Persistent respiratory symptoms and lung function abnormalities in recovered patients of COVID-19.

Background and Objectives: COVID-19 is a disease caused by SARS-CoV-2 which belongs to a family of coronaviruses. After the acute phase of illness, the majority of the patients recover quickly but, in some cases, symptoms can persist for a variable duration, bringing into light another entity known as post-COVID syndrome. The objective was to estimate the burden of various persistent respiratory symptoms and lung function abnormalities among recovered patients of COVID-19 and also to correlate them with initial disease severity, demographic factors and comorbidities. Methods: Eighty-five post-COVID patients were recruited as per inclusion/exclusion criteria. Detailed history taking, physical examination and spirometry were done in all patients and data were correlated with baseline disease severity. Results: Fatigue and breathlessness were the most common symptoms followed by cough, chest pain and fever. Persistent symptoms and their severity were significantly higher in severe/moderate cases. Spirometry was abnormal in 45.88% of subjects and the most common pattern was restrictive type. It was seen that the likelihood of persistent symptoms and abnormal lung function increased significantly with the severity of COVID-19, age, comorbidities, hospital stay duration and steroid/oxygen therapy. Conclusion: The current study estimated the burden and array of various pulmonary sequelae encountered by post-COVID patients and elicited various risk factors associated with their occurrence after recovery from active infection. Awareness of these symptoms/sequelae and their risk factors is necessary for their follow-up and timely management, as the threat of this relatively new virus has still not abated.

Treatment gap for mental and behavioral disorders in Punjab.

Background and Aims: There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey. Settings and Design: Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely Faridkot, Moga, Patiala, and Ludhiana (for urban metro areas). Data were collected from October 2015 to March 2016. Materials and Methods: Mini International Neuropsychiatric Interview 6.0.0 and Adapted Fagerstrom Nicotine Dependence Scale were used to diagnose mental and behavioral disorders and tobacco use disorder, respectively. Pathways Interview Schedule of the World Health Organization was applied to persons having any disorder to assess treatment gap and health care utilization. Exploratory focused group discussions (FGDs) were conducted to understand the community perceptions regarding mental and behavioral disorders. Results: The treatment gap for mental and behavioral disorders was 79.59%, and it was higher for common mental disorders than severe mental disorders and higher for alcohol and tobacco use disorders as compared to opioid use disorders. The median treatment lag was 6 months. Only seven patients out of 79 were taking treatment from a psychiatrist, and the average distance traveled by the patient for treatment was 37.61 ± 45.5 km. Many attitudinal, structural, and other barriers leading to high treatment gaps were identified during FGDs in the community, such as stigma, poor knowledge about mental health, deficiency of psychiatrists, and distance from the hospital. Conclusions: Vertical as well as horizontal multisectoral integration is required to reduce the treatment gap and improve healthcare utilization. Increasing mental health literacy, providing high-quality mental health services at the primary-healthcare level and human resources development are the need of the hour.

Prevalence of substance use disorders in Punjab: Findings from National Mental Health Survey.

Background & objectives: Substance use disorders are a major public health concern in Punjab. However, reliable estimates of prevalence of substance use disorders are not available for the State. The present study reports estimates of prevalence of substance use disorders in Punjab, conducted as part of National Mental Health Survey, India. Methods: Using multistage stratified random cluster sampling, 2895 individuals from 719 households of 60 clusters (from 4 districts of Punjab) were interviewed. Mini International Neuropsychiatric Interview and Fagerstrom nicotine dependence scale were used to assess substance use disorders. Results: The sample comprised almost equal numbers of males and females. Nearly 80 per cent had less than or equal to high school education, and 70 per cent were married. The weighted prevalence of alcohol and other substance use disorders was 7.9 and 2.48 per cent, respectively. The prevalence of tobacco dependence was 5.5 per cent; 35 per cent households had one person with substance use disorder. The prevalence was highest in the productive age group (30-39 yr), urban metro and less educated persons. The prevalence of alcohol and other substance use disorders was much higher in Punjab as compared to other States where survey was done. Tobacco dependence was lowest in Punjab. Majority (87%) of the persons with substance use disorders did not suffer from any other mental disorder. Treatment gap was 80 per cent. Interpretation & conclusions: Punjab has a high burden of substance use disorders. The estimates will help clinicians and policymakers to plan the strategies against the menace of substance use disorders effectively.

Disability and socio-economic impact of mental disorders in the state of Punjab, India: Findings from national mental health survey, 2015-2016.

BACKGROUND: Mental illness results in a plethora of distressing issues, has tremendous socio-economic impact and causes socio-occupational dysfunction in the individual as well as the caregivers. There is a felt need to explore the disability caused by mental illness and the associated socio-economic impact at the population level in a developing nation like India. AIMS: To elucidate the disability and socio-economic impact associated with mental illness at the individual and household levels for the state of Punjab in India. METHOD: This was a multisite cross-sectional study carried out during 2015-2016 (as a part of the National Mental Health Survey of India) in three districts and one urban metro area of Punjab. The sample was selected using multi-stage, stratified, random cluster sampling technique, with random selection based on Probability Proportionate to Size (PPS) at different stages. A validated set of questions was used to assess the socio-economic impact of mental illness and the Sheehan Disability Scale was used to document self-perceived disability among individuals with mental morbidity. Median (IQR) and proportions were used to summarize quantitative and qualitative data, respectively Results: Subjects with any mental morbidity reported disability of varying severities across different domains of life; family life was affected the most (70.1%). One in every six persons reported that their mental illness interfered with their daily activities to a large extent. Economic burden was high and a typical family would spend about INR 1500/month (US$23) towards the treatment of its member with mental morbidity. Family members had to forego their work for at least 7 days in 3 months to take care of their relative with mental illness. CONCLUSION: Mental illness causes disability in the individual and has tremendous socio-economic impact on the family, incapacitating a family's productivity to a large extent and thus affecting the society.

Prevalence of mental disorders in Punjab: Findings from National Mental Health Survey.

BACKGROUND: Knowledge of the prevalence of mental disorders is essential for setting up services and allocation of resources. Existing studies suffer from methodological problems which limit their utility and generalizability. There was a long felt need to conduct a scientifically robust study in different regions of India to have national prevalence rates. AIMS: This study aims to estimate the prevalence of mental disorders in a representative population of Punjab as a part of the National Mental Health Survey. SETTINGS AND DESIGN: Community-based survey carried out in rural and urban areas of Punjab using multistage, stratified, random cluster sampling technique and random selection was based on Probability Proportion to Size. MATERIALS AND METHODS: The survey was conducted in 60 clusters of 4 districts (Faridkot, Ludhiana, Moga, and Patiala) of Punjab. Mini-International Neuropsychiatric Interview adult version 6.0 for mental morbidity, case definition for generalized tonic-clonic seizure, an expansion of the Fagerström Nicotine Dependence Scale for tobacco use and screener for intellectual disability were used. Appropriate statistical methods were applied. RESULTS: A total of 2895 respondents aged >18 years from 719 households were interviewed. The prevalence of lifetime and current mental morbidity was 17.94% and 13.42%, respectively. Higher prevalence of mental morbidity was found among persons aged >60 years and those belonging to lower income group and rural population. CONCLUSIONS: The prevalence of mental morbidity is high in the population. The findings give a clear picture of magnitude of the problem and will help policy planners to tackle the situation which looks grave and warrants immediate intervention.

Nutrition Campaign Knowledge and Dietary Behavior in Middle School Students.

BACKGROUND: Federal nutrition campaigns are designed to make dietary recommendations accessible but have not been extensively evaluated. This paper explores whether knowledge of nutrition campaigns is associated with dietary behavior among young adolescents. METHODS: Cross-sectional survey data were collected from 4,773 middle school students in Southern California. Hierarchical logistic regression models were used to assess the association between dietary behaviors and nutrition campaign knowledge, controlling for gender and ethnicity. RESULTS: Knowledge of the Fruit & Veggies-More Matters campaign was associated with increased odds of high fruit and vegetable consumption, knowledge of the MyPlate campaign was associated with neither, and both were associated with increased odds of not consuming soda. CONCLUSION: Overall, low percentages of students demonstrated knowledge of nutrition campaigns, and knowledge was associated with some dietary behaviors. More research is needed to examine the impact of nutrition campaigns while also accounting for other psychosocial and environmental factors that may affect soda, fruit, and vegetable consumption.

Premarital health counseling: A must.

Premarital Health Counseling (PMHC) is emerging as a growing trend worldwide. The couples are provided with accurate and unbiased information and assistance, who are planning to get marry with the aim of screening, educating, and counseling about nutritional disorders, communicable diseases, medical conditions, hereditary/genetic disorders, and guiding for a healthy pregnancy. Premarital screening and adequate counseling are essential for changing attitudes toward consanguineous marriage particularly in places where consanguineous and "tribal" marriages are common, resulting in a high incidence of genetic disorders. Although making PMHC obligatory in India may appear to be a very exciting and promising proposal, its implementation still has various ethical issues and other barriers that need to be addressed.

Menstrual Pattern among Unmarried Women from Northern India.

BACKGROUND: Menstruation disorders are also responsible for emotional, physical, behavioural and dietary practice changes. These changes affect their normal functioning and social life. The present study was carried out to find the prevalence of menstrual problems among unmarried girls of Chandigarh, India and to compare their knowledge and beliefs regarding menstruation in different sub-groups. METHODOLOGY: A community based cross-sectional study was conducted among 744 unmarried females in Rural, Urban and Slum strata of UT Chandigarh, India. Data were collected using a self-administered structured questionnaire on menstruation. Chi-square value was used for testing statistical significance. RESULTS: The mean age of the respondents was 16.84±3.05 years. Maximum respondents (40.9%) were educated up to 10th standard/High school. 448 (60.2%) were aware of menstruation before starting of menarche. Awareness was found to be significantly associated (p=0.02) with age. Socio-economic status and prior knowledge of respondents was also found to be significantly associated (p< 0.001). 61% (454) of the respondents had a regular flow during menses. Normal flow was reported by 70.2 %(522) of the respondents. Dysmenorrhea was found to be the most common problem suffered by 429 (57.7%) respondents. CONCLUSION: Menstrual hygiene is an issue that needs to be addressed at all levels. A variety of factors are known to affect menstrual behaviors, the most influential ones being economic status. It is essential to design a mechanism to address and for the access of healthy menstrual practices.

Needle stick injury and HIV risk among health care workers in North India.

OBJECTIVES: To determine the occurrence of needle stick injuries among various categories of health care workers (HCWs), the causal factors, and the circumstances under which these occur. 2. To explore the possibilities of measures to prevent these through improvement in knowledge, attitude, and practice. MATERIALS AND METHODS: The study was conducted in two government tertiary level hospitals. Study sample comprised 107 HCWs, providing medical care in two government tertiary level hospitals of Chandigarh. Subjects were enquired about their exposure to needle prick injuries during patient management in the last 6 months and also the action taken following exposure. The statistical tools employed were: ratio, proportions, and other basic methods of data interpretation. RESULTS: The study among 107 HCWs included 27 doctors (25.2%), 68 nurses (63.5%), and 12 paramedics (11.2%), with 87 (81.3%) being females. The prevalence of needle stick injury and exposure to blood was reported by 73 (68.2%) participants. The main factor ascribed for this exposure was heavy patient load (42.5%). The maximum accidents occurred during emergency care (30.1%). Most common action following exposure was cleaning with spirit (46.3%). Only 51 (47.7%) of HCWs admitted following universal precautions. Among those exposed, only 10 (13.7%) persons had undergone HIV testing. CONCLUSION: Two-thirds of HCWs were exposed to needle stick injuries. Lack of awareness about post-exposure prophylaxis (PEP) was found.

Awareness of andropause in males: a North Indian study.

BACKGROUND: According to the Indian census 2011, India has the largest population of the elderly. Very few studies have been carried out in North India to assess the awareness about andropause in men, which is why this study was conceived. OBJECTIVES: To assess the awareness about andropause and its treatment modalities among the men of Chandigarh. MATERIALS AND METHODS: The present study was conducted at an Urban Health Training Center (UHTC-44 B) of Government Medical College and Hospital Sector 32, Chandigarh (GMCH) in male patients attending the outpatient department. This non-interventional individual cross-sectional study was carried out from August 2010 to August 2011 in men aged 40 years and above. Systematic, random sampling was carried out and the study sample comprised 757 men. The subjects were given pre-structured and pre-tested questionnaires that had questions pertaining to socio-demographic profile, ADAM scale, views about andropause, its treatment modalities, etc., RESULTS: Out of the sample size of 757 men, subjects from the urban area (323; 43.1) were more in contrast to that of the peri-urban (41; 31.9) and slum areas (393; 259). Maximum number of patients belonged to the age group of 40-49 years (342; 26.3), followed by those in age group 60-69 years (141; 18.6). It was found that awareness about the term andropause was found only among 17 (2.2%) subjects, whereas the knowledge of a syndrome synonymous to that of menopause in females was even less 7 (0.9%) patients positive for andropause were found to increase with increase of age (40-49; 35.7, 50-59; 81.2, 60-69; 96.5). Only 123 (11.4%) had an idea about the treatment of andropause. The keenness to resort to treatment or seek medical advice was shown by 355 (47.3%). Subjects in the age group of less than 60 years resorted to injections (15; 4.7) and transdermal patches (6; 1.09) as testosterone-replacement therapy. Herbal medicines were especially taken by those subjects in the age group 60-70 years, (74.3%; 101). CONCLUSION: Awareness about andropause and its treatment modalities is less in men.

Psychiatric morbidity among elderly in Chandigarh.

OBJECTIVE: To find out the prevalence of Psychiatric Morbidity Among Elderly in the age-group of 65 years and above. METHODOLOGY: This community based study was conducted by house to house visit after selecting a sample by stratified random technique from the 47 sectors in urban areas and 27 villages in Chandigarh. A total of 250 households in urban and 50 households in rural areas were covered which consisted of 362 elderly (313 urban and 49 rural) who were enrolled and psychiatric morbidity was assessed by using R Kellner & B F Shaffield (1979) scale. RESULTS: All study subjects had at least one symptom related to psychiatric morbidity. Over two-third elderly were having somatic (72.1%) and depression (68.2%) related symptoms of anger - hostility, cognition and anxiety. Paranoid and psychotic symptoms were noticed among 6.9% and 6.6% of elderly, respectively. Anxiety, depression, somatic, cognitive symptoms were more prevalent in females while anger hostility was more common in males. Some of the common symptom from each of the 7 groups were : Anxiety : Nervousness (37.3%), Depression : Feeling tired lack of energy (57.2%), Somatic : Irritable (48.3%), Anger Hostility: Angry (55.8%), Cognitive : Poor memory (45.6%), Paranoid : Feeling that people do not like you (7.5%) and Psychotic : Strange experiences which other people do not have (4.4%). CONCLUSION: Prevalence of high morbidity related to psychiatric symptoms among elderly in Chandigarh, India highlights the significance and need to develop comprehensive mental health care program for elderly.

Awareness of emergency contraception among female college students in Chandigarh, India.

UNLABELLED: Adolescents and young women are at the greatest risk of unintended pregnancy because they are unlikely to see a family planning provider before or immediately after the sexual activity. Therefore, preventing unintended pregnancy among them is the important concern. Sexually active young women are clients with special needs for contraception. They are eligible to use a variety of the available contraceptives. Introduction of emergency contraception (EC) in the recent past can help them avoid such unintended pregnancies. OBJECTIVE: To investigate the awareness of emergency contraception in female college students. STUDY DESIGN: Cross-sectional, questionnaire-based study. MATERIALS AND METHODS: This study was conducted among college-going undergraduate and graduate female students of Punjab University, Chandigarh. Systematic random sampling was used to select the respondents. RESULTS: Of the 1,017 college students included in the study, 507 (49.9%) knew about different contraceptive methods. Maximum awareness was regarding oral contraceptive pills (239, 47.1%). Only 74 (7.3%) had knowledge about emergency contraceptive pills (ECP). Of them, 10 (14.7%) students knew the correct time for use of ECP and the side effects of ECP were known to 48 (88.9%) respondents. CONCLUSIONS: Awareness about ECP was very low among female college students of Chandigarh, especially regarding correct timing of its use and its side effects. Appropriate awareness programs on EC are needed for them.

Uptake of newer vaccines in Chandigarh.

OBJECTIVE: To ascertain the uptake of newer vaccines in Chandigarh. METHODS: Uptake of newer vaccines was ascertained in under five children through house to house survey during Jan 2004-Sep 2005 in sector 44 of Chandigarh. RESULTS: Of 1031 children of the total urban population, More than 40% got immunized with newer vaccines. Maximum coverage was seen for Hepatitis B 461 (44.7%) for 3 doses followed by immunization against Hib 287(27.8%). MMR vaccine coverage was 285 (27.6%). For typhoid and varicella coverage was less. More than 50% children got immunization from private sector. CONCLUSION: The newer vaccines are available in the market and being used by the people especially being catered by the private sector.