Assistive technology usage, unmet needs and barriers to access: a sub-population-based study in India.

Background: Assistive technology (AT) is essential to minimize functional limitations. The current study aimed to estimate the prevalence of needs, met and unmet needs for AT, and barriers to accessing AT among a subnational population in India. Methods: This cross-sectional study was conducted in eight districts, representing four zones of India, using the WHO Rapid Assistive Technology Assessment (rATA) tool. The tool was administered by trained staff using read aloud technique. Multi-stage cluster random sampling was used, as well as the probability proportional to size, to select smaller administrative units from the larger ones. Findings: In total, 8486 participants were surveyed out of 8964 individuals enumerated with a response rate of 94.6%. The sample prevalence of at least one difficulty was 31.8% (2700), with 6.3% (532) having severe or total difficulties. The sample prevalence for AT need was 27.8% (2357) with an estimated population prevalence of 24.5% (95% CI: 23.5-25.4). Similarly, the sample prevalence of unmet needs was 9.7% (823) with an estimated population unmet needs of 8.0% (95% CI: 7.43-8.60). The unmet needs among persons with severe or total difficulties was 52.3% (278/532), and was higher among females, rural residents, and older persons. Spectacles were the most used products, followed by canes/sticks, tripods, and quadripods. Nearly two-thirds of AT users purchased assistive products at their own expense, particularly from the private sector. The inability to afford AT (36.9%) was the most common barrier. Interpretation: The results show that the need for AT was substantial in the study population, the highest being for seeing difficulties. The unmet needs are higher in females, older population, rural residents, and persons having serious difficulties. While the majority of users have to make out-of-pocket payments to obtain AT, inability to afford and limited availability were the common barriers among those with unmet needs. Funding: This research is non-commercial, and was conducted in the interest of public health. The authors have not declared any specific grant for this research.

Job Satisfaction among Indian Migrants and Nonmigrants and its Relationship with their Psychological Profile-A Cross-Sectional Study.

Background: Unemployment, insufficient resources, family poverty, and poor financial benefits are crucial determinants for internal or external migration of large sections of educated youth. Aims: To perform a comparative analysis of different levels of job satisfaction and the status of mental morbidity among migrant and nonmigrant population. Settings and Design: A cross-sectional study was employed between March 2016 and October 2017 at the field practice area of one of the tertiary health care institutes in Anand District of Gujarat State of India. Methods and Material: A total of 456 educated and skilled professionals participated in the study. Job descriptive index, Job in General, and Global Health Questionnaire-28 were utilized. Statistical Analysis: The data entry was performed in Epi Info™ 7 followed by data analysis in EPI-INFO Software. Results and Conclusions: The overall job satisfaction in the study was found to be significantly higher among nonmigrants than migrants. All three scores were correlated with each other significantly. Overall, migrants were found to be significantly less satisfied with their jobs in general and more psychologically distressed, as compared to their nonmigrant counterparts.

Role of Faith healers: A barrier or a support system to medical care- a cross sectional study.

BACKGROUND AND AIMS: Faith healing is a method of treating illnesses through the exercise of faith rather than medical methods. The current study was done with the objective to find out demographic variables of faith healers, various conditions for which the people approach them, various practices and processes used and to look for scope of integrated approach to healthcare with faith healers. SETTINGS AND DESIGN: RHTC village was a sub center village of PHC Morad. Hence, for the study, all the villages which comes under PHC Morad were selected. The design of the study was a cross-sectional study. METHODS AND MATERIAL: The study was a cross sectional study where faith healers were interviewed based on a semi structured questionnaire comprising of both close and open-ended questions. STATISTICAL ANALYSIS USED: Absolute numbers. RESULTS: Different reasons for which the persons usually came for ranged from supernatural possession, unemployment, family problems etc., and various different processes were used by these healers to solve the problems included giving charms and amulets, personal sacrifices like "baddha" (Nischay/praan) and many others. CONCLUSION: The study concludes that faith healers in many conditions and situations became the first point of contact as the faith of the community in these faith healers is deeply rooted.

Prevalence Study of Cognitive Impairment and its Associated Sociodemographic Variables using Mini-Mental Status Examination among Elderly Population Residing in Field Practice Areas of a Medical College.

CONTEXT: The world is aging rapidly through "demographic transition." The aging leads to CI Refers as Cognitive Impairment (CI) - a risk factor for dementia. A community-based cross-sectional study was conducted among the elderly aged ≥50 years. OBJECTIVES: The objective of the study is to estimate the prevalence of cognitive dysfunction among the elderly and to identify the associated sociodemographic variables. SETTINGS AND DESIGN: This was a community-based cross-sectional study in rural and urban field areas of a medical college. SUBJECTS AND METHODS: Participants aged ≥50 years were interviewed using a structured questionnaire and screened for cognitive dysfunction using Gujarati version of Mini-Mental Status Examination. A score of 23 out of 30 was taken as the cutoff. Written informed consent was obtained from participants. STATISTICAL ANALYSIS USED: Univariate and multivariate analyses were done using SPSS version 17 and Epi Info version 6 to identify significant variables. RESULTS: Of 560 participants, 140 (25%) had CI. Rural (27.6%) and female (29.8%) prevalence was higher than urban (18.5%) and male (19.1%) prevalence. On multivariate analysis, age ≥60 years (odds ratio [OR]: 2.98) and illiteracy (OR: 39.8) had significant positive association with outcome; being employed (OR: 0.18), living with spouse (OR: 0.07), and living with spouse and children (OR: 0.08) had significant negative association with outcome. CONCLUSIONS: CI - a precursor of dementia - has serious clinical and public health consequences. Awareness generation and capacity building of primary health-care workers and family caregivers are core control strategies.

Developing and pilot testing of a tool for "clinicosocial case study" assessment of community medicine residents.

BACKGROUND: Practical and clinical skills teaching should constitute a core part of the postgraduate curriculum of Community Medicine. The clinicosocial case study is a method to enhance learners' skills but there is no generally accepted organized system of formative assessment and structured feedback to guide students. A new tool based on the principles of mini-Clinical Evaluation Exercise (mini CEX) was developed and pilot tested as a 'clinicosocial case study' assessment of community medicine residents with feedback as a core component. METHODS: Ten core domains of clinicosocial skills were identified after reviewing the relevant literature and input from local experts in community medicine and medical education. We pilot tested the tool with eight faculty members to assess five residents during clinicosocial case presentations on a variety of topics. Kappa statistic and Bland Altman plots were used to assess agreement between faculty members' average assessment scores. Cronbach's alpha was used to test the internal consistency with faculty members as domains. RESULTS: All 95% confidence limits using the Bland-Altman method were within the predetermined limit of 2 points. The overall Kappa between two faculty members was fair ranging from 0.2 to 0.3. Qualitative feedback revealed that both faculty and residents were enthusiastic about the process but faculty suggested further standardization, while residents suggested streamlining of the process. DISCUSSION: This new assessment tool is available for objective and unbiased assessment of residents through 'clinicosocial case study,' which enriches learning through comprehensive feedback. Further validation in different settings is needed.

Effect of Probiotic Dietary Intervention on Calcium and Haematological Parameters in Geriatrics.

INTRODUCTION: Probiotics are live microorganisms which when administered in adequate amounts confer a health benefit on the host. Sufficient calcium intake has been reported to support bone growth and prevent bone loss during the ageing process. AIM: To determine the effect of Lactobacillus helveticus MTCC 5463 probiotic dietary intervention on serum calcium & haematological parameters in geriatric population. MATERIALS AND METHODS: Healthy volunteers with age ranging from 64-74 years were recruited from the nearby residential areas in and around Anand, Gujarat. Study duration was from 2012 to 2015. Of the 112 subjects initially enrolled in the trial, 36 withdrew before the intervention because of not matching with criterias. Of the 76 participants, 5 subjects (4%) under test group and 12 subjects (11%) under placebo left the study. We had 59 subjects who successfully completed a double blind cross over trial. Probiotic fermented milk products (in form of "Lassi") was prepared by supplementing toned milk with honey and fermenting with probiotic Lactobacillus helveticus MTCC 5463 and Streptococcus thermophilus MTCC 5460. The final product had at least 10(8) CFU/ml of viable Lactobacillus helveticus MTCC 5463 at the time of feeding. During feeding period, 200 ml of fermented product containing the test strain to one group and a similar product but without the test strain as placebo were fed regularly at the time of breakfast in morning for 4 weeks. Subjects of each group were given a washout period of 4 weeks before they were crossed over and included to the other group. The study was approved by institutional ethics committee. RESULTS: The socio-demographic and clinical profiles were similar at baseline. The mean (SD) calcium level improved significantly in test {9.36 (0.45) vs 8.45 (0.61), p<0.001}. No significant effect was observed with respect to haemoglobin & haematological parameters. CONCLUSION: The well-documented probiotic Lactobacillus helveticus MTCC 5463 confirmed increase in serum calcium level but no effect on haematological parameters when administered to geriatrics.

Geriatric Respondents and Non-Respondents to Probiotic Intervention Can be Differentiated by Inherent Gut Microbiome Composition.

SCOPE: Probiotic interventions are known to have been shown to influence the composition of the intestinal microbiota in geriatrics. The growing concern is the apparent variation in response to identical strain dosage among human volunteers. One factor that governs this variation is the host gut microbiome. In this study, we attempted to define a core gut metagenome, which could act as a predisposition signature marker of inherent bacterial community that can help predict the success of a probiotic intervention. METHODS AND RESULTS: To characterize the geriatric gut microbiome, we designed primers targeting the 16S rRNA hypervariable region V2-V3 followed by semiconductor sequencing using Ion Torrent PGM. Among respondents and non-respondents, the chief genera of phylum Firmicutes that showed significant differences are Lactobacillus, Clostridium, Eubacterium, and Blautia (q < 0.002), while in the genera of phylum Proteobacteria included Shigella, Escherichia, Burkholderia and Camphylobacter (q < 0.002). CONCLUSION: We have identified potential microbial biomarkers and taxonomic patterns that correlate with a positive response to probiotic intervention in geriatric volunteers. Future work with larger cohorts of geriatrics with diverse dietary influences could reveal the potential of the signature patterns of microbiota for personalized nutrition.

Assessment of a Group Activity Based Educational Method to Teach Research Methodology to Undergraduate Medical Students of a Rural Medical College in Gujarat, India.

CONTEXT: Early undergraduate exposure to research helps in producing physicians who are better equipped to meet their professional needs especially the analytical skills. AIM: To assess the effectiveness and acceptability of small group method in teaching research methodology. SETTING: Sixth semester medical undergraduates (III MBBS-part1) of a self-financed rural medical college. MATERIALS AND METHODS: The workshop was of two full days duration consisting of daily two sessions by faculty for 30 minutes, followed by group activity of about four hours and presentation by students at the end of the day. A simple 8 steps approach was used. These steps are Identify a Problem, Refine the Problem, Determine a Solution, Frame the Question, Develop a Protocol, Take Action, Write the Report and Share your Experience. A Pre-test and post-test assessment was carried out using a questionnaire followed by anonymous feedback at the end of the workshop. The responses were evaluated by blinded evaluator. RESULTS: There were 95 (94.8%) valid responses out of the 99 students, who attended the workshop. The mean Pre-test and post-test scores were 4.21 and 10.37 respectively and the differences were found to be significant using Wilcoxon Sign Rank test (p<0.001). The median feedback score regarding relevance, skill learning, quality of facilitation, gain in knowledge was four and that of experience of group learning was 5 on a Likert scale of 1-5.There were no significant differences between male and female students in terms of Pre-test, post-test scores and overall gain in scores. CONCLUSION: Participatory research methodology workshop can play a significant role in teaching research to undergraduate students in an interesting manner. However, the long term effect of such workshops needs to be evaluated.