Mental health promotion for elderly populations in World Health Organization South-East Asia Region: Needs and resource gaps.

The accelerated population growth of the elderly (individuals aged 60 years or more) across the globe has many indications, including changes in demography, health, the psycho-social milieu, and economic security. This transition has given rise to varied challenges; significant changes have been observed in regard to developing strategies for health care systems across the globe. The World Health Organization (WHO) is also engaging in initiatives and mediating processes. Furthermore, advocacy is being conducted regarding a shift toward the salutogenic model from the pathogenic model. The concept behind this move was to shift from disablement to enablement and from illness to wellness, with the notion of mental health promotion (MHP) being promoted. This article attempts to discuss the MHP of elderly individuals, with special reference to the need to disseminate knowledge and awareness in the community by utilizing the resources of the health sector available in the WHO South-East Asia Region countries. We have tried to present the current knowledge gap by exploring the existing infrastructure, human resources, and financial resources. There is much to do to promote the mental health of the elderly, but inadequate facilities are available. Based on available resources, a roadmap for MHP in elderly individuals is discussed.

Stress, internet use, substance use and coping among adolescents, young-adults and middle-age adults amid the 'new normal' pandemic era.

Background: Globally, there is a constant state of flux amid the 'new normal' period of the COVID-19 pandemic. People try to accommodate to uncertainty, stress, and the threat of facing subsequent waves. It is crucial to explore and compare the psychological and behavioral processes of adolescents, young adults, and middle-aged adults amid such an era in a developing country like India. Aim: The present study compared the stress, internet use, substance use, and coping among adolescents, young adults, and middle-aged adults amid India's 'new normal' era. Methods: A cross-sectional design was used on an online platform. The sample included 1027 participants [ 456 adolescents; 347 young adults, and 224 middle age-adults] using PerceivedStress Scale, Internet Gaming Disorders-9, DSM-5 Self-Rated Level-1, and Brief-COPE scale. Results: Results showed moderate stress among all participants across all ages. Adolescent females perceived the highest stress (20.91, SD = 8.65); Adolescents reported higher internet use (Females: M = 3.59, S.D. = 2.44; Males: M = 3.40, S.D. = 2.30); Young and middle-aged adults Males reported significantly higher substance use (M = 1.60, S.D. = 2.96; M = 1.17, S.D. = 2.21). Maladaptive coping was used more by Young Adult Males (M = 10.83, S.D. = 4.66). Internet use was positively correlated with perceived stress (0.40) and maladaptive coping (0.40). Substance Use was also moderately positively correlated with maladaptive coping (0.38). Discussion: The study reveals significant variations in perceived stress, internet use, substance use, and coping based on gender and age variations. Adolescent females were the most affected and reported high perceived stress, whereas middle-aged adults were the least affected. Conclusion: The study provides further avenues to understand the stress and coping in different sections of society amid the 'new normal' era. It also gives an idea about resilience and identifies the sections of society which require focused interventions.

Development of Comprehensive Satisfaction Index (ComSI) and Its Association with WHOQOL-BREF.

BACKGROUND: Comprehensive satisfaction in life may be considered as a significant contributor to health for everyone, including the aging population (individuals aged 45 years and above). For understanding the comprehensive satisfaction, an assessment measure with various psychometric properties may be useful. During a longitudinal study of aging and geriatric mental health, a 26-item tool was developed in Hindi for the assessment of satisfaction. This article aimed to analyze the items of Comprehensive Satisfaction Index (ComSI) applying Varimax rotation and to find out its association with World Health Organization Quality of Life Brief (WHOQOL-BREF). METHODS: Data of 260 subjects were extracted from the longitudinal study to analyze the psychometric properties of the tool named as Comprehensive Satisfaction Index and its association with various domains of WHOQOL-BREF. Varimax rotation was applied after computing Kaiser-Meyer-Olkin and Bartlett's test of sphericity. Furthermore, the association between various components of ComSI and various domains of WHOQOL-BREF was explored. RESULTS: Of the total 26 items of the tool, item no. 17 was excluded due to its -ve/ <0.31 value. A total of three components were generated with >1 eigenvalues; maximum items were loaded in component 1 (19) followed by components 2 (4) and 3 (2). Each of these factors has been significantly correlated with each other. Furthermore, these components also were compared with various domains of WHOQOL-BREF, and positive correlation was obtained for most of them. CONCLUSION: There is a positive association between ComSI and WHOQOL-BREF. This tool will help in identifying the satisfaction level of the aging subjects promptly and efficiently, which would further help in making strategies for interventions.

Sample attrition rate of a community study: An analysis of Lucknow urban and rural elderly follow-up over a period of 9 years.

BACKGROUND: Longitudinal/follow-up studies of older adults are a tough task as sample attrition rates due to mortality and other factors may be high in this particular group. However, such studies are very much needed to assess the outcome of health status as well as explore preventive, protective, interventional aspects, as well as risk factors. Given this, a follow-up study was planned and carried out. AIM: To discuss the rate of sample loss as well as the reasons over 9 years. METHODS: An Indian Council of Medical Research (ICMR) supported follow-up study of urban and rural elderly was done during June, 2016-May, 2017; these subjects were studied in 2007-09 through two independent ICMR supported studies. Similar methodology and assessment tools were applied in these studies. During follow-up a semi structured proforma was developed to get the information of study cohort, obtained data was analyzed and presented applying percentage statistics. RESULTS: The sample attrition rate was reported to be comparatively high in urban 52.1% (n= 633) cohort than their rural counterparts 36.3% (n= 457). CONCLUSION: Over a period of 9 years chances of cohort loss due to mortality is about 32%-35%.

Nonpharmacological methods in managing patients with dementia in a tertiary care hospital.

Management of dementia is very crucial. Nonpharmacological methods (NPM) are well appreciated and encouraged to be used as first-line treatment for managing elderly patients with dementia (PwD). The present case reports aimed to share the strategies of NPM for managing PwD. NPM requires a structured blueprint to record, follow-up, and monitor the outcomes. A structured proforma has been developed in the department. After getting all the basic information from the patient, needed assessments are being done by the concerned team member to identify and rate the level of severity of the problem, and specific NPM strategies are being provided. Concerted efforts give positive results; knowledge and understanding about the illness help the caregiver in managing the patient. No negative impact has been reported; NPM is a cost-effective approach and therefore should be studied on a larger level to provide evidence from India and prove its efficacy.

Prevalence of Psychiatric Illness among Residents of Old Age Homes in Northern India.

CONTEXT: There are many factors which compelled older adults to live in old age homes (OAHs) and vulnerable to psychological problems. Studies reported high prevalence of mental health problems (20%-60%) among elderlies of OAHs. Therefore, the study was conducted to explore prevalence of psychiatric illness (PI) among residents of OAHs of Northern India. SETTINGS AND DESIGN: The present study was conducted in OAHs of Districts Bareilly, Lucknow, Varanasi, Dehradun, and Haridwar, using cross-sectional descriptive study method. Sample Size were 306 (male - 98 [32.5%] and female n = 208 [68%]) residing in OAHs selected by means of purposive sampling. SUBJECTS AND METHODS: Inclusion criteria: (a) older adults aged 60 years and above residing in OAHs and able to communicate. (b) Staying in OAHs for 6 months or more. (c) Able to understand comprehends and reply to questions and (d) Giving written informed consent. Exclusion criteria: (a) Residents who declined/not interested to participate in the study. (b) Residents having any sensory impairment/physical health problem which can impede the interview. Research tools were (i) a semi-structured pro forma, (ii) Hindi Mental Status Examination, (iii) Survey psychiatric assessment schedule, and (iv) Schedules for clinical assessment in neuropsychiatry-based clinical interview for diagnosis of PIs according to International Classification of Disease 10. STATISTICAL ANALYSIS USED: The quantitative data obtained was analyzed by means of frequency tables. RESULTS: The results show overall prevalence of PI is 43% among residents of OAHs. The prevalence of PI was found to be higher among females compared to males. Depression was the most common among the residents of OAHs. CONCLUSIONS: There is an urgent need of trained professionals to provide professional help for highly prevalent psychiatric disorders among residents of OAHs.

Postherpetic Neuralgia Presenting as Delusional Parasitosis: A Case Series.

Delusional parasitosis (DP) or Ekbom's disease is a rare psychiatric condition where the sufferers have a firm-fixed belief of insects crawling over their skin. The condition may be primary monosymptomatic hypochrondrical delusion or secondary to an underlying psychiatric or organic condition. We present two cases of elderly men presenting with classical symptomatology of DP, which is found to be secondary to postherpetic neuralgia following an acute episode of shingles or herpes zoster infection. One patient responded to a combination of antipsychotic, olanzapine, and pregabalin, used for neuropathic pain, and the other patient responded completely with medications used for neuropathic pain only without any antipsychotic use.

Opposing orientations of the anti-psychotic drug trifluoperazine selected by alternate conformations of M144 in calmodulin.

The anti-psychotic drug trifluoperazine (TFP) is an antagonist observed to bind to calcium-saturated calmodulin ((Ca(2+) )4 -CaM) at ratios of 1:1 (1CTR), 2:1 (1A29), and 4:1 (1LIN). Each structure contains one TFP bound in the hydrophobic cleft of the C-domain of CaM. However, the orientation of the trifluoromethyl (CF3 ) moiety differs among them: it is buried in the C-domain cleft of 1A29 and 1LIN, but protrudes from 1CTR. We report a 2.0 Å resolution crystallographic structure (4RJD) of TFP bound to the (Ca(2+) )-saturated C-domain of CaM (CaMC ). The asymmetric unit contains two molecules of (Ca(2+) )2 -CaMC . Chain backbones were nearly identical, but the orientation of TFP in the cleft of Chain A matched 1A29/1LIN, while TFP bound to Chain B matched 1CTR. This was accommodated by a flip of the M144 sidechain and small changes in sidechains of M109 and M145. Docking simulations suggested that the rotamer conformation of M144 determined the orientation of TFP within the cleft of (Ca(2+) )2 -CaMC . Chains A and B show that the open cleft of (Ca(2+) )2 -CaMC is promiscuous in accepting TFP in reversed directions under the same crystallization conditions. Observing multiple orientations of an antagonist bound to a single protein highlights the challenge of designing highly specific pharmaceuticals, and may have importance for QSAR of other CF3 -containing drugs such as fluoxetine (anti-depressant) or efavirenz (reverse transcriptase inhibitor). This study emphasizes that a single structure of a complex represents an energetically accessible state, but does not necessarily show the full range of energetically equivalent states.

The Indian concepts of lifestyle and mental health in old age.

Lifestyle is the perception of a particular person or entire society towards life and it is the way people live, think and behave. In Indian lifestyle, principles of Karma (action) and dharma (the righteous way to perform the work) are given significant value. In India, earlier, the life of an individual was being regulated harmoniously according to the stages (Ashrams) of life, i.e., studentship (Brahmcharya); householder (Grihstha); forest dweller (Vanprasth); ascetic (Sanyas) and was meant to maintain the discipline, peace and harmony in the family and society. However, revolution in the social milieu and political scenario changed the patterns of religious beliefs and lifestyle of individuals. And thus, the Indian lifestyle got colored with shadows of cults and cultures. The lifestyle affects the longevity and health in old age. Lifestyles also have role in developing cognitive disorders like Alzheimer's disease (AD). AD found to be more common in socially isolated older adults. Deteriorations in health (especially mental health) are often the results of faulty lifestyles like smoking, alcohol intake, improper diet and lack of exercise as well as an adverse psycho-social milieu. Adopting the advocated principles of Indian concepts of lifestyle and paying proper attention to mental illnesses of older adults and recognizing their problems may preserve mental health in old age.

Structural basis of the binding of fatty acids to peptidoglycan recognition protein, PGRP-S through second binding site.

Short peptidoglycan recognition protein (PGRP-S) is a member of the mammalian innate immune system. PGRP-S from Camelus dromedarius (CPGRP-S) has been shown to bind to lipopolysaccharide (LPS), lipoteichoic acid (LTA) and peptidoglycan (PGN). Its structure consists of four molecules A, B, C and D with ligand binding clefts situated at A-B and C-D contacts. It has been shown that LPS, LTA and PGN bind to CPGRP-S at C-D contact. The cleft at the A-B contact indicated features that suggested a possible binding of fatty acids including mycolic acid of Mycobacterium tuberculosis. Therefore, binding studies of CPGRP-S were carried out with fatty acids, butyric acid, lauric acid, myristic acid, stearic acid and mycolic acid which showed affinities in the range of 10(-5) to 10(-8) M. Structure determinations of the complexes of CPGRP-S with above fatty acids showed that they bound to CPGRP-S in the cleft at the A-B contact. The flow cytometric studies showed that mycolic acid induced the production of pro-inflammatory cytokines, TNF-α and IFN-γ by CD3+ T cells. The concentrations of cytokines increased considerably with increasing concentrations of mycolic acid. However, their levels decreased substantially on adding CPGRP-S.

Mental health problems among inhabitants of old age homes: A preliminary study.

BACKGROUND: An exceptional increase in the number and proportion of older adults in the country, rapid increase in nuclear families, and contemporary changes in psychosocial matrix and values often compel this segment of society to live alone or in old age homes. As this group of people is more vulnerable to mental health problems, therefore a pilot study was carried out by the Department of Geriatric Mental Health, Lucknow with following aim. AIM: To study mental health and associated morbidities among inhabitants of old age homes. MATERIALS AND METHODS: It was an exploratory study in which information about available old age homes at Lucknow were obtained and three of them were randomly selected. All the heads of these institutions were contacted and permission to carry out the study was obtained. Consent from the participants was obtained. Survey Psychiatric Assessment Schedule (SPAS), Mini Mental State Examination (MMSE), Mood Disorder Questionnaire (MDQ), and SCAN-based clinical interviews were applied for assessment by a trained research staff. RESULTS: Forty five elderly inhabitants who had given their consent to participate in the study were interviewed. Depression (37.7%) was found to be the most common mental health problem followed by anxiety disorders (13.3%) and dementia (11.1%). CONCLUSIONS: A majority of the inhabitants (64.4%) were having psychiatric morbidity and no one was observed physically fit. Large sample studies are needed to substantiate the observations.

Status and requirements of geriatric mental health services in India: an evidence-based commentary.

In view of appreciable improvements in health care services in India, the longevity and life expectancy have almost doubled. As a result, there is significant demographic transition, and the population of older adults in the country is growing rapidly. Epidemiological surveys have revealed enormous mental health morbidity in older adults (aged 60 years and above) and have necessitated immediate need for the development of mental health services in India. The present population of older adults was used to calculate psychiatric morbidity based on the reported epidemiological data. The demographic and social changes, health care planning, available mental health care services and morbidity data were critically examined and analyzed. The service gap was calculated on the basis of available norms for the country vis-à-vis average mental health morbidity. Data from a recent epidemiological study indicated an average of 20.5% mental health morbidity in older adults. Accordingly, it was found that, at present, 17.13 million older adults (total population, 83.58 millions) are suffering from mental health problems in India. A differing, but in many aspects similar, picture emerged with regard to human resource and infrastructural requirements based on the two norms for the country to meet the challenges posed by psychiatrically ill older adults. A running commentary has been provided based on the available evidences and strategic options have been outlined to meet the requirements and minimize the gap. There is an urgent need to develop the subject and geriatric mental health care services in India.

Crystal structures of a type-1 ribosome inactivating protein from Momordica balsamina in the bound and unbound states.

The ribosome inactivating proteins (RIPs) of type 1 are plant toxins that eliminate adenine base selectively from the single stranded loop of rRNA. We report six crystal structures, type 1 RIP from Momordica balsamina (A), three in complexed states with ribose (B), guanine (C) and adenine (D) and two structures of MbRIP-1 when crystallized with adenosine triphosphate (ATP) (E) and 2'-deoxyadenosine triphosphate (2'-dATP) (F). These were determined at 1.67Å, 1.60Å, 2.20Å, 1.70Å, 2.07Å and 1.90Å resolutions respectively. The structures contained, (A) unbound protein molecule, (B) one protein molecule and one ribose sugar, (C) one protein molecule and one guanine base, (D) one protein molecule and one adenine base, (E) one protein molecule and one ATP-product adenine molecule and (F) one protein molecule and one 2'-dATP-product adenine molecule. Three distinct conformations of the side chain of Tyr70 were observed with (i) χ(1)=-66°and χ(2)=165° in structures (A) and (B); (ii) χ(1)=-95° and χ(2)=70° in structures (C), (D) and (E); and (iii) χ(1)=-163° and χ(2)=87° in structure (F). The conformation of Tyr70 in (F) corresponds to the structure of a conformational intermediate. This is the first structure which demonstrates that the slow conversion of DNA substrates by RIPs can be trapped during crystallization.

Structural evidence for the order of preference of inorganic substrates in mammalian heme peroxidases: crystal structure of the complex of lactoperoxidase with four inorganic substrates, SCN, I, Br and Cl.

Lactoperoxidase (LPO) is a member of the family of mammalian heme peroxidases. It catalyzes the oxidation of halides and pseudohalides in presence of hydrogen peroxide. LPO has been co-crystallized with inorganic substrates, SCN(-), I(-), Br(-) and Cl(-). The structure determination of the complex of LPO with above four substrates showed that all of them occupied distinct positions in the substrate binding site on the distal heme side. The bound substrate ions were separated from each other by one or more water molecules. The heme iron is coordinated to His-351 N(ϵ2) on the proximal side while it is coordinated to conserved water molecule W-1 on the distal heme side. W-1 is hydrogen bonded to Br(-) ion which is followed by Cl(-) ion with a hydrogen bonded water molecule W-5' between them. Next to Cl(-) ion is a hydrogen bonded water molecule W-7' which in turn is hydrogen bonded to W-8' and N atom of SCN(-). W-80 is hydrogen bonded to W-9' which is hydrogen bonded to I(-). SCN(-) ion also interacts directly with Asn-230 and through water molecules with Ser-235 and Phe-254. Therefore, according to the locations of four substrate anions, the order of preference for binding to lactoperoxidase is observed as Br(-) > Cl(-) > SCN(-) > I(-). The positions of anions are further defined in terms of subsites where Br(-) is located in subsite 1, Cl(-) in subsite 2, SCN(-) in subsite 3 and I(-) in subsite 4.

Scorpion sting envenomation in children: factors affecting the outcome.

OBJECTIVE: To identify and correlate various factors affecting the outcome of children with scorpion sting envenomation treated with prazosin in a tertiary care hospital. METHODS: The study included 90 children admitted with scorpion sting envenomation over a period of four and half year. Grading of severity was done on the basis of local or systemic involvement, and management protocol was followed as per hospital guidelines. All cases with envenomation were given prazosin at a dose of 30 µg/kg/dose;first repeat dose at 3 h followed by every 6 h till recovery. Patients with acute pulmonary edema (APE) were treated as per standard protocol. RESULTS: All patients had perspiration and cold extremities. Most of them had sting over extremities except two,having over the trunk. Shock was present in 48(53.3%), whereas myocarditis, encephalopathy, pulmonary edema and priapism were present in 38(42.2%), 32(35.5%), 34(37.8%), and 28(31.1%) children, respectively. Eight (8.9%) children had died. The mean value of blood pressure, sodium and potassium among survivors and non-survivors was insignificant. Mortality was significantly higher in children presented after 6 h of bite. Patients, who had metaboloic acidosis, tachpnea, myocarditis, APE, encephalopathy and priapism had significantly higher mortality (p < 0.05). CONCLUSIONS: Symptoms of acidosis, tachypnea, myocarditis, APE, encephalopathy after 6 h of sting are major contributing factors affecting outcome in children with scorpion sting envenomation.

Mode of binding of the tuberculosis prodrug isoniazid to heme peroxidases: binding studies and crystal structure of bovine lactoperoxidase with isoniazid at 2.7 A resolution.

Isoniazid (INH) is an anti-tuberculosis prodrug that is activated by mammalian lactoperoxidase and Mycobacterium tuberculosis catalase peroxidase (MtCP). We report here binding studies, an enzyme assay involving INH, and the crystal structure of the complex of bovine lactoperoxidase (LPO) with INH to illuminate binding properties and INH activation as well as the mode of diffusion and interactions together with a detailed structural and functional comparison with MtCP. The structure determination shows that isoniazid binds to LPO at the substrate binding site on the distal heme side. The substrate binding site is connected to the protein surface through a long hydrophobic channel. The acyl hydrazide moiety of isoniazid interacts with Phe(422) O, Gln(423) O(epsilon1), and Phe(254) O. In this arrangement, pyridinyl nitrogen forms a hydrogen bond with a water molecule, W-1, which in turn forms three hydrogen bonds with Fe(3+), His(109) N(epsilon2), and Gln(105) N(epsilon2). The remaining two sides of isoniazid form hydrophobic interactions with the atoms of heme pyrrole ring A, C(beta) and C(gamma) atoms of Glu(258), and C(gamma) and C(delta) atoms of Arg(255). The binding studies indicate that INH binds to LPO with a value of 0.9 x 10(-6) m for the dissociation constant. The nitro blue tetrazolium reduction assay shows that INH is activated by the reaction of LPO-H(2)O(2) with INH. This suggests that LPO can be used for INH activation. It also indicates that the conversion of INH into isonicotinoyl radical by LPO may be the cause of INH toxicity.

Unusual presentations of Visceral leishmaniasis.

We report 3 cases of Visceral leishmaniasis, who presented with unusual clinical manifestations. One child was diagnosed as hemophagocytic syndrome; another masqueraded with features of leukemoid changes alongwith hemophagocytosis and trilineage myelodysplasia; the third case presented with pyothorax. All the three patients showed amastigote forms of Leishmania donovani and positive serology (rk39 antigen). They showed complete clinical, hematological and parasitological resolution with Amphotericin B therapy.

An unusual cause of meconium peritonitis in a foetus.

Meconium peritonitis is a sterile chemical peritonitis resulting from intestinal perforation in-utero. We present a preterm male neonate weighing 1820 g in whom foetal meconium peritonitis was diagnosed by antenatal utrasonogram. Examination of the newborn in the immediate postnatal period revealed a firm lump of size 5 x 3 cm in the right lumbar and umbilical area. Rest of the abdomen was normal without any clinical evidence of intestinal obstruction. X-ray of abdomen done at 3 hours of life showed a cystic mass with calcified margin. Ultrasonography of abdomen ruled out any definite cause of intestinal obstruction and perforation. He was kept on conservative management. At 11 hours of life the neonate passed a small sticky white mucus plug per rectum followed by black colored meconium of normal consistency 2 hours later. The bowel habit remained regular thereafter. Screening for intrauterine infections and cystic fibrosis was negative. He is under regular follow-up and is now 6 months old with normal bowel habit. A lump of size 2 x 2 cm is still palpable and a small calcified mass is persistent in x-ray. Role of an intestinal mucus plug as the potential factor for intestinal obstruction and subsequent perforation has been highlighted in the present case.