Upper-middle Socioeconomic Status Research Articles

Influence of Parents Socioeconomic Status on Newborn Telomere Length

Background: Telomeres, the marker of biological aging, are substantially influenced by parental untoward exposures and their socioeconomic status (SES). This study aimed to find the association between parents–newborn leukocyte telomere length (LTL) among different SES highlighting reprogramming during fetal life. Methods: The parents' and newborn blood samples (n = 612, 204 each) were collected from September 2021 and July 2022, from Ziauddin Hospitals, Karachi. The real time PCR was used to quantify telomere length (T/S ratio). IBM statistical package for the social sciences (SPSS) was used to carry out analyses and graphs were formed by using GraphPad prism. A P-value of <0.05 was considered statistically significant. Results: The mean age of mothers range between 25-35 (27.5%) and fathers <25 years (55.9). The mothers and their newborns in the upper middle SES had significantly longer LTL (2.7±1.30, 2.14±1.39, p<0.001). Whereas low SES group showed insignificant difference between (Newborn vs. mother). Among father newborns upper middle and high SES groups showed significant differences in TL (p=0.001). Longer TL was seen in father-newborn of the upper middle group (2.69+1.37; 2.79+1.30) with significant difference (p=0.001). Conclusion: Newborns had longer TL compared to their parents, highlighting the in-utero reprogramming in all socioeconomic groups. These findings show the importance of risk factors and their comprehensive understanding and their significance in contributions during vital beginning period of newborns' TL.

ASSESSMENT OF EYE DROP INSTALLATION TECHNIQUE AMONG PATIENTS ATTENDING OUTPATIENT CLINIC AT PT. JLNGMC, CHAMBA

Objective: A good eye drops installation technique and its knowledge is vital for curing eye ailments and preventing eye from harmful effects of over-dose and under-dose of drugs. The current study assessed the eye drop installation technique and corrected it by imparting them education regarding the same. Methods: A total of 120 patients were enrolled in the cross-sectional study using consecutive sampling technique till the sample size was achieved in a tertiary care hospital. The participants were observed by the trained observers for their steps of technique for installing eye drops and the errors were noted which were corrected by the observers and followed up till 3 visits to observe a change in the steps of technique. Results: The mean age of study participants was 41.44±15.4 y. Majority of them were in the age group 18-30 y (35%), females (55.8%), and belonging to upper middle socio-economic status (31.7%). Majority of study participants had 6/6 VA in right eye (65%) and left eye (61.7%). “Drop land on first attempt” and “direct bottle towards eyes” showed maximum improvement of 45.8% each followed by “tilt head while putting” showed 45 % improvement between 1st visit and 3rd visit. “Trouble putting drops” showed least improvement by 20% between 1st and 3rd visit. All the favorable ophthalmic practices showed a statically significant (<0.05) increase in their proportion in each visit. Conclusion: A high prevalence of errors while installing eye drops among participants were observed which were improved by educating them about right steps, as observe in follow up visits.

Feasibility and satisfaction level of caregivers with telemedicine in childhood cancer: A mixed-methods study.

1549 Background: Telemedicine has emerged as a crucial solution to addressing health care disparities, especially in countries like India where healthcare disparities are pronounced and specialist care is concentrated in urban areas. Methods: We conducted a mixed-methods study among caregivers of children with cancer who had utilised telemedicine in the past 6 months. Telephonic quantitative interviews collected information on diagnosis, current treatment status, residence and socio-economic parameters. A logistic regression model was created to assess patient and caregiver related factors associated with satisfaction with telemedicine. In-depths interviews were conducted in a sub-set of participants followed by thematic analysis. Results: Caregiver of 465 patients [median (range) age: 8 (0.1-18) years; 70.04% male; 82.54% with haematological malignancy] participated in this study. Patients had a median (range) of 2 (1-30) telemedicine in the past year, with parents being the most common care giver being involved [n=326 (70.10%)]. Telemedicine was reported to be more convenient than in-person visits and helpful in saving time and money by 90.54% (n=421) patients and 88.6% (n=421) patients reported easier follow up and access to care using telemedicine. Difficulty in explaining issues over telephones or emails was the reason for dissatisfaction for 47.53% (n=221) patients, additionally 22.37% (n=104) patients felt they received inadequate attention during telemedicine. Majority of the patients (85.38%, n=397) planned to continue teleconsultation and 88.39% (n=411) would recommend teleconsultation to others. Socioeconomic status of upper and upper-middle class upper and upper-middle socioeconomic status [OR (95%CI): 2.14 (1.38-3.32), p: <0.001; aOR (95%CI): 2.11 (1.35 - 3.31), p: 0.001] was significantly associated with caregiver satisfaction with telemedicine. Qualitative interview showed themes of monetary and time savings with telemedicine, ease of consultations for minor complaints, delay in responsiveness of doctors, language barriers and difficulty in using telemedicine platforms due to low literacy levels. Conclusions: Telemedicine has emerged as a valuable tool for paediatric cancer care offering convenience and accessibility. While most caregivers expressed satisfaction, challenges remain in communication and limited access among caregiver of lower socio-economic strata. Further studies should aim at developing more patient friendly telemedicine platforms.

Locus Of Control in Cancer And Cardiac Patients: Comparison Across Gender And Socio-economic Status

The objective of the study was to explore the locus of control in cancer and cardiac patients in comparison to gender and SES (socio- economic status). A total of 360 respondents constituted the sample of the present study. Modification of Rotter’s Internal-External Control of Personality Scale (Ara’s Bengali Adaptation 2006) was used for the collection of data. The sample was equally divided into three categories (cancer, cardiac, normal) on the basis of type of individuals (N=120 for each category). Again they were equally divided into male and female on the basis of gender (N=60 for each group).Each category was again equally subdivided into lower middle and upper middle on the basis of SES (N=30 for each group). Results analyzed through ANOVA revealed that the main effects for type of individuals, gender and SES were statistically significant. That is, Both cancer and cardiac patients were more externally controlled as compared to normal individuals, Females were more externally controlled as compared to males and lower middle SES individuals were more externally controlled as compared to upper middle SES individuals. Again the two way interactions between type of individuals & gender, and gender & SES were statistically significant. The Chittagong Univ. J. B. Sci.,Vol. 7(1 &2):131-149, 2012.

An Assessment of the Nutritional Status and its Predictors amongst Women in a Rural Community of Dharwad Taluk, Karnataka, India

The connection between food insecurity and health is becoming more widely acknowledged, as it plays a major role in the onset and advancement of non-communicable illnesses. The family's overall well-being and health are directly impacted by the health status of the female. Rural women play a dominant role in the country’s economy and their nutritional status has direct bearing on the whole family. Hence the present study was conducted with the objective to assess nutritional status and to identify the predictors of poor nutrition among rural women of Dharwad taluk, Karnataka. The sample of the study included 500 rural women in the age group of 16-80 years. A self structured questionnaire, SES Agarwal 2005, Anthropometric measurements were used to assess BMI, Hb level, knowledge level and morbidity status. More than one third of the rural women were selected were in the age group of 40-80 years, were illiterates and involved in agriculture. Majority belong to social tribes and staying in nuclear families. Two third of the selected rural womenconsume non-vegetarian food. More than half of the families belonged to upper middle socio economic status. Majority of them had health related problems and were in mild to moderate anemia category. Low SES, low nutritional knowledge, non working status, morbidity condition, middle age group, anemia status and poor protein diet were found to be the risk factors of poor nutritional status among rural women. Low SES was found to be 2.6 times riskier; anemia condition was 4.68 times risk when compared to normal Hemoglobin level.

Quality of life among institutionalized and non-institutionalized elderly: A comparative study

Ageing is a natural process that causes several changes in social, hormonal, psychological, and physical circumstances. A person’s ageing is influenced by a variety of factors, including physiological, social, psychological, economic, environmental, and cultural factors, all of which have a substantial impact on the elderly’s quality of life. The present study investigated the quality of life among institutionalized and non-institutionalized elderly in Hubli-Dharwad taluk during 2021-22. The sample comprised 180 elderly (ninety from institutionalized setting and ninety from noninstitutionalized setting) aged 65 years and above were drawn through the purposive sampling method. The self-structured questionnaire, Older people’s Quality of life-35 and Agarwal’s socio-economic status scale were used for collecting information. The results revealed that the female population (55.60%) was more among the institutionalized elderly, while the male population (54.90%) was more among the non-institutionalized elderly. As per age of the elderly 75-84 years old were more (43.40%) among institutionalized elderly and 62 years old were more (68.90%) among non-institutionalized elderly. When it comes to education, most of the institutionalized elderly were studied up tothe 10th standard (33.30%) but most of the non-institutionalized elderly were illiterates (32.20%). According to socio-economic status (SES), most of the institutionalized elderly (38.90%) had upper middle SES category and most of the non-institutionalized elderly (51.10%) had lower middle SES category.The quality of life was high (58.90%) among non-institutionalized elderly as compared to the institutionalized elderly (35.60%).

Cross-cultural adaptation of Nepalese literacy and stigma of suicide scales (LOSS-SF-Nep and SOSS-SF-Nep) among Nepalese medical and nursing students.

Nepal is a country in South-east Asia with high suicide. There is ongoing trend of emerging research on suicide from Nepal but there is lack of validated scale in measuring literacy or stigma. In the view of poor media reporting and large treatment gap, this study was conducted. All previous validation studies were done in non-Hindu populations. A cross-sectional study was planned where the short forms of Nepalese literacy of suicide scale (LOSS-SF-Nep) and Stigma of Suicide Scale (SOSS-SF-Nep) were validated using standard procedure at a medical college in southern Nepal. Medical and nursing students of all batches were approached offline after successful pretesting. The psychometric properties of the scales were tested, and the statuses of literacy and stigma were assessed. Patient Health Questionnaire-9 and General Anxiety Disorder Scale-7 were used for revealing depression and generalized anxiety. Three hundred and nineteen Nepalese students participated and most of them were males, belonged to nuclear family, upper-middle socioeconomic status and represented 46 out of 77 districts of Nepal. The mean score of LOSS-SF-Nep was 6.36±1.92 and literacy ranged from 37.9% to 89.7%. The deeper exposure to suicidal patients was associated with better literacy. Factor analysis of SOSS-SF-Nep revealed three subscales: stigmatization, isolation/depression, and normalization/glorification and had acceptable psychometric properties. Gender, occupation of head of the family, region and years of education, using mental health services, and depression were associated with variable literacy or stigma. Literacy and stigma scales were validated in Nepali, and SOSS factor structures were revealed with modified descriptors. The literacy and stigma levels in medical students were calculated for the first time in Nepal and Hindu majority population.

An observational study on deliberate self-harm in individuals with alcohol dependence syndrome.

Comorbidities in alcohol dependence syndrome (ADS) are often associated with poor treatment outcomes and high service utilization. Deliberate self-harm (DSH) in India is a silent epidemic. There is a shortage of research on individuals with ADS, psychiatric comorbidities, and DSH. To study DSH and psychiatric comorbidity in persons with ADS. A cross-sectional study of 1-year duration is conducted in out patient department/indoor patient department of a tertiary care hospital. Eighty-one individuals with ADS were selected purposefully. A semi-structured pro forma, the severity of alcohol dependence questionnaire, Mini-International Neuropsychiatric Interview (MINI), and Deliberate Self-Harm Inventory were administered for assessment. The statistical analysis used is as follows: correlation statistics and logistic regression. Most subjects were married, belonged to upper-middle socioeconomic status, had at least secondary education, and had moderate alcohol dependence severity. Almost 3/4th of the subjects had at least one lifetime psychiatric disorder. A past episode of major depressive disorder was found in 47%. Nearly 20% of study subjects had a history of DSH, which was significantly associated with unmarried status, and earlier age of alcohol dependence. Marital status, educational level, and age of onset of alcohol dependence explain 64.3% of the variance in DSH attempts. Suicidality was significantly related to the presence of DSH. The study found a high prevalence of psychiatric disorders and a history of DSH in individuals with ADS. The study confirmed the association between DSH and suicidality and indicated a specific subpopulation of ADS who need thorough clinical assessments to recognize these psychiatric comorbidities and DSH.

Health-related quality of life among patients with childhood acute lymphoblastic leukemia in Saudi Arabia: A cross-sectional study

BackgroundAcute lymphoblastic leukemia (ALL) is the most common hematological malignancy affecting children. Patients with cancer experience debilitating symptoms resulting from cancer or the adverse effects of chemotherapy. Therefore, maintaining or improving health-related quality of life (HRQOL) is crucial to prolong survival. The aim was to assess pediatric HRQOL in patients with ALL. In addition, we report the influential factors, and the relationship between patient variables that decrease the HRQOL. Material and methodA cross-sectional study was conducted with 100 patients aged 2–12 years (59 boys and 41 girls) from King Saud University Medical City and King Fahad Medical City. The parent proxy report of Pediatric Quality of Life Inventory TM (PedsQL™) 3.0 Cancer Module (Arabic version) was used to measure the HRQOL. ResultPatients aged ≤6 had more procedural anxiety than older patients and exhibited increased worry during their first year of treatment. The boys had increased cognitive problems than girls. Upper-middle socioeconomic status posed enhanced barriers to communication, and more non-Saudi than Saudi patients experienced pain and hurt. Collectively, most patients had poor HRQOL. ConclusionA significant association was observed between the male sex and cognitive problems; younger age and procedural anxiety; short duration of treatment and worry; nationality with pain, hurt, and nausea; and communication barriers with upper-middle socioeconomic status.

Assessing Triadic Interactions and the Family Alliance among Belgian Lesbian Mothers and Their Donor-Conceived Children

Both empirical and clinical evidence with heterosexual parents and their biological children has shown the significant influence of early family interactions on children’s socioemotional and cognitive development during their first years. Yet, very little research has applied family-level assessment to families who are diverse with respect to parents’ gender and sexual orientation, and child’s method of conception. The present cross-sectional study compared 24 lesbian mother families with donor-conceived children and 24 heterosexual parent families with spontaneously conceived children with respect to triadic interaction quality and the family alliance (i.e., emotional and interactional coordination during family activities), as observed during the Lausanne Trilogue Play procedure. All parents were first-time parents, White, cisgender, residing in Belgium, had an upper-middle socioeconomic status, and a child aged 3–74 months (M = 21.00, SD = 17.72). Across family types, triadic interactions demonstrated similar scores in each family alliance dimension, characterized by appropriate levels of participation, organization, focalization, and affect sharing. The results have clinical implications for the use of the LTP as both a clinical assessment and a tool to reinforce and intervene with lesbian coparents. Family psychologists may find the results particularly informative when working to support coparenting relationships among diverse families.

Periodontal Disease Risk Factors Assessment in Association with Frequency of Tooth Brushing

Aim: To analyze the co-relation between frequencies of tooth brushing as a periodontal risk assessment tool in a population. Study design: Cross Sectional Survey Place and duration of study: Bacha Khan Medical College, Mardan from 1st January 2021 to 31st December 2021. Methodology: Four hundred and eleven participants were enrolled. Data was collected by administering the study questionnaire including 14 items assessing risk factors for periodontal disease as well as their oral hygiene habits. Descriptive statistics were used for data summarization and presentation. Results: Approximately 34.3% of study participants claimed to brush twice daily and 61.6% once daily. Mean age was 22.1 years and majority of them females constituting 66.7%. 39.33% had a history of bleeding gums while 28.2% had swollen gums. 51% of the subjects reported brushing for less than 2 minutes duration. 67% participants of population were of upper middle socioeconomic status. Conclusion: The clear correlation establish amongst risk of emerging periodontal disease and occurrence of tooth brushing. Keywords: Periodontal disease, Oral hygiene, Risk factors, Tooth brushing

Factors associated with medication non-adherence among patients with severe mental disorder - A cross sectional study in a tertiary care centre

BackgroundMedications are an essential treatment modality of mental disorders. There is limited scientific literature on medication non-adherence among patients in Severe Mental Disorders with respect to patient-related factors. The current study explores the factors associated with medication non-adherence in such patients. Objectives: To study the relationship between socio-demographic, clinical, treatment related factors, self-stigma, patients' & caregivers' attitude towards psychotropic medications, doctor-patient communication and medication non-adherence in patients with severe mental disorders. MethodsA cross-sectional observation study, where patients with severe mental disorders attending Psychiatry Outpatient services, and their caregivers, were recruited. Sociodemographic and clinical variables were recorded using data collection form and illness-specific severity scales. Patients were administered Medication adherence rating scale (MARS), Internalised stigma of mental illness inventory (ISMI- 9), Attitude of patients towards psychotropic medication scale and Doctor-patient communication questionnaire (DPCQ). The Attitude of caregivers towards psychotropic medication scale was administered for caregivers. ResultsAmong 152 patients, 58 (38.16%) patients had a diagnosis of schizophrenia, 11 (7.24%) had delusional disorder, 32 (21.05%) patients were diagnosed with bipolar disorder type 1 – mania and 19 (12.50) with bipolar disorder type 2 – depression whereas 32 (21.05%) had major depressive disorder. Majority of the patients were non-adherent to medications (88.16%). MARS score was significantly higher among patients of middle socioeconomic class (p = 0.014), urban domicile (p = 0.033) and those with higher caregivers' age (p = 0.019) . Among 79.61% of patients, ISMI-9 score was minimal to mild. Most patients (76.97%) and caregivers (83.55%) had negative attitude towards psychotropic medications. MARS score negatively correlated with BPRS (p = 0.0001*), HAM-D (p = 0.0004*), YMRS (p = 0.0007*), ISMI-9 (p ≤0.0001*) and the attitude of the caregivers towards psychotropic medicationsnegative scale scores (p = 0.003*) . MARS score positively correlated with DPCQ scores (p ≤0.0001*) . ConclusionMedication adherence was higher among patients belonging to uppermiddle socioeconomic status, urban domicile and higher caregiver age. Higher severity of illness, self-stigma and negative attitude of patients and caregivers towards psychotropic medications were associated with lower adherence whereas better doctor-patient communication was associated with higher adherence to medications.

Endometrial Fluid study for prevalence of tuberculosis by testing for diagnosis by CB NAAT culture

The frequency of Genital TB is 0.69% in evolved nations and 19% in non-industrial nations. The fallopian tube is most regularly influenced followed by endometrium and cervix. It is optional to TB concentrate somewhere else in body brought about by Mycobacterium Tuberculosis. History of essential fruitlessness in a lady whose assessment uncovers no evident reason and gives family ancestry or individual history of TB emerges doubt of genital TB. 1: To study the prevalence rate and risk factors for endometrial TB in infertile females; 2: To study clinical and reproductive profile of women diagnosed with endometrial TB; 3: To study the importance of CB NAAT over other diagnostic tests in diagnosing TB.Hospital based cross sectional study done on 100 subjects for one and a half year (June 2017 to July 2019).Labour room. Minor OT. OPD 2-5 ml endometrial fluid was retrieved on day 1/2 of menses using pipelles cannula. It was transferred to falcon tube and CB NAAT analysis was done using cartridge.Out of 100 cases, 4 were detected to be positive for endometrial TB. Out of them, 3 fell in age group of 30-39 years; all belonged to upper middle socioeconomic status. 3 cases had achieved menarche at >14 years of age and one had oligomenorrhoea.Number of patients testing positive for endometrial TB by CB NAAT Culture.Genital TB is a major cause of infertity and is generally underestimated because of asymptomatic nature of infection and diagnostic challenges. Large multicentric studies are needed to estimate the magnitude of female genital TB. Our study confirmed the usefulness of CB NAAT compared to Chest X-ray and smear microscopy for early diagnosis of suspected endometrial TB. Its simplicity, sensitivity, speed and automation makes this technique a very attractive tool for diagnosis of mycobacterial TB.

Prevalence of nutritional anemia in children of high socioeconomic status in a tertiary care center

Background: Anemia is a highly prevalent condition developed in children belonging to all socioeconomic status and is mainly caused due to iron deficiency in nutrition. Aim: To identify the Prevalence of nutritional anemia in children of high socioeconomic status. Methods: Children between 6 months and 14 years of age belonging to high socioeconomic status, admitted in pediatric ward of Kauvery Hospital, a tertiary center at Trichy were included in the study. Children with hemolytic anemia, chronic illnesses, and those who received blood transfusion were excluded from the study. The World Health Organization classification was used for grading the severity of anemia as mild, moderate, and severe based on hemoglobin levels for the age. Modified Kuppuswamy scale 2016 was used to assess the socioeconomic status of the children. Children belonging to upper and upper middle socioeconomic status were included in the study. Results: The overall prevalence of anemia among the study population was 44.5%. Out of 400 subjects, 178 participants were anemic. Of the 178 anemic children, 78.1% were in the age group of 6 months–5 years, 20.2% in 5–11 years, and 1.7% in 12–14 years. Among children between 6 and 23 months, 75 were anemic. Almost all patients showed microcytic hypochromic anemia. There were a significantly higher number of overweight and obese children among those anemic in all age groups. Conclusion: This study concludes that every other child is anemic even in families of high socioeconomic status, especially <2 years of age. There is an urgent need to screen and treat all children regardless of their socioeconomic status or body mass index.

Knowledge and attitude of caregivers of people with dementia.

This study aimed to evaluate the knowledge and attitude of caregivers of people with dementia towards the disease (Alzheimer disease). The secondary objective of the study was to assess the association of attitude and knowledge towards dementia. In total, 50 patients with dementia and their caregivers were included in the present study. Caregivers were evaluated on the Dementia Attitude Scale and Alzheimer's Disease Knowledge Scale (ADKS) to assess the level of knowledge and attitude. The mean age of patients was 72.2 years, and the majority of them were men, married, from joint/extended family setup, urban background, and upper or upper-middle socioeconomic status. The mean age of the caregivers was 48.04 years, and the majority was educated more than the matric level. Nearly half of the caregivers were children, and about one-third were the spouse of the person with dementia. The mean duration of the caregiver role was 3.6 ± 3.0 years, while the average time spent in caregiving was 7.4 ± 2.9 h/day. Using the Alzheimer's Disease Knowledge Scale, the mean knowledge score for the caregivers was 16.9 ± 2.7. In terms of individual items on the knowledge scale, most of the caregivers were aware of most aspects of dementia. In terms of the mean weighted score, the maximum score was for the domains of course and symptoms and this was followed by the domain of "treatment and management." The lowest score was obtained for the domain of assessment and diagnosis on ADKS. On the Dementia Attitude Scale, the mean total score was 76.4 ± 18.4. The mean total score for the knowledge domain was higher than the support domain. The current study suggests that most caregivers with dementia have a reasonable level of knowledge about dementia. However, in terms of attitude, caregivers of people with dementia have a less positive attitude towards dementia. The study's finding suggests that there is a need to evaluate the knowledge and attitude of the caregivers of people with dementia and the gaps must be addressed to improve the outcome, both for the people with dementia and their caregivers. Geriatr Gerontol Int 2022; 22: 19-25.

Parasympathetic activity, emotion socialization, and internalizing and externalizing problems in children: Longitudinal associations between and within families.

Biopsychosocial models of children's socioemotional development highlight the joint influences of physiological regulation and parenting practices. Both high and low levels of children's baseline respiratory sinus arrhythmia (RSA) have been associated with children's maladjustment, indicative of nonlinear associations. Negative or unsupportive parental responses to children's emotions are consistently linked with internalizing (IP) and externalizing problems (EP), although few studies have examined how associations vary within families. This study examined within- and between-person associations of children's quadratic baseline RSA, negative maternal emotion socialization, and children's problems over 7 years. RSA was measured in 133 3.5-year-old children (72 female) in predominantly middle- to upper-middle socioeconomic status, Caucasian families. Mothers reported on their emotion socialization practices and their children's adjustment concurrently and 1, 5, and 7 years later. Multilevel structural equation models revealed quadratic associations between baseline RSA and both IP and EP at the between-person level, suggesting that children with moderate RSA had fewer adjustment problems, on average, than children with lower or higher RSA. Across time and between families, children displayed more problems if their mothers reported more negative responses to their children's emotions. Within families, IP were elevated on years when mothers reported higher than usual negative responses, and children with either high or low baseline RSA had more problems on years when mothers reported greater than usual negative responses to their children's emotions. Altogether, these findings suggest that high and low baseline RSA may increase the risk for maladjustment, particularly in the time-varying context of aversive emotion socialization practices. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Quality and Location of the Surgical Episode Mediate a Large Proportion of Socioeconomic-Based Survival Disparities in Patients with Resected Stage I-III Colon Cancer.

Lower socioeconomic status (SES) is associated with shorter overall survival (OS) in patients with locoregional colon cancer. We aimed to estimate: (1) the proportion of SES-based OS disparities mediated by disparities in the quality and location of surgical treatment in patients with resected stage I-III colon cancer and (2) the relative importance of components of surgical quality. We examined patients ages 18-80 years with resected stage I-III colon adenocarcinoma using the 2010-2016 National Cancer Database. SES was defined at the zip code level. Inverse odds weighting mediation analysis was used to estimate the proportion mediated (PM) for nine treatment quality-related and facility-related factors and composite PMs in models including all nine mediators. Models compared high SES patients with each lower SES stratum. Among 171,009 patients, 5-year OS increased from 70.4% in low SES patients to 78.1% in high SES. When high SES patients were compared with low, lower-middle, and upper-middle SES patients, PM ranges among lower SES strata were: minimally invasive surgery 16.0-16.6%, lymph nodes examined 7.7-9.6%, positive margins 3.8-6.5%, length of stay 16.7-28.1%, readmissions insignificant to 3.7%, treatment at > 1 CoC facility 2.7-3.1%, facility type insignificant to 7.3%, facility volume 2.9-8.2%, and adjusted facility 90-day mortality rates 33.2-42.8%. Composite PMs were 76.9% (95% CI 61.3%, 92.4%) for low SES, 68.7% (95% CI 56.4%, 81.1%) for lower-middle SES, and 60.9% (95% CI 43.1%, 78.6%) for upper-middle SES. These data suggest that improving the quality of the surgical episode for disadvantaged patients undergoing resection for locoregional colon cancer could decrease SES-based survival disparities by over half.

Relationship Pattern of Personality Disorder Traits in Major Psychiatric Disorders: A Cross-Sectional Study.

Background:Normal personality development, gone awry due to genetic or environmental factors, results in personality disorders (PD). These often coexist with other psychiatric disorders, affecting their outcome adversely. Considering the heterogeneity of data, more research is warranted.Methods:This was a cross-sectional study on personality traits in psychiatric patients of a tertiary hospital, over 1 year. Five hundred and twenty-five subjects, aged 18–45 years, with substance, psychotic, mood, or neurotic disorders were selected by convenience sampling. They were evaluated for illness-related variables using psychiatric pro forma; diagnostic confirmation and severity assessment were done using ICD-10 criteria and suitable scales. Personality assessment was done using the International Personality Disorder Examination after achieving remission.Results:Prevalence of PD traits and PDs was 56.3% and 4.2%, respectively. While mood disorders were the diagnostic group with the highest prevalence of PD traits, it was neurotic disorders for PDs. Patients with PD traits had a past psychiatric history and upper middle socioeconomic status (SES); patients with PDs were urban and unmarried. Both had a lower age of onset of psychiatric illness. Psychotic patients with PD traits had higher and lower PANSS positive and negative scores, respectively. The severity of personality pathology was highest for mixed cluster and among neurotic patients. Clusterwise prevalence was cluster C > B > mixed > A (47.1%, 25.2%, 16.7%, and 11.4%). Among subtypes, anankastic (18.1%) and mixed (16.7%) had the highest prevalence. Those in the cluster A group were the least educated and with lower SES than others.Conclusions:PD traits were present among 56.3% of the patients, and they had many significant sociodemographic and illness-related differences from those without PD traits. Cluster C had the highest prevalence. Among patients with psychotic disorders, those with PD traits had higher severity of psychotic symptoms.

Alarming rates of psychological problems among caregivers of pediatric kidney patients admitted during the COVID-19 pandemic lockdown.

Introduction:Caregivers of children with comorbidities suffer from various psychological problems. We envisage more such complications during this COVID-19 pandemic.Methodology:A cross-sectional study to assess psychological issues in caregivers of children with kidney diseases, admitted during lockdown period in India was done. Psychological tools including Peritraumatic Distress Inventory (PDI), Insomnia Severity Index, Depression Anxiety Stress Scale (DASS II), Positive and Negative Affect Schedule (PANAS) and a new “COVID Stress Survey Questionnaire” were used. Standard statistical analysis using SPSS Statistic 23 (IBM SPSS Statistics, New York, United States) was done.Results:Forty-seven caregivers (33 mothers; 14 fathers) were included. Of these, 33 (70.2%) experienced psychological distress. On PANAS, 45 (95.7%) scored below cut off on a positive affect and 42 (89.4%) scored above cut off on a negative effect. The DASS II score revealed that 38 (80.9%) reported mild stress, 23 (48.9%) severe anxiety, and 37 (78.7%) had moderate depression. Upper middle socioeconomic status caregivers reported more insomnia. Further, parents of children with acute kidney injury (AKI) or prolonged hospital stay scored higher on subjective distress and aversive feelings.Conclusion:We observed an alarming level of distress, insomnia, and anxiety among caregivers, more so in upper middle socioeconomic status, children with AKI and prolonged hospital stay. We suggest due counseling should be done.

Trauma related psychiatric disorders and their correlates in a clinical sample: A cross-sectional study in trauma affected patients visiting a psychiatric clinic in Nepal.

BackgroundNepal, like many other low-income countries, has a great burden of mental health issues but few resources to meet them. In addition, Nepal has endured several traumatic events in recent decades but the impact on mental health has not been studied in clinical settings. This study explores trauma-related psychiatric disorders and their correlates.Methods100 patients with a history of trauma who visited the outpatient psychiatry clinic at a University hospital in Kathmandu were assessed. The Composite International Diagnostic Interview 2.1 (CIDI) was used to evaluate lifetime and current depressive disorder, generalized anxiety disorder (GAD) and lifetime post-traumatic stress disorder (PTSD). Current PTSD was evaluated using PSTD Checklist—Civilian Version (PCL-C).ResultsThe median number of lifetime traumatic events was two. Natural disaster was the most common trauma type (84%) compared to other types of trauma. Rape was reported as the most traumatizing. Current PTSD was found in 15%, depression in 33% and GAD in 38% of the patients. The lifetime rates were PTSD 83%, depression 45% and GAD 40%. There was high comorbidity between the disorders. The 31 to 45 years age group, above high school education level and trauma types other than earthquake were independently associated with current PTSD. Marital status and upper socioeconomic status (SES) compared to upper-middle SES were independently associated with lifetime PTSD. Both lifetime and current depression rates were independently associated with the upper SES compared to upper-middle SES. Place of living, education above high school and lower-middle SES were significantly associated with lifetime and current GAD.ConclusionPTSD, depression and GAD were prevalent in a trauma exposed patient population visiting a psychiatric clinic in Nepal. High rates of comorbidities and several risk factors were identified. Our findings highlight the need for addressing trauma related disorders in clinical settings in developing countries.