An investigation on the prevalence and patterns of multi-morbidity among a group of slum-dwelling older women of Kolkata, India.

BACKGROUND: Multi-morbidity is a pervasive and growing issue worldwide. The prevalence of multi-morbidity varies across different populations and settings, but it is particularly common among older adults. It poses substantial physical, psychological, and socio-economic burdens on individuals, caregivers and healthcare systems. In this context, the present study aims to provide an insight on the prevalence and degree of multi-morbidity; and also, on the relationship between level of multi-morbidity and morbid conditions among a group of slum-dwelling older women. METHODS: This community based cross-sectional study was conducted in the slum areas of urban Kolkata, West Bengal, India. It includes total 500 older women, aged 60 years or above. Pre-tested schedules on so-demographic and morbidity profile have canvassed to obtain the information by door-to-door survey. To determine the relationship between the level of multi-morbidity and morbid conditions, correspondence analysis has performed. RESULTS: The study revealed three most prevalent morbid conditions- back and/or joint pain, dental caries/cavity and hypertension. The overall prevalence of multi-morbidity was 95.8% in this group of older women. It was highly over-represented by the oldest-old age group (80 years and above). Majority were found to suffer from five simultaneous morbid conditions that accounted for 15.2% of the total respondents. All of the oldest-old women of this study reported to suffer from more than two medical conditions simultaneously. Three distinct groups were formed based on the inter-relationship between level of multi-morbidity and morbid conditions. The group 1 and 2 represents only 27.8% and 18% of the total sample. Whereas, group 3 comprises the highest level of morbidities (≥ 6) and 52.8% of total sample, and strongly related with general debilities, cardiac problems, asthma/COPD, gastrointestinal, musculoskeletal problems, neurological disorders, hypothyroidism and oral health issues. CONCLUSION: The findings confirmed the assertion that multi-morbidity in slum living older adults is a problem with high prevalence and complexity. This study proposes an easily replicable approach of understanding complex interaction of morbidities that can help further in identifying the healthcare needs of older adults to provide them with healthy and more productive life expectancy.

Understanding Frailty: Perspectives and Experiences of Rural Older Adults in India.

OBJECTIVES: In India, frailty has been predominantly studied as a physiological aspect, overlooking the subjective perceptions of community-dwelling older adults, which holds global significance. This study aims to explore frailty perceptions among community-dwelling older adults, comparing those enrolled in a geriatric welfare program facility to those not-enrolled. METHODS: A cross-sectional design with a qualitative descriptive framework was employed, using focus group methodology. The study took place in rural West Bengal, located in eastern India, with a sample of 27 participants aged 60-87 years. Data collection occurred between October 2018 and January 2020, conducted through a face-to-face, semistructured discussion guide. Thematic analysis was performed to ensure data saturation and reliability. RESULTS: Three key themes emerged from the analysis: (a) Perceptions of frailty were associated with aging, functional dependence, and psychosocial health, (b) Exposure to a scientific definition led to an ideological dilemma influenced by personal experiences, (c) Walking speed and grip strength were prominent components of frailty. The findings revealed that there was no difference in perception between program-enrolled and nonenrolled older adults, likely due to the concept of frailty being new to all participants. However, it was noteworthy that participants enrolled in the welfare program exhibited a resilient mindset toward the definition and demonstrated a proactive interest in preserving their overall health. DISCUSSION: This novel study underscores the necessity of enhancing community awareness and integrating frailty management into the Indian health care system, which is yet to be fully integrated, aiming to promote the well-being of older adults.

Neuropsychiatric symptoms of dementia and caregivers' burden: a study among Indian caregivers / Sintomas neuropsiquiátricos de demência e sobrecarga dos cuidadores: um estudo entre cuidadores indianos

ABSTRACT Dementia is considered a most serious and disabling condition, affecting both the individual suffering from it and their caregiver. Objective: The study aimed to evaluate the relationship between neuropsychiatric problems of dementia and caregiver burden. Methods: A total of 138 caregivers of people with dementia participated in this cross-sectional study. The caregivers completed the questionnaires containing sociodemographic information as well as neuropsychiatric problems of dementia and caregiver burden. Results: The findings showed that all of the care-recipients were suffering from some kind of neuropsychiatric symptoms, the most common being apathy, anxiety, motor disturbance, and hallucination. Out of 12 symptoms, 11 were significantly associated with caregivers' burden. The most important finding is that the severity of neuropsychiatric symptoms is highly responsible for severe caregivers' burden. Conclusions: The identification of neuropsychiatric symptoms of dementia that influence caregiver burden is very critical for both caregivers' and care-recipients' health perspective. These findings can also be utilized to create care settings for demented people and help determine policies in the future.

RESUMO A demência é considerada a condição mais grave e incapacitante que afeta ao mesmo tempo tanto o indivíduo que a sofre como o seu cuidador. Objetivo: O estudo tem como objetivo avaliar a relação entre problemas neuropsiquiátricos de demência e sobrecarga do cuidador. Métodos: 138 cuidadores de pessoas com demência participaram do estudo transversal. Os cuidadores preencheram os questionários contendo informações sociodemográficas, bem como problemas neuropsiquiátricos de demência e sobrecarga do cuidador. Resultados: Observou-se que todos os atendidos apresentavam algum tipo de sintoma neuropsiquiátrico; os mais comuns foram apatia, ansiedade, distúrbios motores e alucinações. Com exceção de um sintoma, 11 outros sintomas foram significativamente associados à sobrecarga dos cuidadores. O achado mais importante é que a gravidade dos sintomas neuropsiquiátricos é altamente responsável pela sobrecarga dos cuidadores. Conclusões: A identificação de sintomas neuropsiquiátricos de demência que influenciem a sobrecarga do cuidador é muito importante para a perspectiva de saúde dos cuidadores e dos receptores de cuidados. Essas descobertas também podem ser utilizadas para criar ambientes de atendimento para pessoas com demência e ajudar a determinar políticas no futuro.

Neuropsychiatric symptoms of dementia and caregivers' burden: a study among Indian caregivers.

Dementia is considered a most serious and disabling condition, affecting both the individual suffering from it and their caregiver. Objective: The study aimed to evaluate the relationship between neuropsychiatric problems of dementia and caregiver burden. Methods: A total of 138 caregivers of people with dementia participated in this cross-sectional study. The caregivers completed the questionnaires containing sociodemographic information as well as neuropsychiatric problems of dementia and caregiver burden. Results: The findings showed that all of the care-recipients were suffering from some kind of neuropsychiatric symptoms, the most common being apathy, anxiety, motor disturbance, and hallucination. Out of 12 symptoms, 11 were significantly associated with caregivers' burden. The most important finding is that the severity of neuropsychiatric symptoms is highly responsible for severe caregivers' burden. Conclusions: The identification of neuropsychiatric symptoms of dementia that influence caregiver burden is very critical for both caregivers' and care-recipients' health perspective. These findings can also be utilized to create care settings for demented people and help determine policies in the future.

A demência é considerada a condição mais grave e incapacitante que afeta ao mesmo tempo tanto o indivíduo que a sofre como o seu cuidador. Objetivo: O estudo tem como objetivo avaliar a relação entre problemas neuropsiquiátricos de demência e sobrecarga do cuidador. Métodos: 138 cuidadores de pessoas com demência participaram do estudo transversal. Os cuidadores preencheram os questionários contendo informações sociodemográficas, bem como problemas neuropsiquiátricos de demência e sobrecarga do cuidador. Resultados: Observou-se que todos os atendidos apresentavam algum tipo de sintoma neuropsiquiátrico; os mais comuns foram apatia, ansiedade, distúrbios motores e alucinações. Com exceção de um sintoma, 11 outros sintomas foram significativamente associados à sobrecarga dos cuidadores. O achado mais importante é que a gravidade dos sintomas neuropsiquiátricos é altamente responsável pela sobrecarga dos cuidadores. Conclusões: A identificação de sintomas neuropsiquiátricos de demência que influenciem a sobrecarga do cuidador é muito importante para a perspectiva de saúde dos cuidadores e dos receptores de cuidados. Essas descobertas também podem ser utilizadas para criar ambientes de atendimento para pessoas com demência e ajudar a determinar políticas no futuro.

VEGF Expression to Support Targeted Therapy in Ovarian Surface Epithelial Neoplasms.

INTRODUCTION: Vascular Endothelial Growth Factor (VEGF), a promoter of angiogenesis, is a promising target for anti-angiogenic therapy in ovarian cancer. In our study, we examined the expression of VEGF in the spectrum of epithelial ovarian neoplasms (benign, borderline and malignant) by Immunohistochemistry (IHC). AIM: Diagnosing ovarian epithelial neoplasms, examining the expression of VEGF in benign, borderline and malignant neoplasms and correlating it with histological grade and stage of malignant cases. MATERIALS AND METHODS: This is a cross-sectional, observational study where, total of 50 cases of surface epithelial ovarian neoplasms were examined for expression of VEGF by IHC. Scoring for VEGF expression was done for each case. RESULTS: A total of 42 of the 50 cases (84%) showed VEGF expression. Out of the 42 positive cases, 19 were high VEGF expressors and 23 were low VEGF expressors. VEGF expression was significantly higher in carcinomas as compared to benign and borderline neoplasms (p=<0.001). All neoplasms of serous morphology were positive for VEGF. High VEGF expression was significantly associated with high grade (p=0.003) and stage (p=0.001) of disease. CONCLUSION: Ovarian surface epithelial neoplasms significantly express VEGF. Though, some VEGF expression was noted in benign and some borderline neoplasms, high VEGF expression was noted only in carcinomas and one case of borderline serous papillary tumour. Thus, these results suggest that epithelial ovarian tumours are candidates for VEGF targeting therapy as most of them are dependent on VEGF for progression.

Eating attitudes and its relationship with nutritional status: a micro level study on a group of adolescent girls in the city of Howrah, West Bengal.

BACKGROUND: To assess the relationship between eating attitudes and nutritional status. METHODS: This cross-sectional study was conducted among 400 adolescent girls (258 aged 14-17 years and 142 aged 18-21 years) from the city of Howrah, West Bengal. Eating attitude was measured using eating distress syndrome (EDS) questionnaire. Nutritional status was assessed using body mass index, waist-hip ratio (WHR) and body fat percentage (BF%). RESULTS: Participants with disordered eating attitudes revealed significantly higher values for body mass index (BMI), WHR and BF% than those with normal eating attitudes (p≤0.01). Hierarchical linear regression analyses show that eating attitudes and socio-demographic characteristics (like mothers' education and occupation, age and birth order of the participants) significantly predict nutritional status. CONCLUSION: The nutritional status of adolescents depends on their eating attitudes and socio-demographic characteristics.

Weight concerns and food habits of adolescent girls in two contrasting ecological regions: A comparative study in India.

OBJECTIVE: To compare the incidence of weight concerns and food habits between two ethnically different groups of adolescent girls residing in two distinct ecological settings: the plains of Kolkata and the mountains of Sikkim. METHODS: Two separate cross-sectional studies were conducted within a period of five years in urban hilly areas of Sikkim and the city of Kolkata, India. A total of 506 girls aged 14-19 years were selected from the study areas of Sikkim (n=224) and Kolkata (n=282). Girls were interviewed for weight concerns and food habits along with socio-demographic characteristics. Weight concerns were assessed with four variables such as, perceptions about own body weight, felt dissatisfied with own body weight, urge for dieting and use of weight reduction diet. Food habits included consumption of major foods during the past one week. RESULTS: Bivariate analyses showed that Kolkata girls perceived themselves as overweight, remained dissatisfied with body weight, expressed perceived need for dieting and followed weight reduction diet more compared to the girls of Sikkim. Food habits indicated that all Sikkimese girls preferred to consume cereals regularly, while Kolkata girls consumed vegetables, pulses, fish, fruits, bread and butter and fried foods more than Sikkimese girls. Multivariate analyses showed that place of residence was significantly (p<0.05) associated with both weight concerns and food habits of girls. CONCLUSION: Diversity in culture, ethnicity and socio-economic standard perhaps develop the disparity in food habits and weight concerns between girls of urban hilly areas of Sikkim and the city of Kolkata.

Body weight and body shape concerns and related behaviours among Indian urban adolescent girls.

OBJECTIVE: To assess the associations of body weight and body shape concerns and related behaviours with actual weight status among urban adolescent girls. DESIGN: In the present cross-sectional study, a self-administered questionnaire was used to collect data on body weight and body shape concerns and related behaviours. Sociodemographic information was collected using a pre-tested schedule. Weight and height of each girl were measured to assess actual weight status. SETTING: Twin cities of Kolkata and Howrah, West Bengal, India. SUBJECTS: A total of 1223 adolescent girls aged 14-19 years were selected from nine schools in Kolkata and Howrah in West Bengal. RESULTS: Many overweight girls perceived themselves as overweight and engaged in weight-reducing activities. However, several normal-weight girls also perceived them as overweight and attempted to lose weight. Unhealthy eating practices to reduce weight were followed by both overweight and normal-weight girls and even by a few underweight girls. Multivariate binary logistic regression showed a significant association between actual weight status and use of unhealthy weight-loss measures. The likelihood of adopting unhealthy eating practices was significantly higher among overweight than normal-weight girls. CONCLUSIONS: Health education programmes should be introduced at schools to promote effective weight-control practices that help dispel myths about weight loss.

Efficacy of Baptisia tinctoria in the treatment of typhoid: its possible role in inducing antibody formation.

Typhoid is one of the most serious infectious bacterial diseases in third world countries. It is usually treated by traditional antibiotics but due to the appearance of antibiotic resistant strains physicians opt for phyto products and other alternative medicines for the treatment of typhoid. Baptisia, an extract from indigo plant root, has been proved to be highly effective ultradilute medicine for the treatment of typhoid; however, the mode of action of the ultradilute extract is uncertain. Due to the antigenic variations of Salmonella it seems to induce immuno system by activating both T and B cells by the formation of antibodies. This principle seems to be highly effective for the development of typhoid vaccine. The present studies found that Baptisia administration possibly caused a salmonella-like reaction in the body as this extract produces an endogenous antibody similar to salmonella reaction. Thus, this study suggests that Baptisia tinctoria extract can be used for the prevention and treatment of typhoid.

Reproductive health and its bio-cultural correlates among Rai and Bhutia women of rural Sikkim: a micro level study.

This study addresses the relationship between utilization of maternal health services in terms of antenatal care, delivery care, and contraceptive use, and current prevalence of gynecological problems mediated through socioeconomic, demographic and biological correlates, in two ethnic communities of Sikkim. Study participants included 506 parous, nonpregnant women of Rai and Bhutia communities. Information on morbidity status and utilization of maternal health care facilities were collected using appropriate pretested questionnaires. Bivariate and multivariate analyses were used. Anthropometric measurements were taken and blood tests were carried out for estimating hemoglobin concentration, and erythrocyte sedimentation rate (ESR). Logistic regression showed significant association between participant's education, parity, husband's cooperation and maternal health care utilization on one hand and prevalence of gynecological problems, hemoglobin concentration, ESR and parity on the other. Study results reinforce an interrelation between prevalence of gynecological problems and maternal health care utilization during pregnancy and delivery. A single effective health care program can be launched to meet the needs of these two ethnic groups.

Socioeconomic correlates of reproductive morbidity among adolescent girls in Sikkim, India.

UNLABELLED: The present study investigates the prevalence of reproductive health morbidities, treatment-seeking behavior, and its association with sociodemographic correlates among unmarried and married adolescent girls of Sikkim. The study sample includes 1250 adolescent girls randomly selected from both urban and rural blocks of the State. Information on socioeconomic and demographic characteristics, prevalence of reproductive health morbidities, and treatment-seeking behavior was collected using standard pretested questionnaires. RESULTS: of the study indicate that the prevalence of reproductive health morbidities among both married and unmarried girls is quite high. Age, media exposure, and economic status emerged as significant correlates of treatment-seeking practices among both married and unmarried girls. High prevalence of reproductive health morbidity in this vulnerable group, particularly in rural settings, requires urgent intervention of health planners. This study reinforces an indirect and mediatory role of socioeconomic and demographic factors in the prevalence of reproductive health morbidities and associated treatment-seeking behaviors.

Eating and weight concerns among Sikkimese adolescent girls and their biocultural correlates: an exploratory study.

OBJECTIVES: Growing concern about ideal body image among adolescent girls in developing countries has led them to follow dietary modifications. In general, the ideal body image is perceived as a 'thin body' and now tagged with the concept of being physically fit. The present study evaluates the prevalence of weight concerns, and subsequent eating behaviour modifications among a group of adolescent girls in Sikkim. DESIGN: Pre-tested FFQ and dietary behaviour questionnaire were canvassed through direct interviews. Anthropometric measurements were taken following standard techniques. In the present study, dieting stands for skipping meals or avoiding certain food items. SETTING: Sikkim, India. SUBJECTS: A total of 577 girls were selected from several blocks of all four districts of Sikkim. RESULTS: The results of the study show that concern with weight reduction is growing among adolescent girls, particularly among urban girls of affluent families. Girls from families with a higher economic status are about two times more likely to report dissatisfaction with their body weight (OR = 1·96; P ≤ 0·05) and these girls are five times more likely to report the need for dieting. CONCLUSIONS: It is evident that weight concern and dissatisfaction over body weight are growing among adolescents. It can be safely argued that eating disorder, once a problem of the Western world, is now slowly creeping in among adolescents of the developing world as a consequence of rapid lifestyle changes over the past few decades.

Hypertension and its correlates in two communities of dissimilar genetic ancestry in Sikkim, India.

BACKGROUND: Hypertension has emerged as a major health risk among adults and the elderly in India. In spite of sharing similar physical and cultural environments, group level cultural variability and distinct genetic ancestry may result in differences in patterns of hypertension prevalence. AIM: The present study investigates the relationships between socio-economic, lifestyle and anthropometric variables and hypertension in two communities (Rai and Bhutia) of Sikkim. Both groups live in a similar ecological setting and are exposed to forces of modernization of almost equal magnitude. SUBJECTS AND METHODS: The study sample consists of 582 Rais and 315 Bhutias. Information on socio-demographic characteristics, substance uses and other lifestyle variables were collected through relevant pre-tested questionnaires. Anthropometric measurements were taken following standard methods. Three consecutive blood pressure measurements were taken and averaged for analysis. RESULTS: The results of covariance analyses show that ethnicity is not a significant covariate of either systolic or diastolic blood pressure. Use of tobacco and alcohol consumption, level of education and activity patterns were found to be significant correlates of hypertension. The diagnostic ability of waist circumference is found to be better than body mass index for assessment of risk of hypertension among the present study populations. CONCLUSIONS: Lifestyle factors more than ethnicity and socio-economic factors contribute to the development of hypertension in these populations. Based on the results of this study, we would suggest that a sustainable increase in physical activity and reduction in alcohol consumption would be helpful in the proper management of hypertension for both groups.

Pregnancy-related food habits among women of rural Sikkim, India.

OBJECTIVE: Every society follows its own traditional health-care beliefs and practices during and after pregnancy, which is intimately linked to its socio-cultural environment. The objective of the present study was to document pregnancy-related food practices and the social-cultural factors linked with them. DESIGN: The present study was a cross-sectional one conducted among a group of women residing in five villages in east Sikkim, India. Mothers who had given birth to a child one year before the survey participated in the study. The mothers answered a pre-tested questionnaire on food habits and practices followed antepartum and for 6 weeks postpartum. SUBJECTS: The study group consisted of 199 women of Nepali caste groups with variations in economic condition. RESULTS: More than 86 % of mothers consumed special foods during the postpartum period. Taboos on different food categories during the postpartum were reported only by 65.3 % of mothers. Factors found to be significantly associated with special food consumption were literacy status during the antepartum and parity during the postpartum. CONCLUSIONS: The change in consumption patterns reflects the success of a safe motherhood campaign propagated by the government. Detailed investigation in this area, involving per capita daily consumption during pregnancy and the postpartum period, is needed.