Impact of COVID-19 on Mental Health Among Healthcare Workers in India: A Mixed-methods Systematic Review

Healthcare workers (HCWs) experienced significant mental health challenges during the COVID-19 pandemic. This review aimed to comprehensively assess the impact of the COVID-19 pandemic on the mental health of HCWs in India. We conducted a mixed-methods systematic review, which adopts a results-based convergent approach that incorporates quantitative and qualitative data. A comprehensive literature search was conducted in relevant databases: PubMed-Medline, CINAHL, Web of Science, and ProQuest. All available full-text studies in the English language that assessed the mental health outcomes (anxiety, stress, and depression) of HCWs during the pandemic and published until 28 February 2022 were included. A total of 31 studies were included in this review (27 quantitative studies, three qualitative studies, and one mixed-method study). The pooled prevalence of depression, anxiety, and stress among HCWs in India was 32.96%, 29.49%, and 33.47%, respectively. Integration of quantitative and qualitative findings using social determinants of health framework resulted in various contributing factors and coping strategies. There is a need for a supportive work environment, mental health support, and mental health policies for HCWs in India.

Quality of Life among Postmenopausal Women with Osteoporosis in Southern India: A Cross-sectional Study

Introduction: Osteoporosis is characterised by reduced bone mass and structural destruction of bone tissue which increases the brittleness of bone that leads to increased fracture risk. It is very common among postmenopausal women. Since osteoporosis is closely related to oestrogen deficiency, postmenopausal women are predisposed to it. The decrease in oestrogen during the menopausal transition period causes more bone resorption than formation, resulting in osteoporosis. Aim: To assess the quality of life of among the postmenopausal osteoporotic women without fracture and to find out the association of quality of life with selected demographic variables. Materials and Methods: The present cross-sectional was conducted at the Osteoporosis Clinic of Orthopaedic Outpatient Department of Kasturba Medical College Hospital, Manipal, India, between June 2019 and September 2021, after obtaining the permission from concerned authorities. The sample was 120 postmenopausal osteoporotic women who belong to the age group 45-65 years. Postmenopausal women with uncomplicated osteoporosis without fractures were included in the study. The independent variable was of quality of life of the postmenopausal women and the dependent variables were the age, religion education occupation, and Bone Mineral Density (BMD). After obtaining the informed consent, the participants were interviewed using Short Form-36 (SF-36) quality of life questionnaire. The questionnaire consisted of 36 items and eight subscales which are summarised in two domains: Physical Component Summary (PCS) and Mental Component Summary (MCS). The statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) software version 22.0. The collected data was analysed using descriptive and inferential statistical measures. One way Analysis of Variance (ANOVA) and the Pearson correlation coefficient test was used to find out the association. Results: The mean±Standard Deviation (SD) age of the participants was 56.8±2.5 years, 99 (87.5%) participants were Hindus and n=52 (56.25) belonged to general category. Higher proportions of the women were housewives i.e., n=85 (68.75%). Higher scores show a better quality of life. The results of this study showed that participants scored less (29.99±9.56) in role limitations due to emotional problems. Also, the participants scored less (43.39±4.57) in the domain of MCS in comparison to PCS (47.78±4.53). Further, association of PCS and MCS scores of quality of life were tested (p-value<0.05) with selected demographic variables such as age, religion, education, occupation and BMD. The results showed that there was no significant association found between PCS scores and age (p-value=0.84), religion (p-value=0.94), occupation (p-value=0.805) and BMD (r= -0.058, p-value >0.05). Also, there was no significant association between MCS scores and age (p-value=0.69), religion (p-value=0.86), occupation (p-value=0.70) and BMD (r-value=-0.0604, p-value >0.05). Conclusion: The participants scored less in the subscale of role limitations due to emotional problems of the SF36 questionnaire. The quality of life was less in the mental component subscore. This indicated that osteoporosis make the postmenopausal women anxious and affects their daily activities.

Burden of Osteopenia and Osteoporosis Among Postmenopausal Women in India: A Systematic Review and Meta-Analysis

Aim

Postmenopausal osteoporosis is a major public health problem around the world. The objective of this systematic review is to determine the prevalence of osteoporosis in postmenopausal women in India.

Materials and Methods

This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified relevant studies through a search of literature published from 2010 to January 2021 in the databases PubMed, Web of Science, ProQuest, CINHAL, and PEDro databases. We searched for cross-sectional studies involving India that were published in English.

Results

There was a total of 1631 hits in the initial search and out of which 60 studies were selected for full-text review. Twelve studies were selected for qualitative analysis. Excluded studies were 48 with reasons: 20 studies had included other diseases such as knee arthritis, celiac diseases, diabetes mellitus, and kidney diseases. Eleven studies included premenopausal women, young adults, and men. Ten studies outcomes were different, and seven studies were excluded as they have done retrospective analysis and were commentaries. The pooled prevalence of osteoporosis at the lumbar spine region was 29%, the hip region was 6% and the femoral neck region was 29% whereas the pooled prevalence of osteopenia at the lumbar spine region was 37%, the hip was 6%, and femoral neck region was 37%.

Conclusion

This systematic review found that postmenopausal women are at significant risk of developing low bone mineral density, and the prevalence of osteoporosis and osteopenia was high in the lumbar area.

Effect of exercise on bone mineral density and quality of life among postmenopausal women with osteoporosis without fracture: A systematic review

BACKGROUND

Osteoporosis is a progressive disease commonly seen in postmenopausal women which is characterized by decreased bone mass. This is becoming an important public health issue in India. This review aimed to evaluate the effect of exercise on quality of life and bone health status among postmenopausal osteoporotic women.

METHODS

We searched the following databases: Pubmed-Medline, Proquest, CINAHL, Scopus, Cochrane Central and PEDro. The review included randomized controlled trials that examined the use of exercise aimed at improving bone mineral density and quality of life in postmenopausal osteoporotic women without a history of fracture. Risk of bias was assessed by the Cochrane Risk of Bias tool.

RESULTS

This review suggests exercise is effective in improving the bone mineral density and quality of life of postmenopausal women with osteoporosis. The exercise interventions included in the studies were heterogeneous and included: Tai Chi, high intensity aerobic exercises, Modified Eight Section Brocade exercises, progressive slow loading low impact exercises, pilates and closed kinetic exercises. Four studies had a small sample size and in three studies, interventions were for a shorter duration. Meta-analysis could not be performed as the studies were not homogenous.

CONCLUSION

There is a need to conduct more experimental trials with robust research methods so that a high risk of bias can be avoided. The available evidence supports the positive effects of exercises on postmenopausal osteoporosis.