Barriers and Enablers for Physical Activity Engagement Among Individuals From India With Type 2 Diabetes Mellitus: A Mixed-Method Study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a complex, chronic condition that can cause multiple complications due to poor glycemic control. Self-management plays a crucial role in the management of T2DM. Lifestyle modifications, including physical activity (PA), are fundamental for self-management. This study explored the knowledge, perception, practice, enablers, and barriers of PA among individuals with T2DM. METHODS: A mixed-method study was conducted among individuals with T2DM in Udupi taluk, India. A cross-sectional survey (n = 467) followed by an in-depth interview (n = 35) was performed. The data were analyzed using descriptive statistics and thematic analysis, respectively. RESULTS: About half (48.8%) of the participants engaged in PA of which 28.3% had an adequate score in the practice of PA. Walking was the most preferred mode. Self-realization, Comprehension, perception, and source of information, PA training, Current PA practices, enablers and barriers for PA were 6 themes derived under knowledge, perception, and practice of PA. CONCLUSION: Despite knowing the importance of PA, compliance with PA was poor. The personal/internal, societal, and external factors constituted the trinity of barriers and enablers in compliance with PA. Behavioral changes, societal changes, policy initiatives, and PA training in health care settings may enhance PA practice among individuals with T2DM.

Non-pharmacological interventions to reduce anxiety among children undergoing surgery: A systematic review.

A hospitalized child experiences anxiety more frequently as compared to non-hospitalized children. Surgery can be emotionally distressing for children, and subsequently their parents and caregivers, this distress can cause profound adverse impacts on children. We aimed to identify the effect of non-pharmacological interventions on children's (1-18 years) anxiety undergoing surgery. The following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Proquest, Web" of Science, and Cochrane Central Register of Controlled Trials were systematically searched for full-text articles. The review included 15 randomized controlled trials. The risk of bias was assessed using Cochrane Risk of Bias tool. The interventions included in the study were preoperative education, puppet play, therapeutic play, distraction activities, parental presence, and clown therapy. The review presents a narrative reporting of the findings. This review identifies that non-pharmacological interventions are effective in reducing anxiety among children undergoing surgery. There are a limited number of studies from developing countries. Further research is required to underpin the use of these interventions with children before surgery.

Anxiety and Pain in Children Undergoing Surgery: A Scoping Review.

PURPOSE: Anxiety and pain are experienced by most children undergoing surgical procedures. Untreated anxiety delays postoperative recovery and also increases the risk of complications. The purpose of this scoping review was to examine the relationship between perioperative anxiety and postoperative pain among children. DESIGN: A scoping review METHODS: A comprehensive literature search was done on the following databases: PubMed-MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index of Nursing and Allied Health Literature), ProQuest, and Cochrane library to identify the original research studies published in English between January 01, 2000 to March 31, 2021. Two authors independently screened the studies based on pre-specified criteria. The results of the search are described narratively. FINDINGS: A total of eleven studies were included in this review from 1,180 studies initially retrieved. Most of the studies revealed that children who had higher levels of perioperative anxiety experienced higher levels of postoperative pain. CONCLUSIONS: This review identified that perioperative anxiety has a significant effect on postoperative pain among children. The review results indicate the need to develop age-appropriate interventions to reduce perioperative anxiety and postoperative pain among children to reduce further postoperative complications.

Smartphone de-addiction among children and adolescents: An hour of need.

Sudden closure of schools due to coronavirus disease 2019 (COVID-19) pandemic introduced extensive use of digital technology in education across the globe. The gadgets connected to the internet have become an essential part of the lives of children in the contemporary world. Children and adolescents are more exposed to smart devices for academic learning and entertainment. The concern of smartphone addiction among children and adolescents in recent decades has been heightened by the spread of COVID-19. Excessive use of smartphones has physical, psychological, and social unfavorable outcomes signifying the need for developing strategies to reduce the usage.

Psychological Well-being and Perceived Parenting Style among Adolescents.

The family of an adolescent assists in shaping the adolescent's behavior and psychological well-being throughout life. In order for the adolescents to maintain an identity, they require security and affection from their parents. To assess the psychological well-being, perceived parenting style of adolescents and to determine the relationship between psychological well-being and perceived parenting style among the adolescents, a correlational survey was conducted in five randomly selected schools in Southern India with 554 adolescents studying in 8th grade to 9th grade. A self-administered perceived parenting scale and a standardized Ryff scale for the assessment of psychological well-being were adopted to collect data, which were analyzed using SPSS. Without gender differences, majority (51%) had a high psychological well-being; 49% revealed low psychological well-being. Majority (95.5%) had a purpose in life and positive relation with others. Most (93.2%) of the adolescents perceived their parents as authoritative. A moderately positive relationship was found between psychological well-being and authoritarian and permissive parenting styles and a negative correlation between psychological well-being and neglectful parenting style. The study concluded that parenting styles will have an influence on adolescents' psychological well-being. Among the four parenting styles, authoritative parenting is warm and steady and hence will contribute to the psychological development of adolescents. They also had maintained a positive relation with others and have a purpose in life. Adolescents who perceived their parents as authoritarian had a decreased autonomy and those who perceived their parents as permissive had a diminished personal growth.

Specialist nurse initiated interventions in breast cancer care: A systematic review of randomised controlled trials.

AIMS AND OBJECTIVES: To evaluate the effectiveness of specialist nurse interventions in the care of women with breast cancer. BACKGROUND: Nurses perform a crucial role in physical and psychosocial support of women with breast cancer. However, only few reviews have explored and discussed the roles and interventions carried out by specialised nurses in breast cancer care. DESIGN: Systematic review based on PRISMA guidelines. METHODS: A comprehensive literature search was conducted in PubMed, CINAHL, Scopus, Web of Science, Science Direct, Cochrane Library, IndMed and Shodhganga databases for articles published in English language from 1980 to 2018. Only RCTs were included. Quality assessment, data extraction and analysis were completed on all included studies. RESULTS: Sixteen papers were assessed for methodological quality. Due to methodological heterogeneity of the papers, a meta-analysis was not performed. The reviewers categorised the main outcomes under different domains like physical problems, psychological problems, patient satisfaction, patient needs, quality of life and cost data. DISCUSSION: This review provides evidence on specialist nurses' role in breast cancer care. The methodological aspects of studies in this review vary in different aspects. More studies with rigorous scientific methods are needed to provide robust evidence on effectiveness of specialist nurses' role. CONCLUSION: Even though specialist nursing interventions can contribute to health outcomes of women with breast cancer, there is limited number of studies reported from developing countries. This warrants the need for specialist nurse interventions in breast cancer care from developing countries. RELEVANCE TO CLINICAL PRACTICE: Offering a specialist nurse service helps the patients to meet their informational and educational needs, supportive care and coordination of care. Specialist breast nurse services can be integrated into hospital setting to improve patient care and treatment adherence.

Quality of life of patients with head and neck cancer: A mixed method study.

AIM OF THE STUDY: The current research was conducted with the aim of determining the quality of life of head and neck cancer (HNC) patients using mixed method approach. METHODS: A mixed method triangulation design (QUAN + QUAL) was adopted in the study. Quantitative data were collected among 54 and qualitative data were collected till data saturation using nested sampling technique. Data were collected from seven oncological wards of two tertiary care hospitals during the 4th week of radiation therapy. Quantitative data were collected through functional assessment of cancer therapy: head and neck, and a semi-structured interview schedule was adopted to elicit their experiences. Quantitative and qualitative data were compared during the analysis phase. Both qualitative and quantitative data were depicted in meta-matrices. RESULTS: Results showed that the most affected domains were functional well-being followed by HNC subscale. Similar findings were observed in narrative description of participants. Most focused experience was pain, and difficulty in eating and swallowing was experienced due to pain. Their verbal communication was inefficacious due to loss of voice and tone. Moreover, communication was difficult owing to changes in the oral mucous membrane and pathology. CONCLUSION: Patients with HNC suffer from varying degrees of psychosocial problems, and it is important to identify the psychosocial adjustment of the patients since the symptoms are sufficient to lay heavy burden.

Impact of multimodal interventions on medication nonadherence among elderly hypertensives: a randomized controlled study.

Purpose: The study was conducted to investigate the effects of multimodal interventions on medication nonadherence, quality of life (QoL), hypertension (HTN), self-efficacy, and clinical outcome in terms of blood pressure (BP) among elderly people with HTN. Methods: An experimental design using a randomized controlled trial was adopted (N=80+80). The experimental group received multimodal interventions and the control group received routine care. Both groups were followed up at baseline and at 3 and 6 months. The data collection tools of demographic and clinical proforma, structured knowledge questionnaire on HTN (r=0.84), Revised Medication Adherence Self-Efficacy Scale (r=0.94), Morisky Medication Adherence Scale (r=0.83), World Health Organization Quality of Life-BREF scale (r=0.87), and digital BP apparatus were used. Necessary administrative permission was obtained for the study. Results: The study results proved that nurse-led multimodal interventions led to an improvement in medication adherence [F(1.75,214.30)=774.18, p<0.001], knowledge on HTN [F(2,244)=43.83, p<0.001], and self-efficacy [F(1,122)=3.99, p=0.04] of elderly people on antihypertensives over a period of 6 months. Overall QoL did not exhibit any statistically significant improvement, and no statistically significant reductions in the systolic BP (SBP) and diastolic BP (DBP) scores were obtained (p>0.05) in the experimental group over a period of 6 months. However, the clinical significance of multimodal interventions for improvements in medication adherence, QoL, knowledge on HTN, and self-efficacy was more favorable compared with the reduction in SBP and DBP scores. Conclusion: Nurses play a crucial role in improving medication adherence among elderly people with HTN. Trial details: Ethical clearance was obtained (IEC no. KH IEC 253/2012) from the Institutional Ethical Committee of Manipal University, Manipal, and the study was conducted in accordance with the Declaration of Helsinki. The study is registered under Clinical Trials Registry of India (CTRI/2017/04/008405). Informed consent was obtained from participants, and the confidentiality of information was assured.

"Personified as Paragon of Suffering...... Optimistic Being of Achieving Normalcy:" A Conceptual Model Derived from Qualitative Research.

BACKGROUND: Conceptual models developed through qualitative research are based on the unique experiences of suffering and individuals' adoptions of each participant. A wide array of problems are faced by head-and-neck cancer (HNC) patients due to disease pathology and treatment modalities which are sufficient to influence the quality of life (QOL). Men possess greater self-acceptance and are better equipped with intrapersonal strength to cope with stress and adequacy compared to women. METHODOLOGY: A qualitative phenomenology study was conducted among seven women suffering from HNC, with the objective to understand their experiences of suffering and to describe the phenomenon. Data were collected by face-to-face, in-depth, open-ended interviews. Data were analyzed using Open Code software (OPC 4.0) by following the steps of Colaizzi process. RESULTS: The phenomenon that emerged out of the lived experiences of HNC women was "Personified as paragon of suffering.optimistic being of achieving normalcy," with five major themes and 13 subthemes. CONCLUSION: The conceptual model developed with the phenomenological approach is very specific to the women suffering from HNC, which will be contributing to develop strategies to improve the QOL of women.

A Randomized controlled trial to evaluate the impact of a Nurse Navigator Programme on outcomes of people with breast cancer: study protocol.

AIM: To evaluate the effectiveness of a Nurse Navigator Programme on anxiety, psychological distress and quality of life in people with breast cancer. BACKGROUND: Breast cancer is the most frequently detected malignancy and a major cause of cancer death among women around the world. The lengthy course of illness from initial diagnosis to treatment and subsequent follow-up causes deterioration in physical, psychological and social status among patients. Nurses have a major role in cancer care. As women with breast cancer have to undergo various treatment modalities, continued care by a pivot nurse is thought to enhance treatment adherence. Limited studies have been reported from developing countries on Nurse Navigation Programmes. DESIGN: A Stratified Randomized controlled trial with repeated measures. METHODS: One hundred and twenty newly diagnosed women with breast cancer admitted to surgery wards of a tertiary care hospital in South India will be recruited. (Project funded in Octo"ber 2014). Women are randomly allocated to a control and intervention group. The outcome variables are anxiety, psychological distress and quality of life. Data on outcome measures will be collected at five different time points: before surgery, at discharge, beginning of adjuvant therapy, middle of adjuvant therapy and at the end of adjuvant therapy. DISCUSSION: This study may give evidence on the effectiveness of a Nurse Navigator Programme for women with breast cancer. If significant effects were detected, the programme could be integrated into hospital services to improve the patient care.

Self-image of the Patients with Head and Neck Cancer: A Mixed Method Research.

AIM: The aim of the study was to assess the self-image of the patients with head and neck cancers (HNCs) by using a mixed method research. SUBJECTS AND METHODS: A mixed method approach and triangulation design was used with the aim of assessing the self-image of the patients with HNCs. Data was gathered by using self-administered self-image scale and structured interview. Nested sampling technique was adopted. Sample size for quantitative approach was 54 and data saturation was achieved with seven subjects for qualitative approach. Institutional Ethical Committee clearance was obtained. RESULTS: The results of the study showed that 30 (56%) subjects had positive self-image and 24 (44%) had negative self-image. There was a moderate positive correlation between body image and integrity (r = 0.430, P = 0.001), weak positive correlation between body image and self-esteem (r = 0.270, P = 0.049), and no correlation between self-esteem and integrity (r = 0.203, P = 0.141). The participants also scored maximum (24/24) in the areas of body image and self-esteem. Similar findings were also observed in the phenomenological approach. The themes evolved were immaterial of outer appearance and desire of good health to all. CONCLUSION: The illness is long-term and impacts the individual 24 h a day. Understanding patients' self-concept and living experiences of patients with HNC is important for the health care professionals to improve the care.

Clinical profile and functional disability of patients with migraine.

BACKGROUND: Migraine is a common disabling primary headache disorder. Globally, migraine was ranked as the seventh highest cause of disability. AIM: The aim of the study was to explore the clinical profile and functional disability of patients with migraine. SETTINGS AND DESIGN: A cross-sectional survey was conducted at the neurology outpatient department of a tertiary care hospital in Karnataka. MATERIALS AND METHODS: Using a consecutive sampling technique, 60 patients were recruited for the study. Descriptive and inferential statistics were used to analyze the data. RESULTS: Majority of the participants were in the age group of 18-40 years with a mean age 35.22 years. There was a female preponderance with 70% of study participants being females. The various symptoms experienced by patients include throbbing pain (90%), photophobia (93.3%), phonophobia (85%), nausea (76.7%), and vomiting (41.7%). Most of the subjects (73.3%) under the study belonged to moderate to severe levels of functional disability. About 53.3% of patients were in the category of episodic migraine and 46.7% were in the category of chronic migraine. CONCLUSION: Migraine is associated with moderate to severe functional disability. Frequency of migraine has a positive correlation with the levels of disability/migraine disability assessment scores of migraineurs.

The experiences of mothers of pediatric surgery children--a qualitative analysis.

The purpose of this study was to explore the experiences of mothers of children admitted in the pediatric surgery ward. Respondents consisted of a convenience sample of 10 mothers. Data were collected through in-depth interview and were analyzed based on the synthetic approach to grounded theory analysis. The core category that emerged from the analysis was "staying hopeful that the child is alright." The categories identified include discovering the condition, questioning God, seeking information, trusting the health care system, coming to terms, desiring to participate in the care of the child, and maintaining quality of care. Implications for health professionals include a need for thorough assessment and anticipatory guidance to the parents. Limitations of the study and recommendations for future research are also given.