Practice of complementary and alternative medicine use in North Indian children with type 1 diabetes: an exploratory study.

Purpose: Intermittent or concurrent use of Complementary and Alternative medicines (CAM) with insulin may have adverse effects in children with Type 1 Diabetes (T1DM). This study explores the practices of CAM use in children with T1DM. Methods: An exploratory study was conducted among parents of children with T1DM attending a tertiary-level diabetes clinic. Data were collected using a structured pre-tested questionnaire. Results: Two-hundred parents were invited; 183 (91.5%) completed the study. The mean age of the children was lower among CAM users than others (7.9 ± 4.3 vs 9.3 ± 4.3 years, p 0.032). The two groups were similar in gender, family income, parental education, and age at diagnosis. Sixty-seven (36.6%) had used CAM. The parents' reasoning for CAM use was to cure diabetes (62.7%), to improve glycemic control (28.3%), or considering it harmless (17.9%). The most commonly used CAMs were Ayurveda (32.8%) and homeopathic preparations (31.3%). The time interval between diagnosis and CAM use ranged from 1 day to 4 years. The duration of CAM use varied widely; 50.7% used CAM for < 1 month. Only 10 CAM users had HbA1C estimated during CAM use; their mean HbA1C was 12.4 ± 3.6%. Twenty-seven CAM users (40.2%) reported poorer glycemic control; 26.8% had no effect, and the rest had undefined effects due to too short duration of use. Conclusion: CAM, mostly herbal, is frequently used among children with T1DM in North India and has detrimental effects on glycemic control. This information should be used during diabetes education to avoid medical emergencies related to sub-optimal insulin dosing. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-023-00663-9.

Caregivers' knowledge and medication adherence in children with thyroid disorders: an exploratory study.

OBJECTIVES: Many thyroid disorders in children demand long-term therapy. The parent's understanding of the child's condition is of utmost importance for adherence to treatment. The study objective was to assess the knowledge, medication adherence, reasons for non-adherence, and their relationship with various clinical parameters. METHODS: An exploratory, cross-sectional study with a total enumeration sampling technique was conducted between July 2022 and September 2022. Children and young adults aged ≤18 years who were diagnosed with a thyroid disorder and taking medications for at least 3 months were included. Data were collected by interviewing parents using the Adherence to Refills and Medications Scale (ARMS) and structured knowledge questionnaire. RESULTS: Parents of 102 children were interviewed. The mean age of the children was 9.2 ± 0.4 years; 58 (57 %) were girls. The mean duration of treatment was 5.5 ± 0.3 years. Many (66 %) informants were mothers. Three-fourths (75.5 %) of parents were educated up to senior secondary and above. Most (91.2 %) of parents had poor knowledge about the disease and its management. Poor disease knowledge was significantly linked to lower education (p<0.001). Nonetheless, strong adherence (>80 %) was noted on the ARMS scale. No significant correlation was found between physical growth, thyroid function, and adherence/knowledge (p-values 0.20-0.71). CONCLUSIONS: The caregivers' knowledge of thyroid disorders was poor and related to their educational level. There is a need to use clear language and ensure that parents have an adequate understanding of their child's condition. Healthcare professionals should assess and address gaps in parental knowledge and adherence.

Socio-Ecological determinants of myopia in rural school students in North India: Results from a nurse-led program.

Socio-ecological determinants of high myopia incidence among school students largely remain unexplored, especially in developing countries. A cross-sectional study was conducted in rural schools in North India to assess the relationship between these determinants and myopia among adolescent students. A public health nurse used a pre-tested questionnaire (demographics, family ocular status, and screen time) and Snellen's chart for testing visual acuity, and referred suspected cases for cycloplegic refraction assessment. Among the total of 955 students, the median (range) age was 14 (13-15) years. The prevalence of myopia was 5.03% (95% confidence interval [CI]: 4.99-5.07). Myopia was found to be associated with computer usage at school (P = 0.058), malnutrition (P = 0.001), and familial myopia (P = 0.079) in the bivariate analysis. Significant predictors of myopia in the regression model were females (odd ratio [OR]: 6.29; 95% CI: 2.69-14.72), higher maternal age (OR: 1.09; 95% CI: 1-1.17), and reading distance <20 cm (OR: 1.98; 95% CI: 1.01-3.87).

Evaluation of a nurse-led counselling intervention on selected outcome variables for parents of children with congenital adrenal hyperplasia.

OBJECTIVES: Long-term care of children with congenital adrenal hyperplasia (CAH) has psycho-social implications for parents. Experts recommend a customized educational program for parents to facilitate their psychological adaptation and improve disease management. Such educational programs often provided by nurse counsellors are well evaluated in developed countries. There is a dearth of data on nurse-led counselling in the context of less developed countries. We aimed to evaluate the effect of a nurse-led counselling intervention on various psycho-social outcomes among parents of children with CAH. METHODS: Fifty consecutive parents of children with CAH attending an outpatient clinic at a tertiary-care teaching hospital were enrolled. Parents' stress level, stigma, knowledge, practices, and treatment adherence were assessed by using Cohen's Perceived Stress Scale (PSS), DSD Stigma scale, and HILL-Bon Medication Adherence Scale (HB-MAS). Three educational counselling sessions were conducted within a month's gap, using PowerPoint presentations and a booklet. Assessment of outcomes was done at baseline and at the end of the third session. RESULTS: At baseline, the majority (90%) of the parents had moderate stress. Half of the parents had mild and the rest had moderate stigma. After the intervention, the majority (94%) of parents had shifted to mild levels of stress and stigma. At baseline, 86% of the parents had poor knowledge about the disease whereas post-intervention, 80% were having good knowledge. Disease management practices and treatment adherence also improved after the intervention. CONCLUSIONS: Nurse-led counselling was effective in reducing psycho-social problems, increasing knowledge, as well as improving practices and treatment adherence.

Stem cell therapy for type 1 diabetes: a scientometric assessment of global research during the twenty-first century.

Purpose: We aimed to provide a scientometric assessment of global research in stem cell therapy (SCT) for type 1 diabetes (T1D) during 1999-2020. Methods: The published data on SCT in T1D were retrieved from Elsevier's Scopus database and analyzed using select bibliometric tools. We used VOSviewer software and the Biblioshiny app to construct and visualize bibliometric networks. Results: The global yield totaled 1806 publications in the 22-year study period, registering a 17.7% annual growth peaking at 196.9% in the last 11 years. The average citations per publication (CPP) decreased from 62.0 during 1999-2009 to 24.3 during 2010-2020. The funded publications were 727 (40.2%). Randomized controlled trials (RCTs) were only 2.4% (45). Amongst 70 participating countries, the USA led with a 38.6% share. Of the 388 global organizations, Harvard Medical School, USA, San Raffaele Scientific Institute, Italy, and the University of Florida, USA were the topmost contributors. Florina, Couri, and Trucco were the top productive authors, whereas Melton, Abdi, and Simoes were the most impactful. Only 129 (3.1%) publications were highly-cited; their total and average CPP were 31,228 and 214.0 (range 101-1841), respectively. Conclusions: The quantity of research in SCT for T1D has increased during the last two decades while the quality has dipped. The research landscape is dominated by high-income North-American and Western-European countries. There is a need for conducting large-scale RCTs and promoting research collaborations between high- and low-income countries for long-term sustainability and global impact.

Effect of Reuse of Insulin Needle on Glycaemic Control and Related Complications in Children with Type 1 Diabetes Mellitus: A Prospective Observational Study.

Background: Children with type 1 diabetes (T1D) take multiple subcutaneous injections of insulin daily to survive. It is controversial whether the insulin needles can be reused safely or not. This study assesses the effect of the reuse versus single-use of insulin needle on glycaemic control and injection-related complications. Methods: Nearly 121 children (<15 years) with T1D were prospectively observed for existing practice of needle reuse for first 3 months and then were asked to practice single-use for the next 3 months. Results: It was found that 78% participants were reusing needles more than three times. After 3 months of needle reuse, 91.3% patients had lipodystrophy. Frequency of reuse positively correlated with local redness, bleeding and leakage of insulin. The patients achieving HbA1c ≤7.5% was significantly low among those reusing needles more than four times. After 3 months of single-use, no significant difference was found in mean HbA1c. However, hyperglycaemic episodes, lipodystrophy and local complications reduced significantly. There was a significant reduction in mean HbA1c among those using needles more than six times earlier. Conclusion: Reuse of insulin needles up to six times does not affect the glycaemic control significantly. To achieve target HbA1c (<7.5%) the needle reuse should be restricted to three times only, which can also reduce injection-related local complications.

Perceptions and Perceived Barriers regarding Proning among Nurses of a Tertiary Care Center in India.

Current study was conducted to assess the perception and barriers regarding proning among nurses. 385 nurses were conveniently surveyed using pre-tested tools. 3.9% of nurses "felt like running away" while providing care to the patients in prone position. 93.5% believed that prone position for COVID-19 patients is beneficial in reducing morbidity and that teamwork is required to be effective (96.6%). 93% nurses believed that inadequate staff-patient ratio is a significant barrier for prone positioning. Other barriers were fear of dislodgement of tubings (91.5%), difficulty in providing routine care (87.3%) and inadequate institutional protocol (83.9%). 12.5% were trained regarding proning.

Reporting adverse events of ChAdOx1 nCoV-19 coronavirus vaccine (Recombinant) among the vaccinated healthcare professionals: A cross-sectional survey.

Background & objectives: The safety of the ChAdOx1 nCoV-19 vaccine is a cause of concern for many who have been vaccinated. The people have multiple concerns and fear regarding the adverse events of the vaccine. Thus, this study was undertaken to establish the safety profile of ChAdOx1 nCoV-19 Corona Virus Vaccine (Recombinant) among the healthcare professionals. Methods: This was a descriptive cross-sectional survey. After taking clearance from the institutional ethics committee 1500 healthcare professionals, who had their vaccination in the past two weeks were selected. They were provided with an online survey proforma regarding adverse events following immunization (AEFIs) of COVID-19 vaccine developed using google forms with an informed consent form affixed to it. Results: A total of 1036 individuals participated in the study. The mean and median (inter quartile range) age of the participants was 37.7 ±11.25 and 35 (29-46) yr, respectively. Of these, 52.1 per cent were female, 29.3 per cent were doctors, 33.4 per cent were nurses and 9.5 per cent were paramedical staff. Forty six per cent participants experienced one or more minor AEFIs such as pain, tenderness, redness, etc. at the injection site. Fatigue (31.75%), generalized feeling of unwell (28.57%), muscle pain (23.16%) and fever (21.71%) were the most commonly reported systemic AEFIs followed by headache (20.07%), dizziness (10.03%) and joint pains (15.25%). Most of them experienced these AEFIs within 24 h of the first dose of administration. About 42 per cent of the participants took oral antipyretics/analgesics for managing the AEFIs. Interpretation & conclusions: ChAdOx1 nCoV-19 Corona Virus Vaccine was found to be associated with mild local and systemic AEFIs that were more common after the first dose as compared to the second dose. There adverse events could be dealt with oral over-the-counter medications, with no requirement of hospitalization.

Financial burden for families of children with type 1 diabetes: a cross-sectional survey from North India.

Introduction: Type 1 diabetes (T1D) incurs substantial out-of-pocket expenses (OOPE) on insulin and diabetes-related supplies. The information on OOPE is scarce from low- and middle-income countries. We aimed to estimate annual OOPE for children with T1D attending our diabetes clinic located in North India. Methods: An online survey was conducted among parents of 380 children with T1D (mean age: 10.3 ± 4.6 years). Modified BG Prasad scale was used to estimate the socioeconomic status (SES). Results: The mean duration of T1D was 3.6 ± 2.6 years; 54.9% of children were boys. The median HbA1c (IQR) was 7.9% (5-15%). 51.9% belonged to lower or lower-middle SES. Mean annual spending on glucose monitoring, insulin administration, and laboratory investigations were Indian Rupee (INR) 21,576, INR 28,965, and INR 5069, respectively (total INR 55,185, IQR: 26,575-105,027). The cost of a single visit to the doctor was approximately INR 2889. Thirty children required hospitalization during the last year, which costs INR 27,495 on average. 30.3% had more than 50% of their total family income spent on diabetes care, with a significant negative correlation with their SES (r = - 0.738, p = 0.00). Only 11.6% were receiving financial support from any agency. 36.6% of families had to borrow money; the OOPE exceeded income from all sources in 8.2% of families. Conclusions: There is a high financial burden of T1D care for North Indian children, almost on the verge of losing sustainability. Further studies are warranted to furnish larger OOPE data to guide policy decisions aimed at reducing direct costs to patients.

Diabetes Self-Management Education and Support to Improve Outcomes for Children and Young Adults With Type 1 Diabetes: An Umbrella Review of Systematic Reviews.

PURPOSE: The objectives of this umbrella review were to describe various aspects of diabetes self-management education and support (DSMES)-related interventions and their effect on clinical, behavioral, and psychosocial outcomes among children and young adults with type 1 diabetes (T1DM) and identify gaps in current DSMES-related research. METHODS: An umbrella review of systematic reviews on DSMES interventions was conducted in accordance with the PRISMA 2009 statement. Four international medical databases were searched for eligible review articles published in English in the last 10 years that dealt with children and youths with T1DM and were conducted in accordance with a priori protocol. RESULTS: Out of the 234 citations screened, only 8 systematic reviews representing 166 studies were considered eligible for further analysis. Glycemic management (A1C) is the most common outcome variable (108 studies). Common behavioral and psychosocial outcome variables examined are episodes of hypoglycemia (27 studies) and diabetic ketoacidosis (21 studies) and self-care behavior and generic quality of life (20 studies each). Several gaps in DSMES-related research studies are identified, including uneven geographical distribution of study population, methodological weaknesses in study designs, missing important outcome variables, use of nonstandardized assessment tools, and lack of assessment of the sustainability of effects. CONCLUSION: The effects of DSMES interventions on clinical, behavioral, and psychosocial outcomes are varied. The heterogeneity of implementation and evaluation makes it difficult to draw clear conclusions about elements of DSMES that are most effective. There is a need for long-term assessment of the psychosocial and behavioral outcomes using validated and generalizable instruments.

"Puddles on the Road": Hurdles in the Pathway from Symptoms to Diagnosis and Treatment in Children with Type 1 Diabetes.

INTRODUCTION: This study was conducted to investigate the pathway from first symptoms to initiation of insulin regimen in children with new-onset Type 1 Diabetes Mellitus (T1DM) and explore the reasons behind diabetes ketoacidosis (DKA) at onset among children with T1DM. MATERIALS AND METHODS: An exploratory study was conducted using a pretested questionnaire, among parents of children diagnosed with T1DM within preceding 3 months. RESULTS: Out of the total 105 children, 56.1% were males. The median age was 7 years. The commonest reported symptoms were polydipsia (97.8%), polyuria (75.2%), and nocturia (75.2%). The mean time taken by parents from onset of symptoms to decide to visit the physician (appraisal gap) was 7.85 ± 7.95 days. The help-seeking gap (from decision-making to visiting a physician) was 3.01 ± 8.31 days, diagnostic gap (from first visit to diagnosis) was 4.19 ± 6.72 days, and the treatment gap (from diagnosis to the start of insulin) was 2.12 ± 6.87 days. The DKA at onset (was present in 39 out of 105 children 37.1%) and was higher among children with lower per-capita income (P-0.017), lack of previous experience among parents (P-0.017), longer appraisal (P-0.023), and treatment gap (P-0.009). CONCLUSION: Increasing awareness about the diabetes among children among the public and primary healthcare workers can help prevent DKA at onset.

A high potency multi-strain probiotic improves glycemic control in children with new-onset type 1 diabetes mellitus: A randomized, double-blind, and placebo-controlled pilot study.

BACKGROUND: Studies in animal models and humans with type 1 diabetes mellitus (T1DM) have shown that probiotic supplementation leads to decreased pro-inflammatory cytokines (responsible for damaging ß-cells of the pancreas), improved gut barrier function, and induction of immune tolerance. OBJECTIVE: To study the effect of supplementation of probiotics in children with T1DM on glycemic control, insulin dose, and plasma C-peptide levels. METHODS: A single-centered, double-blinded, and randomized placebo-controlled pilot trial was conducted in children (2-12 years) with new-onset T1DM. Ninety-six children were randomized and allocated to Placebo or Intervention groups. The intervention included high dose (112.5 billion viable lyophilized bacteria per capsule) multi-strain probiotic De Simone formulation (manufactured by Danisco-Dupont) sold as Visbiome® in India. The probiotic was supplemented for 3 months and HbA1c, fasting C-peptide, blood sugar records, and insulin dose was recorded at baseline and 3 months. RESULTS: A total of 90 patients (45 in each group) were analyzed for outcome parameters. We found a significant decrease in HbA1c (5.1 vs. 3.8; p = 0.021) and a significant decline in total and bolus insulin dose (U/kg/day; p = 0.037 and 0.018, respectively) in the intervention group when compared with the placebo group. A significantly higher (p = 0.023) number of children achieved remission in the treatment group. We did not notice adverse effects in either of the study groups. CONCLUSION: Children with newly diagnosed T1DM managed with standard treatment along with probiotics showed better glycemic control and a decrease in insulin requirements; however, more extensive studies are further warranted.

Mental health and environmental factors associated with falls in the elderly in North India: A naturalistic community study.

AIM: To determine the prevalence of falls and to assess its relationship with cognitive deficits, depression, visual impairment and self-reported hearing impairment among the elderly. METHODS: This was a community-based, cross-sectional study conducted in 52 villages in the Naraingarh and Barara block of Ambala district which involved 468 participants. A pretested predesigned questionnaire was used to collect data regarding demographic profile, falls, and physical morbidities. Geriatric Depression Scale-Hindi, Hindi-mini-mental state examination, Snellen chart, Katz- Activity of Daily Living were used to collect data for depression, cognitive decline, vision and activity of daily living respectively. RESULTS: The prevalence of falls was found to be 28.7%. An association was found between falls and slippery floors in the houses, hearing loss, vertigo, hypertension, use of multiple medications, depression and functional disability in univariate analysis. On multivariate regression analysis, slippery floors (OR = 2.28), use of multiple medications (OR = 1.71), hearing loss(OR = 1.83) and presence of depression (OR = 1.62) were found to be independent risk factors with falls. CONCLUSION: There is high prevalence of falls among the elderly and these are commonly related to preventable factors. Appropriate environmental modifications and exercise programs can help reduce the rate of falls as well as injuries related to falls among the elderly.

Effect of Music Therapy on Pain Perception, Anxiety, and Opioid Use During Dressing Change Among Patients With Burns in India: A Quasi-experimental, Cross-over Pilot Study.

The effectiveness of music therapy for relieving pain and anxiety during burn dressing changes has not been reported from India. PURPOSE: This study was conducted to assess the effect of music therapy on pain, anxiety, opioid use, and hemodynamic variables during burn dressing change. METHODS: Patients in a tertiary care burn unit who were >10 years old, conscious, able to respond, and oriented to time, place, and person participated in a 2-month, quasi-experimental, cross-over pilot study. Each served as his/her own control. Dressings were changed every other day alternating between the control (standard pain management) and experimental (control plus patient-selected music) intervention. Pain was assessed using a numerical rating scale, anxiety was scored using the State Trait Anxiety Test (higher scores indicated more pain and anxiety), and hemodynamic parameters and analgesics were recorded. Wilcoxon Test and chi-squared tests were utilized for statistical analysis. RESULTS: Median pain scores (5, interquartile range [IQR] IQR: 3-7; and 6, IQR: 5-8) and median anxiety scores (12, IQR: 8-17; and 14, IQR: 10-19) were significantly lower during the experimental than during the standard dressing change, respectively (P <.001), and opioids were used significantly less frequently during the experimental change (P = .002). CONCLUSION: Music therapy helps reduce anxiety, pain, and opioid use during burn dressing change.

Feasibility of implementing cervical cancer screening program using smartphone imaging as a training aid for nurses in rural India.

BACKGROUND: The Indian national program stresses implementation of cervical cancer screening by health workers/nurses using VIA (Visual Inspection under Acetic acid). We demonstrate its feasibility and reliability in rural setting, assessing the role of smartphone-imaging for continuous training of nurses. DESIGN: A cross-sectional design to assess the reliability of the nurse-led VIA test. To assess feasibility, VIA positive patients were observed till confirmative diagnosis was made. SAMPLE: Hospital-based purposive sampling was used to recruit participants. MEASURES: A structured questionnaire for recording participants' details, VIA findings and follow-up information; and an observational checklist to record implementation parameters during each clinic. An expert assessed the nurse's judgment using smartphone-images of cervix. RESULTS: During October 2016-June 2017, 2758 patients attended the weekly clinic; 238 (8.6%) met the criteria, of those 180 (75.6%) tested after consent. Nurse reported 25 (13.8%) VIA-positive cases, but only 19 accessed the referral service. Kappa statistic: 0.45 (CI: 0.26-0.63) suggested moderate nurse-expert agreement. Image retrieval and quality affected expert's evaluation. Implementation challenges include low awareness among the population and referral link-up. CONCLUSION: Appropriately trained nurses can reliably conduct screening. Real-time expert feedback might improve reporting. Rigorous awareness activities and on-site treatment can reduce drop-outs. The medical institute's involvement and administrative will were instrumental.