Annual Cost of Care of Parkinson's Disease and Its Determinants in North India - A Cost of Illness Study with Patient Perspective.

Background: Parkinson's disease (PD) is a slowly progressive and disabling disorder, so the cost of illness may change with time. We aimed this study to know the annual cost of care of PD in India. Methods: After ethics approval, a prospective cohort study was conducted at the movement disorder clinic of tertiary care hospital for 2 years (2014-2016). The outcomes were a description of the total annual direct cost of Parkinson's disease including health care as well as non-health care cost. We also did correlation analysis to know the determinants of the total cost. Results: A total of 200 consecutive patients of PD with 141 (70.50%) males and 59 (29.50%) females with a mean age of 56.84 ± 10.51 years were enrolled. The annual Median Direct cost of care was INR 27,315.0 (IQR 13636.6-44908.4), whereas the Indirect cost was INR 21,400 (IQR 9800 - 96800). Cost on drugs (Direct health care) formed 68.50% (Median) of the total Direct cost. Total direct cost formed 11.38% of the Median total yearly income of our patients. Of the direct cost, the Median expenditure on drugs was INR 18,712.8 (8064.0 -30696.0). Only 5% of patients had health care insurance. The total direct cost was determined by the stage of Parkinson's disease and duration of disease (P = < 0.01) but not predicted by age, gender, age at onset, and the yearly income of patients. Conclusion: Annual cost of care of Parkinson's disease is high and increases with the duration of the disease as well as the progression of the disease.

Assessment of knowledge, attitude, practice (KAP) regarding directly observed therapy (DOT) in tuberculosis among ASHA workers from tribal subpopulation zone of Rajasthan.

Introduction: A high level of community awareness and positive perception towards tuberculosis and its management is crucial for the successful outcome of any control measure. In India the Accredited Social Health Activist (ASHA) plays a key role in providing awareness and counselling on healthcare issues and management, particularly in remote areas. The tribal population is vulnerable to such infectious diseases due to resource limitations and remote locations. We assessed the knowledge, attitude, and practice (KAP) regarding directly observed therapy (DOT) among ASHA workers in the tribal belt of the Sirohi district of Rajasthan state. Material and Methods: This cross-sectional study was conducted among ASHA workers of Sirohi district from January 2021 to June 2021. A predesigned and structured questionnaire was used to gather information on knowledge, attitude, and practices regarding the management of tuberculosis and DOT. Results: A total of 95 ASHAs participated in the study with a mean age of 35.82 years. Good knowledge (Mean score = 6.2947 ± 1.08052) was observed regarding tuberculosis and DOT. 81% (n = 74) have good knowledge regarding DOT whereas most have a poor attitude and only 47% have adequate practice. A 55% of ASHAs did not adhere even a single TB patient in the last three years. Conclusion: In our study, knowledge gaps were identified which may result in substandard patient care. The structured refresher training towards DOT and also training to work in tribal areas will further improve the KAP of ASHAs. It might be needed to provide a module or curriculum regarding awareness among ASHAs for strengthening follow-up system for tuberculosis patients among the tribal population.

Economic Burden of Acute Stroke Care in Beneficiaries and Non-Beneficiaries under Social Security Schemes at Tertiary Care Hospitals of Western Rajasthan.

OBJECTIVE: A cost of illness study was conducted with aims to asses various cost of acute stroke care and its determinants among beneficiary (patients enrolled in any social security scheme) and non beneficiary (patients not enrolled in any social security scheme) of various social security schemes. METHOD: A cross-sectional study was conducted at government hospitals in western Rajasthan from March to May 2019. All consecutive stroke patients were enrolled during study period. Data related to socio-demographic, disease-related and cost-related data was collected by direct patient and main caregiver's interview. Primary study outcome was description of direct and indirect cost of acute stroke care among beneficiary and non beneficiary patients. Secondary outcome was description of determinants of cost or significant cost-driven variables. RESULTS: Total of 126 stroke patients were enrolled in 3 months. Mean age was 57.67 ± 15.0 and male: female ratio was 82:44. Both beneficiary and non-beneficiary patients were similar in baseline characteristic except monthly income (P < 0.01) Mean hospital stay was 6.52 ± 2.23 Total out of pocket direct cost among beneficiary was INR 12727.21 [95% C.I. 8658.50, 16795.92] and among non beneficiary was INR 23649.68 [95%C.I. 18591.37, 28707.99]. There was significant difference indirect cost of beneficiary and non-beneficiary patients (P < 0.01). Mean Indirect cost (wages loss) among beneficiary was INR 12414.75 [95% C.I. 9691.13, 15138.37] and among non-beneficiary was INR 16460 [95% C.I. 13044.81, 19875.19]. There was no significant difference in Indirect cost of beneficiary and non-beneficiary patients (P = 0.06). Monthly income, stroke severity (modified Rankin score) and hospital stay were significant direct cost determinants. CONCLUSION: Public health insurance scheme reduces direct cost of acute stroke care significantly. Severity of stroke and prolonged hospital stay were main cost-driven variables.

Critical Appraisal of Guidelines for Evaluation and Certification of Specified Neurological Disabilities.

New disability law called "Rights of Persons with Disabilities Act 2016" has been acted in 2016. The United Nations' Convention for Rights of Persons with Disabilities is the sole of this new act. Of the total 21 categories, three new neurological legal disability categories such as chronic neurological conditions, Parkinson disease (PD), and multiple sclerosis have been notified first time in the new act. The new guidelines have been notified in the year 2018 for evaluation and certification of specified disabilities. As a new addition in these guidelines, modified Rankin scale score has been added to measure locomotor disability of stroke. Certainly, newer guidelines have many lacunae also. There are no recommendations of any method of disability measurement associated with movement disorders such as PD, chronic neurological conditions such as migraine, epilepsy, and ataxia. The tables of older guidelines for disability calculation in conditions such as unconsciousness and epileptic fits have been removed in newer guidelines. Professional bodies should come into action immediately and do effort for rectifying these shortcomings and/or fallacies in new guidelines.

Newer innovations in treatment of retracted nipple.

OBJECTIVES: To compare the efficacy, merits and demerits of various methods for the treatment of retracted nipple, i.e., two new innovative methods (rubber band method and sucking by the husband) with the in-use syringe method. METHODS: A prospective study on 213 women having retracted nipple, 71 in each of the three groups was carried out. Group A included patients in which syringe method was used; Group B comprised of woman in which rubber band method was used and Group C included patients with vigorous sucking by the husband. RESULTS: Highest success rates were seen in Group C (vigorous sucking by the husband), being 52, 88 and 94 % on days 3, 7 and 14 respectively. Success rates in Group B (rubber band method) were lower, being 43, 66 and 74 % respectively and lowest in Group A (syringe method), i.e., 33, 47 and 64 %, respectively on corresponding days. Problem of difficulty in applying technique were common in Group B (38 %), less common in Group A (22 %) and nil in Group C. The incidence of local pain had the same trend i.e., 48 and 30 % in Group B and A, respectively, and nil in Group C. Disliking taste of milk in mouth and problem of privacy were highest in Group C i.e., 28 % and 100 % respectively. CONCLUSIONS: Although syringe method is well established, sucking by husband is definitely superior and a boon for difficult cases too. Rubber band method is a bit inferior due to complicated technique, local pain and no lactation stimulation.