Aseptic-clinical hand hygiene knowledge survey amongst health care workers in a tertiary care hospital in Western India

Background: Maintenance of hand hygiene among health care workers (HCWs) is the cornerstone of infection prevention and control programmes in a health care facility. Poor hand hygiene amongst HCWs is the single most common cause of cross-transmission of infections between patients and HCWs in the hospital. The objective of this study was to identify the risk factors for non-adherence and assess the knowledge regarding maintenance of hand hygiene amongst health care workers at a tertiary health care centre in Western India.Methods: A descriptive, cross-sectional study was conducted on HCWs - doctors, undergraduate students and staff nurses at a tertiary care hospital and post-graduate institute in western India after ethical committee clearance. A self-report questionnaire by the World Health Organisation (WHO) for the Hand Hygiene Knowledge Survey (2009), which consisted of ten questions and “My 5 moments of hand hygiene”, was answered by the study participants after their written/informed consent. Data was analysed using one-way Anova and Student’s t-tests.Results: 317 participants responded to the survey which included 131 doctors, 111 medical students and 75 staff nurses. 90.85% participants routinely used an alcohol-based hand rub (ABHR) but their overall hand hygiene knowledge score was only 61.04%. Prior formal training in hand hygiene significantly improved the knowledge of HCWs (P<0.001). There was a significant difference between the knowledge and actual practice of “My 5 Moments of hand hygiene”.Conclusions: Hand hygiene knowledge remains unsatisfactory till date amongst HCWs. There is a need to educate HCWs through frequent training session’s right from the time of undergraduate medical study

The power of narrative persuasion: how an entertainment-education serial drama tackled open defecation and promoted contraceptive use in India

Television and radio serial dramas have been used as an effective entertainment-education (EE) strategy to address complex health and social issues around the world. In this article, we analyse India’s experience with the EE television serial, Main Kuch Bhi Kar Sakti HoonSeason 3 (I, A Woman, Can Achieve Anything, hereafter MKBKSH-3), broadcasted in 2019. Produced by Population Foundation of India, MKBKSH-3purposely employed principles of narrative persuasion to tackle open defecation, promote contraceptive use, and advocate for gender equality in a deeply entrenched patriarchal system. As part of a larger programme evaluation, we conducted data collection using two complementary methods: (1) field experiments in Uttar Pradesh’s Kanpur Dehat district with repeated measures among viewers and non-viewers; and (2) viewer surveys through the popular interactive voice response system with callers from across 28 states and union territories. Wherever possible, we kept questions consistent to help triangulate research findings. Our results indicate a significant increase in toilet ownership and decrease in open defecation among MKBKSH-3viewers. Further, MKBKSH-3’scharacters and storylines helped raise awareness of injectable contraceptives, and viewers—both male and female—displayed an increased likelihood of moving toward adopting contraceptives that were promoted. These empirical findings add to the growing literature on the value of entertainment-education serial dramas as enabling media for social and behaviour change.publishedVersio

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

A Multicenter, Randomized, Placebo‐Controlled Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Patients With Rheumatoid Arthritis

Objective: Rheumatoid arthritis (RA) is associated with increased cardiovascular event (CVE) risk. The impact of statins in RA is not established. We assessed whether atorvastatin is superior to placebo for the primary prevention of CVEs in RA patients. Methods: A randomized, double‐blind, placebo‐controlled trial was designed to detect a 32% CVE risk reduction based on an estimated 1.6% per annum event rate with 80% power at P 50 years or with a disease duration of >10 years who did not have clinical atherosclerosis, diabetes, or myopathy received atorvastatin 40 mg daily or matching placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization. Secondary and tertiary end points included plasma lipids and safety. Results: A total of 3,002 patients (mean age 61 years; 74% female) were followed up for a median of 2.51 years (interquartile range [IQR] 1.90, 3.49 years) (7,827 patient‐years). The study was terminated early due to a lower than expected event rate (0.70% per annum). Of the 1,504 patients receiving atorvastatin, 24 (1.6%) experienced a primary end point, compared with 36 (2.4%) of the 1,498 receiving placebo (hazard ratio [HR] 0.66 [95% confidence interval (95% CI) 0.39, 1.11]; P = 0.115 and adjusted HR 0.60 [95% CI 0.32, 1.15]; P = 0.127). At trial end, patients receiving atorvastatin had a mean ± SD low‐density lipoprotein (LDL) cholesterol level 0.77 ± 0.04 mmoles/liter lower than those receiving placebo (P < 0.0001). C‐reactive protein level was also significantly lower in the atorvastatin group than the placebo group (median 2.59 mg/liter [IQR 0.94, 6.08] versus 3.60 mg/liter [IQR 1.47, 7.49]; P < 0.0001). CVE risk reduction per mmole/liter reduction in LDL cholesterol was 42% (95% CI −14%, 70%). The rates of adverse events in the atorvastatin group (n = 298 [19.8%]) and placebo group (n = 292 [19.5%]) were similar. Conclusion: Atorvastatin 40 mg daily is safe and results in a significantly greater reduction of LDL cholesterol level than placebo in patients with RA. The 34% CVE risk reduction is consistent with the Cholesterol Treatment Trialists’ Collaboration meta‐analysis of statin effects in other populations

25th annual computational neuroscience meeting: CNS-2016

The same neuron may play different functional roles in the neural circuits to which it belongs. For example, neurons in the Tritonia pedal ganglia may participate in variable phases of the swim motor rhythms [1]. While such neuronal functional variability is likely to play a major role the delivery of the functionality of neural systems, it is difficult to study it in most nervous systems. We work on the pyloric rhythm network of the crustacean stomatogastric ganglion (STG) [2]. Typically network models of the STG treat neurons of the same functional type as a single model neuron (e.g. PD neurons), assuming the same conductance parameters for these neurons and implying their synchronous firing [3, 4]. However, simultaneous recording of PD neurons shows differences between the timings of spikes of these neurons. This may indicate functional variability of these neurons. Here we modelled separately the two PD neurons of the STG in a multi-neuron model of the pyloric network. Our neuron models comply with known correlations between conductance parameters of ionic currents. Our results reproduce the experimental finding of increasing spike time distance between spikes originating from the two model PD neurons during their synchronised burst phase. The PD neuron with the larger calcium conductance generates its spikes before the other PD neuron. Larger potassium conductance values in the follower neuron imply longer delays between spikes, see Fig. 17.Neuromodulators change the conductance parameters of neurons and maintain the ratios of these parameters [5]. Our results show that such changes may shift the individual contribution of two PD neurons to the PD-phase of the pyloric rhythm altering their functionality within this rhythm. Our work paves the way towards an accessible experimental and computational framework for the analysis of the mechanisms and impact of functional variability of neurons within the neural circuits to which they belong

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Aseptic-clinical hand hygiene knowledge survey amongst health care workers in a tertiary care hospital in Western India

Background: Maintenance of hand hygiene among health care workers (HCWs) is the cornerstone of infection prevention and control programmes in a health care facility. Poor hand hygiene amongst HCWs is the single most common cause of cross-transmission of infections between patients and HCWs in the hospital. The objective of this study was to identify the risk factors for non-adherence and assess the knowledge regarding maintenance of hand hygiene amongst health care workers at a tertiary health care centre in Western India.Methods: A descriptive, cross-sectional study was conducted on HCWs - doctors, undergraduate students and staff nurses at a tertiary care hospital and post-graduate institute in western India after ethical committee clearance. A self-report questionnaire by the World Health Organisation (WHO) for the Hand Hygiene Knowledge Survey (2009), which consisted of ten questions and “My 5 moments of hand hygiene”, was answered by the study participants after their written/informed consent. Data was analysed using one-way Anova and Student’s t-tests.Results: 317 participants responded to the survey which included 131 doctors, 111 medical students and 75 staff nurses. 90.85% participants routinely used an alcohol-based hand rub (ABHR) but their overall hand hygiene knowledge score was only 61.04%. Prior formal training in hand hygiene significantly improved the knowledge of HCWs (P&lt;0.001). There was a significant difference between the knowledge and actual practice of “My 5 Moments of hand hygiene”.Conclusions: Hand hygiene knowledge remains unsatisfactory till date amongst HCWs. There is a need to educate HCWs through frequent training session’s right from the time of undergraduate medical study

Time Lags in Narrow-Line Seyfert 1 Galaxies and the Origin of Their Soft Excess Emission

The origin of soft X-ray excess emission from type 1 active galactic nuclei has remained a major problem for the last two decades. It has not been possible to distinguish alternative models for the soft excess emission despite the excellent data quality provided by XMM-Newton and Chandra. Here we present observations of time lags between the soft and hard band X-ray emission and discuss the implications to the models for the soft excess. We also device a method to distinguish the models for the soft excess using Suzaku's broadband capability.Comment: 4 pages, To appear in the conference proceedings "The Extreme Universe in the Suzaku Era" (Progress of Theoretical Physics, Supplement