Krishna Vaddiparti

Mental health consequences of violence against women and girls

Purpose of review Recent studies on mental health consequences of violence against women and girls were reviewed in a range of situations. Recent findings Although several studies continued to show cross-sectional associations between child sexual abuse (CSA) and mental health outcomes, a few prospective studies showed a robust association between CSA and depression. Studies on the impact of dating violence are still at a nascent stage and focus on antecedents of violence rather than its consequences. Women at higher risk, such as adolescents, migrants, the homeless, and women in the perinatal period have been studied and specific vulnerabilities identified. Women reporting bidirectional violence had higher rates of depression and post-traumatic stress disorder (PTSD). Cumulative violence, severity of violence, and recent violence are associated with higher morbidity. Studies among women in conflict zones have emphasized the role of different forms of sexual and physical violence on mental health. Summary Newer emerging areas that need more research include mental health consequences of women in conflict zones and among same sex relationships. There are also few studies on the violence experience of both older women and adolescents. The need to better delineate the psychopathology of complex manifestations of PTSD is underscored.

Factors influencing consent to HIV testing among wives of heavy drinkers in an urban slum in India.

Abstract The study examined the influence of socio cultural factors, perception of risk and exposure to violence on consent to HIV testing among at risk women in an urban slum. Married women chosen via a multistage probability sampling in a section of Bangalore, India, between 18 and 44 years, sexually active and considered to be at risk because of their husbands hazardous drinking were recruited for the study. Written informed consent was obtained and measures of risk behavior and violence were administered. Pretest HIV counseling was then conducted and consent for HIV testing was sought. Factors influencing refusal of and consent to HIV testing were documented. Data collected on 100 participants indicated that over half the sample (58%) refused consent for HIV testing. There were no significant differences between the groups who consented and those who refused on perception of risk and exposure to violence. Reasons women refused testing include the following: spouse/family would not allow it (40%), believed that they were not at risk or would test negative (29%) and underwent HIV testing during an earlier pregnancy (21%). Among those who consented for HIV testing, 79% did so because the testing site was easily accessible, 67% consented because testing was free and because the importance of HIV testing was understood. The findings highlight the role of social, logistic and awareness related factors in utilizing voluntary counseling and testing services by women in the slum community. They have important implications for HIV testing, particularly among at risk monogamous women.

Building global capacity for brain and nervous system disorders research

The global burden of neurological, neuropsychiatric, substance-use and neurodevelopmental disorders in low- and middle-income countries is worsened, not only by the lack of targeted research funding, but also by the lack of relevant in-country research capacity. Such capacity, from the individual to the national level, is necessary to address the problems within a local context. As for many health issues in these countries, the ability to address this burden requires development of research infrastructure and a trained cadre of clinicians and scientists who can ask the right questions, and conduct, manage, apply and disseminate research for practice and policy. This Review describes some of the evolving issues, knowledge and programmes focused on building research capacity in low- and middle-income countries in general and for brain and nervous system disorders in particular.This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.

Problem drinking among married men in India: comparison between husband's and wife's reports.

INTRODUCTION AND AIMS This study compared the husbands report and wifes report of her husbands problem drinking, among residents of an urban slum in Bangalore, India. DESIGN AND METHODS The data come from a feasibility study to prevent HIV infection among at-risk women in Bangalore. Household enumeration was carried out (n = 509) to choose 100 married men between 18 and 50 years who reported problem drinking (scores 8 and above) on the Alcohol Use Disorder Identification Test (AUDIT). Wives of these married men, considered to be at risk for HIV because of their husbands hazardous drinking, were subsequently recruited for the study (n = 100). Written informed consent was obtained; wives were asked about the drinking history of their husbands through the AUDIT-WR (Wifes Report) developed for the present study. RESULTS Prevalence of problem drinking in the enumerated sample (n = 509) was high (n = 186; 37%). The husbands report and his wifes report of his problem drinking was concordant (r = 0.57-0.75) on eight out of 10 items, and the total AUDIT score. DISCUSSION AND CONCLUSIONS The AUDIT-WR is a reliable and culturally relevant measure of husbands problem drinking. In India, men with problem drinking are hard to reach. Therefore, proxy report of the wife may be useful when the husband is either unavailable or uncooperative for assessment.

Community-based diagnosis of non-communicable diseases and their risk factors in rural and urban Haiti: a cross-sectional prevalence study

Objective To estimate the prevalence of hypertension, diabetes and chronic kidney disease and their risk factors in a rural and urban region of Haiti. Setting and participants Community health workers enumerated 2648 households (909 rural and 1739 urban) via a multistage cluster random sampling method from July 2015 to May 2016, completed 705 rural and 1419 urban assessments for adults aged 25–65 years. Outcome measures We performed a WHO STEPS based questionnaire, measured two blood pressure values, weight, height, abdominal circumference and point of care test finger stick blood sample for haemoglobin A1c, creatinine and cholesterol (total, high density lipoprotein (HDL) and triglycerides). Results After adjusting for age and sex, the overall prevalence rates of hypertension, diabetes and chronic kidney disease were 15.6% (±2.93%), 19.7% (±1.57%) and 12.3% (±2.72%), respectively. Of the three non-communicable diseases (NCDs), only diabetes showed a significant difference between rural and urban sites (p=0.000), with the rural site (23.1%) having a higher prevalence than the urban site (16.4%). When comparing male and female participants, females were significantly more likely than males to have an NCD (p≤0.011). Females had a higher prevalence of most of the risk factors when compared with males. The urban location had a higher prevalence than the rural location for four risk factors that showed a significant difference between location (p≤0.037). Conclusions Women in Haiti had significantly higher prevalence rates of most NCDs and risk factors than men, and urban populations frequently, but not always, had higher rates of NCDs risk factors than the rural population. Further, it was shown that using point of care blood tests combined with community health workers, it is feasible to screen for NCDs and risk factors in remote areas which otherwise have limited access to healthcare.

Personality disorders and pathological gambling

Purpose of review To explore recent developments in the field of personality disorders and their association with pathological gambling or gambling disorder. The review covers literature published from 2015 to present time (August 2016) to understand the prevalence rates of common personality disorders among pathological gamblers. Recent findings Commonly seen personality disorders among pathological or problem gamblers represent Cluster B disorders. There are reports indicating prevalence of Clusters A and C personality disorders as well. The rates of personality disorders among pathological gamblers reported in these studies align with Hills guidelines – Strength, Specificity, Temporality, Biological gradient, Plausibility and Replicability indicating a strong association between pathological gambling and personality disorders. Studies are predominantly cross-sectional and consistently show that the presence of a personality disorder is associated with gambling severity and early age of onset pathological gambling. Summary Research on pathological gambling should advance beyond estimating rates of personality disorders and focus on longitudinal research to understand the pathways between personality disorders and onset and severity of pathological gambling.

Clinical Comorbidities among Cocaine Users Screened in the Community through HealthStreet.

OBJECTIVES We investigated the differences in clinical characteristics and musculoskeletal (MSK) conditions by cocaine use. METHODS HealthStreet, a community engagement program assessed 7936 adults for medical conditions. RESULTS Among 6145 African Americans (77%) and 1791 (23%) Caucasians, 15.5 % and 25% reported cocaine use, respectively. African-American cocaine users were older (p < .001) and more likely to report hypertension (p < .001) and HIV (p <.001) than Caucasian users. Compared to non-users, back pain was reported by 42% of African Americans (p < .001) and 48% of Caucasian cocaine users (p < .003). African-American cocaine users had significantly higher odds of back pain, 1.60 (95% CI 1.27, 2.04) and arthritis, 1.40 (95% CI 1.19, 1.64) than Caucasians. CONCLUSIONS Cocaine users are more likely to endorse MSK conditions than non-users. Racial disparities among users existed; however, how race affects health among users requires further research.