Incidence of Postpartum Depression and Its Association With Antenatal Psychiatric Symptoms: A Longitudinal Study in 25 Villages of Rural South Karnataka.

Background: Postpartum depression (PPD) is the commonest mental health disorder post-childbirth, yet there is a paucity of data in rural areas regarding the actual incidence of PPD, which excludes pre-existing or antenatal depression. To estimate the incidence of PPD among rural women of south Karnataka and identify predictors of PPD, including antenatal psychiatric disorders. Methods: A longitudinal study in 25 villages in south Karnataka among 150 pregnant women in the third trimester of pregnancy using simple random sampling. Baseline data collected and revised Clinical Interview Schedule used to screen antenatal psychiatric disorders. Participants followed-up 6-8 weeks postpartum, end-line data collected, and Edinburg Postnatal Depression Scale administered. Chi-square and Fischer's exact tests for association between PPD and covariates. Logistic regression to calculate adjusted odds ratios. Results: Prevalence of antenatal psychiatric disorders was 15.3%. The incidence of PPD was 11%. A significantly higher proportion of PPD was found among women with adverse events in the last year, low socioeconomic status, and perceived lack of care/support at home. Predictors of PPD were antenatal psychiatric disorders (AOR = 4.3, 95% CI = 1.22-5.11; P = 0.028), mothers reporting worry about their infant's health (AOR = 7.7, 95% CI = 1.22-48.32; P = 0.012) and mothers receiving postpartum care by caregivers other than their own mother (AOR = 4.0, 95% CI = 1.13-8.09; P = 0.030). Conclusions: Our study found that one in ten rural women is developing PPD and there is a strong link between PPD and antenatal psychiatric disorders and family factors. This calls for capacity building of general physicians and village-level workers and strengthening of the Home-Based Newborn Care Program, where weekly postpartum home visits by ASHA are an opportunity for screening and counselling mothers.

Effectiveness of Color Coded Diabetic Control Monitoring Charts among Elderly Diabetics Attending Outreach Primary Care Geriatric Clinics in Rural Karnataka: An Open Label Randomized Control Trial.

INTRODUCTION: Type 2 diabetes mellitus problem is progressively rising every day. The adherence to the treatment approaches and health-seeking make major difference in case of diabetics particularly elderly. Visual tools improve the involvement of patients in their care, especially among populations with low health literacy. OBJECTIVE: To evaluate the effectiveness of color-coded diabetic control monitoring charts on glycemic control among elderly diabetics. METHODOLOGY: 144 elderly diabetic patients attending rural primary care geriatric clinics were randomized into two groups. Those randomized to the intervention group received the color-coded diabetic monitoring chart and a health education package in addition to the usual consultation services. Baseline and 1-year follow-up glycated hemoglobin (HbA1C) values were used to assess the effectiveness of the intervention. RESULTS: The results of multivariate linear regression analysis showed that there was an average reduction of 0.265% in HbA1C value in the intervention group when compared to the nonintervention group when adjusted for baseline HbA1C and number of visits during the intervention period (ß coefficient = 0.265, P < 0.05). CONCLUSION: Color-coded diabetes charts are effective in achieving glycemic control among elderly diabetics, and steps should be made to inculcate visually appealing management approaches in case of elderly diabetic patients.

Screening for Mental Health Disorders among Pregnant Women Availing Antenatal Care at a Government Maternity Hospital in Bengaluru City.

INTRODUCTION: Antepartum anxiety and depression are two of the most common risk factors for the development of postpartum depression. Women are at a higher risk of developing depression and suffering from mental disorders during pregnancy and the postnatal period. Psychopathological symptoms during pregnancy have physiological consequences for the fetus, such as impaired blood flow leading to low birth weight, as well as cognitive delay and behavioral problems. OBJECTIVES: To screen antenatal women for common mental health disorders and to determine the factors associated with mental health disorders during pregnancy. METHODS: A cross-sectional study among 208 pregnant mothers in the third trimester attending the antenatal clinic at a Government Maternity Home in a low-income urban area of Bengaluru was conducted using clinical interview schedule-revised (CIS-R) questionnaire as a screening tool for detecting the presence of mental morbidity. Data collected were analyzed using SPSS version 16. RESULTS: In the study population, 12 (5.8%) screened positive for antepartum mental morbidities, of which depression was the most common. 3.8% of all women screened positive for depression, with 15.4% demonstrating depressive symptoms. Overall, 82 (39.4%) had the presence of one or more psychological symptoms, including fatigue, irritability, anxiety, and problems with sleep and concentration but scored less than the CIS-R cutoff score of 12. Factors associated with the presence of antepartum mental morbidities included poor relationships with their spouse, poor/satisfactory relationship with siblings or in-laws, as well as the desire to have a male child. CONCLUSION: In the study population, 12 (5.8%) screened positive for antepartum mental morbidities. Considering the effects on quality of life for these women as well as poor fetal outcomes associated with maternal mental morbidity, it is important to include screening and treatment of mental morbidity as a part of routine antenatal care.

A study of emotional intelligence and perceived parenting styles among adolescents in a rural area in Karnataka.

CONTEXT: Adolescence is the time which is crucial for the overall development of a person both mentally and physically. In this period, along with academic intelligence, emotional intelligence (EI) also plays an equal or strong role in student life. AIMS: This study was to assess EI, parental bonding, and their association among adolescents in high schools under Sarjapur PHC area. SUBJECTS AND METHODS: This was a cross-sectional study conducted among high school students under Sarjapur PHC area. The EI was assessed using EI scale which measured self-awareness, self-regulation, motivation, empathy, and social skills. The parental bonding instrument was utilized to determine the parental styles of both the parents and was interpreted in terms of care and protection as neglectful parenting, affectionless control, optimal parenting, and affectionate control. RESULTS: A total of 300 adolescents were interviewed. It was seen that most of them had low EI in self-awareness, i.e., 92 (30.7%), motivation 99 (33%), and social skills 101 (33.7%). It was also observed that most of them had high EI in self-regulation, i.e., 98 (32.7%) and moderately high EI in empathy 117 (39%). The study group perceived that 147 (49%) of the fathers and 109 (36.3%) of the mothers had affectionless control. CONCLUSION: Along with poor parenting, most of the respondents also have low EI in self-awareness, motivation, and social skills which has to be addressed for the future of the country.

Polyionic hydrocolloids for the intestinal delivery of protein drugs: alginate and chitosan--a review.

The protein pharmaceutical market is rapidly growing, since it is gaining support from the recombinant DNA technology. To deliver these drugs via the oral route, the most preferred route, is the toughest challenge. In the design of oral delivery of peptide or protein drugs, pH sensitive hydrogels like alginate and chitosan have attracted increasing attention, since most of the synthetic polymers are immunogenic and the incorporation of proteins in to these polymers require harsh environment which may denature and inactivate the desired protein. Alginate is a water-soluble linear polysaccharide composed of alternating blocks of 1-4 linked alpha-L-guluronic and beta-D-mannuronic acid residues where as chitosan is a co polymer of D-glucosamine and N-acetyl glucosamine. The incorporation of protein into these two matrices can be done under relatively mild environment and hence the chances of protein denaturation are minimal. The limitations of these polymers, like drug leaching during preparation can be overcome by different techniques which increase their encapsulation efficiency. Alginate, being an anionic polymer with carboxyl end groups, is a good mucoadhesive agent. The pore size of alginate gel microbeads has been shown to be between 5 and 200 nm and coated beads and microspheres are found to be better oral delivery vehicles. Cross-linked alginate has more capacity to retain the entrapped drugs and mixing of alginate with other polymers such as neutral gums, pectin, chitosan, and eudragit have been found to solve the problem of drug leaching. Chitosan has only limited ability for controlling the release of encapsulated compound due to its hydrophilic nature and easy solubility in acidic medium. By simple covalent modifications of the polymer, its physicochemical properties can be changed and can be made suitable for the peroral drug delivery purpose. Ionic interactions between positively charged amino groups in chitosan and the negatively charged mucus gel layer make it mucoadhesive. The favourable properties like biocompatibility, biodegradability, pH sensitiveness, mucoadhesiveness, etc. has enabled these polymers to become the choice of the pharmacologists as oral delivery matrices for proteins.