Depressive Symptoms and Health-Related Quality of Life in Patients with Cardiovascular Diseases Attending a Tertiary Care Hospital, Puducherry-A Cross-Sectional Study

Background  Globally, coronary artery disease (CAD) was the leading cause of health losses. The emergence of revascularization has brought a major change in the management of CAD. Depression and cardiovascular diseases (CVD) are the two highly prevalent noncommunicable diseases (NCD), which lead to poor quality of life and high socio-economic loss for the patient. The rate of depressive episodes was higher in CAD population in comparison to population with other heart problems.

Objectives  The primary objective of the current study is to determine the proportion of those with depressive symptoms through Patient Health Questionnaire-9 (PHQ-9) among CAD patients in a tertiary care public hospital.

Methods  It was a cross-sectional analytical design, which assess the percentage of patients with depressive symptoms among CAD patients, using a pretested, semistructured questionnaire. The PHQ-9 and EuroQoL five-dimensional three-level (EQ-5D-3L) questionnaire, a quality-of-life instrument (five items), were used, which was validated in the Tamil version.

Statistical Analysis  Categorical variables was expressed as proportion. We used Chi-square as a statistical test to calculate the p value and risk estimation with 95% CI.

Results  Out of 541 patients, 159 (30%) patients had mild-to-moderate depressive symptoms, of which 144 (89%) participants were greater than 50 years. In EQ-5D-3L, around one-third of the participants reported pain or discomfort and anxiety or depression.

Conclusion  The study concludes that the assessment of health-related quality of life (HRQoL) is becoming increasingly important in the management of CAD patients. Studies have shown that depression predicts subsequent quality of life, while others have shown that HRQoL is a risk factor for ongoing depression. Treatment of depression may improve subsequent physical HRQoL; hence, it is vital to address both during their follow-up to improve outcomes among patients with CAD.

Worldwide trends in breast cancer incidence from 1993 to 2012: Age-period-cohort analysis and joinpoint regression

Background:

Breast cancer is the most common cancer accounting for about one-fourth of total cancer cases and 15% of all cancer deaths among women worldwide. It is important to determine its trend across the regions in the world to find the high-focus regions. Hence, the current study was done to assess the global trends and deviations in the incidence of breast cancer.

Materials and Methods:

A descriptive trend analysis was done using the data on breast cancer incidence from the WHO Cancer Incidence Data of Five Continents plus database. Joinpoint regression was performed to determine the average annual percent change (AAPC), and age-period-cohort analysis was done to obtain age-, period-, and cohort-specific deviations and rate ratio.

Results:

All the regions showed an increasing trend in breast cancer incidence, with an exception of America. Maximum increase was observed in Asia (AAPC = 2.6%; 95% confidence interval [CI]: 2.4%–2.9%) followed by Europe (AAPC = 0.7%; 95% CI: 0.5%–1%). There was consistent rise in the breast cancer incidence across the age groups in all the four continents with maximum burden in elderly (P < 0.001). Except in America, all other regions showed consistent rise in the incidence of breast cancer through the periods 1998–2002 to 2007–2012 (P < 0.001). There was consistent increase across the cohorts from 1923–1927 to 1978–1982 in continents such as Asia and Oceania (P < 0.001).

Conclusion:

To summarize, the incidence of breast cancer shows an increasing trend globally with a maximum increase in the Asian region. This makes a strong need for newer strategies irrespective of current prevention and control interventions.

Patient and Provider's Experience and Perspective in Addressing Barriers to Medication Adherence Among Noncommunicable Disease Patients in Rural Puducherry, South India-A Qualitative Study

Background

Trend in morbidity and mortality due to noncommunicable diseases (NCDs) is rising because of poor control status. Medication nonadherence is one of the most common and modifiable causes of inadequate control status.

Objectives

To examine the barriers in drug adherence among NCD patients in rural Puducherry.

Methods

This qualitative study includes in-depth and key informant interview conducted among 6 NCD patients and 4 health-care providers. Interviews were audio-recorded, and transcript was prepared in verbatim format. Thematic content analysis was done to derive the categories and themes.

Results

Major barriers for nonadherence to medications found were stress, substance abuse, forgetfulness, lack of family support, and high case load of health facilities. Corrective measures suggested to address the barriers were to provide health education to patients and family members, awareness campaigns in community, and health education sessions at the clinic.

Conclusion

Psychological factors such as stress, social isolation, and negligence are major barriers for drug adherence. Health education session at community and health system is needed to improve the adherence.