Psychometric Properties of the Hindi Version of the World Health Organization Quality of Life Questionnaire-Older Adults (WHOQOL-OLD) Module in Dehradun, India.

BACKGROUND: The perception of quality of life (QOL) is a subjective concept; however, attempts have been made to discern the key points and to give a metric view of this concept. The World Health Organization Quality of Life Questionnaire-Older Adults (WHOQOL-OLD) module is an international and cross-cultural tool that quantifies the QOL in older adults. OBJECTIVES: This study aimed to assess the psychometric properties of the Hindi version of the WHOQOL-OLD module by calculating its reliability and validity among the elderly residing in the Dehradun district of India. METHODOLOGY: This cross-sectional study was conducted among 440 elderlies from the rural and urban areas of Dehradun by using the Hindi version of the WHOQOL-OLD questionnaire. The mean and standard deviations were calculated for QOL scores. Reliability was checked by calculating Cronbach's alpha (α), and factor analysis was done for the validity of the questionnaire. RESULTS: Mean (±SD) for total QOL score was 54.3 (±9.3). The death and dying facet had the maximum mean score, whereas the minimum mean score was calculated in the autonomy facet. Cronbach's alpha reliability coefficient for the overall QOL score was calculated as 0.86 which shows good internal consistency of the items in the questionnaire. To measure the construct validity, exploratory factor analysis (EFA) by principal components analysis (PCA) was performed on the 24 items of the WHOQOL-OLD module, and a six-factor model was identified. Satisfactory goodness-of-fit statistics were found on the confirmatory factor analysis (CFA). CONCLUSION: QOL is a multidimensional concept. The Hindi version of the WHOQOL-OLD module is reliable and valid. QOL in the elderly population can be measured by using the WHOQOL-OLD module in India.

Clinical Empathy and Its Correlates Among Indian Medical Students: A Cross-Sectional Study of Bihar.

Background Clinical empathy is standing in the patient's shoes and perceiving his/her emotions to experience the patient's feelings. Practicing empathy ensures an enticing prospect in patient care. This study was done among undergraduate medical students to assess their empathy level and the factors affecting it. Methods This was a cross-sectional study conducted with 400 medical students in Bihar, India. Students not willing to participate were excluded from the study. The coding system was designed to strictly maintain anonymity. The study tools included the Jefferson Scale for Physician Empathy - Student Version (JSPES), a semi-structured questionnaire on the general profile, a perceived stress scale (PSS), and a multidimensional scale of perceived social support (MSPSS). Participants were allotted 20 minutes to complete the test and submit their responses. Results were expressed as means and standard deviations (SDs), with appropriate statistical tests applied. The data were presented in tables, and statistical significance was checked at a 5% level. All statistical analyses were conducted using SPSS software. Results The arithmetic mean (±SD) of empathy scores was 99.87±14.71. Empathy was found to be positively correlated with social support and negatively with stress. The factors found to be significantly associated with empathy on univariate analysis were subjected to stepwise multiple linear regression, which provided a six-factor model comprising gender, choice of future specialty, stress, social support, residence, substance abuse, and stay in hospital as an attendant. Conclusions Stress and social support were found to be significant predictors of empathy. The female gender, living in urban areas, and having previous experience of hospital stay as an attendant of a patient were positively associated with empathy. In contrast, choosing a technical branch as a future specialty and substance abuse were negatively associated with empathy. Stress management, enhancement of social support, and avoidance of habit-forming substances could be beneficial in improving empathy among doctors. Since we could only identify a few factors, we recommend further studies on this topic to explore other factors.

Genomic Variations in ATP7B Gene in Indian Patients with Wilson Disease.

OBJECTIVE: To report genotype data of the patients with Wilson disease (WD) hailing from across several parts of India to add to the available spectrum of causative variants in ATP7B gene (ATPase copper transporting beta polypeptide gene) and associated phenotypes in the Indian population. METHODS: The entire ATP7B gene was sequenced in 58 patients with WD and additional testing was also done by MLPA to look for intragenic deletions duplications and exome sequencing to rule out genetic variations with similar phenotypic overlap. RESULTS: Of all patients, 37 patients had a total of 33 distinct pathogenic variations, including 29 in the exonic regions and 4 at intronic splice sites. Of the variations identified, six were novel. The underlying genomic variations could be identified in nearly two-thirds of the patients by sequencing the entire gene. CONCLUSIONS: This study reports the genotype-phenotype data to add to the available spectrum of causative variants in ATP7B gene. The inability to detect a pathogenic variation in some patients and the existence of phenotypic variations in individuals with the same variation suggest that additional factors or genes may play a role in causation of the disease. Further, a marked genetic heterogeneity was found in the study patients, indicating ethnic diversity of the Indian population.

Quality of Life of Patients with Wilson's Disease and Their Families.

Objectives: Wilson's disease (WD) is a chronic disease caused by altered copper metabolism requiring lifelong therapy. Its long-term and debilitating nature has the potential to affect the quality of life (Qol) of patients as well as their families. Our study aims to assess this impact of the disease on patients and their families. Methods: We conducted a prospective, observational study over 2 years on 73 patients and 73 age-matched controls with 33 children and 40 adults in each group. The Qol of cases and controls was assessed using the PedsQL Generic Core Scales and World Health Organisation Quality of Life BREF (WHOQOL-BREF) for children and adults, respectively. Families of child and adult patients were interviewed using PedsQL Family Impact Module and Family Attitude Scale (FAS), respectively. The data were statistically analyzed. Results: Mean age of the cases was 22.04 ± 11.8 years. Qol scores for both adults and children were worse in cases with neuropsychiatric disease than in those with hepatic disease. For children, the mean scores of overall psychological functioning were lower in cases compared with controls (P = 0.0001). Qol of parents of the patients was significantly lower than those of parents of the controls as was the family functioning (P = 0.0001 and P = 0.016). Family Attitude Scale scores for adults did not differ significantly between cases and controls. Conclusion: The Qol of patients with neuro-WD is worse than that of hepatic disease. The disease impacts the psychological functioning of the children and the Qol of their families, which improves with the duration of the disease. What is known: WD is a long-term, debilitating disease. Patients have to take lifelong treatment with frequent medical visits and often multiple hospitalizations. What is new: WD affects the Qol of not only the patients but also their families. Qol of patients with neuro-WD is worse than that of patients with hepatic disease.

Moving Out of Shadows: Depression among the Elderly in Dehradun District of Uttarakhand, India.

BACKGROUND: Depression, a stigma swept under the rug, has morphed to be tabbed as the theme of World Health Day 2017 by the World Health Organization (WHO). Depression in old age is stereotypically tethered to the ageing process but it is a medical problem that has been under-researched. This study was conducted to estimate the point prevalence of depression among the elderly in Dehradun district of Uttarakhand and to identify its predictor variables. METHODS: It was a cross-sectional study conducted in Dehradun district of Uttarakhand (India) among 660 elderlies (≥60 years) from three strata (rural, urban and special groups). The Hindi version of long form of Geriatric Depression Scale (GDS-H) was used to identify mild and severe depression. All statistical analyses were carried out by SPSS software (version 22) at 5% level of significance. RESULTS: The arithmetic mean (±SD) of GDS scores was 10.62 (±6.1). 55% elderly were found to be suffering from depression (46.8% mild and 8.2% severe depression). Bivariate analysis showed significant association of depression with increasing age, female gender, place of residence, type of family, living without spouse, financial dependency, involvement in any kind of substance abuse and suffering from some chronic morbidities like osteoarthritis, chronic respiratory illness, skin diseases, visual impairment or hearing impairment. These predictor variables were further subjected to multivariate analysis. CONCLUSION: The high prevalence of depression in old age and its multifactorial association tags it as a public health problem in this age group which should be recognized and managed before it becomes a health menace.

Supplement (mis)use in adolescents.

PURPOSE OF REVIEW: Dietary supplement usage by adolescents has been on the rise in the last decade and is expected to continue to grow, although the evidence of their benefits in healthy individuals remains unclear. This review aims to spread awareness about the poorly regulated supplements and their effects on the health of adolescents to minimize medical hazards. RECENT FINDINGS: In this review, we have attempted to summarize some of the commonly consumed supplements, their alleged benefits, effects and side effects, along with the motivation that drives adolescents into consuming them. SUMMARY: The widespread use of dietary supplements among adolescents, in the background of lack of knowledge and medical guidance, predisposes adolescents to significant health risks. Although supplements may be necessary and safely consumed in certain specific situations, most healthy adolescents do not need them. The lack of regulation of supplements encourages contamination and ensures indiscriminate, easy access.

Van Wyk Grumbach Syndrome: A Rare Consequence of Hypothyroidism.

Long standing hypothyroidism presenting as an ovarian mass has been well described in literature as the Van Wyk Grumbach syndrome (hypothyroidism, isosexual precocious puberty and ovarian mass). Here, authors report this entity in a 11 y 7 mo old girl child who was referred to a surgeon in view of intestinal obstruction along with a multiloculated ovarian cyst. On evaluation, she was found to have raised serum creatinine, short stature, delayed bone age and pituitary enlargement. She was diagnosed with autoimmune thyroiditis and was started on replacement therapy with thyroxine, after which the ovarian cysts regressed. This entity should be kept in mind in cases of ovarian cysts, especially those with isosexual precocity, to prevent unnecessary evaluation and surgical misadventures.