Determinants of Metabolic Syndrome Among People With Substance Abuse: A Cross-Sectional Study From North India.

Objective: To estimate the prevalence and predictors of metabolic syndrome among substance users in North India.Methods: A total of 302 participants with a history of substance use (per ICD-10 code) visiting either medicine or psychiatry outpatient departments and referred to a deaddiction center in the psychiatry department of a tertiary care hospital were enrolled. The cross-sectional study was conducted over 6 months between September 2019 and February 2020. Information regarding sociodemographic profiles was collected. Weight, height, waist circumference, hip circumference, and blood pressure were measured. A fasting venous blood sample was collected to measure blood glucose; triglycerides; high-density, low-density (LDL), and very low-density lipoprotein (VLDL) levels; and other blood parameters. The International Diabetes Federation criterion was used to define metabolic syndrome. Descriptive analysis was performed, and multiple logistic regression was used.Results: The mean ± SD age of the study participants was 37.1 ± 11.4 years, and the majority were males (n = 299, 99.0%). The prevalence of metabolic syndrome among substance users was 16.9% (n = 51). Mean age, age of initiation, weight, body mass index (BMI), hip circumference, total cholesterol, LDL, and VLDL were significantly higher (all P < .05) among study participants with metabolic syndrome than among those without. On multivariable regression analysis, professional employment, high BMI, high hip circumference, and elevated VLDL were predictors of metabolic syndrome among substance users.Conclusions: Coexisting substance use and metabolic syndrome is a public health concern considering the large number of people who are substance users. It is essential to screen such patients regularly for cardio-vasculo-metabolic disorders to prevent further morbidity and mortality.

Suicide deaths among medical students, residents and physicians in India spanning a decade (2010-2019): An exploratory study using on line news portals and Google database.

BACKGROUND: Despite having one of the world's largest medical education consortium, India lacks a comprehensive and nationally representative data on suicide deaths among medical students and physicians unlike the one found in most of the developed nations of the world. AIM: We aimed to explore the different characteristics of suicide deaths among medical students, residents and physicians in India over a decade (2010-2019). METHODS: Content analysis of all suicide death reports among medical students, residents and physicians available from online news portals and other publicly available sites was done. Search was done retrospectively using pertinent search words individually or in combination with language restricted to Hindi and English and timed from January 2010 to December 2019. Reports on completed suicide by allopathic medical students, residents and physicians from India were included. Socio-demographic and suicidological variables were analysed using R software. RESULTS: A total of 358 suicide deaths among medical students (125), residents (105) and physicians (128) were reported between 2010 and 2019. Around 7 out of 10 suicides happened before the age of 30 and had mean age 29.9 (±12.2) years. Female residents and physicians were younger than their male counterparts at the time of suicide. Overall maximum suicide deaths were concentrated in South India except the state of Kerala. The specialty of anesthesiology (22.4%) followed by obstetrics-gynaecology (16.0%) had the highest suicide deaths. Violent suicide methods were more commonly used by all, with hanging being the most common mean of suicide. Academic stress among medical students (45.2%) and residents (23.1%), and marital discord among physicians (26.7%) were the most noticeable reasons for suicide. Mental health problems were the next most common reason in medical students (24%) and physicians (20%) while harassment (20.5%) was in residents. Twenty six percent had exhibited suicide warning signs and only 13% had ever sought psychiatric help before ending their lives. A total of nine reports of suicide pact were found with the average deaths per pact being 2.4 and predominantly driven by financial reasons. CONCLUSION: Academic stress among medical students and residents, and marital discord in physicians emerged as the key reasons for suicide. However, this preventable domain should be further explored through focused research. This is the first of its kind study from India which attempted to explore this vital yet neglected public health issue using the most feasible and practical method of online news content-based analysis.

Impact of a Brief Structured Psychoeducation Session on Antiepileptic Drug Adherence and Treatment Outcome in Persons with Epilepsy: A Prospective Cohort Study.

BACKGROUND: Poor adherence to antiepileptic drugs is one of the most important causes of treatment failure in persons with epilepsy (PWE). This study was aimed at assessing the impact of psychoeducation on drug adherence and treatment outcome in PWE. METHODS: It was a prospective cohort study with a pre and posttest intervention design. A cohort of 100 epilepsy patients aged 18-65 years and on antiepileptic drugs for at least 6 months attending the outpatient department was enrolled in the study. Drug adherence was measured by Medication Adherence Rating Scale. A structured eight-domain epilepsy psychoeducation session with pictorial description was given to the study subjects in two parts (group and individually) lasting for a total of 30 min on the day of baseline assessment. Adherence and treatment outcome variables were assessed by an independent observer 4 months after the psychoeducation session. Chi-square test and paired t-test were used to analyze the data using SPSS version 20 with P value less than 0.05 considered as significant. RESULTS: There was a statistically significant (P < 0.001) increase in the number of patients who were adherent to medications after psychoeducation session. There was a significant reduction in mean seizure frequency (0.68 ± 0.65) and seizure severity in terms of injuries sustained during seizure episodes post intervention. Regularities in the follow-up visits were also witnessed. A significant decrease in the number of hospital admissions (0.09 ± 0.32), mean inpatient treatment days (0.44 ± 2.19), and emergency room visits (0.19 ± 0.15) was noted 4 months after the psychoeducation session indicative of better treatment outcome. CONCLUSION: The present study proves the efficacy of a structured educational program in improving drug adherence and treatment outcome in a cohort of people with epilepsy.

Factors Associated with Poor Antiepileptic Drugs Adherence in Below Poverty Line Persons with Epilepsy: A Cross-Sectional Study.

Background Adherence to antiepileptic drugs (AED) is essential for adequate seizure control in epilepsy. People with low socioeconomic status are more vulnerable to poor adherence to AED. The present study aimed to explore factors associated with poor adherence to antiepileptic drugs in below poverty line (BPL) persons with epilepsy (PWE). Methods The research had a cross-sectional design with inclusion of persons aged 18 to 65 years and an established diagnosis of epilepsy. Holding a BPL card (Yellow card) was taken as a measure for BPL criteria. Adherence to antiepileptic drugs was assessed using medication adherence rating scale (MARS). Univariate analysis with Chi-square test was used to determine the association between various variables and AED adherence, while the predictors of adherence were identified using multivariate logistic regression analysis. Results There was a total of 88 BPL PWE. The mean age of male and female patients was 35.0 ± 15.0 & 32.0 ± 10.1 years, respectively. Adherence for drugs were found to be 30.7% and nonadherence to be 44.3%. Low (illiterate or primary) education (OR 0.041 [0.01-0.21]), polytherapy (OR 0.088 [0.02-0.40]), and substance abuse (OR 0.05 [0.01-0.58]) were found to have significant association with nonadherence to AEDs. Age, gender, marital status, family composition, occupation, rural urban background, distance from health care facility, duration of epilepsy, and side effects of AED were not found to have significant association with adherence. Conclusion There is a need for psychoeducational programs for the people having low education status and polytherapy to form positive beliefs in AEDs. Substance abuse should also be addressed while treating them.

Factors causing stress in postgraduate dental students during COVID-19 pandemic: A cross-sectional survey.

BACKGROUND: COVID-19 pandemic has impacted the academic and clinical training of postgraduate dental students. This study aimed to assess various factors causing psychological stress in them, and the extent of stress perception during pandemic. MATERIALS AND METHODS: In this cross-sectional study, 250 postgraduate students from nine dental colleges of Haryana and National Capital Region, India, responded to an online questionnaire sent electronically to them in September 2020, which included modified dental environment stress (DES) score, Perceived Stress Scale (PSS), and questions regarding COVID-associated stress (CAS). Students already diagnosed with any psychiatric disorder or having a history of any major adverse event during the last 6 months likely to affect their psychological health were excluded from this study. The data obtained were analyzed using Chi-square test, Independent t-test, univariate ANOVA with post hoc tests, Pearson moment correlation, and multiple hierarchical regression tests. P < 0.05 was considered statistically significant. RESULTS: DES score was moderate for 48.8% and high for 34.4% of the participants. PSS was moderate for 69.2% and high for 18.8% of the participants. The most stressful factor in dental environment was the pattern of university examination, while the most stressful factor specific to COVID-19 was the fear of family members contracting the infection. PSS score was significantly higher in female participants. DES and CAS scores were significantly higher in students staying in hostels. Multiple hierarchical regression model depicted gender, mean health, and DES score as significant predictors of PSS. CONCLUSION: Postgraduate dental students reported the adverse impact of COVID-19 pandemic upon their training and prospects as a reason for the increase in stress.

Study of Domestic Violence among Currently Married Females of Haryana, India.

BACKGROUND: No nation is untouched by domestic violence, and it is well-known that domestic violence has serious impact on women's health and well-being. The present study aimed to assess the prevalence and characteristics of domestic violence and injuries owing to domestic violence among currently married women. MATERIALS AND METHODS: This was a community-based, cross-sectional study conducted in the rural and urban areas of Haryana. In total, 880 currently married females of the reproductive age group were interviewed using the Women's Questionnaire (used in National Family Health Survey-3) which is according to the Modified Conflict Tactics Scale. RESULTS: Totally, 37% of the females had ever experienced domestic violence and 28.9% currently experienced domestic violence. All types of violence (except sexual violence) were significantly more common in the rural area than the urban area. Injuries owing to domestic violence were reported by more than half (55.4%) of the women. Among spousal violence, emotional violence was the most common type of violence followed by physical violence. Only 0.1% and 4.5% of females had ever initiated physical and emotional violence respectively, against their husbands, and in rest of the cases, it was the husband who initiated violence. CONCLUSION: Awareness regarding domestic violence needs to be made, and law enforcement regarding it needs to be made stringent. Rehabilitation of victims of domestic/spousal violence should also be considered on priority.

Medical students' attitude toward suicide attempters.

BACKGROUND: Majority of health professionals have unfavorable attitudes toward the patients presenting with self-harm, which further compromises their therapeutic endeavors and outcomes. OBJECTIVES: This study was aimed to assess the medical students' attitudes toward suicide attempters. MATERIALS AND METHODS: A cross-sectional study was conducted in a tertiary care medical institute of Haryana, a Northern state of India. Two hundred and five final year medical students were recruited through total enumeration method. "Suicide Opinion Questionnaire" was administered to assess their attitudes toward suicide attempters. RESULTS: Only minority had previous exposure of managing any suicidal patient and attended suicide prevention programs. Majority agreed for suicide attempters being lonely and depressed. Nearly half of the students reported small family, disturbed interpersonal relationship, weak personality, self-punishment approach, cultural inhibitions in emotional expression, national instability, and disbelief in afterlife, as a major push to attempt suicide. Compared to boys, girls reported the greater contribution of weak personality and self-destructive behaviors and lesser contribution of family disturbances and religious convictions as suicide triggers. They held favorable attitude for only one-third of the attitudinal statement, and they were uncertain for two-third of the attitudinal statements. CONCLUSIONS: Such a high proportion of uncertain responses imply toward lack of awareness and clinical expertise for managing suicide attempters. It also signifies the urgent need for enhancing their educational and clinical exposure, to improve their attitudes toward patients presenting with self-harm.