Cross-sectional study of psychiatric morbidity in patients with melasma.

CONTEXT: Patients with dermatological problems have higher prevalence of psychiatric illnesses than the general population. Melasma, hyperpigmentation of skin over sun-exposed areas, has bidirectional cause-effect relationship with depression and stress through psycho-neuro-endocrine pathways. AIMS: The aim of this study is to study the psychiatric morbidity and perceived stress in patients with melasma and statistically compare objective study parameters with those without melasma. SETTINGS AND DESIGN: This cross-sectional descriptive study was carried out in Tertiary hospital in urban setting, jointly by psychiatrist and dermatologist. METHODS AND MATERIALS: The study involved 50 consecutive patients with melasma and 30 relatives of patients coming to dermatology clinic not having any skin disorder. Cases were assessed by psychiatrist as per the International Classification of Diseases-10 Diagnostic Criteria for Research, Cohen's 4 item perceived stress scale, Disability Assessment Scale 2.0 by WHO and Hospital Anxiety Depression Scale (HADS) and Dermatologist calculated melasma area severity index score (MASI). RESULTS: Majority patients were females (88%) in the reproductive age group. The most common psychiatric morbidity seen in 42% cases was major depressive disorder. Adjustment disorder (26%) was the second most common diagnosis. Nonparametric analysis using Mann-Whitney U test revealed significantly more perceived stress (P = 0.001), more disability (P = 0.000) and anxiety-depression on HADS (P = 0.0 16) in cases than in their relatives. LIMITATIONS: This was a hospital-based study and thus melasma patients in the community are not represented. Small sample size, less number of controls, lack of structured diagnostic interview are other limitations of this study. CONCLUSIONS: There is high psychiatric comorbidity (76%) of depressive and stress disorders, higher functional disability and perceived stress in patients with melasma compared to controls.

Resident doctors' attitudes toward tuberculosis patients.

BACKGROUND: The attitude of the resident doctors toward tuberculosis (TB) patients can affect their treatment seeking behavior, compliance to treatment as well as reinforce the stigma attached to the disease by the society at large. AIMS: To assess the attitudes of resident medical doctors toward TB patients. MATERIAL AND METHODS: A cross-sectional study was conducted among postgraduate resident medical doctors at B.J. Government Medical College and Sassoon General Hospital, Pune in September 2014. The background characteristics and attitudes were assessed using a semi-structured questionnaire. The responses were analyzed using Chi-square/Fishers exact test and calculating odds ratio (OR). RESULTS: Of the 212 resident doctors who responded to the question on attitudes, 132 (62%) see TB patients on a daily basis, 40 (19%) of the resident doctors had attended a training program on TB, and 99 (47%) respondents knew of a colleague with TB. Only 104 (49%) of the residents reported feeling compassion for and the desire to help TB patients. The residents who had attended a training program in TB were three times more likely to report compassion and a desire to help TB patients than those who had not undergone such training [28/40 vs 76/172; p=0.005; OR=2.95, 95% CI (1.33-6.61)]. Compared to residents who did not know of a colleague with TB, residents who knew of a colleague with TB were nearly three times more likely to avoid managing TB patients or fear them and think they may cause infection [33/99 vs 17/113; p=0.002; OR=2.82, 95% CI (1.39-5.76)]. CONCLUSION: The feeling of fear, lack of compassion, and tendency to avoid TB patients reported by 51% of the patients is a cause of concern. Addressing the knowledge gaps through training programs and ensuring safe working environment will make residents more supportive and compassionate toward TB patients which will contribute to TB control.

TB Risk Perceptions among Medical Residents at a Tertiary Care Center in India.

SETTING: Government tertiary health care center in India. OBJECTIVE: To understand the perceptions of medical residents about their risk of developing TB in the workplace. DESIGN: Cross-sectional study in which a semistructured questionnaire which included an open-ended question to assess their main concerns regarding TB in workplace was used to collect data. RESULTS: Out of 305 resident doctors approached, 263 (94%) completed a structured questionnaire and 200 of these responded to an open-ended question. Daily exposure to TB was reported by 141 (64%) residents, 13 (5%) reported a prior history of TB, and 175 (69%) respondents were aware of TB infection control guidelines. A majority reported concerns about acquiring TB (78%) and drug-resistant TB (88%). The key themes identified were concerns about developing drug-resistant TB (n = 100; 50%); disease and its clinical consequences (n = 39; 20%); social and professional consequences (n = 37; 19%); exposure to TB patients (n = 32; 16%); poor infection control measures (n = 27; 14%); and high workload and its health consequences (n = 16; 8%). CONCLUSION: Though many resident doctors were aware of TB infection control guidelines, only few expressed concern about lack of TB infection control measures. Doctors need to be convinced of the importance of these measures which should be implemented urgently.

Trends in choosing place of delivery and assistance during delivery in Nanded district, Maharashtra, India.

Delivery in a medical institution promotes child survival and reduces the risk of maternal mortality. Many initiatives under the National Rural Health Mission (NRHM) focus on increasing the institutional deliveries. This study describes the trends in choosing place of delivery in Nanded district at the end of the first phase of the mission. Key informants were interviewed to document the initiatives under NRHM implemented in the district. A cross-sectional descriptive study was conducted in 30 villages selected using one stage cluster-sampling method. A house-to-house survey was conducted in June 2009. A set of structured open-ended questionnaire was used for interviewing all women who had delivered during January 2004-May 2009. The outcomes studied were place of delivery and assistance during delivery. Analysis was done by calculating chi-square test and odds ratio. Interventions to improve the quality of health services and healthcare-seeking behaviour were implemented successfully in the district. The proportion of institutional deliveries increased from 42% in 2004 to 69% in 2009. A significant increase was observed in the proportion of institutional deliveries [60% vs 45%; chi2 = 173.85, p < 0.05, odds ratio (OR) = 1.8 (95% confidence interval (CI) 1.65-1.97)] in the NRHM period compared to the pre-NRHM period. The deliveries in government institutions and in private institutions also showed a significant rise. The proportion of deliveries assisted by health personnel increased significantly during the NRHM period [62% vs 49%; chi2 = 149.39; p < 0.05, OR = 1.73, 95% CI 1.58-1.89]. However, less than 10% of the deliveries in the home (range 2-9%) were assisted by health personnel throughout the study period. There was a wide geographic variation in place of delivery among the study villages. The results showed a significant increase in the proportion of institutional deliveries and deliveries assisted by health personnel in the NRHM period. Since a less proportion of deliveries in the home is conducted by health personnel, the focus should be on increasing the institutional deliveries. Special and innovative interventions should be implemented in the villages with a less proportion of institutional deliveries.

Time of default in tuberculosis patients on directly observed treatment.

BACKGROUND: Default remains an important challenge for the Revised National Tuberculosis Control Programme, which has achieved improved cure rates. OBJECTIVES: This study describes the pattern of time of default in patients on DOTS. SETTINGS AND DESIGN: Tuberculosis Unit in District Tuberculosis Centre, Yavatmal, India; Retrospective cohort study. MATERIALS AND METHODS: This analysis was done among the cohort of patients of registered at the Tuberculosis Unit during the year 2004. The time of default was assessed from the tuberculosis register. The sputum smear conversion and treatment outcome were also assessed. STATISTICAL ANALYSIS: Kaplan-Meier plots and log rank tests. RESULTS: Overall, the default rate amongst the 716 patients registered at the Tuberculosis Unit was 10.33%. There was a significant difference in the default rate over time between the three DOTS categories (log rank statistic= 15.49, P=0.0004). Amongst the 331 smear-positive patients, the cumulative default rates at the end of intensive phase were 4% and 16%; while by end of treatment period, the default rates were 6% and 31% in category I and category II, respectively. A majority of the smear-positive patients in category II belonged to the group 'treatment after default' (56/95), and 30% of them defaulted during re-treatment. The sputum smear conversion rate at the end of intensive phase was 84%. Amongst 36 patients without smear conversion at the end of intensive phase, 55% had treatment failure. CONCLUSIONS: Patients defaulting in intensive phase of treatment and without smear conversion at the end of intensive phase should be retrieved on a priority basis. Default constitutes not only a major reason for patients needing re-treatment but also a risk for repeated default.

Age heaping and accuracy of age data collected during a community survey in the yavatmal district, maharashtra.

BACKGROUND: Age is an important variable in epidemiological studies and an invariable part of community-based study reports. AIMS: The aim was to assess the accuracy of age data collected during community surveys. SETTINGS AND DESIGN: A cross-sectional study was designed in rural areas of the Yavatmal district. MATERIALS AND METHODS: Age data were collected by a house-to-house survey in six villages. An open-ended questionnaire was used for data collection. STATISTICAL ANALYSIS: Age heaping and digit preference were measured by calculating Whipple's index and Myers' blended index. Age Ratio Scores (ARS) and Age Accuracy Index (AAI) were also calculated. RESULTS: Whipple's index for the 10-year age range, i.e., those reporting age with terminal digit "0" was 386.71. Whipple's index for the 5-year range, i.e., those reporting age with terminal digit '0' or '5' was 382.74. Myer's blended index calculated for the study population was 41.99. AAI for the population studied was 14.71 with large differences between frequencies of males and females at certain ages. CONCLUSION: The age data collected in the survey were of very poor quality. There was age heaping at ages with terminal digits '0' and '5', indicating a preference in reporting such ages and 42% of the population reported ages with an incorrect final digit. Innovative methods in data collection along with measuring and minimizing errors using statistical techniques should be used to ensure the accuracy of age data which can be checked using various indices.

Medical equipment in government health facilities: missed opportunities.

BACKGROUND: The availability and optimal utilization of medical equipment is important for improving the quality of health services. Significant investments are made for the purchase, maintenance and repair of medical equipment. Inadequate management of these equipment will result in financial losses and deprive the public of the intended benefits. This analysis is based on the conceptual framework drawn from the WHO recommended- lifecycle of medical equipment. AIMS: (1) To identify the problems in different stages of the life cycle. (2) To assess its financial implications and effect on service delivery. SETTINGS AND DESIGN: Analysis of secondary data from the latest Comptroller and Auditor General (CAG) Reports for the states in India. The study variables were category of equipment, financial implications and problems in the stages of life cycle. STATISTICAL ANALYSIS: Calculation of proportions. RESULTS AND CONCLUSIONS: A total of forty instances mentioning problems in the first phase of the life cycle of medical equipment were noted in 12 state reports. The equipment from the radiology department (15), equipment in the wards (5), laboratory (3) and operation theatres (4) were the ones most frequently implicated. In a majority of cases the financial implications amounted to twenty-five lakhs. The financial implications were in the form of extra expenditure, unfruitful expenditure or locking of funds. In 25 cases the equipment could not be put to use because of non-availability of trained staff and inadequate infrastructural support. Careful procurement, incoming inspection, successful installation and synchronization of qualified trained staff and infrastructural support will ensure timely onset of use of the equipment.