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Objective: To understand the perceptions of health care providers about barriers to improved patient safety in the Indian state of Kerala. Materials and Methods: Five focus group discussions were held with 16 doctors and 20 nurses across three institutions (primary, secondary and tertiary care centers) in Kerala, India. Transcripts were analyzed by thematic analysis. Setting: One rural primary care clinic, one secondary care hospital and one tertiary care center in Kerala, India. Participants: 16 doctors and 20 nurses participated in five focus groups. Results: Overall, there were 129 unique mentions of barriers to patient safety; these barriers were categorized into five major themes. ′Limited resources′ was the most prominent theme, followed by barriers related to health systems issues, the medical culture, provider training and patient education/awareness. Conclusions: Although inadequate resources are likely a substantial challenge to the improvement of patient safety in India, other patient safety barriers such as health systems changes, training, and education, could be addressed with fewer resources. While initial approaches to improving patient safety in India and other low- and middle-income countries have focused on implementing processes that represent best practices, this study suggests that multifaceted interventions to also address more structural problems (such as resource constraints, systems issues, and medical culture) may be important.

High rates of suicide attempts and domestic violence (DV) in women of reproductive age group have been reported from South India, but the association between them was not studied. Hence, this study was undertaken to assess whether DV is a risk factor for attempted suicide in married women of reproductive age group. A hospital-based case-control study with 77 incident cases of attempted suicide in married women of the age group of 18 to 45 years and 153 controls belonging to the same age group, without history of suicide attempt, was undertaken over a period of 6 months. Univariate and multivariate analyses were done. The crude odds ratio (cOR) for DV was found to be 6.15 (95% confidence interval [95% CI] = [2.95, 12.82], p value =.0001). Other statistically significant risk factors included younger age group (below 30 years); gross family income > Rs. 5,000; higher occupational status of spouse; having poor social support; having a family history of psychiatric disorders, substance use disorders, and suicide/suicide attempt; higher impulsiveness scores; having higher scores of stressful life events over the past 12 months, and alcohol use disorder in husband. Islamic faith was found to be a significant protective factor. On logistic regression, DV was found to be an independent risk factor for attempted suicide in this study population (adjusted OR = 3.79, 95% CI = [1.35, 10.62], p value =.011). Age groups, stressful life events, impulsiveness, and alcohol use disorder in husband were the confounders adjusted for in logistic regression along with other significant risk and protective factors. Significant dose–response relationship was also observed between DV and attempted suicide. In accordance with the stress-diathesis model for suicidal behavior, DV is found to be a stressor which precipitates suicide attempt in those with diathesis like family history of psychiatric disorders. Clinical, research, and policy implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Periodontal disease is an immunoinflammatory disease characterized by loss of clinical attachment with subsequent tooth loss. It includes periodontitis and gingivitis. The studies regarding the prevalence of periodontitis among the tribal populations are scarce. The periodontal health status of the tribal population of Attapady has not been reported so far. Objective: The present study was conducted to assess the prevalence of periodontitis and its association with oral hygiene habits, tobacco usage, and oral health beliefs among tribal population of Attapady. Materials and Methods: This population-based cross-sectional survey of periodontal disease consisting of 360 individuals was conducted among the tribal population of three different panchayats of Attapady. A multistage stratified random sampling was used in the selection of hamlets and cluster sampling for selection of study participants. The sociodemographic characteristics, oral hygiene habits, tobacco usage, and oral health beliefs were assessed using a questionnaire, and clinical examination was based on WHO oral health assessment form 2013. Results: The prevalence of periodontal disease among tribal population of Attapady was 87.5% (95% Confidence interval [CI] 78.48, 96.51).73.3% had gingival bleeding and 13.3% had no/mild periodontitis, The proportion of periodontitis was 84.2% (95% CI 75.5, 92.8). Among chronic perioodntitis subjects 22.8% had moderate periodontitis and 61.4% had severe periodontitis. A significant association was observed between tobacco use (Odds ratio [OR] 5.6, CI 2.99, 10.74), bad oral hygiene habits (OR 4.9, CI 2.64, 9.43), unfavorable oral health beliefs (OR 3.21, CI 1.63, 6.32), and periodontitis. Conclusions: The prevalence of periodontal disease and periodontitis are high among tribal population of Attapady. Unfavorable oral health belief, bad oral hygiene habits, and detrimental habits like tobacco use were the modifiable risk factors identified in this group. [ABSTRACT FROM AUTHOR]