The prevalence of alcohol use disorders using alcohol use disorders identification test (AUDIT) in the Indian setting: - a systematic review and meta-analysis.

There is a wide discrepancy in the epidemiology of alcohol use disorders (AUDs) due to diverse scales and survey approaches. We estimated the prevalence of AUDs by comparing the pooled prevalence based on the alcohol use disorders identification test (AUDIT) Vs. non-AUDIT (all scales other than AUDIT). This review searched the community-based prevalence of AUDs in PubMed, Web of Science, PsycINFO, Scopus, Ovid, and Google Scholar. Articles published during the years from 2000 to 2020 were included. The methodological quality of each study was scored, and data were extracted from the published reports. Pooled prevalence was estimated, and the publication bias was evaluated. Twenty-one studies conducted in different states of India included 73997 community-based respondents, which estimated the overall prevalence of AUDs as 12.5% (95% CI: 9 to 17.3%). The pooled prevalence based on AUDIT was 12.4% (AUDIT ≥8; 95% CI: 8.8 to 17.1%) in which the magnitude of hazardous and harmful alcohol use (8.6%; 95% CI: 5.7 to 12.8%; AUDIT 8-19) was significantly higher than dependent alcohol use (2.3%; 95% CI: 1.1 to 4.8%; AUDIT ≥ 20). The pooled prevalence using the non-AUDIT tool was 14.2(95%; CI: 6-30%). Our findings further reveal that about one in twelve of the population of India have AUDs, and there is a gross variation in the patterns of alcohol use across the country. The high prevalence of AUDs suggests developing a national policy to benefit alcohol use, justifying regional variations.

Pathways to severe mental illness care: A retrospective study of patients seeking psychiatric care at Department of Psychiatry, AIIMS, Delhi.

BACKGROUND AND AIM: Globally, very few patients with mental illness go to health care facilities to receive psychiatry treatment. This study aims to identify pathways used by patients with severe mental disorders who seek mental health care services in the psychiatry unit of AIIMS, New Delhi. MATERIALS AND METHODS: It is a retrospective cross-sectional study with convenience sampling technique was used, and data were collected from 123 caregivers of patients with severe mental illnesses using standardized tools like MINI, BPRS, YMRS and WHO Encounter pathway. RESULTS: The findings revealed that 41.5% of the patients made their first contact with the faith healers, 27.6% with AYUSH medical practitioners, 14.6% with psychiatrists and 12.2% with allopathic medical practitioners. About 26% of the patients reported hallucinations as the first symptom for seeking help. In the majority of cases (96.7%), the patient's relatives made the decision for the patient to seek treatment the first time to manage the symptoms. The psychotic symptoms (65.1%) helped the patient's relatives to take the decision for first seek. The mean delay for seeking treatment from psychiatrists was 13.31 ± 10.6 (months). CONCLUSION: This study showed that a higher proportion of patients received treatment from the faith healer at the first seek, whereas only a few patients approached psychiatrist directly. Hence, there is an immense need to create awareness regarding mental illness and treatment options available.

Prevalence and determinants of workplace violence among nurses in the South-East Asian and Western Pacific Regions: a systematic review and meta-analysis.

BACKGROUND: Workplace violence (WPV) includes verbal abuse, physical violence, bullying or mobbing, assault and sexual harassment. The area has been well researched in the developed and high-income countries among nurses and healthcare professionals, but in the case of the low and upper-middle-income countries, there remains a paucity of comprehensive data on the prevalence of WPV and its contributing factors. AIMS: To estimate the prevalence and determinants of WPV among nurses working in the South-East Asian Region and Western Pacific Regions. DESIGN: Systematic review and Meta-analysis. METHOD: A comprehensive search was done to retrieve articles based on a PRISMA compliant protocol registered in PROSPERO: CRD 42020223605. Study selection, quality assessment and data abstraction were independently done by the team members and discrepancies addressed through mutual consensus. Random-effect meta-analysis, I2 statistics and subgroup analysis were done. RESULTS: The review included 41 studies conducted among 42,222 nurses from 13 countries. The pooled prevalence of WPV, verbal abuse, physical violence, threatening behaviour, physical assault, sexual harassment and bullying/mobbing were 58% (CI 51%-64%), 64% (CI 59%-70%), 23% (CI 14%-34%), 30(CI-11%-52%), 21% (CI 8%-38%), 12% (CI 7%-17%) and 25% (17%-33%), respectively. The various determinants of WPV included attributes related to the patient, nurses and organisation. Moreover, the impact of WPV included physical, psychological repercussions on nurses and the various measures used to manage it. CONCLUSION: Nurses encounter a high level of WPV especially verbal abuse in their workplace settings. Nursing councils and professional nursing organisations should put in their effort towards the formulation and implementation of occupational safety legislation in their respective countries through appropriate political lobbying. RELEVANCE TO CLINICAL PRACTICE: Our review highlights the emerging need to focus on the prevention of WPV among nurses working in lower, middle and upper-middle-income countries. Legislation changes and organisational commitment are vital for ensuring effective policies to combat WPV.

Decline in the mental health of nurses across the globe during COVID-19: A systematic review and meta-analysis.

BACKGROUND: Nurses represent the major proportion of frontline health care professionals delivering 24/7 services to patients with an increased vulnerability towards COVID-19 infection. Mental health issues among nurses during the COVID-19 pandemic are poorly reported across the globe. Henceforth, a systematic review and meta-analysis was performed to explore the prevalence and determinants of mental health outcomes (anxiety, stress, depression, PTSD, insomnia) among nurses across the globe due to the COVID-19. METHODS: A PRISMA compliant systematic review (PROSPERO-CRD 42020204120) was carried out to identify articles from multiple databases reporting the prevalence of mental health outcomes among nurses. Proportion random effect analysis, I2 statistic, quality assessment, and sensitivity analysis were carried out. RESULTS: Pooled data on mental health outcomes were generated from 25 cross-sectional studies: 32% anxiety (95% confidence interval (CI) = 21%-44%, n (number of studies) = 21, N (sample size) = 13 641), 40.6% stress (95% CI = 25.4%-56.8%, n = 10, N = 4204), 32% depression (95% CI = 21%-44%, n = 17, N = 12 294), 18.6% PTSD (95% CI = 4.8%-38%, n = 3, N = 638), 38.3% insomnia (95% CI = 5.8%-78.6%, n = 2, N = 261) and significant risk factors for mental ailments includes; caring for COVID-19 patients, being a female, low self-efficacy, resilience, social support and having physical symptoms (sore-throat, breathlessness, cough, lethargy, myalgia, fever). CONCLUSION: The study results highlighted a higher proportion of poor mental health outcomes namely, anxiety, stress, depression, PTSD and insomnia among nurses from different parts of the world. Poor mental health outcomes among nurses warrants the need to implement proactive psychological interventions to deter the collapse of health care systems in responding to the pandemic and in particular all possible efforts should be undertaken to mitigate the risk factors. Health care organizations should provide support to nurses with sufficient flexibility. The disaster preparedness plan envisaged by nations should have provisions to address the mental health of nurses. Greater investment in addressing the global shortage of nurses should be given priority in national health policies. Attractive salary packages should be offered to nurses to prevent their emigration from low- and middle-income countries (LMICs). REGISTRATION: PROSPERO (CRD42020204120).

Impact of structured teaching program on the parent's knowledge of domiciliary management of seizure-A randomized controlled trial.

The aim of study was to assess the combined effectiveness of structured teaching program (STP) and patient information pamphlet (PIS) on caregivers' knowledge with regard to domiciliary management of seizure as compared with PIS alone. Study participants included caregivers of typically developing children aged 1-18 years with at least one episode of convulsion. The enrolled participants were allocated to either of the two groups: intervention group (STP along with PIS) and control group (PIS). The outcome was measured by a structured questionnaire - 'first-aid measures knowledge questionnaire'. Baseline knowledge scores were recorded and compared with postintervention scores measured at one-month follow-up. The preintervention knowledge scores were comparable in the two groups (p = 0.72). The control group has shown no significant difference in the knowledge scores at one-month follow-up (p = 0.58). Postintervention knowledge scores (p < 0.01) and mean difference in the knowledge scores (p < 0.01) were significantly higher in the intervention group when compared with controls. Structured teaching program regarding first-aid measures for convulsion along with PIS was effective in improving the knowledge of caregivers than PIS alone.

Quality of Life in People Living with HIV (PLWH).

A cross-sectional, descriptive study was conducted to assess Quality of life (QOL) of people living with HIV (PLWH) at ART clinic at a tertiary care centre. The study population conveniently selected comprised of 200 PLWH consenting to be apart of the study who met the inclusion criteria. The ethicalpermission was taken from the centre. The lowest quality of life is seen in social relations, followed by physical quality of life. There was positive association of age with physical domain, independence and spiritual domain of quality of life and significant p value. Positive association was seen between marital status, education and income and quality of life.

Fatigue and depression and sleep problems among hemodialysis patients in a tertiary care center.

High prevalence of sleep problems, fatigue and depression are reported in maintenance hemodialysis (MHD) patients. To assess fatigue, depression, sleep problems and their co-relates among MHD patients in a tertiary care center in India, we studied 47 patients on MHD for >3 months. Patients demographic, medical and co-morbidity profile were recorded. Pittsburgh Sleep Quality Index (poor sleeper if score >5) and Epworth Sleepiness Scale (EPSS, abnormal daytime sleepiness if score >13) were used to assess sleep abnormalities and quality. Beck Depression Inventory (BDI) was used to screen for depression. Depression was classified on BDI scores as mild-moderate (score 11-30) and severe (score >30). Fatigue Severity Scale was used to assess fatigue (score ≥36 indicates fatigue). The correlations of these parameters among themselves and with social and demographic parameters were also analyzed. The mean age of the study population was 37.1 ± 13.1 (range 19-65 years) years, with 89.3% being males. The majority (68.1%) of the MHD patients was poor sleepers, but only five (10.6%) patients had borderline or abnormal daytime sleepiness. Of the patients, 44.7% reported fatigue and (72.3%) had depression (mild to moderate in 59.7% and severe in 12.6%). Fatigue scores were found to be significantly associated with lesser frequency of dialysis (P < 0.05). There was higher daytime sleepiness in patients who were working (mean EPSS score 6.2 ± 3.7) than who were unemployed (mean EPSS score 3.9 ± 2.7). Depression was found to be higher in those who were paying for the treatment themselves (mean BDI score 20 ± 11.8) as compared with those who were getting medical expenditure reimbursed (mean BDI score 12.9 ± 8.8). Fatigue positively correlated with that of daytime sleepiness (P = 0.02), poor nighttime sleep (P = 0.02) and depression (P=0.006). In the present study, there was no correlation (P <0.05) found between daytime and night time sleep and depression. We found a high prevalence of fatigue, depression and poor sleep quality in our MHD patients. These abnormalities are closely related to each other and to the socioeconomic and demographic profiles of the population.

HIV knowledge improvement among nurses in India: using a train-the-trainer program.

Nurses play a major role in the health care delivery system; therefore, education of nurses is critical to successful prevention programs for persons with HIV. Little is known about nurses' knowledge of HIV in India. The purpose of this study was to determine the effects of a nurse-led train-the-trainer HIV education program on improving the HIV knowledge of nurses. A group of senior nurses (N = 10), were responsible for training a cohort of 10 nurses each, totaling 100 nurses. The 2-day training program included HIV epidemiology and etiology, infection control, psychosocial support, counseling, modes of transmission, natural history of the disease, symptoms of early and late disease, diagnostic testing, and legal and ethical issues. Pre- and posttest scores were calculated using a self-administered structured questionnaire that measured HIV-related knowledge in terms of cognitive and transmission knowledge. Paired t-tests indicated that both measures of HIV knowledge improved significantly from pretest to posttest.

Multidimensional health status of HIV-infected outpatients at a tertiary care center in north India.

BACKGROUND: Quality of life (QOL) scores inform researchers acquainted with such tools about patients' perception of various domains of their health. The scores provide a useful denominator for clinical trials, especially in chronic diseases with therapeutic side effects, such as HIV. However, in clinical settings, there is a felt need of description of problems commonly perceived by patients. AIM: This study describes the multidimensional health-related issues of HIV-positive patients. SETTINGS AND DESIGN: Cross-sectional design with convenient sampling was used to recruit 138 HIV-positive patients at the outpatient section of the Department of Medicine of a tertiary care hospital in north India. MATERIALS AND METHODS: A structured questionnaire was used to collect information about health-related problems. Identified problems were assessed using a Likert scale for severity. RESULTS: Out of the 20 assessed problems, the patients reported positive for an average of 12.01 +/- 3.78 problems. The most prevalent problems were those related to emotions (98.6%), lack of energy (96.4%), and health perception (92.0%). The most distressing problems were 'feeling that health was not good' (77.5%) and 'health was bad' (75.4%). The number of problems reported was significantly related to weight loss ( P = 0.006) and clinical category ( P = 0.023). A significant correlation was observed between weight loss and problems in social activities ( P P P P = 0.002). CONCLUSION: Many patients have significant problems in dimensions other than physical. A physician's awareness about these problems is important for a holistic patient management.

Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic.

BACKGROUND: In many developing countries, out-of-pocket payment remains a primary mechanism by which patients infected with HIV access treatment. In India, this has been changing as the National AIDS Control Organization (NACO) has been rolling out free antiretroviral therapy throughout the country since 2004. The vast majority of patients, however, remain without access to free medicines. METHODS: A retrospective chart review was performed on data obtained from a registry of ninety-three (93) patients attending a self-pay clinic at the All India Institute of Medical Sciences in Delhi, India. Multivariable Cox proportional hazard and logistic regression models were explored to assess the relationship between lost-to-follow-up status and the predictor variables: age, sex, household income, baseline CD4 count, and distance from clinic. RESULTS: Lost-to-follow-up rates were very high; 68% (63/93) were lost-to-follow-up till the time of chart review, including 59% (55/93) who were lost within one year. In both regression models, younger age, low baseline CD4 counts, and low income level were significantly associated with increased risk of lost-to-follow-up. Additionally, there was a significant interaction between income and CD4 counts. The patients with both low CD4 counts and low income level were more likely to be lost-to-follow-up than would be predicted by each covariable alone. CONCLUSION: In this small cohort of AIDS patients attending a self-pay antiretroviral clinic at a large tertiary care center in Delhi, India, follow-up rates were quite poor. Poorer patients tended to present to clinic with more depressed CD4 counts and were less likely to be retained in care. These findings indicate that greater strides must be taken to improve the recruitment and retention of poor patients. The expansion of free antiretrovirals is one step among many necessary to achieve this objective.