Expenditure audit of women with breast cancer in a tertiary care hospital of Delhi.

Background: Breast cancer is associated with substantial medical and economic burden. This study assisted the expenditure incurred by the subjects on diagnosis and treatment till the period of follow-up. Materials and Methods: This is a prospective study; a case series of patients studied at the time of diagnosis and followed after 6 months. The study was conducted at one of Hospitals in India, from January 2006 to December 2007. One hundred and seventy-two women with new primary breast cancer were included in the study. During the study period 69 subjects were lost to follow-up. The comparative analysis was done for 103 subjects. Cost implications of breast cancer include direct medical costs and indirect costs. Questionnaire for the data collection was used. Descriptive statistics and correlation analysis were used. Results: The median total direct and indirect expenditure was Rs. 12,100 (US$ 1 = Rs 50) with the range of Rs. 0-54000. The largest component of total direct medical costs was in stage I (median Rs. 6530), total indirect costs (median Rs. 7500), and median total cost was Rs. 17,600. The total expenditures (median Rs. 13,100) were the highest in younger age group (<40). The median direct expenditure was higher in the subjects who visited private setup before coming to Hospital (Rs. 8250) than those who came directly (Rs. 4500). Conclusions: Cost of treatment for breast cancer depends on many factors, including the stages of the cancer, the woman's age, perhaps the costs of treatment, private hospital and insurance.

Assessing the Quality of life and Needs of HIV-AIDS Patients in Manipur A Preliminary Study.

This study aims to as.es. the quality of life (QoL) as perceived by HIV/AIDS patients and the needs of such people in their local context in Manipur. A cross sectional study was carried out in two selected districts of Manipur namely, Imphal west and Chandel. A total of 20 People Living with HIV/AIDS (PLHA) respondents were interviewed using WHOQoL-HIV instrument and a semi-structured interview. The overall quality of life mean score was 3.07 from the range of score between 0-5. Similarly, on a scale of 4-20, the scores in the six domains of the quality of life in descending orders were spirituality, religion, personal beliefs or SRPB (12.73); psychological (12.72); physical (12.41); level of independence (12.28); social relationship (11.83); and environment (11.54). Comparison of QoL showed female faring better with 3.12 mean score than their male counterparts (mean score: 2.83). The study also identified some of the needs of HIVIAIDS infected people in relation to clinical, financial, educational, psychological, socio-cultural, household needs, etc.

Hepatitis B and C Virus Infection in an Urban Slum of Northern India.

A community based cross sectional study was conducted in an urban slum amongst males to assess the magnitude of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections among males between 20-50 years of age. All of the 288 males who were contacted had agreed to participate in the study. However, the information could be collected from a total of 260 subjects, using a pretested, pre-coded schedule included socio-demographic characteristics. Serological tests were done for Hepatitis B and C. The data were analyzed using EPI-INFO 3.2.2. Proportion of persons tested serologically positive for Hepatitis B and C in the present study was observed to be 10.38% and 1.15%, respectively. Higher proportion for hepatitis Band C was observed amongst those Muslims, below 35 years of age, stay in the area for less than 5 years, Illiterates, unstable occupation, staying away from home and those with no history of blood transfusion or donation; however the difference was not statistically significant. There is a need to carry out more community based studies amongst such populations at risk in order to assess the true prevalence and risk factors for appropriate intervention.

Effectiveness of HIV Counseling Services on Knowledge, Attitude, Behavior and Practice (KABP) Among Pregnant Women Attending PPTCT Program.

Counseling services is an important component of National AIDS Control Program which aims at creating awareness and promoting changes in reducing high risk behavior against HIV/AIDS. Pregnant women attending antenatal clinics are being counseled about HIV/AIDS under prevention of parent to child transmission (PPTCT) program. The objective of this study was to assess (KABP) regarding HIV/AIDS among pregnant women attending PPTCT program before and after counseling at Lok Nayak Hospital, New Delhi. A Quasi-experimental study was conducted. Data was collected by interviewing 600 pregnant women attending ANC clinic during May 2006 to May 2007 using a pre-test and post-test interview schedule. About 69.2% of the pregnant women had heard about AIDS before the counseling. Knowledge regarding mother to child transmission of HIV was 53.5%. 38.2% knew that mother to child transmission can be reduced by drugs. The knowledge of pregnant women about AIDS was significantly different in pre-test (mean score =15.3) and post test (mean score=35.6) (P<0.0001). Attitude of study participants towards people living with HIV/AIDS (PLWHA) indicated that individual. with HIV should be allowed to work (79.9%) and all commercial sex workers should compulsorily be tested for HIV (55.1%). There was significant difference between in pre-test and post-test attitude about PLWHA and HIV testing (p<0.0001). The condom use among the study participant significantly improved after counseling (1.2% in pre-test and 58.6% after counseling) (p<0.0001). Counseling services were effective in increasing knowledge and changes in attitude and behavior among pregnant women and the efforts needs to be sustained.

Assessment of Quality of Life among HIV Positive People Attending Tertiary Hospital of Delhi, India.

As per global HIV/AIDS estimates, a total of 33 million [30.3 – 36.1 million] People were living with HIV in 2007. The world's second-most populous country, India, is experiencing a highly varied HIV epidemic, which appears to be stable or diminishing in some parts while growing at a modest rate in others. Quality of life (QOL) of HIV/AIDS patients is becoming an important component of overall assessment of health care and management in health care settings. It is one of the indicators effectiveness of management of PLHAS . The objective of this study was to determine the QOL of patients with HIV/AIDS in New Delhi. Purposive sampling was used to identify subjects from the antiretroviral therapy clinic (ART) in Lok Nayak hospital. 180 patients were interviewed with the WHOQOL-HIV instrument. This questionnaire included demographic data, multi-item scales and six domains namely physical, psychological, level of independence, social relationships, environment and spirituality religion. Study subjects were aged between 20-56 years. Mean age of all study subjects was 33.85±7.01 years, comprising of 34.4 females. More than 50% of the total subjects had received less than secondary school education. All domains have higher scores for women than men except the psychological domain. Correlation of scores of six domains with overall QOL score and among individual domains was statistically significant. Younger people showed poorer QOL and level of education correlated positively with all domains of QOL. Overall results indicate that quality of life of AIDS attending Lok Nayak hospital is satisfactory.

Risk factors with breast cancer among women in Delhi.

BACKGROUND: The incidence of breast cancer is on the rise in India, breast cancer is the second most common malignancy in Indian women. AIM: The aim of this study was to find out the association of various risk factors with breast cancer among women in Delhi. SETTINGS AND DESIGN: This was a case-control study in Lok Nayak Hospital, Delhi. METHODS AND MATERIAL: 332 women were studied. Subjects were women with breast cancer (N = 115) and age matched Control subjects (N-217) without breast cancer, attending Lok Nayak Hospital during 2006. Subjects were interviewed using a pretested questionnaire. The risk factors studied were: age, parity, socioeconomic status, marital status, breast feeding, menarche, menopause, family history. STATISTICAL ANALYSIS: Data was expressed in proportion. RESULTS AND CONCLUSIONS: Age of the patient ranged from 25 to 80 years. In this study, 69 (60%) cases and 127 (58.5%) controls were illiterate, the mean duration sum of total breast feeding for all children was 6.58 years in cases and 7.4 years in controls (OR = 1.91; 95% CI, 1.17 - 3.13) (P P P< 0.05). There was a significant difference between breast cancer cases and controls in relation to place of residence, occupation, marital status, body mass index and breast feeding.

E-endocrinology: An update.

Internet, from a long time, has opened up a myriad resource of knowledge and applications for academicians, researchers and clinicians alike in all health care professions across the globe. Basic endocrinologists are exploring through bench-top protocols to understand endocrine system and to design therapeutic interventions. Clinicians are required to continuously look for new developments relating to investigation, diagnosis and therapeutic options in their everyday practice for better quality of life of patients. All these require managing a large body of information. Now, these innovative technologies have opened up newer avenues for endocrinologists. As internet is serving the backbone for modern technologies, it is of utmost necessity to use and refine internet applications for future endocrinologists. Increasingly, easy access to internet has dramatically reduced barriers in sharing information among basic and clinical endocrinologists. Considering the growing scope for endocrinologists in the use of internet, it is necessary to understand internet as a source of information and backbone of modern applications. This review illustrates the expanding roles of the internet for endocrinologists and provides a ready-to-use compilation of useful academic, research, clinical resources, and is expected to introduce, stimulate and guide endocrinologists into the realm of WWW.

"Knowledge, attitude, behavior and practice (KABP) regarding HIV/AIDS among pregnant women attending PPTCT programme in New Delhi".

In India, several thousand HIV-infected babies are expected to be born every year. Despite effective intervention, the identification of HIV infected pregnant women prior to delivery is a major problem. KABP and acceptance of rapid screening of women for HIV among pregnant women attending ANC clinic and availing Voluntary Counselling and Confidential Testing services was assessed. The study was done among 90 pregnant women. There was no significant difference between one's husbands's job and income with respect to pregnant women's awareness of risk factors except that of tattooing. Education level had significant bearing on awareness level. Attitude about PLWHA indicates that 29% of the participants believed individuals with HIV shouldn't be allowed to get married, while 31% saying that they should not be allowed to have children. Participants supported compulsory HIV testing for pregnant women (39%) and couples before marriage. Almost 96% of participants had unprotected sex, though 41% casually used condom. All denied herself or her husband indulging in extramarital sex. The country is about to embark on its prevention of mother to child transmission (PMTCT) programme. This study throws some light on the level of knowledge acceptability and adoption of VCT and other PMTCT strategies among potential beneficiaries.

Perception of risk and potential occupational exposure to HIV/AIDS among medical interns in Delhi.

A cross sectional study was conducted among 129 medical interns of Maulana Azad Medical College, New Delhi for assessing the perceived levels of risk of acquiring HIV infection in the health care settings among medical interns, reasons for the same and their exposure to situations having potential of HIV transmission. Majority of the interns (68.3%) perceived themselves to be at a very high/high risk of acquiring HIV infection during their medical career. The common reasons for perceived risk of acquiring HIV infection were getting injuries due to needle pricks/cuts during surgical procedures (32.4%), frequent exposure to the blood/ secretions of patients (28.5%) and insufficient availability of gloves (17.6%). Some (23.2%) were of the opinion that students in future might lose interest in the medical profession due to increasing risk of HIV infection and few (3.1%) were even considering to leave the medical profession for the same reason. Majority of the interns (72.9%) had experienced needle pricks and more than half (53.7%) of them even had had blood splashes in their eyes/ nose/ mouth during surgical procedures. The findings of the study call for efforts for bringing a reduction in the risk perception of the interns through awareness campaigns and reorientation trainings, ensuring availability of gloves and other items necessary for observing universal work precautions and proper disposal of potentially contaminated articles.

Prevalence of bacterial vaginosis among women in Delhi, India.

BACKGROUND & OBJECTIVE: Bacterial vaginosis is the most common cause of vaginal discharge among women in reproductive age. Surveillance studies on bacterial vaginosis are mostly based on specialist clinic settings. As few population-based prevalence surveys of bacterial vaginosis have been conducted, we studied the prevalence of bacterial vaginosis in the urban and rural communities in Delhi, and to associate the presence of bacterial vaginosis with demographic profile, risk factors and presence of other reproductive tract infections (RTIs)/ sexually transmitted infections (STIs). METHODS: Vaginal specimens for Gram-stain evaluation of vaginal flora for diagnosis of bacterial vaginosis and culture of Trichomonas vaginalis and Candida spp, blood samples for HIV and syphilis serology, and urine for detection of Neisseria gonorrhoeae and Chlamydia trachomatis were collected from women (15-49 yr) from rural and urban areas. Information on demographic characteristics, risk factors and clinical symptoms was obtained. RESULTS: Bacterial vaginosis was diagnosed in 70 (32.8%) subjects. A high percentage though asymptomatic (31.2%) were found to have bacterial vaginosis. Highest prevalence was seen in urban slum (38.6%) followed by rural (28.8%) and urban middle class community (25.4%). All women with vaginal trichomoniasis were found to have bacterial vaginosis while 50 per cent of subjects having syphilis also had bacterial vaginosis.. INTERPRETATION & CONCLUSION: The study showed high prevalence of bacterial vaginosis. The asymptomatic women having bacterial vaginosis are less likely to seek treatment for the morbidity and thus are more likely to acquire other STIs. Women attending various healthcare facilities should be screened and treated for bacterial vaginosis to reduce the risk of acquisition of other STIs.

Validity of verbal autopsy in determining causes of adult deaths.

A verbal autopsy (VA) questionnaire, which had an open-ended description of the deceased's illness followed by a series of close-ended questions on specific symptoms and signs, was used by three trained field workers to interview relatives of the deceased who had died in a Chandigarh hospital in previous year. The sensitivity and specificity of the cause of death assigned by physician from the verbal autopsy was calculated against the cause of death derived from the hospital records. Of the 262 verbal autopsies, 60% were males and 23% belonged to rural area. Specificity of VA cause of death was high (>95%) for all broad cause groups except cardiovascular (79%) diseases. Sensitivity was highest for injuries (85%) and it was in the range of 60% to 65% for circulatory diseases, neoplasms, and infectious diseases. Sensitivity was low (20% to 40%) for respiratory, digestive and endocrine diseases. Cause specific proportionate mortality for major cause groups by the VA were statistically similar to the causes of deaths derived from the hospital records (p>0.05). Therefore, VA can be used for determining causes of adult deaths.

Economic burden of tuberculosis in patients attending DOT centres in Delhi.

Tuberculosis inflicts a negative impact on global socioeconomic prosperity. Though India carries one third of the global burden of the disease, few studies have focussed in the country on this aspect. The present study was therefore, framed to estimate economic loss amongst TB patients. A total of 156 patients attending two DOT centres were interviewed in depth, regarding economic loss due to tuberculosis, using a semi structured pretested interview schedule during a period of 5 months. More than 75% of the subjects belonged to the age group of 15-44 years of which 71.6% were males. 34.6% of patients were housewives and 10.9% were students. Mean expenditure before registration in DOT centre was Rs. 3385.5 irrespective of all socioeconomic classes. The upper lower socio-economic class of patients incurred maximum mean expenditure of Rs. 9782.0. Mean duration of wage loss was found to be 47.1 days. Study participants incurred economic loss both in terms of direct and indirect costs, more so in lower socio-economic group, besides delay in attending DOT centres for treatment. Awareness campaign focussing on treatment availability and DOT centre could help in reducing such economic loss.

Socio-demographic co-relates of psychiatric disorders.

OBJECTIVE: To find out the magnitude of probable psychopathology in children and study association of psychopathology with demographic, developmental and social factors. METHODS: Childhood Psychopathology Measurement Schedule (CPMS) was used to measure the magnitude of probable psychopathology in 620 children from an urban slum of Miraj (Maharashtra). A second schedule recorded demographic, developmental and social factors. RESULTS: CPMS score > 10 was observed in 102 children (16.5%). It was significantly higher in children aged 7-10 years, in males, belonging to lower socioeconomic status, large families, being first born, having low birth weight (LBW); body mass index (BMI) less than 18.5. Low maternal education and alcohol abuse in father also had significant association with CPMS score > 10. CONCLUSION: Findings suggest a need to educate the community about psychological implications of LBW, large family size and overcrowding in children. Improving maternal education and controlling alcoholism could help in reducing childhood psychopathology.

Sexual abuse of street children brought to an observation home.

This study was conducted to assess the magnitude and pattern of sexual abuse among male inmates of an observation home in Delhi. A total of 189 boys aged 6 to 18 years were assessed for sexual abuse using Finkelhors scale and Child Maltreatment History Self-Report followed by clinical examination using American Medical Associations guidelines. Majority of boys were runaways and 38.1 percent had suffered sexual abuse. On clinical examination, 61.1 percent showed physical signs and 40.2 percent showed behavioral signs of sexual abuse. Forcible sex was reported by 44.4 percent of victims and 25 percent had signs suggestive of sexually transmitted diseases. Strangers were the most common perpetrators of sexual abuse.