Assessment of Dependency in Activities of Daily Living (ADL) and its Predictors: A Cross-Sectional Study among the Elderly Rural Population in a Sub-Himalayan UT of India.

Background: With an increase in life expectancy over the last few decades, there has been a parallel increase in the prevalence of disabilities among the elderly population. To estimate the prevalence of dependency in activities of daily living (ADL) and its predictors among the rural elderly population. Material and Methods: This was a cross-sectional study carried out in the community among the rural geriatric population in the field practice area of PG Department of Community Medicine, Government Medical College Jammu. The Barthel Scale Index was used to measure ADL dependency. PSPP software was used to analyze the data. Results: The mean age of study participants was 68.31 ± 7.9 years. ADL dependency was observed in 46.3% of the subjects, with the majority demonstrating mild to moderate dependence. Only 2.5% of the respondents reported a severe degree of ADL dependence. The mean ADL score was 94.47 ± 8.98. On multivariate logistic regression analysis, age, educational status, the presence of stress in the family, personal history, and the presence of co-morbidities emerged to be independent predictors of ADL dependence. Conclusion: High prevalence of physical disability in the geriatric population is now an area of major concern. This emphasizes the significance of setting up geriatric care centers especially in rural areas preferably integrating with health and wellness centers.

Food Insecurity and its Association with Dietary Diversity: A Cross-Sectional Study in Rural Households in Jammu.

Background: Food insecurity is a matter of public health concern as it is associated with adverse health outcomes particularly among vulnerable population. Accessibility and availability of nutritious and culturally appropriate food is paramount to achieve zero hunger. To assess the prevalence of household food insecurity, to estimate the household dietary diversity and its association with household food insecurity. Material and Methods: Using multistage sampling 381 rural households were surveyed. Household Food Insecurity Access Scale and House hold Dietary Diversity Scale were used as study instruments. Chi square test was used to compare the two groups and P < 0.05 was considered to be statistically significant. Results: Prevalence of household insecurity was 33.3% (127) among the surveyed households and 8.1% (31) had severe food insecurity. The mean HFIS score was 6.85 ± 4.82. The household Dietary diversity score was 8.14 ± 1.54 for food secure and 6.51 ± 1.38 for severely food insecure households. There was a statistically significant difference in intake of milk and milk products, fruits, eggs and meat/poultry among food secure and insecure households (P < 0.001 respectively). Conclusion: Food insecurity was high in rural households and was associated with lower dietary intake of foods from protein group, necessitating a need to reinforce the food security programmes in rural India with focus to enhance protein rich diet.

Psychiatric morbidities among patients with type-2 diabetes mellitus attending outpatient department in a rural area of North India.

Background: Both diabetes mellitus and psychiatric morbidities are widely prevalent diseases which show a discerning upward trend globally. Coexistence of diabetes and psychiatric morbidities usually manifests as impaired quality of life and poor treatment adherence. Objectives: The study aimed to estimate the prevalence of psychiatric morbidities among rural diabetic patients and to determine their association with different variables. Methodology: The present cross-sectional study was conducted in CHC of Rural Health Block attached with PG Department of Community Medicine GMC (Government Medical College) Jammu. The eligible diabetic patients attending medical outpatient department services were enrolled using a consecutive sampling method. DAS scale was used to assess psychiatric morbidity among the study subjects. Results: The findings revealed that the prevalence of psychiatric morbidity in the study participants was 38.9%, 68.5% and 25.64% for depression, anxiety and stress, respectively. Psychiatric morbidities were slightly higher in female patients and were significantly associated with age, marital status, sedentary lifestyle, history of substance abuse, duration of diabetes, presence of complications and underlying morbidities (P < 0.05). Conclusions: The prevalence of anxiety and depression among rural diabetic patients was found to be quite high. Diabetic patients need thorough screening for psychiatric evaluation, and there is an urgent need for psychiatric counselling at regular intervals.

Psychiatric comorbidities and breast cancer: A study from Jammu region of UT of J&K, India.

BACKGROUND: Breast cancer is the most common cancer among females of all age groups. The diagnosis of cancer itself has a menacing impact on the psychosocial health of an individual leading to various psychiatric comorbidities. This can impact the overall prognosis of cancer patients. OBJECTIVES: To study the prevalence of psychiatric comorbidities among female breast cancer patients and to assess its association with sociodemographic and clinical factors among these. MATERIALS AND METHODS: A cross-sectional hospital-based study was conducted for a period of 1 year in the Regional Cancer Centre. All females in the age group of 18 years and above, who were confirmed to have breast cancer were included in the study. A self-designed proforma was administered to elicit information about sociodemographic and clinical details of the study subjects. Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS) were used to assess the prevalence of psychiatric comorbidities like depression, anxiety, and stress among these subjects. Data thus obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) Software. RESULTS: A total of 205 subjects were included in the study. The mean age was reported as 49.25 ± 11.44 years, most of these were married homemakers residing in nuclear families in rural areas. Prevalence of depression, anxiety, and stress was found to be 60%, 73.17%, and 83.41%, and these were significantly associated (P < 0.05) with residence, number of living children, visits per month to hospitals, time since diagnosis, and type of treatment received. CONCLUSION: There is a high risk of psychiatric comorbidities among breast cancer female patients and an urgent need for effective strategies to prevent these.

Prevalence and determinants of Internet addiction among the students of professional colleges in the Jammu region.

Background: With ever-increasing digitization, the internet has intertwined into the daily lives of users to a large extent. It holds tremendous educational benefits to college students; however, its excessive usage can lead to addiction and even psychological morbidities. Objectives: To determine the prevalence of internet addiction and its association with various factors including depression, anxiety, and stress. Materials and Methods: A cross-sectional study was conducted among undergraduate students of two professional colleges, i.e., medical and engineering colleges in the Jammu region. A pre-tested, semi-structured questionnaire was used to elicit the information regarding socio-demographic and personal details of students. Young's internet addiction scale was used to assess internet addiction, whereas the DASS 42 scale was used to measure depression, anxiety, and stress. Data thus collected were analyzed using the PSPP software. Results: A total of 480 students constituted the study population. The prevalence of internet addiction was found to be 78.7%, with a significantly higher prevalence seen among the male students in comparison to females (P < 0.005). A significantly positive correlation of internet addiction was found with depression, anxiety, and stress. Conclusions: Internet addiction is significantly associated with psychopathology among the respondents. In this context, there is an urgent need to develop effective strategies for the prevention of internet addiction by promoting awareness among the students.

Patient satisfaction with hospital services in COVID-19 era: A cross-sectional study from outpatient department of a tertiary care hospital in Jammu, UT of J&K, India.

Background: In the coronavirus disease (COVID-19) era, healthcare delivery toward patient-centered orientation has gone a paradigm shift. High levels of adherence to treatment and recommended prevention are usually the outcome of perceived patient satisfaction. Aims: The present study aimed to assess patient satisfaction levels in the COVID-19 era and explore its determinants. Settings and Design: A cross-sectional study from outpatient department of a tertiary care hospital in Jammu, UT of J&K, India. Materials and Methods: The present cross-sectional study was carried out in outpatient department of a tertiary care hospital in the Jammu district. A total of 220 patients were interviewed using consecutive sampling. The tool used to assess patient satisfaction was the patient satisfaction questionnaire-18 (PSQ-18). Statistical Analysis: Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. Tests of significance used were ANOVA and t-test. Results: The overall mean satisfaction score was found to be 2.91 ± 0.17 and it was highest in the communication domain (3.12 ± 1.50), whereas it was lowest in the accessibility and convenience domain (2.73 ± 1.17). Except for religion, which was found to be statistically significant (P < 0.05) with overall mean satisfaction score, other sociodemographic variables (occupation, marital status, and monthly family income) were found to be statistically insignificant (P > 0.05). Conclusions: Out of the seven subscales of patient satisfaction, results revealed high scores for communication and financial aspects. Only religion as a demographic variable was found to be significantly associated with patient satisfaction scores. There is a need to improvise the healthcare services in this COVID-19 era in such a manner so that we can contribute to better patient trust leading to a positive influence on health outcomes.

Prevalence and Determinants of Cognitive Impairment and Depression among the Elderly Population in a Rural Area of North India.

BACKGROUND: Demographic transition has resulted in population aging, which has led to advancement in multiple geriatric problems including cognitive impairment (CI) and depression. OBJECTIVES: The objective was to find the prevalence and determinants of CI and depression in the rural elderly population. MATERIALS AND METHODS: This was a community-based cross-sectional study conducted in a rural area. The prevalence of CI was measured using the Mini-Mental State Examination scale and depression was assessed using the Geriatric Depression Scale. The data so collected were analyzed using PSPP software. RESULTS: The mean age of the study participants was 67.47 ± 6.43 years. The prevalence of CI and geriatric depression was found to be 36% (153/425) and 29.1% (124/425), respectively. Variables which were found to have independent significant association on multivariate analysis with CI were literacy, memory complaints, and depression. For geriatric depression, an independent association was seen with literacy, socioeconomic status, memory complaints, stress in the family, and presence of CI. CI and geriatric depression were found to be strongly correlated with each other (r = -0.252, P < 0.001). CONCLUSIONS: Almost one-third of the geriatric population is suffering from depression (29.1%) and CI (36%). This necessitates for accurate and timely diagnosis, so as to ensure proper care and support to the elderly population with emphasis on geriatric mental health care.

Prevalence and correlates of Attention Deficit Hyperactive Disorder (ADHD) risk factors among school children in a rural area of North India.

BACKGROUND: Attention-deficit hyperactive disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood and has the potential for continuity into adolescence and adulthood. Its presence increases difficulties in academic performance and social interactions besides leading to low self-esteem. The present study aimed to determine the prevalence of ADHD among children of age 6-12 years in Government schools of a rural area in Jammu district of J and K. METHODS: The present study was conducted in R.S. Pura block of Jammu district. Miran Sahib zone of R.S Pura block was chosen randomly and all the government primary schools in this zone were included in the survey. The presence of ADHD was assessed using Vanderbilt ADHD diagnostic teacher rating scale. The children positive for ADHD were visited at their residential places and a personal information questionnaire (PIQ) was administered to their parents-preferably the mother. The data thus collected was presented as proportions. RESULTS: ADHD prevalence was found to be 6.34% (13/205). Majority (69.3%) of the ADHD-positive children were living in a joint family and belonged to lower/lower middle class. Family history of ADHD was absent in all the ADHD-positive children. CONCLUSION: The current study conducted in a rural area among 6- to 12-year-old children of Government schools has shown a reasonably high ADHD prevalence of 6.34%.

Prevalence and correlates of depression in a rural adult population in Northwest India.

BACKGROUND: Mental disorders are showing a discerning upward trend globally and it is projected that by 2030, depression would be the leading cause of disease burden globally. Depression has not only confined the developed world but is increasingly seen as a major public health problem in the developing world too. METHODS: A stratified two-stage design was used to conduct a house-to-house survey in selected villages among consenting eligible members of the family. A three-part questionnaire, with the first part eliciting sociodemographic information was used. Patient Health Questionnaire (PHQ-9), the second part of the questionnaire was used to screen those positive for depression and Beck's Depression Inventory (BDI-II). The third part was used for rating the depression. Data thus collected was analyzed and Chi-square test was used as test of significance. RESULTS: The prevalence of depression was found to be 8.94% (73/816). Beck's Depression Inventory (BDI- II) for rating the depression revealed that mild depression was present in nearly half of the cases (47.95%), while 39.7% and 9.5% of the cases had moderate and severe depression, respectively. Among the various variables, literacy level, marital status, alcohol intake, chronic illness, and socioeconomic status were significantly associated with the depression. CONCLUSIONS: Prevalence of depression to the tune of 8.94% in rural adults seems to be a cause of concern for the health planners. Prevention and treatment of depression must be taken on priority and as a challenge by the health professionals.

Is there a need to cover all households under health insurance schemes: A cross-sectional study in a rural area of Jammu.

BACKGROUND: For tackling unforeseen health expenditure and improving healthcare accessibility in general, it is important that people should not only be aware but also be covered under health insurance schemes. The present study was conducted with the aim to assess the health expenditure, health insurance awareness, and coverage among rural households. MATERIALS AND METHODS: This was a community-based cross-sectional study carried out in randomly selected families falling under a rural health block in Jammu district of Jammu & Kashmir, Union Territory. A predesigned, pretested, and semistructured questionnaire was used for data collection. RESULTS: A total of 380 families were surveyed, of which 14.5% belonged to the priority household group. Among the priority and nonpriority households, 8.80% and 5.69% of monthly income were spent on health-related activities and 9.91% of household expenditure was on health. A total of 24.32% of priority households had even borrowed money to meet health expenditures. A total of 28.15% families had heard about the Ayushman Bharat scheme. Attitude towards health insurance was positive in both groups. A total of 29.23% of nonpriority households and 14.54% of priority households had health insurance coverage. CONCLUSION: A significant proportion of household expenditure was health related. The absence of good insurance coverage raises the need for policies and laws to cover all the households under health insurance schemes.

Does being under treatment improve knowledge attitude practice for hypertension: A hospital-based study from North India.

BACKGROUND: Studies suggest that approximately half of patients with raised blood pressure (BP) are undetected, that half of those detected are not treated, and that half of those treated are not controlled, famously described as the "rule of halves." Importantly, the cornerstone of the primary prevention of cardiovascular diseases is early detection and drug treatment (antihypertensive) of patients with high BP. Studies across populations in developed world have shown that awareness and management of high BP levels are far from optimal. The present study was planned with the aim to assess the knowledge, attitude, and practices (KAP) regarding hypertension in hypertensive patients visiting Tertiary Care Hospital in North-West India. MATERIALS AND METHODS: Already diagnosed hypertensive patients seeking care at the tertiary care center were selected for this study. The participants were recruited using consecutive sampling technique. All participants were interviewed with the help of a semi-structured questionnaire after obtaining a written informed consent. The components of the KAP were recorded using a score sheet. RESULTS: In all, 394 hypertensive patients of whom majority (239/394; 61%) were males, were included in the study. The KAP score among the study subjects was 88.4%, 90.83%, and 95.83%, respectively. Males had higher knowledge about normal BP levels which was statistically significant (P < 0.01). Among the attitude, regular intake of anti-hypertensive drugs, regular investigations, lifestyle changes, avoidance of salt and allopathic medicines being the best for the treatment of hypertension were found to be significant statistically (P < 0.01). CONCLUSION: The high score among the study population can be attributed to the fact that all study participants were diagnosed patients of hypertension seeking care in a tertiary care hospital.

Goiter prevalence in school-going children: A cross-sectional study in two border districts of sub-Himalayan Jammu and Kashmir.

INTRODUCTION: Iodine deficiency disorder remains one of the major public health problems, despite it being easily preventable. Initially thought as the disorder of Himalayan goiter belt, the disorder has been found to have a pan-India presence. The study was planned with the aim to assess the prevalence of goiter among 6-12 years school-going children and to identify levels of iodine in salt consumed at the household level in the study area. MATERIALS AND METHODS: The study was conducted among 3955 school-going (2162 children from Rajouri and 1793 children from Poonch) children age 6-12 years in Rajouri and Poonch districts of Jammu Province. The children were examined clinically to detect and grade the goiter. Salt samples were collected from subsample (n = 400) to estimate iodine content in the salt. RESULTS: The prevalence of goiter in the study population was found to be 18.87% and 9.70% in Rajouri and Poonch districts, respectively. Goiter prevalence was higher in 9-12 years age group as compared to 6-9 years age group and the difference in goiter prevalence in males of these two age groups was statistically significant (P = 0.02). Estimation of iodine content of the salt samples revealed that all of them (100%) had adequate iodine content. CONCLUSION: Despite the implementation of Universal Iodization Program and adequate content of iodine in salt consumed by the families, the goiter prevalence in both the districts is high. The future research should focus on identifying the reasons for this high prevalence.