Prevalence of Depressive Symptoms and Its Association with Religiosity and Spiritual Intelligence Among Adults in Rural Puducherry, India: A Community-Based Study.

Depression is a serious mental health problem globally, and its multifactorial origin and interconnections with spiritual intelligence are yet to be explored. Spiritual intelligence and religiosity are distinct concepts but share a collective goal of connecting to the divine force. This cross-sectional study (March 2021-September 2022) in rural Puducherry, India, aimed to find out the prevalence of depression and its association with spiritual intelligence and religiosity. Out of the 381 participants, 14.4% reported signs of depression, and individuals without depressive symptoms showed high levels of religious engagement and subjective religiosity. Those with low spiritual intelligence reported more depressive symptoms (15.4%) compared to those with moderate levels (3.4%). The findings highlight a significant depression burden in rural areas, emphasising the potential roles of spiritual intelligence and religiosity in mental health among diverse populations, especially the elderly.

Anxiety and depression during post covid-19 lockdown period among medical students, and it's relation with stress and smartphone addiction in India.

OBJECTIVES: Medical profession, a competitive and ever-updating field which requires great commitment, imposes a stressful environment for students. Our study aimed to find the prevalence and factors associated with psychological illness. METHODS: A cross-sectional analytical study was done among medical students in Puducherry. A stratified random sampling strategy was incorporated to achieve a calculated sample size of 384. The presence of anxiety and depression, perceived stress and addiction to the phone were assessed using the Hospital Anxiety and Depression Scale, Perceived Stress Scale, and Smartphone Addiction Scale - short version. Prevalence of anxiety and depression was summarized as a proportion with a 95 % confidence interval (CI). The prevalence ratio (PR) for the factors associated was estimated using log-binomial regression. RESULTS: With the response from 383 students, the prevalence of anxiety and depression was 39.4 % (95 %CI: 34.5-44.3 %) and 26.6 % (22.2-31.1 %). Perceived stress was moderate in 68.2 % and high in 14 % of students. Higher age (aPR=1.49), female gender (aPR=1.22), tobacco or alcohol use (aPR=1.24), smartphone addiction (aPR=2.09) and high stress (aPR=1.93) were the predictors of anxiety among medical students in our study. Use of tobacco or alcohol (aPR=2.07), smartphone addiction (aPR=1.96) and high stress (aPR=1.72) were the predictors of depression. CONCLUSIONS: Anxiety was more prevalent than depression among the medical students. Use of tobacco or alcohol, smartphone addiction and stress increase the risk of psychological morbidity. Medical training should have a module on coping mechanisms to overcome psychological illness and have better mental well-being.

Performance of microscopy compared to conventional PCR in identification of soil-transmitted helminth infections among antenatal women in a low-prevalence setting.

PURPOSE: Traditional microscopy-based methods may provide inaccurate estimates of Soil transmitted helminth (STH) infections in mild intensity of infection. Therefore, we aimed to determine the prevalence of STH infections using molecular diagnostic methods and compare the diagnostic performance of microscopy with polymerase chain reaction (PCR) in stool samples collected from pregnant women in primary care settings in Puducherry, India. METHODOLOGY: A singleplex PCR assay was developed to detect three species of STHs, namely Ascaris lumbricoides, Necator americanus, and Ancylostoma duodenale, by targeting the internal transcribed spacer regions (ITS1 and ITS2) of 5.8S rRNA. The PCR generated 420, 662, and 515 base pairs of DNA for the respective organisms. In addition to singleplex PCR, wet and concentration microscopy techniques were used. The results were expressed as percentages with 95% confidence intervals, and the diagnostic performance of microscopy was compared with PCR in terms of sensitivity, specificity, and positive, negative predictive values and kappa statistics. RESULTS: Among the 650 pregnant women included, 48.8% were aged 25 years or less, 59% were primigravida, and half were from rural areas. The overall prevalence of any STH infection was higher in PCR compared to microscopy (8.9% vs. 7.2%). The prevalence of Ascaris lumbricoides was higher by microscopy (5.4% vs 2.6%), while the prevalence of Necator americanus was higher by PCR (6.3%) than by microscopy (1.8%). No species of Ancylostoma duodenale was detected. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of microscopy for detecting any STH infection was 22.4%, 94.3%, 27.7%, and 92.5%, respectively. The agreement between microscopy and PCR for the identification is as follows: for any STH infection, k â€‹= â€‹0.12, Ascaris k â€‹= â€‹0.16, and Necator k â€‹= â€‹0.20, respectively. CONCLUSION: The prevalence of any STH infection identified by PCR was higher than microscopy, and the agreement between the two methods was poor.

Comparing Sensitivity and Specificity of Ultrasonography With Chest Radiography in Detecting Pneumothorax and Hemothorax in Chest Trauma Patients: A Cross-Sectional Diagnostic Study.

Background Thoracic trauma accounts for 20-25% of all traumas and is the third most frequent cause of death, after abdominal injury and head trauma. In the Emergency Department (ED), shifting an unstable patient to the X-ray room for detecting pneumothorax and hemothorax is always risky and bedside X-ray causes radiation exposure not only to the particular patient but also to the surrounding patients in a congested and busy ED. This can be avoided by using bedside ultrasonography (USG) as the initial imaging modality in chest trauma patients. Objective To compare the sensitivity and specificity of ultrasonography and chest radiography in detecting pneumothorax and hemothorax in chest trauma patients. Methods This cross-sectional diagnostic study was conducted for a period of one year at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, a tertiary care centre. All consecutive patients (n=255) with a suspected history of chest trauma were included in the study. The patients were evaluated bedside using USG by point of care ultrasonography trained emergency medicine physician and subsequently underwent chest radiography for documentation of pneumothorax and hemothorax. Sensitivity and specificity were calculated for ultrasonography and chest X-ray (CXR) compared with the composite gold standard (chest radiography and computed tomography thorax). Results Of the 255 patients, 89% were males. The mean age of the patients was 43.46 (standard deviation 16.3). Road traffic accident (RTA) was the most common mode of injury (81%). The median (interquartile range) time interval between injury and arrival at the hospital was four hours (2.5-7). About 16.1% of the patients had subcutaneous emphysema. About 88.2% of the patients were hemodynamically stable and 78% of the patients had associated other system injuries. The sensitivity and specificity of USG in detecting pneumothorax were 85.7% and 95.3% respectively and that of CXR were 71.4% and 100% respectively. Our study found that the sensitivity and specificity of USG in detecting hemothorax were 79% and 97.9% respectively and that of CXR were 62.9% and 100% respectively. Even in the subset of patients in whom a computed tomography scan was done, the sensitivity of USG was higher than that of CXR in detecting pneumothorax and hemothorax. The specificity of USG in detecting pneumothorax was the same as that of CXR and the specificity of USG in detecting hemothorax was higher than that of CXR in that subset of patients. Conclusion The sensitivities of USG in detecting pneumothorax and hemothorax were higher than that of CXR. The specificities of USG in detecting pneumothorax and hemothorax were comparable to that of CXR. Hence bedside USG performed by emergency physician during resuscitation helps in rapid diagnosis and early management of chest trauma patients.

Soil-Transmitted Helminth Infections among Antenatal Women in Primary Care Settings in Southern India: Prevalence, Associated Factors and Effect of Anti-Helminthic Treatment.

Community-based studies from India on prevalence of soil-transmitted helminth (STH) infections have reported estimates as high as 50% in children. However, prevalence estimates during pregnancy in India are lacking. We aimed to describe the burden, associated factors of STH and cure rate after deworming in primary care settings. Pregnant women were recruited from four urban and five rural centers in Puducherry, South India, from December 2019 to April 2022. One stool sample was collected from each participant before deworming and one repeat sample was collected from STH positive woman after three weeks of deworming. The samples were processed with saline; iodine wet mount, and microscopic concentration techniques. Cure rate (CR) was assessed using Kato-Katz thick smear. Of 650 women included, 49 (7.5%, 95% CI 5.6-9.8) had one of the STH infections; the prevalence of Ascaris lumbricoides, hookworm and Strongyloides was 5.4%, 1.8% and 0.3%, respectively. The prevalence of any STH was higher among ages 26-30 years (9.1%), working women (8.3%), multigravida (8.3%), urban setting (8.3%), those who did not wash their hands before food (9%) and anemic women (8.9%), compared to their counterparts, but not statistically significant. The CR for hookworm was 100% and Ascaris lumbricoides was 88.6%. To conclude, the prevalence of STH was low among pregnant women compared to school aged children. Continued deworming activities along with improved sanitation could further reduce the burden.

Prevalence of Phantom Vibrations and Ringing Syndrome, and its Association with Smartphone Addiction among Medical Students of Teaching Hospital, South India.

INTRODUCTION: Phantom vibration syndrome (PVS) and phantom ringing syndrome (PRS) is a false sensation of phone vibration and ringing when it is not. This study aimed to estimate the prevalence of PVS/PRS among medical students and to determine factors including level of smartphone usage associated with the development of phantom sensations. METHODS: Using cross-sectional analytical design, sociodemographic details, information on phantom sensations and phone usage among medical students in our institution in Puducherry, India, was obtained. Stratified random sampling strategy was incorporated to achieve a sample size of 369. Also, overuse of phone was assessed using Smartphone Addiction scale - short version (SAS-SV). Prevalence of PVS and PRS was summarized as a proportion with a 95% confidence interval (CI). Prevalence ratio for the factors associated with the phantom syndrome (PVS/PRS) was estimated using log-binomial regression. RESULTS: Using data from 383 students, the prevalence of phantom syndrome (PVS/PRS) was 44.9% (39.9-50.0%). PVS was more prevalent than PRS (27.9% vs 21.2%). There was a significant difference in SAS-SV scores between those with the phantom syndrome and those without. Students who stay in hostel (aPR = 1.88; 95% CI: 1.46 to 2.43), self-reported overuse of phone (aPR = 1.96; 95% CI: 1.56 to 2.45) and higher smartphone addiction score (aPR = 1.26; 95% CI: 1.04 to 1.53) were found to be significant determinants to have PVS/PRS. CONCLUSION: Overall, one in two medical students had either PVS or PRS in our institution, Puducherry. Higher smartphone usage was a significant predictor of the presence of PVS/PRS.

Down referral and assessing comprehensive diabetes care in primary care settings: An operational research from India.

BACKGROUND AND AIMS: In this study, we aimed to refer eligible (patients with stable blood sugar and without any history of cardiovascular events or proliferative retinopathy) and willing persons with diabetes (PwDs) to primary healthcare centers (PHCs) from tertiary care and to compare the care indicators. METHODS: This before-after interventional study was conducted among PwDs aged ≥18 years at a tertiary care hospital in South India. Care indicators (regularity to the clinic, waiting time, and blood sugar control status) were assessed before down referral and after three months of follow-ups at PHCs. RESULTS: Of 204 PwDs referred to PHCs. Among them, 88% (n = 180) registered at PHCs for care and 46% (n = 94, 95% CI 39.1-53.2%) were lost to follow-ups at PHCs. The main reason for loss to follow-ups was the unavailability of medicines at PHCs(n = 41, 44%). Among those who were on regular follow-ups at PHCs, there was no significant difference in fasting blood glucose (FBG) control status compared to tertiary (52%-64.6%, p = 0.083). However, there was a significant improvement in the regularity of clinic visits (75% vs. 100%, p < 0.001), consultation waiting time (90 vs. 60 min, p = 0.028), and waiting time at pharmacy queues (120 vs. 30 min, p < 0.001) between tertiary care and PHCs. However, among those registered at PHCs, only 40.6% (n = 73, 95% CI 33.3-48.1) were willing to continue care at PHCs for their diabetes management. CONCLUSION: Primary care was better than tertiary care in terms of PwD's regularity of clinic visits and waiting time for care.

A Systematic Review of Antenatal Risk Scoring Systems in India to Predict Adverse Neonatal Outcomes.

Background: The purpose of antenatal care (ANC) is to identify 'at-risk' pregnant women, to provide quality care for all, and maximize the allocation of resources for those who need them the most. To address the synergistic effect of risk factors, clinicians across the globe developed antenatal scoring systems. Objective: This review aims to investigate various antenatal risk scoring systems developed and used in India to predict adverse neonatal outcome. Methods: We reviewed articles published between January 2000 and April 2020, which have either developed a scoring system or used a scoring system, among the Indian population. This systematic review is reported based on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Prediction model study Risk Of Bias Assessment Tool (PROBAST) was employed for the assessment of the quality of included studies. Data sources such as Embase, MEDLINE/Pubmed, APA PsycExtra, PsycINFO, CINHAL Plus, Cochrane Library, IndMED, LILACS, Scopus, WHO Reproductive Health Library and Web of science were searched. Results: An initial search retrieved a total of 6246 articles. This systematic review identified six studies, of which one study developed an antenatal scoring system and the other five studies used two antenatal systems for predicting adverse neonatal outcome. The study which developed a risk scoring system had a high risk of bias (ROB) and concern for applicability. The overall sensitivity of the antenatal scoring system was high (77.4%), but the specificity was low (45%). Similarly, the positive predictive value is low (15.3%), and the negative predictive value is high (94.2%). A meta-analysis was not conducted due to the heterogeneity of the studies and insufficient data. Conclusions: There is a need for a systematically developed antenatal scoring system for India. Such scoring systems can be promising in public health, proposing a paradigm shift in the implementation of effective mother and child health programmes locally as well as nationally. Supplementary Information: The online version contains supplementary material available at 10.1007/s13224-021-01484-z.

Alcohol use among adult men and its impact on personal and family life: findings of a community-based cross-sectional survey and focus groups discussions from a low alcohol taxed region, Puducherry, India.

BACKGROUND: There is limited published literature on the impact of alcohol use among alcohol dependents and their family members. OBJECTIVES: To find the factors associated with alcohol use and explore the impact of alcohol use on alcohol dependents and their family members. METHODS: A cross-sectional analytical study was conducted among 316 men aged above 18 years, and four focus group discussions (FGDs) were conducted among alcohol dependents and their family members. A validated semi-structured questionnaire was used. RESULTS: The mean (SD) age of the study participants was 45.2 (15.1) years, and 276 of them (87.3%) were educated. The prevalence of alcohol use was found to be 38% [95% confidence interval (CI) = 32.8-43.4]. Older age [adjusted prevalence (APR) = 2.23 (95% CI = 1.17-4.27)], no formal education [APR = 1.20 (95% CI = 1.20-1.20)], rural residence [APR = 1.05 (95% CI = 1.05-1.05)], self-reported comorbidities [APR = 1.21 (95% CI = 1.21-1.21)], tobacco use [APR = 2.42 (95% CI = 1.98-2.97)] and individuals having a family history of alcohol use [APR = 2.42 (95% CI = 1.73-3.37)] were the factors associated with alcohol use. The family members of alcohol users suffer mainly mental, emotional and physical abuse. Abusive language used by the alcoholic father and family break-ups have an influence on children and in their schooling. CONCLUSIONS: Prevalence of alcohol use in a low alcohol taxed region in India was high. The family members of alcohol users mainly suffer mental, emotional and physical abuse.

Decentralizing diabetes care from tertiary to primary care: how many persons with diabetes can be down-referred to primary care settings?

BACKGROUND: In a cohort of persons with diabetes (PWDs) seeking care at a tertiary care center, we aimed to determine the proportion of PWDs eligible and willing for down referral to primary health centers (PHCs). METHODS: We conducted a cross-sectional analytical study among PWDs on treatment for at least 1 year. PWDs with stable blood sugar, no history of cardiovascular events and proliferative retinopathy were considered as 'eligible' for primary care management. RESULTS: Of the total 1002 PWDs, mean (SD) age was 56 (12) years; 62% were male and 81% were from rural areas. About half (49%) of them were on insulin, and 52% had comorbidities. In total, 45.6% (95% CI: 42.3-48.8%) were eligible to be managed at PHCs. Among those who were eligible, 46.6% were willing to go back to PHCs. Males (APR = 1.16), people with diabetes for more than 10 years (APR = 1.23), and the presence of comorbidities (APR = 1.13) were significantly associated with unwillingness. Quality of medicines (46%) and poor facilities (40%) at PHCs were the main reasons for unwillingness. CONCLUSIONS: About half of the PWDs availing care at tertiary hospitals can be managed at primary care settings; of those, only half were willing to receive care at PHCs.

Association between indoor air pollution and cognitive function among nationally representative sample of middle-aged and older adults in India-A multilevel modelling approach.

We have used a nationally representative sample of middle-aged and older adults in India to study the association between indoor air pollution and cognitive function. Longitudinal aging study in India (LASI) Wave-I data was utilized for this study. A two-level mixed-effects linear regression model was used to study the association between indoor air pollution and cognitive function and interpreted as adjusted beta coefficient (ꞵ) with 95% confidence interval (CI). In total, 56,179 participants aged ≥45 years were included in the analysis. The proportion of participants living in households with indoor air pollution were 30.6% (95%CI: 30.0%-31.3%). After adjusting for all the potential confounders (age, gender, education, region, religion, separate kitchen, socioeconomic status, marital status, residence, smoking, alcohol consumption, body mass index, self-rated health, and sleep problems), participants living in households with indoor air pollution had significant decline in the cognitive function when compared to those living in households without indoor air pollution (ꞵ = -0.57; 95%CI: -0.69 to -0.45). Since the LASI survey is being conducted as a biennial panel survey, assessing the impact of indoor air pollution on cognitive decline using the follow-up data can provide further insights into the pathogenesis of condition.

Prevalence of intestinal parasitic infection and its associated factors among children in Puducherry, South India: a community-based study.

There is paucity of studies at community level on prevalence of intestinal parasitic infection among under 18 years age group. This cross-sectional community-based research aimed to determine the prevalence of intestinal worm infections and its associated risk factors among 1 to 18 years age group in Puducherry, India. Sociodemographic, behavioral and other associated factors were collected using a structured questionnaire. One stool sample was collected from each participant and examined using direct (saline/iodine wet mount) and concentration (floatation/sedimentation) microscopic techniques. Log binomial regression analysis was used to find the factors independently associated with intestinal parasitic infection. Of 187 participants who provided the stool sample, 25 (13.4%) had at least one of the parasitic infections and among them 12 (6.4%) had Soil Transmitted Helminth infection (STH) and 13 (6.9%) had intestinal protozoan parasites. Parasitic infection is marginally higher among 1 to 7 years age group (14.4%) compared to 8 to 18 years age group (12.1%). After adjusting for confounding, urban residence (APR = 3.3, 95% CI 1.4-8.0) and open-air defecation (APR = 3.3, 95% CI 1.4-7.5) were significantly associated with intestinal parasitic infections. One out of eight children had any of the parasitic infection and nearly 50% of parasitic infections were caused by STH. Those children residing in urban areas and practice of open-air defecation had higher prevalence of parasitic infection.

Prevalence and health risk score of tobacco and alcohol use by using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test among construction workers in Puducherry, India.

BACKGROUND: Construction workers are one of the important neglected occupation groups. The study aimed to assess the prevalence and health risk score of tobacco and alcohol use and its association with sociodemographic factors and self-reported morbidities among construction workers. MATERIALS AND METHODS: A cross-sectional study was conducted among 400 male construction workers in a tertiary care medical institution in Puducherry, India. A semi-structured questionnaire based on the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) guidelines for assessment and health risk score of alcohol and tobacco use was used. The association of current tobacco and alcohol use with associated factors was analyzed by univariate analysis. RESULTS: About 371 male construction workers participated. The mean (standard deviation) age of construction workers was 28.28 (9.04) years. The prevalence of current tobacco and alcohol use was 60.1% (223/371) and 47.7% (177/371), respectively. Out of 133 smokers, 60.9% (81) were used only bidi, 27.1% (36) only cigarette, and 12% (16) both bidi and cigarette. Most of the workers (126/151 [83.4%]) used khaini among smokeless tobacco users. The majority (204/241 [84.6%]) of ever smokers and nearly half of alcohol users (103 [49.8%]) had moderate risk based on ASSIST score. Higher current tobacco consumption is associated with higher age group, married, lower education status, unskilled occupation, contractual workers, migrants from other states, more duration of work in construction field, and the presence of self-reported health problems (P < 0.05). Current alcohol consumption is associated with more duration of work in construction field and the presence of self-reported health problems (P < 0.05). CONCLUSIONS: Tobacco and alcohol use is high, and health risk due to substance use is also more in construction workers.

Contraceptive knowledge, practice, and associated factors among currently married women of reproductive age group: A community-based study in Puducherry, India.

In the present cross-sectional study, the researchers aimed to assess the contraceptive knowledge, practice, and associated factors among 2228 women in Puducherry, India. National Family Health Survey questionnaire was adopted for data collection and about 1924 women participated. Current use of any contraceptive was 78.6% and female sterilization was 62%. The majority (99.8%) knew female sterilization, but below average for other contraceptive methods. About 10.4% were aware of more than three contraceptive methods. Age group, homemaker, with children or one son, aware of less than three methods, residing nearby to health facility were associated with the higher practice of contraceptive methods.

Validation and Reliability Assessment of the Mini-Nutritional Assessment-Short Form Questionnaire among Older Adults in South India.

BACKGROUND: Nutrition of the elderly affects immunity and functional ability and leads to increased morbidity and mortality. Validation of a short-form (SF) scale will make the assessment easier for primary care physicians. Hence, the study was done to assess the validity and reliability of Mini-Nutritional Assessment-SF (MNA-SF) Questionnaire among elderly in Puducherry. METHODS: A cross-sectional study among 279 elderly was conducted in four villages of rural Puducherry. We have used three forms of MNA questionnaire. Diagnostic accuracy of the MNA-SF was assessed and internal consistency was interpreted using Cronbach's alpha. RESULTS: The prevalence of malnutrition by the MNA full-form scale was 17.9%. Similar prevalence was reported by the body mass index (BMI) MNA-SF (16.5%), but calf-circumference (CC) MNA-SF overestimated the prevalence (38%). Sensitivity was higher in CC-MNA-SF (92%) when compared to BMI-MNA-SF (72%), while specificity was higher in BMI-MNA-SF (95.6%) when compared to CC-MNA-SF (73.8%). The positive predictive value was higher in BMI-MNA-SF (78.3%) when compared to CC-MNA-SF (43.4%), while the negative predictive value almost similar in both the scales. Reliability of the questionnaire showed the highest value for MNA full form (alpha = 0.71). CONCLUSION: This shows that both the forms of MNA-SF (BMI-based, CC-based) were valid and can be recommended as a screening tool for the assessment of nutritional status of the elderly.

Preference on prenatal sex determination and its associated factors among currently married women of reproductive age group in Puducherry, India.

BACKGROUND: Sex determination refers to knowing the sex of foetus during prenatal period for non-medical reasons. Attitude of married women to sex determination is important to improve the sex ratio at birth. AIM AND OBJECTIVES: This study aimed to assess preference on sex determination and associated factors among currently married reproductive age group women. MATERIALS AND METHODS: This cross-sectional community-based study was done during 2016-2017 among 2228 currently married women of 18-49 years' age group in urban and rural Puducherry, India. Information on the demographic characteristics, level of awareness and preference for sex determination was obtained. Multiple logistic regression was used to identify factors influencing preference for sex determination. Unadjusted and adjusted odds ratio (AOR) as a measure of effects was used. RESULTS: Of 1979 respondents, all were aware that sex determination is possible. Majority of them did not prefer sex determination (95.4%, 1888). About 80 (4.0%) preferred, while 11 (0.6%) were undecided about it. Majority of them were aware that sex determination without medical indication is a crime. Common source of information was healthcare workers (76.4%). After adjusting for confounders, age group (18-24, AOR = 5.334; 25-29, AOR = 3.249; 30-34, AOR = 3.857; 35-39, AOR = 2.279), middle level education (AOR = 2.3), those with unmet need for family planning (AOR = 2.970) and urban area (AOR = 67.679) subjects were preferred more; housewife (AOR = 0.481) and those without living son (AOR = 0.406) had preferred lesser for sex determination compared to their counterparts. CONCLUSION: About one in 25 currently married women preferred sex determination. It is comparatively more in urban areas. High-risk groups should be educated to develop correct awareness and attitude on prenatal sex determination.

Quality of life and its determinants among sewage workers: A cross-sectional study in Puducherry, South India.

BACKGROUND: There is a paucity of information on sewage worker's quality of life (QoL). Hence, we aimed to assess the QoL and its associated factors among sewage workers in Puducherry, coastal south India. MATERIALS AND METHODS: A total of 210 sewage workers were included in the study. QoL was assessed using a validated Tamil version of WHO QoL-BREF. The association of QoL with age, educational status, residence area, self-reported chronic illness, use of protective measures, tobacco and alcohol use was assessed by univariate analysis. Multiple linear regression analysis was used to assess the independent factors associated with QoL. RESULTS: Overall mean (standard deviation) score of QoL was 56.9 (9); mean score of social relationship domain was comparatively lower than physical, psychological and environmental domains. Current tobacco and alcohol uses were 17% and 67%, respectively, while alcohol use during work (entering sump) was 5%. At least one morbidity was present among 94 (45%) subjects. About half (47%) used at least one protective measure while entering the drainage sump. Age group above 50 years, below primary level education, presence of chronic illness, smokers and alcohol users had significantly lower QoL score. CONCLUSIONS: Social relationships' domain of QoL was very low among sewage workers. The majority of them do not use any personal protective devices and almost half had chronic illnesses.

Spatial pattern and determinants of HIV infection among adults aged 15 to 54 years in India - Evidence from National Family Health Survey-4 (2015-16).

OBJECTIVE: To assess the spatial pattern and determinants of HIV infection in India. METHODS: We conducted a secondary data analysis using the National Family Health Survey-4 data obtained from the Demographic Health Survey programme. We accounted for clustering and stratification in the sampling design using the svyset command. Spatial analysis was performed by generating the Moran's I statistic and local indicators for spatial association (LISA) maps. Logistic regression was performed to identify the determinants of HIV infection. RESULTS: 230 213 individuals were included. Prevalence of HIV infection in India was 0.24% (95% CI: 0.21%-0.28%). Being separated/widowed/divorced (aOR = 2.58, 95% CI: 1.22-5.40), living in an urban area (aOR = 2.46, 95% CI: 1.79-3.37), being resident in the North-Eastern (aOR = 4.25, 95% CI: 2.60-6.93), Southern (aOR = 3.13, 95% CI: 1.99-4.91) or Western region (aOR = 2.17, 95% CI: 1.08-4.33), having a history of multiple sexual partners (aOR = 1.99, 95% CI:1.42-2.79), a suspected STI (aOR = 2.32, 95% CI: 1.38-3.90) or self-reported TB (aOR = 7.80, 95% CI: 2.52-24.05) were significantly in association with HIV infection. Moran's I was 0.377, suggesting positive spatial autocorrelation. The LISA cluster map indicated 60 hotspot districts in India, mostly in southern states such as Karnataka, Andhra Pradesh and Telangana followed by north-eastern states such as Nagaland, Manipur, Mizoram, Tripura and Assam. CONCLUSION: HIV infection among adults aged 15-54 years in India is spatially clustered with the majority occurring in southern and north-eastern states. Hence, region- or district-specific strategies with focused interventions should be adopted.

Extent of contraception methods practised by unmet need couples after counselling: a cross-sectional follow-up study in Puducherry, South India.

BACKGROUND: Information is paucity about the extent of contraception practise among the unmet need eligible couples after counselling. OBJECTIVE: To assess the prevalence and associated factors of unmet need for family planning (FP), the extent to which they practise desired contraception methods after baseline counselling and the reasons for not practicing it. METHODS: A community-based cross-sectional analytical study was conducted between 2016 and 2019 among 2228 currently married couples with periodic follow ups of unmet need group. Baseline data on unmet need were collected based on the National Family Health Survey questionnaire. Individual and couple counselling were performed through informing choice and the support for decision making was based on the unmet need reasons with follow-ups. The data were analysed using Stata software version 12.0 (StataCorp, College Station, TX). RESULTS: The total study population was 1924. The prevalence of unmet need for FP was 7.1% (137) with 2.9% (55) of unmet need for spacing and 4.3% (82) of limiting births. Age groups between 18 and 24 [adjusted odds ratio (AOR) = 4.463], 25-29 (AOR = 2.339), not having a child (AOR = 0.250), having one child (AOR = 2.369) and having lower socioeconomic status (AOR = 0.155) were significantly associated with unmet need. During the follow-ups, 37.2% (29/78) received who desired limiting births, while 43.6% (34/78) changed to spacing methods. In fact, the main reason for not adopting limiting births is the fear of post-operative surgery-related health problems. CONCLUSIONS: This study emphasizes the need for follow-up counselling for guiding contraceptive use and recorded that majority of the unmet need couples started practicing contraception methods during the follow-ups. Besides, change in desired contraception methods was observed.

Prevalence and association of depressive symptoms with spiritual intelligence among older adults: A community-based study in rural Puducherry, South India.

INTRODUCTION: Depression is more common among older adults, but there is a paucity of information about its association with spiritual intelligence. This study aimed to determine the prevalence and association of depressive symptoms with spiritual intelligence among older adults. MATERIALS AND METHODS: This community-based cross-sectional analytical study was conducted among 292 older adults in a rural area of Puducherry, India. A structured questionnaire was used to collect each participant's socio-demographic and behavioral factors; the presence of depressive symptoms was assessed by using Geriatric Depression Scale (short form), spiritual intelligence by the Spiritual Intelligence Self-Report Inventory-24 questionnaire and activities of daily living by Katz Index of Independence scale. Proportion for prevalence estimate, bivariate and multivariable log binomial regression analysis were done. RESULTS: The prevalence of depressive symptoms was 64.1 % (187/292; 95 % CI 58.3-69.3). Of total, 103 (35.3 %) had low, 92 (31.55 %) had moderate and 97 (33.2 %) had high spiritual intelligence. About 11 % (32/292) were partially or fully dependent. Depressive symptoms showed a significant association with marital status, education, sleep pattern, relationship with family members and spiritual intelligence in bivariate analysis. Depressive symptoms were high among those with low spiritual intelligence and disturbed sleep pattern with Adjusted Prevalence Ratio of 1.33 (95 %CI 1.26-1.4) and 1.06 (95 %CI 1.0-1.14) respectively. CONCLUSION: Majority of the older adults had depressive symptoms and significantly more among those with low spiritual intelligence and disturbed sleep. This study gives new evidence on spiritual intelligence among older adults in a community setting and the magnitude of association of depressive symptoms with spiritual intelligence.