RESUMEN

BACKGROUND: Qualitative methods through lived experience narratives provide relevant sociocultural insights into healthy aging. OBJECTIVES: The aim of this qualitative study was to explore social and cultural perceptions of healthy aging from older adults (OAs), their next of kin, and those involved in providing services to OAs in Bengaluru, India. MATERIALS AND METHODS: We conducted in-depth interviews with 28 participants, all purposefully selected based on specific inclusion criteria, to get as varied a sample as possible. A pilot-tested, open-ended topic guide was used for every interview which was audio recorded with the permission of the respondent. Verbatim data were transcribed, reviewed for errors, and coded using NVivo 12 software and the framework analysis method of combining deductive and inductive codes. RESULTS: In total, 794 codes covering concepts of healthy aging, enablers and threats to healthy aging, and perspectives for the future were categorized into four themes supporting healthy aging, namely emotional well-being and a sense of purpose, family and social support, financial security, and health-care access. Each of these had a bearing on the OA's physical and mental health. Across socioeconomic groups, a sense of purpose at the level of the self, family, and society emerged as a key emotional sustainer. Social and economic deprivations were key threats to healthy aging and hence required social security and governmental interventions. CONCLUSION: Sociocultural economic factors are key to healthy physical and mental aging in the context of India. The same factor could be an enabler and in its absence a threat.

Asunto(s)

RESUMEN

Background: Cardiovascular Disease (CVD) is the leading cause of mortality globally. Over 75% of CVD deaths occur in low- and middle-income countries. Objectives: To assess the 10-year CVD risk among adults aged 30 years and above attending the outpatient department at a Taluk Hospital, Bangalore Urban District, Karnataka. Methods: A cross-sectional study was conducted among 217 subjects above 30 years of age attending the hospital. They were selected by consecutive sampling and administered a face-validated interview schedule. WHO/ISH CVD risk assessment tool was used to categorize them into four categories of CVD risk. Additional risk factors like alcohol use and smoking were also assessed. Results: The mean age of the subjects was 55.7 ± 12.3 years. About 65% of the study population had low risk (<10%), 21.2% had mild risk (10%-20%), 9.7% had moderate risk (20%-30%) and 4.1% had high risk (>30%) according to the World Health Organization/International Society of Hypertension (WHO/ISH) CVD risk assessment tool. In the study population, 4.6% were abusing alcohol as per the CAGE questionnaire. Conclusion: The burden of CVD risk among the adults interviewed was high. The WHO/ISH chart is an inexpensive tool that can be used for screening in a regular OPD.

RESUMEN

INTRODUCTION: As part of undergraduate training in community medicine, students of 1st-year MBBS at our medical college in South India undergo rural residential community-based training called Rural Orientation Program (ROP). OBJECTIVE: The objective was to study the impact of ROP at a medical college in South India. METHODOLOGY: Short-term impact was studied immediately before and after ROP using a 30-item questionnaire administered to 142 students. Medium-term impact was studied among 23 students in 2nd-year MBBS. Quantitative component consisted of objective structured practical examination scores and qualitative component documented reflections on learnings. Long-term impact was studied by surveying 287 alumni (batches of 1979 onward) to explore the impact of ROP on their career. RESULTS: We found a significant (P < 0.001) improvement in the median posttest score (21, interquartile range [IQR]: 20-23) when compared to pretest (12, IQR: 10-16). The mean OSPE score was 19.34 ± 3.19 (maximum score = 25) with 54.55% obtaining a score ≥20. Thematic analysis of reflections depicted that students gained insights on factors influencing health and social organizations in rural areas. ROP helped develop empathy toward patients and a holistic approach toward health, in understanding rural dynamics and improved communication skills. CONCLUSION: ROP increases subject knowledge and plays a role in molding attitudes of students toward the care of people in rural areas and improves communication skills. This time-tested model can be replicated in other medical colleges across the country.

Asunto(s)

RESUMEN

CONTEXT: Buses take up more than 90% of public transport in Indian cities and serve as a cheap and convenient mode of transport for all classes of society. However, the well-being of employees of this mode of transport is paramount in passenger and personal safety. As in any job, the person has to balance work and personal issues. Work-life balance is a concept that supports the effort from an employee in any sector to split their time and energy to balance work and personal lives. MATERIALS AND METHODS: A cross-sectional study using a structured interview schedule was conducted among 103 Karnataka State Road Transport Corporation (KSRTC) workers in Anekal town, Karnataka, to determine the work-life balance among them. The total score was classified into high, medium, and low work balance categories. The scores for each domain were analyzed separately to derive at the factors which act against work-life balance. RESULTS: Low work-life balance was found in 26 (25.2%) of all subjects. The important factors that affected work-life balance were identified to be shift work, work load, night duties, social functions, and negative attitude of family members. The reasons that motivated them to work were to support family (35%), future security (33%), and to clear personal debts (15.5%). CONCLUSION: Given the low work-life balance in a quarter of several individuals in this study, there is a need to address this issue to ensure necessary balance and safety and well-being of both road transport employees and passengers.

RESUMEN

Multiple myeloma (MM) is a plasma cell neoplasm and constitutes 10% of hematologic malignancies. Malignant myelomatous pleural effusions are very rare and occur in <1% of cases of MM. In this article, we report a rare case of a patient who initially presented with pleural effusion and was subsequently found to be secondary to MM with an underlying raised IgG paraprotein. The patient symptomatically improved and was in partial remission with palliative radiotherapy, VTD chemotherapy, and bisphosphonates.

RESUMEN

AIM: In India, owing to cultural norms and a lack of formal long-term care facilities, responsibility for care of the older person falls primarily on the family. Based on the stress process model, we assessed the association of type and number of impairments of older persons (∼primary stressors) with caregiver burden among their family caregivers in rural South India. METHODS: All impaired older persons (aged ≥60, with impairment in activities of daily living (ADL) or cognition or vision or hearing) residing in 8 villages in Bangalore district, Karnataka, India, and their primary informal caregivers were interviewed. Caregiver burden was measured using the Zarit Burden Interview (ZBI; higher score indicating greater perceived burden). Linear regression models, adjusting for background characteristics of older persons and caregivers, assessed the association of type of impairment (physical [Yes/No], cognitive [Yes/No], vision [Yes/No] and hearing [Yes/No]) and number (1 or 2 or 3 or 4) of older person impairments with caregiver burden. RESULTS: A total of 140 caregivers, caring for 149 older persons, were interviewed. The mean (standard deviation) ZBI score was 21.2 (12.9). Of the various older person impairments, ZBI score was associated only with physical impairment (ß=6.6; 95% CI: 2.1-11.1). Relative to caregivers of older person with one impairment, those caring for an older person with all 4 impairments had significantly higher ZBI score (ß=13.9; CI: 2.5-25.4). CONCLUSION: Caregivers of older persons with multiple impairments, especially physical impairment, are vulnerable.

Asunto(s)

RESUMEN

Background. The efficacy, safety, and cost benefit of olanzapine (OLN) when compared to aprepitant (APR) in the prevention of chemotherapy induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy (HEC) were evaluated. Methods. A prospective pilot study was done in chemotherapy-naive patients receiving HEC to compare OLN versus APR along with palonosetron and dexamethasone. 100 patients consented to the protocol and were randomized and evaluated for Complete Response (CR) (no emesis, no rescue). Results. CR was 86% for the acute period, 86% for the delayed period, and 80% for the overall period in 50 patients receiving the APD regimen. CR was 84% for the acute period, 88% for the delayed period, and 78% for the overall period for 50 patients receiving the OPD regimen. Patients without nausea were APD: 88% acute, 84% delayed, and 84% overall, and OPD: 84% acute, 88% delayed, and 84% overall. There were no significant grade 3 or 4 toxicities. OPD was comparable to APD in the control of CINV. Conclusion. In this study, there was no significant difference between olanzapine and aprepitant in preventing CINV with highly emetogenic chemotherapy. Olanzapine may thus be used as a potential, safe, and cost beneficial alternative to prevent nausea and vomiting in HEC.

RESUMEN

Elder abuse and neglect is a problem that occurs across all settings and all populations. Elder abuse has many forms, such as abandonment, emotional or psychological abuse, financial or material exploitation, neglect, physical abuse, and sexual abuse. We conducted this research to determine the prevalence of various types of abuse and neglect and their associated factors among elderly patients attending the urban and rural geriatric clinics at a medical college hospital in Bangalore, India. A total of 200 elderly patients participated in the study. The overall prevalence of elder abuse or neglect was 32 (16%), comprised of: verbal abuse in 25 (12.5%); neglect in 22 (11%); financial abuse in 17 (8.5%); and physical abuse in 3 (1.5%). Hence, many elderly patients had experienced multiple forms of abuse. There was statistically significant association between elder abuse and total financial dependence, lack of social support, and depression among the elderly patients.

Asunto(s)

RESUMEN

Despite a rapidly aging population, geriatrics--the branch of medicine that focuses on healthcare of the elderly--is relatively new in India, with many practicing physicians having little knowledge of the clinical and functional implications of aging. Negative attitudes and limited awareness, knowledge or acceptance of geriatrics as a legitimate discipline contribute to inaccessible and poor quality care for India's old. The aim of this paper is to argue that knowledge translation is a potentially effective tool for engaging Indian healthcare providers in the delivery of high quality geriatric care. The paper describes India's context, including demographics, challenges and current policies, summarizes evidence on provider behaviour change, and integrates the two in order to propose an action plan for promoting improvements in geriatric care.

Asunto(s)