Mental Health Programme in India: Has the tide really turned?

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India’s NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.

Study Of High-Speed Solar Wind Streams Events & Solar Proton Density During Solar Cycles 22 & 23.

A geomagnetic storms is a global disturbance in Earth's magnetic field usually occurred due to abnormal conditions in the interplanetary magnetic field (IMF) & solar wind plasma emissions caused by various solar phenomenon. 138 solar wind streams in solar cycle 22 & 173 solar wind streams in solar cycle 23, have been found, which are associated with proton density, observed during 1986 to 2010. We have analyzed & studied them statistically. We have found that yearly occurrences of geomagnetic streams are strongly correlated with proton density in 11-years sunspot cycle, but no significant correlation between the maximum & minimum phase of solar cycle 22 & 23 have observed

Nurse-led translational research: An emerging field in multidisciplinary research

Translational research is well-known concept in healthcare still nurse-led translational research is an emerging area of multidisciplinary nursing research. This study intends to offer an in-depth look at translational research and the process for its applications in nursing education, practice, and research. Nurses, educators, researchers, and policymakers will better understand nurse scientists’ expanded role in education and clinical practice. This paper will assist the nurse educators, researchers to stay informed of translational research and its nursing impact. To develop a narrative synthesis study, a detailed systematic literature review was conducted in Pub Med, Web of Sciences, Scopus, ProQuest, Ovid using the keywords “translational research,” “nursing,” “implementation science,” “barriers in translational research” themes generated in selected paper are discussed in detail in this paper. 32 articles were found to be relevant to discuss the concepts of translational research in nursing practices. In contrast to basic research, translational research works cooperatively to assess the efficacy of evidence from the bench to the bed, from one realm to another. It requires the transparent method for dealing with roadblocks, such as following evidence-based recommendations while assessing evidence, so that policymakers can determine whether to embrace them for the development of the health-care system. Nurse-led translational research under the direction of a nurse scientist has the potential to advance nursing excellence in both clinical and community health settings.

Response of Conservation Agriculture on System Productivity and Carbon Sequestration in Rice-Based Cropping Systems

Low crop yields due to constant monocropping systems and deteriorating soil health in a smallholder farmers’ field of Indo-Gangetic plains of India have led to a quest for sustainable production practices with greater resource use efficiencies. The aim of the study was to elucidate the short term effects of conservation agricultural systems on productivity, soil health and carbon sequestration rate of soils in three different diversified cropping systems. The treatments consisted of two different tillage systems (conventional and reduced tillage), two mulch levels (no and straw mulch) and two levels of fertility (100 and 75% RDF) were compared in three rice-based cropping systems (rice-wheat; rice-vegetable pea-greengram; and rice-potato-maize sequences) for two years on an experimental field (clay loam) located at Norman E Borlaug Crop Research Center, Pantnagar, India. The resource conservation technologies (RCT) i.e. reduced tillage, mulch, and 100% RDF had recorded 2.5 and 3.0% higher system productivity and relative production efficiency in rice-vegetablepea-greengram and rice-potato-maize sequences, respectively in two consecutive years. Conservation tillage had sequestered three times higher carbon than conventional tillage while mulching acted four times higher than non-mulched condition in agricultural soils. Even though cropping system not significant significantly influenced on carbon sequestration, rice-vegetablepea-greengram sequence had recorded higher carbon sequestration rate and higher soil organic carbon stock noted in surface plough sole layer than any other cropping systems. Therefore, our results suggested that Indo-Gangetic farmers should consider adopting resource conservation practices together in indogangetic area because of benefits to soil health, carbon sequestration and system productivity.

Quality of routine immunization service: Perception of clients

Background: Immunization prevents over 2�million deaths each year worldwide. In India, even though vaccines are offered free of cost at public health facilities the coverage remains low. Limited scrutiny has been conducted at health service and client interface for routine immunization (RI) services, which may have been affecting the acceptance of vaccines. This emphasizes the importance of assessing the level of satisfaction and perceived quality of clients regarding RI services. Objectives: This study aimed to assess the perceived quality and level of overall general satisfaction with RI services of clients. In addition, determine the association of factors influencing clients perceived quality and overall general satisfaction with RI services. Methods: A community-based cross-sectional study was conducted in an urbanized village of Delhi from November 2015 to April 2017. A total of 279 RI visits were covered in the study, and the clients were interviewed at their residence using a pretested tool. Results: The dissatisfaction toward the domains of perceived quality of RI services was reported to be 3.2% for vaccine availability, 9.7% for vaccine information, 3.2% for staff behavior, 6.1% for doctor behavior, and 7.5% for infrastructure. Multivariable-regression analysis indicated that distance to health facility, literacy and age of the client, doctor behavior, staff behavior, and infrastructure had an effect on overall general satisfaction of client toward RI services. Conclusions: The client's perception is multidimensional; improvement in one domain is likely to strengthen the other. By understanding the client's perspective toward quality of RI service, the health-care mangers may improve the level of overall satisfaction.

Revisiting metastatic central nervous system tumors with unknown primary using clinicopathological findings: A single neurosciences institutional study

Background: Metastatic tumors are the most common central nervous system (CNS) tumors wherein the primary site remains unknown in most of the cases. Aim: The study was carried out to evaluate metastatic CNS tumors with unknown primary by using simplified diagnostic (clinico-histopathologic) approach. Material and Methods: A 2 years study was conducted on 32 cases of CNS metastases having unknown primary tumors in a neurosciences institute. Statistical Analysis: All the results were prepared using software version of SPSS 22. Results: The most common metastatic site found in brain was cerebrum (59.3%) [frontal > frontoparietal > parieto-occipital > temporal] [left cerebrum > right cerebrum], followed by cerebellum (12.5%), spinal cord (9.3%), and leptomeninges (3.12%). Most of the metastatic tumors presented as ill-defined (34%) rather than well-defined (22%) lesions with ring enhancement seen only in 16% of the cases on magnetic resonance imaging (MRI).On histopathology findings with targeted immunohistochemistry, most common histological tumor type identified irrespective of site was adenocarcinoma (68.7%), followed by squamous cell carcinoma (15.6%) and poorly differentiated carcinoma (12.5%). Only one case of lymphoma was reported. Corroborating all the above findings along with clinical history and other relevant investigations, primary sites could be detected in 23 cases (71.8%).The most common primary site deduced was lungs (39.1%), followed by thyroid (17.3%), breast in females (13.0%), gastrointestinal tract (8.6%), and prostate in males (4.3%). Only in nine cases (28.1%) with mainly poorly differentiated histopathological type, primary site remained unknown. Conclusion: Detection of the primary site in metastatic CNS tumors is possible by adopting this simple and effective diagnostic approach at centers/hospitals having cost and other constraints.

Workplace violence against resident doctors: A multicentric study from government medical colleges of Uttar Pradesh

According to the World Health Organization, between 8% and 38% of health workers suffer physical violence at some point in their careers. This multicentric study was conducted to find the prevalence, perceived risk factors, and measures to prevent workplace violence among doctors. The sample consisted of all 2nd- and 3rd-year resident doctors (n = 305) from three colleges in Uttar Pradesh. An anonymous, pretested in a similar setting, self-administered questionnaire was used. 69.5% of doctors reported to have experienced violence in one or other form in the past 1 year. In most incidents, relatives and attendants (69.3%) were involved in violence. No action was taken immediately in regard to violence in 35.3% of instances; 60.3% of study participants reported that they had repeated disturbing memories, thoughts, or images of the attack. Nonavailability of medicines (38.6%) and less staff (36.7%) were cited as top reasons behind violence.

Peripheral neuropathy and the role of nerve biopsy: A revisit

Background: Nerve biopsy has been widely used to investigate patients with peripheral neuropathy and in many centers, it is still a part of the diagnostic armamentarium. In this study, the histopathological spectrum of the nerve biopsies received is being revisited to analyze the various clinical and pathologic features and also to assess their relevance. Materials and Methods: Retrospective analysis of the data retrieved was done for 74 cases of nerve biopsies. Results: On the basis of the data and histopathological features, broad diagnoses were obtained in 52 cases and further categorized into biopsies being supportive for patient management (including acute and chronic axonopathies and demyelinating neuropathies) and biopsies considered essential for patient management (including vasculitic neuropathies, leprous neuropathies, hereditary neuropathies, and chronic inflammatory demyelinating neuropathies). Nine nerve biopsies did not show any abnormal histopathological features, while 13 nerve biopsies were found to be inadequate for diagnosis, both these groups were categorized as noncontributory. Conclusion: With advanced nerve conduction studies available, nerve biopsy is losing its relevance. However, in our experience, nerve biopsy did complement the clinical findings and nerve conduction studies, with which a close correlation is required to make the histopathology of nerve biopsy more relevant in terms of guiding further specific workup and management.

Effect of photoperiod and temperature on testicular regression in Channa punctatus.

In Channa punctatus testicular regression commonly observed during spawning and postspawing phases of reproductive cycle. In the present study, testicular regression was frequently noticed in fish maintained under both long photoperiod-warm temperature (LD 16 : 8-300C) and short photoperiod-warm temperature (LD 8 : 16-30oC) regimes. Testicular regression was characterized by distortion of cellular boundary of lobules and formation of collagenous capsules containing degenerating germ cells, blood cells and colloidal mass within the lobules. The magnitude of testicular regression was more in fish exposed to short photoperiod regime (R-73.33%, SP-41.67%) than long photoperiod regime (R-50.83%, SP-19.16%) and control group (R-20.83%, SP-16.67%) in both resting (R) and spawning (SP) phases. Further, the frequency of testicular regression during resting phase was 73.33% (short photoperiod), 50.83% (long photoperiod) and 20.83% (control) whereas during spawning phase was 41.67% (short photoperiod) 19.16% (long photoperiod) and 16.67% (control). In the present study, occurrence of more testicular regression during resting phase than spawning phase may be due to change in the endogenous condition of the fish.

Skill building programme in population-based research for medical undergraduates: learners' feedback.

OBJECTIVES & METHODS: A training programme in population-based research was introduced for interns in 1993, in a Delhi medical school. Guided by the persistent feedback from learners, the timing of such training was advanced to MBBS para-clinical phase in 1999--integrated with 10 months first slot of community medicine posting. Present article analyzes learners' feedback on this newly designed training programme from 16 consecutive batches from 2002-2006. RESULTS: In 7 of the 9 units of learning, around 90% of the students rated their participatory involvement at > or = 3 points on a 5 point rating scale. This rating was best in data collection (97.8%); and identification of research question (97.6%)--and least in presentation of report (48.7%); and report writing (61.8%). For 77.6% of the students, this was their first hands-on experience in population-based research. Over 55% of the students expressed their willingness to maintain their interest in population-based research after finishing the community medicine posting. On the other hand, 22.6% distinctly expressed their unwillingness in this regard. Main reasons cited by unwilling/not sure students were: 'low level of personal interest in population-based research' (39.7); 'such activity was not contributory in getting admission to postgraduate courses' (33.2%); and 'Not so useful in likely job responsibilities' (21.2%). Almost half (48.9%) of the students chose para-clinical phase as most suitable period of MBBS for such learning exposure. Pre-clinical; clinical; and internship phases were preferred by 19.7%, 13.9%, and 10.7% respectively. CONCLUSION: Present feedback provides us a broad direction in opting for the para-clinical phase where exposure to population-based research can be effectively placed on a systematic basis, without extra resources.

Health-risk behaviors related to road safety among adolescent students.

BACKGROUND: Injuries are now a major cause of death and disability among the adolescents in the world. Road accidents are the main cause of death of young men worldwide. OBJECTIVE: To study health-risk behavior related to road safety amongst adolescent students in south Delhi and its epidemiological correlates. STUDY DESIGN: Cross-sectional study. SETTING: Three schools and two colleges in south Delhi. PARTICIPANTS: Five hundred fifty adolescent students aged 14-19 years selected by cluster sampling. STATISTICAL ANALYSIS: Proportions, Chi-square test, multivariate logistic regression. RESULTS: More than half (52.4%) reported 'not always' wearing a seat belt. About 72.1% (300) of two-wheeler riders reported 'not always' and 23.3% (97) reported 'never' wearing a helmet. Nearly 20% (91) students rode with a driver who had alcohol before driving, and 37.3% (185) subjects had driven with a driver not possessing a driving license, in the past 30 days. Such 'road-hazard' behaviors were found to be significantly more in males and in lower-age groups. Logistic regression analysis revealed that the significant correlates of such behaviors were gender of the respondent and living status of the parents. Almost 77.5% (426) of the respondents were 'at risk' as far as behaviors related to safety on roads are concerned. CONCLUSION: The results should evoke earnest responses from the government, policy makers and all personnel concerned with adolescent welfare on how best to reduce the extent of this preventable problem.

Predictors of knowledge about malaria in India.

BACKGROUND & OBJECTIVES: Reduction of malarial morbidity and mortality is important to meet the overall objectives of reducing poverty and has been included in the Millennium Development Goals. To achieve these targets it is imperative to have active community participation to control malaria. Community participation in turn depends on people's knowledge and attitude towards the disease.This study was conducted to examine the factors that predict the knowledge of Indian population regarding malaria. A questionnaire based cross-sectional survey was conducted for data collection. RESULTS: Data were collected from 15,750 adult respondents using a pre-tested questionnaire representing urban, rural, tribal and slum population from 21 states. Knowledge about various aspects of malaria was tested using a structured questionnaire. Logistic regression analysis was applied to determine predictors of knowledge about etiology, clinical features, mode of transmission, prevention and control. INTERPRETATION & CONCLUSION: Common predictors of correct knowledge about etiology and clinical features of malaria were male sex and college education. Female sex, illiteracy and tribal population were more likely to have been associated with wrong beliefs about fatality of malaria. Being tribal respondent was the single most important predictor of inadequate knowledge. Similarly, use of smoke for killing of adult mosquito was predicted by rural or slum residence and illiteracy. All findings were based on logistic regression analysis. Geographical variations also influenced knowledge about malaria. It may be inferred that improvement in knowledge, attitude and practices related to malaria may be attained only after looking at its predictors at micro level. However, a strategic framework at national level is certainly needed to provide directions at local level.

Psychological problems and quality of life in children with thalassemia.

OBJECTIVE: The study is aimed to assess psychological problems and quality of life (QOL) in children with thalassemia. METHODS: Thirty-nine children (8-16 yr) with transfusion dependent thalassemia attending day care services for blood transfusion were assessed for psychological problems using the Childhood Psychopathology Measurement Schedule and QOL was assessed using the EQ-5D. RESULTS: Forty-four percent of the children had psychological problems and 74% had a poor QOL. Anxiety-related symptoms (67%), emotional problems, particularly depression (62%) and conduct problems (49%) were the main findings. The children were most likely to report impaired QOL due to severe difficulties in pain/discomfort (64%) dimension, followed by depression and mobility problems of equal severity (33%). The side effects of chelation were an independent predictor of psychological problems and impaired QOL. Also psychological problems were a significant predictor of impaired QOL. CONCLUSION: The recognition and management of the psychological problems that accompany chronic physical illnesses including thalassemia would optimize treatment outcomes and QOL.

Osmotic adjustment increases water uptake, remobilization of assimilates and maintains photosynthesis in chickpea under drought.

Eight chickpea advanced breeding lines (ABLs) and their parents were evaluated for osmotic adjustment (OA), leaf carbohydrates and gas exchange under dryland field . These (ABLs) were derived from crosses between CTS 60543 x Kaniva and Tyson x Kaniva. Mean leaf water potential (LWP) fell down from -1.00 MPa at pre-stress level to about -2.25 MPa during terminal stress. Relative water content (RWC) showed periodic changes with alternate decrease or increase at certain interval, which also influenced the values of OA (low or high) in number of genotypes e.g. Kaniva, CTS 60543, Tyson and M 75. Significant variation in OA ranging 0.45 to 0.88 MPa was observed at high level of stress at -2.5 MPa. However, none of the genotypes showed stability of OA over the period of stress. Leaf starch declined even at mild stress (LWP, -1.6 MPa) resulting in an increase in hexose sugars and activation state of sucrose-phosphate synthase (SPS) that led to accumulation of sucrose. Both photosynthesis (Pmax) and transpiration decreased concurrently in two chickpea lines M 129 and Tyson with increasing water stress. However, rate of decline in the photosynthesis slowed down even drought was further intensified. The observed periodic changes in OA, RWC and photosynthesis appeared to be associated with drought-induced changes in SPS and carbohydrates which modify water uptake of the leaves.

Profile of animal bite cases in Pune.

A Cross-sectional study was carried out to determine the profile of animal bite cases reporting to the Anti Rabies clinic of Sassoon Hospital, rune. The data was collected using pretested questionnaire. All 250 cases who reported during the period of study were included in the analysis. The male female ratio was 1.98 : 1. Children in the age group 0-14 years were the victims in 132 (52.8%) cases. Dog was the biting animal in 94.4% cases, followed by cat (2.4%), Jackal (1.2%), mongoose (1.2%), monkey (0.4%) and horse (0.4%). Of the 236 dog bite cases 30% of bites were inflicted by pet dogs of which only 38.02% were immunized. The wound was washed with soap and water in only 3.6% of cases. 64.8% of the bites were on the lower extremity and 63.2% of cases reported within 24 hours of the bite. Of the 247 cases administered Beta Propio Lactone (BPL) inactivated vaccine only 18.8% did not have any local reaction and 58.3% had one or more systemic reaction. A three pronged strategy has been recommended to reduce the burden of morbidity and mortality associated with rabies.