Middle Socioeconomic Class Research Articles

Clinico-biochemical relation of Vitamin D3 with the severity of atopic dermatitis and response to supplementation of Vitamin D3: A randomized controlled trial

Background: Atopic dermatitis (AD), also known as eczema, is one of the most common skin disorders among children and adults, with a steep rise in diagnoses among children. Many studies have investigated the relationship between Vitamin D3 (Vit D3) and AD. Methods: A randomized controlled trial was conducted among 60 children at SCB Medical College, Cuttack from August 2014 to November 2016. Children were randomly assigned to an intervention group that received 60,000 IU of Vit. D3 every week for 6 weeks in addition to regular treatment for AD and a control group that received same treatment of AD except for Vit. D3. Both the groups were followed up at 4 weeks and 8 weeks. Results: In 60 cases of moderate to severe AD, 70% of the patients were male. About 81.7% of patients were from urban areas and 56.7% belonged to a middle socioeconomic class. In 76.6% of cases, family history of atopy was present. At baseline, mean SCORAD was 47.8±7.5 in the intervention group, and 49.2±10.3 in the control group. At baseline, serum Vitamin. D3 level (ng/ml) was 17.6±1.8 in intervention and 17.3±3.5 in control group. After Vitamin. D3 supplementation, the SCORAD improved to 12.8±5.1 (75% reduction) at 4 weeks, and 3.6±2.1 (92% reduction) at 8 weeks in the intervention group. In the control group, the mean SCORAD was 18.8±9.1 (61% reduction) at 4 weeks, and 7.3±4 (85% reduction) at 8 weeks. Discussion: The improvement of serum 25-hydroxy Vit. D3 was 134% and 366% in the intervention group compared to 78% and 121% in the observation group after 4 weeks and 8 weeks respectively. The p-values at both the time points were significant (<0.05) for the intervention group as compared to the control group. Conclusion: Short-term therapeutic supplementation of Vitamin. D3 in children with moderate to severe AD improves the clinical score. There is an inverse relationship between serum Vitamin. D3 level and severity of AD.

PREVALENCE OF BURNOUT AMONG NURSING STAFF: AN EXPERIENCE FROM A TERTIARY CARE HOSPITAL IN INDIA

Objective: The present study aimed to assess the prevalence of burnout in staff nurses at a tertiary care hospital and to examine the relationship of socio-demographic factors with burnout. Methods: In this present cross-sectional study, data from 100 staff nurses were collected using the Maslach Burnout Inventory (MBI) and Modified Kuppuswamy Scale. It was analyzed to find out the burnout level. Results: All the participants were females with mean age of 27.36±3.258 years. Most of participants (68%) belonged to the upper middle socioeconomic class. High level of burnout was reported in 33% participants in depersonalization and 28% in personal accomplishment domain, respectively. Medium level of burnout was found in 37%, 46%, and 25% of participants in emotional exhaustion, depersonalization, and personal accomplishment domains, respectively. About 63% of participants reported low level of burnout in emotional exhaustion domain. Conclusion: The present study reported a medium and high level of burnout in depersonalization and personal accomplishment domains among significant number of participants which needs to be addressed for efficient human resource management at tertiary care hospital.

Prevalence and clinical implication of adverse childhood experiences and their association with substance use disorder among patients with schizophrenia

BackgroundAdverse childhood experiences (ACEs) and substance use disorder (SUD) are well-known risk factors for psychosis and dramatically affect schizophrenia. In this research, we aimed to measure the prevalence of adverse childhood experiences and substance use disorder in patients with schizophrenia and assess the effect of ACEs on the clinical presentation and overall functioning and the association between them and SUD in patients with schizophrenia. A cross-sectional study included a random sample of 165 schizophrenic patients who were examined by doing drug screen in urine, structured questionnaire to collect Socioeconomic characteristics, history of schizophrenia, structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-fifth edition, Positive and Negative Syndrome Scale (PANSS), Adverse Childhood Experiences International Questionnaire (ACE-IQ), World Health Organization Disability Assessment Schedule 2.0, compliance rating scale, addiction severity index fifth edition (ASI) for individuals with positive urine drug screen.ResultsOnly 14.4% of the studied patients had no adverse childhood experiences. The prevalence of positive substance abuse screening was 18.2%. There were statistically significant negative correlations between total ACE score and educational level, socioeconomic level, and the onset of schizophrenia. On the other hand, statistically significant positive correlations were found between the total ACE score and PANSS score and ASI score. The first most frequent ACE was significantly associated with female gender, lower education levels, low and middle socioeconomic classes, lifetime substance use, smokers, and positive drug screening. Emotional neglect and contact sexual abuse were significantly associated with positive drug screening. At the same time, Physical abuse was significantly associated with both lifetime substance use and positive drug screening.ConclusionThe current study’s findings indicate that childhood adverse experiences and substance abuse are prevalent problems in patients with schizophrenia. Given that there is an association between both issues, they may affect the symptomatology of the disorder, the prognosis, and the therapeutic plan. It is advised that a greater emphasis on and identification of childhood trauma and drug use disorder may be a necessary step in assessing patients with schizophrenia.

To study the effectiveness of mindfulness-based meditation in the functional outcome of osteoarthritis knee and perceived stress scores and markers of obesity in postmenopausal women

Background: The global burdens of cardiovascular diseases (CVDs) and obesity are rising, producing enormous losses of life and disability-adjusted life-years in both developed and developing nations. Stress is a modifiable risk factor for the development of CVD. Postmenopausal women with osteoarthritis (OA) of knee joint may often report episodes of knee instability limiting their daily activities and this causes an added stress. Aims: To evaluate the effects of mindfulness-based meditation on functional outcome of OA knee and to study the effect of mindfulness-based meditation on perceived stress scores (PSSs) and markers of obesity in postmenopausal women. Materials and Methods: This interventional study was conducted on forty postmenopausal women in a tertiary care hospital of Eastern India after taking institutional ethical clearance and informed consent of the patients. Presumptive stressful life events scale (PSLES) scores and PSSs of the patients were assessed. Patients with PSLES scores more than 200 were included in the study. They were all on nonvegetarian diet and came from the middle socioeconomic class. Patients were randomly allocated into two groups and received either balancing exercises and mindfulness-based meditation (Group A) or balancing exercises (Group B). Patients of both groups were age matched. Body mass index (BMI) and waist/hip ratios were measured. The outcome measures were visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Results: There was no significant difference in age, PSLES and PSS scores, and WOMAC and VAS scores between the two groups before intervention. AGE Group A 62.4 ± 4.16 versus Group B 62.15 ± 3.75, P = 0.85; BMI Group A 26.6 ± 1.97 versus Group B 26.2 ± 1.002, P = 0.41; waist/hip Group A 0.833 ± 0.033 versus Group B 0.832 ± 0.03, P = 0.96; PSLES Group A 296.3 ± 34.95 versus Group B 291.8 ± 25.2, P = 0.65; PSS Group A 33.38.1 ± 1.97 versus Group B 32.8 ± 2.86, P = 0.185. PSS scores (20.75 ± 1.9 vs. 27.1 ± 1.65; P < 0.0001) and waist/hip ratio were significantly less in Group A as compared to Group B following intervention. Group A had significantly lower WOMAC (38.1 ± 4.03 vs. 50.8 ± 3.78; P < 0.0001) and VAS (4.35 ± 0.77 vs. 5.75 ± 0.68; P < 0.0001) scores as compared to Group B after practice of balancing exercises along with mindfulness-based meditation. Waist/hip ratio was significantly less in the group practicing mindfulness-based meditation (Group A) as compared to Group B. Conclusion: The results of the present study indicate that balancing exercises when practiced along with stress relaxation exercises are more effective in improving the functional ability of OA knee in postmenopausal women.

COVID-19 infodemic and digital health literacy in vulnerable populations: A scoping review.

BackgroundPeople from lower and middle socioeconomic classes and vulnerable populations are among the worst affected by the COVID-19 pandemic, thus exacerbating disparities and the digital divide.ObjectiveTo draw a portrait of e-services as a digital approach to support digital health literacy in vulnerable populations amid the COVID-19 infodemic, and identify the barriers and facilitators for their implementation.MethodsA scoping review was performed to gather published literature with a broad range of study designs and grey literature without exclusions based on country of publication. A search was created in Medline (Ovid) in March 2021 and translated to Medline, PsycINFO, Scopus and CINAHL with Full Text (EBSCOhost). The combined literature search generated 819 manuscripts. To be included, manuscripts had to be written in English, and present information on digital intervention(s) (e.g. social media) used to enable or increase digital health literacy among vulnerable populations during the COVID-19 pandemic (e.g. older adults, Indigenous people living on reserve).ResultsFive articles were included in the study. Various digital health literacy-enabling e-services have been implemented in different vulnerable populations. Identified e-services aimed to increase disease knowledge, digital health literacy and social media usage, help in coping with changes in routines and practices, decrease fear and anxiety, increase digital knowledge and skills, decrease health literacy barriers and increase technology acceptance in specific groups. Many facilitators of digital health literacy-enabling e-services implementation were identified in expectant mothers and their families, older adults and people with low-income. Barriers such as low literacy limited to no knowledge about the viruses, medium of contamination, treatment options played an important role in distracting and believing in misinformation and disinformation. Poor health literacy was the only barrier found, which may hinder the understanding of individual health needs, illness processes and treatments for people with HIV/AIDS.ConclusionsThe literature on the topic is scarce, sparse and immature. We did not find any literature on digital health literacy in Indigenous people, though we targeted this vulnerable population. Although only a few papers were included, two types of health conditions were covered by the literature on digital health literacy-enabling e-services, namely chronic conditions and conditions that are new to the patients. Digital health literacy can help improve prevention and adherence to a healthy lifestyle, improve capacity building and enable users to take the best advantage of the options available, thus strengthening the patient’s involvement in health decisions and empowerment, and finally improving health outcomes. Therefore, there is an urgent need to pursue research on digital health literacy and develop digital platforms to help solve current and future COVID-19-related health needs.

Factors influencing adherence to self-care practices among patients of type 2 diabetes mellitus from Saurashtra region of Gujarat: A conclusive research.

It is commonly understood that diabetes self-care practice is critical in the management of the disease. However, the magnitude and determinants of self-care practices are not well evaluated at the community level. A community based cross-sectional study was conducted among 178 type 2 DM patients. Self-care practices were evaluated for the last seven days and each item was scored from 0 (none of the days in a week) to 7 (all 7 days were followed). Adherence to medication (89.3%) and blood glucose monitoring (65.2%) were relatively higher than other domains. Factors associated with dietary adherence were secondary level education and above (OR = 22.1, 95% CI = 6.85 to 71.3), physician or endocrinologist treating doctors (OR = 3.36, 95% CI = 1.24 to 11.32), joint and three-generation family (OR = 3.32, 95% CI = 1.23 to 8.92) and upper and middle socioeconomic class (OR = 2.5, 95% CI = 1.1 to 6.2). Good glycemic control was significantly associated with dietary adherence (OR = 6.81, 95% CI = (2.71 to 17.16), medication adherence (OR = 4.59, 95% CI = 1.3 to 16.24) and regular exercise (OR = 3.65, 95% CI = 1.62 to 8.19). There is need to develop structured diabetes self-care education programs with involvement of private practitioners as a majority of the patients consult private practitioners for treatment. Health educators might have to place emphasis on self-care education to patients as well as caregivers belonging to low socioeconomic class and having lower education.

Knowledge and Practices Regarding Foot-Care among Diabetic Patients Residing in Meicheri Taluk, Salem, TamilNadu

Background: Diabetes mellitus is a major public health problem in India. The life time risk of developing a foot ulcer in DM is estimated to be 15%. The patients with foot problem spend 32.3% of the total income towards treatment. The objective of the study was to assess the knowledge and practices regarding foot care among diabetic and to estimate the association of the factors with knowledge and practices of foot care. Methodology: This cross-sectional study was conducted among diabetes mellitus with more than 5 years duration living in and around Meicheri. Convenient sampling was followed. Sample size was estimated to be 160. Results: Only 59.4% of patients had good knowledge regarding foot care. Only 26.9% of patients followed good foot care practices. In our study majority 80% belonged &gt;50 years of age. About 31.9% were illiterate and 65% belonged to upper lower and lower middle socio-economic class in this study. Previous foot care advice reception has an association in knowledge regarding foot care but not with practicing it. Regular screening for blood sugar and other systemic illnesses is associated with foot care knowledge among patients. Type of drugs used by the patient is associated with foot care knowledge which is statistically significant. Conclusions: Foot care advice received previously had a significant increase in practices, so that health education regarding diabetic foot care knowledge should be improved to prevent the diabetic foot ulcer morbidities.

Frequency of subclinical hypothyroidism and mean serum TSH level in first trimester of pregnancy.

Objective: To find out the frequency of subclinical hypothyroidism (SCH) in our pregnant population during 1st Trimester and the mean TSH level in first trimester of pregnancy. Study Design: Cross Sectional Descriptive study. Setting: Dow University Hospital and Dr Ruth KM Pfau CHK. Period: June 2015 to May 2016. Material &amp; Methods: All Pregnant women with &lt;14 weeks gestation were screened for Serum TSH level. Data were recorded after informed consent and institutional ethical approval. Variables recorded were age, parity, gestational age and serum TSH level. Data were analyzed on SPSS version 16. Mean and SD were calculated for quantitative variables ie. Age, parity, gestational age, serum TSH level and serum free T4 level. Mean TSH level according to age group, parity and gestational age groups were determined by applying ANOVA test. Correlation of Serum TSH level with the maternal age, parity and gestational age groups were also assessed by Pearson Correlation test. Significant P-value was taken as &lt;0.05. Results: The frequency of SCH found was 19.35% by taking cut off limit of &lt;2.5 IU/L and 3.55% by taking cut off limit of &lt;4.5 IU/L among total of 310 pregnant women. Mean TSH level was 1.84±1.36 IU/L. The mean maternal age was 27.22 ± 4.43 yrs. while median parity was 1. Mean gestational age of these patients were 9.41 ± 2.748 weeks and out of these 160 (51.61%) were between 4-9 weeks and 150(48.38%) between 10-14 weeks. Majority (74%) of these women belonged to lower middle socioeconomic class. Mean TSH level coorelation between different age groups, parity groups and gestational age groups were found to be insignificant. Conclusion: The prevalence of SCH is not so high and mean TSH level in our population was 1.84 IU/L. But to establish reference range for Pakistani population, further studies in population of different backgrounds and geographical distribution needs to be evaluated.

Socioeconomic Classes of University Students in Pakistan as Predictors of their Personality Traits: A Case Study

The current study was heading for determining the impact of Pakistani university students’ socioeconomic classes on their personality traits. Demographic and personality questionnaires were filled by available university students online. The stepwise regression technique facilitated to generate regression models to define impacts of different socioeconomic classes on students’ different personality traits. Different regression models highlighted the significant negative impacts of the middle upper socioeconomic class on Agreeableness, Extraversion and Neuroticism personality traits. The lower socioeconomic class was found to have positive impact on only one personality sub-trait self-discipline. Whereas, the upper lower socioeconomic class caused positive impacts on students’ trust sub-trait, Conscientiousness trait and negative impact on excitement seeking sub-trait of personality. The importance of these impacts of socioeconomic classes on different personality traits and the possible implications are discussed with respect to university students’ academic performance and academic behaviour.

Behaviour of brand switching of milk product for young children aged 1-3 years in consumers of middle to lower socioeconomic class in urban communities in malang

A total of 56.7% of Indonesia’s population today is concentrated in urban areas. More than 80% of Indonesians belong to the middle and lower socioeconomic class and this segment is the biggest consumer of milk products for young children aged 1-3 years called growing-up milk (GUM). Understanding the brand and customer behaviour is significantly important. This study aimed to examine the behavior of GUM brand switching on middle to lower socioeconomic class consumers in urban communities. The research was conducted in Malang Municipality, East Java Province, using guided interviews with questionnaires. The research respondents were 102 consumers of GUM that were selected by proportional random method in all five sub-districts. The data were processed using Structural Equation Modeling-Partial Least Squares (SEM-PLS). The results showed that the prior experience in purchasing variables had a highly significantly negative effect and the consumer dissatisfaction had a significantly positive effect on the process of brand switching for consumers of GUM products. Empty product stock in the store is one of the real examples of bad prior experience as well as dissatisfaction of the consumers that trigger them to change the old brand to new brand. The GUM companies have to maintain product suppliability.

A STUDY ON EXTRA PULMONARY TUBERCULOSIS: SOCIO ECONOMIC CLASS DISTRIBUTION

Background:Extra-pulmonary tuberculosis can affect the lymph nodes, pleura, bones, joints, genitourinary tract, nervous system (meningitis, tuberculoma), abdominal tuberculosis (intestines, mesentery, solid organs), skin. Materials and Methods: It is a record based, observational prospective study which assesses the presentation and evaluation of the socio-economic distribution of extrapulmonary tuberculosis and management of it in a tertiary care hospital. Result: In present study, out of 50 cases 52% patients were from low socio-economic class, 44% patients were from middle socioeconomic class and 4% were from high socio-economic class. Conclusion:The frequency of extrapulmonary TB in this study was highest in low socio-economic class followed by middle and high socio-economic class.

Unmet need for family planning in Pakistan: prevalence and factors influencing unmet need among women of reproductive age.

Introduction: Despite government efforts, the contraceptive prevalence rate is low in Pakistan. UMNFP still exists in Pakistan like other low-middle income countries. Our study aims to determine the prevalence and factors affecting the unmet need for family planning in Pakistan.&#x0D; Methods: The analysis was performed using PDHS 2017-18 data set. In our study, 11847 women of reproductive age were included out of 14498.&#x0D; Result: In binary logistic regression, age, wealth index, and the number of living children found statistically significant. UMNFP was lower in women of older age (45-49) in contrast to younger women of age between 15-19 years. Regarding the women's socioeconomic status, those who belong to the middle socioeconomic class had a lower UNMFP in contrast to the poorest. UMNFP was 1.7 times more in women having more than three children in contrast to women who had less than or equal to three children. However, women's age, women socioeconomic status, and working status of women were found to be statistically significant with an unmet need for spacing in the multinomial model. In addition, the age of women, region, number of living children, socioeconomic status, and knowledge of family planning was found to be statistically significant with an unmet need for limiting.&#x0D; Conclusion: In the light of our study, overall unmet need is lower in older age and richer wealth quintile while UNMFP is high in women who had more than three children. Policymakers should design interventions to target high-risk populations to overcome the issue of rapid population growth.

Feasibility, Outcomes, and Safety of Telehepatology Services During the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID‐19) has hampered health care delivery globally. We evaluated the feasibility, outcomes, and safety of telehepatology in delivering quality care amid the pandemic. A telemedicine setup using smartphones by hepatologists was organized at our tertiary‐care center after pilot testing. Consecutive patients availing telehepatology services were recruited between March and July 2020. An adapted model for assessment of telemedicine was used after validity and reliability testing, to evaluate services 7‐21 days after index teleconsultation. Of the 1,419 registrations, 1,281 (90.3%) consultations were completed. From 245 randomly surveyed patients, 210 (85.7%) responded (age [years, interquartile range]: 46 [35‐56]; 32.3% females). Seventy percent of patients belonged to the middle or lower socio‐economic class, whereas 61% were from rural areas. Modes of teleconsultation were audio (54.3%) or hybrid video call (45.7%). Teleconsultation alone was deemed suitable in 88.6% of patients. Diagnosis and compliance rates were 94% and 82.4%, respectively. Patients’ convenience rate, satisfaction rate, improvement rate, success rate, and net promoter scores were 99.0%, 85.2%, 49.5%, 46.2% and 70, respectively. Physical and mental quality of life improved in 67.1% and 82.8% of patients, respectively, following index teleconsultation. Person‐hours and money spent by patients were significantly lower with teleconsultation (P < 0.001); however, person‐hours spent by hospital per teleconsultation were higher than in physical outpatient services (P < 0.001). Dissatisfied patients were more likely to have lower diagnosis rate, unsuitability for teleconsultation, noncompliance, poorer understanding, and uncomfortable conversation during teleconsultation. Connectivity issues (22.9%) were the most common barrier. Three patients, all of whom were advised emergency care during teleconsultation, succumbed to their illness. Conclusion: Telehepatology is a feasible and reasonably effective tool for rendering health care services using smartphones during the COVID‐19 pandemic. Systematic implementation, possible integration into routine health care delivery, and formal cost‐effectiveness of telehepatology services need further exploration.

CLINICAL PROFILE AND PREDICTORS OF MORTALITY OF EXTRAMURAL NEONATES ADMITTED IN NICU OF TERTIARY CARE HOSPITAL IN CENTRAL RAJASTHAN : PROSPECTIVE OBSERVATIONAL STUDY

OBJECTIVE: This study was undertaken to know the clinical profile and predictors of mortality of outborn neonates admitted in Neonatal Intensive Care Unit (NICU). METHOD:This prospective study was conducted in NICU of department of pediatrics,JLN medical college &amp; hospital, Ajmer from January 2019 to December 2019. RESULTS:Of the 2250 neonates admitted,There was male preponderance (64%),male:female ratio was 1.78:1.Majority of neonates (68.4%) were term while 31.2% were preterm and 0.4% were post term gestation. Majority of neonates (79.8%) were admitted in early neonatal period while 20.1% neonates were admitted in late neonatal period. As per birth weight,44.1% neonates were between 1.5-2.49 kg,42.6% neonates had birth weight more than 2.5 kg while 3.4% neonates were &lt;1 kg.Majority of neonates (88.7%) were delivered vaginally while 11.3% were delivered by caesarean section.Majority of neonates (85.1%) were delivered at govt.hospitals while 11% and 3.9% neonates were delivered at private hospitals and at home respectively. Rural residency (73.7%) was far more as compared to urban residency (26.3%).42.8% mothers had primary education and 47.7% mothers had secondary education while 3.8% mothers were illiterate. Majority of cases (66.1%) belonged to middle socioeconomic class. Major causes of NICU admission were birth asphyxia / HIE of newborn (21.11%),neonatal sepsis (16.36%),neonatal jaundice (12%),RDS of newborn (8.6%), and prematurity (7.7%). Out of 2250 neonates admitted, 70.1% babies were successfully discharged while 29.9% neonates died during treatment.Birth Asphyxia / HIE of Newborn (22.25%),RDS of Newborn (20.47%),Neonatal Sepsis (16.02%), Shock (10.98%), Congenital Malformations (6.82%), and ELBW (6.38%) were found to be major causes of mortality among neonates admitted in NICU. CONCLUSION: The majority of morbidities and subsequently the mortalities can be reduced by improving maternal care and essential newborn care,appropriate primary interventions and timely referral to tertiary care centers for high risk cases,with better transport facilities for sick neonates.

MO1051KNOWLEDGE, ATTITUDE AND ACCEPTANCE OF TELENEPHROLOGY SERVICES AMONG PATIENTS IN NEPHROLOGY: A STUDY FROM INDIA

Background and AimsThere is an increasing burden of kidney diseases in developing countries like India where access to specialist care is available only to a small proportion of patients. Telemedicine, has been relatively less used in India especially in public sector hospitals. The current study was designed to assess the patient’s knowledge, attitude and acceptance of telenephrology services at our institute, a public sector hospital in a developing country.MethodThis study is a cross-sectional survey carried out among patients who had availed our telenephrology services during the preceding three months. A total of 150 patients were selected by stratified random sampling from the list of attendees of telenephrology consultation in the past 3 months. The questionnaire was administered in local language by telephone interview method. The frequency distributions and average and median values for each of the questionnaire variables were calculated using SPSS software.ResultsThe average age of the study cohort was 42.52 ± 15.1 years (17 – 83yrs). 68% of the patients were males. The questionnaire was answered by the patient himself/herself in 56% cases, spouse in 14.0% and children in 20.7% cases. 51.3% patients were graduates or post graduates. 40.7% patients belonged to the upper middle and 39.3% belonged to the lower middle socioeconomic class. 54.6% patients were residing in towns, 28.7% in cities and 16.7% in villages. Prior to the telenephrology service, the median distance travelled to attend our OPD was 113.5 (3 – 2249 km). Attendees incurred loss of work in 54.7% cases. Information about availability of telenephrology services was obtained from institutional helpline number by 59 (39.3%) patients while 50 (33.3%) patients obtained it from the internet. Others got information from friends, television or short message service (SMS). The average number of teleconsultations was 2 per patient.A large majority of patients (99.3%) felt that Telenephrology service was a right approach during the COVID-19 pandemic. On asking how they felt regarding Telenephrology experience, 70.67% said they were very happy, 25.3% were happy and 4.0% said they were apprehensive or doubtful. 96.6% patients said that they were confident discussing their complaints over phone. 92.6% patients were comfortable sharing reports over phone while 7.3% needed help from caretakers. Regarding the problems faced during teleconsultation, 36% patients responded that they wish to see the doctor in person to feel satisfied while 3.3% found difficulty in understanding drug dosages. 86% patients felt that Telenephrology services should continue even after the COVID pandemic.ConclusionIn developing countries like India, with the majority of the population residing outside major cities, wherein the accessibility to a specialist is limited and the digital development outscores the physical infrastructure, Telenephrology has huge potential to provide quality nephrology care to the remotest parts of the country.

Paediatric Contacts of Adult COVID-19 Patients: Clinical Parameters, Risk Factors, and Outcome.

Background There is insufficient data in Pakistan and in South Asia regarding paediatric COVID-19 demographics and related parameters. The main aim of this study was to assess the paediatric population exposed to SARS-CoV-2 infection, their clinical parameters, risk factors, and outcome. Methods This was a descriptive retrospective study conducted at the Pakistan Institute of Medical Sciences and Federal General Hospital Islamabad from 23rd July 2020 to 22nd August 2020. All paediatric contacts (≤13 years) of one hundred adult COVID-19 patients were included. Data of the index cases was taken from the medical records. Paediatric data was collected on the phone using a predesigned proforma. Results There were 137 paediatric contacts of 100 adult COVID-19 index cases. The index cases were predominantly males (67%) and belonged to the middle socioeconomic class (89%), and 14% succumbed to the disease. Females had more paediatric contacts. The mean age of contacts was 6.6 years, and the majority (80%) developed no symptoms. Among the symptomatic contacts, fever and cough were the most common symptoms. None of the contacts developed dyspnoea or required hospitalization. Majority of the contacts had been vaccinated with the BCG vaccine. Testing for COVID-19 was done in only 77 (56%) contacts, 25 (32%) by the government team, and 52 (67%) privately. A higher number of symptomatic contacts were positive (15/17 (88%)) as compared to that of the asymptomatic contacts (6/60 (10%)) (p = 0.002). Development of symptoms in the contacts was associated with the history of respiratory illnesses, recurrent infections, use of hematinics, a positive COVID-test result, and health professionals being index cases (p ≤ 0.01). Parents with higher education and in the health profession and the families of symptomatic contacts reported better compliance with quarantine regulations. Conclusion A significant number of children were exposed to adult COVID-19 patients. Most paediatric contacts remained asymptomatic. Children with preexisting medical conditions and with parents in health profession were susceptible to infection.

Intimate Partners Violence against Women during a COVID-19 Lockdown Period: Results of an Online Survey in 7 Provinces of the Democratic Republic of Congo.

Intimate Partners’ Violence (IPV) is a public health problem with long-lasting mental and physical health consequences for victims and their families. As evidence has been increasing that COVID-19 lockdown measures may exacerbate IPV, our study sought to describe the magnitude of IPV in women and identify associated determinants. An online survey was conducted in the Democratic Republic of Congo (DRC) from 24 August to 8 September 2020. Of the 4160 respondents, 2002 eligible women were included in the data analysis. Their mean age was 36.3 (SD: 8.2). Most women (65.8%) were younger than 40 years old. Prevalence of any form of IPV was 11.7%. Being in the 30–39 and >50 years’ age groups (OR = 0.66, CI: 0.46–0.95; p = 0.026 and OR = 0.23, CI: 0.11–048; p < 0.001, respectively), living in urban setting (OR = 0.63, CI: 0.41–0.99; p = 0.047), and belonging to the middle socioeconomic class (OR = 0.48, CI: 0.29–0.79; p = 0.003) significantly decreased the odds for experiencing IPV. Lower socioeconomic status (OR = 1.84, CI: 1.04–3.24; p = 0.035) and being pregnant (OR = 1.63, CI: 1.16–2.29; p = 0.005) or uncertain of pregnancy status (OR = 2.01, CI: 1.17–3.44; p = 0.011) significantly increased the odds for reporting IPV. Additional qualitative research is needed to identify the underlying reasons and mechanisms of IPV in order to develop and implement prevention interventions.

High Prevalence of Diabetes in Hospitalized Patients With COVID-19 and Its Association With Greater Severity of COVID-19 in Delhi, India

: India is home to 77 million people with diabetes and has a large number of COVID 19 cases, albeit with a low fatality (<1.5%). Little Indian data is available about the prevalence of diabetes in COVID 19 and its impact on outcomes. This observational prospective study (approved by the Institutional Ethics Committee) was carried out in a designated COVID facility, largely catering to middle and upper socioeconomic classes. A total of 401 (125 F, mean age 54 y, range 19–92 y) consecutive adults hospitalized with COVID-19 infection as proven by positive nasal swab for SARS-CoV2 by RT-PCR were included. Diabetes mellitus was diagnosed either by known history or HbA1c≥6.5%. Severity was assessed using the WHO ordinal scale1. Clinical outcomes and markers of inflammation were compared between diabetes and non-diabetes groups. Out of 401 patients, 210 (52.4%) had either diabetes (189,47.1%) or hyperglycemia requiring insulin treatment (21, 5.2%). 152 (37.9%) reported known diabetes, and 37 (9.2%) had preexisting but undiagnosed diabetes (HbA1c≥ 6.5%). People with diabetes were significantly older (mean age 59.9 vs 47.7 y), and had a higher proportion of men (74.6 vs 63.7 %), hypertension (58.7 vs 25%), CAD (13.8 vs 4.2%), and CKD (5.3 vs 0.9%) and a higher mean baseline severity score (3.4±0.7 vs. 3.2±0.5, p-0.000). The diabetes group had a higher number of severe cases (WHO scale≥5) (20.1% vs 9%, p-0.002) and higher mortality (6.3 vs 1.4%, p-0.015). A higher proportion of the diabetes group required ICU admissions (24.3 vs 12.3%, p-0.002), glucocorticoid therapy (78.3 vs 54.2%, p-0.000), oxygen administration (53.4 vs 28.3%, p-0.000), inotropic support (7.4 vs 2.4%, p-0.019), and renal replacement therapy (3.7% vs 0,p-0.005). The mean duration of hospital stay was higher for the diabetes group (10.4 vs 9.1 days, p-0.016). Of those who died, 12/15 (80%) had diabetes. Baseline Hba1c (n=331) showed a significant correlation with outcome severity scores (r 0.136, p-0.013). Markers of inflammatory response, CRP (41.0±4.4 vs. 19.4±3.8, p-0.000), ferritin (404.8±41.6 vs. 258.8±40.2, p-0.012), IL6 (65.5±11.6 vs. 26.9±4.4, p-0.002), LDH (321.8±10.1 vs. 286.8±8.4, p-0.008) were significantly higher in the diabetes group. Procalcitonin and D Dimer did not differ significantly. In conclusion, we report the highest prevalence of diabetes in a hospitalized COVID-19 population so far. The diabetes group had more severe disease and greater mortality. Baseline HbA1c correlated with poor outcomes. The comorbidities could have contributed to these poorer outcomes in the diabetes group. Strategies to improve outcomes in this pandemic it is imperative to include screening for and better control of diabetes. Reference: 1 https://www.who.int/blueprint/priority-diseases/key-action/COVID-19_Treatment_Trial_Design_Master_Protocol_synopsis_Final_18022020.pdf

Maternal knowledge on infant hearing loss and acceptability of hearing aids as an intervention at a Referral Hospital in southwestern Uganda

ObjectiveInfant hearing screening enables early detection and management of hearing loss (HL) so that speech and language development delays are minimized. Parents play a critical role in successful screening and management of Infant Hearing loss (IHL) but there is limited data from resource limited settings on parental knowledge about HL and acceptability of IHL interventions. This study was aimed at exploring the maternal knowledge on the various causes of IHL and their acceptability of hearing aids as an intervention for IHL. MethodsA cross-sectional study was conducted at a referral hospital in southwestern Uganda. A semi-structured questionnaire was used to interview postpartum mothers to assess their knowledge on causes of IHL and acceptability of a hearing aid if prescribed. Logistic regression was used to calculate odds ratio (OR) for the factors associated with hearing aid refusal. Results401 mothers with a mean age of 25 years (Standard Deviation = 5.6 years) were recruited. Half of the mothers correctly identified at least five causes of IHL. The most well-known causes were measles (63.3%) and a positive family history of HL (61.6%). 60% of mothers held at least one superstitious belief as a cause of IHL. Majority of mothers (86%) would accept a hearing aid as an IHL intervention. Mothers with a positive family history of HL (OR = 0.42, p = 0.04), in middle or higher socioeconomic class (OR = 0.45, p = 0.01) and those with more than 3 antenatal visits in their recent pregnancy (OR = 0.44, p = 0.01) were less likely to refuse a hearing aid while mothers that were either widowed or separated from their spouses (OR = 15.64, p = 0.01) were more likely to refuse a hearing aid. ConclusionAlthough mothers had limited knowledge on some causes of IHL, there was a high acceptability of hearing aids as an intervention for IHL. Marital status, family history of hearing loss, socioeconomic status and antenatal care attendance are factors that could be used to identify mothers that might accept or refuse a hearing aid for their infant. There is need to increase awareness about causes of hearing loss to improve knowledge as well as dispel any non-biological beliefs held by communities.

Study of cognitive impairment in depression

IntroductionCognitive impairment is frequently observed in patients suffering from depression. Cognitive dysfunction play a critical role in increasing the individual’s vulnerability for the first onset, maintenance and future recurrence of depressive episodes.ObjectivesThe objectiv was to assess the cognitive impairment in patient with depressive episode.MethodsA cross sectional, hospital based study was conducted among 100 patients with depressive episodes diagnosed by International Classification of Diseases - 10 visiting outpatient and inpatient in Department of Psychiatry of Manipal Teaching Hospital, Pokhara, Nepal. The subjects were interviewed with Beck’s depression inventory, Perceived deficient questionnaire, Frontal assessment battery, Trail making test A and B and Forward and Backward Digit Span test. For the assessment of correlates, regression analyses were done using SPSS v 20.0.ResultsThe mean age of the participants was 32.47 years (SD±12.25), majority were female, married, Hindu and from urban population. Higher number of respondent were student. Most of them were educated till intermediate level and belonged to middle socioeconomic class family. Different domain of cognitive function according to severity of depression was found to be statistically significant (p&lt;0.05). This study also found that age, sex, education, medication use and Becks depression inventory score predicted the cognitive function.ConclusionsCognitive impairment is not ucommon among patient with depressive episodes. The impairment is not only seen in severe cases but also in mild to moderate cases. The assessment of cognitive deficits should be the regular part of the assessment in depressive patients.