Level of stress perception and predictors of higher stress perception among informal primary caregivers of Eastern Indian people living with HIV/AIDS

Background: HIV illness and its related problems were significantly and positively correlated with both caregiver’s burden and caregiver’s adjustment. As there were limited studies on HIV caregiver’s stress, present study was conducted to estimate the magnitude and level of perceived stress among the predominant informal care giver of the PLHIV and to find out its correlates.Methods: This was a cross-sectional descriptive epidemiological study conducted on informal primary caregiver of PLHIV who was receiving ART since more than 2 months and attending the FIART centre of Bankura Sammilani Medical College and Hospital, Bankura between July 2018 to December 2018. PLHIV who were severely ill and informal caregivers having a psychological illness, disability, a severe form of chronic diseases except for HIV, were excluded. Data were collected using predesigned, pretested, semi-structured interviewer administered anonymous questionnaire including 10 points Sheldon Cohen’s perceived stress scale (PSS) following simple random sampling method. Multivariate logistic regression was done to find out the predictors of higher stress using SPSS software version 22.0.Results: Ultimately 108 caregivers were included. Mean score of PSS was 19.93±11.44 and score ranges from 0 to 40. In multivariate linear regression, it was found that caregiver who were belonging to lowest socio economic status were 3.9 times more perceive moderate to high stress than others. If HIV patients were suffering from other co-morbidities their primary caregiver perceived moderate to high stress 6.2 times more than others.Conclusions: Support group interaction among caregivers can alleviate the stress

Assessment of training need and training efficacy for national program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke among medical officers of West Bengal, India

Background: The national program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS) has been rolled out in West Bengal, with its implementation initiated through state-wide training of Medical Officers (M.O). For attaining requisite competency for meeting NPCDCS objectives, MOs have been trained at their respective district levels. Present study aimed to assess the training need, training efficacy and need for further training.Methods: A repeat cross-sectional study was conducted from May-July 2018 for M.Os of six randomly chosen districts of West Bengal, out of those whereat NPCDCS was launched in first phase. 40-45 M.Os were randomly selected from each district in liaison with district level health authorities. The total sample size was 352 with Finite population correction. On the days of training, pre and post training surveys were conducted with an identical semi-structured, pre-tested and validated questionnaire (Cronbach’s alpha >0.8) covering different levels of cognitive domain, with a maximum possible score of 100 marks. No negative marking was done for incorrect responses. Training was imparted by the Principal Investigator (accredited trainer). Ethical clearance was granted by the State Health Directorate. Informed consent from each participant was obtained.Results: Dependent sample t-test revealed significant increment (p<0.0001) in post-test scores (t=63.134) & one-way repeated measure general linear model (GLM) also revealed F=29.617 (p<.0001). The “Effect Size” was classified as “Huge” (Cohen’s D=63.134/√(352)= 3.365), as was noted between pre-test and post-test scores, based on Cohen’s convention and Sawilowsky’s addition. It was further noted that even after six hour training sessions there was 27.44% knowledge gap (p<0.0001) after adjusting for Bonferroni.Conclusions: Imperativeness of training coupled with periodic refresher training has been established as a pre-requisite for successful implementation of NPCDCS.

Level of stress perception and its predictors among school going Bengali late adolescents in a rural block of Eastern India

Background: As adolescents are in transit from childhood to adulthood, they are vulnerable to stress and related complications. Measuring stress and its influencing factors is a prerequisite for developing strategy for this age-group. Objective of the study was to assess the level of perceived stress among school going late adolescents and to find out its predictors.Methods: This cross-sectional analytical epidemiological study was conducted among the school going Bengali late adolescents (15-17 years) of a rural block of West Bengal, India within July 2017 to December 2017. Finally, 102 students of class IX and XI were selected via two stage simple random sampling method. Data were collected by interview using pre-designed, pre-tested, semi structured questionnaire including 10 points Cohen’s perceived stress scale (PSS-10). Independent ‘t’ test, ANOVA, Mann Whitney U and Kruskal Wallis H test were utilized to establish the association between independent variables and PSS score. Independent variables found to be associated (p≤0.05) were considered in multiple linear regression to identify the predictors of stress.Results: Mean perceived stress score of participants were 16.8±3.7 (mean±2 SD) out of 40 (highest PSS score) with minimum and maximum score 8 and 26, respectively. In multiple linear regression, de-motivating comment, sibling pattern and love affair were found as predictors of stress perception among Bengali late adolescents. These factors collectively explained 15.6% variations of PSS score and individually contributed 3.8%, 5.6% and 6.2%, respectively.Conclusions: Stress can be alleviated by arranging motivational programme, counselling, and life skill education.

Wandering ascaris coming out through the T-tube tract--a rare occurrence.

A case of ascariasis of the common bile duct in the postoperative period of cholecystectomy and choledocholithotomy with T-tube drainage is reported. The living adult wandering ascaris came out through the T-tube tract immediately after removal of the T-tube. No such previous report has been found in the available literature.

Haemobilia due to a large gall bladder polyp.

A 61-year-old male presented with recurrent bouts of haematemesis and melaena for last 10 days. On examination, he was found anaemic and had jaundice and a mass felt in the right hypochondrium. He required multiple blood transfusions. Oesophagogastroduodenoscopic (OGD) evaluation demonstrated no lesion, no fresh bleeding noticed from ampulla of Vater. Ultrasonographic evaluation demonstrated a heterogeneous mass within the gall bladder lumen with a chink of free lumen between the mass and gall bladder wall and also dilated biliary tract. Laparotomy confirmed mass within the gall bladder lumen without any lymph node involvement at porta or any liver metastasis, and had dilated common bile duct. Cholecystectomy was carried out. The cut section of the gall bladder showed a polypoid mass (5.5 cm x 4 cm) projecting inside lumen having a haemorrhagic spot on irregular surface and which was attached with fundus of the gall bladder through a small stalk. Choledochotomy showed only blood clots within the duct-choledochoduodenostomy was also done. Histopathological examination showed adenomatous polyp with foci of carcinoma in-situ or ly without any evidence of local metastasis. Follow-up was uneventful till after 11 months.