Background:Distress can bring about an unfavorable attitude among the patients toward tackling their disease which can affect adherence to medications. The purpose of this study was to assess the effect of distress on adherence to medication among patients with diabetes.Methodology:In this cross-sectional study, 124 type 2 diabetes patients above 18 years, attending the hospitals affiliated to Kasturba Medical College, Mangalore, selected using nonprobability sampling were interviewed to assess the presence of diabetes-related distress (DRD) and their level of adherence to medications. Distress was assessed using diabetes distress scale. Morisky Adherence Questionnaire was used to assess the level of adherence. Approval was obtained from the Institutional Ethics Committee. Multivariate logistic regression was conducted to assess the influence of domains of distress on adherence to antidiabetic medication and P < 0.05 was considered statistically significant.Results:In our study, 41.9% (n = 52) of the participants had high diabetes distress. Exactly 43.5% (n = 54) of the participants had low adherence to antidiabetic medications. On univariate analysis, participants with low regimen distress, low physician distress, and low interpersonal distress were found to have good adherence to antidiabetic medication. However, on multivariate analysis, only low regimen distress was found to be significantly associated with good adherence to medication among the study participants.Conclusion:DRD is a problem in our study participants which affects the adherence to medications. Identifying distress at an early stage can help doctors formulate and implement remedial measures, thereby improving adherence to medications.

Background: Poor adherence is generally associated with bad outcomes of the disease especially in Non-communicable disease like diabetes. Objectives: To study the level of adherence and factors associated with adherence to anti-diabetes medication among patients with diabetes. Method: ology: In this cross-sectional study, 124 diabetes patients attending medicine OPDs at hospitals affiliated to Kasturba medical college, Mangaluru were assessed regarding their adherence to anti-diabetes medications using the Morisky 8-Item Medication Adherence scale. Univariate and multivariate analysis was done to determine the factors associated with good adherence. Results: The mean age of the patient was 59.8 ± 11.2 years. The median duration of diabetes was 7 (3-12) years. In our study 43.5% (n = 54) of the participants had low adherence to anti diabetes medications. On Univariate analysis, absence of side effects, and regular blood glucose monitoring were found to be significantly associated with good adherence (P < 0.05). However, on multivariate analysis, absence of side effects was found to be significantly associated with good adherence (P < 0.05). Conclusion: Absence of side effects is the factor independently associated with good adherence. The interventions planned to combat the problem of non-adherence to medications should be targeted towards reducing the side effects of medication.

Study DesignProspective observational study.PurposeTo evaluate the disability domains relevant to Indian patients with low backache and propose a modified disability questionnaire for such patients.Overview of LiteratureThe Oswestry Disability Index (ODI) is a self-reported measurement tool that measures both pain and functional status and is used for evaluating disability caused by lower backache. Although ODI remains a good tool for disability assessment, from the Indian perspective questions related to weight lifting and sexual activity of ODI are questioned in some of the earlier studies. Activities of daily living in Indian patients vary substantially from those in other populations and include activities like bending forwards, sitting in floor and squatting which are not represented in the ODI.MethodsIn this prospective observational study, a seven-step approach was used for the development of a questionnaire. Thirty patients were interviewed to identify the most challenging issue they faced while performing their daily activities (by free listing) and understand how important the questionnaire items were in terms of the standard ODI. Thus, a comprehensive disability questionnaire comprising 14 questions was developed and administered to 88 patients. Both qualitative (interviews) and quantitative methods (to establish the validity, reliability, and correlation with the Visual Analog Scale [VAS] and Rolland Morris disability questionnaire) were used to identify the 10 questions that best addressed the disability domains relevant to Indian patients.ResultsAccording to free listing, four new questions pertaining to bending forward, sitting on the floor, walking on uneven surfaces, and work-related disabilities were included. In the second phase, wherein the questionnaire with 14 items was used, 56.8% patients did not answer the questions related to sexual activity, whereas 23.8% did not answer those related to walking on uneven surfaces. The modified questionnaire demonstrated good internal consistency (Cronbach’s alpha=0.892) and correlation with the Rolland Morris questionnaire (Cronbach’s alpha=0.850, p>0.05), as well as with the VAS score for disability (Cronbach’s alpha=0.712, p>0.05) and pain (Cronbach’s alpha=0.625, p>0.05).ConclusionsA modified disability questionnaire that was designed by adding two questions related to bending forward and work status and removing questions related to sexual activity and weight lifting or traveling (depending on the occupation) can help evaluate disability caused by back pain in Indian population.

Introduction: As the number of patients on anti-retroviral therapy (ART) rises, it is important to identify factors that predict mortality among these patients so that they can be closely monitored. Aim of the study was to determine the mortality rate among a cohort of HIV patients on naïve ART and to assess the predictors of mortality among them. Material and methods:In this retrospective study, records of 249 patients living with HIV (PLHIV) who were ART naïve, enrolled in the ART centre attached to Kasturba Medical College Hospital, Mangalore from February 2012 to February 2015, were analysed. Univariate and multivariate logistic regression was carried out to assess the factors predicting mortality among these patients.Results: By the end of the study period, 47 out of 249 patients died, giving an overall mortality rate of 18.8%. The mean age of the PLHIV was 43.4 ± 9.1 years. WHO stage 3/4 disease was present in 47.4% of patients. On univariate analysis, mortality was found to be significantly associated with alcohol consumption, being non-ambulatory, underweight (body mass index [BMI] < 18.5 kg/m 2 ), WHO stage 3 or 4 disease, presence of opportunistic infections (OIs), presence of tuberculosis, being on an efavirenz-based regimen, poor adherence (< 95%), CD4 count < 350 cells/mm 3 , anaemia and raised creatinine levels. However, on multivariate analysis, presence of OIs and low BMI were found to independently predict mortality. Conclusions:Our study identifies lower BMI and presence of OIs as independent risk factors predicting mortality.