Manish Kumar Goel

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.

Psycho-Social Behaviour of Urban Indian Adolescent Girls during menstruation.

BACKGROUND Adolescence in females signifies the transition from girlhood to womanhood and is marked with the onset of menarche. Indian society is interwoven into a set of traditions, myths and misconceptions, especially regarding menstruation and related issues. The present study was conducted to assess knowledge and psycho-social behavior related to menstruation among adolescent girls in urban Haryana (state), India. METHOD A total of 478 adolescent girls in the age group of 15 -19 years from three educational institutes of Rohtak city were selected randomly. It was a community-based, descriptive, cross-sectional questionnaire based study, and a pre-tested, pre-coded, closed ended questionnaire was used. RESULTS Feeling of sickness was the most common (in more than two-third of subjects) followed by irritability and emotional disturbances. More than 3/4(th) of the subjects did not worship during menstruation, 45% were not allowed in kitchen and nearly one-fourth followed dietary restrictions. More than 16% subjects thought menstruation to be a sign of onset of a disease and little more than 7 % thought it to be a curse. Girls preferred to discuss their menstruation related problems either with their mothers or with their friends. CONCLUSION Girls have inaccurate and partial information regarding menstruation. There is a need of early intervention in the area of adolescent psycho-social behavior during menstruation.

Tracking the implementation to identify gaps in integrated disease surveillance program in a block of district Jhajjar (Haryana)

Context: To strengthen the surveillance system in India, Integrated Disease Surveillance Program (IDSP) was launched in 2004. The frequent occurrence of epidemics even after the launching of the IDSP was an indication toward inadequacy of the system. The responsibility for effective implementation of IDSP at the sub-center level lies with the health workers. Aims: The aim of the following study was to assess the knowledge and practice of health workers regarding IDSP and to assess the quality of IDSP reports at the sub-center level. Settings and Design: It was cross-sectional study carried out in the area under Community Health Center Dighal which is the rural field practice area attached to Post Graduate Institute of Medical Sciences, Rohtak in the State of Haryana, India. Subjects and Methods: All the 24 sub-centers in the area were visited and 46 health workers (22 male; 24 female) who met the inclusion criteria i.e. who had completed 1 year of their service or had been trained for IDSP, were included in the study. Data were collected on a self-designed, semi-structured and pre-tested schedule by interviewing the study subjects and observation of the records/reports. Statistical Analysis Used: Percentages and proportions. Results: Only 14/46 (~30%) of the workers could expand the abbreviation “IDSP” correctly. Only 4/46 (~9%) workers could narrate any of the trigger events and none could tell all the trigger events. Only at 12 such sub-centers, diagnoses were being written in their out-patient registers according to the defined syndromes. 43/46 (~93%) workers were not aware of the zero reporting. Conclusions: The surveillance system is much less alert and intense than the desired level and needs to be strengthened.

Is Perceived Nutritional status Important among Adolescents

Adolescence is a phase of rapid transitions. Adolescents undergo many physiological and behavioural changes during this phase. Because of the increased growth rate and changes in body composition associated with puberty their nutritional needs are increased drastically.1 Meeting these increased nutritional needs in an appropriate manner is a challenge for them and also for the society. Nutrition during this phase of life is an important determinant for occurrence of several chronic diseases, including obesity, coronary heart disease, certain types of cancer, stroke, type 2 diabetes and several other nutritional deficiency diseases; later in the adulthood and also malnutrition is associated with significant immediate and long term health risks, and also a predictor of increased risk of adult morbidity and mortality.2-4