Ph.D Thesis

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Study to assess the effectiveness of yoga on stress level and quality of life of breast cancer patients undergoing chemotherapy
(SRHU, 2022-07-09) Prakash, kamli
Background: Among cancer of different organs in the body, the carcinoma of the breast is highest in occurrence worldwide, after lung cancer. The treatment of cancer and cancer itself cause many side effects and complications, which affect the quality of life (QOL) and cause a considerable consequence on Health Related QOL (HR-QOL) in common. While going through cycles of chemotherapy, breast cancer patients experience many side effects such as nausea, vomiting, weakness, anemia, and alopecia. Supportive or complementary therapies such as yoga, are easy to administer, economical, and useful in reducing the adverse effects of cancer treatment and helpful in enhancing the quality of life of patients with cancer. Objectives: To determine the effectiveness of yoga on the stress level & quality of life of breast cancer patients undergoing chemotherapy Materials and Methods: Quantitative Research approach with Randomized Clinical Controlled Trial & Time series design was adopted in this study. The consecutive sampling technique was used to recruit 100 breast cancer patients fulfilling the eligibility criteria and undergoing chemotherapy in Cancer Research Institute, Swami Rama Himalayan University. The recruited patients were randomized to control (N=52) and experiment (N=48) group by concealed randomization. The informed written consent was taken from each participant. The baseline data was collected during first cycle of chemotherapy with Anxiety, Depression, Stress Scale and EORTC QLQ-C30 (version 3) & BR23. The participants in experimental group were taught diaphragmatic breathing, systematic relaxation and alternate nostril breathing, joints and glands exercises of neck and shoulder. They were instructed to practice twice daily at home. They were supervised in practicing these when they were receiving second, third, fourth, fifth and sixth cycles of chemotherapy. The participants in the control group received routine care. The data was again collected during second, third, fourth, fifth and sixth cycles of chemotherapy. Results: The sample in both groups had similar demographic and clinical characteristics. They had similar anxiety, depression & stress and quality of life scores during first cycle of chemotherapy. The mean depression scores of breast carcinoma patients belonging to the control group remained almost the same over a period of six cycles. However the depression scores of the experimental group decreased significantly from the baseline in all six cycles. The mean xvi scores of the physical function for the control group decreased significantly from the baseline score in the second through the sixth cycle, whereas, scores of the experimental group decreased only in the fourth cycle. The mean scores of the emotional function of both experimental and control groups decreased significantly from the baseline score in the 3rd, 4th, 5th and the 6th cycles. However, the control group had a greater decrease in scores compared to the experimental group. The fatigue scores increased more in control group compared to the experimental group. The mean scores of body image of the experimental and the control group decreased significantly from the baseline score in the second through the sixth cycle. However, the experimental group revealed statistically significant variation from the control group in the third and fifth cycles. The mean scores of future perspectives of patients in the control group decreased in the second through the sixth cycle from the baseline score. In the experimental group the mean scores increased significantly in the second through the sixth cycle from the baseline score. Conclusion: The yoga was effective in decreasing symptoms of depression, improving the quality of life of breast cancer patients in the experimental group in the areas of global health status, physical function, role function and emotional function, perception of body image and future perspectives and decreasing the symptoms of fatigue, insomnia, loss of appetite, constipation, during the period of chemotherapy.
Study of environmental carcinogens interference in bio molecular kinetics of cell cycle regulatory machinery using systems biology approach and their protection by nano particles
(SRHU, 2022-09-07) Kumari, Anukriti
Incidents of cancer are increasing each year and lung cancer and head and neck cancers contribute to majority of deaths related with cancer. Environmental carcinogens are leading cause of lung cancer and head and neck cancer. BaP and NNK are the most dangerous environmental carcinogens which have been placed in group 1 category of carcinogens by IARC. Industrial and vehicle exhausts, tobacco smoke, pyrolysis of various organic matters are the major sources BaP. NNK is found in abundance in various types of tobacco related products like cigars, cigarettes, tobacco snuffs etc. It also gets formed endogenously in the saliva of people who come in contact of nicotine because of the reaction between salivary nitrate and nicotine. In this study we have tried to identify the major biomolecular targets of BaP and NNK using various tools of systems biology. We have also tried to analyze the scavenging and protective potentials of carbon nanoparticles (Single walled carbon nanotubes, multiwalled carbon nanotubes and fullerenes) against these environmental carcinogens (BaP and NNK) with the help of molecular docking simulations and adsorption load analysis. x Objectives: To fulfill the aims of our study, we have divided the study into four objectives Objective 1: Identification of most probable biomolecular targets of environmental carcinogens (BaP & NNK) among the cell cycle regulatory proteome once they enter the biological system. Objective 2: Construction of network system for functional coverage of most potent biomolecular targets of environmental carcinogens among the cell cycle regulatory proteome. Objective 3: Designing of cell cycle regulatory bio-model along with its kinetics and determining the impact of environmental carcinogens on normal cell cycle regulation. Objective 4: Determination of the binding efficiencies of environmental carcinogens with carbon-based nanoparticles, environmental carcinogens adsorption load over nanoparticles and comparison of binding efficiencies of carcinogens with their biomolecular targets and nanoparticles. Methodology: For finding the genes hampered by BaP, T3DB database was used and Pubmed was used for finding the genes that get hampered by NNK by using various keywords like NNK, humans, cancer, cell cycle etc. Once the genes were identified, proteinxi protein interaction networks were generated with the help of STRING.db software. The networks were analyzed with the help of Cytoscape software. Modulation and enrichment analysis were done using MCODE and ClueGO apps of the cytoscape software. Seed proteins were identified from the clusters generated by MCODE and then network were generated using these seed proteins for BaP and NNK separately. The nodes present in both the BaP and NNK rewired PPINs were analyzed on the basis of their topological properties like degree, clustering coefficient, betweenness score and bottleneck scores. To further screen out the proteins, molecular docking simulations were performed on all the selected proteins for BaP and NNK. Once top bio-molecular targets were identified for BaP and NNK, cell cycle regulatory model was designed using cell designer software and then SBMLsqueezer was used to incorporate the biokinetics in the model. Time course analysis was performed using COPASI software and changes in concentrations and fluctuations in the oscillations were analyzed. Finally, we tried to analyse the scavenging capacity of carbon nanoparticles (SWCNT, MWCNT and Fullerenes) by comparing the binding efficiencies of carcinogens and carbon nanoparticles with that of carcinogens and their top bio-molecular targets and finding the adsorption load capacity of carbon nanoparticles for BaP and NNK. Results: 4000 genes were found to be hampered by BaP where as 544 genes were extracted from Pubmed that were hampered by NNK. QSOX1, PTGS2, NOS2 were the xii top three biomolecular targets for BaP. CDK7, CCNA1 and CDKN1B were the top biomolecular targets for NNK. On the analysis of the scavenging potentials of SWCNTs, MWCNTs and Fullerenes against BaP and NNK, it was found that MWCNT had the highest scavenging potential against BaP and showed highest adsorption capacity while for NNK, SWCNT showed the highest binding energy and MWCNT showed the highest adsorption load capacity. Conclusion: QSOX1, PTGS2 and NOS2 came out to most influencing key regulatory biomolecular targets which may govern whole BaP associated interactome while CDK7, CCNA1 and CDKN1B were the most influencing key regulatory biomolecular targets which may govern whole NNK associated interactome. Out of all the three carbon based nano-particles used to scavenge BaP and NNK, MWCNT has the highest binding affinity as well as adsorption capacity against BaP while for NNK, SWCNT showed highest binding affinity and MWCNT showed highest adsorption capacity.
Effectiveness of Home Based Newborn Care HBNC on knowledge attitude and practices among ASHAs Accredited Social Health Activists working in rural areas of Uttarakhand
(SRHU, 2022-09-07) Devi, Rajkumari Sylvia
Neonatal mortality stays high regardless of a decline in under-five deaths. About 40% of all under-five deaths are among infants.1 Almost all (99%) of these neonatal deaths were happened in developing nations with the most elevated rates in sub-Saharan Africa.2 More than 50% of child deaths occur below the age of five years. In 2008, the number of death of under-five children was 1,829,826 out of which 1,003,767 (54.8%) died in the neonatal period. Preterm birth, neonatal infections, asphyxia, sepsis, diarrhea, malnutrition, etc. are the main reasons for most neonatal deaths.3-5 India ranks second with the largest population, accounting for about 17% of the global population and 20% of worldwide births. India accounts for a fifth of the global under-five child death. Around 27 million live births and two million deaths of under-five children are reported each year. The annual mortality rate of under-five children in India represents a quarter of the global child mortality. Therefore control of child death is very crucial if the world is destined to achieve the targeted Sustainable Development Goal (SDG).6 Indian Academy of Pediatrics (IAP) has critically examined numerous health programs of children started by state and central government. Mission 20/20 by IAP has come up to further decrease IMR. With this mission, IAP conveys its zeal to commit its endeavors and assets to catalyze the decrease of IMR in India. This activity supports all necessary requirements to achieve the objective of the mission, IMR of 20 by 2020.7 2 The present neonatal mortality rate is still far from achieving the targeted goal of less than 20/1000 live births.8 Control of neonatal death is crucial to attain the targeted sustainable development goal of WHO. The government of Indian, through the Ministry of Health and Family Welfare (MoHFW) and the National Health Mission (NHM), has initiated various health programs to control newborn mortality in both villages and cities.9-10 Under the scheme “Janani Suraksha Yojana”, institutional deliveries have been intended to improve by health professionals through cash rewards to the mothers.9,11 This may further encourage providing children with good food and quality health care. However, the achievement concerning the control of neonatal mortality rate is still far from the targeted rate. Significant inequalities of NMR are found in rural and urban, and different socioeconomic classes. The neonatal mortality in villages is just double as compared to developed cities (31 vs 15 per 1000 live births).8 The failure may be due to the way of functioning of the health departments. At this point of time, it is imperative to execute sincere and collaborative services from all related departments i.e. government and private health sectors, and society organizations. Various factors influence the survival of children after birth that include proper breastfeeding, maintaining a warm body temperature, periodic medical check-ups and getting treatment, etc. The early few years of birth of children is a stage of life where possible maximum care must be provided as they are exposed all of a sudden to a polluted external environment from the sterile condition. The children need to be protected in all respects in the new environment. As a result, a huge number of neonates fall under prey in economically least developed and developing countries. Under-five 3 deaths are mainly due to premature birth, neonatal sepsis, birth asphyxia, pneumonia, diarrhea, etc in rural areas of India.12-13 Efforts have been made to reduce the death rate by incorporating new strategies with respect to premature birth, asphyxia, pneumonia, etc. in several child survival programs.14-17 Reports are available on the successful implementation of some effective measures related to child health care being taken up by rural health care workers. Management of pneumonia in under-five children using cotrimoxazole could result in a 20% reduction in neonatal mortality that hints the importance of possible home-based care in the management of child mortality
Isolation identification and drug resistance testing of gram negative bacilli at a tertiary care hospital with special emphasis on the phenotypic and genotypic characterization of carbapenem resistance
(SRHU, 2022-09-07) Khanduri, Naresh
The study included specimens from OPD and IPD patients of all age groups and both sexes. Specimens were cultured on suitable media. Isolates were identified by biochemical methods, both in house and by VITEK 2. Susceptibility to carbapenem drugs (imipenem, meropenem and ertapenem), as well as ampicillin, amoxycillinclavulanate, ampicillin-sulbactam, piperacillin-tazobactam, cephalothin, cefoxitin, cefotaxime, ceftazidime, cefepime, aztreonam, gentamicin, amikacin, ciprofloxacin, levofloxacin, co-trimoxazole, tetracycline, tigecycline, chloramphenicol, and colistin performed by Kirby-Bauer disc diffusion method. A total of 1544 isolates of Gram negative bacilli were studied from different specimens, of which 184 were resistant to one or more carbapenem drugs. Acinetobacter calcoaceticus baumannii complex (104 isolates; 52%) was the dominant species, followed by Pseudomonas aeruginosa (31 isolates; 15.5%). Among the 49 isolates of Enterobacteriaceae, K. pneumoniae was the commonest with 17 (34.6 %) isolates, followed by E. coli with 15 (30.6 %) isolates. Most carbapenem-resistant GNB came from the intensive care units and the neurosurgery ward. The largest numbers of carbapenem-resistant isolates were isolated from pus, urine, and endotracheal tube aspirates. Carbapenem-resistant isolates were generally also resistant to most other antimicrobials except tigecycline and colistin. False-positive carbapenem-resistance Six (10.9%) Enterobacteriaceae isolates appeared to be carbapenem-resistant upon testing with the Kirby-Bauer disc diffusion technique with discs procured from HiMedia. These isolates later turned out to be sensitive when retested with the Kirby-Bauer disc diffusion technique with discs procured from Rosco Diagnostica, Denmark, and also by the Etest method, resulting in a false-positivity rate of 10.9% for disc diffusion. In addition, four isolates of Stenotrophomonas maltophilia and six isolates of Elizabethkingia meningoseptica had to be left out of the study because they are intrinsically resistant to carbapenem Minimum Inhibitory Concentration The Etest method for minimum inhibitory concentration (MIC) showed that the carbapenem MICs of most resistant isolates were ≥32 μg/ml. The remaining 184 isolates were then tested for carbapenemase enzymes and efflux pumps by phenotypic and genotypic methods. PHENOTYPIC METHODS Modified Hodge Test (MHT) Of the 184 isolates tested by MHT, only 22 tested positive. Rosco KPC and MBL detection kit Of the 49 Enterobacteriaceae isolates, 40 were MBL positive, 2 were both MBL and KPC positive and the remainder did not produce any of the enzymes and were presumed to be resistant by other mechanisms. Rosco Rapid CARB Blue kit 43 (41.3%) Acinetobacter, 13 (41.9%) P. aeruginosa & 39 (79.5%) Enterobacteriaceae isolates showed the presence of carbapenemases by this kit. Rosco Neo Rapid CARB kit The Enterobacteriaceae and Pseudomonas isolates were then tested by Rosco neo rapid CARB kit. 40 (81.6%) Enterobacteriaceae isolates and 16 (51.6 %) P. aeruginosa isolates were tested positive as carbapenemase producers Carba NP test, CarbAcineto NP and Blue Carba tests with modifications Overall 45 (91.8%) Enterobacteriaceae and 19 (61.2%) P. aeruginosa isolates were found to be positive for carbapenemase production by Carba NP and Blue Carba tests Overall 84.6% Acinetobacter calcoaceticus baumannii were positive by CarbAcineto NP and Blue Carba test for the carbapenemase detection. In terms of modifications, no difference in results was found regarding the source of imipenem while in three (6.25 %) Enterobacteriaceae isolates carbapenemase production was found to be inducible by imipenem Carbapenem inactivation method (CIM) Of the resistant isolates, 73 (70.1%) Acinetobacter spp., 15 (48.3%) P. aeruginosa and 38 (77.5%) Enterobacteriaceae isolates were tested positive for carbapenemase activity by this test. GENOTYPIC METHODS Detection of different carbapenemase genes Majority of the isolates showed the presence of NDM-1 carbapenemase gene. In addition to NDM-1gene, the isolates also showed the presence of VIM and OXA-48 genes. Majority (83.3 %) of the VIM positive were P. aeruginosa. OXA-48 was detected in only K. pneumoniae isolates. None of the study isolate found to be positive for KPC gene. EFFLUX PUMP ACTIVITY The presence of efflux was detected by two methods namely ethidium bromide cartwheel method and agar dilution method using reserpine as efflux inhibitor Ethidium bromide cartwheel method On performing the efflux protocol 27 isolates were found to be positive. i.e. (the strains showing little or no fluorescens under UV light) Reserpine as efflux pump inhibitor Only 20 isolates showed a decrease in the MIC of meropenem when reserpine was added.
Post traumatic stress disorder ptsd and quality of life qol of natural disaster victims of uttarakhand
(SRHU, 2022-09-07) Mahalingam, V.
Introduction In view of catastrophe happen in disaster prone Uttarakhand, its poor preparedness and severe outcome in terms of destruction and loss of human lives & property, a study was designed to look into other 'not too visible' areas loss in terms of Post-Traumatic Stress Disorder (PTSD) and Health related Quality of Life (H-QOL) of the disaster victims and estimate this burden. Hence, the present study was planned to estimate magnitude/prevalence of PTSD and assess Health related QOL with potential relationship between variables of PTSD & Health related QOL among the disaster victims of Sub Himalayan Uttarakhand state of India . Methods: The research design adopted had both Quantitative and Qualitative as it was most appropriate to attain the data from the Disaster victims. Quantitative component of the study design was used to assess Prevalence of PTSD and post Disaster H-QOL among the afflicted. The Qualitative component study design was used to do SWOT analysis on ongoing disaster preparedness and mitigation process. Data collection was done in two different time intervals i.e. Six month after disaster (Baseline) and eighteen month after disaster (End line). At baseline 2667 disaster victims were sampled by multi stage probability sampling in a cross sectional study with key respondents being head of the family , next to head of the family, any individual directly injured during disaster, aged ≥14 years and non-alcoholic were included in the study. Among the baseline disaster victims 1719 of them were given responses about PTSD and HQOL at end line. Total of fifteen (15) ASHA workers were selected who were already staying in the village with disaster victims to collect the data. Focus group discussion and in depth interviews were been done to generate information for SWOT analysis on ongoing disaster preparedness and mitigation process. Instruments used were PCL-S and WHOQOL- BREF tools besides a structured, pre-tested instrument to elicit socio- demographic data. The purpose of the study was explained and written informed consent was obtained from the study participants. Results: ➢ More than half (51%) of the disaster victims were diagnosed with PTSD at the Baseline. ➢ End line prevalence showed that every fifth (22%) disaster victim met the criteria of PTSD symptom and 78% of disaster victims overcame the stress. ➢ The base line PTSD mean score is significantly higher than the end line PTSD mean score at the level of significance p≤.05. ➢ At baseline the overall H QOL score was found to be ‘poor’ (1.76±.43). Sub scales of H QOL like physical (2±.03); social (2±.02) and environmental H–QOL (2±.01) were found to be ‘poor’. And psychological domain of H- QOL of disaster victims was found to be ‘very poor’ as it was 1.1±.40. ➢ Total H QOL score at end line was found to be improved from the baseline 2.53±.43 and it was ‘neither poor nor good’. Other domains like physical (3.02±.06), Social (3.7±.71) showed improvement. The radical improvement was seen in environmental (4.1±.05) domain. Even though psychological domain was also found to be nominally improved from ‘very poor’ to ‘poor‘ (1.9±.30). ➢ The total H QOL score across all domains indicates significant improvement in symptoms at the end line (2.53±.43) at the significant level of p ≤.05. ➢ Health related QOL was found to be negatively correlated with PTSD among the disaster victims. ➢ Socio-demographic and other variables, namely gender, education, occupation, family income, marital status, kind of disaster exposed to, frequency of disaster, type of loss and type of exposure significantly contributed development of PTSD. ➢ Except duration of disaster exposure all socio-demographic and other variables, like gender, education, occupation, family income, marital status, kind of disaster exposed to, frequency of disaster, type of loss and type of exposure significantly affected the Health related Quality of Life of Disaster victims. Conclusion: ➢ The findings of study highlight requisite need for identification and intervention for PTSD for Disaster Victims in context of developing countries. ➢ The scope of the study may be extended into a larger sample and coverage area; the initiative has the potential to be replicated at socio-epidemiological state with similar perspective. ➢ PTSD may persist for several years after a disaster that may result in various functional impairment in affected people both physically and psychologically. ➢ Required treatment program should be organized to cure post-disaster stress along with assessment, diagnosis and interventions for survivors should be taken as priority goal in a program of public health. ➢ Both community and provider capacity unit for disaster-preparedness and mitigation system should be built. Imparting appropriate coping skills to deal with post disaster affects via proper designed modules is an imperative need. ➢ Research studies can also test whether treatment targeting PTSD symptoms have a beneficial effect on HQOL and whether interventions specifically effectively reduce PTSD symptoms. ➢ State and central government authorities need to focus on minimizing the damage to existence, belongings and surroundings before the catastrophe moves.
Psycho behavioral determinants affecting quality of life of staff nurses posted in critical vs non critical units
(SRHU, 2022-09-07) Sharma, Rakesh
itical unit and vice a versa for the duration of 2 months. After completion of 2 months they were re-shifted to their original units. Data were collected with self-reported questionnaires included demographic proforma to collect personal and professional characteristic of staff nurses, MBI-HSS to assess burnout level, and WHOQOL-BREF to assess quality of life. A computerised stress profile test (CSPT) was conducted to record heart rate, GSR value and skin temperature of study participants posted. Burnout and quality of life of staff nurses were assessed at baseline, every 15th day during change in posting and after re-shifting at 15th and 30th day. A computerised stress profile test (CSPT) was xiv conducted at base line and at 60th day during change in the posting. Data was analyzed and interpreted by using descriptive as well as inferential statistics. Statistical analysis was done with the help of SPSS-22 for Windows. Results: At baseline scores of psycho-behavioral determinants were higher and lower quality of life among staff nurses working in critical unit then the non-critical units (p0.05). There was a reduction in scores of psycho-behavioral determinants and increase in quality of life scores of staff nurses after shifting to non-critical units from critical units (p0.05). After change in posting of staff nurses from non-critical to non-critical units, their scores of psychobehavioral determinants was significantly increased and reduced in the scores of quality of life (p0.05). Conclusion: It is an important area to identify the levels of emotional outcome as a burnout among staff nurses and quantify them with physiological parameters, which affect their quality of life. A change in work unit was a significant strategy to reduce levels of burnout, improve in physiological parameters and finally improved in quality of life of staff nurses working in critical unit.
Comparison of two fluoride application regime in oral cancer patients a randomized controlled trial
(SRHU, 2022-11-29) Kandwal, Abhishek
Introduction: Oral cancer ranks first among males and second overall in the Indian population as per GLOBOCAN 2020. In these patients Supportive oral care lack as an integrated part of cancer care. The most prevalent side effect of chemoradiotherapy (CT-RT) is Radiation caries and their sequel. This results in increased dental disease burden and poor oral health-related quality of life scores (OHRQOL). Aim: Present Randomized controlled trial was conducted to evaluate the effect of fluoride on dental disease burden in terms of DMFT scores in patients who have received CT-RT in the region of the oral cavity. Oral health-related quality of life in terms of OHIP-14 scores was also assessed. Materials& Methods: 111 patients participated in the randomized controlled trial as per the CONSORT statement. Two regimens, Monthly, and quarterly application were further divided into varnish and gel subgroups. This resulted in a total of four groups including monthly varnish application (AV), monthly gel application (AG), quarterly varnish application (BV), and quarterly gel application (BG). These were analyzed for DMFT and OHIP-14 scores at baseline, one month, six months, and one-year recall post chemo-radiotherapy (CT-RT). Results: Median and Interquartile range of DMFT scores for the AV group were 2(0.25-6), 2(1-6), 3(1-7.7), and 4(1-9) at baseline, one month, six months and one xviii year recall respectively. For the AG group, it was 2(1-5), 2(1-5), 4(1-8), and 5(1-8) respectively. For BV Group it was 3(1-4), 3(1-4), 3(2-6), and 4(2-6) respectively, while for BG Group it was 2(0-4), 2(0-4), 391.5-4.5) and 4(2-5) respectively for four recall points. These values were highly significant P<0.001. OHIP-14 score’s Median and Interquartile range at baseline, one month, six months, and one year recall were 14(11-25.7), 35(28.2-40), 5.5(0-6) respectively. For AG group it was 13(2-24), 29(26-36), 6(0-12) and 0(0-6) respectively. For BV group it was 15(10-24), 34(27-46), 3(0-14) and 0(0-7) respectively. While For BG it was 11(5-18.5) 29(23.5-40), 3(0-11) and 0(0-6.5) respectively. These values were highly significant with P<0.001. Intergroup comparison was not significant for DMFT and OHIP-14 scores for four intervention groups. OHIP-14 score’s Mean and standard deviation values for sufficient mouth opening and insufficient mouth opening were 20.6 ±9.5 and 12.8 ±9.8 respectively, which was highly significant with p <0.001. Conclusion: DMFT scores reported a significant and minimal constant increase in patients at one-year recall from baseline. Fluoride application was effective in controlling the DMFT scores at one-year recall in these patients. OHIP-14 scores significantly improved at recall visits from baseline by use of fluoride as part of the Supportive Oral Care Protocol (SOCP). Fluoride varnish and gel applied either monthly or quarterly provided similar changes in DMFT and OHIP-14 scores. Hence any combination of these can be considered effective in the care of these patients. Insufficient mouth opening drastically reduces oral health-related quality of life scores in these patients and hence they required more care. xix Clinical Recommendation: Fluoride application as per supportive oral care protocol (SOCP) is recommended as an integral part of the oral care needs of head and neck cancer patients including oral carcinoma. Monthly topical fluoride application during the first year post CT-RT and thereafter-quarterly application lifelong is advised. Involvement of a Dental supportive care expert from the point of diagnosis of cancer is needed. A Dental expert as a part of the multidisciplinary team for cancer care of head and neck cancer patients is recommended.
Effectiveness of nurse led intervention on self-care behavior psychological symptoms and quality of life among kidney transplant recipients in a selected tertiary care hospital of New Delhi
(SRHU, 2022-11-29) Dahiya, Ujjwal
Background: Chronic disease of kidney is an important cause of global mortality & morbidity. It has become a fast expanding global problem related to health in all the nations. Patients with end stage renal disease prefer kidney transplantation as the treatment over dialysis due to increased expectancy & quality of life but a costly choice in developing countries. Therefore, strict adherence to therapy and lifestyle modification is required for improved graft survival. Objectives: To determine the effectiveness of nurse led intervention on self care behaviour, psychological symptoms and quality of life among kidney transplant recipients. Materials and Methods: A prospective randomized controlled with time series design was adopted for the study. The study was carried out according to Consolidated Standards of Reporting Trials (CONSORT). The consecutive sampling technique was used to recruit 120 kidney transplant recipients attending transplant clinic who had completed three months after transplantation and fulfilling the eligibility criteria. The subjects were randomized to receive either standard care (N=60) or standard care plus nurse led intervention (N=60) by concealed randomization. The nurse led intervention included the components of formal health education, relaxation therapy, counselling and telephonic reinforcement. The intervention comprised of three sessions of 45 minutes each and telephonic reinforcement weekly for two months. Sociodemographic xxi and clinical data was collected using structured questionnaire, self care behaviour was assessed by self care practice checklist and Morisky Green Levine adherence scale.Psychological symptoms & quality of life were assessed by DASS 21 and WHOQOL Bref respectively. The outcome measures were assessed at baseline and at six months and nine months post kidney transplant. Results: The mean age of participants was 40.05±10.91 years in experimental and 39.45± 10.09 years in control group. Baseline characteristics in the groups were comparable. There was statistical significant difference in the total self care practice scores between experimental & control group (p=0.001). Adherence to immunosuppressive therapy scores showed there was statistical significant difference between experimental and control group in Posttest 1(p=0.03) and Posttest2 (p=0.001). There was statistical significant difference for psychological symptoms of stress
A study on risk factors of Malnutrition and effectiveness of family based intervention Program (FBIP) on nutritional Status of children and Knowledge and practices of mothers in selected villages of Nainital district Uttarakhand
(SRHU, 2022-11-29) Haldar, Pratiti
Introduction Nutrition is very essential for the children below five years of age. Insufficient nutrients intake during early phases of development, predisposes them to develop nutritional deficiencies and altered growth and development. In order to overcome the problem of malnutrition it is necessary to have an intervention which is not only effective but also it is reachable, feasible, culturally acceptable and can also be combined with local health services. The present study focuses on developing and testing a nutritional intervention specific to the needs of children in the hilly areas of North India. The objectives of the study were to assess the nutritional status of children, explore the risk factors of malnutrition and evaluate the effectiveness of Family-Based Intervention Program (FBIP) on nutritional knowledge and nutrition related practices of mothers. Materials & Methods The present study was conducted in two phases. In phase I, exploratory approach with cross-sectional survey design was adopted to identify the nutritional status of children and to explore the risk factors related to malnutrition. Muti-stage cluster random sampling technique was adopted to select a sample of 703 children, aged 1-3 years, from four sub-centers selected as clusters. Door-to-door survey was done for assessment of nutritional status of children and to explore the risk factors. All the children identified as malnourished in the Phase I were recruited for the Phase II of the study. The research approach used for phase II was experimental approach with cluster randomized control trial design. The four selected sub-centers were randomly allocated to intervention (two sub-centers with 75 children) and control group (two sub-centers with 74 children). Nutritional status was estimated from anthropometric measurements, and semi-structured questionnaires were used to assess the risk factors of malnutrition, nutritional knowledge and nutrition related practices. The intervention group received Family Based Intervention Program. Post-tests were conducted at 1st, 3rd month, 6th and 9th month. xxv Results The result of the study shows that, 76 (11%) children were underweight, 74 (10.8%) children in mild to moderate category and 2 (0.2%) in severe category. About 39 (5.5) children were found to have wasting, 28 (4%) with mild wasting and 11(1.5%) with moderate wasting. Stunting was found in 88 (12.6%) children, 87 (12%) in mild to moderate category and 1 (0.14%) in severe category. The overall prevalence of malnutrition was 152 (21.6%). The common risk factors of malnutrition identified in the study were anemia during pregnancy, birth weight of child below 2.5 kg, non-initiation of breast feeding within one hour of birth, weaning before six months, bottle feeding, recurrent illness during childhood, skipping of meals, not enjoying meals while eating, open drainage, not having pucca house, not having toilet and not sowing own vegetables were significant factors related of nutritional status of children. A significant difference was observed in the nutritional status between groups in terms of weight gain. The mean weight of intervention group was significantly higher than the control group at 6th (10.79 + 0.81, 10.32 + 1.01, t = 3.08, p < 0.05) and 9th month (11.32 + 1.51, 10.68 + 2.26, t = 3.08, p < 0.05). No significant difference was observed in height. The post-test nutritional knowledge and nutrition related practices were also significantly higher among the experimental groups (p < 0.05). Conclusion Malnutrition in under five children is very significant problem affecting their health. The present study shows that Family Based Intervention is effective in improving the weight of children. So, interventions like screening of children at regular intervals, exploring the risk factors of malnutrition and providing need-based intervention involving the active participation of parents can be adopted as a measure to reduce malnutrition prevalence in children.
A study to assess the effectiveness of nurse led cognitive stimulation program (NLCSP) on cognitive functions and quality of life among elderly in the selected rural community of Panipat, Haryana
(SRHU, 2023-09-01)
Background: Aging is natural unrestrictive and irreversible process and elderly population is increasing day-by-day, and their number will increase twice by 2050 and approximately will get up to 2 billion as per national aging report. In old age there is loss in number and functioning of neurons which ultimately leads to decrement in cognitive functions with several causes. This decrement of cognitive functions (attention, memory, orientation, and executive function etc.) is known as cognitive impairment which changes overall personality of the elderly. Prevalence of decline cognitive functioning is directly related with age and is increasing rapidly. Apart from the pharmacotherapy, there are other approaches and programs like cognitive stimulation therapy found effective in improving cognitive functions and quality of life. Cognitive stimulation is considered as “involvement in a range of activities and discussion (generally in a group) which target at general building up of cognitive and social abilities.” Aim: To explore and gain understanding about various problem related with decline cognitive functions among elderly population and also to promote and strengthen their cognitive functions and quality of life. Methods: Mixed method approach with a sequential exploratory design was adopted for the study. Study was conducted in two phases. In first qualitative phase problem related to declining cognitive abilities were explored in elderly and their caregivers by adopting techniques of focused group discussion till the point of data saturation. Following this phase intervention was developed and in second quantitative phase planned Nurse-Led Cognitive Stimulation Program (NLCSP) was taught to the experimental group biweekly for seven weeks in 14 sessions to groups of elderly. In this study multi-stage sampling technique was used to gather 100 elderlies from selected villages of district Panipat (Haryana). Tools used in the study were—socio-demographic proforma; semi-structured interview schedule for focused group discussion; and Mini Mental State Examination of Hindi version and QOL-AD scale, which were standardized tools to assess the cognitive functions and quality of life. After the seven-week intervention immediate post-test was done followed by follow up after three months and one year of intervention in both experimental and control group to assess the retention of the program. The gathered data was edited, tabulated as well as analyzed and interpreted statistically. Results: Elderly in both groups had similar demographic characteristics and also indistinguishable in pre-cognitive and quality of life scores. In thematic analysis in first phase, the reported experience was that decline in cognitive functioning is an age-related process, which has an adverse impact on life of the elderly and their caregivers. In the quantitative phase, mean post-test cognitive function score of post-test1 and follow ups at three months and one-year post intervention within the experimental group, as analyzed by repeated measure ANOVA, was significantly higher than baseline score. Also, while comparing pre-test and post-test of cognitive functions score in between groups unpaired t test result reveals remarkable differences. Mean quality of life score in control group remained same and even decreased slightly from baseline to immediate post-test score and follow up at three months and one-year post intervention; but, within experimental group the mean post-test quality of life score was increased significantly from baseline. Comparison of quality-of-life score between groups also exhibits statistical differences at p<0.05. Conclusions: Nurse Led Cognitive Stimulation Program (NLCSP) was effective in building the level of cognitive functions score as well as improving the quality of life among elderly. The findings also reveal that age is having an impact on quality of life.
Prognostic significance of nutrition and immunity in head and neck cancer- a prospective observational study
(SRHU, 2023-09-01) Arora, Anshika
Background: In developing countries, HNSCC differs from Western world in terms of age at presentation, subsite of disease, etiology (more tobacco and alcohol related), higher malnutrition and molecular biology. Certain special challenges are faced by developing countries like illiteracy, poverty, lack of awareness, advanced stage of cancer, limited access to specialized health care, and limited treatment infrastructure create difficulties in management of cancer patients. To improve the survival in clinical practice, simple and low cost indices predicting a raised risk for poor clinical outcome, in terms of recurrent disease, distant metastasis or mortality, are required in HNSCC patients. There is need for alow cost model to predict prognosis in Indian patients, specially tailored to the needs of a lowermiddle- income country. Aims and Objectives: i. To study the nutritional profile and systemic immunity in patients with HNSCC. ii. To study the correlation between the nutritional status and systemic immunity with outcome of treatment in patients being treated for HNSCC. iii. To develop a low cost model for early prognosis using nutritional status and systemic immunity marker in patients being treated for HNSCC. Materials and Methods: This was a prospective cohort study, conducted at Cancer Research Institute, Swami Rama Himalayan University,Dehradun. The patients starting treatment for HNSCC were enrolled in the study after a written informed consent, they were evaluated for nutrition status (using anthropometric methods and Subjective Global Assessment score) and systemic immunity (using peripheral blood neutrophil/lymphocyte ratio), before starting, during, and at completion of planned treatment. The disease status and overall survival were assessed upto 6 months of completion of planned treatment. The primary end points of the study were Nutritional status and Systemic Immunity before and xxxiii after treatment, and disease status and overall survival at 6 months of completion of treatment. Statistical Analysis: MS Excel 2010 was used for data entry, SPSS software version 22 was used for statistical analysis. Parametric and non-parametric tests were used for association and correlation analysis. “Cochran's and Mantel-Haenszel Statistic” were used to calculate Risk Ratio (RR). Multivariate analysis was performed using the Multi-nominal Logistic Regression model. ROCs were generated to get cut-off values and their sensitivity and specificity to predict the outcome. Survival curves were generated using Kaplan- Meiermethod and Cox-Regression model, and were used to calculate the Hazard Ratio (HR) for outcomes i.e., the Progression Free Survival (PFS) and Overall Survival (OS). Using the RR and ROC cut-off values of variables that were significantly associated with the outcome, novel Risk Stratification models were developed to predict outcomes- failure to complete planned treatment, disease recurrence 6months and death at 6 months. Results: Malnutrition (defined as either ≥10% weight loss or BMI <18.5, or SGA score ≥40) was found in 47.1% patients pre-treatment and this proportion increased to 87.6% patients post-treatment. The median neutrophil tolymphocyteratio (NLR) IQR was 3 (2-4) pretreatment and increased to 5 (3.8-8.4) post-treatment. There was statistically significant moderate positive correlation between NLR and SGA score, pre-treatment percent weight loss and a moderate negative correlation between NLR, weight and BMI. Malnutrition was significantly associated with failure to complete planned treatment in node positive patients and raised NLR in node negative patients. On multivariate analysis, Cox-Regression and Survival Analysis with Kaplan-Meier curves, both poor nutritional status and raised NLR, were associated with poor six months progression free and overall survival. Conclusion: The H0 hypothesis (there is no correlation between nutritional status and systemic immunity in patients with Head and Neck Squamous Cell Carcinoma) is rejected and the alternate H1 hypothesis (there is a positive correlation between nutritional status and systemic immunity in patients with Head and Neck Squamous Cell Carcinoma) is accepted. xxxiv The novel low cost risk stratification models, developed in this study using clinical parameters, nutritional status and the NLR were successfully tested for internal validation as predictive for poor clinical response (failure to complete planned treatment, early disease recurrence and mortality) in patients being treated for HNSCC. Clinical Recommendations: i. Apart from the regular clinical and disease parameters (like PS, clinical stage, pathological features, subsite etc.) patients’ baseline nutritional status and systemic immunity marker, NLR, should be taken into account while planning the oncological management for HNSCC patients. ii. A patient with malnutrition at the start of oncological treatment for HNSCC should be offered structured nutritional advice and regular nutritional monitoring during the ongoing active treatment to improve clinical outcomes of these patients. iii. Systemic immunity marker, NLR, as calculated from the peripheral blood sample, is a cost effective and easily available tool and should be utilized routinely to prognosticate HNSCC patients planned for treatment into high risk groups for poor clinical outcomes. iv. The novel low cost risk stratification models developed in this study were validated internally to prognosticate patients as low, medium, and high risk, for poor clinical outcomes, and now need to be validated externally on different HNSCC patient populations by other researchers.
Efficacy of Comprehensive childbirth preparation package on childbirth experiences and Maternal-Neonatal outcomes among Primigravidae in selected Health Center of Noida, Uttar Pradesh
(SRHU, 2023-09-01) Bist, Lekha
Introduction Childbirth causes physical and mental changes to pregnant women. The woman's childbirth experience is very important and her childbirth memories remain alive for lifetime. Childbirth preparation programs have shown to promote women knowledge, expectation and experience of childbirth. Childbirth preparation program can make a symbolic difference to a women childbirth experience. The purpose of the study was to assess the efficacy of comprehensive childbirth preparation package on childbirth experiences and maternal-neonatal outcomes among primigravidae in selected health center of Noida, Uttar Pradesh. Methodology The present study was conducted in two phases. In phase I, exploratory research approach was adopted to explore childbirth preparedness and childbirth experiences based on which a need based comprehensive childbirth preparation package was developed and in phase II a randomized control trial was conducted to evaluate efficacy of comprehensive childbirth preparation package on childbirth experiences and maternal-neonatal outcomes. Primigravidae between 28-34 weeks were allocated to experimental and control group by simple random sampling technique. Data collection procedure was started after obtaining ethical, administrative permission and consent from the participants. Pre-test was conducted in both the groups and intervention was delivered once a week for a period of three weeks. Post-test was conducted on 15th day of the intervention to assess childbirth preparedness, childbirth expectation. On 3rd day of delivery post-test was done to assess childbirth experiences, childbirth fear, labour outcome and breast-feeding self-efficacy. On 7th day and 6th week of delivery postnatal outcomes of mother and baby was assessed. Results There was no significant difference in the mean pre-test scores of childbirth preparedness between groups (p = 0.37) and a statistically significant difference was observed in post test scores of childbirth preparedness (p = 0.03). The pre-test childbirth expectation scores had no significant difference between experimental and control group (p = 0.75), whereas, statistically significant difference was observed in post-test childbirth expectation scores between experimental and control group (p ≤ 0.001). This reveals that comprehensive xxvi childbirth preparation package was effective in terms of childbirth expectation. A statistically significant difference among study participants in experimental and control group in childbirth fear scores (t =7.85, p= 0.001) whereas no difference was observed at pre intervention level in childbirth fear (t =1.19, p=.23) between groups. Significant difference was observed in mean score of labor and birth experience between experimental (113.9 ±5.7) and control group (85.9±6.5) at p=.001. Maternal−neonatal outcomes between experimental and control group in terms of labor outcome and breast-feeding self-efficacy found to be significant at (p<0.5). Conclusion The comprehensive childbirth preparation package was effective in terms of childbirth experiences and maternal-neonatal outcome. From the findings of the study conclusion can be drawn that primigravidae who were exposed to comprehensive childbirth preparation package were having significantly positive childbirth experiences and better maternal-neonatal outcome than the control group.
A study of the impact of Risk factors on portfolio returns
(SRHU, 2023-09-01) Ali, Alin S.
The study examines the efficacy and applicability of various asset-pricing models by testing them against single-sorted and double-sorted portfolios comprising of companies listed on the National Stock Exchange from December 2000 to January 2020. The study also focuses on studying the significance of impact that various factors included in the aforementioned models have on portfolio returns. Going by the results, there is significant size and value effect. The observations also indicate a significant Profitability effect; however, its magnitude is found to be lesser than the Size and Value effects. The same cannot be said of the Investment effect. The study also finds a persistent twelve-month Momentum effect that remains unexplained by asset-pricing models not comprising of a momentum factor. Moreover, no significant evidence was found which would favor the FFFF model over other models. Even though the FFTF model performs comparably against other asset-pricing models that are tested here, the study concludes in favor of the FFTF model as the superior amongst all, owing to the parsimonious nature of the model.
Effectiveness of an individualized communication protocol on clinical outcomes of comatose patients in selected intensive care unit of tertiary care hospital
(SRHU, 2023-09-01) Thakur, Pooja
Background: Communication with patients is one of the important aspects of nursing care in critical care settings. Nurses play an important role in communicating with seriously ill patients Objectives: To assess the effectiveness of Individualized Communication Protocol (ICP) on clinical outcomes of comatose patients in terms of physiological adverse events, consciousness, agitation & sedation and pain level. Methods: A “quasi-experimental” was adopted to conduct the study on 113 comatose patients admitted in ICU. Initially, 58 patients were enrolled in the control group and their clinical outcomes viz. physiological adverse events, consciousness, agitation & sedation and pain level were collected twice daily till 14 days or transfer out of patients from ICU/Death/LAMA, whichever was earlier. Training was imparted to ICU nurses regarding Individualized Communication Protocol (ICP) consisting of environmental preparation, verbal and nonverbal communication with patients in coma by nurses and family members. After training of staff nurses, patients were enrolled in experimental group (n=55) and similar outcome variables were collected for experimental group. xxxi Results: Study results revealed that patients in experimental and control group were homogenious in term of their socio-demographic and clinical variables. The study findings showed that nurses’ knowledge and practice regarding individualized communication increased in post test. The conscious level improved in experimental group on 4th day as compared to control group (p<0.0001). It was observed that patients in experimental group required less sedation as compared to control group. Pain score also decreased in experimental group compared to control group. Conclusions: The ICP developed by the researcher facilitated communication with comatose patients by staff nurses in ICU. Therefore, it is recommended that ICP should be incorporated as a routine care.
Bio remediation of Monocrotophos Pesticides by Actinobacteria
(SRHU, 2024-03-26) Rani, Ankita
The persistent use of pesticides in agriculture is an issue of global concern due to their potential environmental impact and adverse health effects. Despite their efficacy in controlling pests and improving crop yields, pesticides can disrupt ecosystems, contaminate soil and water, and endanger non-target species. Additionally, the widespread reliance on these chemicals can lead to pesticide resistance in pests, reducing their effectiveness over time. These challenges underscore the need for more sustainable and environmentally friendly pest management strategies. This study introduces Actinobacteria as a potential solution to these challenges. Actinobacteria, a diverse group of Gram-positive bacteria, have been recognised for their potential in agricultural applications due to their unique metabolic capabilities. Remarkably, some Actinobacteria strains have demonstrated the ability to degrade various pesticides, mitigating their environmental impact. This study examines the feasibility of utilising indigenous Actinobacteria strains to degrade monocrotophos, a commonly used pesticide in agricultural practices. The findings provide valuable insights into the potential of these microorganisms as a sustainable alternative to conventional pesticide use.
Prescription of Generic Drugs Impact on Pharma Marketing Dispensation of of Medicines and Social Good
(SRHU, 2024-06-20) Madan, Sunil
The aim of the study is to examine influence of knowledge, attitude and practice on medical practitioners’ behavior towards generic drugs limiting its mass use. Most of the countries in the world, rich or poor, are taking more interest in generic medicines due to rising healthcare costs. Aside from the high out-of-pocket healthcare expenditures in India, affordability is also a challenge due to its demographics. Generic medicines offer an alternative to expensive medicines. Government is promoting use of generic medicines; doctors are being advised to prescribe medicines in generic names, however, there are several challenges in its mass use. The study is of national importance as it addresses the issue of low generic prescriptions despite unaffordable access to expensive branded medicines.
Impact of Employee Engagement and work life balance on job satisfaction in Aviation industry
(SRHU, 2024-06-24) Dubey, Deepti
In today’s dynamic environment, aviation industry faces difficulty in retaining their talented employees. There is a growing disengagement among employees today, and there is deterioration in WLB and EE. Engaged employees with full workforce can make the difference between a company organization's survival and success during a downturn in the economy. The relationship between WLB, JS and EE in aviation industry is main emphasis of this study. This study aims to investigate how WLB and EE affect aviation industry employees' JS. In order to do this, study was carried out on 739 workers in Indian aviation sector. Study uses step-wise multiple regression analysis, factor analysis, and Pearson's to ascertain how employee involvement affects work satisfaction. The results indicated a strong and favourable correlation among WLB, EE and JS. This research offers significant insights into the relationship between WLB, JS, and EE, making it useful for practitioners and scholars alike.
Effectiveness of a comprehensive breastfeeding promotion program on breastfeeding self efficacy practices and outcomes among Primigravid mothers a randomized controlled trial
(SRHU, 2024-06-27) Frederick, Neha
Breast milk is the complete and best nutrition of all the babies. Both mothers and newborns can benefit from breastfeeding in terms of health. Additionally, breastfeeding can assist mothers and the baby ward off several ailments and disorders. The present study focuses on developing a breastfeeding promotion program specifically for the primigravid mothers of Uttar Pradesh. The objectives of the study to assess the breastfeeding knowledge practices and problems related to breastfeeding among the postnatal mothers and to assess the effectiveness of the comprehensive breastfeeding promotion program on breastfeeding self-efficacy, practices and outcomes among primigravid mothers.
A study of financial performance of commercial Banks in post Demonetization period A comparative study of Public and Private sector Banks
(SRHU, 2024-06-27) Dobhal, Jyoti
Banks play an important role in the economic development of a country. The banking system serves as the financial engine of the nation's economy. It meets the financial needs of the economy, industry, and agriculture. Small changes in government policy can have a significant impact on the banking sector's operations, which can directly affect the growth and development of the nation's economy. The demonetization of the 500- and 1000-rupee notes took place in India on 8 Nov. 2016. The various banking operations underwent significant changes as a result of the sudden demonetization. Demonetization had affected many sectors of the nation, but banking sector was the most affected one because it served as a primary source via which the entire process carried out. It becomes necessary to understand the demonetization impact on banks performance. The present study is an attempt to evaluate the financial performance of public and private sector banks during demonetization period. Three public sector banks (SBI, PNB, BOB) and three private sector banks (HDFC, ICICI, AXIS) are chosen for analysis. With the help of ratio analysis, the financial performance of public and private sector banks is compared in pre and post demonetization period. The findings indicated that private banks performed better than private sector banks in pre and post demonetization period.
Effectiveness of Comprehensive Nursing interventions on well being and quality of life among Senior Citizens in Rural community Nepal
(SRHU, 2024-06-27) Mainali, Shila
Aging is a physiological and degenerative process causing generalized degradation of body functions, raising the risk of age related disorders, affecting well- being and quality of life. Comprehensive nursing interventions address the needs and problems of the rapidly accelerated ageing population.