Sexual dysfunction among men in secondary care in southern India: Nature, prevalence, clinical features and explanatory models.

BACKGROUND: Sexual dysfunction, common in general medical practice, is under-recognized and inadequately managed resulting in significant morbidity and reduction in quality of life. We examined the nature, prevalence, clinical features and explanatory models of illness among men with sexual dysfunction in a general healthcare setting. METHODS: We recruited 270 consecutive men attending a general health clinic. Participants were evaluated using a structured interview. The International Index of Erectile Function-5, the Chinese Index of Premature Ejaculation-5, Short Explanatory Model Interview and the Revised Clinical Interview Schedule were used to assess sexual dysfunction, explanatory models and psychiatric morbidity. RESULTS: Premature ejaculation and erectile dysfunction were reported by 43.0% and 47.8% of men, respectively. The most common perceived causes were loss of semen due to masturbation and nocturnal emission. Popular treatments were herbal remedies and resources used were traditional healers. The factors associated with erectile dysfunction were diabetes mellitus, financial stress, past history of psychiatric treatment and common mental disorders such as depression and anxiety; those associated with premature ejaculation were common mental disorders, older age and financial debt. Sexual dysfunctions and concerns were under-diagnosed by physicians when compared to the research interview. CONCLUSION: There is a need to recognize sexual problems and effectively manage them in general medical settings. The need for sex education in schools and through the mass media, to remove sexual misconceptions, cannot be under-emphasized.

Rates and factors associated with suicide in Kaniyambadi Block, Tamil Nadu, South India, 2000-2002.

BACKGROUND: Inefficient civil registration systems, non-report of deaths, variable standards in certifying death and the legal and social consequences of suicide are major obstacles to investigating suicide in the developing world. OBJECTIVE: The aim of this study was to prospectively determine the suicide rate in Kaniyambadi Block, Tamil Nadu, South India, for the years 2000-2002 using verbal autopsies. METHOD: The setting for the study was a comprehensive community health programme in a development block in rural South India. The main outcome measure was death by suicide, diagnosed by a detailed verbal autopsy and census, and birth and death data to identify the population base. RESULTS: The average suicide rate was 92.1 per 100,000. The ratio of male to female suicides was 1:0.66. The age-specific suicide rate for men increased with age while that for women showed two peaks: 15-24 years and over 65 years of age. Hanging (49%) and poisoning with organo-phosphorus compounds (40.5%) were the commonest methods of committing suicide. Acute and/or chronic stress was elicited for nearly all subjects. More men suffered from chronic stress while more women had acute precipitating events (chi2 = 4.58; p < 0.04). People less than 44 years of age had more acute precipitating events before death while older subjects reported more chronic stress (chi2 = 17.38; p < 0.001). CONCLUSION: The study replicates findings of an earlier study from the area. The suicide rate documented in this study is very high and is a major public health concern. There is a need for sentinel centres in India and in developing countries to monitor trends and to develop innovative strategies to reduce deaths by suicide.

Suicide in the elderly in Kaniyambadi block, Tamil Nadu, South India.

BACKGROUND: Inefficient civil registration systems, non-report of deaths, variable standards in certifying death and the legal and social consequences of suicide are major obstacles in investigating suicide in the developing world. Very high rates of suicide have been recorded in the region in the general population and among younger people. OBJECTIVE: This paper describes the suicide rate among the elderly in Kaniyambadi block, Tamil Nadu, South India for the years 1994-2002 using verbal autopsies. METHOD: The setting for the study was a comprehensive community health program in a development block in rural South India. The main outcome measure was death by suicide diagnosed by a detailed verbal autopsy and census, birth and death data to identify the population base. RESULTS: The average annual suicide rate was 189 per 100,000 for people over 55 years of age. The ratio of male to female suicides was 1: 0.66. The age-specific suicide rate for men and women increased with age. Hanging (52%) and poisoning with organo-phosphorus compounds (39%) were the commonest methods employed for committing suicide. Significantly more women chose drowning or burning than men who preferred poisoning or hanging (chi2 19.75; df 1; p < 0.001). CONCLUSIONS: The suicide rate documented in this study among the elderly is very high. The reasons for the high suicide rate observed in older people are not known. There is a need to develop innovative strategies to reduce deaths by suicide.

Training teachers of day care centres for primary ear care.

The feasibility of training teachers of day care centres for children (balwadi teachers) to recognize and manage common ear problems was studied so that they could provide primary care for ear related morbidity in the community. A training module was designed, piloted on grass root level workers and used to train 19 balwadi teachers. Their knowledge, skills and technique of examination was assessed following training. Pathways for referral were established between the balwadis, secondary and tertiary hospitals. The knowledge score of the balwadi teachers increased from a mean of 28.4% to 86%; they scored an average of 75% in an assessment of their examination technique. Their sensitivity in identifying overall ear related morbidity was 75%, and 96% in identifying children with ear discharge, specifically. Age, education and experience did not affect the outcome of their training. While it may be premature to comment on the impact of the training, periodic supervision, close monitoring and review sessions would sharpen the skills of the balwadi teachers and improve their efficiency.