Nature, prevalence and factors associated with depression among the elderly in a rural south Indian community

Background: Depression in old age is an important public health problem causing considerable morbidity and disability worldwide. There is a dearth of community studies from India investigating geriatric depression and its associated risk factors. This study aimed to establish the nature, prevalence and factors associated with geriatric depression in a rural south Indian community

Perinatal outcomes in a South Asian setting with high rates of low birth weight

<p>Abstract</p> <p>Background</p> <p>It is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration. Also, it is not known whether the traditional focus on preventing low birth weight has been successful. We addressed these and related issues by studying births in Kaniyambadi, South India, with births from Nova Scotia, Canada serving as a reference.</p> <p>Methods</p> <p>Population-based data for 1986 to 2005 were obtained from the birth database of the Community Health and Development program in Kaniyambadi and from the Nova Scotia Atlee Perinatal Database. Menstrual dates were used to obtain comparable information on gestational age. Small-for-gestational age (SGA) live births were identified using both a recent Canadian and an older Indian fetal growth standard.</p> <p>Results</p> <p>The low birth weight and preterm birth rates were 17.0% versus 5.5% and 12.3% versus 6.9% in Kaniyambadi and Nova Scotia, respectively. SGA rates were 46.9% in Kaniyambadi and 7.5% in Nova Scotia when the Canadian fetal growth standard was used to define SGA and 6.7% in Kaniyambadi and < 1% in Nova Scotia when the Indian standard was used. In Kaniyambadi, low birth weight, preterm birth and perinatal mortality rates did not decrease between 1990 and 2005. SGA rates in Kaniyambadi declined significantly when SGA was based on the Indian standard but not when it was based on the Canadian standard. Maternal mortality rates fell by 85% (95% confidence interval 57% to 95%) in Kaniyambadi between 1986–90 and 2001–05. Perinatal mortality rates were 11.7 and 2.6 per 1,000 total births and cesarean delivery rates were 6.0% and 20.9% among live births ≥ 2,500 g in Kaniyambadi and Nova Scotia, respectively.</p> <p>Conclusion</p> <p>High rates of fetal growth restriction and relatively high rates of preterm birth are responsible for the high rates of low birth weight in South Asia. Increased emphasis is required on health services that address the morbidity and mortality in all birth weight categories.</p

Designing Clinical Data Presentation Using Cognitive Task Analysis Methods

Despite the many decades of research on effective use of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practicing dentists in the United States. One critical reason is the poor usability of clinical systems, which makes it difficult for providers to navigate through the system and obtain an integrated view of patient data during patient care. Cognitive science methods have shown significant promise to meaningfully inform and formulate the design, development and assessment of clinical information systems. Most of these methods were applied to evaluate the design of systems after they have been developed. Very few studies, on the other hand, have used cognitive engineering methods to inform the design process for a system itself. It is this gap in knowledge – how cognitive engineering methods can be optimally applied to inform the system design process – that this research seeks to address through this project proposal. This project examined the cognitive processes and information management strategies used by dentists during a typical patient exam and used the results to inform the design of an electronic dental record interface. The resulting 'proof of concept' was evaluated to determine the effectiveness and efficiency of such a cognitively engineered and application flow design. The results of this study contribute to designing clinical systems that provide clinicians with better cognitive support during patient care. Such a system will contribute to enhancing the quality and safety of patient care, and potentially to reducing healthcare costs

The use of evaluation in the design and development of interactive medical record systems

An explorative study was done to develop an evaluation methodology. This method can be applied during the development of interactive medical record systems in order to provide information which can be used to improve user interaction with the system. Th e evaluation methodology consists of a number of interactive sessions with potential users of the interactive medical record system. During the first two sessions the subjects are trained to use the system. During the third and last session the subjects are videotaped while they are doing a set of benchmark tasks on the system under evaluation. The video recordings are analysed to obtain performance data. This performance data consists of task timings and a list of problems experienced (errors made) by the subjects. The systems evaluated during the study were a problem-oriented manual medical record and an interactive computerized medical record. The computerized record system was specifically developed for this study. The design and subsequent improvements to this system are documented in the study

Community based studies to Investigate Risk Factors and to develop a Nursing Intervention to Reduce Suicide

The community based studies were carried out in Kaniyambadi block of Vellore district, Tamil Nadu, Southern India. The Department of community health, Christian Medical College, Vellore has been operating, a community health programme in this block for the past five decades. The qualitative study employed focus group discussion to elicit local perspectives about suicide in a diverse group of individuals. The psychological autopsy study is the first community based study from India to use verbal autopsies for all deaths as part of an ongoing community surveillance programme. It also employed the standard psychological autopsy procedure and used a standard structured interview schedule for diagnosis. The intervention study was a structured educational intervention for school students to enhance their knowledge and attitude regarding suicide. SIGNIFICANT FINDINGS OF THE STUDY: Perceptions regarding suicide: • Many participants particularly emphasized marital discord (14/45), family problems and interpersonal conflict, while only a minority mentioned mental disorders as the main cause for suicide. • Participants commonly reported that social and financial difficulties had an adverse impact on individuals coping, significantly straining relationships and forcing them to commit suicide. • Participants considered suicide as an option during the time of duress. • Participants said that poisoning (16/45) and hanging (7/45) were the common methods of committing suicide, employed by all age groups. • Most participants (20/45) reported that the social impact of suicide was more in the rural community. They also highlighted the psychological impact of suicide on families. • Participants knew little about the support services available for suicide prevention. However, they gave suggestions regarding suicide prevention. RISK FACTORS FOR SUICIDE: • Widowhood or separated (p = 0.02) was identified as the risk factor for suicide, which increased the risk by three times. • Lack of close friends during past six months (p = 0.001), ongoing stressors (p = 0.001) and chronic pain (p = 0.006) were the significant psychosocial risk factors for suicide. • Being single (p = 0.02) was a significant demographic risk factor associated with suicide after adjusting for the effects of potential confounders. • Other factors like living alone (Fisher’s exact test p < 0.001) and break in steady relationship (Fisher’s exact test p < 0.001) were also significantly associated with suicide but were not present in the control group. • 37% (95% CI 27.54 – 46.46) of suicide and 16% (95% CI 8.81 – 23.19) of controls had at least one Axis I psychiatric diagnosis. • Majority among those who had psychiatric illness had adjustment disorder (15% in cases and 5% in controls; p = 0.02) and men with alcohol dependence (16% in cases 7% in controls; p = - 0.04). • Family history of suicide, previous suicide attempt, and family history of psychiatric illness, major depressive disorder, Dysthymia and paranoid schizophrenia were not significantly associated with suicide. EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING SUICIDE FOR SCHOOL CHILDREN. • There was significant difference found in the intervention group between the pretest and post test mean score on overall knowledge, attitude regarding suicide and their ability to identify the severity using case vignettes after the structured teaching programme ( p = 0.001). • The control group did not have significant difference between the pretest and post test mean scores on over all knowledge, attitude regarding suicide and their ability to identify the severity using vase vignettes without the structured teaching programme. • Intervention and control groups significantly differed on the various aspects of knowledge regarding suicide such a risk factors (p = 0.002) warning signs (p = 0.001) beliefs or myths about suicide (p = 0.01) and interventions to prevent suicide (p = 0.02) after the structured teaching programme. Three hypotheses were formed on the basis of the objectives and were tested. The findings are as follows: H1 - Depression was not common among subjects who committed suicide. H2 - Alcohol abuse was more likely to be common among men who commit suicide than among male controls. H3 - The students who received the structured educational intervention about suicide had greater knowledge about the issues. The findings of the studies confirmed only the third hypothesis stated. IMPLICATIONS OF THE STUDY: NURSING PRACTICE: Nurses spend a lot of time with patients on a one – to – one basis. Nurses working in health services like accident and emergency, child and adolescent mental health and community, offer care to people who engage in suicidal behaviour. So they need to be well trained in suicide risk and suicide prevention strategies. Nurses who are the prime care givers to the suicidal should focus on the interventions regarding safety and alleviation of immediate crisis. The nurses working at the community play a vital role as teachers, facilitators, counselors and guides. They should plan and educate the public regarding suicide prevention. They should take more efforts to strengthen the interventions aimed at people with a high risk for suicide and those who present with early warning signs. A trusting relationship can be developed which may encourage individuals to reveal concerns, they are reluctant to share even with their family. So, it is an important part of the nurses to educate the family to pick up changes in behaviour or cues that can precipitate a suicide attempt. Mass education should be planned and conducted at periodic intervals to increase the public awareness regarding suicide. School health services are an essential component of community health. The nurses working in the community need to educate the school students regarding suicide facts and coping skills. The school teachers can be equipped with adequate knowledge about adolescent suicide by providing appropriate training. Nursing as a discipline has a duty and is challenged to provide what is needed and necessary in helping prevent suicide among this population. NURSING EDUCATION: The educational back ground of the nurses should equip them with the knowledge necessary to recognize warning signs of suicide and its management. At present the syllabi of basic nursing courses have a very minimal emphasis on suicide prevention. The nursing curriculum should include more content on suicide. The nurses working in the hospital and in the community should be given in service education to update their knowledge and abilities in identifying people who are at risk for suicide. The nurse educators should train the students in the area of counseling people in distress. NURSING ADMINISTRATION: The nurse administrators should take an active role in developing teaching modules on suicide that are cost effective, which can be used to educate these school children and public. The nurse administrators also should take an active role in developing policies regarding suicide prevention. Periodical workshops and conferences can be organized for the nurses to update their knowledge regarding suicide prevention. NURSING RESEARCH: The present studies can be done in an urban setting and the risk factors can be compared between the rural and urban population. The psychological autopsy can be carried out between living controls, suicide attempters and suicide victims to understand the issues regarding suicide in depth. RECOMMENDATIONS: The present study findings revealed that psychosocial stress and adverse life events play a major role as risk factors for suicide. The structured teaching programme was effective and there was a significant increase in the knowledge and attitude regarding suicide. Following strategies are recommended for reducing suicide. 1. Conduct regular school health programme on suicide prevention. 2. Prepare appropriate teaching modules on suicide to use with different population. 3. Conduct training programme for school teachers to identify students with poor coping skills and counsel them. 4. Conduct regular mass education to increase public awareness. 5. Educate the nursing personal in the area of counseling. So, that they will be equipped in dealing with people in distress. 6. Interventions to foster supportive family relationships 7. Reducing the availability of means of suicide 8. Control the access to lethal means of committing suicide. 9. Establish counseling centers in rural areas. 10. Educate the public about mental illness and its treatment. 11. Support the broad population based socio economic interventions to improve the overall life standards and social justice. CONCLUSION: The qualitative study revealed that many people in the local community perceived suicide as an option to get over interpersonal, family and financial stress among normal individuals as well as among those with mental illness. The psychological autopsy study documented severe mental disorder only in a minority of subjects who killed themselves. The psychological autopsy study also reported that psychosocial stress and social isolation are risk factors for suicide in the region. The intervention study demonstrated the effectiveness of a structured educational programme about suicide in improving knowledge and attitude among students who received the education. Suicide remains as a distinct global public health problem and the reduction of rates continues to be major concern of many countries. Knowledge of risk and protective factors can be a guide for support and prevention of suicide

The information and planning needs of health visitors.

Rationale: The health visiting service is not planned on the basis of the health needs of the local population. Although relevant information is available it has not been made accessible for use. This study aims to: 1. Obtain baseline data regarding aims, planning methods, health goals and information needs of health visitors in selected practices in Sheffield. 2. Provide information concerning the health visitors' potential caseload and monitor its impact on the production of community profiles and identification of health goals. 3. Evaluate whether health visitors perceive positive change in their planning abilities and whether information provided meets their information needs. 4. Evaluate the social and political effects on the organisation of the health visiting service relating to the information provision. Nature. Scope and Method: An action research approach is used. The sample included, health visitors (N = 31) and their managers (N = 8), who were interviewed with an audiotaped interview schedule, piloted (N = 11). The health visitor sampled attended information workshops resulting in their building community profiles, negotiating practice with managers and producing an innovative method of planning. Workshop discussions and interview results were relayed back to all participants. The health visitor sample completed an evaluation questionnaire. Organisational changes during the research period were recorded. Contribution to knowledge: Community profiles can be used to assist community diagnosis relating the planning of the health visiting service to the health needs of the population. Profiles can fill information gaps existing in the service. Organisational changes to aid profile effectiveness include implementing, an information policy and system, appraisals, clear general policy statements, management training, and addressing a series of changes sought by health visitors. Alternative sources of funding for the service are suggested, as is grassroots representation in the planning process. The study provides an insight into the information and planning needs of health visitors in their organisational setting