Validation of a structured questionnaire to assess the perception and satisfaction of respiratory therapy students toward career prospects and learning resources.

Background: Respiratory therapy is an emerging profession that has existed in India since 1995. Respiratory therapy students will play a significant role in strengthening various aspects of healthcare in the future. There are no validated instruments to evaluate students' perceptions of their careers and satisfaction with the learning resources. The primary objective of the current study is to develop and validate a structured questionnaire (SQ) for respiratory therapy students in India, encompassing all the components of their career development and satisfaction. Methods: Based on the literature review and content validity from respiratory therapy experts through multiple focused group discussions, a reliable SQ was generated with 40 items based on the Likert scale. After getting institutional ethics clearance and informed consent, the SQ was administered to 904 respiratory therapy students across the country. We performed principal component analysis (PCA), structural equation modeling, and confirmatory factor analysis (CFA) for the global fit. Cronbach's alpha was performed to estimate the internal consistency. Results: The PCA generated a 4-factor model, and internal consistency for the total scale exceeded the standard criterion of >0.70. Satisfactory goodness of fit data were yielded from CFA. Average variances extracted were higher than the correlation coefficients of the factors, which show sufficient discriminant validity. Conclusion: This study shows a clinically acceptable model, it fits and suggests the possibility of applying a SQ to a respiratory therapy student with relatively good construct validity and internal consistency, based on the results of CFA.

Effects of Yoga Versus Sham Yoga on Oxidative Stress, Glycemic Status, and Anthropometry in Type 2 Diabetes Mellitus: A Single-Blinded Randomized Pilot Study.

Studies have shown a beneficial role of yoga in tre a t i n g type 2 diabetes mellitus. The present study proceeds in the field by providing an active control. We aimed to evaluate the effect of 3 months of yoga on oxidative stress, glycemic status, and anthropometry in type 2 diabetes mellitus. Forty participants were randomized to receive either yoga (n = 20) or sham yoga (n = 20) as a control. Yoga included postures and breathing exercises, and nonaerobic stretching exercise comprised the control. Significant within-group differences in malondialdehyde, vitamin C, superoxide dismutase, fasting blood glucose, glycosylated hemoglobin, body mass index, waist circumference, and blood pressure were evident in both groups. Yoga participants had significantly greater improvement in reduced glutathione compared to controls. No significant differences between groups were observed in any other outcome variables. Yoga and sham yoga had identical effects on oxidative stress, glycemic status, and anthropometry in type 2 diabetes mellitus. Levels of reduced glutathione improved only in the yoga group. This research needs to be confirmed by larger and sufficiently powered studies.

Assessment of fatigability, depression, and self-esteem among head-and-neck carcinoma patients in a tertiary care hospital in South India.

BACKGROUND: Head and Neck Carcinoma (HNCs) are the most common form of cancer in India. Patients with head-and-neck carcinomas often suffer from various distressing symptoms. The exact cause of these symptoms, as to whether disease or treatment or other factor induced, needs to be established. OBJECTIVES: This study was done to assess fatigability, depression, and self-esteem among HNC study group before start, during, and in postradiation period and to find out the determinants of these parameters. MATERIALS AND METHODS: Seventy newly diagnosed HNC patients and equivalent number of age- and gender-matched controls were interviewed using standardized questionnaires, before start of concurrent chemoradiotherapy (CCRT). The study group patients were interviewed again in the 4th week and postcompletion of CCRT in the 7th week. RESULTS: Mean age of the study group was 55.1 ± 11.3 years. Three-fourth of them (52 [74.3%]) were males. Majority of them (26 [37.1%]) had oral carcinomas. Baseline fatigue (P < 0.001) and depression scores (P < 0.001) were significantly more, while self-esteem scores (P = 0.004) were significantly less among the study group compared to controls before the onset of radiation. Mean fatigue and depression scores were found to significantly increase (P < 0.001), while self-esteem scores were found to significantly deteriorate (P < 0.001) over the course of CCRT among these patients. There was significant positive correlation (P < 0.001) between fatigue and depression scores and negative correlation (P < 0.001) of these parameters with self-esteem scores before, during, and after CCRT. There was no association between age and gender of the study group with any of these parameters. Multivariate analysis showed that baseline fatigue was significant (P < 0.001) and, depression after completion of the entire course of CCRT was significantly influenced by baseline depression levels (P = 0.011). CONCLUSIONS: Fatigue and depression need to be periodically screened among HNC study group on CCRT so as to initiate prompt remedial measures for its alleviation.

Development of a Modified Disability Questionnaire for Evaluating Disability Caused by Backache in India and Other Developing Countries.

STUDY DESIGN: Prospective observational study. PURPOSE: To evaluate the disability domains relevant to Indian patients with low backache and propose a modified disability questionnaire for such patients. OVERVIEW OF LITERATURE: The Oswestry Disability Index (ODI) is a self-reported measurement tool that measures both pain and functional status and is used for evaluating disability caused by lower backache. Although ODI remains a good tool for disability assessment, from the Indian perspective questions related to weight lifting and sexual activity of ODI are questioned in some of the earlier studies. Activities of daily living in Indian patients vary substantially from those in other populations and include activities like bending forwards, sitting in floor and squatting which are not represented in the ODI. METHODS: In this prospective observational study, a seven-step approach was used for the development of a questionnaire. Thirty patients were interviewed to identify the most challenging issue they faced while performing their daily activities (by free listing) and understand how important the questionnaire items were in terms of the standard ODI. Thus, a comprehensive disability questionnaire comprising 14 questions was developed and administered to 88 patients. Both qualitative (interviews) and quantitative methods (to establish the validity, reliability, and correlation with the Visual Analog Scale [VAS] and Rolland Morris disability questionnaire) were used to identify the 10 questions that best addressed the disability domains relevant to Indian patients. RESULTS: According to free listing, four new questions pertaining to bending forward, sitting on the floor, walking on uneven surfaces, and work-related disabilities were included. In the second phase, wherein the questionnaire with 14 items was used, 56.8% patients did not answer the questions related to sexual activity, whereas 23.8% did not answer those related to walking on uneven surfaces. The modified questionnaire demonstrated good internal consistency (Cronbach's alpha=0.892) and correlation with the Rolland Morris questionnaire (Cronbach's alpha=0.850, p>0.05), as well as with the VAS score for disability (Cronbach's alpha=0.712, p>0.05) and pain (Cronbach's alpha=0.625, p>0.05). CONCLUSIONS: A modified disability questionnaire that was designed by adding two questions related to bending forward and work status and removing questions related to sexual activity and weight lifting or traveling (depending on the occupation) can help evaluate disability caused by back pain in Indian population.

Knowledge, Attitude, and Practice of Yoga in Medical Students: Assessment of Anthropometry and Lifestyle Factors.

Medical students often experience significant stress during their undergraduate training. Evidence has shown short-term yoga to be effective in decreasing stress in students. This study aimed to assess knowledge about, attitude toward, and practice of (KAP) yoga among medical students. A secondary objective was to analyze their dietary habits and physical activity. Participants consisted of 224 medical students aged 18-23 years in pre- and paraclinical groups. A closed-ended KAP questionnaire was used to collect data. Anthropometric measurements were taken. Results showed that paraclinical students (70.5%) favorably perceived the health benefits of yoga. Nearly three-fourths of study subjects had previously practiced yoga; greater numbers intended to practice yoga in the future. About 95.5% of the preclinical students who had done yoga had discontinued the practice. Perceived barriers to the practice of yoga were lack of time, insufficient facilities, lack of company, and lack of interest. Consideration of the undergraduates' lifestyle revealed that 50.4% of preclinical students did not exercise, and they routinely consumed more junk food with fewer servings of fresh fruits/salads. Preclinical students exhibited higher BMI and waist circumference compared to paraclinical students. Findings suggest that knowledge of and attitude regarding yoga were good among medical undergraduates.

Antibiogram and genetic relatedness of clinical isolates of Enterococcus spp. in Mangalore, India.

INTRODUCTION: Drug-resistant Enterococcus species is a persisting clinical problem and may serve as a reservoir of resistant genes. The present study was undertaken in Mangalore, India to know the antibiogram and genetic relatedness of Enterococcus spp. isolated from clinical samples. METHODOLOGY: A total of 150 non-repetitive Enterococcus spp. isolated from clinical samples were subjected to antimicrobial susceptibility testing by Kirby Bauer disk diffusion method. Molecular typing of the isolates was done by Random amplification of polymorphic DNA (RAPD). RESULTS: Among the 150 isolates, 79 were from urine, 68 from pus and three from blood samples. Of this 58.7 % were E. faecalis and the remaining were E. faecium. Urinary isolates of E. faecium showed a higher percentage of antibiotic resistance when compared to E. faecium isolates from pus (p < 0.001). E. faecium from blood samples were resistant to ampicillin, penicillin, ciprofloxacin and were sensitive to vancomycin and teicoplanin. E. faecalis blood isolates were resistant to ciprofloxacin, penicillin, and erythromycin. 73% of Enterococcus isolates from pus were resistant to erythromycin. All the Enterococcus spp. were sensitive to vancomycin. Among the total Enterococcus isolates 44 were high-level aminoglycoside resistant (HLAR) by disc diffusion method which corresponded to MIC of > 500 µg/mL for gentamicin and > 1000 µg/mL for streptomycin. These isolates were subjected to RAPD, which showed similarity and differences in the banding patterns. CONCLUSIONS: Our study showed a baseline resistance among Enterococcus spp. in our area, which poses a challenge to the treating physicians and a reservoir for transmission of antibiotic resistant genes.

Problem-Based Learning as an Effective Learning Tool in Community Medicine: Initiative in a Private Medical College of a Developing Country.

BACKGROUND: Knowledge of community medicine is essential for health care professionals to function as efficient primary health care physicians. Medical students learning Community Medicine as a subject are expected to be competent in critical thinking and generic skills so as to analyze community health problems better. However, current teaching by didactic lectures fails to develop these essential skills. Problem-based learning (PBL) could be an effective strategy in this respect. This study was hence done to compare the academic performance of students who were taught Community Medicine by the PBL method with that of students taught by traditional methods, to assess the generic skills of students taught in a PBL environment and to assess the perception of students toward PBL methodology. MATERIALS AND METHODS: This study was conducted among seventh-semester final-year medical students between June and November 2014. PBL was introduced to a randomly chosen group of students, and their performance in an assessment exam at the end of postings was compared with that of the remaining students. Generic skills and perception toward PBL were also assessed using standardized questionnaires. RESULTS: A total of 77 students took part in the brainstorming session of PBL. The correlation between self-assigned scores of the participants and those assigned by the tutor in the brainstorming session of PBL was significant (r = 0.266, P = 0.05). Out of 54 students who took part in the presentation session, almost all 53 (98.1%) had good perception toward PBL. Demotivational scores were found to be significantly higher among males (P = 0.024). The academic performance of students (P < 0.001) and success rates (P = 0.05) in the examination were higher among students who took part in PBL compared to controls. CONCLUSION: PBL helped improve knowledge of students in comparison to those exposed only to didactic lectures. As PBL enabled students to identify the gaps in their knowledge and enhanced their group functioning and generic skills, we recommend PBL sessions: They would help optimize the training in Community Medicine at medical schools. Good correlation of tutor and self-assessment scores of participants in the brainstorming session suggests that the role of tutors could be restricted to assessment in presentation sessions alone. Demotivation, which hinders group performance in PBL, needs to be corrected by counselling and timely feedback by the tutors.

Prevalence, risk factors and treatment practices in diarrhoeal diseases in south India.

OBJECTIVES: This study was done to determine the risk factors, management practices and awareness about diarrhoea. METHODS: It was a cross sectional study done in a semi urban and rural areas of South Canara district of India in February 2013. A total of 167 households (575 study population) chosen systematic randomly were visited and one adult member in each house was interviewed. The houses were also inspected to assess the living conditions. RESULTS: Mean age of study population was 31.1 ± 20.2 years. The period prevalence of diarrhoea was 69 (12 %). Commonest associated symptoms in cases of diarrhoea were fever 30 (43.4 %) followed by abdominal cramps 29 (42 %). Nearly half of the cases with diarrhoea 34 (49.3 %) did not take any medications. Commonest treatment taken was allopathic medicines 26 (37.8 %) followed by home remedies 8 (22.9 %). Age ≤10 years (p < 0.001) was associated with risk of developing diarrhoea using binary logistic regression analysis. Among the 167 participants, awareness level about the disease was poor among 16 (9.6 %) and moderate among 149 (89.2 % participants). Awareness level was more among females (p = 0.001) and literate participants (p = 0.013). One hundred and sixteen (69.5 %) participants were not aware of any sign or symptom of dehydration other than loose stools. Majority of the participants 138 (82.6 %) preferred home remedies as the initial management of diarrhoea. Misconception about fluid restriction in diarrhoea was stated by 12(7.2 %) participants. CONCLUSION: Public education program on proper feeding and management practices is required to address the various issues identified and for containment of diarrhoea cases in future.

Faculty Perception Towards a "Hybrid" Problem Based Learning Methodology.

This sequential quantitative and qualitative study was done to assess the perception of faculties towards a hybrid Problem Based Learning (PBL) methodology. To begin with, all faculty members of the department featured in a round of PBL facilitation. Later in phase I, their perception was assessed using a validated self-administered questionnaire. In phase II, personalized interview was conducted with each faculty. Finally phase (III) involved a focus group discussion on issues identified in previous phases. Among the 10 faculties, 9 had good and 1 had average perception about PBL. The various issues brought out by faculty in phase (II) and (III) were; need of formalized training in PBL for facilitators, need of integrated PBL sessions, need of variety of PBL exercises and need of student's assessment for every session.

Fast Food Consumption Pattern and Its Association with Overweight Among High School Boys in Mangalore City of Southern India.

CONTEXT: Fast foods are quite popular among children owing to taste, appearance and hype created by mass media. However, the increased incidence of lifestyle disorders seen now-a-days at an early age could be attributed to fast foods. AIM: This study was done to assess the awareness of health hazards, consumption pattern of fast foods and to find out its association with overweight among high school students. SETTINGS AND DESIGN: This cross-sectional study was done among boys of 3 private schools in Mangalore city in March 2012. MATERIALS AND METHODS: Data was collected using a semi-structured self-administered questionnaire. STATISTICAL ANALYSIS: Chi-square test, one-way ANOVA and binary logistic regression analysis was used for analysis. P-value ≤ 0.05 was considered as statistically significant association. RESULTS: Mean age of boys was 13.5±0.9 years. Out of 300 participants, 41(13.7%) were overweight and 8 (2.7%) were obese. 292(97.3%) were fast food users of which 42(14.4%) consumed it every day. Majority of participants were introduced to fast foods through television commercials 193(64.3%). 73(57%) developed this habit as they were bored with home food. Awareness of harmful effects of fast food consumption was known to 186(62%) students and this was found to be associated with the perceived need to control its usage (p<0.001). Parental consumption of fast foods was found to influence fast food consumption among children (p=0.024). As many as 68(22.7%) and 206(68.7%) children were not eating vegetables and fruits respectively every day. Increased frequency of fast food consumption in a week was found to be associated with overweight or obesity among children after adjusting the effects of confounders (p=0.003). CONCLUSION: Awareness on health hazards of fast foods needs to be taught at schools so as to minimize its consumption. Parents have to set an example themselves by not eating fast foods and improving home food to support discouragement of fast foods. This would minimize life style disorders among children to a greater extent.

Factors associated with morbidities among infants in three sub centre areas of belgaum district of South India: a longitudinal study.

BACKGROUND: Health status of infants is a sensitive indicator of development and factors influencing it need to be better understood. OBJECTIVES: This study was conducted to search for factors associated with morbidity among infants and to find out their influence on weight gain during infancy. MATERIALS AND METHODS: This longitudinal study was undertaken in south India from November 2004 till April 2006. A birth cohort of all children born during first 6 months of the study period were assessed at enrollment and followed up monthly till they attained 1 year of age. RESULTS: Incidence of morbidity among infants was found to be least among those exclusively breast fed (EBF) for 6 months and most when EBF for less than 6 months (P = 0.045). It was also more when infants were weaned with a combination of animal milk, formula milk, semi-solids and solid diet and least when weaned only with semi-solids and solids (P = 0.018). Diarrheal episodes were more in infants who were bottle-fed (P < 0.001). Weight gain between 6(th) and 12(th) month of infancy was found to be significantly affected by various morbidities (P = 0.001). Incidence of morbidities was less among preterm babies and more among partially immunized (P < 0.001) babies with birth order ≥ 3 (P = 0.012), babies of mothers with low socio-economic and educational status. Delayed milestones during infancy was seen more in babies with history of birth asphyxia (P = 0.018). CONCLUSION: Several factors influenced incidence of morbidities and these morbidities had a negative effect on weight gain. Hence these factors need to be addressed to promote better child health.

Infant rearing practices in South India: a longitudinal study.

BACKGROUND: Rearing practices are a major determinant of nutritional and health status of infants. Therefore these practices need to be better understood. OBJECTIVES: To find out infant rearing practices in the study area. MATERIALS AND METHODS: A longitudinal study was conducted on a birth cohort of 194 infants. Information on rearing practices and anthropometric measurements were recorded every month for a period of 1 year. RESULTS: Only 67 (34.5%) newborns were breast fed within half an hour of delivery. Prelacteal feeds was given to 65 (33.5%) newborns and this was seen more among home deliveries (P=0.018). Demand feeding was practiced by 169 (87.1%) mothers. Exclusive breast feeding (EBF) for 6 months was practiced by 81 (41.7%) mothers. Bottle feeding was seen in 7 (3.6%) cases. Weight gain during infancy was found to be maximum when infants were EBF for 6 months (P<0.001) and weaned with semi-solid and solid diet alone in the following 6 months (P=0.002). Gain in all anthropometric measurements was more in the initial 6 months of infancy compared to latter. Four (2.1%) infants were malnourished. Oil massage before bath was practiced by 189 (97.4%) mothers. Over 50% mothers practiced oil application to eyes or ears of infants. Delayed initiation of bath (beyond 1week) was seen in 15 (7.7%) cases. CONCLUSION: Faulty rearing practices need to be corrected in order to improve the health status of infants.

Quality of life among dentists in teaching hospitals in South Canara, India.

OBJECTIVES: This paper reports on the quality of life among dentists using World Health Organization Abbreviated Instrument for Quality of Life Assessment, comprising 26 items which measure the following broad domains: Physical health, psychological health, social relationships, and environment. MATERIALS AND METHODS: The instrument was self-administered among dentists in four teaching dental institutions. A total of 191 questionnaires were given out. Of those, 187 were consented and answered, making up a response rate of 97.9%. The internal consistency of the questionnaire, measured by Cronbach's alpha was estimated at 0.75. RESULTS: Highest mean score was seen for Domain 3 (Social relationships) (16.15 + 2.38) and the least score was for Domain 4 (Environment) (14.72 + 2.12). Higher proportions of respondents rated their quality of life as good (65.1 percent), and also majority of dentists (63.5 percent) were satisfied with their health. CONCLUSION: Quality of life recognizes the value of an individual's health in the broader psychologic and social aspects of his/her life. In this study, the overall rating of quality of life among dentists in teaching hospitals is good.

Effect of 3-month yoga on oxidative stress in type 2 diabetes with or without complications: a controlled clinical trial.

OBJECTIVE: To assess the effect of yoga on anthropometry, blood pressure, glycemic control, and oxidative stress in type 2 diabetic patients on standard care in comparison with standard care alone. RESEARCH DESIGN AND METHODS: The study involved 123 patients stratified according to groups with microvascular complications, macrovascular complications, and peripheral neuropathy and without complications and assigned to receive either standard care or standard care along with additional yoga for 3 months. RESULTS: In comparison with standard care alone, yoga resulted in significant reduction in BMI, glycemic control, and malondialdehyde and increase in glutathione and vitamin C. There were no differences in waist circumference, waist-to-hip ratio, blood pressure, vitamin E, or superoxide dismutase in the yoga group at follow-up. CONCLUSIONS: Yoga can be used as an effective therapy in reducing oxidative stress in type 2 diabetes. Yoga in addition to standard care helps reduce BMI and improve glycemic control in type 2 diabetic patients.

Validation of the MDRF-Indian Diabetes Risk Score (IDRS) in another south Indian population through the Boloor Diabetes Study (BDS).

OBJECTIVE: To validate the MDRF-Indian Diabetes Risk Score (IDRS) in a south Indian population in coastal Karnataka. METHODS: The study was conducted at Boloor locality in Mangalore on adults aged 20 years or more. The study group comprised 551 participants (68.9% response rate). The OGTT was performed using 75 gms of glucose. The MDRF-IDRS was calculated using age, family history of diabetes, physical activity and waist measurement. ROC curves were constructed to identify the optimum value (> or = 60%) of IDRS for determining diabetes as diagnosed using WHO consulting group criteria. RESULTS: We found that 71 of the study individuals were known diabetic subjects (KD) while 45 subjects were diagnosed to have newly diagnosed diabetes (NDD). An IDRS score of > or =60 had the best sensitivity (62.2%) and specificity of (73.7%) for detecting undiagnosed diabetes in this community. CONCLUSION: Our study confirms and validates the MDRF-IDRS as being a valid simple and reliable screening tool to identify undiagnosed diabetes in the community. The MDRF-IDRS score > or =60 had the highest sensitivity and specificity to identify undiagnosed diabetes.

Effect of the insulin plant (Costus igneus) leaves on dexamethasone-induced hyperglycemia.

UNLABELLED: Costus igneus, commonly known as insulin plant in India, belongs to the family Costaceae. Consumption of the leaves are believed to lower blood glucose levels, and diabetics who consumed the leaves of this plant did report a fall in their blood glucose levels. OBJECTIVES: The present study was planned to evaluate the effect of the leaves of Costus igeus on dexamethasone-induced hyperglycemia in male Wistar rats. Four groups of male Wistar rats (n= 6) were treated with 10 mg/kg/day of dexamethasone subcutaneously for 20 days. From day 11 to day 20, different groups received 100, 250 or 500 mg/kg/day of powdered leaves of Costus igeus in distilled water orally or Glibenclamide 500 microg/kg orally. On the 20th day, after overnight fasting, a retro-orbital puncture was performed for obtaining blood samples to estimate the fasting blood glucose level, and the same procedure was followed on the other eye 1 hour after a glucose load of 2.5 g/kg orally for estimation of post-glucose load blood glucose levels. Fasting blood sugar and postglucose load blood sugar levels were raised in the group that received dexamethasone when compared to normal controls (P < 0.001), whereas 250 and 500 mg/kg powdered leaf of Costus igeus and Glibenclamide 500 microg/kg decreased the dexamethasone-induced hyperglycemia (P < 0.01). The leaves of Costus igeus reduced the fasting and postprandial blood sugar levels, bringing them towards normal, in dexamethasone-induced hyperglycemia in rats.

A comparative study to assess the awareness of palliative care between urban and rural areas of ernakulum district, kerala, India.

AIM: To assess the knowledge and attitude toward palliative care among people residing in urban and rural areas. MATERIALS AND METHODS: This cross-sectional study was conducted among 185 urban and 165 rural households. Senior-most member of the household present was interviewed using a questionnaire. Only those people who have heard about palliative care were included in the study. RESULTS: Out of 350 people, 47 (13.4%) have heard about palliative care. Of these 38 (20.5%) belonged to urban and 9 (5.4%) belonged to rural areas (P < 0.0001).Twenty-nine (15.7%) participants in urban and 7 (4.2%) in rural areas had some knowledge about palliative care (P = 0.0002). Source of information for 25 (53.2%) participants was newspapers followed by television 17 (36.2%). Thirty-three (86.8%) participants in urban and 7 (77.8%) in rural areas felt that palliative care helps in improving quality of life. Twenty (52.6%) participants in urban and 4 (44.4%) participants in rural areas felt that palliative care can be better provided at homes than hospitals. Thirty (78.9%) urban participants felt that bad news about the patient's condition needs to be told to the patient first and then to their family members. In case of rural participants majority 7 (77.8%) said vice versa (P = 0.0039). CONCLUSION: Overall awareness of palliative care was poor. This calls for large-scale awareness campaigns. As home-based palliative care was preferred by many, home visits by care providers and training of family members of patient's needing palliative care needs to be practiced widely.

Prevalence of overweight and obesity among preschool children in semi urban South India.

This study was conducted to ascertain the prevalence of overweight and obesity in 425 pre-school children (2 to 5 years) using the new Child Growth Standards released by the World Health Organization. Overweight and obesity were defined as body mass index (BMI) > 85th and 95th percentiles for that age and sex, respectively. The prevalence of overweight and obesity was 4.5% and 1.4%, respectively.