Prevalence patterns and associated factors of elder abuse in an urban slum of eastern India.

BACKGROUND: The prevalence of elder abuse in various parts of the world has been reported between 2.2 and 90.4%. According to some studies conducted in India, elder abuse prevalence ranges between 9.6 to 61.7%. Yet, elder abuse is an underreported issue. Most available evidence shows the involvement of close family members and caregivers in the abuse of older adults. Several factors associated with various forms of elder abuse need to be studied further. This study has attempted to capture the prevalence, pattern and associated factors of elder abuse in urban slums. METHODS: This study was a cross-sectional community-based study conducted between August 2019 to August 2020 in an urban field practice area of the All India Institute of Medical Sciences, Bhubaneswar. It covers four wards of the Bhubaneswar Municipal Corporation, served by the Urban Primary Health Centre, IRC Village, Nayapalli. A total of 360 participants aged 60 years and above were included in this study. They were interviewed using various semi-structured interview schedules. Validated study tools such as Activities of Daily Living (ADL- Barthel Index), Hindi Mental Scale Examination (HMSE), Geriatric Depression Scale (GDS), and Vulnerability to Abuse Screening Scale (VASS) were also used to assess various factors. RESULTS: Approximately one in five (19.4%) older adults reported some form of abuse. The types of elder abuse reported were physical abuse in 12 (3.3%), verbal abuse in 25 (6.9%), emotional abuse in 40 (11.1%), and financial abuse in 15 (4.2%) older adult participants. The sons and daughters-in-law of the older adult participants were the main perpetrators of abuse reported. Depression and past history of abuse were found significantly associated with any type of abuse. CONCLUSIONS: The prevalence of elder abuse in this study was considerably high, with 70 (19.4%) out of the 360 participants reporting some form of abuse. Emotional abuse was the most reported, and physical abuse was the least reported type. The most common perpetrators were those on whom the older adults depended, like their sons and daughters-in-law.

EEG based functional connectivity in resting and emotional states may identify major depressive disorder using machine learning.

OBJECTIVE: Disrupted brain network connectivity underlies major depressive disorder (MDD). Altered EEG based Functional connectivity (FC) with Emotional stimuli in major depressive disorder (MDD) in addition to resting state FC may help in improving the diagnostic accuracy of machine learning classification models. We explored the potential of EEG-based FC during resting state and emotional processing, for diagnosing MDD using machine learning approach. METHODS: EEG was recorded during resting state and while watching emotionally contagious happy and sad videos in 24 drug-naïve MDD patients and 25 healthy controls. FC was quantified using the Phase Lag Index. Three Random Forest classifier models were constructed to classify MDD patients and healthy controls, Model-I incorporating FC features from the resting state and Model-II and Model-III incorporating FC features while watching happy and sad videos respectively. RESULTS: Important features distinguishing MDD and healthy controls were from all frequency bands and represent functional connectivity between fronto-temporal, fronto-parietal and fronto occipital regions. The cross-validation accuracies for Model-I, Model-II and Model-III were 92.3%, 94.9% and 89.7% and test accuracies were 60%, 80% and 70% respectively. Incorporating emotionally contagious videos improved the classification accuracies. CONCLUSION: Findings support EEG FC patterns during resting state and emotional processing along with machine learning can be used to diagnose MDD. Future research should focus on replicating and validating these results. SIGNIFICANCE: EEG FC pattern combined with machine learning may be used for assisting in diagnosing MDD.

Dual diagnosis and their care pathways for help-seeking: A multicenter study from India.

Background: Understanding pathways to dual diagnosis (DD) care will help organize DD services and facilitate training and referral across healthcare sectors. Aim: The aim of our study was to characterize the stepwise healthcare and other contacts among patients with DD, compare the characteristics of the first contact persons with common mental disorder (CMD) versus severe mental illness (SMI), and estimate the likelihood of receiving appropriate DD treatment across levels of contacts. Methods: This cross-sectional, descriptive study in eight Indian centers included newly enrolled patients with DD between April 2022 and February 2023. The research spans varied geographic regions, tapping into regional variations in disease burden, health practices, and demographics. The study categorized healthcare contacts by using the WHO Pathways Encounter Form. Results: The sample (n = 589) had a median age of 32 years, mostly males (96%). Alcohol was the most common substance; SMI (50.8%) and CMD were equally represented. Traditional healers were a common first contact choice (18.5%); however, integrated DD care dominated subsequent contacts. Assistance likelihood increased from the first to the second contact (23.1% to 62.1%) but declined in subsequent contacts, except for a significant rise in the fifth contact (97.4%). In the initial contact, patients with CMD sought help from public-general hospitals and private practitioners for SUD symptoms; individuals with SMI leaned on relatives and sought out traditional healers for psychiatric symptoms. Conclusion: Recognizing the cultural nuances, advocating for integrated care, and addressing systemic challenges pave the way to bridge the gap in DD treatment.

Exploring help-seeking pathways and disparities in substance use disorder care in India: A multicenter cross-sectional study.

Background: Substance use disorders (SUDs) are among the leading causes of morbidity in the population. In low- and medium-income countries like India, there is a wide treatment gap for SUD. A multicentric study on the care pathways for SUD in India can help to understand service provision, service utilization, and challenges to improve existing SUD care in India. Aim: We aimed to map pathways to care in SUD. We compared the clinical and demographic characteristics of patients who first consulted specialized services versus other medical services. Methods: This was a cross-sectional study of consecutive, consenting adults (18-65 years) with SUD registered to each of the nine participating addiction treatment services distributed across five Indian regions. We adapted the World Health Organization's pathway encounter form. Results: Of the 998 participants, 98% were males, 49.4% were rural, and 20% were indigenous population. Addiction services dominated initial (50%) and subsequent (60%) healthcare contacts. One in five contacted private for-profit healthcare. Primary care contact was rare (5/998). Diverse approaches included traditional healers (4-6%) and self-medication (2-8%). There was a 3-year delay in first contact; younger, educated individuals with opioid dependence preferred specialized services. Conclusion: There is a need to strengthen public healthcare infrastructure and delivery systems and integrate SUD treatment into public healthcare.

Effects of the COVID-19 Pandemic on the Mental Health of Anesthesiologists: A Cross-Sectional Study.

Introduction: In the COVID-19 pandemic, frontline health-care workers (HCWs) including anesthesiologists have been fatigued due to long working hours in critical care units or operation theaters and necessity to remain available on call at odd hours. In addition, the exposure to numerous diseased and morbid patients throughout the prolonged pandemic period has predisposed them to psychological distress. Materials and Methods: This is a cross-sectional study to evaluate the depression and anxiety among the HCWs during COVID. The demographic and general information of 237 HCWs across India, through an online survey was collected and analyzed. Results: The male: female ratio of the studied population was 53:47. In addition, 50% of the participants were aged <35 years, and 80% of participants were married and living with family and parents. The consultants working in combined (COVID and non-COVID) areas exhibited maximum participation in the survey, with 80% of them involved in aerosol-generating procedures. Of the total, 73.1% of participants exhibited depression, 45.8% of participants exhibited anxiety, 36.2% of participants exhibited stress, and 25.3% of participants exhibited disturbed sleep patterns. Conclusions: Most HCWs on COVID-19 duty exhibited emotional disorders such as anxiety, depression, stress, and insomnia. Addressing risk factors identified in the present study with targeted interventions and psychosocial support will allow health-care workers to cope better.

Effect of Supplementation of Vitamin D in Patients with Periodontitis Evaluated before and after Nonsurgical Therapy.

Background: Vitamin D has anti-inflammatory properties and the potential to increase the generation of antimicrobial peptides like cathelicidin and defensins that may have a good impact on oral health. Higher vitamin D consumption has also been linked to a reduced risk of periodontal disease progression. Hence, the primary objective of this study was to evaluate and compare the clinical and laboratory parameters of oral supplementation of vitamin D as an adjuvant to scaling and root planing and to assess the bone mineral density via qualitative ultrasound bone density scanner in chronic periodontitis patients. Methodology. This study included 40 patients with periodontitis categorized into 2 groups with twenty patients each, Group I comprising scaling and root planing (SRP) alone and Group II comprising SRP along with vitamin D supplementation. Plaque index, gingival index, probing pocket depth, and clinical attachment loss was measured as clinical parameters. Serum vitamin D levels were assessed before and after SRP at both baseline and 6 weeks. Results: The intergroup comparison of clinical parameters (PI, GI, PPD, and CAL) at 6 weeks for both the groups showed statistical significance. Intragroup comparison of clinical parameters from baseline to 6 weeks showed a statistically significant reduction in both groups. The mean bone mineral density level in both the control and test groups demonstrated a mean T score of -1.3 and -1.21, respectively. The mean vitamin D levels were 27.8460 and 28.1020 for the test and control groups, respectively, which was statistically insignificant (p = 0.705) and those at six-week intervals improved to 31.3650 and 28.0240 which were statistically significant (p ≤ 0.001). Conclusion: It could be stated that a positive relationship exists between periodontitis and osteopenia which could aggravate periodontal destruction. All periodontitis cases should thus be evaluated for BMD and supplemented with vitamin D3 in an appropriate dosage and time frame to treat both these diseases.

Impact of COVID-19 lockdown on substance availability, accessibility, pricing, and quality: A multicenter study from India.

Background and Aim: Pandemic and consequent lockdowns are likely to affect the drug market by the sudden disruption of the supply chain. We explored the change in the availability, access, purity, and pricing during lockdown from respondents seeking treatment for drugs, alcohol, and tobacco dependence. Materials and Methods: A cross-sectional survey was conducted among 404 respondents from seven treatment centers across India. A structured questionnaire assessed the change in availability, access, quality, and price of substances used during the first phase (March 24-April 14) and the second phase (April 15-May 3) of lockdown. Results: A majority of the respondents in treatment used tobacco (63%) and alcohol (52%). Relatively few respondents used opioids (45%) or cannabis (5%). Heroin (44%) was the most common opioid the respondents were treated for. Seventy-five percent, 65%, and 60% of respondents treated for alcohol, tobacco, and opioid problems, respectively, reported a reduction in the availability and access during the first phase of the lockdown. In the second phase, respondents with alcohol and tobacco dependence reported greater availability than those with opioid and cannabis dependence. The reported price of all substances increased more than 50% during the first phase of lockdown and remained higher throughout the second phase. Deterioration in purity was reported by more than half of the people who used opioid. Conclusion: Lockdown could have affected both licit and illicit drug markets, albeit to a varying degree. The observed changes seemed short-lasting, as suggested by the recovering trends during the second phase of lockdown.

A multicentric survey among patients with substance use disorders during the COVID-19 lockdown in India.

Background: The unprecedented first wave of the COVID-19 pandemic severely impacted mental health services globally. However, the negative impact of such disruptions on people with substance use disorders (SUD) seeking treatment remains unclear. We aim to explore the behaviors adopted by these individuals to overcome the service disruptions. Materials and Methods: We explored the changes related to substance use behavior (quit attempts, withdrawal experienced, treatment-seeking, and risky behaviors), and behavioral changes in response to COVID-19 lockdown. A cross-sectional survey was conducted among 404 people with SUD seeking treatment from seven centers across India. They were assessed by a specially designed structured questionnaire during the first wave (June-September) of the pandemic. Results: An overwhelming majority experienced withdrawal symptoms, with close to half making quit attempts and seeking treatment during the lockdown. Three-fourth of the sample reported difficulty in accessing treatment services and medications. Patients with opioid use were significantly more likely to think about quitting (χ2 = 20.408, P = 0.000), make attempts (χ2 = 12.436, P = 0.000), seek treatment (χ 2 = 7.536, P = 0.006), and self-medicate for withdrawal symptoms (χ2 = 5.885, P = 0.015). In turn, those with alcohol use were more likely to use telepsychiatry services (χ2 = 35.143, P = 0.000) and experience stigma by family members (χ2 = 29.951, P = 0.000) and neighbors (χ2 = 17.725, P = 0.000). Among COVID-19 safety precautions, majority practised wearing masks and social distancing but not others. Conclusion: COVID-19 lockdown led a significant proportion of substance users, especially opioid users, to make quit attempts and seek help. However, these could not be sustained due to difficulty in accessing treatment services. Further, significant proportion failed to adhere to COVID-19 safety precautions.

Mental health implications of COVID-19 pandemic and its response in India.

INTRODUCTION: Mental health concerns and treatment usually take a backseat when the limited resources are geared for pandemic containment. In this global humanitarian crisis of the COVID-19 pandemic, mental health issues have been reported from all over the world. OBJECTIVES: In this study, we attempt to review the prevailing mental health issues during the COVID-19 pandemic through global experiences, and reactive strategies established in mental health care with special reference to the Indian context. By performing a rapid synthesis of available evidence, we aim to propose a conceptual and recommendation framework for mental health issues during the COVID-19 pandemic. METHODS: A search of the PubMed electronic database and google scholar were undertaken using the search terms 'novel coronavirus', 'COVID-19', 'nCoV', SARS-CoV-2, 'mental health', 'psychiatry', 'psychology', 'anxiety', 'depression' and 'stress' in various permutations and combinations. Published journals, magazines and newspaper articles, official webpages and independent websites of various institutions and non-government organizations, verified social media portals were compiled. RESULTS: The major mental health issues reported were stress, anxiety, depression, insomnia, denial, anger and fear. Children and older people, frontline workers, people with existing mental health illnesses were among the vulnerable in this context. COVID-19 related suicides have also been increasingly common. Globally, measures have been taken to address mental health issues through the use of guidelines and intervention strategies. The role of social media has also been immense in this context. State-specific intervention strategies, telepsychiatry consultations, toll free number specific for psychological and behavioral issues have been issued by the Government of India. CONCLUSION: Keeping a positive approach, developing vulnerable-group-specific need-based interventions with proper risk communication strategies and keeping at par with the evolving epidemiology of COVID-19 would be instrumental in guiding the planning and prioritization of mental health care resources to serve the most vulnerable.

Homozygous PLA2G6 (PARK 14) gene mutation associated neuropsychiatric phenotypes from southern India.

PLA2G6 gene associated neurodegenerative disorders resulting from homozygous c. 2222G > A (p.Arg741Gln) mutation were detected in two cases having variable neuropsychiatric phenotypic and imaging findings. Exome analysis helped identification of rare alleles, reinforcing ethnographic antecedents to geographical clustering of rare mutations and, essential to understanding biology of neurodegenerative disorders.

Clinical factors associated with lithium treatment response in bipolar disorder patients from India.

BACKGROUND: Bipolar Disorder (BD) is a chronic and disabling psychiatric illness with waxing and waning course. Lithium is the mainstay of treatment for Bipolar disorder (BD). There is limited literature on the clinical markers of Lithium treatment response from south Asia. METHODS: Two hundred and ten individuals with BD I and a history of at least 6 months of treatment with Lithium were recruited from the outpatient services of the National Institute of Mental Health and Neurosciences (NIMHANS) after obtaining informed consent. A diagnosis of BD I was made according to the DSM-IV criteria. The characterization of response to lithium prophylaxis was done using NIMH Retrospective Life Chart and "Retrospective Criteria of Long Term Treatment Response in Research Subjects with Bipolar Disorder" scale. RESULTS: There were 132 (62.86%) good responders and 78 (37.14%) non-responders. Good responders were noted to have less number of hospitalizations and more onset episode of depression than non-responders. Using continuous phenotype, Lithium response was inversely correlated with total number of episodes, number of episodes of mania/ depression, number of hospitalisations and presence of suicide attempt. Multivariate analysis only revealed number of episodes and hospitalization to be associated with Lithium response. CONCLUSION: Our Lithium response rates were higher than what have been reported in the few previous studies. Illness severity was the only factor associated with Lithium response. There is a need to examine this question in larger prospective samples and to focus on biological/ molecular markers of treatment response.

Auditory Neuropathy Spectrum Disorder Masquerading as Social Anxiety.

The authors report a case of a 47-year-old man who presented with treatment-resistant anxiety disorder. Behavioral observation raised clinical suspicion of auditory neuropathy spectrum disorder. The presence of auditory neuropathy spectrum disorder was confirmed on audiological investigations. The patient was experiencing extreme symptoms of anxiety, which initially masked the underlying diagnosis of auditory neuropathy spectrum disorder. Challenges in diagnosis and treatment of auditory neuropathy spectrum disorder are discussed.

Biochemical pulping of bagasse.

This study deals with pretreatment of wheat straw with lignin-degrading fungi and its effect on chemical pulping. Ceriporiopsis subvermispora strains, which preferentially attack the lignin, were used for biochemical pulping of bagasse. Treatment of depithed bagasse with different strains of C. subvermispora reduced the kappa number by 10-15% and increased unbleached pulp brightness by 1.1-2.0 ISO points on chemical pulping at the same alkali charge. Bleaching of biopulps at the same chemical charge increased final brightness by 4.7-5.6 ISO points and whiteness by 10.2-11.4 ISO points. Fungal treatment did not result in any adverse effect on the strength properties of pulp.