Readiness of Accredited Social Health Activist Workers for Tobacco Cessation Counseling after a Brief Intervention in Odisha, India: A Quasi-experimental Study.

AIM: The aim of the study was (1) to explore the baseline beliefs and practices of accredited social health activist (ASHA) workers of Khurda district of Orissa with respect to tobacco cessation and (2) to assess whether a brief intervention will be effective in improving the beliefs and practices of ASHA workers. The results of this study could be utilized by policy makers for framing important strategies for tobacco cessation in rural areas utilizing ASHA workers. MATERIALS AND METHODS: A quasi-experimental study (before and after comparison) was performed in Khurda district of Orissa to find out whether a brief intervention could improve the beliefs and practices of ASHA workers related to antitobacco counseling in rural areas. A 14-item structured, interviewer-administered questionnaire, written in English (translated in Odiya), was used. The final sample size was estimated as 135. Data were entered into Statistical Package for the Social Sciences (version 21) for analysis. RESULTS: All the mean belief items, practice items, degree of preparedness, and interest in training scores of study population increased significantly from baseline to postintervention. The study population showed a statistically significant improvement in postintervention composite belief and composite practices score. CONCLUSION: The majority of ASHA workers had positive beliefs and favorable practices after attending a brief intervention toward smoking cessation in their community. After attending the intervention, nearly half of the respondents felt themselves either somewhat or very well prepared for tobacco cessation. Most of them showed their interest toward getting further training in the field. CLINICAL SIGNIFICANCE: Training programs and regular tobacco cessation activities should be planned in the primary health-care delivery system of India.

Skin disease: clinical indicator of immune status in human immunodeficiency virus (HIV) infection.

BACKGROUND: Dermatological manifestations are seen at every stage of HIV/AIDS (human immunodeficiency virus), and are often the presenting features. These manifestations not only act as markers but also reflect the underlying immune status. OBJECTIVE: To establish skin diseases as clinical indicators of underlying immune status in HIV disease by estimating and correlating with the CD(4), CD(4) : CD(8) ratio. MATERIALS AND METHODS: The CD(4), CD(8), CD(4) : CD(8) ratios were estimated using the fluorescence activated cell sorter (FACS) count system in 20 asymptomatic HIV patients, 80 HIV patients with various skin manifestations and 72 healthy volunteers as the control group. RESULTS: In comparison with the CD(4) cell count of the control group (mean 885/mm(3), standard deviation 331), that of the HIV-positive individuals (mean 409.83/mm(3), standard deviation 263.07) was statistically correlated with low counts (z = 10.099 and P < 0.05). Similarly there was statistical significance with the CD(4) : CD(8) ratio among these two groups. In comparison with the CD(4) cell count of the asymptomatic HIV-positive individuals (mean 620.65/mm(3) and standard deviation 262.065), the CD(4) cell count of the HIV-positive patients with various dermatological manifestations (mean 357.15/mm(3), standard deviation 236.95) was statistically correlated with low counts (z = 4.0978 and P < 0.05). Similarly there was statistical significance with the CD(4) : CD(8) ratio among these two groups. CONCLUSIONS: There was an inverse relation between the CD(4) counts and the incidence and severity of skin diseases in the HIV/AIDS patients. Cutaneous manifestations of HIV can be considered as good clinical indicators to predict and access the underlying immune status in resource-poor countries.