Barriers to healthcare contribute to delays in follow-up among women with abnormal cancer screening: data from the Patient Navigation Research Program

Thesis (M.S.C.E.) -- Boston UniversityBACKGROUND: Patient navigation programs were designed to address barriers to healthcare among underserved populations in order to reduce delays in cancer care delivery. While emerging data suggest modest effects of navigation on reducing delays, there is limited understanding of the association between barriers to care and clinical outcomes within patient navigation programs. OBJECTIVE: To investigate the impact of barriers on timely diagnostic care in the multicenter Patient Navigation Research Program (PNRP). STUDY DESIGN: Secondary analysis of data from the intervention arms of PNRP centers that navigated women for abnormal breast or cervical cancer screening tests from 2007 to 2010. METHODS: Analyses were performed separately for breast and cervical subjects. The main independent variables were (a) number of unique barriers to care (0, 1, 2, or 3+) documented during patient navigation encounters and (b) presence of socio-legal barriers (yes/no), those social problems related to meeting life’s most basic needs that are supported by public policy, regulation, and programming and thus potentially remedied through legal advice or advocacy. The outcome of interest was median time to diagnostic resolution, or the interval from index screening abnormality to diagnostic resolution, estimated using Kaplan-Meier cumulative incidence curves. Multivariable Cox proportional hazards regression with time to diagnostic resolution as the outcome examined the impact of barriers, controlling for socio-demographics and stratifying by study center. RESULTS: Among 2600 breast screening subjects, three-quarters had barriers to care (25% 1 barrier, 16% 2 barriers and 34% 3+ barriers). Among 1387 cervical screening subjects, slightly more than half had barriers (31% 1 barrier, 11% 2 barriers, and 13% 3+ barriers). Among breast subjects, we found the presence of barriers was associated with less timely resolution for any number of barriers compared to no barriers. Among cervical subjects, only the presence of 2 or more barriers was associated with less timely resolution. Both socio-legal and non socio-legal barriers were associated with delay among breast and cervical subjects. CONCLUSIONS: Navigated women with barriers resolve cancer screening abnormalities at a slower rate compared to those with no barriers. Further research is necessary to maximize the impact of patient navigation programs nationwide

A Study on the Impact of Yoga Tourism on Tourists Visiting Kerala

Yoga tourism is the latest trend which includes both treatments as well as tourism. Kerala has emerged as the most acclaimed yoga tourist destination in the world. This study delineates the major reasons that increase the suitability of Kerala for yoga practice, the source of information about destinations in Kerala, the kind of tourism which are preferred to be combined with yoga trips, and how long have the tourists been doing yoga in their lives and the impact of yoga in their lives. The study was carried out by a descriptive research design based on survey method. Averages, percentages, chi-square test and factor analysis were used for analyzing the study. The result showed that traditional system of yoga was the major reason for suitability of Kerala for yoga practices, friends, relatives and travel agents remain key persons in giving information to the yoga tourists, and yoga has a high positive impact on tourists’ lives

Participation, retention and dropout of children and adolescents in club-based community tennis

Promoting participation in sport to achieve sporting excellence and health outcomes is a national policy of Australia. Organised, club-based sport at community level is important as it provides a pathway to elite sporting success and contributes to health and wellbeing of participants. Dropout from all forms of club-based sports including tennis occurs specifically during adolescence in Australia and internationally. Little is known about the factors that collectively influence this age group in their choice to continue playing club-sport or to drop out. This PhD program of research investigated the trends and determinants of retention and dropout among children and adolescents playing community level club-based tennis in the Australian state of Victoria. The program of research used the socio-ecological model underpinned by Leisure Constraint Theory and Fun Integration Theory to understand the different factors that influence retention. The mixed-methods explanatory sequential research design comprised of two consecutive phases of quantitative study that involved secondary data analysis of state-wide club-tennis participation and an on-line survey that examined the determinants of retention and dropout with a socio-ecological perspective. This was followed by an informed qualitative study to explore the key findings in depth. Players aged 10-18 years who were or had been registered players at tennis clubs in Victoria were invited to participate. Analysis of survey data and interviews identified a range of factors that influence and impact the decision of young players to continue playing club-based tennis or to drop out. The result from this program of research highlighted the two intrapersonal determinants ‘enjoyment’ and ‘competency’ as ‘core’ determinants of young players’ choice to be retained or to drop out. Many previous studies have listed enjoyment and competency and several other socio-ecological factors as determinants influencing retention. This research created new knowledge by explaining how each individual socio-ecological element influenced retention through enhancing or diminishing the two core determinants. Mapping of the interaction of multiple socio-ecological elements in leading to retention or dropout while presenting enjoyment and competency as core determinants is unique. Improving retention in club-based tennis during adolescence is important for maintaining participation as a habit into adulthood. As a practical way to achieve this, factors that are identified in this study as influencing enjoyment and competency can be targeted through interventions at various levels through policies and strategies in delivering club programs, coaching and competition. Competency and enjoyment are interconnected in promoting retention. Increasing access to affordable and good quality coaching promotes enjoyment through improving competency and hence should be prioritised to sustain children’s interest and passion for the game. The knowledge about interconnectivity of several apparently distinct elements reiterates the importance of a holistic approach in sport retention studies. It provides the theoretical backing for strategies aimed at retaining more children and adolescents in organised sport which is important for carrying regular physical activity habit into adulthood and ensuring sustainability of organised sports.Doctor of Philosoph

Effectiveness of Lower Extremity Weight Bearing Training along with the Conventional Training to Improve Balance, Vibration Perception and Ankle Mobility in Diabetic Peripheral Neuropathy Patients: A Quasi Experimental study

BACKGROUND: Diabetic peripheral neuropathy (DPN) is a condition which challenging the quality of life of the patients. According to the world health organization report, 108 million persons had diabetes during 1980s; 422 million persons had diabetes in the year 2014. The global prevalence of diabetes has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population. Mostly the diabetic patients are sedentary in their life style, inactivity contribute the deconditioning of the skin, uncontrolled hyperglycemia and lowering the tolerance for weight bearing activities. Historically these patients are advised to avoid more stress to the plantar tissues to avoid foot ulceration, but moderate lower extremity weight bearing exercises help to improve the patient mobility without increase the risk of foot ulcers. A progressive program may preserve the lower extremity muscles, improve sensory perception and functional balance. AIM AND OBJECTIVE: To study the effect of lower extremity weight bearing training along with conventional training on static balance using sharpen Romberg test, on dynamic balance using TUG test, on vibration perception using biothesiometer and active range of motion using universal goniometer among Diabetic peripheral neuropathy patients. METHODOLOGY: Quasi-experimental research design with purposive sampling technique was employed. 300 Type 2 diabetic patients were selected. Patients who have diabetic history more than 10years, age between 40-65 years, MNSI score >2 and vibratory perception between 15-50V were included. Thirty patients fulfilled the inclusion criteria and they were randomly allocated in to two group. Group A (Experimental) received Lower extremity weight bearing training along with conventional training and group B (control) received the same conventional training alone. Post-test measures of thirty patients were taken after 8 weeks of treatment. OUTCOME MEASURES: Static balance using sharpen Romberg test, dynamic balance using TUG test, Vibratory perception using biothesiometer and Active range of motion using Universal goniometer are used. RESULTS: The data was analyzed using ‘t’ test at 5% level of significance. The homogeneity is maintained between two groups. The experimental group that receive Lower extremity weight bearing training along with conventional training had significant improvement in both static balance (t stat=26.89), dynamic balance (t stat=27.8), vibration perception in right foot (t stat=12.07), left foot (t stat=16.74) and active ankle range of motion than the control group that receive only conventional training. CONCLUSION: The results of this study conclude that lower extremity weight bearing training enhance balance both static and dynamic, vibration perception and active ankle range of motion among diabetic peripheral neuropathy patients

Influence of crop combinations and soil factors on diversity and association of arbuscular mycorrhizal fungi in arecanut based cropping systems

Arbuscular mycorrhizal (AM) species diversity and extent of association were investigated in arecanut based cropping systemsdiffering in crop combinations. The study was carried out in farmers’ fields under acidic soil conditions at three locations representinglow land (Maneikkara), midland (Cheruvanjeri) and high land (Nedumpoyil) regions of Kannur district in Kerala. The croppingsystems in Maneikkara, Cheruvanjeri and Nedumpoyil had arecanut-banana, arecanut-banana-black pepper and arecanut-bananablackpepper-cardamom as component crops. AM spore load and root colonization differed significantly in arecanut in the threecropping systems. Highest spore load was recorded in Maneikkara followed by that in Nedumpoyil and Cheruvanjeri regions.Crops which formed components of the cropping system differed in root colonization levels, with banana recording the highestlevel, followed by arecanut, black pepper and cardamom. Colonization pattern was Paris type in all crops, but varied with respectto predominance of arbuscules in arecanut and vesicles in banana. Arecanut-black pepper-banana system at Cheruvanjeri inmidland was superior with respect to species diversity and species richness as evidenced by Shannon–Weiner index (Hs), Simpson’sindex of diversity (Ds) and species richness index. Arecanut-banana cropping system in Maneikkara in low land had low level ofspecies diversity and species richness, indicating the combined influence of crop combinations and soil factors such as N and P onAM diversity and distribution. Rhizophagus fasciculatus, Funneliformis geosporum, F. mosseae, Glomus macrocarpum,G. aggregatum, G. multicaule, G. glomerulatum and Acaulospora bireticulata were the AMF species identified from the arecanutcropping systems. F. geosporum was the most abundant (29-50%) species in the cropping system. The relative occurrence andabundance of AM species varied significantly with respect to the crops and locations

Effectiveness of an intensive lifestyle modification program in reducing the weight of obese children aged 12-18 years

Objective: To find out the effectiveness of an intensive lifestyle modification program in reducing the weight of obese children aged 12-18 years. Material and Methods: Quasi-experimental single group pre-test/post-test study was conducted for 1 year in the outpatient unit of a tertiary care hospital. Obese children aged 12-18 years who gave consent to participate in the study were included as the study subjects. Obesity was diagnosed based on revised Indian Academy of Pediatrics (IAP) 2015 reference percentiles that have been proposed for Asian Indian children with a body mass index (BMI) >27 kg/m2 adult equivalent cut-off taken as obesity. Intervention done was lifestyle modification including diet and moderate aerobic exercises under supervision thrice a week, 1 h each day. Results: A total of 72 children were initially enrolled, and final analysis was performed on 58 children. After completing the 6 months program, the mean BMI reduced from 29.31±4.83 kg/m2 to 27.27±4.46 kg/m2. The mean weight of the study participants decreased to 70.82±16.43 kg from 76.1±17.98 kg, both of which were statistically significant. Conclusion: Study shows the effectiveness of an intensive lifestyle modification program of diet and exercise in reducing the weight of obese children

Neonatal resuscitation guidelines - A survey among pediatricians attending a newborn conference in North Kerala

Background: Meticulous understanding and adequate skills for prompt neonatal resuscitation by health-care personnel working in the labor, maternity, and newborn units is important. Various studies have identified areas of non-uniformity among pediatricians regarding neonatal resuscitation practices. Aim: The aim is to evaluate the knowledge among pediatricians regarding the current neonatal resuscitation guidelines and the practices they follow in their unit. Materials and Methods: A cross-sectional survey of 17 questions, based on guidelines of Neonatal Resuscitation Program (NRP) 2015 and Navjaat Shishu Suraksha Karyakram, wasconducted using a questionnaire distributed to pediatricians attending a neonatology conference. The responses were noted andanalyzed using SPSS. The relation of knowledge score with demographic profile and status of training was assessed. Results: The response rate was 66%. Majority (52%) of the participants were working in private hospitals. Neonatal intensive care unit with mechanical ventilation facilities was available for 60% of respondents. Nearly 40% were trained in neonatal resuscitation. About 85% reported correct knowledge regarding effective chest compressions. Nearly 50% reported the use of room air for bag and maskventilation during resuscitation in babies more than or equal to 35 weeks. Tracheal suction was practiced by 54% in meconiumstained liquor, and 55% practiced delayed cord clamping for 30-60 s. Nearly 62% did not have oxygen blender in the resuscitation corner, whereas 33% had cardiac monitor. No significant association was found between the place of work and knowledge score (using Chi-square test for association, p=0.280). Designation of the delegate did not have a significant association with knowledge score (p=0.300). Knowledge score of delegates from teaching hospitals was not superior to those from the non-teaching hospitals.No significant association was found between knowledge score and training (p=0.999). Conclusions: Knowledge about neonatal resuscitative practices in pediatricians as well as infrastructural facilities needs to be improved with regular NRP training.&nbsp