Anuradha Davey

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 doctors 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 doctors 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.

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 31st 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.

Mobile-health technology: can it strengthen and improve public health systems of other developing countries as per Indian strategies? A systematic review of the literature.

Introduction: The use of mobile-health (m-health) technology in public health is rapidly growing in developing countries. Objective: The objective of this study was to critically analyze the role and incorporation of m-health into public health systems of developing countries. Materials and Methods: A systematic review of related studies in the literature published in the last 10 years on key search word m-health role in developing countries was conducted using abstracting databases such as PubMed, World Health Organization, Cochrane, Google scholar and Bio-med Central. m-health studies on impact, effectiveness and evaluation of m-health in public health were the three main criterias taken for inclusion and studies on m-health in developed world as well data from thesis/dissertation were excluded in this review. This study is unique in methodology as similar kind of studies with this type of method and focus has not been carried out previously in the literature. Results and Discussion: From 23 articles, which finally met the inclusion criteria it was found that, a variety of m-health applications and m-health strategies are available in the mobile phone market of developing countries; however, lack of appropriate governmental regulation and oversight from health-care authorities are impacting the results in terms of costs, benefits and utility of these applications. Conclusions: m-health technology has the potential to impact greater health-care access to larger segments of rural populations and an improved capacity to meet the demand in developing countries as seen from Indian strategies, provided it is also intelligently used for improving health-care of people in developing countries.

Role of reorientation training in enhancement of the knowledge regarding growth monitoring activities by anganwadi workers in urban slums of delhi.

Early childhood developments constitute the foundation of the human development. Early years of the life are the most crucial period for the physical, mental, social, emotional, language development and lifelong learning. In a malnourished child, development of the milestones is delayed. Developmental delays are mainly observed in the areas like vision and fine motors, language and comprehension and personal social development. The delay was noticed to the extent of 7-11 months in these areas in different age groups.(1) In urban areas, nutritional status of the slum children is poorer than their counterparts in the rural areas.(2) Two-third of the preschool children in the urban slum are underweight. According to NFHS-2 of Delhi, 35% of children under 3 years of age are underweight and 37% are stunted.(3) Anaemia is the most frequent malnutrition among the children from the slum community.(4) ICDS scheme, in such scenario of health, occupies a significant place as an intervention in the socially and economically disadvantaged class of the society. The effective outcome of the nutrition services rendered through the Anganwadi centers (AWCs) depends on the knowledge of the anganwadi workers (AWWs) regarding growth monitoring (GM). A sound knowledge of the AWWs strengthens their skills and raises their capabilities to identify the children earliest moving towards malnutrition with the help of regular GM so as to take appropriate and early corrective action for further departure from good health. It also helps them as a teaching tool for empowering the mothers for preventive actions and better nutrition care of their children. Therefore, attempt has been made to discuss knowledge of AWWs about GM activities and the influence of reorientation training on their correct knowledge.

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 24–28th 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 2nd 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.

Privatization of medical education in India: A health system dilemma

Background: Privatization of medical education can widen its scope and availability via creation of large no of medical professionals in allopathic system for Indian people, but can it be an alternative to create human resources with appropriate skill mix, especially when services in health system involves lives of the human being needs rethinking on an urgent basis. Objectives: To review the issues related with privatization of medical education system of India. Materials and Methods: A systematic review on key search word: Privatization of medical Education in India was done from main indexed journals of key medical search engines i.e. Pubmed, Cochrane, Bio-med Central, and Google Scholar etc. in all forms including e-journals till 15 th August 2013 since last 20 years. Conclusions: Indian allopathic medical education system is one of the largest in the world. Medical Colleges in India have rapidly progressed in last 25 years, especially in private set ups; there is no doubt that they can help Indian health care system, but the need of hour is, to critically look at the quality of students opting M.B.B.S course, quality of medical faculties in terms of their skill mix for clinical as well as para-clinical services, and quality of medical education imparted by these institutions, which can be achieved by strict implementation of strict Medical Council of India (MCI) norms, in order to ultimately improve the health care system of India in long run.

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 1st Jan 2014 to 1st 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.

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.

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.

Utilization of Statistical Methods in Microbiological Research

Most papers published in medical journals contain analyses that have been carried out without any help from a statistician. Although nearly all medical researchers have some acquaintance with basic statistics, there is no easy way for them to acquire insight into important statistical concepts and principles. There is also little help available about how to design, analyze, and write up a whole research paper. A high level of statistical errors has been noted in several reviews of journal articles and has caused much concern. It has been suggested that comprehensive statistical guidelines could help by making medical researchers more aware of important statistical principles, and by indicating what information ought to be supplied in a paper.