient knowledge about vitiligo and psoriasis. For example, 90.03% (316/351) and 82.05% (288/351) of students recognised that vitiligo and psoriasis, respectively, are non infectious diseases. More than two-thirds of respondents were aware that vitiligo and psoriasis are not contagious by touching or sharing things. Concurrent to the present study, the notion of contagiousness was maintained by less number (29.3%) of the participants in the study conducted in Saudi Arabia (24). In another study people assumed psoriasis is contagious and is elated to personal hygiene (25). Good knowledge about the disease was observed to be associated with positive attitude in vitiligo and psoriasis. Inadequate knowledge concerning the nature of these diseases may result in discrimination of these patients (20),(25).
More than two-thirds of respondents identified that vitiligo and psoriasis are not dangerous diseases or caused due to lack of hygiene. Likewise, >90% of students knew that vitiligo or psoriasis is different from leprosy. Similar to this study >50% of the participants were aware that vitiligo and psoriasis are different from leprosy and not caused due to lack of hygiene (26). A 42.29% (173/351) of students were wrongly under the impression that vitiligo is a hereditary disease, whereas 36.47% (128/351) thought that psoriasis is a hereditary disease. In concurrent with this study, Alshammrie FF et al., found that the majority of surveyed participants considered vitiligo an inherited disease (59%) (18).
Only 55.84% (196/351) knew that psoriasis is not a disease that concerns only the skin. The 76.35% (268/351) and 79.49% (279/351) students classified vitiligo and psoriasis, respectively, as immune system diseases. Most of the students were aware that vitiligo and psoriasis result from an unknown cause. 76.92% (270/351) and 85.19% (299/351) students were cognizant that vitiligo and psoriasis, respectively, were more prevalent and exaggerated with exposure to psychological stress. In addition, because vitiligo and psoriasis are often instantly visible to others, patients become victims of social anxiety and emotional stress (25),(27).
An 86.04% (302/351) of students were aware of available treatments for psoriasis, but only 71.51% (251/351) knew that there is a treatment for vitiligo. Lack of sufficient knowledge about the availability of numerous treatment options for vitiligo and psoriasis might result in patients adopting alternative medicine rather than allopathy. As seen in a study conducted by Bhalla M and Thami GP, most vitiligo patients preferred complementary and alternative systems of medicine (28). A relatively higher proportion of subjects responded that vitiligo and psoriasis are not contagious by having a meal together or by air transmission and are not correlated with consumption of specific foods. In contrast, a study conducted in Saudi Arabia showed that the most popular misconception related to vitiligo was taking certain foods, such as milk or fish (29).
In the present study, 87.7% and 72.4% of students showed positive attitude towards vitiligo and psoriasis, respectively. ‘Good knowledge’ about vitiligo and psoriasis was directly proportional to ‘positive attitude’ towards these diseases. For example, they would sympathise with the patients, shake their hands, and eat or share food prepared by them. In contrast to this study, research conducted by Yong SS et al., reported that 42.9% of respondents had concerns about shaking hands, 61.6% about sitting next to patients with psoriasis, and 36.6% about eating foods prepared by patients with psoriasis (30). More than two-thirds of these medical students were ready to engage these patients as their employees. In addition, >90% of students said that they would not stare at these patients.
The 80.91% (284/351) and 70.37% (247/351) of students were ready to continue marital lives with vitiligo and psoriasis, respectively. The most awful response was that many respondents were not willing to marry individuals affected by vitiligo or psoriasis. This might be why it is difficult for these patients to initiate relationships (30). Similar to this study, 69.14% of participants were unwilling to marry a vitiligo patient even when he or she was otherwise a suitable match (1). More than half of the students were ready to ask vitiligo and psoriasis patients about their disease. Supporting this, it has been observed that vitiligo and psoriasis patients tend to develop negative feelings about their condition because of their past experiences (22).
Although according to the year of MBBS, there was no statistically significant difference about knowledge of vitiligo yet there was a statistically significant difference (p-value=0.002) about attitude. Alternatively, there was a statistically significant difference (p-value=0.002) regarding knowledge of psoriasis but there was no statistically significant difference in attitude, according to the year of MBBS. Education of every detailed aspect about vitiligo and psoriasis, especially among medical students, might change the attitude that could prevent the isolation of patients with these diseases. A study conducted in Central India found that being married or engaged in a healthcare-related occupation significantly predictors of good attitude levels (1).
Good knowledge about vitiligo was associated with positive attitude (90.1%). Likewise, good knowledge about psoriasis was associated with positive attitude (80.5%). Thus, in the present study, authors found that the medical student’s knowledge about vitiligo and psoriasis had a significant relationship with their attitude, concurrent with previous studies (20),(21),(22),(23),(24),(25),(26),(27),(28),(29),(30).
Focusing on training undergraduate medical students about vitiligo and psoriasis will empower them to disperse correct information about these diseases. Hence, creating awareness in society about these diseases is an essential step to change the attitude towards these illnesses and reduce the emotional burden of these patients.
Limitation(s)
This research was a self-reported and a single-institutional study.
The majority of the undergraduate medical students had ‘good knowledge’ and a ‘positive attitude’ towards vitiligo and psoriasis. Good knowledge was highly proportional to a positive attitude. Unfortunately, a considerably high number of participants reported that they would not marry a person with vitiligo or psoriasis. To reduce stigma, educational campaigns for the medical trainees are the need of the hour, which will lead to a positive attitude and further will decrease the discriminatory behaviour towards the patients and their relatives. Consequently, an increased self-confidence, social integration, and psychological well-being of the patients will result in better treatment outcomes.
DOI: 10.7860/JCDR/2022/53155.16094
Date of Submission: Nov 04, 2021
Date of Peer Review: Nov 30, 2021
Date of Acceptance: Feb 15, 2022
Date of Publishing: Mar 01, 2022
AUTHOR DECLARATATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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