Impact of a Psychodermatological Education Package on the Subjective Distress, Family Burden, and Quality of Life among the Primary Caregivers of Children Affected with Epidermolysis Bullosa.

BACKGROUND: Epidermolysis bullosa (EB) has profound effect on the subjective distress, family burden, and quality of life (QOL) of the primary caregivers (PCG). Knowledgeable PCG can efficiently manage children with these skin diseases and also improve their QOL. OBJECTIVES: To assess the subjective distress, family burden, and QOL, to develop and assess the short-term effectiveness of a psycho-dermatological education package (PDEP) for the PCG of children with EB. METHODS: In this interventional study, 30 PCG of EB were assessed for subjective distress, family burden, and QOL. PDEP, a structured educational tool explaining the disease and its care and stress management, was developed by the authors for the PCG and administered to them after one month of enrolment. They were reassessed after three months and compared with the baseline assessment scores. For comparison, 37 PCG of CI were also studied. RESULTS: The mean age (years) of the subjects was 28.7 ± 6.7 for EB and 30.5 ± 4.6 for CI. The mean or median (range) baseline scores for subjective distress, family burden and QOL of PCG (n = 20) of EB were 8.4 ± 7.9, 6.5 (0-30); 28.5 ± 17.5, 24 (7-77) and 12.6 ± 6.7, 11.5 (4-28) and for PCG (n = 14) of CI were 12 ± 4.3, 38.9 ± 16.2 and 17.7 ± 3.6 respectively. The PDEP improved the QOL (p = 0.01), knowledge (p < 0.01) and practices (p < 0.001) for PCG of EB and it improved subjective distress (p < 0.001), QOL (p < 0.01) and knowledge (p < 0.01) for PCG of CI. CONCLUSIONS: PDEP is an effective educational tool in improving the QOL and knowledge of PCG, which in turn provides efficient management and psychological support to children affected with EB and CI. It should, therefore, be routinely used for educating the PCG of children with EB and CI.

Mental health effects of domestic violence against women in Delhi: A community-based study.

BACKGROUND: Domestic violence (DV) against women is an all-pervasive phenomenon considered to have serious health consequences for women. This study aimed to assess the association of DV against women with their mental health status. MATERIALS AND METHODS: This community-based, cross-sectional study was carried out among 827 ever married women from Delhi selected through cluster sampling followed by systematic random sampling. Data were collected using structured and in-depth questionnaires. Mental health status was estimated using self-reporting questionnaire 20. RESULTS: The prevalence of psychological, physical, sexual, physical, or sexual violence and any form of violence was very high. A quarter of the women (25.3%) reported unhealthy mental status (>8 score) in the past 4 weeks. Women who had experienced DV showed poor mental health status and more suicidal tendencies when compared with women who had not experienced violence. CONCLUSION: DV has significant effect on women's mental health underscoring the need to develop public health interventions.

A Randomized Controlled Trial of 2 Inhalation Methods When Using a Pressurized Metered Dose Inhaler With Valved Holding Chamber.

BACKGROUND: Information on the comparative efficacy of single deep breathing versus tidal breathing for inhaled asthma medications is limited, although such information can be of much use for the treatment of patients suffering from asthma. The objective of the present study was to compare the relative difference in improvement in peak expiratory flow (PEF) with single maximal inhalation with breath-holding versus 5 tidal breaths during inhalation of salbutamol from a pressurized metered dose inhaler (pMDI) with valved holding chamber (VHC) in children 5-15 y of age with asthma. METHODS: The randomized controlled trial was carried out on children with asthma between 5 and 15 y of age using a pMDI with a VHC either by a single deep breath with breath-hold or 5 tidal breaths. The experimental group received 200 µg of salbutamol from the pMDI with VHC with a single maximal inhalation and breath-hold technique, whereas the control group received 200 µg of salbutamol from pMDI with VHC using the 5 tidal breaths technique. The outcome variable, PEF, was reassessed 30 min after salbutamol use. RESULTS: Eighty-two subjects (mean age 8.79 ± 2.5 y, 65 boys and 17 girls) were analyzed. There was significant improvement in the PEF, from baseline (pre-intervention) to post-intervention within the single maximal inhalation with breath-hold group and tidal breathing group independently (P < .001). The mean difference in improvement in PEF between the single maximal inhalation with a breath-hold and 5 tidal breaths group was 30.0 ± 18.16 and 28.29 ± 13.94 L/min, respectively, and was not statistically significant (P = .88). CONCLUSIONS: Single maximal inhalation with a breath-hold technique is not superior to tidal breathing for improvement in PEF following salbutamol inhalation. Either method may be used in children between 5 and 15 y of age. (India's Clinical Trials Registry CTRI/2013/04/003559.).

Determinants of Health Care Services Utilisation for Childhood illness in a selected village of Jhajjar, Haryana - A Survey.

This quantitative community-based study identifies-households, primary caregivers (PCGs), child, demographic factors and health care services characteristics and the pattern of health care services utilisationfor childhood illnesses. A cross-sectional household sur- vey was conducted in a ,selected village of Jhajjar district of Haryana from June 2011 to June 2012, in which 1265 households were contacted. Total 340 primary care givers of children suffering from illness currently or during last 2 weeks .were- interviewed using a semi-structured interview schedule. One way ANOVA and the chi-square test were used to determine the association with selected variables (p<0.05, CI 95%). Major- ity of primary care givers were mothers 269 (79.1%), in the age group of 25- 35 years (149, 43.8%) with mean age 28.2 ? 9.9 years (15-70). Majority of sick children 328 (96.4%) were between 2 months to 5 years, male (206, 60.6%). Majority of sick children suffered from cold and cough (218, 64.1%) During the current illness majority of PCGS 205 (60.3%) had been to the private health care facility to seek the treatment. Signft- cant relationship- was found between the private health care facility utilisation and the selected variables. All primary care givers despite low socio economic status, health care services from private sector due to availability and accessibility of health care profes- sionals even in the evening and night time, quick relief and good individual attention by them without loss of wages.

Predictors of breastfeeding problems in the first postnatal week and its effect on exclusive breastfeeding rate at six months: experience in a tertiary care centre in Northern India.

In spite of the countless benefits of breastfeeding, prevalence of exclusive breastfeeding (EBF) has been far from optimal in the developing world. Breastfeeding problems at or after 4 weeks has been reported as one among the constraints to EBF. The study aimed to determine the breastfeeding problems in the 1 st postnatal week, their predictors and impact on EBF rate at 6 months. Under a prospective cohort design, 400 mother-newborn dyads were assessed for breastfeeding problems before discharge and at 60 ± 12 h of discharge. Nearly 89% of the mother-newborn dyads had one or more BF problems before discharge. Major concern was difficulty in positioning and attaching the infant to the breast (88.5%), followed by breast and nipple problems (30.3%). BF problems continued to persist even after discharge in a significant proportion of the mothers (72.5%). The only independent predictor of BF problems in the 1 st week was the caesarean section (odds ratio: 1.9, 95% confidence interval: 1.3-3.2, P < 0.05). There was a marked improvement in the EBF status (69.5%) at 6 months, and BF problems did not predict EBF failure at 6 months.

Neonatal nursing: an unmet challenge in India.

Nurses comprise a key component to maternal and newborn health care delivery, including the care of 'at-risk' or sick newborns. However, the efficiency and effectiveness of services rely heavily on adequate numbers of highly skilled neonatal nurses. Currently, in India, a significant shortage of trained nurses in the field of newborn care is contributing to poor neonatal outcomes. Specifically, nurses caring for newborns lack the competency and experience needed to ensure optimal care. This deficiency has been linked to a lack of expert faculty, standardized training and minimal or no exposures to newborn clinical care areas during pre service education. Moreover, in addition to a lack of operational research in the area, nurses who provide care for newborns are often faced with numerous system related issues that impede their ability to provide optimal care. Most notably, frequent changes of work place, poor wages, and lack of continuing education, skill maintenance, recognition, and collaborative team culture further compromise the nursing care. All these lead to poor motivation and competency. To meet this challenge, it is essential that emphasis be placed on the identification and support of nursing faculty with expertise in newborn and neonatal care who are able to ensure that nurses receive standardized education for pre-service, in-service and ongoing care. In addition, importance should be placed on encouraging newborn nursing research as well as on governmental increases in salary compensation. Lastly, given the shortage of physicians to take care of sick neonates in remote areas, the creation of a cadre of Neonatal nurse practitioner/ advanced practice nurses would be an invaluable solution in developing countries. Furthermore, centralized oversight of newborn education and training would be best served, if responsibility was placed with Reproductive maternal newborn child health (RMNCH) workers and district level officers.

Coping strategies adopted by nurses experiencing domestic violence by their marital partners.

This facility-based study was conducted at a tertiary care hospital in New Delhi. Thirty nurses identified to be exposed to physical or sexual violence ever in life through a pilot study were purposively selected for further studying their coping strategies. The pilot study was initially conducted among 60 ever married female nurses sampled conveniently. Data was collected using self-administered standardised questionnaire adapted from WHO multi-country study on women's health and domestic violence. To estimate coping strategies, Section 9 of the data were analysed using SPSS 12 software. Eleven respondents (36.3%) experiencing physical or sexual violence, informed friends and close relatives about husband's violent behaviour while 40 percent talked to no one. Only 5 (16.7%) nurses sought help from formal agencies. Reasons for not seeking help mainly were considering violence as normal/not serious (20%), fear that he would end relationship (20%), fear of consequences (16.7%). Nurses mainly sought help on being encouraged by friends/family (6.7%). The study found that relatively few nurses experiencing domestic violence talk to someone or seek help from formal agencies.

Perception of Indian parents on health-related quality of life of children during maintenance therapy of acute lymphoblastic leukemia: a comparison with siblings and healthy children.

BACKGROUND: Advancements in treatment have improved the prognosis of children with acute lymphoblastic leukemia (ALL). Therefore, there is a need to explore health-related quality of life (HRQOL) in depth, specifically in maintenance therapy, where the available data are minimal. This study was conducted to assess the varied items listed in the domains of HRQOL of Children with ALL during maintenance therapy from a parent's perspective. METHODS: Forty children on the maintenance therapy of ALL, 40 siblings, and 40 healthy children were enrolled, and the HRQOL was assessed by parent proxy reports and child self-reports using PedsQL generic core 4.0 in local language. RESULTS: Parents significantly overrated the HRQOL of ALL patients, their siblings, and healthy children in comparison with child self-report in all domains of health. The HRQOL of children with ALL on maintenance therapy was significantly poorer than siblings and healthy children, but their ability to self-care, household work, attentiveness, and ability to do homework were not affected as per parents' reports. Parents reported that absenteeism because of sickness and hospital visits was more among children with ALL than siblings and healthy children. Children with ALL had emotional problems such as fear, anger, sleeping problems, and worries. In a social health domain, parents reported difficulty in competing among children with ALL. The HRQOL of siblings was as good as healthy children in physical, social, and school health domains as per parents' reports. CONCLUSIONS: In our cohort, parents overrated HRQOL in all groups of children. The study identified the various items in each domain of HRQOL that were affected in children with ALL from parents' perspective; this would guide health care professionals to focus on these specific items so as to improve the overall HRQOL of children with ALL.

Knowledge, attitude and performance of IMNCI trained nursing personnel: an evaluative survey.

OBJECTIVE: A cross-sectional survey of nursing personnel's knowledge, attitude and their consultations with sick children under 5 y of age, at specified levels of health care in terms of IMNCI guidelines, was conducted at six community health centers (CHC) of a selected district of Haryana, India. METHODS: Total enumeration technique was used to assess knowledge and attitude of 183 IMNCI trained nursing personnel towards the training programme using a pretested structured questionnaire. Total 236 consultations of sick children presenting to the facilities made by conveniently selected 65 nursing personnel were also observed. RESULTS: Majority of nursing personnel had good knowledge 94 (51.4 %) and excellent attitude 98 (53.55 %) scores related to IMNCI programme. Nursing personnel performed best in assessing sick children (2 mo-5 y) in areas of fever (89.7 %, CI 96.9-79.7), cough (89.2 %, CI 96.7-81.6), and identifying treatment (89.1 %, CI 96.7-83.7). Their performance in identifying classifications related to diarrhea (74.1 %, CI 84.7-62.8), malnutrition (67.2 %, CI 78.6-59.0), anemia (77.3 %, CI 87.5-70.0), immunization (78.9 % CI 88.8-71.8) and feeding problem (75.9 %, CI 86.3-66.9) was relatively less. Similarly, in assessing young infants (0-2 mo) performance of nursing personnel was best in the areas of possible serious bacterial infection (PSBI) (88.1 %, CI 99.1-87.3), and identifying the treatment (86.7 %, CI 94.9-80.2) and low in dehydration (70.8 %, CI81.8-52.6), feeding problem (50.5 %, CI 62.7-40.9), feeding assessment (50.6 %, CI 62.8-39.8), and immunization (70 %, CI 81.1-61.2). CONCLUSIONS: IMNCI trained nursing personnel have good knowledge and attitude towards child care and their performance can be improved further with drills, exercises and supervised practices.

Comparing the Effectiveness of Webinars and Participatory learning on essential newborn care (ENBC) in the class room in terms of acquisition of knowledge and skills of student nurses: a randomized controlled trial.

A randomized controlled trial was conducted in tertiary level center to compare the effectiveness of Webinars (WL) vs. Participatory learning (PL) on Essential Newborn Care (ENBC) in terms of acquisition of knowledge and skills of pre-service 6th semester student nurses. They were randomized to receive teaching on four topics of ENBC by two facilitators. Gain in knowledge and skill scores in ENBC were measured using validated assessment methods. Baseline characteristics including age, education, marks and hours of internet surfing were comparable between two groups (WL: n = 28, PL: n = 30). Pre-training mean knowledge scores in WL and PL group (mean ± SD) (30.96 ± 5.62 vs. 31.43 ± 4.74 p = 0.42), and skill scores (19.14 ± 3.37 vs. 19.20 ± 3.71 respectively, p = 0.77) were comparable. Training methods resulted in equal gain in knowledge in both groups. Satisfaction scores among the participants were also comparable. Thus, using webinars on ENBC as new technology in class room teaching may be an effective, alternative method to using participatory learning.

Comparison of health-related quality of life of children during maintenance therapy with acute lymphoblastic leukemia versus siblings and healthy children in India.

Data on quality of life (QOL) specifically in maintenance therapy of acute lymphoblastic leukemia (ALL) are minimal. This study was done to assess various items listed in domains of QOL (physical, emotional, social and school health domains) of children with ALL during maintenance therapy, and compare the same with those of their siblings and other healthy children. Forty children on maintenance therapy of ALL, 40 siblings and 40 healthy children were assessed for QOL by child self-report using PedsQL 4.0 Generic Core in the local language. Means were computed and compared for each domain with one-way analysis of variance (ANOVA), wherein higher values reflected better QOL. Overall QOL of children with ALL in maintenance therapy (77.16 ± 10.98) was significantly poorer than that of siblings (93.56 ± 4.41) and healthy children (93.02 ± 3.76) (p < 0.001), but their abilities of self-care, household work, exercise, attentiveness, memory and homework were unaffected. There was significantly higher absenteeism due to sickness and hospital visits, and increased emotional problems (fear, anger, sleeping problems) among children with ALL. In the social health domain, children with ALL reported difficulty in maintaining friendships and competing. QOL of siblings was as good as that of healthy children in physical, social and school health domains, but they had increased emotional problems such as anger and sadness. Healthy children reported significantly higher future worries and bullying than children with ALL and siblings. This study validated that the QOL of children with ALL during maintenance therapy was significantly poorer than that of siblings and healthy children. The study identified various items in each domain of QOL that were affected in these children, and thus would assist in guiding healthcare professionals to focus on these specific items so as to improve their overall QOL.

Study of cardiovascular risk factors among tertiary hospital employees and their families.

BACKGROUND: The aim of the present study was to estimate the prevalence of cardiovascular risk factors among administrative employees working at a tertiary hospital (All India Institute of Medical Sciences, New Delhi) and their families. METHODS AND RESULTS: A cross-sectional survey was conducted among a total of 453 individuals aged 30 years and above. The mean age of the study group was 43.3 ± 9.5 years. There was a high prevalence of major cardiovascular risk factors - current smoking 58 (12.8%), tobacco consumption 26 (5.7%), family history of coronary artery disease 79 (17.4%), diabetes mellitus 25 (5.8%), hypertension 94 (20.7%), hypercholesterolemia 110 (25.7%), hypertriglyceridemia 148 (34.5%), physical inactivity 180 (39.7%), body mass index ≥23 kg/m(2) 350 (77.3%), central obesity 201 (80.1%) of males and 163 (80.7%) of females, inadequate fruit and vegetable consumption 387 (85.4%), heavy drinking 12 (2.6%), and stress 58 (12.7%). CONCLUSION: This indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention programme at workplace and community level.

Skeletal muscle strength in young Asian Indian females after vitamin D and calcium supplementation: a double-blind randomized controlled clinical trial.

CONTEXT: Randomized control trials (RCT) of the effect of vitamin D/calcium supplementation on skeletal muscle strength have not shown promising effect in the elderly. OBJECTIVE: Our objective was to assess the effect of vitamin D and/or calcium on muscle strength in young adults with vitamin D deficiency. DESIGN AND SETTING: We conducted a RCT using a factorial design at a tertiary-care center from September 2010 to April 2011. SUBJECTS: A total of 173 healthy females with mean age, body mass index, and 25-hydroxyvitamin D [25(OH)D] of 21.7 ± 4.4 yr, 20.8 ± 2.96 kg/m(2), and 9.3 ± 3.37 ng/ml, respectively, were block randomized to 1) double placebo, 2) calcium/placebo, 3) cholecalciferol/placebo, and 4) cholecalciferol/calcium for 6 months. Cholecalciferol was given at 60,000 IU/wk for 8 wk followed by 60,000 IU/fortnight. Elemental calcium was given in doses of 500 mg twice per day for 6 months. METHODS: Assessment included hand grip (primary outcome) and pinch grip strength, distance walked in 6 min, dyspnea score, quality of life by Short Form (36) Health Survey (SP-36), serum 25(OH)D, 1,25-dihydroxyvitamin D, and intact PTH. RESULTS: The serum 25(OH)D increased significantly to 29.9 ± 8.35 and 27.0 ± 9.54 ng/ml in two groups on cholecalciferol. The mean hand grip strength (19.4 ± 3.92, 21.1 ± 3.31, 20.6 ± 3.92, and 20.1 ± 4.00 kg) and its increase from baseline (0.3 ± 2.25, 0.3 ± 2.64, -0.3 ± 2.41, and 0.6 ± 2.30 kg) were comparable in four groups at 6 months. Quality of life, urinary calcium/creatinine ratio, and adverse effects were also comparable in groups. CONCLUSION: Oral cholecalciferol/calcium supplementation in the dose/schedule used is effective and safe in increasing and maintaining serum 25(OH)D. However, this does not lead to improved skeletal muscle strength in young females.

Domestic Violence against Nurses by their Marital Partners: A Facility-based Study at a Tertiary Care Hospital.

BACKGROUND: In recent times, domestic violence against women by marital partners has emerged as an important public health problem. OBJECTIVES: 1. To determine the prevalence, characteristics and impact of domestic violence against nurses by their marital partners, in Delhi, India. 2. To identify nurses' perceptions regarding acceptable behavior for men and women. MATERIALS AND METHODS: A facility-based pilot study was conducted at All India Institute of Medical Sciences (AIIMS), New Delhi. Data were collected using self-administered standardized questionnaire, among 60 ever married female nurses working at AIIMS hospital, selected by convenience sampling. The principal outcome variables were controlling behavior, emotional, physical and sexual violence by marital partners. Data were analyzed using SPSS 12 software. The test applied was Fisher's exact test and 1-sided Fisher's exact test. RESULTS: Sixty percent of nurses reported marital partner perpetrated controlling behavior, 65% reported emotional violence, 43.3% reported physical violence and 30% reported sexual violence. About 3/5(th) of nurses (58%) opined that no reason justified violence, except wife infidelity (31.67%). Of the physically or sexually abused respondents, 40% were ever injured, and 56.7% reported that violence affected their physical and mental health. CONCLUSION: There is a high magnitude of domestic violence against nurses and this is reported to have affected their physical and mental health.

Study of cardiovascular risk factors among tertiary hospital employees and their families.

BACKGROUND: Cardiovascular diseases have become the leading cause of mortality and morbidity in most countries of the world. The aim of the present study was to estimate the prevalence of cardiovascular risk factors among administrative employees working at a tertiary hospital (All India Institute of Medical Sciences, New Delhi) and their families. METHODS AND RESULTS: A cross-sectional survey was conducted among a total of 453 individuals aged 30 years and above (N1 = 453 for the questionnaire, anthropometric and clinical parameters; N2 = 429 for biochemical investigations). Evaluation for cardiovascular risk factors, anthropometric measurements, blood pressure, fasting blood glucose and serum lipids were performed using standard definitions. The mean age of the study group was 43.3 +/- 9.5 years. There was a high prevalence of major cardiovascular risk factors--current smoking in 58 (12.8%), tobacco consumption in 26 (5.7%), family history of coronary artery disease 79 (17.4%), diabetes mellitus in 25 (5.8%), hypertension in 94 (20.7%), hyperlipidemia--hypercholesterolemia in 110 (25.7%) & hypertriglyceridemia in 148 (34.5%), physical inactivity in 180 (39.7%), body mass index e" 23 kg/m2 in 350 (77.3%), central obesity i.e. waist circumference > 90 cm for males and > 80 cm for females -in 201 (80.1%) of males and 163 (80.7%) of females, inadequate fruit and vegetable consumption in 387 (85.4%), heavy drinking in 12 (2.6%), and stress in 58 (12.7%). CONCLUSION: The study demonstrated an overall high prevalence of cardiovascular risk factors even amongst employees at a tertiary hospital and their families. This indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention programme at workplace and community level.

Quality of life and psychosocial functioning of HIV infected children.

OBJECTIVE: To assess the quality of life (QOL) and the psychosocial problems of HIV infected children. METHODS: The present study was a comparative, cross-sectional survey conducted in the clinic of a tertiary care hospital in north India from July-December 2007. Children suffering from cystic fibrosis (CF) were chosen as a comparison group. Children (3) 6 yr of age with HIV infection or Cystic Fibrosis, with no acute illness at the time of survey were included in the study. Quality of life of the enrolled children was assessed by using the Pediatric Quality of Life Inventory (PedsQL). Pediatric Symptom Checklist (PSC) was used for assessing the psychosocial problems in the enrolled children. RESULTS: Forty one HIV infected and 30 children with cystic fibrosis were enrolled. According to child self -report in the PedsQL 4.0, the difference of perceived physical health status between the two study groups was statistically significant (p=0.04), with HIV infected children demonstrating a better QOL in this domain. A significantly greater number of children with cystic fibrosis (8/30 or 26.67%) suffered from psychosocial problems as compared to HIV children (3/41 or 7.32%) [p=0.026]. CONCLUSIONS: The quality of life and psychosocial functioning is reasonably good in children with HIV infection. Thus, we should strive to maintain and optimize the overall quality of life of these children so that they can have a productive and meaningful future.

Cabbage leaves vs hot and cold compresses in the treatment of breast engorgement.

This study was conducted to evaluate the effect of cold cabbage leaves and alternate hot and cold compresses in decreasing breast engorgement and pain in post-natal mothers admitted in AIIMS, New Delhi.

Knowledge, attitude and practices among health care professionals regarding pain.

OBJECTIVE: To assess the knowledge, attitude and practices among health care professionals regarding pain in children. METHODS: This was a prospective descriptive survey conducted at a tertiary care hospital in north India. A semi structured questionnaire regarding pain in children was administered to pediatric residents and nurses in a teaching hospital. The questionnaire consisted of 24 items, of which 18 items were rated on a 5-point scale ('strongly agree' to 'strongly disagree') and 6 items were open-ended questions. RESULTS: The response rate was 89.5%. Of 77 participants, 47 (61.1%) were nurses and 30 (38.9%) were pediatric residents. The knowledge about pain scales among the studied healthcare professionals was not widespread. Majority of respondents believed that the best judge of intensity of pain is the child. Nearly two-thirds of the respondents felt that non-pharmacological measures were better to control pain and also their practices showed that most were willing to allow the parental presence during minor invasive procedures. CONCLUSION: There is need to improve the knowledge of health care personnel regarding pain assessment and management in children.