Dementia and Diabetes Mellitus: Association with Apolipoprotein E4 Polymorphism from a Hospital in Southern India

Objective. To evaluate the association of Apolipoprotein E4 (ApoE4) in Alzheimer's dementia (AD) with comorbid diabetes mellitus (DM). Methods. The study included subjects with Alzheimer's dementia (AD) (n = 209), individuals with non-Alzheimer's dementia (nAD) (n = 122), individuals with parental history of AD (f/hAD) (n = 70), and control individuals who had normal cognitive functions and no parental history of dementia (NC) (n = 193). Dementia was diagnosed using International Classification of Diseases-10 revision (ICD-10) criteria. DM was assessed on the basis of self-report and/or use of antidiabetic medications. ApoE genotyping was done using sequence-specific primer polymerase chain reaction. Results. ApoE4 allele frequencies were highest among AD with comorbid DM (0.35) followed by AD without DM (0.25), nAD with DM (0.13), nAD without comorbid DM (0.12), and NC (0.08). Frequency of ApoE4 in persons with f/hAD was 0.13. The association of AD with co-morbid DM in ApoE4 carriers was more in comparison to NC with DM (OR = 5.68, P = 0.04). Conclusion. There is a significant association between AD with co-morbid DM and ApoE4 genotype

The effectiveness of a low-intensity problem-solving intervention for common adolescent mental health problems in New Delhi, India: protocol for a school-based, individually randomized controlled trial with an embedded stepped-wedge cluster randomized controlled recruitment trial

Background Conduct, anxiety and depressive disorders account for over 75% of the adolescent mental health burden globally. The current protocol will test a low-intensity problem-solving intervention for school-going adolescents with common mental health problems in India. The protocol also tests the effects of a classroom-based sensitization intervention on the demand for counselling services in an embedded recruitment trial. Methods We will conduct a two-arm individually randomized controlled trial in six Government-run secondary schools in New Delhi. The targeted sample is 240 adolescents in grades 9-12 with persistent, elevated mental health symptoms and associated impact. Participants will receive either a brief problem-solving intervention delivered over 3 weeks by lay counsellors (intervention), or enhanced usual care comprised of problem-solving booklets (control). Self-reported adolescent mental health symptoms and idiographic problems will be assessed at 6 weeks (co-primary outcomes) and again at 12 weeks post-randomization. In addition, adolescent-reported impact of mental health difficulties, perceived stress, mental wellbeing and clinical remission, as well as parent-reported adolescent mental health symptoms and impact scores, will be assessed at 6 and 12 weeks post-randomization. We will also complete a parallel process evaluation, including estimations of the costs of delivering the interventions. An embedded recruitment trial will apply a stepped-wedge, cluster (class)-randomized controlled design in 70 classes across the six schools. This will evaluate the added impact of a classroom-based sensitization intervention over school-level recruitment sensitization activities on the primary outcome of referral rate into the host trial (i.e. the proportion of adolescents referred as a function of the total sampling frame in each condition of the embedded recruitment trial). Other outcomes will be the proportion of referrals eligible to participate in the host trial, proportion of self-generated referrals, and severity and pattern of symptoms among referred adolescents in each condition. Power calculations were undertaken separately for each trial. A detailed statistical analysis plan will be developed separately for each trial prior to unblinding. Discussion Both trials were initiated on 20 August 2018. A single research protocol for both trials offers a resource-efficient methodology for testing the effectiveness of linked procedures to enhance uptake and outcomes of a school-based psychological intervention for common adolescent mental health problems

Cost of dementia care in India: Delusion or reality?

Context: In 2010, nearly 37 lakh Indians have been estimated to be suffering from dementia. Estimated costs of care in published literature do not reflect the actual expenses of individual households. Hence, a household budget approach was undertaken to arrive at the costs of dementia care in India. Materials and Methods: We identified and listed the different components of care, classified the applicability of care for the different components with respect to mild, moderate, and severe cases. This framework was utilized to assign costs of care and arrive at the household costs of care for a Person with Dementia (PwD) in both urban and rural areas. Results: The total expense was similar to that reported by individual households. The annual household cost of caring for a person with dementia in India, depending on the severity of the disease, ranged between INR 45,600 to INR 2,02,450 in urban areas and INR 20,300 to INR 66,025 in rural areas. Costs increased with increasing severity of the disease process. The costs of informal care contributed to nearly half of the total costs either in rural or urban area. With increasing severity, proportion of medical costs decreased while social cost increased. Medical costs in rural areas were nearly one-third of the total costs as against less than one-fifth in urban areas. Conclusion: The household budget model realistically estimated the household costs of care. It is hoped that the comprehensive and generic framework would prompt health professionals, researchers, and policy makers in India to catalyze geriatric health services, particularly for care for PwD

Need for developing unified workplace mental health screening tool for the Indian population: Commenting on the Tool to assess and classify work (TAWS-16)

Workplace mental health has gained importance in the recent days. However, its assessment is challenging considering the complexity involved in it. The earliest and highly cited Indian research on the workplace mental health listed 12 workplace factors viz. role overload, role ambiguity, role conflict, unreasonable (group & political) pressure, individual responsibility, under participation, powerlessness, poor peer relations, intrinsic impoverishment, low status, strenuous working condition and unprofitability. However, in view of the deficiency, the workplace factors have been rephrased by subsequent investigators. Numerous investigators have attempted to develop or partially use the pre-existing tool for assessing the workplace stress. These primary observations are often heterogeneous, difficult to interpret, and contribute to the challenges during drafting guidelines / policies. Therefore, a tool validated for larger population perhaps after amalgamation of the existing validated tools is recommende

Development and validation of tool for screening occupational mental health and workplace factors influencing it

Introduction: Occupational mental health is one of the key entity for ideal work place. Earlier studies have identified certain workplace factors to influence the mental health of the worker. “Workload”, “Reward”, “Community”, “Control”, “Values” and “Fairness” are the key areas identified in occupational psychology that determine the mental health of the worker. An imbalance in these factors may lead to negative occupational mental health, i.e. burnout. The burnout, a psychological syndrome is combination of emotional exhaustion, depletion of compassion and sense of reduced accomplishment. To note, the concept of occupational mental health in nation with second largest workforce is nascent. Further, the utility of existing western tools in Indian context is limited by multiple factors such as less comprehensibly, culturally inappropriate, patented and other factors. Hence, a tool was developed to screen the occupational mental health and workplace areas. Methods and results: Conventional steps involved in psychological tool development, viz. construct identification, drafting of pertinent questions, content validation, field testing of questions and others were adopted. After series of steps, a tool for screening the occupational mental health consisting of 21 questions and screening the key constructs influencing the mental health at workplace (workplace assessment) consisting of 25 questions were developed. Each of these questions sought responses using a 3-point scale i.e. “Never”, “Sometimes” and “Always”. As intended, the questions were relatively simple, shorter, comprehensible and compliant (no rejections) as observed by the feedback obtained during the pilot (feasibility) study involving 58 consenting volunteers. The tool was explored on larger sample involving workforce from various occupational background in addition to screening of the general mental health using general health questionnaire 5 (GHQ 5). The screening tool exhibited adequate test - retest reliability, internal consistency / reliability (cronbach’s α > 0.73) and correlation (correlation coefficient > 0.6) with the general mental health in larger evaluation of 153 consenting workers. Conclusion: Present study attempted to develop tool for screening adverse occupational mental health (burnout) and workplace factors that are known to be detrimental for mental health. Considering the magnitude of workforce and relatively naïve the concept of occupational mental health in the country, a tool (such as the one reported in the study) for screening the mentioned constructs are need of the hour. Hence, the proposed simple and easy to administer tool, would aid in recognizing the burnout and aid in early diagnosis and management of those requiring intervention

Mindfulness-based cognitive therapy in patients with late-life depression: A case series

Depression is the most common mental illness in the elderly, and cost-effective treatments are required. Therefore, this study is aimed at evaluating the effectiveness of a mindfulness-based cognitive therapy (MBCT) on depressive symptoms, mindfulness skills, acceptance, and quality of life across four domains in patients with late-onset depression. A single case design with pre- and post-assessment was adopted. Five patients meeting the specified inclusion and exclusion criteria were recruited for the study and assessed on the behavioral analysis pro forma, geriatric depression scale, Hamilton depression rating scale, Kentucky inventory of mindfulness skills, Acceptance and Action Questionnaire II, The World Health Organization quality of life Assessment Brief version (WHOQO-L-BREF). The therapeutic program consisted of education regarding the nature of depression, training in formal and informal mindfulness meditation, and cognitive restructuring. A total of 8 sessions over 8 weeks were conducted for each patient. The results of this study indicate clinically significant improvement in the severity of depression, mindfulness skills, acceptance, and overall quality of life in all 5 patients. Eight-week MBCT program has led to reduction in depression and increased mindfulness skills, acceptance, and overall quality of life in patients with late-life depression