Jugal Kishore

Understanding survival analysis: Kaplan-Meier estimate.

Kaplan-Meier estimate is one of the best options to be used to measure the fraction of subjects living for a certain amount of time after treatment. In clinical trials or community trials, the effect of an intervention is assessed by measuring the number of subjects survived or saved after that intervention over a period of time. The time starting from a defined point to the occurrence of a given event, for example death is called as survival time and the analysis of group data as survival analysis. This can be affected by subjects under study that are uncooperative and refused to be remained in the study or when some of the subjects may not experience the event or death before the end of the study, although they would have experienced or died if observation continued, or we lose touch with them midway in the study. We label these situations as censored observations. The Kaplan-Meier estimate is the simplest way of computing the survival over time in spite of all these difficulties associated with subjects or situations. The survival curve can be created assuming various situations. It involves computing of probabilities of occurrence of event at a certain point of time and multiplying these successive probabilities by any earlier computed probabilities to get the final estimate. This can be calculated for two groups of subjects and also their statistical difference in the survivals. This can be used in Ayurveda research when they are comparing two drugs and looking for survival of subjects.

Aggression in schools: Cyberbullying and gender issues

Due to increasing internet and mobile penetration, children in India are at risk of cyberbullying. A survey of 174 middle graders in Delhi showed that, of total, 8% indulged in cyberbullying and 17% reported being victimized by such acts. However, prevalence of in-person bullying, fighting and victimization by either was 16%, 12% and 17% respectively. Males were more likely to bully and fight in-person than females. They were also more likely to be victims of both online and offline aggression. Interwoven modes of bullying along with safe use of technology need to be understood.

Sexual and Reproductive Health: Knowledge, Attitude, and Perceptions among Young Unmarried Male Residents of Delhi.

Context. Men play a significant role in all spheres of domestic life including reproduction. Youth is a period of critical development and ignoring sexual and reproductive health (SRH) needs of young men ought to have wider social and health consequences. Aims and Objectives. To assess the knowledge, attitude, and perceptions regarding SRH among young unmarried men (18–25 years). Settings and Design. A semiqualitative study conducted across four health centers (2 rural, 2 urban) across Delhi. Materials and Methods. Focus group discussions (FGDs) were held among sixty-four participants regarding various aspects of SRH. Data Analysis. The data generated were analyzed using free listing and thematic content analysis along with simple quantitative proportions for different variable groups. Results. Good knowledge regarding HIV/AIDS was observed though found poor regarding other STIs/RTIs. Inadequate knowledge and negative attitude towards SRH and condom use were observed among rural participants. Peer group and mass media were the commonest SRH information sources among rural and urban participants, respectively. Conclusions. Poor SRH knowledge, perceptions, and available nonformal, unreliable information sources expose young men to poor SRH outcomes. Early, comprehensive SRH information provision can have life-long protective benefits to them and their partners.

A Comparative Study of Shift Work Effects and Injuries among Nurses Working in Rotating Night and Day Shifts in a Tertiary Care Hospital of North India

Background: Shift work can have an impact on the physical and psychological well-being of the healthcare worker, affecting patients as well as their own safety at the workplace. This study was conducted to compare the health outcomes and injuries, along with associated risk factors between the nurses working in rotating night shift (RNS) as compared to day shift (DS) only. Materials and Methods: It was a cross-sectional study conducted from June to November 2016 in a tertiary care hospital of Delhi. It involved 275 nurses working in RNS and 275 nurses from DS of various departments, selected through simple random sampling. Standard Shift Work Index Questionnaire (SSI) was used as the study instrument, with selected variables (according to objectives of the study). Data were analyzed using descriptive statistics, Chi-square, t-test, and multivariate regression. Results: Female nurses had more sleep disturbance, fatigue, and poor psychological health. Working on a contractual basis, RNS, and living outside the hospital campus were associated with higher odds of having needle stick injury (NSI).The nurses working in RNSs were found to have significantly lower mean scores in job satisfaction (p = 0.04), sleep (p < 0.001), and psychological well-being (p = 0.047) as compared to DS workers. Conclusions: Health outcomes among nurses working in RNSs call for the interventions, focused on various factors which can be modified to provide supportive and safer working environment.

Tuberculosis patients not covered by treatment in public health services: findings from India's National Family Health Survey 2015-16

Half of the TB patients in India seek care from private providers resulting in incomplete notification, varied quality of care and out‐of‐pocket expenditure. The objective of this study was to describe the characteristics of TB patients who remain outside the coverage of treatment in public health services.

1043 Comparative study of shift work effects and injuries among nurses working in rotating night shift & day shift in india

Introduction Shift work can have an impact on the physical and psychological well-being of the health care worker. The impact can be manifold in developing countries like India, where health sector already suffers due to the poor doctor: nurse and nurse: population ratio. This study was conducted to compare the health outcomes and injuries, along with associated risk factors between the nurses working in Rotating Night Shift (RNS) as compared to Day Shift only (DS). Methods It was a cross-sectional study conducted from June to November 2016 in a tertiary care hospital of Delhi. It involved 275 nurses working in rotating night shift and 275 nurses from day shift of various departments, selected through simple random sampling. Standard Shift Work Index Questionnaire (SSI) was used as the study instrument, with selected variables (according to objectives of the study). Data were analysed using descriptive statistics, chi-square, t-test and multivariate regression. Result The nurses working in rotating night shifts were found to have significantly lower mean scores in job satisfaction (p=0.04), sleep (p<0.001) and psychological well-being (p=0.047) as compared to day shift workers. Working on a contractual basis, rotating night shift and living outside the hospital campus were associated with higher odds of having needle stick injury (NSI). Discussion This study revealed some modifiable targets for improving shift work adaptation, e.g sleep, job satisfaction and general health. These can be modified by including appropriate interventions in their training itself, such as behavioural changes for good sleep hygiene, counselling and periodic screening. Prevention of needle stick injuries is the best strategy, but setting up of adequate surveillance mechanism in every hospital is also necessary. Fixed timing and duration of duty hours in case of rotating shifts can also contribute to lesser human errors and better job satisfaction.

Occupational Health and Safety in Healthcare Settings – Effect of Training on the Knowledge of Resident Doctors

Background: Over the past years several diseases and disorders associated with different kinds of occupations have been identified, including healthcare. It is important for medical personnel especially resident doctors to have adequate knowledge of occupational health and safety and prevention of occupational hazards. Objective: To assess the knowledge among resident doctors regarding occupational health and safety in healthcare settings, and the effect of training on the same. Methodology: A before and after intervention study without control was done among a group of resident doctors of a medical college in Delhi. Training on occupational health and safety was given to the study participants in the form of a two-day workshop. Pre- and post-test questionnaires filled by the participants were scored and the mean scores were compared and tested for statistically significant difference using Mann Whitney U test. Results: The study was done on 17 post-graduate resident doctors. The mean post test score was higher than the mean pre-test score and the difference was statistically significant at p<0.05. Conclusion: Training of doctors and other health personnel on occupational health and safety and prevention and control of occupational hazards can prove to be effective in improving their knowledge regarding the same.

Road Traffic Injuries Surveillance – Need of Hour in India

Injuries are increasingly recognized as a global public health epidemic. Among injuries, road traffic accidents have been recognized globally as an important public health problem. Due to growth of motorization and rapid expansion of road networks, there has been an increase in road traffic accidents over the recent years. Road traffic accidents are the leading cause of unintentional injuries worldwide. Road traffic accidents are a leading cause of death among young people, aged 15-29 years. Low and middle-income countries account for almost 90% of global mortality due to road traffic injuries. In India, the total number of road accidents have increased by 2.5 per cent between 2014 and 2015.

Knowledge, Attitude and Practices of the Standard Precautions among the Laboratory Technicians in a Tertiary Care Hospital at New Delhi

Healthcare Workers are always at high risk of infection since they deal with the infectious patients and materials in the hospital. The knowledge about the acquired infections and diseases as an occupational hazard, preventive methods and the improvisation of such knowledge by following standard precautions is not known and not followed by significant number of laboratory technicians. Objectives: To determine the awareness and practices of standard precautions among the laboratory technicians of a tertiary care hospital at New Delhi. Methodology: The present study is a hospital-based cross-sectional study. A semi-structured, selfadministered bilingual questionnaire, based on WHO standard precautions and ICMR good lab practices, was used to assess the knowledge, attitude and practices of standard precautions among laboratory technicians of biochemistry, pathology, microbiology, DOTS and hematology laboratories of a tertiary care hospital. Ethical certificate for the study was been obtained from the Institute Ethics Committee of VMMC and Safdarjung Hospital. Result: 84 forms were administered to study samples. 81 forms (96.4%) were filled and returned. 17.28% (14) of the participants had experienced needle pricks at some time in the past. 90% of the study participants were aware about the standard precautions. Majority (98.76%) of them did not know about the biosafety level of their laboratories and all of them reported absence of accident register. Majority (69.1%) of them were somewhat knowledgeable (>75% of the total score). There was no significant difference in the knowledge level of the participants based on their sex (p-0.296), age groups (p-0.083) or the departments (p-0.324). Conclusion: The study concluded that there was lack of knowledge among technicians for their safety and health which demands CME program, refresher trainings, re-orientation classes and hands-on-training for reinforcements on standard precautions, regularly.

Clinico-social Profile of Chikungunya Cases Reported in 2016 at a Tertiary Care Hospital in New Delhi

Background: Chikungunya epidemic is a public health problem in South-East Asian countries.There was an epidemic of chikungunyain the year 2016 in New Delhi. Therefore, this present study was planned to understand the epidemiological profile of Chikungunya cases attending fever clinic in a tertiary care hospital in New Delhi. Objective: To studyepidemiological and clinical profile of Chikungunya cases attending fever clinic in Safdarjung Hospital. Methods: A total of 200 patients with fever of up to 7days duration were enrolled at fever clinic of VMMC and Safdarjung Hospital, New Delhi from May 2016 to October 2016.Total number of 47874 fevercases were reported in fever clinic from May 2016 to October 2016. A preformed semi-structured, interviewer administeredquestionnairewas used for data collection. Serum specimens were screened for chikungunya infection by serology (IgM). Chikungunya infection was detected in 16.5% patients byanti- CHIKV IgM antibodies by ELISA. Results: Among these 200 suspected cases of chikungunya, fever (96.0%),joint pain (81.0%),Myalgia (77.5%) and lower backache (57.5%) were the major clinical features. Major joints involved were knee joint (45.5%), wrist (32.5%), hand (phalanges) (34.5%) and ankle joints (31.0%). Myalgia, rashes, joint pain and joint swelling was frequently observed among chikungunya confirmed cases (p<0.05). All group of ages, both gender and all class of socioeconomic scale were equally susceptible to chikungunya infection. Conclusion: Chikungunya virus had a wide spectrum of clinical features and all age groups, gender and socioeconomic status people were equally susceptible to Chikungunya infection.All acute febrile illness patients with joint pain shouldbe screened in the laboratory for both Chikungunya IgM antibodies. Predictability of chikungunya is more in presence of joint pain and swelling, myalgia and rashes. This study emphasizes the need for a continuous surveillance on the disease burden.