Effect of Life-Style Modification Intervention Programme on Bone Mineral Density among Postmenopausal Women with Osteoporosis

Objectives: Osteoporosis is one of the major public health problems worldwide among postmenopausal osteoporotic women. Lifestyle modification interventions along with pharmacotherapy helps to revert the bone loss and prevent the complications. Methods: A randomized controlled trial was conducted at Kasturba Hospital, Manipal from January 2019 to December 2021 among postmenopausal women with osteoporosis. The postmenopausal women who attended the osteoporosis clinic and were within the age group of 45-65 years, could speak and understand English or Kannada, and whose Bone Mineral Density (BMD) score was between -1 and -3 were included for the study. The total sample size of the study was 120 with 60 in each of the experimental and control group. After obtaining the informed consent, stratified block randomization method was used to allocate the participants to intervention and control group. The BMD was monitored by the portable ultrasound densitometer by a technician at the outpatient departments. The baseline information was collected by a structured demographic questionnaire. Intervention group participants received Lifestyle Modification Intervention Program (LMIP) whereas control group received the standard regular care by the physician.  Follow up was done at three and six months. Results: The results revealed that the increase in the BMD median score among the experimental group was from -2.2 [(-2.5, -1.8)] to -1.5 [(-1.8, -0.65)] where as in the control group it was from -2.3 [(-2.6, -1.9)] to -2.0 [(-2.4, -1.5)].  The increase in the median score of the experimental group (0.7) was higher than in the control group (0.3). The results of Mann Whitey U test showed a statistical significance between the intervention and control groups in the post test after 6 months (U =.505.5, p<0.05). Wilcoxon signed rank test showed the significant change in both the intervention and control groups from pre-test to post-test I (3 months) and Post-test II (6 months) (p<0.001). Conclusion: The lifestyle modification intervention was found to be effective in improving the bone health status of postmenopausal women. Hence it is very important to integrate in regular therapy. Keywords: LMIP, postmenopausal women, bone health status, bone mineral density

The utilisation of systematic review evidence in formulating India's National Health Programme guidelines between 2007 to 2021

Evidence informed policymaking integrates the best available evidence on programme outcomes to guide decisions at all stages of the policy process and its importance becomes more pronounced in resource constrained settings. In this paper, we have reviewed the use of systematic review evidence in framing National Health Programme (NHP) guidelines in India. We searched official websites of the different NHPs, linked to the main website of the Ministry of Health and Family Welfare (MoHFW), in December 2020 and January 2021. NHP guideline documents with systematic review evidence were identified and information on the use of this evidence was extracted. We classified the identified systematic review evidence according to its use in the guideline documents and analysed the data to provide information on the different factors and patterns linked to the use of systematic review evidence in these documents. Systematic reviews were mostly visible in guideline documents addressing maternal and newborn health, communicable diseases and immunization. These systematic reviews were cited in the guidelines to justify the need for action, to justify recommendations for action and opportunities for local adaptation; and to highlight implementation challenges and justify implementation strategies. Guideline documents addressing implementation cited systematic reviews about the problems and policy options more often than citing systematic reviews about implementation. Systematic reviews were linked directly to support statements in few guideline documents, and sometimes the reviews were not appropriately cited. Most of the systematic reviews providing information on the nature and scale of the policy problem included Indian data. It was seen that since 2014, India has been increasingly using systematic review evidence for public health policymaking particularly for some of its high priority NHPs. This complements the increasing investment in research synthesis centres and procedures to support evidence informed decision making, demonstrating the continued evolution of India's evidence policy system

Interventions to support contraceptive choice and use: a global systematic map of systematic reviews

BACKGROUND: To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use. METHODS: Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria. FINDINGS AND CONCLUSION: Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings

Is Clinical Decision Making Skills are Developed through Academic Nurturing? A Review Based on Available Literature

Introduction: Today’s nurses are having challenges, demanding their ability to the profession. Nursing education should concentrate on educating competent health care providers to handle complex health care technology with fundamental implications for latest generation of patients. This paper aims to identify the various strategies used to enhance the clinical decision making ability among nurses. Methods: A comprehensive systematic review of published literature and journal articles from PubMed and Cinhal databases was done. Search strategy specific to each database was used. During initial search 6808 titles were retrieved and after screening 12 articles were selected for full text screening. Finally 12 research articles were selected based on the inclusion criteria. Results: Out of 12 articles, 7 research studies supported that clinical decision making can be developed using different types of simulation (such as human patient simulators, simulated clinical experiences, simulation to create rubric assessment). Two of those studies propose clinical reasoning abilities can be acquired through Outcome-Present state Test (OPT) model. Individual studies used strategies like concept mapping, educational interventions, analogy guided learning experiences, structured reflection in education and workshops can develop clinical decision making. Computer based and multimedia computer simulation program did not showing any clear outcome. Conclusion: Clinical decision making is an abstract skill which can be developed by using different strategies in different specialities and different situations.  Since situational factors and time constraints are evident in practice, findings were supportive for clinical decision making(CDM) skill. The ideal setting for students to learn CDM skills is real clinical practice environment, especially when facilitated by opportunities for immediate feedback and reflection. CDM is necessary for providing quality patient care and favouring patient satisfaction. Keywords: Decision making, Nurses, Judgement, Clinical Competenc

Impact of Covid-19 on Mental Health among Healthcare Workers in India: A Mixed-Methods Systematic Review

Healthcare workers (HCWs) experienced significant mental health challenges during the COVID-19 pandemic. This review aimed comprehensively assess the impact of the COVID-19 pandemic on the mental health of HCWs in India. A mixed-methods review adopted a results-based convergent approach incorporating quantitative and qualitative data. A comprehensive literature search was conducted in relevant databases: PubMed-MEDLINE, CINAHL, Web of Science, and ProQuest. All available full-text studies in the English language that assessed the mental health outcomes (anxiety, stress, depression) of HCWs during the pandemic and published till February 28, 2022, were included. A total of 31 studies were included in this review (27 quantitative studies, three qualitative studies, and one mixed-method study). The pooled prevalence of depression, anxiety, and stress was 32.96%, 29.49%, and 33.47 %, respectively among the HCWs in India. The qualitative analysis resulted in the themes: challenges faced, and coping strategies used during the COVID-19 pandemic. Integration of quantitative and qualitative findings using social determinants of health framework resulted in various contributing factors and coping strategies. There is a need for a supportive work environment, mental health support, and mental health policies for HCWs in India

Effectiveness of antepartum breathing exercises on the outcome of labour: A randomized controlled trial [version 3; peer review: 2 approved]

Abstract Background Childbirth is a life-transforming intense event to a woman and her family. Even though a variety of non-pharmacological techniques are readily available to alleviate the distress of women in labour, the majority of women are unaware of its benefits. The objective of the study was to explore the impact of a simple non-pharmacological technique i.e., antepartum breathing exercises on maternal outcomes of labour among primigravid women. Methods A single centre prospective, single-blinded, randomized controlled trial was conducted at the antenatal outpatient clinic of a secondary healthcare institution. Eligible primigravid women were randomized into intervention and standard care groups. Both groups received standard obstetrical care. In addition, the intervention group were taught antepartum breathing exercises and were advised to practise daily and also during the active stage of labour. The primary outcome of the trial was the maternal outcome of labour measured in terms of onset of labour, nature of delivery, duration of labour, and need for augmentation of labour. Data was collected using World Health Organization (WHO) partograph, structured observational record on the outcome of labour. Results A total of 98 (70%) primigravid women who practised antepartum breathing exercises had spontaneous onset of labour. The odds of spontaneous onset of labour after randomization in the intervention group was 2.192 times more when compared to standard care at a (95% confidence interval 1.31–3.36, p<.001). Also, the requirement for augmentation of labour was minimal and there was a reduction in the rate of caesarean deliveries (p <.05) based on the χ2 test. The overall mean duration of labour was less compared to standard care group F(1)= 133.800, p <.001. Conclusion Antepartum breathing exercises during labour can facilitate spontaneous vaginal birth, shorten the duration of labour, and reduce the need for operative interference

Prevalence of overweight / obesity among school children in Karnataka, South India

Worldwide, non-communicable diseases (NCD) represent 43% of the burden of disease and are expected to be responsible for 60% of the disease burden and 73% of all deaths by 2020.Obesity in children and adolescents is gradually becoming a major public health problem in many developing countries, including India. The present study was undertaken to identify the prevalence of childhood overweight /obesity and to find the relationship between BMI and waist circumference of the children. Eleven schools were selected randomly from Udupi district of Karnataka state, India. A school based survey was carried out among 2938 school children in the age group of 10 – 16 years. On the day of survey, the purpose of the study was explained. The demographic proforma was administered and standard procedures were followed to assess the anthropometric measurements. Result showed that 7% of children were overweight and 5% were obese. The Pearson Correlation computed between BMI and waist circumference showed a positive ( r = 0.763, p =<0.0001) relationship between BMI and waist circumference. The study concluded that childhood obesity prevalence is increasing among children. Higher BMI was found among children in the age of 10 – 12 years and among girls than the boys. The gender difference in BMI could be due to sedentary lifestyles of girls. As the BMI of children increases the waist circumference also increases

Effectiveness of music on anxiety and pain among cardiac surgery patients: A quantitative systematic review and meta-analysis of randomized controlled trials

AIM: The aim of this study is to evaluate the effectiveness of music on anxiety and pain among patients following cardiac surgery. BACKGROUND: Cardiac surgery affects patients physically, psychologically and socially. Anxiety and pain are the usual problems among patients following cardiac surgery. DESIGN: The study design is a systematic review and meta-analysis. DATA SOURCES: The Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medica database (EMBASE) and Web of Science databases were searched for randomized controlled trials from January 2000 to December 2017. REVIEW METHODS: The Cochrane collaboration guidelines were followed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to summarize the quality of evidence. RESULTS: Fourteen studies were included in systematic review and 13 in meta-analysis. The meta-analysis revealed that there was a significant reduction in anxiety and pain among patients who received musical intervention compared with those who did not. CONCLUSION: Music has positive benefits on anxiety and pain. However, well-designed and high-quality trials are needed to generate higher quality evidence

Design and validation of an interprofessional education module to enhance interprofessional competencies among students from healthcare professions

الملخص: أهداف البحث: توضح هذه المقالة عملية تطوير وحدة تعليمية بين المهنيين في اضطراب طيف التوحد والتي تدمج الكفاءات المهنية وتطبيقاتها بين طلاب مهن الرعاية الصحية المختارين. طريقة البحث: اعتمدت الورقة ''طريقة البحث والتطوير لبحوث التعليم'' من قبل ''بورغ وجال'' كأساس للدراسة. كانت الأساليب المستخدمة هي المقابلات شبه المنظمة ومناقشة مجموعة التركيز واستبانة تقييم الاحتياجات. النتائج: تم التحقق من صحة دليل المقابلة (0.92) ودليل مناقشة المجموعة (0.98) واستبيان تقييم الاحتياجات بمؤشرات الصلاحية (1.00). تم اختبار استبانة تقييم الاحتياجات من أجل الموثوقية. تم إعداد وحدة التعليم بين المهنيين وأدوات التقييم لتقييم فعاليتها على أساس النتائج. كانت مؤشرات الصلاحية للوحدة ومقاطع فيديو المحاكاة (0.98) وسيناريوهات الحالة (0.97) وأدوات التقييم (1.00) واختبار تقييم الكفاءة بين المهنيين (0.98) واختبار تقييم الكفاءة بين المهنيين - قائمة مراجعة المراقبة (1.00). كانت درجات الموثوقية في اختبار تقييم الكفاءة بين المهنيين (0.87) واختبار تقييم الكفاءة بين المهنيين - قائمة مراجعة الملاحظة (0.90). الاستنتاجات: ستساعد هذه الوحدة في التعليمية توفير البيانات والمعلومات الضرورية لأولئك الباحثين الذين يقومون بتدخلات تعليمية مماثلة تركز على كفاءات التعليم بين المهنيين والممارسة التعاونية ، وتحديداً من هذه المنطقة. Abstract: Objective: This article describes the process of developing an interprofessional education (IPE) module in autism spectrum disorder, which incorporates the interprofessional competencies and their applications among selected healthcare professional students. Method: The paper adapted the “Research and Development method for education research” by Borg and Gall as a basis for the study. The methods used were semi-structured interviews, focus group discussion, and a needs assessment questionnaire. Results: An interview guide, group discussion guide, and needs assessment questionnaire were validated with validity indices of 0.92, 0.98, and 1.00, respectively. A needs assessment questionnaire was tested for reliability (r = 0.96). The IPE module and evaluation tools to evaluate its effectiveness were prepared on the basis of the findings. Validity indices for module, simulation videos, case scenarios and the evaluation tools, Interprofessional Competency Assessment Test (IPCAT) and IPCAT-Observation Checklist (IPCAT-OC), were 0.98, 0.97, 1.00, 0.98, and 1.00, respectively. Reliability scores for IPCAT and IPCAT-OC were 0.87 and 0.90, respectively. Conclusion: This module will assist in providing data and necessary information for those researchers who undertake similar educational interventions that focus on the competencies of IPE and collaborative practice, specifically from this region