Depressive and generalized anxiety symptoms in adults awaiting cataract surgery in India

BACKGROUND Systematic data on mental health issues among adults awaiting cataract treatment are not readily available in India. We explored the prevalence and predictors of depressive and generalized anxiety (GA) symptoms in a cohort of adults awaiting cataract surgery. METHODS Our study is based on data from baseline assessments which were conducted as part of a multicentre prospective, longitudinal cohort study. Subjects were recruited from four eye hospitals to assess depression and GA and associated risk factors using standardized scales, i.e. Center for Epidemiologic Studies–Depression Scale (CES-D) and Generalised Anxiety Disorder (GAD-7). Variation in the intensity of depression and GA was assessed using multiple classification analysis (MCA). RESULTS A total of 813 adults awaiting cataract surgery participated, of whom 456 (56.1%) were men. The mean (SD) CES-D and GAD-7 scores were 24.6 (7.8) and 6.3 (SD 4.2) for men and 25.8 (8.9) and 6.9 (4.4) for women, respectively. The overall prevalence of depression score of >16 was 87.4% (95% confidence interval [CI] 84.7%– 89.6%), and GA score of >10 was 57.1% (95% CI 53.5%–60.7%). The prevalence of comorbid depressive and anxiety symptoms was 56.6% (95% CI 52.9%– 60.2%). MCA showed that being neglected and mistreated by family/friends because of vision condition and facing difficulty and requiring help with daily tasks had the highest effect on the intensity of both depression (beta=0.254 and 0.238, respectively) and GA (beta=0.219 and 0.211, respectively). CONCLUSION The majority of adults with untreated cataract had both depressive and GA symptoms. These findings could be used for planning mental health interventions for adults awaiting cataract surgery.

Effectiveness of a community-based intervention on nutrition education of mothers of malnourished children in a rural coastal area of South India

Background: There is a paucity of evidence on improvement in malnutrition status after follow-up intervention among malnourished under-five children. Objective: The objective of the study is to assess the effect of community-based follow-up health education intervention on the awareness level of mothers, calorie intake, protein intake, and weight gain of malnourished children. Methods: This intervention study was conducted from December 2012 to October 2014 in three phases at rural Puducherry, coastal South India. The intervention group (57 mothers of 64 children) and control group (60 mothers of 64 children) included moderate and severely malnourished children aged 13� months. Children in the control group were taken from different areas and matched for age (�months) and sex. Health education intervention and follow-up supervision for 15 months were given to the mothers. Results: Awareness level in all domains increased significantly in the intervention group. In the intervention group, 81% (52) of malnourished children turned out to normal, whereas in the control group, 64% (41) of them became normal. There was a statistically significant difference between the mean changes in the protein intake among boys (15.34 g to 19.91 g in the intervention group against 13.6 g to 16.24 g in the control group) and girls (15.09 g to 19.57 g in the intervention group against 13.36 g to 16.51 g in the control group) and calorie intake among girls (993.86 kcal to 1116.55 kcal in the intervention group against 992.65 kcal to 1078.75 kcal in the control group) between the two groups. Conclusion: There was comparatively marginal increase in protein intake, calories' intake, and weight gain in the intervention group.

Factors limiting the Northeast Indian elderly population from seeking cataract surgical treatment: Evidence from Kolasib district, Mizoram, India

Purpose: Reliable data on the barriers to the uptake of cataract surgical services in the Northeast Indian states are scanty. The purpose of this study was to assess the barriers to uptake of cataract surgical services among elderly patients and suggest appropriate strategies to reduce these. Methods: A cross-sectional study was conducted among patients who failed to avail cataract surgical services, 6–12 months' postinitial diagnosis at a community eye health camp. Validated questionnaire was used to collect information through face-to-face interviews at the residence of the participants. Descriptive statistics and Chi-square tests were conducted to assess the association between the barriers quoted and sociodemographic variables. Results: A total of 140 (89.2%) individuals participated in the study, of whom 56 (40%) were aged between 71 and 80 years. The median age for men and women was 73.5 and 72.5 years, respectively. About 57% of participants were female patients. A total of 66 (47.1%) participants had borderline visual acuity followed by those with poor vision (41.4%, n = 58). “Bad roads/difficult terrain” (P = 0.009), “witnessed bad surgical outcomes in others” and “did not feel important” (P < 0.024), “poor overall health status” (P < 0.001), “lack of information” (P = 0.025) and “no escort” (P = 0.025) were significant barriers reported by this population. Conclusion: Most of the barriers reported in this study seem to be endogenous in nature and appear to be within the purview of the local eye care service provider to remedy. Counseling and targeted awareness and information, education, and communication strategies could nullify many of the barriers reported in this study.

Home Remedies For Oral Diseases

Self-help through self-treatment makes a countless contribution. Home remedy use is a component of health self-management, particularly among people who have experienced limited access to medical care or discrimination by the health care system. Self-care using home remedies survived for long time and it surely give effect in the easiest, safest, fastest and cheapest way. Oral diseases are a significant public health burden in India as well as across the globe. The consequence of poor oral health deteriorates the individual health and wellbeing, decrease economic productivity, and act as significant risk factors for other systemic health ailments. Developing countries have more diverse health systems than developed countries and expenditure in oral health care is low, access to Dental healthcare is limited and restricted to emergency Dental care or pain relief. Moreover, allopathic medicine is expensive and these chemicals can have adverse effects. Hence, there is a need for alternative products and natural extracts obtained from plants which are safe and biocompatible can be considered as good alternatives. In such circumstances use of home remedies would meet the need for treating minor ailments safely. Home remedies are good and comparable methods of equal value which have met the scientific and regulatory criteria for safety and effectiveness. The purpose of this review was to evaluate some of the commonly available foods being utilized in the treatment of oral diseases at home.

Contact with HIV prevention programmes & willingness for new interventions among truckers in India.

Background & objectives: Systematic data on existing coverage and willingness for HIV prevention strategies among truckers are not readily available in India. The present study aimed to further the understanding on contact of truckers with existing HIV prevention services and to assess willingness for new HIV prevention strategies. Methods: A total of 1,800 truck drivers and helpers aged 16-65 yr passing through Hyderabad were approached to assess contact made with HIV prevention programmes, history of previous HIV testing and their acceptance for circumcision, oral HIV testing, new medications to control HIV (PrEP) and telephonic counselling. Dried blood samples were collected on filter paper and tested for HIV. Multiple logistic regression was performed for analysis of association between contact with HIV prevention programme and socio-demographic, sexual risk behaviour variables and work characteristics. Results: A total of 1,602 (89%) truckers gave interview and provided blood sample. Forty five truckers tested positive for HIV resulting in HIV prevalence of 2.8 per cent (95% CI 2.0-3.6%). Only 126 truckers (7.9%; 95% CI 6.5-9.2%) reported ever being contacted by staff providing HIV prevention interventions. Previous HIV testing was reported by19 per cent (95% CI 17.3-21.2%). Those reporting contact with HIV prevention programmes ever were more likely to have undergone HIV testing (odds ratio 3.6, 95% CI 2.4-5.4). The acceptance for pre-exposure prophylaxis (PrEP) was 87 per cent, oral HIV testing 98 per cent, and telephonic counselling 82 per cent, but was only 9 per cent for circumcision.Truckers who reported having sex with a man and those who halted regularly at dhabas were significantly more willing to undergo circumcision for HIV prevention (odds ratios 2.7, 95% CI 1.4-5.4 and 2.1, 95% CI 1.3-3.2, respectively). Interpretation & conclusions: Our findings showed that truckers had low contact with HIV prevention programmes, suggesting a need for urgent measures to reach this population more effectively. The willingness for new HIV interventions was high except for circumcision. These findings could be used for further planning of HIV prevention programmes for truckers in India

HIV testing among adults in a high prevalence district in India.

Background. HIV testing is a key component of HIV control efforts. We examined the distribution of HIV testing in a population-based sample from Guntur district in Andhra Pradesh, which is estimated to have one of the highest prevalence rates of HIV in India. Methods. A total of 12 994 persons (15–49 years of age) were interviewed in Guntur district. We assessed associations with the uptake of HIV test, place and reasons for undergoing HIV testing and awareness of voluntary counselling and testing centres (VCTC) among sexually active adults. Results. The age-, sex-, urban- and rural-adjusted prevalence of HIV testing was 21.1% (95% CI: 19.1–23.2). The uptake of HIV test was higher in women (27.2%) than in men (18.8%). Increasing education level, urban area residence and being in an occupation requiring mobility were significantly associated with uptake of the HIV test. A previous test for HIV was reported by 37.8% of men and 30.3% of women. The adjusted prevalence of VCTC awareness was 5.4% (95% CI: 4.3–6.4), being higher in men (9.2%) than in women (3.5%). Among those who had undergone HIV testing, 83.9% of men and 76.2% of women did so at a private sector health facility. Women were significantly more likely to under-go testing at VCTC/public sector facility (23.5%) than men (15%). More men (47.6%) than women (3.3%) reported undergoing testing voluntarily (p<0.001). Women reported pregnancy (57.4%) as the most common reason for undergoing the test. Conclusion. These population-based data highlight the patterns of HIV testing and their associations. The high proportion of HIV testing in the private sector suggests the need to strengthen counselling in this sector to enhance HIV prevention activities.

Cost and efficiency of HIV voluntary counselling and testing centres in Andhra Pradesh, India.

BACKGROUND: [corrected] As part of the effort to control HIV/AIDS, the number of HlV voluntarycounselling and testingcentres (VCTCs) is increasing rapidly in the public health system of the Indian state of Andhra Pradesh, which is estimated to have one of the highest rates of HIV infection in India. However, systematic data on the cost and efficiency of providing VCT services in India are not available to help guide efficient use of resources for these services. METHODS: We used standardized methods to obtain detailed cost and output data for the 2002-03 fiscal year from written records and interviews in 17 VCTCs in the public health system in Andhra Pradesh. We calculated the economic cost per client receiving VCT services, and analysed the variation and determinants of total and unit costs across VCTCs. We used multivariate regression techniques to estimate incremental unit costs. We assessed hurdles towards serving an optimal number of clients by VCTCs. RESULTS: In the 2002-03 fiscal year, 32 413 clients received the complete sequence of services at the 17 VCTCs, including post-HIV test counselling. The number of clients served by each VCTC ranged from 334 to 7802 (median 979). The overall HIV-positive rate in post-test counselled clients was 20.5% (range 5.4%-52.6%). The cost per client for the complete VCT sequence varied 6-fold between VCTCs (range Rs 141.5-829.6 [US 2.92-17.14 dollars], median Rs 363.5 [US 7.51 dollars]). The cost per client was significantly lower at VCTCs with more clients (p < 0.001, R2 = 0.83; power function) due to substantial fixed costs. Personnel made up the largest component of cost (53.7%). The cost per client had a significant direct relation with percent personnel cost for VCTCs (p < 0.001, R2 = 0.58; exponential function). A multiple regression model revealed that the incremental cost of providing complete VCT services to each HIV-positive and -negative client was Rs 123.5 (US 2.54 dollars) and Rs 59.2 (US 1.22 dollars), respectively. Fourteen VCTCs (82.4%) reported that they could serve more clients with the available personnel and infrastructure, and that inadequate demand for their services was the main hurdle towards achieving this. CONCLUSION: These data suggest that the efforts of the National AIDS Control Organisation of India and the Andhra Pradesh State AIDS Control Society in increasing VCTCs could yield even higher benefit if the demand for these services was enhanced, as this would increase the number of clients served and reduce the cost per client. Ongoing systematic cost-efficiency analysis is necessary to help guide efficient use of HIV-control resources in India.

Stress responses in two genotypes of mulberry (Morus alba L.) under NaCl salinity.

Changes in biomass yield rates, cell membrane stability (CMS), malondialdehyde (MDA) content and in the levels of physiological stress markers such as proline and glycine betaine in two high yielding genotypes (S1 and ATP, salt tolerant and salt sensitive, respectively) of mulberry under NaCl salinity were studied. Biomass yield rates and CMS were significantly decreased in both the genotypes under stress conditions. Per cent of decrease in biomass yield rate and CMS was relatively less in S1 than in ATP. Salt stress results a significant increase in the accumulation of proline, by 6-fold in S1 and 4-fold in ATP. Glycine betaine content was also increased significantly in stressed plants. However, the per cent increase was more in S1 than in ATP. The level of lipid peroxidation as indicated by MDA formation was greater in ATP than in S1. These results clearly support the better salt tolerant nature of S1 compared to ATP genotype.