End-of-life Care and Social Security Issues among Geriatric People Attending a Tertiary Care Hospital of Eastern India.

CONTEXT: The care of sick members is the hallmark of a civilized society. End-of-life care and social security for elderly are emerging issues nowadays. AIMS: The aim of this study is to explore the desires of the elderly regarding the end-of-life care decisions along with to find out social security measures among the study population. SETTINGS AND DESIGN: The cross-sectional study conducted in the geriatric outpatient department of a tertiary care hospital. SUBJECTS AND METHODS: The study period was 4 months from August to November 2017. The geriatric patients attending geriatric outpatient department were interviewed using a predesigned and pretested questionnaire. Convenient sampling was used and a total of 138 participants were included in the study. STATISTICAL ANALYSIS USED: Proportions were used in the study. RESULTS: A total of 63.77% participants expected to die at home surrounded by their family members during their time of death followed by hospital (31.88%). Majority (63.77%) stated their opinions to die a senile death. Organ donation after death was the willingness shown by as high as 70.3%, but registered organ donors were 6.5%. 94.2% participants expected to be cremated after their death while others buried in accord to their religious practices. Only 7.24% of participants had a legal will of their financial establishments. It was observed that even half of the population (47.8%) did not have any form of health or life insurance. CONCLUSION: Home-based care of the elderly is needed so that they can live their last days of life peacefully. Awareness about health and life insurance should be increased by urgent intervention.

Effect of lifestyle interventions to reduce depression, anxiety and stress among married women of reproductive age group: A non-randomised controlled trial in urban slums of Bhubaneswar.

BACKGROUND: Women are more prone to develop mental disorders as compared to men and the role of physical activities to reduce its burden by improving self-esteem is appreciable. This study aimed to evaluate the effect of lifestyle interventions to reduce depression, anxiety and stress among women in urban slums. MATERIALS AND METHODS: This study was a non-randomized controlled trial carried out in two slums of Bhubaneswar in married women of reproductive age group (15 years-49 years) from June 2019 to September 2021 after approval from the institutional ethics committee. A total of 128 married women were recruited, 64 women in each arm. DASS-21 was used for assessing depression, anxiety, and stress of all participants. The lifestyle intervention program was provided to 64 women in the intervention group and educational materials were provided to the control arm. DASS score was assessed again and compared with follow-up scores in both groups. Descriptive statistics were expressed as frequency, mean, median, and standard deviations. Independent t-test and paired t-tests were done where applicable. RESULTS: There was no significant difference in socio-demographic factors and DASS-21 scores in both groups during baseline. Depression, Anxiety, and stress score were significantly lower in the intervention arm than control arm in the follow-up (P < 0.05). There was a significant difference between the pre-intervention and post-intervention levels of depression, anxiety, and stress among the intervention group (P = 0.05). CONCLUSIONS: Simple community-based physical activities as in our intervention program focusing on the reduction of depression, anxiety, and stress levels in women may prevent the rising problems of common mental disorders.

Assessment of stress among parents of neonates admitted in the neonatal intensive care unit of a tertiary care hospital in Eastern India.

BACKGROUND: An infant admitted to the neonatal intensive care unit (NICU) is a potentially stressful event for parents. Severe stress is experienced by parents, affecting their mental health and relationship, and infants' development. The current study aims to assess the stress levels among parents of neonates admitted to NICU and to identify the factors influencing their stress levels. MATERIALS AND METHODS: A cross-sectional study was conducted in a tertiary care hospital of Eastern India over 2 months. Stress levels were assessed using Parental Stressor Scale: NICU questionnaire among 100 NICU parents (mother or father) with more than 24 h of admission. Stress was quantified using the Likert scale. The statistical analysis was performed using the SPSS software. RESULTS: In this study, 60.8% parents experienced severe and extreme stress level for overall stress. The mean for overall stress experienced was 3.71 ± 0.70. There was no significant difference in overall stress between father and mother (P = 0.65). The highest levels of stress experienced were in sight and sound subscale (3.23 ± 0.41) followed by relationship with the baby and parental role," i.e., 2.46 30. There was no significant association in overall stress score with maternal age, parity, education level, previous baby being admitted to the NICU (P > 0.05). Stress in sight and sound domain was statistically significantly higher (P = 0.009) among parents of babies with stay of ≤7 days. CONCLUSION: These results support wider use in research and clinical practice to identify parental stress. Interventions can be developed to ameliorate its negative effects on individual, interpersonal, and societal levels. The stress score was not significantly different between fathers and mothers of neonates admitted to NICU and the length of stay was significantly associated with sight and sound domain. Appropriate counseling should be targeted toward both parents. Future intervention studies should be planned to decrease the stress level among parents.

Anabolic Androgenic Steroid Abuse and their Health Impacts: A Cross-sectional Study among Body Builders in a City of Eastern India.

BACKGROUND: Anabolic-androgenic steroids (AASs), when taken in supraphysiologic doses, increase muscle strength and athletic performance. Evidence suggests that long-term use of AAS in supraphysiologic doses have adverse effects on health. Therefore, the study was conducted to find crude estimate of the prevalence of AAS use among attendees of the gymnasium, the factors that could have influenced them for AAS abuse and to assess the short- and long-term side effects as perceived by them. METHODS: A cross-sectional study was conducted in selected gymnasiums of a smart city of India using a predesigned and pretested questionnaire. Snowball sampling method was undertaken. The study was from July 2015 to June 2016. Informed written consent was taken. The analysis was done using SPSS v. 20.0. RESULTS: Of 84 bodybuilders approached, 74 participants used AAS. All users were male with mean age of 26.5 + 0.55 years. The mean age of initiation of AAS abuse was 23 years, and 66.2% (49) were unmarried. Eighty-five percent (63) preferred injectable. Seventy percent (52) abusers were influenced by trainers for abuse. Most commonly abused was Nandrolone decanoate (55.4%). Seventy-three percent were not aware of any legal ban on steroids. Reported benefits include increased strength, muscle size, and power, while harms were increased acne, deepening of voice, swelling of feet, increased irritability, depressive thoughts, impaired judgment, panic disorder, and withdrawal effect. CONCLUSIONS: Frequency of ASS use was substantial among young bodybuilders. Awareness about side effects was not a deterrent factor. Abusers were highly influenced by coaches. Efforts should be made for preventing easy access to AAS.

Internet use for patient care and health research: A cross-sectional study among physicians in a teaching hospital of Eastern India.

BACKGROUND: Internet is the world's largest network of information and communication services. The internet is widely used in medicine and had a significant impact on research, training, and patient care. OBJECTIVES: (1) To assess internet use to obtain health information for patient care among physicians of a medical college hospital. (2) To investigate the utilization of the internet during their daily practice and to know the reasons for its use and nonuse. MATERIALS AND METHODS: A hospital-based cross-sectional study was conducted for a period of 2 months of May and June 2015 in a Medical College Hospital of Eastern India. A convenient sample of 200 physicians was included in the study. Data regarding access of internet in workplace, time spent on the internet for medical and nonmedical purposes, opinions regarding use of the internet to update medical knowledge, obstacles that affect its use, etc., were collected. The data were analyzed using SPSS software version 20. RESULTS: It was seen that 47% doctors use laptop for accessing internet, followed by mobiles (34%). E-mail was the main purpose (41%) of internet use, followed by research (32.5%). Majority told that e-mail was the main purpose of last internet use (46.5%), followed by browsing medical resources (23%), research (15.5%), and patient care (12.5%). 97.5% agreed that they had ever browsed internet for patient care and 85.5% doctors agreed that they had obtained relevant information. 26.5% told that they need training for accessing free full-text electronic journals and 25% need training to access the sources for best clinical evidence for patient care. Other training needs were literature search (18%), downloading textbooks and other resources (15.5%), and searching internet sites for medical information (10%). CONCLUSION: Providing training for improvement of searching skills for obtaining up-to-date medical information, and evidence-based medicine from internet will improve their practice of medicine.

Validating Neck Circumference and Waist Circumference as Anthropometric Measures of Overweight/Obesity in Adolescents.

OBJECTIVE: To measure neck circumference and waist circumference, to compare it between normal and overweight/obese adolescents, and to validate these with body mass index. METHODS: This cross-sectional study was conducted in 1800 school-going adolescents. Body mass index, waist circumference and neck circumference were measured. Independent samples t-test and Pearson's correlation were used as tests of significance to analyze quantitative data. RESULTS: Positive correlation of neck circumference and waist circumference with body mass index was observed. The neck circumference and waist circumference in overweight/obese adolescents were significantly higher than adolescents with normal body mass index (P<0.001). Area under curve of waist circumference was more than area under curve of neck circumference. Cut-off values of neck circumference for screening adolescent obesity in boys and girls were 30.75 cm, and 29.75 cm, respectively, and waist circumference cut-off value were 70.75 cm for boys and 69.25 cm for girls at fairly good levels of sensitivity and specificity. CONCLUSION: Neck circumference and waist circumference may be used in clinical practice and epidemiological studies as an index of overweight/ obesity among school-going adolescents.

Socio-clinical profile of married women with history of induced abortion: A community-based cross-sectional study in a rural area.

BACKGROUND: Induced abortion contributes significantly to maternal mortality in developing countries yet women still seek repeat induced abortion in spite of the availability of contraceptive services. OBJECTIVES: (1) To study the sociodemographic profile of abortion seekers. (2) To study the reasons for procuring abortions by married women of reproductive age group. MATERIALS AND METHODS: It was a cross-sectional community-based study. All the married women of reproductive age group (15-49 years) with a history of induced abortion were selected as the subjects. RESULTS: The most common reason for seeking an abortion was poverty (39.4%), followed by girl child and husband's insistence, which accounted for 17.2% each. More complications were noted in women undergoing an abortion in places other than government hospitals and also who did it in the second trimester. CONCLUSIONS: To reduce maternal deaths from unsafe abortion, several broad activities require strengthening such as decreasing unwanted pregnancies, increasing geographic accessibility and affordability, upgrading facilities that offers medical termination of pregnancy (MTP) services, increasing awareness among the reproductive age about the legal and safe abortion facilities, the consequences of unsafe abortion, ensuring appropriate referral facilities, increasing access to safe abortion services and increasing the quality of abortion care, including postabortion care.

Contraceptive behavior of couples undergoing sterilization in an Eastern State of India.

BACKGROUND: As a part of a larger study for evaluating the effectiveness of a community-based family welfare program, this study assessed the contraceptive behavior of couples preceding sterilization and termination of pregnancies, if any during the interim period. METHODS: During May-June 2013, a cross-sectional study was undertaken in three districts of Odisha, an eastern state of India with poor maternal health indicators. Using a 15 × 14 cluster design with probability proportionate to size sampling 15 village clusters from each district were selected. Seven beneficiaries from the catchment area of two Accredited Social Health Activist of the selected villages were interviewed (14 respondents from each village) using a pretested predesigned questionnaire. RESULTS: A total of 630 clients with either of the partner having undergone sterilization were interviewed. Male partner having undergone vasectomy was < 1% (n = 3). The mean age (standard error mean [SEM]) of the respondent women was 34.54 ± 0.26 years. The mean age of the women at the time of sterilization was 27.12 (standard deviation [SD], 3.8, SEM 0.15 and median 26.83 years) years. Women as young as 22 years had undergone sterilization. Average family size was 2.81 with about 29 respondents (4.5%) having 5 or more children. The average duration between the last childbirth (LCB) to the date of sterilization was 18.37 months (range: 1-142 months, SD: 24 months, SE: 10 months). Seventy-two percent of the respondents did not use any method of contraception during this period. Methods adopted for contraception among the users was pill (20%) followed by condom (7%), and intrauterine contraceptive device (IUCD) was least used (0.2%). Ten percent of the women had undergone abortion before sterilization either once (7.9%) or more than once (2.1%). CONCLUSION: There was a gross delay in sterilization after LCB. Postpartum sterilization or IUCD were also not used frequently.

Association of personal hygiene with common morbidities among upper primary school children in rural Odisha.

CONTEXT: In India, children of upper primary school receive less attention from health-care providers. The majority of their health problems are preventable through hygienic practices. AIMS: The aim of this study was to find out the association of personal hygiene with common morbidities among upper primary school children. SETTINGS AND DESIGN: A cross-sectional study conducted in a rural upper primary school of Odisha. SUBJECTS AND METHODS: A semi-structured schedule based on the Global School Health Survey Questionnaire and necessary instruments for clinical examination were used. STATISTICAL ANALYSIS USED: Data were entered in Microsoft Excel 2007 and analyzed by SPSS version 20 software. RESULTS: Of 90 participants, 58 (64.4%) were girls. The mean age was 11.8 (±1.01) years. The mean body mass index of females was significantly higher than males (16.95 vs. 14.72; P = 0.001). More than 90% of children maintained good personal hygiene such as clean tongue, clean hair, handwashing, and using footwear. The most common morbidities found were dental caries (38.9%), history of worms in stool and lethargy (20%). A mean score of 6.14 ± 0.11 (out of 8) was seen for personal hygiene and not associated with any particular morbidity or gender. Brushing daily was significantly associated with reduced dental caries (χ2 = 8.7; P < 0.005) and foul-smelling breath (χ2 = 4.93; P < 0.05). Fungal infections were significantly less in children who bathed daily (χ2 = 28.7; <0.005) and wore clean clothes (χ2 = 5.06; P < 0.05). CONCLUSION: Dental caries, foul-smelling breath, and fungal infections were significantly associated with poor personal hygiene. School health services should also focus on upper primary school children for improvement of personal hygiene.

Mobile phone-based education and counseling to reduce stress among patients with diabetes mellitus attending a tertiary care hospital of India.

BACKGROUND: Stress among diabetic patients is much more as compared to normal individuals. A delayed recognition of stress undoubtedly worsens the prognosis for survival for many diabetic patients. Hence, this study was planned to develop an intervention model for the reduction of stress among diabetic patients and to evaluate the developed intervention model in the proposed group. METHODS: This study was conducted in endocrinology outpatient department of a tertiary care hospital. Starting at random, the patients were allocated to control group and test group. Controls were given printed educational materials. Test group were counseled with intense lifestyle education using both printed materials and computers; they were contacted by telephones by the investigator every 3 weeks for 3 months and SMS were sent every week containing some educational tips. RESULTS: Mean age was 54 ± 11.5 years overall ranging from 30 years to 80 years. About two-third of participants were males with similar distribution in both the groups (intervention = 66%, control = 64%). Half (50%) of the participants lived in joint families, followed by nuclear families (40%). Most (83%) were married and with either graduate or above graduate education (n = 39%). No significant difference was observed in socio-demographic characteristics among both control and intervention groups (P > 0.05). The average stress scores were similar (18.9) at baseline for control and intervention arms. At 3-month follow-up, however, these scores reduced to 17.05 in the intervention arm while they increased to 20.7 in the control arm. At 3 months follow-up, higher proportion of stress reduction was seen in the intervention group. CONCLUSIONS: Intervention in the form of intensive lifestyle education and phone calls and SMS significantly decrease their stress score. Mobile-based education has great potential to improve their mental status and increase patient-provider communication, and to decrease stress.

Overweight and Obesity among Adolescents, A Comparative Study Between Government and Private Schools.

OBJECTIVE: To compare prevalence of overweight/obesity among adolescent school children of government and private schools. METHODS: A school-based cross-sectional study was conducted in 1800 children aged 10-16 years. Body mass index (BMI), Waist circumference (WC), Hip circumference (HC), and Neck circumference (NC) were measured using standard guidelines. RESULTS: The prevalence of overweight obesity was 27.8% (private schools 45.2%, government schools 10.5%). BMI, WC, NC, and Waist-hip ratio were significantly higher among private school students. CONCLUSION: A differential strategic plan may be needed to prevent and control obesity among adolescent school children.