Development and validation of a questionnaire for assessing preventive practices and barriers among health care workers in COVID-19 pandemic.

OBJECTIVES: COVID-19 has affected thousands of health care workers worldwide. Suboptimal infection control practices have been identified as important risk factors. The objective of this study was to develop and validate a questionnaire to holistically assess the preventive practices of health care workers related to COVID-19 and identify the reasons for shortcomings therein. METHODS: The development of the questionnaire involved item generation through literature review, focus group discussions and in-depth interviews with health care workers and experts, followed by validation through expert opinion, pilot testing and survey. A cross-sectional survey on 147 healthcare workers was done using an online platform and/or interviews in August 2020 in New Delhi, India. Exploratory factor analysis using principal component extraction with varimax rotation was performed to establish construct validity. Internal consistency of the tool was tested using Cronbach's alpha coefficient. RESULTS: The developed questionnaire consists of two sections: Section A contains 29 items rated on a five-point Likert scale to assess preventive practices and Section B contains 27 semi-structured items to assess reasons for suboptimal practices. The first section has good validity (CVR = 0.87, S-CVI/Av = 0.978) and internal consistency (Cronbach's alpha coefficient = 0.85) CONCLUSIONS: This questionnaire is a valid and reliable tool for holistic assessment of preventive practices and barriers to it among health care workers. It will be useful to identify vulnerable practices and sections in health care settings which would assist policymakers in designing appropriate interventions for infection prevention and control. This will also be useful in future pandemics of similar nature.

The Efficacy of Scrambler Therapy for the Management of Head, Neck and Thoracic Cancer Pain: A Randomized Controlled Trial.

BACKGROUND: Pain is still a common feature in all types of cancers including head and neck and thoracic cancer. Neuromodulatory techniques have gained popularity over opioids in recent times because of the risks associated with chronic opioid therapy. There are no clinical trials evaluating the efficacy of scrambler therapy (ST) for the management of pain due to head and neck and thoracic cancer. OBJECTIVE: This trial was undertaken to evaluate the efficacy of scrambler therapy (ST) for pain relief and to assess the possible effect of ST on the dosage of opioids in patients suffering from cancer pain. STUDY DESIGN: A randomized control trial (RCT) was performed. SETTING: The trial was conducted at the Pain and Palliative Care Unit of the Dr. B.R. Ambedkar Institute Rotary Cancer Hospital of All India Institute of Medical Sciences, New Delhi, India. METHOD: Forty patients were included in each of the 2 arms, control and Intervention. In both arms, patients were given pain management drugs. In the intervention group, patients additionally received 10 consecutive sessions of ST with one follow-up after 7 days. A numeric rating scale (NRS-11) was used to measure pain. Drug dosage was also recorded. RESULTS: Overall, pain decreased in both arms. However, pain decreased more in the intervention arm as compared to the control arm. The total change in the mean score of the NRS-11 from baseline to follow-up was 3.1 and 6.19 in the control and ST arms, respectively. Differences between pain scores in both arms became significant from day 3 onwards. Mean morphine dose was significantly lower in the intervention arm from day 7 onwards. LIMITATIONS: The study followed the patients until one week after the last treatment session and encouraged patients to return for treatment if their pain returned to previous levels within 10 days. Moreover, patients in the control arm received the standard of care in the form of pharmacological treatment but did not receive either transcutaneous electrical nerve stimulation (TENS) or a sham (placebo) procedure. CONCLUSIONS: The trial showed that ST is an effective treatment for the management of pain due to head and neck and thoracic cancer. On the basis of this study, the use of ST for the management of refractory cancer pain in head and neck and thoracic cancer is recommended.

Lifestyle Intervention Framework for Obese Patients with Non-alcoholic Fatty Liver Disease - a Tool for Health Professionals in Resource Constraint Settings.

Purpose Non-alcoholic fatty liver disease (NAFLD), is recognized as a health care burden worldwide. Lifestyle modification remains the first line of treatment. However, the real challenge is ensuring the patient's adherence to lifestyle modification measures, especially in hospitals with resource-limited settings. Methods We developed a six-month-long, dietitian-led, hospital-based, lifestyle intervention framework for obese NAFLD patients and evaluated its content. Literature review, interviews, and discussions with 10 health experts (general physicians, dietitians/nutritionists, gastroenterologists, and a clinical psychologist) and 45 NAFLD patients (35 in Phase I and 10 in Phase II) in a tertiary hospital of India were carried out. Results The lifestyle intervention framework has unique features, such as an intensive nature to ensure adherence, a comprehensive educational format with clear guidelines, the customization of a prescription as per individual patient requirements, and a holistic approach to inculcate self-monitoring and behavioral change in NAFLD patients. Conclusion Health professionals worldwide can use this lifestyle intervention framework to develop counseling interventions for better adherence among obese NAFLD patients.

Effect of Yoga-Based Intervention in Patients with Inflammatory Bowel Disease.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic illness characterized by gross inflammation in the gastrointestinal tract that can result in symptoms such as abdominal pain, cramping, diarrhea, and bloody stools. IBD is believed to be influenced by psychological factors such as stress and anxiety. Therefore, a yoga intervention that reduces stress and anxiety may be an effective complementary treatment for these disorders. MATERIAL AND METHODS: A total of 100 IBD patients [ulcerative colitis (UC) n = 60 and Crohn's disease (CD) n = 40] during the clinical remission phase of disease were included in the study. These patients were allocated randomly to either the yoga group that underwent an 8-week yoga intervention (physical postures, pranayama, and meditation) 1- hour/day in addition to standard medical therapy (UC, n = 30; CD, n = 20) or the control group (UC, n = 30; CD n = 20), which continued with standard medical therapy alone. The main outcome measures were cardiovascular autonomic functions, serum eosinophilic cationic protein, interleukin- 2 soluble receptors, Speilberger's State Trait Anxiety Inventory (STAI) scores, and clinical symptoms. RESULTS: Before the intervention, all the outcome measures were comparable in the two groups. After the 8-week yoga intervention, fewer UC patients reported arthralgia. The number of patients reporting intestinal colic pain in the control group was higher. State and trait anxiety levels were significantly reduced in patients with UC. However, no significant changes were observed in cardiovascular autonomic functions, eosinophilic cationic proteins, or interleukin-2 soluble receptors. CONCLUSIONS: A simplified yoga-based regimen is a safe and effective complementary clinical treatment modality for patients with inflammatory bowel disease during the clinical remission phase.

Status of iodine nutriture and universal salt iodisation at beneficiaries levels in Kerala State, India.

Iodine deficiency disorders are an important public health problem in India. It is wrongly believed that populations residing in coastal areas do not suffer from iodine deficiency as they consume sea foods which are rich in iodine. A high prevalence of iodine deficiency has been reported in 11 districts of Kerala ranging between 9.3 and 44.5%. In spite of the high prevalence of iodine deficiency, the state government of Kerala has not banned the sale of non-iodised salt in the state. Thus, the present study was conducted to assess the current status of iodine nutriture and level of salt iodisation in Kerala state. The study was conducted in all the 14 districts in the state by utilising the uniform sampling methodology. A total of 2110 salt samples were collected randomly from children. On the spot casual urine samples were collected from 689 children. The results revealed that overall 43.8% of the families in the state were consuming salt with 15ppm and more of iodine. It was found that three districts namely Kasargod, Idukki and Kottayam had median urinary iodine excretion level < 100.0 microg/l and also more than 20% of the samples had urinary iodine excretion levels less than 50 microg/l. The findings of the present study revealed continued iodine deficiency amongst the three districts identified as endemic earlier. This indicates the need of immediate ban on the sale of non-iodised salt for the edible purposes and intensive information, education and communication activities for promotion of consumption of iodised salt.

Thirty years of a ban on the sale of noniodized salt: impact on iodine nutrition in children in Himachal Pradesh, India.

BACKGROUND: A survey conducted by the central iodine-deficiency disorders team in Himachal Pradesh, a state in the goiter-endemic belt of India, revealed that 10 of its 12 districts have an endemic prevalence of goiter. The survey was conducted to provide health program managers data to determine whether it would be necessary to initiate intervention measures. OBJECTIVE: To assess the status of urinary iodine excretion and household salt iodization levels after three decades of a complete ban on the sale of noniodized salt in this goiter-endemic state in India as measured by assessment of urinary iodine excretion levels and iodine content of salt at the household level. METHODS: The guidelines recommended by WHO/ UNICEF/ICCIDD for a rapid assessment of salt iodization were adopted. In each of the 12 studied districts, all senior secondary schools were enlisted and one school was selected by using a random sampling procedure. Two hundred fifty children 11 to 18 years of age were included in the study. Urine samples were collected from a minimum of 170 children and analyzed using the wet digestion method. Salt samples were also collected from a minimum of 170 children and analyzed using the spot testing kit. RESULTS: All districts had a median urinary iodine excretion level > 200 microg/L and 82% of the families were consuming salt with an iodine content of 15 ppm or higher. CONCLUSIONS: The results of the present study high-light the successful implementation of the salt iodization program in the state of Himachal Pradesh. This positive impact may be due to the comprehensive strategy adopted by the state government to improve the quality of salt, development of an effective monitoring information system and effective information, education, and communication activities.

Association between breast cancer and vitamin C, vitamin E and selenium levels: results of a case-control study in India.

In women, cancer of the breast is generally the most prevalent neoplasm and cause of cancer death. Though a large number of women are affected with breast cancer, very few studies have been undertaken in India on the association between micronutrients and the risk of breast cancer. We conducted a hospital based case- control study to examine the associations of vitamin C, vitamin E and selenium with breast cancer. One hundred and sixty breast cancer patients and an equal number of normal healthy individuals constituted the study population. Venous blood was collected from the cases and controls for estimation of vitamin C, vitamin E and selenium utilizing standard procedures. Univariate logistic regression analysis was carried out to calculate odds ratios and confidence intervals. The mean vitamin C, vitamin E and selenium levels were lower in patients as compared to the controls. There was a 84% and 77% lower risk of breast cancer if the levels of vitamin C and vitamin E were increased by 1 unit, respectively. Similarly, there was a 7% lower risk of breast cancer if the level of selenium was increased by 1 unit. The results of the present study thus indicated a strong association of vitamin C, vitamin E and selenium with breast cancer in the Indian population.

Status of iodine deficiency amongst school children in twenty four districts in southern India.

The central legislation banning sale of non-iodized salt for edible purposes in the entire country was withdrawn by the Government in the year 2000. The present study was conducted in the year 2001 immediately after lifting the central ban to establish the baseline urinary iodine excretion levels in twenty four districts of Southern India. In each district all the senior secondary schools were enlisted and one school was selected by random sampling. About 120 children in the age group of 11 to 18 years were selected using the random number tables. The urinary iodine excretion levels were analysed using the wet digestion method. It was found that districts Rangareddy, Kolar, Yanam and Perambalour had median UIE levels less than 100 microg/l, indicating iodine deficiency. The findings of the present study highlights the success of Universal salt iodisation programme. The Government of India should reinitiate the process of central ban on sale of non iodised salt in the country to prevent the iodine deficiency disorders.

Prevalence of multiple micronutrient deficiencies amongst pregnant women in a rural area of Haryana.

UNLABELLED: Deficiencies of micronutrients (zinc, iron, folic acid and iodine) during pregnancy are known causes of Low Birth Weight (LBW). Studies have documented status of one or two micronutrients amongst pregnant women (PW). However, no attempt has been made to concurrently assess the prevalence of multiple micronutrient deficiencies and the factors associated with them amongst PW. OBJECTIVE: The present study was undertaken to assess the prevalence of multiple micronutrient deficiencies amongst PW in a rural area. METHODS: A community based cross sectional survey was conducted in six villages of a rural area of district Faridabad in Haryana state, India during November 2000 and October 2001. All PW aged 18 years or more, with pregnancy duration of more than 28 weeks were enrolled. Data were collected on socio-economic status and other demographic parameters. Serum zinc, copper and magnesium levels were estimated by utilizing the Atomic absorption spectrophotometry (AAS); serum ferritin and folate was estimated by Enzyme Linked Immuno Sorbent Assay (ELISA) method and the Radio-Immuno Assay (RIA) method, respectively and serum thyroid stimulating hormone (TSH) level was estimated by the Abbot AxSYM System. Serum zinc, copper, magnesium, ferritin, and folate levels less than 70.0 microg/dl, 80.0 microg/dl, 1.80 mg/dl, 15 ng/ml, and 3 ng/ml, respectively were considered as indicative of deficiency for respective micronutrients. The TSH levels of 4.670 and more indicated iodine deficiency status. Dietary intake of micronutrients was assessed utilizing 1-day 24-hour dietary recall methodology. Food consumption pattern was assessed utilizing the food frequency questionnaire methodology. RESULTS: Nearly 73.5, 2.7, 43.6, 73.4, 26.3, and 6.4 percent PW were deficient in zinc, copper, magnesium, iron, folic acid and iodine, respectively. The highest concurrent prevalence of two, three, four and five micronutrient deficiency was of zinc and iron (54.9%); zinc, magnesium and iron (25.6%); zinc, magnesium, iron and folic acid (9.3%) and zinc, magnesium, iron, folic acid and iodine (0.8%), respectively. No pregnant woman was found to have concomitant deficiencies of all the six micronutrients. Dietary intake data revealed an inadequate nutrient intake. Over 19% PW were consuming less than 50% of the recommended calories. Similarly, 99, 86.2, 75.4, 23.6, 3.9 percent of the PW were consuming less than 50% of the recommended folic acid, zinc, iron, copper, and magnesium. The consumption of food groups rich in micronutrients (pulses, vegetables, fruits, nuts and oil seeds, animal foods) was infrequent. Univariate and Multivariate logistic regression analysis revealed that low dietary intake of nutrients, low frequency of consumption of food groups rich in micronutrients and increased reproductive cycles with short interpregnancy intervals were important factors leading to micronutrient deficiencies. CONCLUSION: There was a high prevalence of micronutrient deficiencies amongst the PW of the area, possibly due to the poor dietary intake of food and low frequency of consumption of food groups rich in micronutrients. The concurrent prevalence of two, three, four and five micronutrient deficiencies were common.

Profile of iodine content of salt and urinary iodine excretion levels in selected districts of Tamil Nadu.

OBJECTIVE: Iodine deficiency disorders (IDD) is the most common cause of preventable mental retardation in world today. Out of 29 districts in Tamil Nadu, 24 have been surveyed and all have been found to be endemic to IDD. There is a complete ban on the sale of non iodised salt in the state since 1995. The present study was conducted to assess the iodine content of salt and urinary iodine excretion levels amongst the beneficiaries in the state to help the government to strengthen the existing Universal salt iodisation (USI) programme activities. METHODS: The study was undertaken in 24 districts of Tamil Nadu during the year 2001. The guidelines recommended by WHO/UNICEF/ICCIDD for a rapid assessment of salt iodisation in a district was adopted. A minimum of 150 salt samples were collected from each district by utilising the uniform sampling methodology. The iodine content of salt samples was analysed using the standard iodometric titration method. At least 60 children from each school were randomly selected and were requested to provide "on the spot" casual urine samples. The urinary iodine excretion (UIE) levels were analysed using the wet digestion method. RESULTS: It was observed that 62.3% of the families were consuming iodised salt with more than 5 ppm of iodine. It was found that district Perambalour had deficient iodine nutriture as revealed by the median UIE levels less than 100 micro g/l. CONCLUSION: The findings of the present study reveals the success of USI programme and highlights need for continued monitoring of the quality of salt provided to the population in order to achieve the goal of IDD elimination.