Journal of Family Medicine and Primary Care最新文献

Introduction: Depression affects women more than men, particularly during pregnancy and the postpartum period. While many women are hesitant to use pharmacotherapy due to concerns about side effects and financial constraints, it becomes imperative to explore alternative therapies like Yoga Nidra, known for reducing stress and anxiety. This study aims to evaluate the impact of Yoga Nidra on mental health during the postpartum period.

Objectives and methods: The objective was to assess the psychological state of postpartum women and the effect of Yoga Nidra on the same. This quasi-experimental study was conducted in a rural-based tertiary care center in central Gujarat. A total of 100 participants, 50 postpartum women in the control group and 50 in the intervention group, were enrolled in the study. The Generalized Anxiety Disorder-7 (GAD-7) and Edinburgh Postnatal Depression Scale (EPDS) questionnaires were administered to the participants at the beginning of the study. The intervention group received eight sessions of Yoga Nidra, each lasting 30 min. At discharge, both groups were administered EPDS again. The data was analyzed using STATA 14 software (STATA 14 Software (StataCorp LLC)).

Results and conclusion: Mean baseline EPDS scores were 12.62 ± 4.6 and 13.76 ± 6.2 in the intervention and control groups, respectively. On average, there was 5.48 units (reduction) improvement in EPDS scores in the intervention group (P < 0.0001) and a 1.5-unit worsening (increase) in the control group (P < 0.0001) at the end of the study. The difference was significant between the groups (+6.98 units, P < 0.0001), thereby concluding that Yoga Nidra is a promising non-pharmacological therapy that can be used to manage immediate postpartum anxiety and depressive symptoms.

Context: Glaucoma is a group of progressive diseases where optic nerve damage leads to vision loss. It is considered the leading cause of irreversible blindness (5.8%), according to the National Programme for Control of Blindness and Visual Impairment (NPCB and VI). Primary open angle glaucoma (POAG) is its commonest form. There is considerable evidence that type 2 diabetes mellitus (T2DM) is a risk factor for POAG. The prevalence of POAG is much higher in the diabetic population than in the general population.

Aims: 1. To estimate the proportion of POAG among the type 2 diabetes mellitus (T2DM) patients attending OPD of a Private Eye Hospital. 2. To determine the associated factors, if any, for POAG among the study population.

Settings and design: A descriptive, observational hospital-based cross-sectional study was conducted for 2 months at a private eye hospital, Kolkata, West Bengal.

Methods and material: 129 previously diagnosed T2DM patients attending the Out Patient Department (OPD) from 01.11.21 to 31.12.21 were interviewed and examined by an ophthalmologist for POAG as per diagnostic criteria comprising both old and new cases.

Statistical analysis used: Student 't' test for comparison of means and Chi-square test determination of association.

Results: Overall proportion of POAG cases was 22.5% (men 19.3% and women 25%). The mean age of POAG for women and men were 59.3 (±8.5) years and 65 (±10.7) years, respectively. Mean blood glucose level and mean intra ocular pressure (IOP) were more among POAG patients (P = 0.037,0.026 and P = 0.004,0.003)). POAG was associated with duration of T2DM (P = 0.004) and hypertension (P = 0.004).

Conclusions: More than one-fifth of T2DM patients had POAG associated with duration of T2DM, mean blood glucose, and hypertension. Tight control of blood glucose and regular ophthalmological examination since early stage are urgently required.

Intrauterine devices (IUCDs), such as the multi-load copper T, are widely used long-acting reversible contraceptive methods due to their effectiveness and convenience. However, complications can arise in rare instances, such as device migration. Case Series Report Case 1: A 26-year-old, G5 P2 A2 L2, presented with 2 months of amenorrhoea and inability to feel CuT thread. USG done revealed intra-uterine pregnancy of approx. 10 weeks gestational age, however intrauterine CuT was not visualized. So, we presumed it a case of expelled CuT. Regular antenatal care continued till term and LSCS was performed at 39 weeks. Intraoperatively a thread was seen embedded in the omentum lying adjacent to the uterus. Further exploration revealed multi-load-copper 375 with pus collection around it. Case 2: A 36-year-old female, Para 2, Live 2, presented with complaints of lower abdominal pain and multiple episodes of haematuria since last 6 months. An initial pelvic ultrasound showed a hyperechogenic intravesical structure of 3.3 cm, suggesting a urinary bladder calculus. A pelvic CT scan revealed a metallic T-shaped structure within the urinary bladder suggestive of a misplaced copper T device. Patient underwent cystoscopic removal of calcified IUCD. Patient had no further urinary symptoms following removal. These cases highlight the importance of monitoring patients with IUCDs for potential complications, especially when threads are missing. They also emphasize considering intravesical migration of CuT as a cause of haematuria in women. Additionally, pelvic cavity exploration during LSCS is vital to locate any migrated IUCDs when such a history exists.

Rhupus syndrome is a rare overlap disorder characterized by the co-occurrence of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Although its pathogenesis remains incompletely elucidated, associations with *HLA-DRβ1*0405*, sex hormone fluctuations, immune dysregulation, and environmental triggers have been proposed; the estimated incidence ranges from 0.01% to 0.2% among arthritis patients. We report two middle-aged female patients (52y and 78y) fulfilling both 2010 ACR/EULAR RA criteria and 2019 ACR/EULAR SLE, complicated by hypertension and hyperglycemia. Metabolic comorbidities constrained immunosuppressant use. Case 1 responded to methotrexate + tofacitinib with antihypertensive/lipid-lowering agents. Case 2 required total knee arthroplasty (TKA) after failed medical therapy, achieving significant pain relief; perioperative glycemic optimization was critical. Rhupus diagnosis mandates dual RA/SLE criteria; antinuclear antibody (ANA) screening is essential for arthritis patients to identify overlap syndromes. Aggressive metabolic control optimizes therapeutic safety. AI-enhanced imaging (e.g. erosion/synovitis detection) holds diagnostic promise.

Background: The delayed acceptance or abject refusal to take vaccines despite the availability of vaccination services has been termed as vaccine hesitancy (VH). The 5C Model of VH includes Confidence, Convenience, Complacency, and Communication as major determinants of VH in the population.

Materials and methods: This study was conducted among vaccinees enrolled at the Vaccination Center of the largest tertiary hospital in the tribal state of Jharkhand. The study was a cross-sectional study aimed to determine the extent of VH for COVID-19 vaccines prevalent in the study population and the associated factors. The study subjects included vaccinees at RIMS, Ranchi Vaccination Center. It included all subjects aged 18 years and above, consenting to be a part of the study. Study participants were recruited from the line list prepared for COVID-19 vaccination from the Co-win portal. A total of 625 participants were recruited. A predesigned, pretested, semistructured questionnaire was administered to all the study participants.

Results: Out of the 625 recruited participants, VH was found in 165 subjects. The factor that is the biggest contributor to VH was the fear of the potential long-/short-term side effects of the vaccine (31.7%), which was followed by the fear of the pain from the shot (14.9%) and distrust in the vaccines due to shorter clinical trials (14.9%).

Conclusion: V is a significant, living phenomenon that is translating into geographical clustering of epidemics and requires attention on both the micro- and macrolevels to be addressed successfully.

Introduction: Elderly people have a higher probability of suffering from multiple health disorders due to reduced physical and mental functions, thus affecting their quality of life (QOL). Better understanding of QOL might help to identify ways to improve the delivery of health services to elderly people.

Objective: To assess the QOL and its various sociodemographic determinants among elderly residing in a town of south-east district of the National Capital Region.

Methods: A cross-sectional study among 400 elderly individuals was conducted in the field practice area of Urban Health Training Centre (UHTC) of a medical college. The WHOQOL-BREF questionnaire was used to assess the QOL of the study participants. Data was analysed using the Statistical Package for Social Sciences (SPSS). Unpaired t-test/analysis of variance (ANOVA) was performed for univariate analysis, and multivariate linear regression was used to identify the predictors of QOL across four domains.

Result: The mean QOL score for physical, psychological, social and environmental domains was 48.9, 47.1, 53.6 and 48.7, respectively. QOL score was 4.04 points (physical domain) and 5.31 points (psychological domain) lower among those who were more than 70 years, compared to those who were in the age group of 60-64 years. For the social relationship domain, the score was 4.24 points higher among 65-69 years old participants compared to 60-64 years.

Conclusion: Poor QOL score among the elderly in the present study highlights the need for focused interventions that cater to this older cohort. Structured integration of the elderly health care programmes with the National Program for non-communicable diseases at the local level will help in catering to their health care needs and further QOL.

Arterial hypertension (AHT) is a chronic disease characterized by persistently elevated blood pressure levels in the arteries. The reported prevalence of AHT in Mexico is 31.5%. Due to the multiple complications that uncontrolled AHT can cause, it is necessary for healthcare personnel to manage this condition professionally. However, the increasing population size and lack of infrastructure to treat both existing and new patients have needed improvements in treatments and patient education on their responsibility in managing their condition. It is within this framework that the Refillable Prescription Program (RPP) was introduced. Additionally, an earlier study suggested that AHT patients enrolled in the RPP in a different population showed a sustained decrease in blood pressure levels after one year of follow-up, resulting in a lower risk of complications related to this condition.

Background: Ageing is a natural phenomenon with challenges mainly in the health aspect. It is a major concern for policymakers all around the world. Over 20% of geriatric adults have mental and neurological disorders, causing 6.6% of all disability adjusted life years, with depression being most common. The field of gero-psychiatry lacks comprehensive studies, with existing research often focusing on hospitalized or primary care patients rather than community-based samples. Aim and Objective: To estimate the prevalence of depression among the geriatric population in the Mehrauli area of South Delhi and to study the various factors associated with depression.

Materials and methods: This was a community-based descriptive cross-sectional study conducted in the Mehrauli area of South Delhi from November 2022 to February 2024. About 338 study participants were interviewed using the Geriatric Depression Scale (GDS-30).

Results: The overall prevalence of depression was 51.2% with mild 34.6% and severe depression 16.6%. Age group, gender, marital status, literacy status, type of family, socioeconomic status, presence of chronic illness, and presence of functional impairment in activities of daily living were significantly associated with the presence of depression among study participants (P < 0.05).

Conclusion: The prevalence of depression in the urban elderly population was high (51.2%). By identifying risk factors for depression among the geriatric population and screening them on time, we can reduce the severity and burden of the disease to a greater extent.

Background: Adoption is a profound and life-changing decision that offers families the opportunity to grow in unique and meaningful ways. In India, adoptive mothers face distinctive emotional, psychological, and societal experiences that can shape their adoption journey. However, there is limited research exploring the inner experiences of adoptive mothers, which hinders the development of informed policies and support mechanisms tailored to their needs.

Objective: This study aimed to explore the inner experiences of women who have adopted a child in India, providing valuable insights for improving the adoption process and enhancing the wellbeing of adoptive mothers.

Materials and methods: This study employed a qualitative research methodology, with purposive sampling used to select three participants from Indian adoption support communities, specifically for and of heart babies and the People's Group for Child Adoption in India. Data collection took place between May and June 2024 through in-depth, semistructured interviews. The data were subsequently analyzed using thematic analysis to identify key patterns and insights.

Results: Five key themes emerged from the participants' narratives: (i) Adoption processes and challenges, (ii) emotional processing and wellbeing, (iii) family dynamics and support, (iv) personal values and beliefs, and (v) societal and cultural influence. The findings highlighted that these experiences align with the 4Ps of Psychopathology and the biopsychosocial model, underscoring how psychological and social factors can act as precipitating and perpetuating influences on adoptive mothers' mental and physical wellbeing.

Conclusion: The study emphasizes the need for psychologists, policymakers, and sociologists to consider these findings when designing interventions.

Objective: Severe nocturnal enuresis in children is not only a medical condition but also a significant psychological burden, often leading to emotional distress and social stigma. Many affected children struggle with self-disclosure of their psychological struggles, which can exacerbate mental health challenges. The objective is to explore the barriers and facilitators of self-disclosure regarding psychological crises in children with severe enuresis, with the aim of providing a foundation for alleviating psychological distress and improving mental health outcomes.

Methods: Purposive sampling was employed to select 13 pairs of children with severe enuresis and their parents from a specialized hospital's urology department. Data were collected through in-depth interviews, and the Colaizzi 7-step method was used to analyze, summarize, and refine the themes.

Results: Factors influencing psychological crisis disclosure in children with severe enuresis included four barriers and ten subthemes. Barriers included emotional disorders (e.g. shame, low self-esteem), psychological burdens (e.g. impact on class participation, fear of sleeping, recurrent anxiety), moral constraints (e.g. limited expressive ability, avoidance of social interaction), and a lack of a safe disclosure environment (e.g. parents' high expectations, excessive anxiety and punishment, social prejudice). Facilitators included perceived benefits of disclosure and mastery of disclosure-related skills.

Conclusions: The self-disclosure of psychological crises in children with severe enuresis is influenced by multiple factors. Clinical nursing and health services should address these factors at various levels to foster positive self-cognition and create a supportive environment for self-disclosure, thereby alleviating psychological distress and promoting mental health.