Epidemiological features of alcohol use in rural India: a population-based cross-sectional study.

OBJECTIVES: We sought to estimate the proportion of adults in Sehore District, India, who consumed alcohol, and the proportion who had behaviours consistent with alcohol use disorders (AUDs), using the Alcohol Use Disorders Identification Test (AUDIT). Among men who drank, we identified individual-level, household-level and community-level factors associated with AUDIT scores. Men with AUDs (AUDIT score ≥ 8) reported on whether and where they had sought treatment, and about alcohol-related internal stigma. DESIGN: Population-based cross-sectional study. SETTING: Rural villages and urban wards in Sehore District, Madhya Pradesh, India. PARTICIPANTS: n=3220 adult (≥ 18 years of age) residents of Sehore District. PRIMARY OUTCOME MEASURE: Score on the AUDIT. RESULTS: Nearly one in four men (23.8%) had consumed alcohol in the past 12 months, while few (0.6%) women were consumers. Among drinkers, 33.2% (95% CI 28.6% to 38.1%) had AUDIT scores consistent with hazardous drinking, 3.3% (95% CI 2.1% to 5.1%) with harmful drinking and 5.5% (95% CI 3.8% to 8.0%) with dependent drinking. We observed that AUDIT scores varied widely by village (intraclass correlation=0.052). Among men who had recently consumed alcohol, AUDIT scores were positively associated with depression, having at least one child, high-quality housing, urban residence, tobacco use and disability. AUDIT scores were negatively associated with land ownership, out-of-pocket healthcare expenditure and participation in the national employment programme. While 49.2% of men with AUDs felt embarrassed by their problems with alcohol, only 2.8% had sought treatment in the past 12 months. CONCLUSIONS: A need exists for effectively identifying and treating adults with AUDs. Health promotion services, informed by commonly-expressed stigmatised beliefs held among those affected by AUDs and which are targeted at the most affected communities, may be an effective step in closing the treatment gap

Health care use and treatment-seeking for depression symptoms in rural India: an exploratory cross-sectional analysis.

BACKGROUND: There is a large "treatment gap" for depression worldwide. This study aimed to better understand the treatment gap in rural India by describing health care use and treatment-seeking for depression. METHODS: Data were analysed from a two round cross-sectional community survey conducted in rural Madhya Pradesh between May 2013 and December 2016. We examined the proportion of individuals who screened positive for depression (≥10) on the Patient Health Questionnaire (PHQ-9) who sought treatment in different sectors, for depression symptoms and for any reason, and compared the latter with health service use by screen-negative individuals. We analysed the frequency with which barriers to healthcare utilisation were reported by screen-positive adults. We also analysed the association between seeking treatment for depression and various predisposing, enabling and need factors using univariable regression. RESULTS: 86% of screen-positive adults reported seeking no depression treatment. However, 66% had used health services for any reason in the past 3 months, compared to 46% of screen-negative individuals (p < 0.0001). Private providers were most frequently consulted by screen-positive adults (32%), while only 19% consulted traditional providers. Structural barriers to healthcare use such as cost and distance to services were frequently reported (54 and 52%, respectively) but were not associated with treatment-seeking for depression. The following factors were found to be positively associated with treatment-seeking for depression: higher symptom severity; lack of energy, lack of interest/pleasure, low self-esteem, or slow movements/restlessness on more than 7 days in the past 2 weeks; being married; having discussed depression symptoms; and reporting problems with medication availability and supply as a barrier to healthcare. No evidence was found for an association between treatment-seeking for depression and most socio-economic, demographic or attitudinal factors. CONCLUSIONS: These findings suggest that the majority of adults who screen positive for depression seek healthcare, although not primarily for depression symptoms, indicating the need to improve detection of depression during consultations about other complaints. Private providers may need to be considered in programmes to improve depression treatment in this setting. Further research should test the hypotheses generated in this descriptive study, such as the potential role of marriage in facilitating treatment-seeking

Impact of major disease outbreaks in the third millennium on adolescent and youth sexual and reproductive health and rights in low and/or middle-income countries: a systematic scoping review protocol

Introduction Sexual and Reproductive Health and Rights (SRHR) of young people continue to present a high burden and remain underinvested. This is more so in low and middle-income countries (LMICs), where empirical evidence reveals disruption of SRHR maintenance, need for enhancement of programmes, resources and services during pandemics. Despite the importance of the subject, there is no published review yet combining recent disease outbreaks such as (H1N1/09, Zika, Ebola and SARS-COV-2) to assess their impact on adolescents and youth SRHR in LMICs. Methods and analysis We will adopt a four-step search to reach the maximum possible number of studies. In the first step, we will carry out a limitedpreliminary search in databases for getting relevant keywords (appendix 1). Second, we will search in four databases: Pubmed, Cochrane Library, Embase and PsycINFO. The search would begin from the inception of the first major outbreak in 2009 (H1N1/09) up to the date of publication of the protocol in early 2022. We will search databases using related keywords, screen title & abstract and review full texts of the selected titles to arrive at the list of eligible studies. In the third stage, we will check their eligibility to the included article’s reference list. In the fourth stage, we will check the citations of included papers in phase 2 to complete our study selection. We will include all types of original studies and without any language restriction in our final synthesis. Our review results will be charted for each pandemic separately and include details pertaining to authors, year, country, region of the study, study design, participants (disaggregated by age and gender), purpose and report associated SRHR outcomes. The review will adhere to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline (PRISMA-ScR). Patient and public involvement Patients or public were not involved in this study. Ethics and dissemination Ethical assessment is not required for this study. The results of the study will be presented in peer-reviewed publications and conferences on adolescent SRHR

FORMULATION AND QBD BASED OPTIMIZATION OF METHOTREXATE-LOADED SOLID LIPID NANOPARTICLES FOR AN EFFECTIVE ANTI-CANCER TREATMENT

Objective: In the current study, the Quality by Design method was utilized for the formulation of solid lipid nanoparticles of Methotrexate (MTX SLNs). Methods: MTX SLNs formulated by melt emulsification method were studied for the effect of independent variables viz. concentration of lipid and surfactants on quality attributes viz. particle size, polydispersity index, and entrapment efficiency of SLNs using 32 factorial design. Results: The optimal formulation was spherical, had a particle size of 147.6±4.1 nm (z-average), a polydispersity index of 0.296±0.058, a zeta potential of −19±0.98 mV, encapsulation efficiency of 98.7±1.55%, and a cumulative drug release of 95.59±0.918% in 5 h. Conclusion: The  in vitro and in vivo studies revealed that SLNs provide a promising oral delivery system to improve the bioavailability of MTX

Challenges for Transformation: A Situational Analysis of Mental Health Care Services in Sehore District, Madhya Pradesh.

The proportion of individuals with mental disorders receiving evidence based treatments in India is very small. In order to address this huge treatment gap, programme for improving mental health care is being implemented in Sehore district of Madhya Pradesh, India. The aim of this study was to complete the situational analysis consisting of two parts; document review of Sehore district mental health programme followed by a qualitative study. The findings suggest that there are major health system challenges in developing and implementing the mental health care plan to be delivered through primary health care system in Sehore district

Factors associated with health service utilisation for common mental disorders: a systematic review.

BACKGROUND: There is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC). METHODS: We searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using "best fit framework synthesis", with reference to the Andersen socio-behavioural model. RESULTS: Fifty two studies met inclusion criteria. 46 (88%) were from HIC. Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies. Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported. Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services. There was a lack of research from LMIC and on contextual level factors. CONCLUSION: In HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that "treatment gap" statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors. TRIAL REGISTRATION: PROSPERO registration number: 42016046551

CORRELATION OF PROLACTIN LEVELS WITH THYROID HORMONE LEVELS IN THYROID DISORDERS, INFERTILITY AND MENSTRUAL DISORDERS

Introduction: Prolactin and Thyroid hormones are regulated through an interrelated pathway. The increased level of TRH in hypothyroidism stimulates the release of prolactin. Prolactin and thyroid disorders are associated in a variety of conditions. Aims: To find if any correlation exists between Prolactin and Thyroid hormone levels in thyroid disorders. Methods: It was an observational, retrospective study. Serum levels of T3, T4, TSH and Prolactin were estimated by ELISA kits. The data was collected from registers and analyzed for correlation. Results: A significant proportion of hyperprolactinemia cases are Euthyroid. Hyperprolactinemia is associated with both hypothyroidism as well as hyperthyroidism. It is more prevalent in hypothyroid cases. Prolactin has a positive correlation with TSH in both hyperthyroidism and hypothyroidism. Conclusion: Prolactin has a positive correlation with TSH in both hyperthyroidism and hypothyroidism. Both prolactin and thyroid hormone levels should be estimated in cases of infertility, menstrual disturbances and thyroid disorders. Keywords: Hyperprolactinemia; Hyperthyroidism; Hypothyroidism

CORRELATION OF PROLACTIN LEVELS WITH THYROID HORMONE LEVELS IN THYROID DISORDERS, INFERTILITY AND MENSTRUAL DISORDERS

Introduction: Prolactin and Thyroid hormones are regulated through an interrelated pathway. The increased level of TRH in hypothyroidism stimulates the release of prolactin. Prolactin and thyroid disorders are associated in a variety of conditions. Aims: To find if any correlation exists between Prolactin and Thyroid hormone levels in thyroid disorders. Methods: It was an observational, retrospective study. Serum levels of T3, T4, TSH and Prolactin were estimated by ELISA kits. The data was collected from registers and analyzed for correlation. Results: A significant proportion of hyperprolactinemia cases are Euthyroid. Hyperprolactinemia is associated with both hypothyroidism as well as hyperthyroidism. It is more prevalent in hypothyroid cases. Prolactin has a positive correlation with TSH in both hyperthyroidism and hypothyroidism. Conclusion: Prolactin has a positive correlation with TSH in both hyperthyroidism and hypothyroidism. Both prolactin and thyroid hormone levels should be estimated in cases of infertility, menstrual disturbances and thyroid disorders. Keywords: Hyperprolactinemia; Hyperthyroidism; Hypothyroidism

Knowledge, attitude and practices towards COVID-19 among people living with HIV in Pune, India: a cross-sectional study

Background: Studies on knowledge, attitude, and practices (KAP) are important for implementation of interventions. This cross-sectional study was conducted among HIV infected individuals attending antiretroviral therapy (ART) centre at Pune, India, to assess KAP towards COVID-19.Methods: The study conducted between June and December 2020 consisted of twelve, five and seven questions pertaining to knowledge, attitude, and practices respectively towards COVID-19. Frequencies and percentages of correct knowledge, attitude and practices were calculated. Overall knowledge scores were categorized into poor, moderate and good using class width equation.Results: Of the total 1175 participants enrolled, 649 (55.2%) were females. Mean age and CD4count of participants at study entry were 44 years (SD: 9.1) and 637 cells/mm3 (SD: 297) respectively. Overall, 400 (34.0%, 95% CI: 31.33-36.83), 612 (52.1%, 95% CI: 49.18-54.98) and 163 (13.9%, 95% CI: 11.95-15.98) participants had good, moderate and poor knowledge respectively regarding COVID-19. Illiterate participants had six times higher probability of having poor knowledge as compared to their counterparts (OR 5.70, 95% CI: 3.94-8.23; p<0.001). Majority of people living with (PLHIV) had correct attitude towards adherence to government prevention and control measures. Healthy preventive practices of social distancing (99.5%), wearing masks at public places (99.7%) and frequent washing hands with soap and water (98.7%) were followed by PLHIV.Conclusions: PLHIV have average knowledge, correct attitude towards adherence to government prevention and control measures, and appropriate practices towards prevention of COVID-19. Counselling sessions at ART centres should include information for improving knowledge related to COVID-19 especially targeting illiterate individuals.