Effectiveness of a Module Based Training on Nurses' Attitude Towards Social Norms and Beliefs That Support Abuse Among women with Mental Illness.

Violence against women is a priority public health issue. Women with mental illness are at a double disadvantage. While social norms and beliefs either support or confront violence against women, research is limited on this issue. A randomized controlled design was adopted for the present study. This study was aimed to evaluate the effectiveness of module-based training in changing nurses' attitudes towards norms and beliefs that support violence against women in mental health care settings. In this study, 68 nurses were randomly assigned to either the experimental or control group (34 in each group). After receiving the training program, the mean scores on norms and beliefs and justifiability of abuse scales were significantly higher in the experimental group compared to the control group (p < 0.05). The results confirmed the positive impact of the training program in changing nurses' attitudes. However, further studies are required to draw firm conclusions on the effectiveness of the training intervention.

Empowerment of nurses' knowledge and skills on violence against women with mental illness: A randomized controlled trail.

BACKGROUND: Nurses play a key role in identifying and supporting women with abusive experiences. However, research that evaluated the effectiveness of educational interventions on violence against women is sparse from India. AIM: To evaluate the effectiveness of a training program in improving nurses' knowledge and skills related to the identification and management of abused Women with Mental Illness (WMI). METHODS: A randomized controlled trial design was adopted for the present study. A total of 68 nurses were randomly assigned to either the experimental or control group (34 in each group). The experimental group was provided eight interactive sessions based on a Nursing Module on abuse among women with mental illness. The assessments were done in both groups at baseline, after the intervention, at three months and six months. The data was collected using a self-rated questionnaire and case vignettes. RESULTS: The mean knowledge score increased significantly in the experimental group after the intervention from 12.26 (SD, 2.03) to 23.60 (SD,1.24) and sustained at three months (23.07 ± 0.94) and six months (23.13 ± 1.61). Similarly, there were significant differences in nurses' skills after the training program (t = 13.17, p < 0.001) and at different time points of assessment (p < 0.001). CONCLUSIONS: Results showed that training had a positive impact on nurses' knowledge and skills related to violence against women with mental illness. Therefore, it is necessary to provide continuous training on this issue to help nurses in providing holistic care to this vulnerable population.

Is dosimetry still a necessity in current dental practice?

Today, dentists have a wide range of imaging modalities to choose from, the film based techniques, digital techniques, and the recent introduction of 3D volumetric or cone beam computed tomography (CBCT). The inherent design features of the new generation dental x-ray equipment has significantly improved over the years with no evidence of substandard x-ray units in operation. In dental facilities radiological workload is comparatively low, newer radiation equipments and accessories follow safety guidelines and employ better radiation protection measures for the patient and the operator. Dentists' knowledge and expertise in radiation protection measures is good, enabling them to carry out riskfree radiation procedures in their practice. Therefore, the present study is aimed at assessing the need for dosimeters in current dental scenario. 'Is there currently a significant risk from dental radiography to merit the use of personal dosimetery in dental practice. 'Dental health professionals (Oral radiologists) and radiographic assistants of fourteen dental colleges in Karnataka state participated in this questionnaire study. The questionnaire consisted of the following questions--the make, type, year of manufacture of radiographic machines used in their setup, number of radiographs made per day in the institution, type of receptors used, number of personnel at risk for radiation exposure, radiation protection measures used, regular monitoring by personal dosimeters, equivalent dosage readings for the past 12 months and whether the reading of thermoluminescent dosimeters (TLD) for any personnel had exceeded the recommended exposure value in the last 3 years. Dosimetry records of the radiology staff in the last three years shows doses no more than 1.50 mSv per year. The various institutions' dose (person mSv) was in the range of 3.70 mSv-3.90 mSv. Personal monitoring for Dentists can be omitted in the dental colleges since the estimated dose of oral radiologists contributed less than 0.01 mSv to the total average annual effective dose equivalent. Hence personal monitoring services (TLD Badges) for dentists employed in dental colleges should not be made mandatory.

Intra-articular Steroid alone vs Hydrodilatation with intra-articular Steroid in Frozen Shoulder - A Randomised Control Trial.

Introduction: Various non-operative treatment modalities have been advocated for a frozen shoulder. In the present study we compared the efficacy of single intra-articular steroid injection vs hydrodilatation with intra-articular steroids for frozen shoulder (FS) in the frozen phase. Materials and methods: This was a prospective, randomised control trial (RCT) done at a tertiary care centre. A total of 108 participants were randomised into two groups-one group received intra-articular steroid with hydrodilatation (HDS) and other group received intra-articular steroid injection only (S). Shoulder Pain and Disability Index (SPADI) scores were taken, and statistical analysis was done to measure the outcome at two weeks, six weeks and three-month intervals after the injection. Result: There was significant improvement in symptoms at each interval for both the groups (p=0.0). There was no statistically significant difference in the SPADI score between the two groups at two weeks post injection, however at six weeks (p=0.04) and 3 months (p=0.001) significant difference in the SPADI score was demonstrated with better scores in group S. The mean duration of analgesia required in group HDS was 5.17 days (S.D.=1.73) and for group S was 4.28 days (S.D.=1.01), with a statistical significance (p=0.002). Conclusion: Better clinical results were obtained at six weeks and three months with the group receiving corticosteroid only and also had a lesser requirement of analgesia post-intervention. Thus, intra-articular steroid injection only seems to be a more desirable method of management during the frozen phase of FS than that of hydrodilatation with intra-articular steroid injection.

A simple screening method for individuals at risk of developing type 1 diabetes: measurement of islet cell autoantibodies (GADA, IA-2A, and IAA) on dried capillary blood spots collected on filter paper.

There is limited information regarding the use of dried capillary blood spots collected on a filter paper (FP) to test for islet cell antibodies. The aim of this study was to validate the use of dried capillary blood spots collected on a FP for the analysis of islet cell antibodies. FP eluates were tested using both single and combined assay for antibodies to glutamic acid decarboxylase (GADA) and/or to the protein tyrosine phosphatase like IA-2 (IA-2A), and a single assay for antibodies to insulin (IAA). The results were compared with those of serum assays. Ninety-one subjects were studied. Forty had Type 1 diabetes mellitus (T1DM) and 51 were first-degree relatives (FDR) of patients with T1DM. The GADA and IA-2A were measured by radio-binding assays, which utilize 35S-labeled GAD65 and IA-2. IAA was measured by a microtiter plate assay using 125I-labeled insulin. Twenty-six of those with T1DM (65%) and 5 of the FDRs (10%) had at least 1 positive test on the single serum assays. The FP combi-assay for GADA and IA-2A had 97.8% concordance rate when compared with serum single assays for GADA and IA-2A. The concordance rate for individual assays were 96.7% for GADA, and 100% for both IA-2A and IAA There was significant correlation of the antibody levels between FP and serum specimen for all 3 antibodies. We conclude that antibody screening performed using dried capillary blood spots collected on a FP correlates well with serum assays, and provides an easy alternative for population screening.

Genetic diversity of Macrophomina phaseolina isolates from certain agro-climatic regions of India by using RAPD markers.

Genetic diversity analysis of Macrophomina phaseolina isolates obtained from different host range and diverse geographical locations in India was carried out using RAPD fingerprinting. Of the thirteen 10-mer random primers used, primer OPB-08 gave the maximum polymorphism and the UPGMA clustering could separate 50 isolates in to ten groups at more than 65% similarity level. The ten clusters correlated well with the geographical locations with exceptions for isolates obtained from Eastern and Western Ghats. There was a segregation of isolates from these two geographical locations in to two clusters thus, distributing 10 genotypes in to eight geographical locations. All the isolates M. phaseolina irrespective of their host and geographical origin, exhibited two representative monomorphic bands at 250 bp and 1 kb, presence of these bands suggests that isolates might have evolved from a common ancestor but due to geographical isolation fallowed by natural selection and genetic drift might have segregated in to subpopulations. Genetic similarity in the pathogenic population reflects the dispersal of single lineage in all locations in India.

Carbon dioxide efflux from soil with poultry litter applications in conventional and conservation tillage systems in northern Alabama.

Increased CO2 release from soils resulting from agricultural practices such as tillage has generated concerns about contributions to global warming. Maintaining current levels of soil C and/or sequestering additional C in soils are important mechanisms to reduce CO2 in the atmosphere through production agriculture. We conducted a study in northern Alabama from 2003 to 2006 to measure CO2 efflux and C storage in long-term tilled and non-tilled cotton (Gossypium hirsutum L.) plots receiving poultry litter or ammonium nitrate (AN). Treatments were established in 1996 on a Decatur silt loam (clayey, kaolinitic thermic, Typic Paleudults) and consisted of conventional-tillage (CT), mulch-tillage (MT), and no-tillage (NT) systems with winter rye [Secale cereale (L.)] cover cropping and AN and poultry litter (PL) as nitrogen sources. Cotton was planted in 2003, 2004, and 2006. Corn was planted in 2005 as a rotation crop using a no-till planter in all plots, and no fertilizer was applied. Poultry litter application resulted in higher CO2 emission from soil compared with AN application regardless of tillage system. In 2003 and 2006, CT (4.39 and 3.40 micromol m(-2) s(-1), respectively) and MT (4.17 and 3.39 micromol m(-2) s(-1), respectively) with PL at 100 kg N ha(-1) (100 PLN) recorded significantly higher CO2 efflux compared with NT with 100 PLN (2.84 and 2.47 micromol m(-2) s(-1), respectively). Total soil C at 0- to 15-cm depth was not affected by tillage but significantly increased with PL application and winter rye cover cropping. In general, cotton produced with NT conservation tillage in conjunction with PL and winter rye cover cropping reduced CO2 emissions and sequestered more soil C compared with control treatments.

Epidermal growth factor receptor defects in leprechaunism. A multiple growth factor-resistant syndrome.

Leprechaunism is a rare genetic disorder characterized by severe growth retardation and insulin resistance. Maximal epidermal growth factor (EGF) binding was reduced in fibroblasts from three unrelated patients with leprechaunism (Ark-1, Can-1, and Minn-1) compared with control (0.8-2.2%/mg protein vs. 5.5%/mg protein). This was due to a decrease in receptor affinity in Ark-1 and Can-1 and a decrease in receptor number in Minn-1. In all cell lines, EGF-stimulated receptor autophosphorylation was also decreased to 18-60% of control, whereas EGF internalization and degradation was normal. Sphingosine (40 microM), a protein kinase C inhibitor, increased EGF receptor affinity twofold in control cells and six- to nine-fold in cells of leprechaunism. However, sphingosine did not enhance EGF-stimulated receptor autophosphorylation in either the controls or the patients' cells. By contrast, only one of the three cell lines of patients with the type A syndrome demonstrated a decrease in EGF binding and all demonstrated normal or near normal EGF-stimulated receptor autophosphorylation. These data indicate that in patients with leprechaunism, there are functional abnormalities of the EGF receptor, as well as of the insulin receptor, that may contribute to the severity of the syndrome. These data also suggest a role for the insulin receptor in maintaining normal EGF receptor function in these cells.

Insulin receptor function in fibroblasts from patients with leprechaunism. Differential alterations in binding, autophosphorylation, kinase activity, and receptor-mediated internalization.

Insulin receptor function was examined in cultured skin fibroblasts from three patients with leprechaunism (Ark-1, Minn-1, and Can-1), a rare syndrome of severe insulin resistance and neonatal growth retardation. All three patients cell lines demonstrated insulin binding less than 15% of control. This was primarily due to reduced affinity of the receptor in Can-1 and due to reduced number of receptors in the other two cell lines (Ark-1 and Minn-1). When expressed as a fraction of total insulin bound, the percentage of cell-associated insulin internalized and degraded did not differ between the patient cell lines and the controls. However, chloroquine, which inhibited degradation by 50% in the control cells, had no effect in the cells from the patients. When normalized to insulin binding, insulin receptor autophosphorylation was normal in cells from Can-1, but reduced in those of Ark-1 and Minn-1. In contrast, the receptor-associated tyrosine kinase activity toward exogenous substrates was decreased in all three patient cell lines. These results suggest that leprechaunism is a biochemically heterogenous disease associated with a variety of alterations in receptor function. Cells from Ark-1 and Minn-1 exhibit parallel alterations in receptor autophosphorylation and kinase activity. Cells from Can-1 demonstrate normal receptor autophosphorylation but reduced kinase activity, thus displaying a unique form of a mutant insulin receptor. Despite reduced kinase activity, all three cell lines exhibit normal rates of insulin internalization, but decreased lysosomal-mediated degradation. Our data imply that receptor autophosphorylation and kinase activity may be regulated separately and that kinase activity may be linked to insulin degradation, but not necessarily internalization.

Tumor-associated peripheral eosinophilia: two unusual cases.

Peripheral eosinophilia is a rare but recognized accompaniment of malignant disease. Two unusual cases, one with a histiocytic lymphoma and the other with cervical carcinoma, are described. In the first patient, pulmonary infiltrates developed at the height of the eosinophilia and in the second, the peripheral eosinophilia heralded the onset of disseminated disease. Tumor-associated peripheral eosinophilia is reviewed, and it is concluded that peripheral eosinophilia associated with a malignant setting is a marker of extensive disease and is thus associated with a poor prognosis.

Altered expression and function of the insulin receptor in a family with lipoatrophic diabetes.

To determine the role of genetic defects in the insulin receptor in the insulin resistance of lipoatrophic diabetes mellitus, we studied insulin binding, insulin receptor autophosphorylation, and insulin receptor mRNA levels and performed Southern blot analysis of genomic DNA in four siblings, all of whom have some degree of insulin resistance and three of whom have lipoatrophy. The insulin receptor concentration in Epstein-Barr virus-transformed lymphocytes was about 30% of normal in all three lipoatrophic siblings (LA1, LA2, and LA3) and was 55% of normal in the nonlipoatrophic sibling (LAS). Insulin receptor mRNA concentrations in the lymphocytes paralleled insulin binding and ranged from 15-67% of the mean normal level. Insulin binding to fibroblasts was also reduced about 50% in the lipoatrophic siblings. In addition, insulin binding to fibroblasts of LAS and LA2 exhibited a rightward shift of the competition curve, suggesting reduced receptor affinity [ED50, 35 and 50 ng/mL (5845 and 8350 pmol/L); normal, 1-3 ng/mL (167-501 pmol/L)]. Receptor autophosphorylation determined using Triton X-100 extracts of the fibroblasts was decreased in LA1 and LA3, but normal in LA2 and LAS. Using restriction enzyme digests of genomic DNA and probes spanning the entire cDNA of the insulin receptor, no gross alterations in receptor gene structure were detected in any members of this family. In 2 of the lipoatrophic siblings (LA1 and LA3) and in the sibling with insulin resistance but no lipoatrophy (LAS), a unique variant BamHI site was detected using a probe to the alpha-subunit region. This site was not found in 200 normal or diabetic insulin receptor alleles. By use of probes 5' and 3' to the alpha-subunit probe and by genomic cloning analysis, this variant BamHI site was localized to an intron in the insulin receptor gene downstream of exon 3 which encodes amino acids 191-296 of the alpha-subunit of the receptor. These data indicate the complex nature of familial lipoatrophic diabetes mellitus, with alterations in insulin receptor expression and/or function in both clinically affected and non-affected siblings. Both the reduced insulin binding and reduced levels of insulin receptor mRNA in the lipoatrophic siblings suggest that an insulin receptor gene defect contributes to this syndrome. Several members of this family also carry a unique variant insulin receptor gene, which, however, could not be linked to a specific alteration in receptor expression or the presence of lipoatrophy.(ABSTRACT TRUNCATED AT 250 WORDS)

Nocardiosis in a recently transplanted renal patient.

Opportunistic infections are common after renal transplantation because of the use of immunosuppression. Nocardiosis is a rare but important cause of morbidity and mortality among renal transplant recipients. Depending upon the transplant center, the estimated incidence of nocardiosis among renal transplant recipients varies widely from 0 to 20%. We report the first case of nocardiosis in a recently transplanted renal patient maintained on tacrolimus, prednisone, and mycophenolate mofetil. It is likely that the nocardial infection in our patient was related to the development of her diabetes mellitus, and to her early episode of rejection and treatment which included high-dose steroids, and the addition of mycophenolate mofetil. Our case illustrates the importance of maintaining a heightened awareness so that nocardiosis may be diagnosed early and treated successfully.

Microscopic peliosis of pancreatic islets in a woman with MEN-1 syndrome.

We report herein a case of histologically identified peliosis of pancreatic islets in the surgically removed portion of the pancreas of a 30-year-old woman with multiple endocrine neoplasm, type 1 (MEN-1) syndrome. In addition to microscopic peliosis, the pancreas contained multiple endocrine tumors producing insulin, glucagon, somatostatin, and growth hormone-releasing factor and showed evidence of widespread nesidioblastosis. It is uncertain whether peliosis of pancreatic islets and MEN-1 syndrome were coincidental or whether the two diseases were causally related. Since hormonal factors can result in hepatic peliosis, it is tempting to speculate that the endocrine imbalance secondary to MEN-1 syndrome might have played a role in the genesis of peliosis in this case. Although no direct proof of vascular damage was encountered, it is conceivable that escape of red blood cells from the circulation and their accumulation in tissue spaces was due to abnormal islet blood flow and increased capillary permeability.

Reducing the incidence of coronary heart disease by managing hypertension: implications of syndrome X.

Syndrome X is a constellation of abnormalities; it appears to be strongly linked to insulin resistance and the risk of atherosclerosis. It consists of hypertension, glucose intolerance, obesity, dyslipidemia and, observed more recently, coagulation abnormalities. It is possible that treating blood pressure levels alone while ignoring or worsening other strongly associated risk factors has resulted in minimal effects on the incidence of coronary heart disease (CHD). Syndrome X has raised the awareness of these associated risk factors and has further led to the consideration of hypertension as a metabolic disease. The epidemiologic evidence in support of the link between insulin resistance and hypertension is reviewed, and the public health implications of these data are outlined.

Anorectic drugs and valvular heart disease: a biological and clinical perspective.

The epidemiologic and pathologic evidence that fenfluramine and related drugs cause valvular heart disease is still speculative. However, at present, there is no alternative explanation for the cases of valvular disease found in patients taking these drugs, and there is evidence that similar substances can cause similar lesions. The manufacturer of fenfluramine and dexfenfluramine has prudently removed them from sale pending further studies.

United Kingdom Prospective Diabetes Study (UKPDS). Effects of glucose and blood pressure control on complications of type 2 diabetes mellitus.

The United Kingdom Prospective Diabetes Study (UKPDS) showed that intensive treatment (i.e., glucose-lowering drugs, with a goal fasting blood glucose level of 108 mg/dL) decreases the microvascular complications of type 2 diabetes mellitus. We summarize the key study results and their implications for clinical management of type 2 diabetes mellitus.

Troglitazone: a new antihyperglycemic agent.

Troglitazone is the first of a new family of antihyperglycemic drugs. We review its use in clinical practice.

Health outcomes in type 2 diabetes.

Outcome evaluation is of great interest throughout the healthcare field, but which outcomes are important depends on the viewpoint one holds. For the healthcare organisation costs and resource utilisation are paramount, whereas patients may be interested in being able to work and lead a productive life without long-term complications. Healthcare policy decisions are influenced by varying degrees of social forces, existing regulations and outcome research findings. Ideally, all three are in agreement but often they may be competitive or may not even be included in policy decision making. With respect to improving outcomes, much energy has been spent on developing diabetes care guidelines. However, these have had minimal impact on physician behaviour. Soon after onset or diagnosis of diabetes, we are most concerned with process measures such as micro-albumin levels, blood pressure monitoring, routine eye and foot examinations and lipid profiles. These process measures are related to the development of intermediate outcomes--proteinuria, retinopathy, foot ulcers and dyslipidaemia. Diabetes is an expensive disease but there is accumulating evidence that improved care can lead to better quality of life and reduction in health care resource utilisation. The UKPDS demonstrated that for one percentage point decrease in HbA1c there was a 35% reduction in the risk of complications. Preliminary data from various diabetes management programmes indicate that instituting standardised care may lead to cost savings and improved health. Rationing health care resources wisely requires consideration of multiple factors including quality of life years (QALYs) and healthy year equivalents (HYEs). Formal quantitative methods are used to measure overall desirability of a medical intervention. Questions to be answered include predictability of responsiveness or adverse events to drug therapy. Outcomes research will have a key role in future development of models of diabetes care.

Effect of yoga on exercise tolerance in normal healthy volunteers.

Twelve normal healthy volunteers (6 males and 6 females) undergoing yoga training for 90 days were studied for the effect of yoga on exercise tolerance. Their ages ranged from 18 to 28 years. The volunteers were taught only Pranayama for the first 20 days and later on yogic asanas were added. Sub-maximal exercise tolerance test was done on a motorized treadmill by using Balke's modified protocol, initially, after 20 days (Phase-I) and after 90 days of yoga training (Phase-II). Pyruvate and lactate in venous blood and blood gases in capillary blood were estimated immediately before and after the exercise. Minute ventilation and oxygen consumption were estimated before and during the test. Post exercise blood lactate was elevated significantly during initial and Phase-I, but not in Phase-II. There was significant reduction of minute ventilation and oxygen consumption only in males in Phase-I and II at the time when the volunteers reached their 80% of the predicted heart rate. Female volunteers were able to go to higher loads of exercise in Phase-I and II.

Setting up a quality assurance model for newborn care to strengthen health system in Bihar, India.

BACKGROUND: A Quality Assurance model was rolled out in Bihar, India. It had two components: external and internal monitoring and giving feedback for action. The parameters included infrastructure and policy, equipment maintenance, stock supply and aseptic measures. METHODS: The performance and gradation into good/average/poor was measured based on the scores translated from the data collected after giving appropriate weights. RESULTS: 12%, 63%, and 25% units were categorized as good, average and poor based on infrastructure. For equipment, 68% of units performed poorly; for stock maintenance 64% and 35% of NBCCs fell under good and average categories respectively; most (54%) NBCCs had average scores for aseptic measures; 30% fell in the poor category. CONCLUSIONS: Involvement of government in monitoring and feedback mechanism, establishing a system of data collection at the grass root level and analysis at the state level were the positive outcomes.