Out-of-pocket and catastrophic health expenditure among patients of sexually transmitted infections at a tertiary care center: A cross-sectional study.

Context: Economic burden imposed by sexually transmitted infections (STIs) is substantial in low-middle-income countries like India, in spite of the fact that national programs for controlling STIs are operational. Aims: The aim of this study was to estimate the out-of-pocket expenses and catastrophic health expenditure (CHE) incurred by patients of STIs and analyze expenditure pattern in relation to various clinical and sociodemographic characteristics. Settings and Design: This was a hospital-based cross-sectional study among patients attending Suraksha Clinic. Subject and Methods: The study was conducted among patients aged ≥18 years. Data were collected regarding various direct and indirect expenses incurred, after adjusting any reimbursement or waive off. Total costs exceeding 10% of annual household income were considered catastrophic. Stepwise regression analysis was used to analyze predictors, and P < 0.05 was considered statistically significant. Results: Out of 157 patients, most were suffering from herpetic ulcers (27.4%). The median and interquartile range (IQR) for total OOPE of STI management was ₹1950 (IQR 1035-5725). Direct expenditure constituted major expenses with a median of ₹1850 (IQR 787.50-5385.0). The cost of STI management was catastrophic in 15.2% of cases. Lower socioeconomic status, longer traveling distance, overnight stay as a part of seeking treatment at Suraksha Clinic, previous history of other than allopathic treatment, and quack consultation were found to be independent predictors of CHE. Conclusions: Despite free diagnostic and treatment services to STI patients under the National AIDS Control Programme, many incurred considerable costs and catastrophic expenditure toward STI care. Better outreach of health services is required to maximize STI control and lower financial morbidity.

Transcranial direct current stimulation as early augmentation in adolescent obsessive compulsive disorder: A pilot proof-of-concept randomized control trial.

BACKGROUND: Transcranial direct current stimulation (tDCS) is proven to be safe in treating various neurological conditions in children and adolescents. It is also an effective method in the treatment of OCD in adults. AIM: To assess the safety and efficacy of tDCS as an add-on therapy in drug-naive adolescents with OCD. METHODS: We studied drug-naïve adolescents with OCD, using a Children's Yale-Brown obsessive-compulsive scale (CY-BOCS) scale to assess their condition. Both active and sham groups were given fluoxetine, and we applied cathode and anode over the supplementary motor area and deltoid for 20 min in 10 sessions. Reassessment occurred at 2, 6, and 12 wk using CY-BOCS. RESULTS: Eighteen adolescents completed the study (10-active, 8-sham group). CY-BOCS scores from baseline to 12 wk reduced significantly in both groups but change at baseline to 2 wk was significant in the active group only. The mean change at 2 wk was more in the active group (11.8 ± 7.77 vs 5.25 ± 2.22, P = 0.056). Adverse effects between the groups were comparable. CONCLUSION: tDCS is safe and well tolerated for the treatment of OCD in adolescents. However, there is a need for further studies with a larger sample population to confirm the effectiveness of tDCS as early augmentation in OCD in this population.

Coping and emotions of global higher education students to the Ukraine war worldwide.

Trauma scientists have raised the alarm about the devastating consequences of the Ukraine war on mental health. We examined how higher education students-as indirect victims-coped with this conflict and how they emotionally reacted during 2022. We involved 2314 students from 16 countries through an online survey. A structural equation model indicated significant relations between war-related worry about military and macroeconomics domains and two coping strategies (opposition, support giving), in turn significantly linked with six emotions. The model was strongly invariant across gender, study field, and geographic area. The most frequent emotions were anger and anxiety, followed by two future-centred emotions (hopelessness and hope). Emotions were more frequent for females and students of the countries geographically close to the war region. Our findings call for evidence-based policy recommendations to be implemented by institutions to combat the negative short and long-term psychological sequelae of being witnesses of armed conflicts.

Psychiatric Co-Morbidities and Profile of Patients with Irritable Bowel Syndrome in Northern India.

OBJECTIVES: To study sociodemographic and clinical variables, including psychiatric co-morbidities, in patients with irritable bowel syndrome. METHODS: A total of 158 patients attending a medical gastroenterology clinic in a tertiary care center in Northern India were screened, from whom 100 were selected for the study. Rome IV criteria were used to diagnose IBS, and the severity of symptoms was assessed by the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS). Psychiatric co-morbidities were screened via clinical evaluation, and if present, a diagnosis was made as per DSM-5. The Depression, Anxiety, and Stress Scale-21 (DASS-21) and Somatic Symptom Scale-8 (SSS-8) were used to assess depression, anxiety, stress, and somatic symptoms. RESULT: The mean age of cases was 35.6 years' old, and the majority of cases (i.e., 38.0%) were between 18 and 29 years' old. Males comprised 62.0% of the sample and females 38.0%. Moderate IBS was present in 61.0% of the cases. Evaluation via DASS-21 revealed that 53.0% were in the moderate category of depression, 43.0% had moderate anxiety, and 36.0% had moderate stress. The somatic symptom scale revealed that 48.0% patients were in the high category. Psychiatric co-morbidities were present in 29.0% of cases. Depressive disorders were the most common psychiatric co-morbidity. CONCLUSIONS: Patients with IBS presenting to a tertiary care center in Northern India were primarily young males living in semi-urban areas who belonged to the Hindu religion, were married, and had a nuclear family. Patients with IBS commonly have associated psychiatric disorders; anxiety disorders and depression are most common.

Psychometric properties and factor structure of the suicidal narrative inventory in major depression: A multicentric evaluation.

BACKGROUND: The Suicidal Narrative Inventory (SNI) is a 38-item self-report measure developed to assess elements of the suicidal narrative, a subacute, predominantly cognitive, presuicidal construct. Our objectives were to assess the factor structure, validity, and reliability of the SNI-38 among adults with major depressive disorder (MDD). METHODS: Using a cross-sectional design, we administered the Hindi version of the SNI along with other self-report measures to adults with MDD, recruited from 24 tertiary care hospitals across India. Confirmatory factor analysis (CFA) was performed to assess the factor structure of SNI-38. Reliability (internal consistency) was assessed using Cronbach's alpha (α). Convergent, discriminant, and criterion validity of the SNI-38 were tested by comparing it against other appropriate measures. RESULTS: We collected usable responses from 654 Hindi-speaking participants (Mean age = 36.9 ± 11.9 years, 50.2% female). The eight-factor solution of the SNI showed good model fit indices (χ2[637] = 3345.58, p <.001, CFI =.98, and RMSEA =.08). Internal consistencies for the SNI subscale scores were good to excellent, α ranging from .73 to.92. While most subscales significantly converged with other measures, associations were comparatively weaker and inconsistent for the 'thwarted belongingness' and 'goal reengagement' subscales. CONCLUSION: Consistent with prior data, our study confirmed an eight-factor solution and demonstrated adequate psychometric properties for the Hindi version of the SNI-38 in our sample. These findings provide empirical support for the use of SNI to assess the suicidal narrative among Indian adults with MDD.

Gender and Geographical Distribution of Editorial Board Members of Three Leading Suicide Journals.

Background: Despite the recent progress of women in academia, there is an underrepresentation of female editors in academic journals. Additionally, although suicide affects more low- and middle-income countries (LMICs) than high-income countries, little is known about the geographical distribution of editors in suicidology journals. Aims: We aimed to determine the gender and geographical distribution of the editorial board members (EBMs) of leading suicide journals. Method: Data were collected between November 27 and 29, 2022. We purposively selected suicidology journals, searched the journal websites, and extracted data on the gender and affiliated country of the EBM to identify the continent and income category of the country. Results: The proportion of female EBMs was 32.37% with better representation in senior positions. Only six positions (3.47%) were occupied by four individuals affiliated with LMIC backgrounds. The highest number of EBMs was located in North America (58.38%) while one member was from Africa. Limitations: Only three purposively selected journals were scrutinized. Conclusion: This study reveals that approximately one third of the editorial positions were occupied by women and less than 4% of editors were from LMICs, where suicide represents a significant burden.

The Efficacy of Transcranial Magnetic Stimulation in the Treatment of Obsessive-Compulsive Disorder: An Umbrella Review of Meta-Analyses.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) has been increasingly used for treating obsessive-compulsive disorder (OCD). Although several meta-analyses have explored its effectiveness and safety, there is no umbrella review specifically focused on rTMS for OCD. This umbrella review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and analyzed relevant meta-analyses on rTMS for OCD. METHODS: Twenty-three articles were identified from PubMed, and after screening, 12 meta-analyses were included in the review. The studies analyzed in the meta-analyses ranged from 10 to 27, with total participants ranging from 282 to 791. The most commonly studied regions were the dorsolateral prefrontal cortex (DLPFC), supplementary motor area (SMA), and orbito-frontal cortex (OFC). RESULT: The majority of the meta-analyses consistently supported the effectiveness of rTMS in reducing OCD symptoms when applied to the DLPFC and SMA. Encouraging results were also observed when targeting the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC) through deep transcranial magnetic stimulation (dTMS). However, there was a high level of heterogeneity in the findings of nine out of 12 meta-analyses. CONCLUSION: In conclusion, existing evidence suggests that rTMS targeting the DLPFC and SMA consistently reduces OCD symptoms, but targeting the mPFC and ACC through dTMS shows variable results. However, the high heterogeneity in the study findings indicates a need for further research and standardization in the field.

Electroconvulsive therapy in South Asia: Past, present, and future.

The practice of electroconvulsive therapy (ECT) varies both between and within countries. We aimed to review historical and current trends in ECT practices, perceptions, and legislations in South Asia, a region with a high burden of mental illness and suicide. We searched MEDLINE (PubMed) and Google Scholar databases for relevant literature on ECT from each country. Additionally, a team of country-specific investigators performed supplemental searches and contacted key country contacts for relevant information. Relevant data were abstracted under the following headings: ECT practices, perceptions, and legislations. Knowledge gaps and research priorities were synthesized. Modified bitemporal ECT, delivered using brief pulse devices, was most commonly offered across institutions. Schizophrenia, not affective illness, was the most common indication. Electroencephalographic monitoring of seizures was rarely practiced. Thiopentone or propofol was preferred for anesthetic induction, while the favored muscle relaxant was succinylcholine. In India and Sri Lanka, perceptions about ECT were largely favorable; not so in Pakistan and Nepal. Only India and Pakistan had laws that governed any aspect of ECT practice; ECT practice guidelines were available only in India. There is a lack of research on efficacy, ECT in special populations, continuation ECT practices, and interventions to improve ECT-related perceptions. Most regional institutions offered modified brief-pulse ECT, and schizophrenia was the most common indication. Knowledge of and attitude towards ECT varied between countries. There is a need to develop a regional ECT consortium to facilitate uniform training, advocacy efforts, and the development of regional practice guidelines.

Exploring the role of ChatGPT in patient care (diagnosis and treatment) and medical research: A systematic review.

Background: ChatGPT is an artificial intelligence based tool developed by OpenAI (California, USA). This systematic review examines the potential of ChatGPT in patient care and its role in medical research. Methods: The systematic review was done according to the PRISMA guidelines. Embase, Scopus, PubMed and Google Scholar data bases were searched. We also searched preprint data bases. Our search was aimed to identify all kinds of publications, without any restrictions, on ChatGPT and its application in medical research, medical publishing and patient care. We used search term "ChatGPT". We reviewed all kinds of publications including original articles, reviews, editorial/ commentaries, and even letter to the editor. Each selected records were analysed using ChatGPT and responses generated were compiled in a table. The word table was transformed in to a PDF and was further analysed using ChatPDF. Results: We reviewed full texts of 118 articles. ChatGPT can assist with patient enquiries, note writing, decision-making, trial enrolment, data management, decision support, research support, and patient education. But the solutions it offers are usually insufficient and contradictory, raising questions about their originality, privacy, correctness, bias, and legality. Due to its lack of human-like qualities, ChatGPT's legitimacy as an author is questioned when used for academic writing. ChatGPT generated contents have concerns with bias and possible plagiarism. Conclusion: Although it can help with patient treatment and research, there are issues with accuracy, authorship, and bias. ChatGPT can serve as a "clinical assistant" and be a help in research and scholarly writing.