Population-based cohort across stroke life course in India-The NIMHANS-NH-SKAN stroke project: A study protocol.

BACKGROUND: Stroke is a leading cause of death and disability worldwide. In India, it is the fourth leading cause of death and fifth leading cause of disability, posing a major public health concern. National surveys reveal an increasing trend in stroke risk factors such as tobacco use, physical activity, alcohol use, hypertension, and dyslipidemia. However, knowledge regarding the combined effect of these risk factors and their various combinations is limited. Understanding the individual, combined, and synergistic effects of known risk factors, along with new risk factors, is essential to address gaps in stroke epidemiology. This study aims to examine the effect of various risk factors of acute stroke and their association with stroke occurrence and its outcomes (survival, disability and quality of life). METHODS: This retrospective-prospective cohort will be conducted in one taluka of Kolara district and two urban wards of Bengaluru with a total population of ~400,000. All stroke-free individuals above 30 years of age ~200,000 individuals in the selected sites will be participants of stroke-free period and all first ever stroke patients in the community will be part of stroke and post-stroke period respectively. The study subjects will be recruited through a complete house-to-house survey at baseline and undergo annual follow-ups during the stroke-free period, with specific assessments at defined time points during the stroke and post-stroke period for a period of one year. Efforts are implemented to minimize loss to follow-up, including community engagement, a helpline number, and hospital-based surveillance. DISCUSSION: This large population-based cohort study addressing stroke epidemiology in the country, is one -of-its-kind, attempting to fill certain critical gaps in the natural history, management, and outcomes of stroke in India. This research has the potential to provide important insights into the effect of novel risk factors of stroke and various combinations of risk factors of stroke. Furthermore, the development of a stroke risk predictability calculator will add value to the existing Indian National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) and offers a model for similar countries once developed.

Title of the study: Practice and attitude of doctors towards patients with substance use: A study from south India.

AIM: To evaluate the practice and attitude of doctors towards substance use disorders (SUD) and their management. METHODS: Following stratified proportionate random sampling, selected doctors in the south zone of Bengaluru, India, were interviewed face-to-face using a structured questionnaire. RESULTS: 150 doctors were interviewed. In their practice, a quarter of patients (median of 27.5 (IQR: 11.45-45) use one or other form of Alcohol, Tobacco or Other Drugs of abuse (ATOD). Doctors, in general, enquire about substance use but do not actively intervene. They have mixed attitudes (both positive and negative) towards persons with SUD. A significant positive correlation was noted between the number of years of experience (post-MBBS) with practices related to "brief-intervention" (p = 0.014) and "concerned and sympathetic" attitudes (p < 0.001). However, a significant negative correlation was observed between the number of years of experience and "substance-specific management" practices (p < 0.001). Further, there was a positive correlation between "brief-interventions" practices with the attitude of being "concerned and sympathetic" (p < 0.001). A mediation analysis revealed that nearly a third of the overall effect of the number of years of experience on brief-interventions practices was mediated by a concerned and sympathetic attitude. CONCLUSIONS: Serious efforts must be made to train doctors in the effective management of SUD. Attitudes of the doctors influence practices such as brief interventions. Programs directed towards changing the attitudes of doctors can bring changes in their practices.

Identifying health priorities among workers from occupational health clinic visit records: Experience from automobile industry in India.

CONTEXT: Occupational health surveillance in India, focused on notifiable diseases, relies heavily on periodic medical examination, and isolated surveys. The opportunities to identify changes in morbidity patterns utilizing data available in workplace on-site clinics is less explored in India context. AIMS: Present paper describes longitudinal assessment of morbidity patterns and trends among employees seeking care in occupation health clinic (OHC). The study also intends to explore associations between work department, clinic visits and morbidity pattern. MATERIALS AND METHODS: Record-based analysis was undertaken on data available (for the period 2010-2014) from two OHCs in a leading automobile industry in India. The doctor, examining every employee, documented the provisional diagnosis in specific software which in turn provides summary diagnosis based on affected body organ system as per ICD-10 categories. This information was used to assess the morbidity pattern and trend among workers. Chi-square test of significance and Extended Mantel-Haenszel chi square test was used assess the association and its linear trend. RESULTS: Respiratory, musculoskeletal and digestive system related diseases were the top three reasons for employees visit to OHC. The nature of morbidity varied across different departments in the industry. There was a significant increase in proportion of employees visiting OHC during 2010-2014. CONCLUSION: A clinic visit record, with its own strengths and limitations, provides information on morbidity pattern and its trends among workers. Such information will help plan, implement and evaluate health preventive, promotive, and curative services.

Comparative assessment of psychosocial status of elderly in urban and rural areas, Karnataka, India.

BACKGROUND AND AIMS: Psychological and social factors form an integral part in the health and well being of an elderly. Understanding these factors and their differential distribution based on geographical location will help in providing quality care. The aim of this study is to provide a comparative assessment of the psychological and social status of the elderly living in urban and rural area of Karnataka and to identify factors associated with the occurrence of psychological problems among elderly. METHODS: This comparative cross-sectional study was done by interviewing 510 elderly in house to house survey in urban and rural area. A pre-tested semi-structured questionnaire was used to collect information pertaining to social and demographic characteristics Cognitive assessment of the elderly was done using Hindi Mini Mental State Examination. Subsequently cognitively normal elderly was assessed for depression using Geriatric depression scale (GDS 15). The Barthel's Activities of Daily Living and Lawton's Instrumental Activities of Daily Living was used for functional assessment of elderly. RESULTS: The proportion of elderly who were at risk of developing depression was higher in rural area (32.6%) when compared to urban area (30.4%). Logistic regression analysis showed that illiteracy, poor perceived mental health, having no one to confide to when they have a problem and feeling financially insecure were significantly associated with risk of depression. CONCLUSION: Study showed that there is a significant difference in the social and psychological status of elderly in urban and rural areas. Understanding these differences is essential to plan and implement services specifically for urban and rural population.

Prevalence and socioeconomic impact of depressive disorders in India: multisite population-based cross-sectional study.

OBJECTIVES: The National Mental Health Survey (NMHS) of India was undertaken with the objectives of (1) estimating the prevalence and patterns of various mental disorders in representative Indian population and (2) identifying the treatment gap, healthcare utilisation, disabilities and impact of mental disorders. This paper highlights findings pertaining to depressive disorders (DD) from the NMHS. DESIGN: Multisite population-based cross-sectional study. Subjects were selected by multistage stratified random cluster sampling technique with random selection based on probability proportionate to size at each stage. SETTING: Conducted across 12 states in India (representing varied cultural and geographical diversity), employing uniform, standardised and robust methodology. PARTICIPANTS: A total of 34 802 adults (>18 years) were interviewed. MAIN OUTCOME MEASURE: Prevalence of depressive disorders (ICD-10 DCR) diagnosed using Mini International Neuropsychiatric Interview V.6.0. RESULTS: The weighted prevalence of lifetime and current DD was 5.25% (95% CI: 5.21% to 5.29%, n=34 802) and 2.68% (95% CI: 2.65% to 2.71%, n=34 802), respectively. Prevalence was highest in the 40-59 age groups (3.6%, n=10 302), among females (3.0%, n=18 217) and those residing in cities with population >1 million (5.2%, n=4244). Age, gender, place of residence, education and household income were found to be significantly associated with current DD. Nearly two-thirds of individuals with DD reported disability of varying severity, and the treatment gap for depression in the study population was 79.1%. On an average, households spent INR1500/month (~US$ 23.0/month) towards care of persons affected with DD. CONCLUSION: Around 23 million adults would need care for DD in India at any given time. Since productive population is affected most, DD entails considerable socioeconomic impact at individual and family levels. This is a clarion call for all the concerned stakeholders to scale up services under National Mental Health Programme in India along with integrating care for DD with other ongoing national health programmes.

Quality of a life skills training program in Karnataka, India - a quasi experimental study.

BACKGROUND: Youth focused Life Skills Education and Counseling Services (YLSECS) program, trained teachers/National Service Scheme (NSS) officers to deliver Life Skills Education (LSE) and counseling services to college going youth in the state of Karnataka in India. Available evaluation of life-skills training program have neglected the recording and or reporting of outcome among those trained to implement life-skills training program. Present paper highlights the quality of YLSECS training program and change in perception among teachers/NSS-officers trained in-terms of improvement in their cognitive/affective domains. METHODS: YLSECS program focused on World Health Organization identified ten essential domains of life-skills. Participants of the YLSECS program were trained by adopting facilitatory approach based on the principles of Kolb's learning theory. Quasi experimental study design was used to evaluate the outcome of training among participants. Quality of the training was assessed using scoring system and change in perception was assessed using Likert scale. Statistical significance of change in perception before and after training was assessed by paired't' test for proportion. RESULTS: Overall, 792 participants rated the quality of training as either "good" or "excellent". Post-training, significant (p < 0.001) proportion of the participants reported improved awareness about life-skills (before training 49.9 to 74.4% vs post-training range from 91.6 to 95.1% for various domains). There was statistically significant (p < 0.001) increase in participants reporting "very confident" in teaching various life skill domains (before training from 22.7 to 34.2% for various domains and post-training it ranged from 65.2 to 74.7% for various domains). There was modest increase in participants reporting perceived ability to conduct life-skills workshop "without assistance" post-training (before training from 16.8 to 22.9% for various domains vs post-training ranged from 29.8 to 36.8% for various domains). Interestingly, considerable proportion of participants who prior to training reported being confident in providing life skills training (without any assistance), later (i.e post training) reported they need some/more assistance for the same. CONCLUSION: YLSECS training program significantly improved participants knowledge and confidence in imparting life-skills and highlight the need for continued handholding of participants for effective implementation of LSE and counseling service program.