Quantification of health-related quality of life among patients with rheumatoid arthritis: An institution-based study in Kolkata, West Bengal.

CONTEXT: Rheumatoid arthritis (RA) is a known chronic debilitating disease accounting for a large percentage of disability globally. Pain and stiffness, decreased work function, depression and emotional state alteration, fatigue, disability, and social handicaps are some patient reported outcomes, which if considered with priority the health-related quality of life (HRQOL) of patients with RA could improve. AIMS: This study was conducted with the aim to assess the HRQOL of the patients with RA and the determinants related to it. SETTINGS AND DESIGN: This was a cross-sectional study conducted at Rheumatology Department of a tertiary care hospital, Kolkata. SUBJECTS AND METHODS: A total of 252 patients with RA were selected in this study through systematic random sampling. STATISTICAL ANALYSIS USED: Data were analyzed using appropriate statistical measures with Statistical Package for the Social Sciences(SPSS) version 16.0 (Armonk, NY: IBM Corporation) software program, version 16.0. Univariate and multivariable logistic regression were carried out. RESULTS: In the study, the mean age of the patients was 43.1 years (mean age ±SD: 43.05±10.63 years). The proportion of female subjects was 84.5%. Unsatisfactory QOL was found in 59.9% study participants. In multivariable logistic regression unsatisfactory quality of life was significantly associated to moderate to high functional disability [AOR: 6.04, CI: 2.86, 12.78], disease activity moderate to high [AOR: 5.41, CI: 1.87, 15.69], presence of comorbidity [AOR: 2.90, CI: 1.39, 6.04], extra-articular manifestations [AOR: 3.14, CI: 1.41, 6.96] and delay in starting Disease-Modifying Anti-Rheumatoid Drugs (DMARDs) [AOR: 1.24, CI: 1.08, 1.42]. CONCLUSION: Findings of this study clearly indicate the presence of high proportion of unsatisfactory QOL among the patients with RA. Early identification and prompt referral are the key strategies to prevent any permanent damage. Regular follow-up of the patients should be carried out to prevent or delay the disability progression and provide high-quality physical and mental health.

Risk factors associated with default among tuberculosis patients in Darjeeling district of West Bengal, India.

BACKGROUND: The treatment outcome "default" under Revised National Tuberculosis Control Program (RNTCP) is a patient who after treatment initiation has interrupted treatment consecutively for more than 2 months. AIMS: To assess the timing, characteristics and distribution of the reasons for default with relation to some sociodemographic variables among new sputum-positive (NSP) tuberculosis (TB) patients in Darjeeling District, West Bengal. SETTINGS AND DESIGN: A case-control study was conducted in three tuberculosis units (TUs) of Darjeeling from August'2011 to December'2011 among NSP TB patients enrolled for treatment in the TB register from 1(st) Qtr'09 to 2(nd) Qtr'10. Patients defaulted from treatment were considered as "cases" and those completed treatment as "controls" (79 cases and 79 controls). MATERIALS AND METHODS: The enrolled cases and controls were interviewed by the health workers using a predesigned structured pro-forma. STATISTICAL ANALYSIS USED: Logistic regression analysis, odds ratios (OR), adjusted odds ratios (AOR). RESULTS: 75% of the default occurred in the intensive phase (IP); 54.24% retrieval action was done within 1 day during IP and 75% within 1 week during continuation phase (CP); cent percent of the documented retrieval actions were undertaken by the contractual TB program staffs. Most commonly cited reasons for default were alcohol consumption (29.11%), adverse effects of drugs (25.32%), and long distance of DOT center (21.52%). In the logistic regression analysis, the factors independently associated were consumption of alcohol, inadequate knowledge about TB, inadequate patient provider interaction, instances of missed doses, adverse reactions of anti-TB drugs, Government Directly Observed Treatment (DOT) provider and smoking. CONCLUSIONS: Most defaults occurred in the intensive phase; pre-treatment counseling and initial home visit play very important role in this regard. Proper counseling by health care workers in patient provider meeting is needed.

Magnitude, types and sex differentials of aggressive behaviour among school children in a rural area of West Bengal.

BACKGROUND: Aggression affects academic learning and emotional development, can damage school climate and if not controlled early and may precipitate extreme violence in the future. OBJECTIVES: (1) To determine the magnitude and types of aggressive behavior in school children. (2) To identify the influence of age and sex on aggressive behavior. MATERIALS AND METHODS: A cross-sectional study was conducted in Anandanagar High School, Singur village, West Bengal. Participants were 161 boys and 177 girls of classes VII to IX. The students were asked to complete a self-administered questionnaire indicating the types of aggressive behavior by them in the previous month and to assess themselves with reference to statements indicating verbal/physical aggression. RESULTS: Overall, 66.5% of the children were physically aggressive in the previous month: Boys 75.8%, girls 58.2% (P = 0.001); 56.8% were verbally aggressive: Boys 55.2%, girls 61% (P = 0.97). Verbal indirect passive aggression was more common among girls (55.3%) than among boys (22.3%) (P = 0.000 [1.17E(-09)]). Boys were more liable to physical aggression, viz. 60.2% of the boys would hit on provocation compared with only 9% of the girls (P = 0.000 [6.6E(-23)]). Regarding attributes indicating verbal aggression, girls were more argumentative (63.8%) than boys (55.2%) (P = 0.134) and disagreeing (41.8%) compared with boys (33.5%) (P = 0.145). With increasing age/class, physical direct active aggression decreased while physical indirect passive and verbal indirect passive aggression increased. No classes had been taken on anger control/management by school the authorities. CONCLUSIONS: Aggressive behavior was common both among boys and girls. Life skills education/counseling/classroom management strategies are recommended.

Disability among new leprosy patients, an issue of concern: an institution based study in an endemic district for leprosy in the state of West Bengal, India.

BACKGROUND: Both magnitude and severity of disability in new leprosy patients measure indirectly the disease transmission in the community and rapidity of case detection. Various factors might be associated with the presence of impairment at registration. AIMS: To find out the prevalence of both grade 1 and grade 2 disability among new leprosy patients along with association of some clinical and sociodemographic factors. METHODS: A cross-sectional study was carried out in the Skin out patient department (OPD) of a Tertiary care hospital in West Bengal, which is situated in a highly endemic district of leprosy (prevalence was 6.5/10,000, year 2007). About 244 new leprosy patients were interviewed and clinically examined during Aug'06-Jun'07. Data was analysed in percentages, χ2 test, Anova. RESULTS: Proportion of disability was quite high among the studied new leprosy patients, 11.5% had grade-1 and 8.6% had grade-2. Disability was more among the patients with pure neuritic type of leprosy (<0.001), multibacillary leprosy (P=0.000), patients with delayed registration (P=0.000) and who were engaged as manual laborers (P=0.001). Feet were commonly involved site and nerve function impairment, both sensory and motor were the commonest nature of disability found in this study. CONCLUSION: To reduce new leprosy cases with grade-2 disability, early diagnosis of the leprosy patients and searching for grade-1 disability should be routine procedure in our health system, for which thorough neurological examination along with appropriate preventive measures is the need of the hour.

Teenage pregnancy: a socially inflicted health hazard.

BACKGROUND: Early marriage and confinement are contributing factors to high maternal and perinatal mortality and morbidity. OBJECTIVE: To assess the magnitude of the problem of teenage pregnancy and its complications. MATERIALS AND METHODS: A hospital-based cohort study was undertaken over 4 months among women admitted to a rural hospital in West Bengal. The study cohort comprised of teenage mothers between 15-19 years old and a control cohort of mothers between 20-24 years old. Data included demographic variables, available medical records, and complications viz. anemia, preterm delivery, and low birth weight. Anemia was defined as a hemoglobin level below 10 gm% during the last trimester of pregnancy, preterm delivery was defined as occurring within 37 weeks of gestation, and low birth weight was defined as babies weighing less than 2500 grams at birth. RESULT: Teenage pregnancy comprised 24.17% of total pregnancies occurring in the hospital during the study period. The study group had 58 subjects and the control group had 91 subjects. The prevalence of anemia was significantly higher (P<0.05) in the women in the teenage group (62.96%) than in the women in the control group (43.59%). However, severe anemia with a hemoglobin level below 8 gm% was only found in the control group. Preterm delivery occurred significantly more (P<0.001) in the study group (51.72%) than in the control group (25.88%). The incidence of low birth weight was significantly higher (P<0.0001) among the group of teenagers (65.52%) than among the women in the control group (26.37%). Not a single newborn was above 3 kg in the study group, while none were below 1.5 kg in the control group. The mean birth weight was 2.36 kg in the study group and 2.74 kg in the control group; the difference was strongly significant (P<0.001). CONCLUSION: The study shows that anemia, preterm delivery, and low birth weight were more prevalent among teenagers than among women who were 20-24 years old. This indicates the need for enhancing family welfare measures to delay the age at first pregnancy, thereby reducing the multiple complications that may occur in the young mother and her newborn baby.

Partner and relationship factors in domestic violence: perspectives of women from a slum in Calcutta, India.

A cross-sectional study in a representative sample of 751 women, living in slums, examined their perspectives on partner and relationship factors of domestic violence. More than 17% of women experienced physical violence in the past year. Individual factors related to the husband-namely, poor socioeconomic status, use of alcohol, extramarital relations, and visiting red light districts-increased the risk of violence. The following relationship factors were associated with a higher risk of violence: age difference of 5 years or less between spouses, husband's irregular contribution to family expenses, not sharing information about his personal expenses, manifestation of controlling behaviors, and longer duration of marriage. The study concludes that adverse socioeconomic conditions create low self-esteem and insecurity among men, who find expression in aberrant behaviors, and violence is used as a compensatory behavior. Interventions, therefore, need to go beyond the victim-centric approach and address partner and relationship issues for greater impact.