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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
Attention Deficit Hyperactivity Disorder and Use of Mobile Phones among Children- Need for Concern?
Correspondence Address :
Dr. Aby Dany Varghese,
Professor, Department of Paediatrics, Nitte University (Deemed to be), KS Hegde Medical Academy, Mangalore-575018, Karnataka, India.
E-mail: abydany@gmail.com
Introduction: The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) is on the rise. Among multiple factors that are linked with ADHD, electronic media use has been gaining considerable attention recently. There is only a limited source of information regarding the burden of ADHD and its association with screen time in the Indian context.
Aim: Screening of the children for ADHD and its association with mobile phone use at an outpatient service in a tertiary care hospital in Kerala.
Materials and Methods: A cross-sectional questionnaire-based study was conducted among 157 children in the outpatient services in a tertiary care hospital in Pathanamthitta district, Kerala, India. School-going children aged between 6 and 11 years were included in the study. ADHD screening was done using Conner’s Abbreviated Rating Scale (CARS).
Results: The mean age of children was 8.1±1.9 years. All the participants used mobile phones, and 15 (9.6%) owned one. The mean duration of mobile phone use per day was 1.4±0.7 hours. Among participants, 53 (33.8%) used mobile phones for more than one hour daily. Parents reported that nearly one-fifth of the children use mobile phones late at night (after 10 pm). Among children, 22.9% screened positive for ADHD. The ADHD scores are significantly correlated with the duration of mobile phone use (r=0.368 p<0.001). Among the children who used mobile phones for more than a year, 32.1% screened positive for ADHD (OR=3.21, CI 1.41-7.32). The mean ADHD score was significantly higher among children with >1 hour of mobile phone use/day than those who use <1 hour/day (t-test=-2.27 p-value=0.025). The vast majority, 148 (94.2%), also noticed behavioural changes among children when denied mobile phones. Significant changes included anger (22.9%), sadness (31.8%), withdrawal (20%), frustration (17.8%) and violence (8.9%).
Conclusion: In this study, 22.9% of children screened positive for ADHD. Mobile phone use was found to be significantly associated with ADHD.
Children, Developmental disorder, Mobile phone, Screen time
The ADHD is one of the most common neurological developmental disorders. The prevalence of ADHD in children, adolescents, and adults is increasingly recognised (1),(2),(3). One of the recent reviews showed that the prevalence of ADHD among children and adolescents ranges from 1.30% to 28.9% in India (3). ADHD commonly exhibits hyperactivity, inattention, impulsivity and distraction. This condition results from complex dealings between genetic, environmental, and developmental traits. The demographic variables such as parents’ low education, mother’s occupation, low socioeconomic status, male gender, birth order and single parent were all risk factors for ADHD (4),(5). In addition to the demographic variables, family-related factors like maternal smoking and drinking behaviour, caesarean delivery, previous abortion, unwanted pregnancy, two-parent family structure, parental psychiatric disorders, history of head trauma, and epilepsy were all found to be contributing to the risk of ADHD (5),(6). Even though ADHD was primarily considered a disease of children, recent studies have proved it can affect adolescents and adults. Besides learning disabilities, ADHD also contributes to road traffic accidents, antisocial behaviour, and crimes among adolescents, negatively impacting families and society (3).
Evidence from recent research supports the association between screen time such as television and ADHD among children (6). Electronic devices have become integral to life, including children and youth. Excessive use of devices and exposure to screen time has been linked with many adverse health events, including addiction, depression, anxiety among adolescents and ADHD among children. There is only a limited source of information regarding the burden of ADHD among school-going children and its association with screen time in the Indian context. As ADHD is one of the most common neurodevelopmental disorders with childhood-onset, there is an urgent need to understand the associated factors. In Asian countries like India, age-specific information about the magnitude of ADHD is needed to frame appropriate treatment guidelines. Screening and early diagnosis of this condition will help initiate proper treatment and prevent adverse effects in the long run (3),(4). Excessive screen time among school children needs to be investigated as there is a shortage of evidence regarding the negative impact. In addition, most studies exploring the association between ADHD and screen time were done only among preschool children from western countries. Considering the increasing use of mobile phones in the current pandemic situation and the available literature on the association between these two factors, data on the effect among children could be of public health importance.The primary objective was screening of the children for ADHD at an outpatient service in a tertiary care hospital in Kerala and identifying the pattern of mobile phone use in these children and if any association between the pattern of mobile phone use and the presence of ADHD.
A cross-sectional questionnaire-based study was conducted in the outpatient services in a tertiary care hospital in Pathanamthitta district, Kerala, India, from July 2019-September 2019. A pilot study was done before proceeding to the study, and suitable modifications were incorporated. Approval from the Institutional Review and Ethics board was taken before the commencement of the study. (IEC number IEC/2019/05/98).
Inclusion criteria: All school-going children between 6 and 11 years presenting to the outpatient services for non emergeny illness, general check-up, vaccination etc., were included in the study population.
Exclusion criteria: Children with pre-existing neurological diseases were excluded.
The sample size was calculated based on a study done by Venkata JA and Panicker AS. Using a prevalence of 11.3% precision of 5% at 95% CI, the sample size was calculated to be 157 (1).
Data were collected after obtaining written informed consent from the parents. The study tool used was a structured questionnaire that included basic sociodemographic details, the pattern of use of mobile phones and ADHD screening. Variables collected were- age, gender, birth order of the child, socioeconomic status, parents’ education, and type of school (private/public). Details regarding mobile phone use, such as duration, purpose, time of use, screen-free days and sleep duration, were collected. ADHD screening was done using CARS (1). CARS is a rating scale consisting of several behavioural parameters for diagnosing ADHD. A score of more than 15 in CARS was considered suggestive of ADHD. CARS was administered to the parents while waiting in the paediatric OPD and they reported back immediately.
Statistical Anlaysis
The data collected was coded and entered in Microsoft Excel. All the statistical analysis was performed using Epi info software version 7. Descriptive statistics comprising mean (SD), frequencies and percentages were calculated. The correlation between ADHD scores and the duration of mobile phone use among children was assessed using Pearson’s correlation test. Mean ADHD scores are compared between different categories using the independent t-test.
Further based on the cut-off scores of ADHD, children were classified as ADHD/No ADHD and proportions were compared using the Chi-square test. Risk estimates were calculated using Odds Ratio (OR) or with a 95% Confidence Interval (CI). A p-value less than 0.05 was considered to be statistically significant.
Basic sociodemographic profile of participants: A total of 157 children were included in the study. Gender distribution was almost equal among the participants, with 82 (52.2%) girls. The majority of the children belonged to higher socioeconomic status. Details are in (Table/Fig 1).
Pattern of mobile phone use among children: All the participants used mobile phones, and 15 (9.6%) owned one. Among participants, 76 (48.4%) were using mobile phones for the last year, 52 (33.1%) for 1-3 years and 29 (18.5%) for more than three years. Among 157, 126 (80.3%) had a sleep duration of <8 hours/day. Details of pattern and behaviour of children in relation to mobile phone use is shown in (Table/Fig 2). Parents reported that 28 (17.8%) of the children prefer to use the mobile phone instead of reading, 40 (25.5%) play indoors, and 13 (8.3%) play outdoors.
Parents’ perceptions and preferences regarding children’s mobile phone use are given in (Table/Fig 3). It has been reported that nearly one third of the parents encourage children to use screentime to keep them occupied. Even though, more than 80% of the children gets <8 hours of sleep, 92.4% of the parents think that their children are getting aqequate sleep.
Section 3- Screening for ADHD and associated factors: The proportion of children screened positive for ADHD was 36 (22.9%) (Table/Fig 4),(Table/Fig 5).
Among the children with a duration of mobile phone use >1 hour/day, the mean ADHD score was higher (16.8±4.6) compared to those who used <1 hour/day (15.1±1), and this difference was statistically significant (t-test=-2.27 p-value=0.025). Among the children who used mobile phones for more than a year, 32.1% screened positive for ADHD, and this association was statistically significant (OR=3.1, CI 1.38-7.03). ADHD scores were significantly correlated to the duration of mobile phone use among children (r=0.368 p<0.001). Sleep disturbances were reported among those children screened positive for ADHD (OR=3.21, CI 1.41-7.32). Factors such as gender, type of school (private or government), socioeconomic status, or the number of siblings were not significantly associated with ADHD.
The ADHD is a behavioural disorder characterised by inattention, impulsivity, and hyperactivity that can significantly impact many aspects of behaviour and performance, both at school and at home (2). In approximately, 80% of children with ADHD, symptoms persist into adolescence and may even continue into adulthood (2). This study is intended to screen children for ADHD and find the association between mobile phone use and ADHD. A high proportion of children screened positive for ADHD in the present study. A recent systematic review showed a wide prevalence range from 1.3% to 28.9% of ADHD among children (3). A similar study done among primary school children in Coimbatore showed a prevalence of 11.32% (1). Higher prevalence was observed in higher age groups, similar to the present study finding.
Hospital-based studies have yielded a higher prevalence of ADHD than studies performed in the community setting (1). The relatively higher proportion of ADHD in this study could be attributed to that. Even though some studies have found a significant association with gender socioeconomic status, this study did not reveal any such association (1),(2),(3),(4),(5). ADHD has a considerable impact on the individual throughout childhood and well into adult life, mainly if not managed optimally. People with ADHD tend to have a lower occupational status and poor social relationships and are more likely to commit motoring offences and develop substance abuse (7),(8),(9),(10). Hence, considerable prevalence of this condition should receive due attention from parents, teachers and healthcare professionals.
This study revealed that all children used mobile phones, and nearly 10% owned one. It is alarming that more than one-third of children use mobile phones for more than one hour/per day. There is a growing concern regarding screen time and its effect on children’s mental health (11),(12). A recent study conducted among children with ADHD showed that more than 80% had screen time of >1 hr/day (13). A significant association was observed between the duration of mobile phone use and ADHD in this study. Literature has shown that nuclear families, parents’ job requirements, and even the current pandemic have resulted in more gadget-based engagement in children than developmentally appropriate activities. Due to their multisensory stimuli, screen-based gadgets can harm their development more among children with ADHD because of their delay aversion and temporal processing impairment (11),(13),(14).
Another finding of this study is that more than one-third of the parents informed that they encourage the use of mobile phones among children to keep them occupied. Even though technology-based learning is a vital part of the current education system, the potential adverse effects of the same should not be underrated (13). It is essential to highlight that more than 90% of parents noticed behavioural changes among children when denied mobile phones. This could indicate behavioural addiction’s early stages, which need further exploration. A study by Montagni I et al., observed dose-dependent associations between screen time and attention problems and hyperactivity among students (11). It is interesting to note that another study done in China also noticed behavioural changes among children who had a daily screen time more than an hour. In this study it was revealed that some children prefer to use a mobile phone instead of playing indoors or outdoors, which could lead to physical inactivity, which is again linked to ADHD (15),(16).
Even though ADHD usually presents during early childhood, parents limited awareness of this condition often delays the identification of ADHD in their children (10). In the Indian context, very little information is provided regarding ADHD and mobile phone usage. In this study, it was found that the duration of mobile phone usage and sleep disturbances were associated with ADHD. To find out if there is an association between mobile phones and ADHD is an innovative approach towards the much-unstudied disease. High prevalence of ADHD and the association with the use of mobile phones warranties an early screening and appropriate management of this condition.
Limitation(s)
The present study was a hospital-based study, and the CARS was administered only to parents. Only the use of mobile phone was considered in this study. Considering other sources of screen time, like television/laptop etc., would help estimate screen time among children.
The proportion of children who screened positive for ADHD was 22.9%. Increased duration of mobile phone and age were the factors signatificantly associated with ADHD. There is a need for structured parent training and education sessions regarding screen time. We need further studies based on this preliminary study to establish a causal association between ADHD and mobile phone use.\
DOI: 10.7860/JCDR/2023/60328.17984
Date of Submission: Sep 19, 2022
Date of Peer Review: Nov 15, 2022
Date of Acceptance: Jan 14, 2023
Date of Publishing: Jun 01, 2023
AUTHOR DECLARATION:
• 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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