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Background The Worldwide Hospice Palliative Care Alliance has recommended integration of palliative care into primary health care. Diminished capacity to provide palliative care is a barrier for integration. The purpose of this study was to screen for palliative care needs in the community. Methods A cross-sectional study was conducted in two rural communities of Udupi district. Supportive and Palliative Care Indicators Tool – 4ALL (SPICT-4ALL) was used to identify the palliative care needs. Purposive sampling was used to collect the individual information from the households for identifying the palliative care need. Conditions requiring palliative care and the sociodemographic factors associated with it were explored. Results Out of 2041 participants, 51.49% were female, and 19.65% were elderly. Less than a quarter of them (23.08%) had at least one chronic illness. Hypertension, diabetes, and ischemic heart disease were commonly found. 4.31% had satisfied the requisite SPICT criteria, which indicated a need for palliative care. Diseases of cardiovascular system followed by dementia and frailty were the most common conditions requiring palliative care. Univariate analysis showed that age, marital status, years of education, occupation, and the presence of morbidities were significantly associated with the need for palliative care. Being unemployed and having one or more morbidities were factors independently associated with requirement of palliative care. Conclusions The estimated palliative care need in the community survey exceeds the perceived need. Although palliative care is traditionally identified with cancer, the proportion of people with noncancer palliative care needs were significantly higher than cancer palliative care.

BackgroundCervical cancer continues to be a leading cancer among women in India. Despite availability of various screening techniques, majority of Indian women remain unscreened for cancer cervix. The increasing incidence could be attributed to the lack of awareness regarding cervical cancer screening and paucity of organized screening facilities in the country. This study assessed the knowledge, attitude and practices (KAP) towards cervical cancer screening among tribal women of coastal Karnataka, southern India.MethodsA community-based cross-sectional study was conducted among 1140 women aged 20–65 years from three tribes. Information on their KAP towards cervical cancer screening was collected using a semi-structured questionnaire.ResultsMean age of the participants was 39.8 ± 10.1 years. Although 82.9% of the participants reported to have heard of cervical cancer, 51% were aware that the disease could be prevented, and only 2.3% knew that it can be detected at an early stage. Over 75% of the participants did not have adequate knowledge regarding cervical cancer. However, majority of them (99.9%) had a favourable attitude towards cervical cancer screening. None of them had undergone cervical cancer screening prior to the study. The knowledge scores were significantly associated with age group, marital status, education level, socioeconomic status and tribal community of the participants (p ConclusionOverall knowledge regarding cervical cancer among the surveyed women was poor, though they exhibited a positive attitude. This calls for a sustained health education and screening program to create awareness and improve the uptake of cervical cancer screening among these women.

Summary Multiplexed technologies for sexually transmitted infections offer a convenient diagnostics option to screen, confirm, and treat multiple pathogens simultaneously. Due to scarce published real-world diagnostic performance data, we did a systematic review. Two reviewers searched major databases for data published between Jan 1, 2009, and April 20, 2020, and abstracted and analysed sensitivity and specificity data from 24 studies, which assessed 17 multiplex rapid nucleic acid amplification test platforms and seven multiplex immunochromatographic devices. Overall, these studies evaluated 19 sexually transmitted infections in 26 126 individuals. High sensitivity and specificity were shown for rapid nucleic acid amplification platform tests and immunochromatographic devices, with performance varying by pathogen, device, seropositivity, and subpopulation screened. As most devices yielded more than 95% sensitivity and specificity, immunochromatographic tests and rapid nucleic acid amplification test platforms can be advised for screening and confirmatory use. These highly accurate devices are appropriate for integrated, rapid screening initiatives for sexually transmitted infections to screen and treat many of these infections simultaneously, for antimicrobial stewardship, and for disease elimination programmes.

Longer survival due to use of antiretroviral therapy (ART) has made human immunodeficiency virus- (HIV-) infected individuals prone to chronic diseases such as diabetes, hypertension, and cardiovascular diseases (CVD). Metabolic syndrome (MS), a constellation of risk factors which increase chances of the cardiovascular disease and diabetes, can increase the morbidity and mortality among this population. Hence, the present study was conducted with the objectives of estimating the prevalence and determinants of MS among ART naïve and ART-treated patients and assess their 5-year CVD risk using the reduced version of Data Collection on Adverse Effects of Anti-HIV Drugs (D : A : D) risk prediction model (D : A : D(R)). This hospital-based cross-sectional study included 182 adults aged ≥ 18 years. MS was defined using the National Cholesterol Education Program-Adult Treatment Panel-3 (NCEP ATP-3) criteria. Univariate and multivariate logistic regressions were done to identify the factors associated with MS. Prevalence of MS was 40.1% (95% confidence interval (CI) = 33.0%–47.2%). About 24.7% of the participants had at least a single criterion for MS. Age >45 years (adjusted odds ratio (AOR) = 2.3; 95% CI = 1.1–4.9, p < 0.018 ) and body mass index (BMI) > 23 kg/m2 (AOR = 6.4; 95% CI = 3.1–13.1, p < 0.001 ) were positively associated with MS, whereas daily consumption of high sugar items was inversely associated (AOR = 0.2; 95% CI = 0.1–0.5, p < 0.001 ). More than 50% of the participants were found to have moderate or high 5-year CVD risk. Observed prevalence of MS among HIV patients was higher than other studies done in India. Considering a sizeable number of participants to be having moderate to high CVD risk, culturally appropriate lifestyle interventions need to be planned.

BackgroundDespite being preventable, cervical cancer remains a major health concern among women. Persistent Human Papillomavirus (HPV) and other viral co-infections may influence cervical dysplasia. We determined and compared the prevalence and risk factors of cervical viral infections among the tribal and general population of southern coastal Karnataka, India.MethodsA population-based cross-sectional survey was conducted among 1140 and 1100 women from tribal and general population, respectively. Cervical infections with HPV, Epstein-Barr Virus (EBV), Cytomegalovirus (CMV) and Herpes-Simplex Virus (HSV) were examined using polymerase chain reactions (PCR) and DNA sequencing.ResultsHPV prevalence was higher among tribal women (40.6%) than general population (14.3%) while the prevalence of EBV (55.1%) and CMV (49.4%) were lower among tribal women than general population (74.3% and 77.5%, respectively). HSV infection was observed in tribal women only (1.8%). Among HR-HPV strains, HPV-18 was predominant among tribal population (28.3%) while, HPV-16 was predominant among the general population (9.1%). Infections were associated with age, educational status, unemployment and personal hygiene of tribal women. Phylogenetic analysis revealed that HPV-16 variants of tribal participants were closely related to non-European sublineages indicating greater risk of HPV persistence and carcinogenesis.ConclusionThe study provides a comparative estimate for DNA virus infections of the cervix among women from general as well as tribal population in this region and also reveals a different type-specific pattern of viral infection. Further research is required to delineate the role of specific interactions between multiple virus infections and their role in carcinogenesis.

Background: Insufficient physical activity is a known risk factor for major non-communicable diseases. While the health benefits of physical activity are well established, women are known to have suboptimal levels of physical activity. Studying the perceived benefits and barriers to exercise can help to improve physical activity among women. Objective: To study the perceived benefits and barriers to exercise and the associated factors among women To assess the level of physical activity among the women. Methodology: A community based cross sectional study was conducted among women aged 18-49 years. The Exercise Benefits and Barrier Scale (EBBS) was used to assess benefits and barriers to exercise. International Physical Activity Questionnaire (IPAQ) was used to assess physical activity. Results: The study included 181 participants with mean (SD) age of 35.2(8.4) yrs. Enhancement of physical endurance (98.4%) and improvement of overall body functioning (97.8%) were the most commonly perceived benefits. Tiredness (52.5%) due to exercise and lack of convenient schedules in exercise facilities (52.0%) were the most common perceived barriers. According to IPAQ, (17.1%) were considered physically inactive. The level of physical activity showed a positive association with mean total and barrier EBBS score (p

Background: Dengue is one of the important causes of acute febrile illnesses in India. Dengue can be a fatal disease, however there are no reliable markers which can predict mortality among these patients.Methods: A prospective cross sectional study was done in patients who were admitted to a tertiary care hospital with features of dengue fever. A total of 364 patients with IgM dengue serology positive were included in the study. Relevant clinical and laboratory parameters were collected from all patients. Association between clinico-laboratory parameters with mortality was studied using appropriate statistical methods.Results: Among the 364 patients recruited in this study, 14 (3.85%) patients died. Mortality among patients with age group 18-40 years was 2.04%, in patients aged above 40 years was 7.56%. Mortality among patients with hypotension was 42.42% (14 out of 33), bleeding manifestations was 15.38% (8/52), platelets 200 was 13.04% (6/46), AST>200 was 12.34% (10/81), prolonged prothrombin time was 60%(12/20), renal failure was 28%(14/50), encephalopathy was 31.57% (6/19), multi organ dysfunction syndrome(MODS) was 43.33% (13/30), acute respiratory distress syndrome (ARDS) was 45.45% (5/11), pleural effusion was 7.5% (6/80).Conclusions: The overall mortality in the present study was 3.85%. Following variables were associated with increased risk of death among the dengue patients: Age >40 years, presence of hypotension, platelets 200U/L, AST>200U/L, prolonged prothrombin time, presence of renal failure, encephalopathy, MODS, ARDS and bleeding tendency (p value

Background: Premenstrual symptoms are a constellation of somatic and emotional symptoms commonly affecting women in reproductive age group. Apart from causing physical, emotional distress, they can influence daily activities and reduce productivity of women. Objective: To determine the prevalence of premenstrual symptoms and lifestyle factors associated with it among medical students. Methodology: This cross sectional study was conducted among 209 medical students and interns of a private medical college. A self- dministered questionnaire was used to assess menstrual history, premenstrual symptoms and diet. Physical activity was assessed using International Physical Activity Questionnaire.Results: The median (IQR) age of the study participants was 21(20, 22). Feeling of tiredness (30.6%) and presence of mood swings (25.4%) reported by at least a quarter of the study participants were the major somatic symptom and emotional/behavioral symptoms respectively. On univariate and multivariate analysis,coffee consumption was positively associated with premenstrual symptoms [Adjusted OR=1.85, 95% CI =1.02-3.34, p=0.042]. Though statistically not significant, a higher proportion of those with premenstrual symptoms were physically inactive as compared to those without symptoms (39.7% Vs. 35.2%).Conclusion: Excessive caffeine intake and physical inactivity can have an influence on premenstrual symptoms. Adopting healthy lifestyle could positively help the medical students to reduce the impact of premenstrual symptoms on their social activities and interpersonal relationships and increase their productivity.

Objective: To determine the association between certain socio-demographic and life style factors with colorectal cancer.Methods: This case-control study was conducted using a pre-designed questionnaire among 100 incident colorectal cancer patients and 200 unmatched controls attending a tertiary care hospital in southern Karnataka. Cases and the controls were interviewed and details regarding their socio-demographic factors were collected. Information on lifestyle factors such as dietary habits, physical activity levels and substance use were documented. They were also assessed for presence of existing co-morbidities and family history of colorectal and other cancers. Multivariable logistic regression was performed to determine the association between various risk factors and colorectal cancer.Results: In the present hospital based study, mean age of the participants was less than 55 years. Sixty three percent of the cases and 54.5% of the controls were males. On multivariable analysis age ≥50years (OR=1.87; 95%CI=1.02-3.45), low physical activity (OR=5.66; 95%CI=3.10-10.34) and low frequency of fruits consumption (OR=4.10; 95%CI=2.21-7.50) and hypertension (OR= 4.65; 95% CI=1.32-16.44) showed a positive association with colorectal cancer. Conclusion: Promoting healthy dietary practices and physical activity among the middle aged population appears to be significant in the context of colorectal cancer prevention in the Indian subcontinent.Keywords: Colorectal cancer, Case–control, Risk factors, Lifestyle, Comorbidities.

BACKGROUND: The understanding of HIV/AIDS by MBBS students and their attitudes towards managing a retropositive patient will impact their practice in future. OBJECTIVES: To study the knowledge and attitude about HIV/AIDS among medical students and to analyse change in knowledge levels based on year of study of MBBS. METHODOLOGY: A cross-sectional questionnaire based study was conducted in a private medical college in Karnataka among 610 MBBS students. Aspects regarding general and clinical knowledge of HIV/AIDS, attitude towards HIV infected patients were dealt with. RESULTS: An increasing trend in the knowledge from 1st to 4th year was seen in the following aspects: knowledge regarding vertical transmission (78% to 93.3%), transmission through breast feeding (31.9% to 85.3%), tuberculosis as the most common opportunistic infection in HIV/AIDS (26.9% to 70%), correct time of initiation of post exposure prophylaxis (5% to 46.7%), facility for getting HIV test done confidentially (0.6% to 42.7%). An increasing trend in the negative attitude towards HIV patients was seen from 1st to 4th year when it came to right to refuse surgical treatment to HIV patient (40% to 56%) and an increasing trend in the favourable response towards HIV patients were seen from 1st year to 4th year when it came to their opinion whether HIV patients can be kept in general ward (57.5% to 78%). CONCLUSION: From the above study we conclude that the knowledge level on HIV/AIDS improved based on year of study. Discriminatory attitude towards HIV patients still persisted among students of all the years.

Introduction/Back ground: Availability of Anti-Retroviral Therapy (ART) has revolutionalised the management of Human Immunodeficiency Virus /Acquired Immuno Deficiency Syndrome (HIV/AIDS) and improved the survival of those infected with the virus. However, adherence to therapy is a prerequisite for treatment success and preventing drug resistance. Aim: The present study was carried out with the aim of determining the level of adherence and factors affecting it among patients receiving free ART. Methods: A cross sectional study design was adopted and 320 HIV positive patients receiving free ART from a district hospital in Udupi were interviewed using a semi-structured questionnaire. Adherence to ART >95% of the prescribed medication was used as the cut off for deciding on the treatment adherence. Results: An encouragingly high 96.9% of the individuals were adherent to the medication over the past month. However, 41.8% of the participants reported to have ever missed doses of ART. On univariate analysis, having ever consumed alcohol, absence of side effects such as fatigue and tingling/numbness, having a feeling of sadness and sleep disturbances, being on Efavirenz based regimen, non-disclosure HIV status, being unsure of continuing lifelong treatment were significantly associated with non-adherence (p