Effectiveness of Nicotine Replacement Therapy on Smoking Cessation and Reduction Among Pulmonary Tuberculosis Patients - A Randomized Controlled Trial.

Background': India is ranked second in the world in terms of tobacco use and tops the list of eight high-burden countries that account for two-thirds of the new tuberculosis (TB) cases globally. As tobacco smoking among TB patients is associated with unsuccessful TB treatment outcomes, effective smoking cessation interventions for TB patients is essential to combat this double pandemic. Aim: The study determined the effectiveness of nicotine replacement therapy (NRT) on smoking reduction and cessation among pulmonary TB patients. Settings and Design: The study included 300 pulmonary TB patients undergoing antitubercular treatment in government health care centers of Dakshina Kannada district in southern India. Materials and Methods: The participants in this two-armed, single-blinded, placebo-controlled, block-randomized trial were divided equally (n = 150) for experimental arm (brief advice + NRT) and control arm (brief advice + placebo). The total duration of treatment and follow-up was 6 months. Unadjusted relative risk (URR) and adjusted relative risk (ARR) were calculated for treatment outcomes at 95% confidence interval (CI). Generalized linear regression analysis was performed upon variables with P value less than 0.2. Results: After 6 months of intervention including follow up, there was a significant reduction in self-reported smoking (ARR = 1.08, 95% CI 1.01-1.17, P = 0.03) in the experimental arm compared with the control arm. Biochemically verified smoking abstinence was not significantly different between the two arms (ARR = 1.01, 95% CI 0.72-1.38, P = 0.97). Conclusion: The study showed statistically significant effectiveness of NRT for self-reported smoking reduction.

An exploratory study of undergraduate healthcare student perspectives regarding human papillomavirus and vaccine intent in India.

OBJECTIVE: Safe and effective human papillomavirus vaccines are available against cervical cancer and other human papillomavirus-associated diseases. Vaccine uptake is low in India given lack of universal vaccination programme. This exploratory study describes the medical, dental and nursing undergraduate student perspectives about human papillomavirus and intentions to receive the vaccine. METHODS: Using a cross-sectional, explorative study design, we conducted two focus group discussions among a convenience sample of male (n = 11) and female (n = 9) student group aged ⩾18 years, respectively, at a medical college in South India. The focus group discussion sessions were recorded, transcribed and analysed using thematic content analysis. RESULTS: Over half of the students showed adequate knowledge of cervical cancer and human papillomavirus. Medical students had much in-depth knowledge of cervical cancer, vaccine cost and its side effects compared to dental and nursing students. Human papillomavirus vaccine knowledge was relatively less among males compared to females; most male participants were unaware of the availability of the human papillomavirus vaccine. Intention to receive the vaccine was higher among females than males. All the participants had positive attitude in creating awareness in the community and making the vaccine cost-effective. Cultural concerns and high vaccine cost were cited major barriers for vaccine uptake. Suggestion of physician recommendation in promotion of human papillomavirus vaccine uptake was an emerging theme. CONCLUSION: Educating male students and those enrolled in dental and nursing courses about human papillomavirus vaccine, addressing cultural concerns and advocating provider recommendation for promoting vaccine uptake are potential strategies to improve future human papillomavirus vaccine intent among students and recommendations to patients in their role as future healthcare provider.

Factors determining sexual behaviour amongst siddi tribe migrating to Udupi district, India: A cross-sectional study.

BACKGROUND: Afro-Indians, locally known as Siddi, are the tribal community descended from the Bantu populace from eastern Africa found in Goa, Gujarat and Karnataka along the Indian west coast. This study determines knowledge, attitude and sexual behaviour amongst the Siddi population in the Udupi district. MATERIALS AND METHODS: A cross-sectional study was conducted from October 2018 to September 2019; men and women aged above 18 years who lived in the locality at the time of the survey were included in the study. RESULTS: A total of 108 Siddi individuals participated in this study. The mean age of the respondents was 31.8 ± 9.5 years. More than half (51.8%) of the respondents received information on sexual matters through friends. Awareness regarding the usage of condoms and other preventive measures was poor (34.7%). Around 65.7% of the respondents felt that sex education in school encourages sex amongst youngsters. The mean age at the first sexual intercourse amongst men and women was 20.3 years and 16.2 years, respectively. About 18.7% of the respondents had sex with a new partner in the migrated place within the last 1 month, of which 80% were married. Only 5% of the respondents used condoms while indulging in sex with a new partner at the migrated place. Factors such as age at marriage, age at the first sexual act and attitude towards sexual activity were significantly associated with a new sex partner at the arrival site. CONCLUSION: There is a high prevalence of unsafe sexual practices amongst the migrated Siddi tribe at the place of destination. This poses the risk of sexually transmitted infections amongst the migrant tribes and local communities at the place of destination and the location of origin. The study finding shows that measures should be taken to create awareness, and change in attitude towards sexual matter should be channelised at an early age amongst the Siddi population.

Determinants of HIV status disclosure to children living with HIV in coastal Karnataka, India.

The caregivers of HIV-positive children either delay or avoid disclosure of HIV status to the child due to several reasons. Keeping the child's HIV status a secret puts them at considerable risk of stopping therapy and transmitting HIV to others. Hence this study was conducted to assess the determinants of disclosure of HIV status to infected children in coastal Karnataka. A cross-sectional study was conducted in a District Hospital in Coastal Karnataka from October 2014 to July 2015. One hundred eighty-five caregivers were recruited for the study purposively and interviewed using a pre-tested, semi-structured questionnaire after written informed consent. Of the 185 caregivers interviewed, 78 (42%) caregivers had not disclosed the HIV status to the child. The child being too young was the most common reason for non-disclosure of HIV status. The majority of the caregivers intended to disclose the HIV status fully to the child after the child attained ten years of age. Nearly two-thirds of the caregivers wanted to disclose it themselves in their own homes. The significant determinants of disclosure of HIV status were the age of the child, and person involved in childcare, and the venue of the disclosure.

Pattern of paediatric HIV status disclosure in coastal Karnataka.

Background & objectives: Karnataka is a high HIV prevalent State in India. Although benefits have been shown by disclosing the HIV status to the child, information regarding HIV status disclosure in Karnataka is limited. Hence, this study was conducted to estimate the proportion of children who had been disclosed of their HIV status and its pattern among those who visited the district antiretroviral therapy (ART) centre in coastal Karnataka. Methods: A cross-sectional study was conducted in an ART centre in a district hospital in coastal Karnataka between October 2014 and July 2015. Caregivers of paediatric HIV patients were approached and willing participants were administered a pre-formed, pre-tested semi-structured questionnaire developed for the study. Results: A total of 185 caregivers of the HIV-positive children were interviewed. Mean age of the children was 11±4 years. Only 107 (57.8%) children were aware of their HIV status. Of these, 95 were disclosed fully. Counsellors in rehabilitation centres were the most probable person to disclose and planned events. Children were told of their HIV status for their knowledge and were more likely to be disclosed if they were around 11-15 yr of age and staying in rehabilitation centres. Interpretation & conclusions: Older children were more likely to be disclosed of their HIV status by counsellors. Steps need to be taken to counsel and encourage caregivers to fully disclose the HIV status to the children at least when they attain the age more than 11 years.

Treatment-seeking behavior and obstacles to treatment compliance in diabetic patients in Mangaluru, India.

AIM: To evaluate the local treatment-seeking behaviors of diabetics with a focus on the root causes of culture-specific barriers to treatment compliance and define targets for intervention. METHODS: A cross-sectional survey was administered in the local language to 204 diabetic adults in rural and urban clinical settings. Fasting blood glucose level was measured in all participants prior to the survey. Questions included sociodemographic characteristics, treatment-seeking behavior, and perceptions of obstacles. RESULTS: Out of 204 participants, predictors of at target status included age (OR 1.06, 95% CI 1.02-1.11) and rural living area (OR 1.92, 92% CI 1.02-3.60). Participants were commonly diagnosed with symptoms of diabetes (44.6%). Participants demonstrated frequent healthcare provider contact (51% in last one month, 74.5% in last three months). Accidental or purposeful deviation from the recommended medications or treatment plan was reported by 18.7% and 12.8%, respectively. From the sample, 111 participants (54.4%) were capable of receiving SMS messages and 79 (71.1%) were willing to receive messages about diabetes. The most frequently self-reported obstacles to diabetes management were: medication costs (49.3%), treatment costs (46.6%), diabetic diet (33.8%), lack of relief on current treatment (17.4%), and transportation (16.7%). CONCLUSION: Though most diabetics have frequent encounters with healthcare providers and report compliant behaviors, the majority do not meet recommended diabetes management guidelines. Screening of at-risk populations, targeted SMS campaigns, or diabetes-specific training for healthcare providers may improve clinical outcomes.

Self-medication patterns among medical students in South India.

BACKGROUND: Self-medication results in wastage of resources, increases resistance of pathogens and generally causes serious health hazards such as adverse drug reactions, prolonged suffering and drug dependence. This study was undertaken to determine the reasons for self-medication and the pattern of self-medication among medical students. METHOD: This cross-sectional descriptive study was conducted at the K.S. Hegde Medical Academy, Mangalore. The participants were medical students from first to final year. Medical students were selected through convenience sampling. The data was collected using a pre-tested semi-structured questionnaire. The data was analysed using SPSS version 16 and the results expressed as proportions. RESULTS: A total of 200 students, 121 (60.5%) female and 79 (39.5%) male, were included in the study. Of the medical students surveyed, self-medication was reported among 92%. The respondents who used self-medication found it to be time- saving in providing relief from minor ailments. The most common ailments for which self-medication were used were: the common cold (69%), fever (63%) and headache (60%). The students consulted their textbooks (39%) and seniors or classmates (38%) for the medications. Antipyretics (71%), analgesics (65%), antihistamines (37%) and antibiotics (34%) were the most common self- medicated drugs. Of the respondents, 33% were unaware of the adverse effects of the medication and 5% had experienced adverse reactions. The majority (64%) of students advised medications to others, more often to family and friends. CONCLUSION: The prevalence of self-medication among medical students is high, facilitated by the easy availability of drugs and information from textbooks or seniors. A significant number of students are unaware of the adverse effects of the medication that they themselves take and suggest to others. Therefore, potential problems of self-medication should be emphasised to the students.

Assessment of attitudes and practices of providers of services for individuals at high risk of HIV and sexually transmitted infections in Karnataka, south India.

BACKGROUND: A key component of prevention programmes aimed at reducing the risk of HIV and sexually transmitted infections (STI) among high-risk groups such as female sex workers (FSW) is the provision of quality STI services. The attitudes and practices of care providers are critical factors in the provision of services and in achieving better participation of high-risk individuals in accessing services. OBJECTIVES: To assess the attitudes and practices of STI care providers towards FSW, and the perceptions of FSW towards STI services, following training. METHODOLOGY: After an intensive physician capacity building programme, 393 exit interviews of FSW were conducted following clinical encounters, and discussions were held with 131 STI care providers (physicians) across several districts in Karnataka. Focus group discussions were held among FSW to understand the perceptions of non-users of services. RESULTS: 60% of women reported that the clinics were accessible. 76% of the women who visited clinics for STI consultations were offered a speculum examination. 85% received a condom demonstration, but only 52% were advised for partner treatment. 69% of women were referred for HIV testing. 79% of physicians felt that sex workers were responsible for spreading HIV in the community, and 47% believed that sex work should be banned to control HIV. CONCLUSIONS: Following physician training, quality of care appears to be generally acceptable, but it is important to improve further the attitudes of providers towards sex work, and improve practices such as speculum examination and partner referral that can enhance quality of care.