Effect of a video-assisted fall prevention program on fall incidence in community-dwelling older adults during COVID.

BACKGROUND: The study evaluated the effectiveness of a video-assisted exercise intervention program on fall incidence, activities of daily living, and fear of falling in community-dwelling older adults. METHODS: A video-assisted 16-week exercise intervention consisting of stretching, strengthening, balance, and dual-task training was delivered to randomly selected 95 older adults with a high risk of falls. The fidelity of implementation was assessed for three areas; exercise program delivery, participant receipt, and enactment. RESULTS: The fall incidence reduced significantly by 45% (IRR 0.55, (95% CI, 0.13-0.86) and difficulty in daily activities decreased (OR: 0.74, 95% CI, 0.16 - 0.96) among participants in the intervention group. Fear of falls did not show any significant difference in the groups at the 12-month follow-up. CONCLUSION: The video-assisted exercise program was found to be effective in reducing fall incidence among older adults at a higher risk of falls.

Association between daily activities and fall in older adults: an analysis of longitudinal ageing study in India (2017-18).

BACKGROUND: Declining functionality affects an individual's musculoskeletal integrity increasing the risk of fall and disability. Individuals with severe functional limitations are 5 times more likely to experience a fall. Thus, this paper investigated the association between functional decline and falls in older adults. METHODS: This study uses secondary data from the Longitudinal Aging Study in India (2017-18). A total of 31,477 people over the age of 60 are included in the study. Descriptive statistics and bivariate analysis were performed to determine the association between activities of daily living (ADL), instrumental activities of daily living (IADL) and fall. Adjusted odds ratio was used to determine the association of ADL and IADL with fall while controlling for age, gender, balance and gait impairments. RESULTS: The study reported 6352 fall episodes in 3270 participants aged 60 and above, over a period of 2 years. More than 30% of participants reported difficulty in ADL and IADL. Age and gender adjusted odds of fall were higher in participants with difficulty in more than 4 ADLs (AOR:1.32; CI:1.08 - 1.67) and in more than 2 IADL (AOR: 1.39; CI:1.02 - 1.89). Similarly, the odds of fall were higher for difficulty in ADL (AOR:1.31; CI:1.11 - 1.73) and IADL (AOR of 1.18; CI:1.07 - 1.29) controlling for gait and balance impairment. Difficulty in pushing-pulling objects (AOR: 1.30; CI: 1.15 - 1.46 & AOR: 1.40; CI: 1.21-1.61) and getting up from the chair (AOR: 1.12; CI:1.01-1.26 & AOR: 1.27; CI: 0.99 - 1.26) was significantly associated with fall when adjusted for age, gender and balance and gait parameters. CONCLUSIONS: This study provides the new insights into the association of fall and risk of functional decline, especially difficulty in pushing and pulling objects and getting up from a chair, can be incorporated in the primary screening of fall risk assessment.

A qualitative study exploring women's journeys to becoming smokers in the social context of urban India.

In India, the prevalence of smoking among women is increasing, and the reasons behind this are unclear. We aimed to study the factors leading to initiation and maintenance of the smoking habit in women in Pune, India. Twenty-seven urban women smokers, ranging from 21 to 60 years of age (31.96 ± 10.70 years), were interviewed between September 2015 and February 2016. The in-depth interviews consisted of questions on pre-decided categories, including initiation, motivation to continue smoking, and risk perception. Thematic analysis revealed that peer pressure, curiosity, fascination, experimentation, and belonging to a group were factors that led to initiation, while lack of alternatives for stress relief, work environments, and lack of leisure time activities provided circumstances to continue smoking. Participants recognized a sense of liberation and independence from smoking cigarettes and perceived health risks as minor and distant. These findings can be used to develop or modify interventions to prevent and control smoking among urban Indian women.

Physiological and Psychological Effects of Medically Supervised Fasting in Young Female Adults: An Observational Study.

Background Large-scale empirical and observational studies confirm the safety and efficacy of short-term intermittent fasting; however, prolonged fasting (fasting for more than two days or more) is not well studied. This study investigated the safety, physiological, and psychological effects of a medically supervised fasting (MSF) regimen on healthy volunteers. Methods In this observational study, 117 female participants with an average age of 21.02 (± 1.45) years underwent 10 days of medically supervised fasting. Daily symptom scores and 24-hour food recalls were collected, along with serum levels of vitamin D and calcium, a complete blood count, anthropometric measurements, quality of life (QoL), and subjective mood, anxiety, and depression scores, at the baseline and at the end of fasting. Results Compared to baseline, significant improvements were observed in vitamin D levels (z = -8.79, p = 0.000), calcium levels (z = -4.08, p = 0.000), red blood cell count (z = -4.61, p = 0.000), and hemoglobin levels (z = -5.57, p = 0.00). Improvements were observed in physical QOL (t (116) = -4.51, p = 0.000); psychological QOL (t (116) = -4.70, p = 0.000); and social QOL (t (116) = -2.68, p = 0.008). We also observed significant reductions in body weight (55.83 (±11.38), 52.99 (±10.94); p = 0.00) and other anthropometric measures. More than 80% (n = 94) experienced at least one symptom associated with fasting. The symptoms associated with fasting changed significantly (p<0.05), with most symptoms peaking from day 3 to day 7 of fasting with remission from day 8 onwards. Conclusion Our findings suggest that MSF is associated with significant improvements in physiological and psychological variables. The symptoms associated with MSF are to be considered in clinical decision-making, and follow-up of patients on fasting therapy, particularly during the peaking of symptoms, may be warranted.

Basic gait pattern and impact of fall risk factors on gait among older adults in India.

BACKGROUND: An unstable gait pattern is an indicator of an increased risk of falls among older adults. Data on basic gait parameters is useful in the early identification of gait impairment. However, reference gait measurements are not available in low- and middle-income countries. RESEARCH QUESTION: What are the normative reference values of gait parameters and do fall risk factors such as impaired balance, functional difficulty, and multimorbidity affect the gait patterns of older adults in India? METHODS: A cross-sectional data of 659 older adults were collected using a semi-structured schedule. Gait parameters were measured using wearable sensors. Descriptive statistics, independent t-test, and one-way ANCOVA were used to determine the significant difference (p < 0.05) in gait parameters across the risk factors. RESULTS: A mean stride length of 123.00 ±â€¯15.19 cm, stride velocity of 110.57 ±â€¯17.57 cm/s, and a cadence of 106.14 ±â€¯11.44 steps/minute were reported in the study. Functional difficulties and balance impairment were the two major risk factors that affected stride velocity, stride length, and cadence after adjusting for age and height. No difference in gait parameters was observed among participants with and without multimorbidity. SIGNIFICANCE: This study provides a baseline or reference values of various gait parameters measured on a large sample of population aged 60 and above from India. Assessment of gait patterns and associated risk factors in a clinical setup will help identify the older adults at risk of falls and reduce the enormous burden of fall injuries. Since gait parameters show a large variation across geographical regions, it is important to have region-specific reference values.

Lived experiences of people with mobility-related disability using assistive devices.

PURPOSE: Assistive devices (ADs) are an essential component for people with disability to achieve functional independence and improved quality of life. The current study explored lived experiences of adults with mobility related disability using ADs, with reference to access to ADs, facilitators and barriers in access, use and adaptation of devices and whether any changes experienced after use of ADs. MATERIALS AND METHODS: Data were collected through interviews using narrative inquiry approach with 25 individuals having mobility related disabilities and who had experience of using one or more ADs for minimum 12 months. Transcripts were analyzed using thematic analysis procedure. RESULTS: The analysis resulted in four main themes. The first theme of "access to ADs" revealed apathy of and disappointment towards public health service providers. The second theme "life with ADs" described personal and social adaptation of ADs. Third important theme was "barriers to use of ADs" which brought out physical barriers in public places, lack of home modification, and inaccessible built environment. Major concern was economic dependence, out of pocket expenditure and lack of services for maintenance and upgradation of ADs. The last theme "achieving a better life" described a sense of achievement with ease of mobility, relief of agony and gaining independence. CONCLUSION: In spite of the challenging experiences of disability, usage of ADs has increased social participation, independence and self-esteem. These major components helped participants to achieve "normalcy" in life.Implications for rehabilitationEarly identification of need of AD is necessary to support disabled individualAvailability, accessibility and affordability of appropriate devices at public health centres will improve rehabilitationRaising awareness and removing stigma about ADs will improve utilization of rehabilitative servicesTimely use and use of appropriate devices are necessary to improve quality of lifeUpgradation and maintenance of devices is a major concern which need to be linked with rehabilitation service provision.

Correlates of Functional Limitations in Midlife: A Cross-Sectional Study in Middle-Aged Men (45-59 Years) from Pune.

BACKGROUND AND OBJECTIVE: The present article aims to determine the correlates of functional limitation in middle-aged men (45-59 years age) in the slums of Pune, India. MATERIALS AND METHODS: A total of 553 community-dwelling middle-aged men were randomly selected from the study area. Data on demographic characteristics, health-related conditions, and social and psychological determinants of health were collected using a pretested, structured questionnaire. Functional ability was assessed using the Pune-Functional Ability Assessment Tool. Univariate analyses and bivariate logistic regression analyses were carried out to examine the associations between various correlates and functional limitations. RESULTS: A total of 55.2% of the respondents displayed functional limitations. Univariate analysis identified significant correlates of functional limitations, which were increasing age, nature of the occupation, presence of chronic diseases, self-reported aches and pains, vision problems, previous hospital admission, and stress. Binary logistic regression displayed the higher odds of having functional decline in men with age above 55 years (odds ratio [OR] = 2.592; 95% confidence interval [CI] = 1.597-4.207), unskilled occupation (OR = 1.681; 95% CI = 1.050-2.692), chronic disease (OR = 2.608; 95% CI = 1.553-4.378), and reporting aches and pains (OR = 6.605; 95% CI = 3.732-11.689) as compared to their counterparts. CONCLUSION: This study has identified the magnitude of functional decline and its risk factors for midlife men. These study findings suggest that men having several risk factors should be monitored to protect against accelerated functional loss. These findings are important because functional decline has implications on older adult's health and disease conditions. A better understanding of these factors will help to develop health promotion interventions for men in midlife.

Predictors of functional disability with focus on activities of daily living: A community based follow-up study in older adults in India.

BACKGROUND: Disability in activities of daily living is a growing concern among older populations all over the world. India has one of the rapidly ageing populations and predicted burden of functional disability is higher for Indian older adults as compared to other ageing Asian countries. METHODS: Total 1140 aged 60 years and over participated in a baseline study. 560 of them participated in the prospective cohort study conducted in the city of Pune, India. An interview and functional assessment using a questionnaire and Pune-FAAT tool was carried out in 2013-14. Binary logistic regression was used to obtain the factors that increased the odds of having ADL disability at follow-up. RESULTS: The mean age of the study population was 69.73±5.48years. Squatting, walking and climbing functions were affected significantly. Total 376 participants (67.1%) reported difficulties and/or disability in performing activities of daily living (ADL) at follow-up. Hospitalization (OR=3.6; 95% CI: 1.9-6.7), being female (OR=2.3; 95% CI: 1.5-3.5), presence of two or more chronic diseases (OR=1.7; 95% CI: 1.1-2.7), experience of memory loss (OR=1.9; 95% CI: 1.2-3.0) and feeling of loneliness (OR=2.3; 95% CI: 1.0-5.3) increased the odds of being in the "With disability" group at follow-up. Apart from this, self-rated health and self-reported depression were associated with limitations in ADL. CONCLUSION: Hospitalization and being female appeared to be the most significant risk factors for disability in urban older adults in India. Rehabilitation services after hospitalization, physical exercise, effective control on chronic illness, and social participation to reduce loneliness is recommended.

Opinions and perceptions regarding the impact of new regulatory guidelines: A survey in Indian Clinical Trial Investigators.

BACKGROUND: Clinical research in India experienced dramatic changes with series of stringent guidelines introduced by regulatory authorities. These guidelines posed significant challenges for the clinical trial industry. OBJECTIVE: To assess the perceptions and opinion of Indian Investigators about the new regulatory guidelines. METHODS: We developed a survey questionnaire on recent regulatory guidelines which was hosted on a web portal. Seventy-three investigators from India participated in the survey. RESULTS: Central registration of Ethics Committees (ECs) was agreed by 90.1% participants, 76.8% participants agreed to compensation of subjects for study related Serious Adverse Events (SAE's). The compulsion to include government sites in clinical trials was not agreed by 49.3% participants while 21.2% agreed to it. Restriction on a number of trials per investigator was agreed by 49.3% of participants while 40.9% disagreed. Participants (50.7%) disagreed to the introduction of audio-video (AV) recording of informed consent, 36.6% agreed and 12.7% were neutral. DISCUSSION: Participants observed that post central registration; ECs have improved systems with adequate member composition, functional Standard Operating Procedures, and timely approvals. Participants agreed that compensation of study related SAE's would assure subject protection and safety. The introduction of AV consenting was strongly debated sighting sociocultural issues in the implementation of the same. CONCLUSION: Participants endorsed guidelines pertaining to the central registration of ECs, SAE related compensation. Restrictions on a number of trials per investigator and AV consenting were debated ardently. The response of the survey participants who are clinical trial investigators in India showed general acceptance, effectiveness and anticipated compliance to the new regulatory guidelines.

A systematic review on the prevalence and utilization of health care services for reproductive tract infections/sexually transmitted infections: Evidence from India.

Several studies have reported prevalence rate of reproductive tract infections (RTIs) but very few studies have described health seeking behavior of patients. This paper critically looks at and summarizes the available evidence, systematically. A structured search strategy was used to identify relevant articles, published during years 2000-2012. Forty-one full-text papers discussing prevalence and treatment utilization pattern were included as per PRISMA guidelines. Papers examining prevalence of sexually transmitted diseases used biochemical methods and standard protocol for diagnosis while studies on RTIs used different methods for diagnosis. The prevalence of RTIs has not changed much over the years and found to vary from 11% to 72% in the community-based studies. Stigma, embarrassment, illiteracy, lack of privacy, cost of care found to limit the use of services, but discussion on pathways of nonutilization remains unclear. Lack of methodological rigor, statistical power, specificity in case definitions as well as too little discussion on the limitation of selected method of diagnosis and reliance on observational evidence hampered the quality of studies on RTIs. Raising awareness among women regarding symptoms of RTIs and sexually transmitted infections and also about appropriate treatment has remained largely a neglected area and, therefore, we observed absence of health system studies in this area.

Development and preliminary validation of a new scale to assess functional ability of older population in India.

Identifying the decline in functional ability and preventing disability is the critical element of the quality of life of an old age. However, the lack of contextual scale to assess the decline in functional capacity is a major issue. Objective of this study is to design the functional ability assessment scale for elderly people in India and test its psychometric properties. Random sample of 659 individuals above 60 years of age from western part of India was recruited. This paper outlines the construction, reliability and validity of a newly developed 14 item scale named as Pune-Functional Ability Assessment Tool (Pune-FAAT). The factors were extracted using the principal component analysis. Two-factor-structure of scale was accepted after applying the K1 rule, scree plot and parallel analysis method. The two factor structure yielded variance of 64.4%. The psychometric properties of the scale were examined using confirmatory factor analysis. The scale has an excellent reliability (Cronbach's α 0.928) and very good test-retest reliability (r=0.884). Each subscale demonstrated good internal consistency (Subscale I - Cronbach's α 0.938 and Subscale II - Cronbach's α 0.762). Excellent convergent validity with Standford's health assessment questionnaire (r=0.959). Discriminant validity was very good as FAAT index showed significant difference in young adults (mean±SD 1.11±0.24) and older adults (mean±SD 1.69±0.70). This new measure is a potentially valuable research tool for investigating older adult's functional ability to perform basic and complex daily activities.

Perspective of tuberculosis patients on family support and care in rural Maharashtra.

BACKGROUND: Role of patients' family in TB-control programme has received least attention in research and negligible attention is paid to support and care experiences of patients in rural societies. AIM: Present study aims at collecting qualitative data on how tuberculosis patients define support and care during illness, and document their experiences and perspectives about care and support. METHODS: This is a qualitative study with grounded theory approach. Data were collected by conducting series of 15 focus group discussions (FGD) covering 113 patients from rural Pune district of Maharashtra. Thematic analysis was undertaken after preparing detailed transcripts of each FGD. RESULTS: Good support and care was considered as receiving necessary attention and help in daily routine, monitary help, emotional and moral support and motivation for early recovery. Family provided support by accompanying to the health centre, reminding about medicines, giving meals. Female patients reported less sympathetic attitude and unfair treatment at husband's home while males received emotional and physical support from spouse. Stigma led to discrimination and hindered the support and care mechanism. CONCLUSION: Family awareness and preparedness for providing support need to be strengthened. Counselling and motivation during each visit are the keys to successful completion of treatment. There is need to make counsellors/psychologists available in the existing system.