Objectives:(1) To find out the prevalence of dementia in the study population and its social determinants. (2) To explore the family caregivers’ perceptions and their support needs.Materials and Methods - Study Setting:This study was undertaken in the field practice area of 55 villages of three Primary Health Centres in Villupuram District of Tamil Nadu.Study Design:An exploratory mixed-methods study design, where a qualitative method (key informant interview) was followed by a quantitative method (survey).Sample Size:A representative sample of 1300 respondents was selected by two-stage sampling.Analysis:Manual content analysis was done for qualitative data. Multiple logistic regression was performed on quantitative data.Results:The prevalence of dementia among study sample was found to be 3.1%. The determinants for dementia were age, sex, socioeconomic status, and previous involvement in family decision making and cardiovascular risk factors. The family caregivers strongly felt that caregiving interferes with their personal and professional life; they also felt that caregiving is an integral part of Indian culture, and the elderly prefer home-based care. Caregivers preferred government owned public health facility for medical care. All the responding caregivers strongly felt that they are not adequately trained in caregiving.Conclusions and Recommendations:Routine screening of elderly for early identification of dementia and its medical and social risk factors should be initiated in primary health care facility. Care of caregivers should be seen as an integral part of dementia care program.
Background
Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings.
Objective
We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling.
Design
Investigator-initiated, two-armed, multicenter randomized controlled trial conducted in three medical schools in India.
Participants
Eligibility criteria included age 18–70 years, active admission to the hospital, and current smoking.
Intervention
A medical student–guided smoking cessation program, initiated in hospitalized patients and continued for 2 months after discharge.
Main Measures
The primary outcome was self-reported 7-day point prevalence of smoking cessation at 6 months. Changes in medical student knowledge were assessed using a pre- and post-questionnaire delivered prior to and 12 months after training.
Key Results
Among 688 patients randomized across three medical schools, 343 were assigned to the intervention group and 345 to the control group. After 6 months of follow up, the primary outcome occurred in 188 patients (54.8%) in the intervention group, and 145 patients (42.0%) in the control group (absolute difference, 12.8%; relative risk, 1.67; 95% confidence interval, 1.24–2.26;
p
< 0.001). Among 70 medical students for whom data was available, knowledge increased from a mean score of 14.8 (± 0.8) (out of a maximum score of 25) at baseline to a score of 18.1 (± 0.8) at 12 months, an absolute mean difference of 3.3 (95% CI, 2.3–4.3;
p
< 0.001).
Conclusions
Medical students can be trained to effectively provide smoking cessation counseling to hospitalized patients. Incorporating this program into the medical curriculum can provide experiential training to medical students while improving patient quit rates.
Trial Registration
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT03521466.
Supplementary Information
The online version contains supplementary material available at 10.1007/s11606-023-08243-y.
Globally, India is the second largest consumer of tobacco. However, Indian medical students do not receive adequate training in smoking cessation counseling. Each patient hospitalization is an opportunity to counsel smokers. Medical Student Counseling for Hospitalized patients Addicted to Tobacco (MS-CHAT) is a 2-arm multicenter randomized controlled trial (RCT) that compares the effectiveness of a medical student-guided smoking cessation program initiated in inpatients and continued for two months after discharge versus standard hospital practice. Current smokers admitted to the hospital are randomized to receive either usual care or the intervention. The intervention group receives inpatient counseling and longitudinal postdischarge telephone follow-up by medical students. The control group receives counseling at the discretion of the treating physician. The primary outcome is biochemically verified 7-day point prevalence of smoking cessation at 6 months after enrollment. Changes in medical student knowledge and attitude will also be studied using a pre- and postquestionnaire delivered prior to and 12 months after training. This trial tests a unique model that seeks to provide hands-on experience in smoking cessation counseling to medical students while simultaneously improving cessation outcomes among hospitalized smokers in India.
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