Is work-associated stress converted into psychological distress among the staff nurses: A hospital-based study.

INTRODUCTION: "Stress is the subjective feeling produced by events that are uncontrollable." Constant stress brings about changes in the balance of hormones in the body which may lead to thoughts that make us feel frustrated, angry, nervous, anxious, etc., The aims of the study are (1) to find out the level of stress among staff nurses; (2) the association between sociodemographic determinants and working environment and stress; and (3) impact on their mental well-being in terms of somatic symptoms, anxiety/insomnia, social dysfunction, severe depression, and on work productivity. MATERIALS AND METHODS: Institutional-based cross-sectional study; total sample size comprised 100 staff nurses. Data were collected using a two-part questionnaire: Part I: socio demographic variables and working envioronment, Part II: Goldberg and Hillier's 28-item scaled version of the General Health Questionnaire (GHQ-28) used to measure the psychological aspect of quality of life of staff nurses. RESULTS: Hospital nurses reported mild (12%) to moderate/severe (77%) levels of job-related stress. The common stressors were poor attitude of male patients, absence of separate washroom for female nurses, posting in busy departments with increased workload, and inadequate salary. The single most important factor responsible for high levels of stress (70%) among the study subjects was inadequate salary. CONCLUSION: Assessing stress and job satisfaction is not a onetime action; it requires continuous monitoring and evaluation. Therefore, it is important to further explore how work-associated stress affects nurses, and what factors in their working environment cause the greatest burden.

Impact of indian public health standards for rural health care facilities on national programme for control of deafness in India: The results of a cohort study.

INTRODUCTION: In National Programme for Prevention and Control of Deafness (NPPCD), the management of ear diseases of rural India is now guided by Revised Indian Public Health Standards (IPHS) for Rural Health Facilities for providing quality ear care. However, despite the IPHS existence, coverage and quality ear care is questionable. Moreover, this issue has not yet been studied till now in the Indian context. The objective of the study was to assess the role of Private Medical College Training Center (Rural Health Training Centre [RHTC]) in augmenting quality of ear care services in NPPCD at district level by adopting IPHS Standards. MATERIALS AND METHODS: A combined retrospective and prospective cohort study was done at RHTC of a Medical College in West Uttar Pradesh from January 1, 2013, to December 31, 2017, by retrospective approach of selecting all ear patients (n = 3840) and prospective way of assessing the impact of IPHS for ear care. The semi-structured Pro forma was used in exploring the coverage and quality of ear care. The data were analyzed by Epi Info version 7.2. RESULTS: Out of total 4817 ear, nose, and throat (ENT) patients, the majority of ear patients (n = 3840) were initially dissatisfied with coverage and quality of ear services provided by ENT specialists at RHTC. However, when IPHS exposure was given from July 1, 2015 to December 31, 2017, not only majority of patients were satisfied (n = 3110, 81%) but also ear curative treatment was significantly higher (n = 2120, 68.1% vs. n = 130, 17.8%, odds ratio = 9.8, RR = 1.5, P < 0.00001). CONCLUSIONS: Adherence to IPHS in NPPCD is essential for delivering better ear care by RHTC through primary health-care approach.

Predictors and consequences of "Phubbing" among adolescents and youth in India: An impact evaluation study.

BACKGROUND: "Phubbing" phenomenon, in the frequent use of a smartphone, describes the habit of snubbing someone in favor of a mobile phone. Its predictors and consequences are few in developed countries, but the literature lacks information on its actual occurrence and impact on adolescents and youth in a developing country such as India. MATERIALS AND METHODS: This impact evaluation study was carried out as part of the Phubbing Project of the University of Poland for 6 months (November 15, 2016-May 15, 2017) on a sample of 400 adolescents and youth selected randomly from the five colleges in the district of Muzaffarnagar of Uttar Pradesh state in India. Data were collected through the Internet using e-questionnaires sent to all students. The phubbing predictors' and consequences' scales available in literature were used and data were analyzed by a mixed method to get the study findings. RESULTS: The prevalence of phubbing was 49.3%. The most important predictors associated with phubbers were Internet addiction (p < 0.0001, Odds Ratio 2.26), smartphone addiction (OR 25.9), fear of missing out (OR 18.8), and the lack of self-control (p < 0.0001, OR = 0.73-1.72). Phubbing also had significant consequences on their social health, relationship health, and self-flourishing, and was significantly related to depression and distress. Logistic regression analysis showed significant impact of phubbing predictors on phubbing consequences in phubbers, especially in depressed and distress status. CONCLUSION: Adolescents and youth of India need special guidance from government adolescent clinics or colleges or even families to control this habit in order to promote better physical, mental, and social health.

Can the management of blood sugar levels in gestational diabetes mellitus cases be an indicator of maternal and fetal outcomes? The results of a prospective cohort study from India.

BACKGROUND: Gestational diabetes mellitus (GDM) is emerging as an important public health problem in India owing to its increasing prevalence since the last decade. The issue addressed in the study was whether the management of blood sugar levels in GDM cases can predict maternal and fetal outcomes. MATERIALS AND METHODS: A prospective cohort study was done for 1 year from October 1, 2013, to September 31, 2014, at 652 diabetic screening units as a part of the Gestational Diabetes Prevention and Control Project approved by the Indian Government in the district of Kanpur, state of Uttar Pradesh. A total of 57,108 pregnant women were screened during their 24-28(th) weeks of pregnancy by impaired oral glucose test. All types of maternal and perinatal outcomes were followed up in both GDM and non-GDM categories in the 2(nd) year (2013-2014) after blood sugar levels were controlled. RESULTS: It was seen that for all kinds of maternal and fetal outcomes, the differences between GDM cases and non-GDM cases were highly significant (P < 0.0001, relative risk >1 in every case). Moreover, perinatal mortality also increased significantly from 5.7% to 8.9% when blood sugar levels increased from 199 mg/dl and above. Perinatal and maternal outcomes in GDM cases were also significantly related to the control of blood sugar levels (P < 0.0001). CONCLUSION: Blood sugar levels can be an indicator of maternal and perinatal morbidity and mortality in GDM cases, provided unified diagnostic criteria are used by Indian laboratories. However, to get an accurate picture on this issue, all factors need further study.

Tobacco use and its impact on pulmonary health among elderly population in rural area of Muzaffarnagar - A cross-sectional study.

BACKGROUND: The tobacco use is significant in Indian rural population. Among them, elderly people in rural area are at special risk due to ageing and other factors. The impact of tobacco use on elderly health, therefore, needs to be studied in depth in rural context. OBJECTIVE: To study the patterns of tobacco use and its consequent impact on pulmonary health of the elderly. DESIGN AND METHODOLOGY: A community-based cross-sectional study was done (April 1st to September 30th, 2014) in the field practice area (village Bilaspur) of Rural Health Training Centre (RHTC) of Muzaffarnagar Medical College, Muzaffarnagar. A simple random sampling was used and elderly of 60 years and above were interviewed by semi-structured interview schedule. The data were analyzed by software Epi-info. version 7.1.3.3. RESULTS AND CONCLUSION: The prevalence of tobacco usage among elderly was 56.7%, in which smoking was the dominant one (37%) and majority being in the form of Bidi (56.7%). Tobacco usage was significantly associated not only with age, sex, and caste (p<0.05 each), but occupational and socio-economic status (p<0.01 each) also; however, literacy was the most significant factor (p<0.0001) among all. The tobacco usage in smoking form was highly significantly associated with the presence of chronic obstructive pulmonary disease (p<0.0001), elucidating a significant impact on their pulmonary health. The rural elderly people need health education regarding curtailing the use of tobacco for their better health from health clinics.

Effect of practice management softwares among physicians of developing countries with special reference to Indian scenario by Mixed Method Technique.

INTRODUCTION: Currently, many cheaper "practice management software" (PMS) are available in developing countries including India; despite their availability and benefits, its penetration and usage vary from low to moderate level, justifying the importance of this study area. MATERIALS AND METHODS: First preferred reporting items for systematic-review and meta-analysis (2009) guidelines were considered; followed by an extensive systematic-review of available studies in literature related to developing countries, on key search term from main abstracting databases: PubMed, EMBASE, EBSCO, BIO-MED Central, Cochrane Library, world CAT-library till 15 June 2014; where any kind of article whether published or unpublished, in any sort or form or any language indicating the software usage were included. Thereafter, meta-analysis on Indian studies revealing the magnitude of usage in Indian scenario by Open Meta-(analyst) software using binary random effects (REs) model was done. Studies from developed countries were excluded in our study. RESULTS: Of 57 studies included in a systematic review from developing countries, only 4 Indian studies were found eligible for meta-analysis. RE model revealed although not-significant results (total participants = 243,526; range: 100-226,228, overall odds ratio = 2.85, 95% confidence interval = P < 0.05 and tests for heterogeneity: Q [df = 3] = 0.8 Het. P = 0.85). The overall magnitude of usage of PMS on Indian physicians practice was however found between 10% and 45%. CONCLUSION: Although variable and nonsignificant effect of usage of PM software on practice of physicians in developing countries like India was found; there is a need to recognize the hidden potential of this system. Hence, more in-depth research in future needs to be done, in order to find a real impact of this system.

Options for a Health System Researcher to Choose in Meta Review (MR) Approaches-Meta Narrative (MN) and Meta Triangulation (MT).

Two new approaches in systematic reviewing i.e. Meta-narrative review(MNR) (which a health researcher can use for topics which are differently conceptualized and studied by different types of researchers for policy decisions) and Meta-triangulation review(MTR) (done to build theory for studying multifaceted phenomena characterized by expansive and contested research domains) are ready for penetration in an arena of health system research. So critical look at which approach in Meta-review is better i.e. Meta-narrative review or Meta-triangulation review, can give new insights to a health system researcher. A systematic review on 2 key words-"meta-narrative review" and "meta-triangulation review" in health system research, were searched from key search engines, such as Pubmed, Cochrane library, Bio-med Central and Google Scholar etc till 21st March 2014 since last 20 years. Studies from both developed and developing world were included in any form and scope to draw final conclusions. However unpublished data from thesis was not included in systematic review. Meta-narrative review is a type of systematic review which can be used for a wide range of topics and questions involving making judgments and inferences in public health. On the other hand Meta-triangulation review is a three-phased, qualitative meta-analysis process which can be used to explore variations in the assumptions of alternative paradigms, gain insights into these multiple paradigms at one point of time and addresses emerging themes and the resulting theories.

A Comparative Evaluation of Public Health Centers with Private Health Training Centers on Primary Healthcare Parameters in India: a Study by Data Envelopment Analysis Technique.

BACKGROUND: The evaluation of primary healthcare services provided by health training centers of a private medical college has not been studied in comparison with government health facilities in Indian context. Data envelopment analysis (DEA) is one such technique of operations research, which can be used on health facilities for identifying efficient operating practices and strategies for relatively efficient or inefficient health centers by calculating their efficiency scores. MATERIALS AND METHODS: This study was carried out by DEA technique by using basic radial models (constant ratio to scale (CRS)) in linear programming via DEAOS free online Software among four decision making units (DMUs; by comparing efficiency of two private health centers of a private medical college of India with two public health centers) in district Muzaffarnagar of state Uttar Pradesh. The input and output records of all these health facilities (two from private and two from Government); for 6 months duration from 1(st) Jan 2014 to 1(st) July 2014 was taken for deciding their efficiency scores. RESULTS: The efficiency scores of primary healthcare services in presence of doctors (100 vs 30%) and presence of health staff (100 vs 92%) were significantly better from government health facilities as compared to private health facilities (P < 0.0001). CONCLUSIONS: The evaluation of primary healthcare services delivery by DEA technique reveals that the government health facilities group were more efficient in delivery of primary healthcare services as compared to private training health facilities group, which can be further clarified in by more in-depth studies in future.

Assessment of Smartphone Addiction in Indian Adolescents: A Mixed Method Study by Systematic-review and Meta-analysis Approach.

There is a considerable debate on addiction and abuse to Smartphone among adolescents and its consequent impact on their health; not only in a global context, but also specifically in the Indian population; considering that Smartphone's, globally occupy more than 50% of mobile phones market and more precise quantification of the associated problems is important to facilitate understanding in this field. As per PRISMA (2009) guidelines, extensive search of various studies in any form from a global scale to the more narrow Indian context using two key search words: "Smartphone's addiction" and "Indian adolescents" was done using websites of EMBASE, MEDLINE, PubMed, Global Health, Psyc-INFO, Biomed-Central, Web of Science, Cochrane Library, world library - World-Cat, Indian libraries such as National Medical Library of India from 1 January, 1995 to March 31, 2014 first for systematic-review. Finally, meta-analysis on only Indian studies was done using Med-Calc online software capable of doing meta-analysis of proportions. A total of 45 articles were considered in systematic-review from whole world; later on 6 studies out of these 45 related to Smartphone's addiction in India were extracted to perform meta-analysis, in which total 1304 participants (range: 165-335) were enrolled. The smartphone addiction magnitude in India ranged from 39% to 44% as per fixed effects calculated (P < 0.0001). Smartphone addiction among Indian teens can not only damage interpersonal skills, but also it can lead to significant negative health risks and harmful psychological effects on Indian adolescents.

Mobile-health approach: a critical look on its capacity to augment health system of developing countries.

BACKGROUND: The mobile-health approach is currently knocking the doors of public health to make use of this rapidly advancing technology in developing countries; therefore, it needs a critical look on its capacity in improving health system of developing countries. MATERIALS AND METHODS: A systematic review of studies in literature published till 31(st) October 2013 of last 10 years on key search word: Capacity of mobile-health in improving health system of developing countries was done from medical search engines abstracting databases such as Pub-med, WHO, Cochrane database, Google scholar, and Bio-med Central. Both types of studies elucidating utility and no benefit of mobile-health in developing countries were included as main criteria for deciding the capacity of mobile-health approach in health system of developing countries. M-health studies on areas of impact, effectiveness, and evaluation and previous reviews, conferences data, and exploratory studies were the main study designs incorporated. Studies on m-health in developed world, Indian studies as well data from thesis or dissertation were excluded in this review. DISCUSSION: Multi-faceted mobile-health applications, strategies, and approaches currently lack proper regulation and standardization from health care authorities, and currently their results also vary from good to no beneficial effects as found in this review. CONCLUSION: Umbrella of mobile-health approaches must be used intelligently, keeping in mind the fact that, it can provide a greater access and quality health care to larger segments of a rural population and its potential to improve the capacity of health system in developing countries.

Occupational stress among staff nurses: Controlling the risk to health.

INTRODUCTION: Nursing has been identified as an occupation that has high levels of stress. Job stress brought about hazardous impacts not only on nurses' health but also on their abilities to cope with job demands. OBJECTIVES: This study aimed at finding out the degree of work-related stress among the staff nurses and various determinants, which have a impact on it. MATERIALS AND METHODS: Institutional-based cross-sectional study conducted on GNM qualified nurses. Predesigned and pre-tested questionnaire covering their sociodemographic variables in part I and professional life stress scale by David Fontana in part II. Analysis used was Chi-square test and logistic regression for various factors. RESULTS: Risk for professional stress due to poor and satisfactory doctor's attitude was found about 3 and 4 times more than with excellent attitude of doctors toward the staff nurses. A statistically significant association (P < 0.024) between department of posting and level of stress. Nurses reported that they had no time for rest, of whom 42% were suffering from moderate-to-severe stress. The nurses who felt that the job was not tiring were found to be less stressed as those who perceived job as tiring (OR = 0.43). CONCLUSION: The main nurses' occupational stressors were poor doctor's attitude, posting in busy departments (emergency/ICU), inadequate pay, too much work, and so on. Thus, hospital managers should initiate strategies to reduce the amount of occupational stress and should provide more support to the nurses to deal with the stress.