Morbidity profile and dynamics of determinants of health-seeking behaviour in geriatric population of Chandigarh, India

Introduction: Aging is a natural process that usually results in physiological, biological, emotional, and financial decline. As a result, a robust health system is required to meet their escalating health needs. Through this study, we got an opportunity to study the morbidity profile of the elderly and to assess their health-seeking behavior and its determinants in urban areas of Chandigarh. Material and Methods: The sample consisted of 360 participants. Multistage and proportionate sampling techniques were used to recruit study subjects. A structured interview was carried out to get information on the different parameters of health-seeking behavior of the elderly population. Results: The most pervasive determinant of health-seeking behavior was perceiving health issues related to age, no family support, and health-care expenditure. Conclusion: The elderly had a positive behavior toward seeking help with regard to health care. Multiple morbidities were evident among the elderly, and modern medication was the greatest choice. Improved perspective toward health, easy accessibility, and awareness regarding the disease may contribute to the willingness of seeking help for the health-care needs.

Assessment of hemoglobin status among cancer patients: a hospital based study

Background: Cancer related anemia (CRA) is a major healthcare issue among patients suffering with cancer. In the Indian context, these figures are likely to be higher due to the prevailing malnutrition and low socio-economic status in the general population. This observational hospital-based study has been conducted among cancer patients with following objectives to assess the socio demographic profile of different cancer patients admitted at hospital. To measure hemoglobin level among different cancer patients admitted at hospital on the basis of socio demographic profile and type of cancer.Methods: The registers maintained in the department of Radiotherapy were checked and those belonging to the year 2011-12 were used to process and analyse the cancer patient抯 data in respect to age, type of cancer, hemoglobin level admitted in health care facility.Results: By far distribution of Hb level is concerned among all cancer patients, 87.56% patients were having Hb level more than 9 gm% and around 12.43 % patients were having Hb level less than 9 gm%. Majority of patients whose Hb level was less than 9gm% were belonging to age group more than 45 years.Conclusions: It is very much evident that anemia among cancer patients is a major healthcare problem and surely adds into morbidity and mortality of cancer patients. It may further aggravate the health condition of cancer patients if not corrected timely. Therefore, anemia among cancer patients should be taken and treated very seriously.

A community-based study on awareness of cancer and anticipated barriers in seeking help

Cancer is a leading public health problem worldwide. Contributing factors include lack of awareness regarding cancer and improper help seeking behavior. Objective: To assess the awareness regarding early warning signs of cancer, its risk factors and anticipated barriers in seeking help. Methodology: A community-based cross-sectional study was conducted among 470 study participants. Trained workers administered a standardized tool to respondents after obtaining their informed consent. Epi Info software for windows version 7.2 was used for the analysis. Results: Overall, merely 7.7% (36/470) of the study respondents were aware of all the nine warning signs of cancer. The most commonly known early warning sign of cancer was “unexplained swelling” (58.3%). Further, although majority knew that cigarette smoking is a risk factor for cancer (90.4%), very few were aware about the role of inadequate physical activity (9.3%) and diet devoid of adequate amounts of fruits and vegetables (11.9%). There were few anticipated barriers in seeking help such as embarrassment (13.2%) and difficult to interact with a doctor (7.9%). Conclusion: There was inadequate awareness about cancer but a favorable help-seeking behavior. It is, therefore, recommended that health-care professionals should scale up efforts for disseminating information regarding cancer among the people.

Thoracic epidural analgesia for off-pump coronary artery bypass surgery in patients with chronic obstructive pulmonary disease.

The benefits of thoracic epidural analgesia in patients undergoing coronary artery bypass grafting are well documented. However, the literature available on the role of high thoracic epidural analgesia (HTEA) in patients with chronic obstructive pulmonary disease undergoing off-pump coronary artery bypass graft (OPCAB) surgery is scarce. We conducted a randomized clinical trial to establish whether HTEA is beneficial in patients with chronic obstructive pulmonary disease undergoing elective OPCAB surgery. After institutional ethics board approval and informed consent, 62 chronic obstructive pulmonary disease patients undergoing elective OPCAB were randomly grouped into two (n = 31 each). Both groups received general anesthesia (GA), but in the HTEA group patients, TEA was also administered. Standardized surgical and anesthetic techniques were used for both the groups. Pulmonary function tests were performed pre-operatively, 6 h and 24 h post-extubation and on days 2, 3, 4 and 5 along with arterial blood gas analysis (ABG) analysis. Time for extubation (h) and time for oxygen withdrawal (h) were recorded. Pain score was assessed by the 10-cm visual analogue scale. All hemodynamic/oxygenation parameters were noted. Any complications related to the TEA were also recorded. Patients in the HTEA group were extubated earlier (10.8 h vs. 13.5 h, P < 0.01) and their oxygen withdrawal time was also significantly lower (26.26 h vs. 29.87 h, P < 0.01). The VAS score, both at rest and on coughing, was significantly lower in the HTEA group at all times, post-operatively (P < 0.01). The forced vital capacity improved significantly at 6 h post-operatively in the HTEA group (P = 0.026) and remained significantly higher thereafter. A similar trend was observed in forced expiratory volume in the first second on day 2 in the HTEA group (P = 0.024). We did not observe any significant side-effects/mortality in either group. In chronic obstructive pulmonary disease patients undergoing elective OPCAB surgery, HTEA is a good adjunct to GA for early extubation, faster recovery of pulmonary function and better analgesia.

Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m 2 for off pump coronary artery bypass surgery.

Perioperative Thoracic epidural analgesia (TEA) is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB). We conducted a randomized clinical trial at tertiary care cardiac institute to compare the effect of TEA and conventional opioid based analgesia on perioperative lung functions and pain scores in obese patients undergoing OPCAB. Sixty obese patients with body mass index >30 kg/m 2 for elective OPCAB were randomized into two groups (n=30 each). Patients in both the groups received general anesthesia but in group 1, TEA was also administered. We performed spirometry as preoperative assessment and at six hours, 24 hours, second, third, fourth and fifth day after extubation, along with arterial blood gases analysis. Visual analogue scale at rest and on coughing was recorded to assess the degree of analgesia. The other parameters observed were: time to endotracheal extubation, oxygen withdrawal time and intensive care unit length of stay. On statistical analysis there was a significant difference in Vital Capacity at six hours, 24 hours, second and third day postextubation. Forced vital capacity and forced expiratory volume in one second followed the same pattern for first four postoperative days and peak expiratory flow rate remained statistically high till second postoperative day. ABG values and PaO 2 /FiO 2 ratio were statistically higher in the study group up to five days. Visual analogue scale at rest and on coughing was significantly lower till fourth and third postoperative day respectively. Tracheal extubation time, oxygen withdrawal time and ICU stay were significantly less in group 1. The use of TEA resulted in better analgesia, early tracheal extubation and shorter ICU stay and should be considered for obese patients undergoing OPCAB.