Unveiling Realities: Exploring and Uncovering Young Adults' Views on Navigating Confidentiality and Disclosure in Healthcare Settings in Bangalore, Southern India.

Introduction Research on the healthcare available to young adults in India is negligible. There is little to no data available to describe the Indian young adults' knowledge and attitude toward a doctor-patient interaction and their perceptions on what might be a barrier to confidentiality. Young adults in India, often face the unique dilemma of being old enough to make their own medical decisions and yet often finding themselves without the freedom or knowledge to do so. Understanding factors that young adults perceive to be affecting confidentiality and a barrier in their healthcare checkups can greatly improve the quality of healthcare provided to them. Objective The objective of the study was to assess knowledge and attitudes among young adults in Bangalore City regarding the maintenance of confidentiality by a doctor while seeking healthcare and to identify perceived factors the young adults believed to be affecting confidentiality and information disclosure when seeking healthcare.  Method A cross-sectional, descriptive study was carried out using multi-stage random sampling. Four colleges were randomly selected from four geographic zones in Bangalore City (North, East, South, and West). The investigators developed a 30-question questionnaire, comprising sections on patient details, perceptions regarding confidentiality, factors influencing history disclosure, etc., which was validated by a panel of four faculty members from one para-clinical and two clinical departments each, belonging to the investigators' medical college. Subsequently, a pilot study with 33 participants was conducted and a sample size of 60 was arrived at assuming an 83.87% favorable knowledge regarding the right to refuse to disclose information to a doctor, with a 95% confidence interval and a 10% absolute allowable error. Further validation was done following the pilot study. Student lists from the chosen colleges were obtained, and the required sample size was distributed based on probability proportional to size (PPS): 19, 19, 12, and 10 participants from the respective colleges. Random number tables were utilized to select the required number of participants from the student population. The participants of the pilot study were not included in the study. The questionnaire was administered digitally by the investigators, and in cases where a student declined to participate, an alternative participant was chosen using random number tables.  Results Results demonstrate that 21.7% (13) of respondents were unaware that a doctor is legally bound to keep details of the visit confidential. A total of 93.3% (56) of the respondents report that a parent/guardian plays an active role in their doctor's visit. Only 16.7% (10) of respondents strongly agreed that they felt comfortable enough to have an honest conversation with their doctor. Respondents report that they were most likely to withhold history regarding sexual practices (55%), alcohol use (35%), and smoking (31.7%). Conclusion  Healthcare providers should take all possible measures to ensure confidential and quality care to the vulnerable young adult population. Breach of confidentiality, often in the form of a parent or guardian being present during the history-taking process. can be a barrier to building good rapport and negatively impact the doctor-patient relationship.

Prevalence and predictors of prehypertension and hypertension in adult population of rural Southern India-An epidemiological study.

INTRODUCTION: Hypertension is considered as one of the major health problem worldwide and the most important risk factor for non-communicable diseases. AIMS: To estimate the prevalence and the risk factors of prehypertension and hypertension. METHODS AND MATERIAL: A community-based cross-sectional study was conducted among adult population of rural area of Chittoor District. WHO STEPS was applied for data collection from 1,742 study participants aged 18 years and above. Chi-square test, Fisher exact, and ANOVA test applied to find out the intragroup and intergroup variable association with raised blood pressure. RESULTS: The overall prevalence of hypertension and prehypertension in our study was 21.5% [95% CI: (19.6-23.5)] and 42.8% [95% CI: (39.5-46.3)], respectively. Males had higher prevalence when compared to females. The mean systolic and diastolic blood pressure was 118.7 ± 17.6 mmHg and 77.1 ± 9.7 mmHg, respectively. The odds of being hypertensive was higher among older age group (OR: 3.83), male study participants (OR: 1.83), either widowed or separated (OR: 2.03), unemployed (OR: 1.51), and those who belonged to upper socioeconomic status (OR: 2.01). Those who were overweight (OR: 3.15), obese (OR: 2.55) and having central obesity (OR: 1.74), and also tobacco smokers (OR: 1.53) were having higher odds of hypertension. Significant association was found between hypertension and age, gender, marital status, body mass index, abdominal obesity, tobacco smoking, and physical inactivity. CONCLUSION: The prevalence of prehypertension and hypertension in this study was found to be high in rural area of Andhra Pradesh. There is a need to develop a community-based program, which would aim at minimizing the risk factors of hypertension.

Voices of Those Who Bear the Brunt - Experiences of Programme Personnel Concerning Private Sector Tuberculosis Notifications in Bengaluru City, India.

This study aims to assess private and public sector contributions to Tuberculosis (TB) notification in Bengaluru city (2011 to 2016) and identify challenges of program personnel in their interaction with private practitioners and procedural barriers for TB notification from the private sector as perceived by them. A mixed methods study was carried out in Bengaluru city, India with TB notification data obtained from TB Units in addition to in-depth interviews with key program implementers. Results showed the contribution of private practitioners to TB notification to be about 20%. Barriers and challenges were: the private practitioners' hesitancy to refer the patients to public sector due to their fear of losing patients and dishonoring of diagnosis from private practitioners, lack of awareness about TB notification, lack of legal punitive measures and constant glitches on the notification website. These need to be resolved on priority to achieve the national target of TB elimination by 2025.

Determinants of helmet use among health-care providers in urban India: Leveraging the theory of planned behavior.

CONTEXT: Wearing helmet during road traffic accidents among motorcycle riders decreases the likelihood of death by 39%. The theory of planned behavior (TPB), a psychological model helps to explain the failure in helmet usage, by assuming a causal chain. The current study was taken up as no studies have elicited the determinants of helmet usage in terms of TPB among health-care providers, the role models for healthful behavior by virtue of their profession in the current urban Indian context. AIMS: The aims of the study were (1) to determine the proportion of proper use of helmets and (2) to identify TPB-related factors and other factors influencing the use of helmets. MATERIALS AND METHODS: A cross-sectional study was conducted among 147 students and staff of a tertiary health-care center, Bengaluru, using a pretested, validated, semi-structured, self-administered questionnaire. Convenience sampling was used. Hierarchical regression model was used to explain variation in the scores of helmet-use behavior on the basis of TPB variables. P < 0.05 was considered as statistically significant. RESULTS: About 65% of respondents practiced "proper use" of helmets. Intention, perceived behavioral control (direct), and attitude (indirect) were significant predictors of helmet use (P < 0.05). Mean scores of knowledge on helmet use and behavior showed positive correlation (P > 0.05). CONCLUSIONS: Application of TPB in urban Indian context was successful in identifying precursors of helmet use. This study throws a light on the strong influencers of helmet use which can assist policy developers in developing effective programs to successfully promote the "proper use" of helmets.

Pain response in newborns to the order of injecting BCG and Hepatitis-B vaccines: a randomized trial.

OBJECTIVE: To determine if acute pain response after administration of the BCG vaccine and the Hepatitis-B vaccine is affected by the order in which they are given. METHODS: This Single-center randomized clinical trial was conducted in the Vaccination room in the Pediatrics Outpatient Department at KVG Medical College; Karnataka, India. 76 healthy term neonates undergoing routine immunization were included in this study. Newborns received either BCG vaccine or the Hepatitis-B vaccine first, followed by the other vaccine. The primary outcome was neonatal pain during vaccine injection as assessed by a validated measure, the Neonatal Infant Pain Scale (NIPS), scored by resident doctors blinded to the study purpose and hypothesis. In addition, a nurse rated pain using a 10-cm visual analog scale(VAS). RESULTS: A total of 76 infants participated: 38 received the BCG vaccine first and 38 received the Hepatitis-B vaccine first. Demographic characteristics did not differ between the groups. Overall mean (SD) pain scores per neonate were significantly lower when BCG was administered first compared to the order when Hepatitis-B vaccine was administered first (for NIPS 5.55 [0.54] vs. 5.84 [0.29], P = .005; for VAS, 6.25 [0.80] vs. 6.58 [0.54], P = .04). When given first, the BCG vaccine caused significantly less pain (P < .001)than the Hepatitis-B, as assessed by the NIPS and VAS (P < .001). CONCLUSIONS: Pain was reduced when the BCG vaccine was administered before the Hepatitis-B in neonates undergoing routine vaccination. The authors recommend that the order of vaccine injections be the BCG vaccine followed by Hepatitis-B.

Cross-sectional population-based study of knowledge, attitudes, and practices regarding HIV/AIDS in Dakshina Kannada district of Karnataka, India.

OBJECTIVE: To assess HIV/AIDS-related knowledge, attitudes, and practices among the general population in South India. METHODS: The 1669 participants (834 males, 835 females) aged 19-49 years were surveyed using a stratified 2-stage random sampling design with probability proportional to size. RESULTS: Although 54% of participants knew that AIDS is caused by "HIV" virus and 44% could correctly identify all modes of transmission, 52% believed in one or more myths, 41% did not know that condoms can prevent HIV, and 18% had not heard of a condom. Higher HIV knowledge scores were significantly associated with male gender, higher education, currently married, higher frequency of reading newspapers, listening to radio or watching television, and willingness to get tested for HIV (P < .01). Thirty-four percent felt that HIV-infected individuals should be kept away from others, and 40% were not willing to accept a family member with HIV. There was a significant and positive correlation between knowledge and attitude scores (P < .01). Among respondents who ever had sexual intercourse, significantly more males declared having more than one sexual partner compared to females (P < .01). Only 16% of respondents reported that they consistently used condoms. Sixty-two percent of the respondents were willing to undergo an HIV test if provided free of cost. This willingness to opt for HIV testing increased significantly with better knowledge score, better attitude score, and higher education status (P < .01). CONCLUSIONS: HIV/AIDS prevention campaigns in India should focus on public education, stigma reduction, promotion of condom use, and risk-reduction behaviors in urban and rural communities targeted toward young adults.

HIV-related knowledge, attitudes, perceived benefits, and risks of HIV testing among pregnant women in rural Southern India.

The rising prevalence of HIV among pregnant women in rural India is of great concern. Prenatal voluntary counseling and HIV testing (VCT) is critical to prevent mother-to-child transmission of HIV (PMTCT). We surveyed 202 pregnant women attending a rural antenatal clinic in Southern India to investigate HIV-related knowledge, attitudes toward infant feeding practices, and perceived benefits and risks of HIV testing. Of the total of 202 women surveyed, 189 women (94%) had heard of HIV/AIDS and 60% of them had relatively good knowledge regarding risk factors for HIV transmission. However, 48% did not know that there are "means to prevent mother-to-child HIV transmission." If women were not to breastfeed her baby, negative attitudes expected from the partner would include 84% thinking that that the mother is harming the baby, 78% thinking she is not a good mother, 74% thinking she has HIV, and 66% thinking she has been unfaithful. Ninety-seven percent of women did not perceive themselves at risk for HIV and only 57% had been tested for HIV. Although, 85% of women expressed their willingness to be tested, most were concerned about confidentiality and disclosing HIV serostatus because of fear of negative reactions from their husbands, parents, and community. Many social and cultural barriers confront pregnant women when they decide to opt for HIV testing. If VCT and PMTCT interventions are to be successful, urgent attention must be focused on education, development of innovative culturally appropriate interventions that empower women to make decisions about HIV testing, involvement of men, and addressing stigma and discriminatory attitudes toward people living with HIV/AIDS.