Bibliography : Health Care Workers

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Balasubramanya B, Nisha C, Ramesh N, Joseph B Staff working in ancillary departments at a tertiary care hospital in Bengaluru, Karnataka, India: How healthy are they? 2016 Indian J Occup Environ Med.
Vol. 20(1), pp. 44-7 
article DOI  
Abstract: BACKGROUND:
Ancillary health services are those supplemental services other than room, board, and medical/nursing services provided to hospital patients in the course of care. Ancillary department staff forms an integral part in the smooth functioning of a hospital. There is a need to focus on the health of these individuals to ensure their well-being and in turn, productivity at the workplace.
OBJECTIVE:
To study the morbidity profile of the staff working at ancillary departments of a tertiary care hospital in Bengaluru, Karnataka, India.
MATERIALS AND METHODS:
We conducted our study in a 1,200-bedded tertiary care hospital in Bengaluru, Karnataka, India. Annual medical checkup (AMC) for all the staff working at the ancillary departments has been started in recent years and is provided free of cost and during working hours. A total of 150 employees from ancillary departments underwent AMC in the year 2013. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 20.0. Spearman's correlation and Chi-square test were used.
RESULTS:
Of the 150 employees, the majority was male (72%); the mean age was 38 ± 11 years. The most common morbidities were diabetes mellitus (11%), hypertension (10.6%), musculoskeletal disorders (9.3%), surgical problems (8.6%, hemorrhoids, varicose veins), and dental caries (6.6%). On stool microscopy, 12% of the dietary workers showed ova/cyst. There was a significant positive correlation between age and the number of chronic morbidities (P < 0.01).
CONCLUSION:
Lifestyle disorders such as diabetes mellitus and hypertension were the major morbidities among the staff in the ancillary departments of the hospital. We ensured regular follow-up, adherence to medication, and lifestyle modifications in terms of diet and exercise.
BibTeX:
@article{BalasubramanyaB2016,
  author = {Balasubramanya B, Nisha C, Ramesh N, Joseph B},
  title = {Staff working in ancillary departments at a tertiary care hospital in Bengaluru, Karnataka, India: How healthy are they?},
  journal = {Indian J Occup Environ Med.},
  year = {2016},
  volume = {20(1)},
  pages = {44-7},
  doi = {http://dx.doi.org/10.4103/0019-5278.183844}
}
Chaudhuri SB, Ray K Safe Injection Practices in Primary Health Care Settings of Naxalbari Block, Darjeeling District, West Bengal. 2016 J Clin Diagn Res.
Vol. 10(1) 
article DOI  
Abstract: INTRODUCTION:
Unsafe injection can transmit many diseases to patients, injection providers and healthy people of community.
AIM:
To find out critical steps whether executed according to recommended best practice methods, availability of equipments inhealth facilities for safe injection practices and some important steps of waste disposal methods.
MATERIALS AND METHODS:
This facility-based cross-sectional observational study was conducted among 30 Auxiliary nurse midwives (ANM) & 27 nursing staffs (NS) to assess certain aspects of their practice while administrating injection and disposal of the disposables. Health facilities were also observed to asses necessary equipments of safe injection and waste disposal methods.
RESULTS:
Among the health workers 93.3% ANM and 100% NS took sterile syringe from sterile unopened packet, all of the study subjects washed hand before giving injection, 13.3% of ANMs and 8% of NS are fully vaccinated against Hep B, 53.3% of ANM and all NS are practices non recapping. Only 13.33% sub centres along with PHC & BPHC had at least one puncture resistant leak proof container, 86.7% sub centres, PHC are free from loose needles. Transport for off side treatment is the method of waste disposal in case of 73.3% cases sub centres, PHC & BPHC.
CONCLUSION:
There is need to educate, train and motivate service providers in proper methods of giving injection along with improve the adequacy of supply of required equipments.
BibTeX:
@article{ChaudhuriSB2016,
  author = {Chaudhuri SB, Ray K},
  title = {Safe Injection Practices in Primary Health Care Settings of Naxalbari Block, Darjeeling District, West Bengal.},
  journal = {J Clin Diagn Res.},
  year = {2016},
  volume = {10(1)},
  doi = {http://dx.doi.org/10.7860/JCDR/2016/15668.7132}
}
Darivemula SB, Goswami K, Gupta SK, Salve H, Singh U, Goswami AK Work-related Neck Pain Among Desk Job Workers of Tertiary Care Hospital in New Delhi, India: Burden and Determinants. 2016 Indian J Community Med.
Vol. 41(1), pp. 50-4 
article DOI  
Abstract: BACKGROUND:
Work-related Neck Pain (WRNP) is a leading cause of disability and absenteeism. There is dearth of information about burden and determinants of WRNP in health facility setting in India.
MATERIALS AND METHODS:
A cross-sectional study was carried out at tertiary care hospital in New Delhi. All Group C desk jobworkers involved in the administrative work were included in the study. Participants were screened for WRNP by using pretested semi-structured questionnaire. Detailed information on probable risk factors was collected among patients with WRNP. Neck examination by trained investigator was done. Work place assessment was done by using observation check-list using the recommendations of the ISO Standard (Ergonomic requirements for office work with visual display terminals). Crude and adjusted odds ratio was calculated with 95% confidence interval to understand the determinants of WRNP.
RESULTS:
In total, 441 participants were included in the study. Of them, 58% were males. Majority of participants aged between31-50 years. One-year prevalence of neck pain and WRNP was reported as 43.3%, (95% CI 38.7%-47.9%) and 28.3%, (95% CI 24.3%-32.7%) respectively. On multivariate analysis, female gender (OR-2.0 95% CI) and poor perception of breaks during working hours (OR-2.4 95% CI), along with work place related factors such as posture (OR-5.4 95% CI) and height of the screen (<10 cms) (OR-2.6) were identified as independent determinants of WRNP.
CONCLUSION:
High one-year prevalence of WRNP was reported among desk job workers. Burden of WRNP was reported more among females as compared to males. Most common factor identified was Computer use for more than 4-6 hours was most important predictor of WRNP followed by work related factors such as height of screen and posture are associated with WRNP.
BibTeX:
@article{DarivemulaSB2016,
  author = {Darivemula SB, Goswami K, Gupta SK, Salve H, Singh U, Goswami AK},
  title = {Work-related Neck Pain Among Desk Job Workers of Tertiary Care Hospital in New Delhi, India: Burden and Determinants.},
  journal = {Indian J Community Med.},
  year = {2016},
  volume = {41(1)},
  pages = {50-4},
  doi = {http://dx.doi.org/10.4103/0970-0218.170967}
}
Gupta E, Gupta A Blood-borne viruses and health care workers: A neglected entity! 2016 Indian J Med Microbiol.
Vol. 34(2), pp. 137-8 
article DOI  
BibTeX:
@article{GuptaE2016,
  author = {Gupta E, Gupta A},
  title = {Blood-borne viruses and health care workers: A neglected entity!},
  journal = {Indian J Med Microbiol.},
  year = {2016},
  volume = {34(2)},
  pages = {137-8},
  doi = {http://dx.doi.org/10.4103/0255-0857.176854}
}
Kumar D, Kumari S, Salian SR, Uppangala S, Kalthur G, Challapalli S, Chandraguthi SG, Kumar P, Adiga SK Genetic Instability in Lymphocytes is Associated With Blood Plasma Antioxidant Levels in Health Care Workers Occupationally Exposed to Ionizing Radiation. 2016 Int J Toxicol.
Vol. 35(3), pp. 327-35 
article DOI  
Abstract: Earlier reports have suggested that exposure to radiation at workplace may induce cytogenetic abnormalities. However, the association between plasma antioxidants and the cytogenetic abnormalities in these patients has not been elucidated till now. Hence, the present study was undertaken to determine the relationship between the cytogenetic abnormalities, plasma antioxidant system, and the radiation exposure levels in men who were occupationally exposed to ionizing radiation. The study included 134 male volunteers, among whom 83 were occupationally exposed to ionizing radiation. Incidence of micronuclei and chromosomal aberration was assessed in lymphocytes. Total and reduced glutathione (GSH), total antioxidant capacity (TAC), superoxide dismutase (SOD), and lipid peroxidation were assessed in the plasma. The micronuclei frequency and chromosomal aberrations were significantly higher in the exposed group in comparison to the nonexposed group (P < 0.01-0.0001). Similarly, GSH, TAC, and SOD in the blood plasma were significantly higher in the exposed group than the nonexposed group (P < 0.01-0.0001). However, the level of malondialdehyde, which is an indicator of lipid peroxidation, did not differ significantly between both the groups. Importantly, radiation absorbed dose exhibited a positive correlation with the incidence of micronuclei in blood lymphocytes but not with chromosomal aberrations. This study shows that the susceptibility of peripheral blood lymphocytes to chromosomal damage is associated with plasma antioxidant levels. Furthermore, increased levels of blood plasma GSH, TAC, and SOD in occupationally exposed individuals could be an adaptive measure in response to oxidative stress to protect somatic cell genetic integrity.
BibTeX:
@article{KumarD2016,
  author = {Kumar D, Kumari S, Salian SR, Uppangala S, Kalthur G, Challapalli S, Chandraguthi SG, Kumar P, Adiga SK},
  title = {Genetic Instability in Lymphocytes is Associated With Blood Plasma Antioxidant Levels in Health Care Workers Occupationally Exposed to Ionizing Radiation.},
  journal = {Int J Toxicol.},
  year = {2016},
  volume = {35(3)},
  pages = {327-35},
  doi = {http://dx.doi.org/10.1177/1091581815625593}
}
Malhotra S, Sharma S, Bhatia NJ, Hans C Needle-stick injury among health care workers and its response in a tertiary care hospital. 2016 Indian J Med Microbiol.
Vol. 34(2), pp. 258-9 
article DOI  
BibTeX:
@article{MalhotraS2016,
  author = {Malhotra S, Sharma S, Bhatia NJ, Hans C},
  title = {Needle-stick injury among health care workers and its response in a tertiary care hospital.},
  journal = {Indian J Med Microbiol.},
  year = {2016},
  volume = {34(2)},
  pages = {258-9},
  doi = {http://dx.doi.org/10.4103/0255-0857.180368}
}
Pandey J, Singh M Donning the mask: effects of emotional labour strategies on burnout and job satisfaction in community healthcare. 2016 Health Policy Plan.
Vol. 31(5), pp. 551-62 
article DOI  
Abstract: Emotional labour involves management of one's emotions to match the demands of their roles. This emotion display involves just expression (surface-level emotional labour) or experience in addition to expression (deep-level emotional labour) of the desired emotions. Emotional labour is required in the effective, efficient and successful healthcare service delivery. Burnout associated with emotional labour is an important factor that decides how satisfied frontline service providers with their job are. This empirical study investigates the link between surface and deep-level emotional labour, burnout and job satisfaction in women community healthworkers from India. Our results from the structural equation modelling of 177 accredited social health activists (ASHAs) indicate a negative relation between surface and deep-level emotional labour, clearly demarcating them as two different strategies for performance of emotional labour in community health care setting. Surface-level emotional labour is associated with higher job satisfaction, and burnout partially mediates this relation. Deep-level emotional labour is associated with lower job satisfaction; burnout fully mediates this relation. Qualitative post hoc analysis based on interviews of 10 ASHAs was done to understand the findings of the quantitative study. Surface-level emotional labour was found to be a more desirable strategy for community health care workers for the effective and efficient performance of their work roles. Our results have a significant contribution to design, redesign, and improvement of employment practices in community healthcare. This study brings forth the neglected issues of emotions and their implications for these healthcare workers in low and middle-income countries who are a vital link that delivers healthcare to weaker section of the society. The findings have relevance not merely for the individual providing this service but the beneficiary and the organization that facilitates this delivery. Interventions based on demographic, community, national and occupational factors have also been presented.
BibTeX:
@article{PandeyJ2016,
  author = {Pandey J, Singh M},
  title = {Donning the mask: effects of emotional labour strategies on burnout and job satisfaction in community healthcare.},
  journal = {Health Policy Plan.},
  year = {2016},
  volume = {31(5)},
  pages = {551-62},
  doi = {http://dx.doi.org/10.1093/heapol/czv102}
}
Prinja S, Nimesh R, Gupta A, Bahuguna P, Thakur JS, Gupta M, Singh T Impact assessment and cost-effectiveness of m-health application used by community healthworkers for maternal, newborn and child health care services in rural Uttar Pradesh, India: a study protocol. 2016 Glob Health Action.
Vol. 9 
article  
Abstract: BACKGROUND:
An m-health application has been developed and implemented with community health workers to improve their counseling in a rural area of India. The ultimate aim was to generate demand and improve utilization of key maternal, neonatal, and child health services. The present study aims to assess the impact and cost-effectiveness of this project.
METHODS/DESIGN:
A pre-post quasi-experimental design with a control group will be used to undertake difference in differences analysis for assessing the impact of intervention. The Annual Health Survey (2011) will provide pre-intervention data, and a household survey will be carried out to provide post-intervention data.Two community development blocks where the intervention was introduced will be treated as intervention blocks while two controls blocks are selected after matching with intervention blocks on three indicators: average number of antenatal care checkups, percentage of women receiving three or more antenatal checkups, and percentage of institutional deliveries. Two categories of beneficiaries will be interviewed in both areas: women with a child between 29 days and 6 months and women with a child between 12 and 23 months. Propensity score matched samples from intervention and control areas in pre-post periods will be analyzed using the difference in differences method to estimate the impact of intervention in utilization of key services.Bottom-up costing methods will be used to assess the cost of implementing intervention. A decision model will estimate long-term effects of improved health services utilization on mortality, morbidity, and disability. Cost-effectiveness will be assessed in terms of incremental cost per disability-adjusted life year averted and cost per unit increase in composite service coverage in intervention versus control groups.
CONCLUSIONS:
The study will generate significant evidence on impact of the m-health intervention for maternal, neonatal, and child services and on the cost of scaling up m-health technology for accredited social health activists in India.
BibTeX:
@article{PrinjaS2016,
  author = {Prinja S, Nimesh R, Gupta A, Bahuguna P, Thakur JS, Gupta M, Singh T},
  title = {Impact assessment and cost-effectiveness of m-health application used by community healthworkers for maternal, newborn and child health care services in rural Uttar Pradesh, India: a study protocol.},
  journal = {Glob Health Action.},
  year = {2016},
  volume = {9}
}
Priya NL, Krishnan KU, Jayalakshmi G, Vasanthi S An analysis of multimodal occupational exposure leading to blood borne infections among health care workers. 2015 Indian J Pathol Microbiol.
Vol. 58(1), pp. 66-8 
article DOI  
Abstract: Occupational exposure poses a significant risk of transmission of blood-borne pathogens to healthcare workers (HCWs). Adherence to standard precautions, awareness about post exposure prophylaxis is poor in developing countries. This retrospective study analyzes the self-reported cases of occupational exposure in a tertiary care hospital. During the study period, 105 HCWs sustained occupational exposure to blood and body fluids. Majority of the victims 36 (34.2%) were interns and the clinical practice that led to the occupational exposure was withdrawal of blood (45.7%). Good infection control practices and emphasis on appropriate disposal are needed to increase the occupational safety for HCWs.
BibTeX:
@article{PriyaNL2015,
  author = {Priya NL, Krishnan KU, Jayalakshmi G, Vasanthi S},
  title = {An analysis of multimodal occupational exposure leading to blood borne infections among health care workers.},
  journal = {Indian J Pathol Microbiol.},
  year = {2015},
  volume = {58(1)},
  pages = {66-8},
  doi = {http://dx.doi.org/10.4103/0377-4929.151191}
}
Kumar S Burnout and Doctors: Prevalence, Prevention and Intervention.Burnout and Doctors: Prevalence, Prevention and Intervention. 2016 Healthcare (Basel).
Vol. 4(3) 
article DOI  
Abstract: Doctors are exposed to high levels of stress in the course of their profession and are particularly susceptible to experiencing burnout. Burnout has far-reaching implications on doctors; patients and the healthcare system. Doctors experiencing burnout are reported to be at a higher risk of making poor decisions; display hostile attitude toward patients; make more medical errors; and have difficult relationships with co-workers. Burnout among doctors also increases risk of depression; anxiety; sleep disturbances; fatigue; alcohol and drug misuse; marital dysfunction; premature retirement and perhaps most seriously suicide. Sources of stress in medical practice may range from the emotions arising in the context of patient care to the environment in which doctors practice. The extent of burnout may vary depending on the practice setting; speciality and changing work environment. Understanding dynamic risk factors associated with burnout may help us develop strategies for preventing and treating burnout. Some of these strategies will be reviewed in this paper.
BibTeX:
@article{S2016,
  author = {Kumar S},
  title = {Burnout and Doctors: Prevalence, Prevention and Intervention.Burnout and Doctors: Prevalence, Prevention and Intervention.},
  journal = {Healthcare (Basel).},
  year = {2016},
  volume = {4(3)},
  doi = {http://dx.doi.org/10.3390/healthcare4030037}
}
Shah R, Eynan R, Srivastava A, Reiss L, Sathyanarayana Rao TS, Parkar S, Dutt L, Kadam K, Links PS Indo-Canadian Collaboration for Suicide Prevention: Training Needs Assessment for Healthcare Professionals in India. 2016 Community Ment Health J.
Vol. 52(5), pp. 511-8 
article DOI  
Abstract: The main purpose of the study was to conduct a comprehensive needs assessment of primary healthcare professionals in order to develop a training program aimed at enhancing competencies in suicide risk assessment and management. A total of 144 primary healthcare professionals (physicians = 46; primary care workers = 98) completed the needs assessment questionnaire. The majority of healthcare professionals rated their level of comfort and competence in assessing, treating, and referring suicidal patients as medium or high. However, their knowledge about suicide, risk factors for suicide, asking about suicidal behaviour, and helping a suicidal patient was rated low or medium. Overall, the scarcity of qualified healthcare professionals and the existing gaps in core competencies for suicide risk assessment and management was identified. Development of innovative and effective competencies-based suicide specific training for primary care providers in India is urgently required.
BibTeX:
@article{ShahR2016,
  author = {Shah R, Eynan R, Srivastava A, Reiss L, Sathyanarayana Rao TS, Parkar S, Dutt L, Kadam K, Links PS},
  title = {Indo-Canadian Collaboration for Suicide Prevention: Training Needs Assessment for Healthcare Professionals in India.},
  journal = {Community Ment Health J.},
  year = {2016},
  volume = {52(5)},
  pages = {511-8},
  doi = {http://dx.doi.org/10.1007/s10597-015-9895-z}
}
Subramaniam DP, Baker EA, Zelicoff AP, Elliott MB Factors Influencing Seasonal Influenza Vaccination Uptake in Emergency Medical Services Workers: A Concept Mapping Approach. 2016 J Community Health.
Vol. 41(4), pp. 697-706 
article DOI  
Abstract: Seasonal influenza has serious impacts on morbidity and mortality and has a significant economic toll through lost workforce time and strains on the health system. Health workers, particularly emergency medical services (EMS) workers have the potential to transmit influenza to those in their care, yet little is known of the factors that influence EMS workers' decisions regarding seasonal influenza vaccination (SIV) uptake, a key factor in reducing potential for transmitting disease. This study utilizes a modified Theory of Planned Behavior (TPB) model as a guiding framework to explore the factors that influence SIV uptake in EMS workers. Concept mapping, which consists of six-stages (preparation, generation, structuring, representation, interpretation, and utilization) that use quantitative and qualitative approaches, was used to identify participants' perspectives towards SIV. This study identified nine EMS-conceptualized factors that influence EMS workers' vaccination intent and behavior. The EMS-conceptualized factors align with the modified TPB model and suggest the need to consider community-wide approaches that were not initially conceptualized in the model. Additionally, the expansion of non-pharmaceutical measures went above and beyond original conceptualization. Overall, this study demonstrates the need to develop customized interventions such as messages highlighting the importance of EMS workersreceiving SIV as the optimum solution. EMS workers who do not intend to receive the SIV should be provided with accurate information on the SIV to dispel misconceptions. Finally, EMS workers should also receive interventions which promote voluntary vaccination, encouraging them to be proactive in the health decisions they make for themselves.
BibTeX:
@article{SubramaniamDP2016,
  author = {Subramaniam DP, Baker EA, Zelicoff AP, Elliott MB},
  title = {Factors Influencing Seasonal Influenza Vaccination Uptake in Emergency Medical Services Workers: A Concept Mapping Approach.},
  journal = {J Community Health.},
  year = {2016},
  volume = {41(4)},
  pages = {697-706},
  doi = {http://dx.doi.org/10.1007/s10900-015-0144-8}
}
Taishete S, Chowdhary A Seroepidemiological survey of health care workers in Maharashtra. 2016 Indian J Med Microbiol.
Vol. 34(2), pp. 237-40 
article DOI  
Abstract: CONTEXT:
HCWs all over the world carry occupational risk of getting infected with major blood borne infections through needle stick injuries (NSIs). As health care industry has been expanding, risk of nosocomial infections is increasing proportionately. Measures to prevent it and put in place a mechanism to control these injuries are needed urgently, especially in India where there is not only increase in domestic demand but impetus in health tourism.
AIM:
To determine HBs Ag, HBc IgM level and to assess anti-HBs level prevalence in HCWs, in a tertiary care hospital and to study the influence of factors like age and sex in the vaccinated HCWs and formulate mechanism to increase awareness to create a safe working environment in the hospitals.
SETTINGS AND DESIGN:
437 HCWs, working in Laboratories, Surgical, Medical or Dental departments in 11 Civil Hospitals and Sub-district Hospitals covering 8 circles of the State.
METHODS AND MATERIAL:
Qualitative and Quantitative estimation of HBs Ag and Anti-HBs by sandwich ELISA technique and qualitative HBc IgM level by antibody-capture, non-competitive test. Liver profile (SGPT, SGOT and Alkaline Phosphatase) by IFCC method done.
STATISTICAL ANALYSIS USED:
Tabulation and Pie Circle Result: 193 of the total 229 vaccinated HCWs tested positive for core antibody, meaning that they were infected prior to HBs Ag vaccination, leaving a total of 36 'truly' vaccinated HCWs. 11 HBs Ag positive HCWs were tested for Liver Profile and all had ALAT, ASAT and ALP within normal range. Out of total number of 141 HCWs having 10 and below IU/L anti HBs, 5 HCWs were positive for HBS Ag, showing a positivity of 3.5%.
CONCLUSION:
Need of vaccination and for post-vaccination serological testing of all HCWs considering the high rates of non-responders and low responders (anti-HBs-34.2%). Importance of educating the HCWs of safety precautions while handling body fluids, and the management of ' sharps ' injuries.
BibTeX:
@article{TaisheteS2016,
  author = {Taishete S, Chowdhary A},
  title = {Seroepidemiological survey of health care workers in Maharashtra.},
  journal = {Indian J Med Microbiol.},
  year = {2016},
  volume = {34(2)},
  pages = {237-40},
  doi = {http://dx.doi.org/10.4103/0255-0857.180355}
}
Agarwal L, Singh AK, Sengupta C, Agarwal A Nasal carriage of Methicillin- and Mupirocin-resistant S. aureus among health care workers in a tertiary care hospital. 2015 J Res Pharm Pract.
Vol. 4(4), pp. 182-6 
article DOI  
Abstract: OBJECTIVE:
Methicillin-resistant Staphylococcus aureus (MRSA) ranks top among the nosocomial pathogens. Nasal formulation of mupirocin is found to eradicate MRSA from colonized individuals, but the emergence of resistant strains is a matter of concern.
METHODS:
Nasal swabs were collected from 200 health care workers (HCWs) who were screened for MRSA. Kirby-Bauer disc diffusion method was used to perform antibiotic susceptibility test. MRSA detection was done using a cefoxitin 30 µg disc and interpreted according to the Clinical and Laboratory Standards Institute guidelines. Determination of mupirocin resistance was performed using Epsilometer test (E-test).
FINDINGS:
About 14% of HCWs showed nasal carriage of MRSA. Nursing orderlies were the predominant carriers. E-test showed four mupirocin resistant isolates. The antibiogram of the MRSA isolates revealed the higher resistance to antibiotics as compared to methicillin-sensitive Staphylococcus aureus. All the MRSA isolates were sensitive to linezolid.
CONCLUSION:
HCWs in our hospital showed high nasal carriage rate of MRSA, particularly the nursing orderlies which is statistically significant. It is advisable to detect mupirocin resistance among the isolates obtained from the HCWs so that in case of resistance, alternative treatment should be sought.
BibTeX:
@article{AgarwalL2015,
  author = {Agarwal L, Singh AK, Sengupta C, Agarwal A},
  title = {Nasal carriage of Methicillin- and Mupirocin-resistant S. aureus among health care workers in a tertiary care hospital.},
  journal = {J Res Pharm Pract.},
  year = {2015},
  volume = {4(4)},
  pages = {182-6},
  doi = {http://dx.doi.org/10.4103/2279-042X.167046}
}
Arora P, Kumari S, Sodhi J, Talati S, Gupta AK Gloves Reprocessing: Does It Really Save Money? 2015 Indian J Surg.
Vol. 77, pp. 1291-4 
article DOI  
Abstract: Gloves are reprocessed and reused in health-care facilities in resource-limited settings to reduce the cost of availability of gloves. The study was done with the aim to compute the cost of reprocessing of gloves so that an economically rationale decision can be taken. A retrospective record-based cross-sectional study was undertaken in a central sterile supply department where different steps during reprocessing of gloves were identified and the cost involved in reprocessing per pair of gloves was calculated. The cost of material and manpower was calculated to arrive at the cost of reprocessing per pair of gloves. The cost of a reprocessed pair of surgical gloves was calculated to be Indian Rupee (INR) 14.33 which was greater than the cost of a new pair of disposable surgical gloves (INR 9.90) as the cost of sterilization of one pair of gloves itself came out to be INR 10.97. The current study showed that the purchase of sterile disposable single-use gloves is cheaper than the process of recycling. Reprocessing of gloves is not economical on tangible terms even in resource-limited settings, and from the perspective of better infection control as well as health-care worker safety, it further justifies the use of disposable gloves.
BibTeX:
@article{AroraP2015,
  author = {Arora P, Kumari S, Sodhi J, Talati S, Gupta AK},
  title = {Gloves Reprocessing: Does It Really Save Money?},
  journal = {Indian J Surg.},
  year = {2015},
  volume = {77},
  pages = {1291-4},
  doi = {http://dx.doi.org/10.1007/s12262-015-1279-7}
}
Basheer S, Anurag K, Garg R, Kumar R, Vashisht S Quality of life of caregivers of mentally ill patients in a tertiary care hospital. 2015 Ind Psychiatry J.
Vol. 24(2), pp. 144-9 
article DOI  
Abstract: OBJECTIVES:
To explore the quality of life (QOL) and its association with psycho-sociodemographic factors among caregivers of mentally ill patients in a tertiary care hospital in urban India.
MATERIALS AND METHODS:
Sample consisted of 100 caregivers attending outpatient services in a tertiary care hospital. Data was collected using World Health Organization QOL-BREF (WHOQOL-BREF) questionnaire. The higher score meant a better QOL.
RESULTS:
Of 100 caregivers, 66% were men, 47% were parents and 64% were literate. 52% of the caregivers were providing care for 1-5 years. The mean total score of QOL of the study population was 13.34 with the highest score 15.15 in the physical domain, followed by 12.75 in social, 12.96 in environmental, and 12.52 in psychological domain. In a multiple linear regression model, caregiver's elderly age was significantly associated most of the domains of WHOQOL.
CONCLUSION:
Caregivers of mentally ill patients have diminished QOL levels. Studies measuring QOL among caregivers can help initiate early intervention among the vulnerable caregivers. This study would help in increasing the awareness among the professionalhealth care workers, to identify at risk caregivers. Health workers by providing better health services and better psycho-education to the caregivers can improve their QOL.
BibTeX:
@article{BasheerS2015,
  author = {Basheer S, Anurag K, Garg R, Kumar R, Vashisht S},
  title = {Quality of life of caregivers of mentally ill patients in a tertiary care hospital.},
  journal = {Ind Psychiatry J.},
  year = {2015},
  volume = {24(2)},
  pages = {144-9},
  doi = {http://dx.doi.org/10.4103/0972-6748.181721}
}
Bhagawati G, Nandwani S, Singhal S Awareness and practices regarding bio-medical waste management among health care workers in a tertiary care hospital in Delhi. 2015 Indian J Med Microbiol.
Vol. 33(4), pp. 580-2 
article DOI  
Abstract: Health care institutions are generating large amount of Bio-Medical Waste (BMW), which needs to be properly segregated and treated. With this concern, a questionnaire based cross-sectional study was done to determine the current status of awareness and practices regarding BMW Management (BMWM) and areas of deficit amongst the HCWs in a tertiary care teaching hospital in New Delhi, India. The correct responses were graded as satisfactory (more than 80%), intermediate (50-80%) and unsatisfactory (less than 50%). Some major areas of deficit found were about knowledge regarding number of BMW categories (17%), mercury waste disposal (37.56%) and definition of BMW (47%).
BibTeX:
@article{BhagawatiG2015,
  author = {Bhagawati G, Nandwani S, Singhal S},
  title = {Awareness and practices regarding bio-medical waste management among health care workers in a tertiary care hospital in Delhi.},
  journal = {Indian J Med Microbiol.},
  year = {2015},
  volume = {33(4)},
  pages = {580-2},
  doi = {http://dx.doi.org/10.4103/0255-0857.167323}
}
Gupta AK, Gupta AC, Gupta A, Ranga SS, Rewari BB, Bansal AP Implementation and impact of a post-exposure prophylaxis helpline. 2015 Occup Med (Lond).
Vol. 65(5), pp. 398-401 
article DOI  
Abstract: BACKGROUND:
Despite a 2007 national and regional training programme, there was poor implementation of a post-exposure prophylaxis (PEP) programme to prevent occupational transmission of HIV in health care workers (HCWs) in Delhi. A new initiative was therefore launched by the Delhi State AIDS Control Society in 2010 to improve uptake of PEP in HCWs.
AIMS:
To assess the implementation and efficacy of the PEP programme in Delhi.
METHODS:
The initiative included a PEP poster and a telephone helpline together with a workshop for senior doctors of 46 public hospitals nominated as PEP supervisors. Data concerning use of the PEP help line and number of HCWs enrolling for PEP between January 2011 and May 2014 were analysed.
RESULTS:
Until September 2010, only 61% (28) of Delhi hospitals had PEP drugs and medical supervisors to manage the programme and reports concerning the programme were not sent. After roll-out of the PEP helpline, 4057 HCWs accessed the helpline, all public hospitals started implementing the programme and sent monthly reports. During the same period, 1450 HCWs suffered from occupational exposures, 15% were started on PEP drugs of who 98% completed the full course of prophylaxis.
CONCLUSIONS:
The PEP helpline is probably the first in a developing country and has been helpful for the effective implementation of the national PEP programme in Delhi.
BibTeX:
@article{GuptaAK2015,
  author = {Gupta AK, Gupta AC, Gupta A, Ranga SS, Rewari BB, Bansal AP},
  title = {Implementation and impact of a post-exposure prophylaxis helpline.},
  journal = {Occup Med (Lond).},
  year = {2015},
  volume = {65(5)},
  pages = {398-401},
  doi = {http://dx.doi.org/10.1093/occmed/kqv053}
}
Kapil R, Bhavsar HK, Madan M Hand hygiene in reducing transient flora on the hands of healthcare workers: an educational intervention. 2015 Indian J Med Microbiol.
Vol. 33(1), pp. 125-8 
article  
Abstract: AIM:
Hand hygiene has now been recognised as one of the most effective intervention to control the transmission of infections in a hospital and education is an important tool to ensure its implementation. In order to convince the users and as a part of education, it is important to generate evidence on the role of hand hygiene in reducing the bacterial flora on their hands. The present study was undertaken in a tertiary care hospital to demonstrate the presence of bacterial flora on the hands of healthcareworkers (HCW) in different categories, to teach them proper hand hygiene technique using alcohol-based hand rub and determine the outcome for reduction of bacteria.
MATERIALS AND METHODS:
A total sample size of 60 subjects including resident doctors, medical students, nurses and hospital attendants were included in the study after obtaining informed consent. Each person was educated on the technique of hand hygiene with alcohol-based hand rub and hand impressions were cultured before and after hand hygiene. All the subjects were also given a questionnaire to assess their perception on hand hygiene. The WHO posters on proper hand hygiene were displayed in the appropriate areas of the hospital in addition, as an educational tool.
RESULTS:
Majority (42 out of 60) of the HCWs had bacterial count up to 100 colonies or more on both hands before the application of hand rub while working in the hospital. After use of alcohol hand rub with a proper hand hygiene technique, it was found that the percentage reduction was 95-99% among doctors and nurses, 70% among hospital attendants and 50% among sanitary attendants. Staphylococcus aureus was present on the hands of eight persons of which three were methicillin-resistant Staphylococcus aureus.
CONCLUSIONS:
The study demonstrates that transient bacteria are present on the hands of HCWs but majority could be removed by proper hand hygiene, which needs continuous education to be effective. It also shows that active education by demonstrating the proper hand hygiene technique and direct observation of the practices, though demanding, are ideal to understand the attitudes and practices of HCWs and helps in planning implementation strategies.
BibTeX:
@article{KapilR2015,
  author = {Kapil R, Bhavsar HK, Madan M},
  title = {Hand hygiene in reducing transient flora on the hands of healthcare workers: an educational intervention.},
  journal = {Indian J Med Microbiol.},
  year = {2015},
  volume = {33(1)},
  pages = {125-8}
}
Kumar HN, Nambiar RP, Mohapatra S, Khanna A, Praveen R, Sai Bhawana D A Cross-sectional Study on Hepatitis B Vaccination Status and Post-exposure Prophylaxis Practices Among Health Care Workers in Teaching Hospitals of Mangalore. 2015 Ann Glob Health.
Vol. 81(5), pp. 664-8 
article DOI  
Abstract: BACKGROUND:
Health care workers (HCWs) are at high risk for acquiring hepatitis B virus infection because of needle stick injury (NSI) and occupational exposures to potentially infectious bodily fluids. Hepatitis B vaccination confers protection against the infection. Very little information is available in India about current vaccination status and postexposure prophylaxis (PEP) practices among HCWs.
OBJECTIVES:
This study had 2 objectives. The first was to characterize current vaccination coverage among HCWs, and the second was to define PEP practices among HCWs after NSI and exposures to potentially infectious bodily fluids.
METHODS:
A questionnaire-based, cross-sectional study was conducted in hospitals attached to Kasturba Medical College, Mangalore. We selected 297 individuals. A pretested, semistructured questionnaire was devised to collect information from study participants. After obtaining permission from the Institutional Ethics Committee, data were collected by interviewing HCWs in the hospitals. Analysis was done using SPSS.
FINDINGS:
Nearly all (93.8%) of the HCWs surveyed had taken 1 dose of hepatitis B vaccine. However, only 57.1% completed the primary series of 3 doses and only 26.4% had taken 1 or more booster doses. Of the HCWs questioned, 24.8% had experienced NSIs, exposure to potentially infectious bodily fluids, or both. Local measures were the PEP practices most commonly used (85.5%) by the HCWs.
CONCLUSION:
The present study demonstrated that there is a need in Mangalore to improve the vaccination coverage and train HCWs in appropriate PEP practices. This will protect the workers from acquiring hepatitis B infection.
BibTeX:
@article{KumarHN2015,
  author = {Kumar HN, Nambiar RP, Mohapatra S, Khanna A, Praveen R, Sai Bhawana D},
  title = {A Cross-sectional Study on Hepatitis B Vaccination Status and Post-exposure Prophylaxis Practices Among Health Care Workers in Teaching Hospitals of Mangalore.},
  journal = {Ann Glob Health.},
  year = {2015},
  volume = {81(5)},
  pages = {664-8},
  doi = {http://dx.doi.org/10.1016/j.aogh.2015.08.015}
}
Mony PK, Vishwanath NS, Krishnan S Tobacco use, attitudes and cessation practices among healthcare workers of a city healthdepartment in Southern India. 2015 J Family Med Prim Care.
Vol. 4(2), pp. 261-4 
article DOI  
Abstract: OBJECTIVE:
To assess tobacco use, attitudes and cessation practices among healthcare workers of a municipal health department in southern India.
MATERIALS AND METHODS:
We undertook a cross-sectional epidemiologic study to investigate 558 healthcare workers from three groups (doctors, auxiliary nurses and community link workers (LWs)) employed by the Bangalore city corporation in southern India. Outcomes included self-reported tobacco use status and attitudes (for all workers), and (for doctors) self-report of performance of "5-A" tobacco cessation interventions: Asking, advising, assessing, assisting, or arranging follow-up for tobacco control, in their client population.
RESULTS:
Doctors reported higher tobacco use rates (6.9%) compared to LW (2%) and nurses (<1%) but were less interested in further tobacco control training (77%) compared to the others (>95%). Many doctors reported asking (100%) and advising (78%) about tobacco use but much fewer were assessing intention/motivation to quit (24%), assisting with quitting (19%), and arranging follow-up for quitting and relapse prevention (9%).
CONCLUSION:
Tailored training in tobacco control would enable doctors, nurses and outreach workers involved in primary healthcaredelivery to be better equipped to deal with a major cause of morbidity and mortality among urban communities in the 21(st) century.
BibTeX:
@article{MonyPK2015,
  author = {Mony PK, Vishwanath NS, Krishnan S},
  title = {Tobacco use, attitudes and cessation practices among healthcare workers of a city healthdepartment in Southern India.},
  journal = {J Family Med Prim Care.},
  year = {2015},
  volume = {4(2)},
  pages = {261-4},
  doi = {http://dx.doi.org/10.4103/2249-4863.154670}
}
Nageeb N, Kulkarni UD Glaucoma Awareness and Self-Care Practices among the Health Professionals in a Medical College Hospital. 2015 J Clin Diagn Res.
Vol. 9(12) 
article DOI  
Abstract: BACKGROUND:
Awareness and self-care practices concerning glaucoma, the silent thief of sight, is poor. This study was conducted to assess the same among health professionals in a medical college.
MATERIALS AND METHODS:
Institutional Ethics Committee Clearance was obtained and a descriptive semi-structured-questionnaire-based study was conducted. Informed written consent was taken from 114 (convenience sampling) health professionals (doctors/paramedicals) and a questionnaire were administered. Participants were questioned about the awareness of glaucoma, what are the features of glaucoma etc. Non-medical hospital workers were excluded. Data was analysed using Microsoft excel, descriptive statistics and chi-square test.
RESULTS:
Respondents included clinicians, non-clinician-doctors and paramedicals (36:30:48) mean age: 37 years, males:females::58:56. Glaucoma awareness was statistically similar in the three study groups: high IOP (82.4%, p=0.55); optic nerve damage (32.4%, p=0.79); normal/low IOP (38.6%, p=0.2); irreversible blindness (47.1%, p=0.29); risk factors like corticosteroids (57%, p=0.11), family history of glaucoma (74.5%, p=0.17) and diabetes (77.1%, p=0.84). Over 13% thought that screening is done after 60 years. Few had undertaken screening for themselves (16.60%) and family members (21.05%). Few knew tests (41.2%, p=0.04) and treatment modalities (41.2%, p=0.0516).
CONCLUSION:
The study revealed unsatisfactory awareness and self-care practices concerning glaucoma among healthprofessionals including clinicians despite studying ophthalmology, although it is presumed and predicted to be the contrary. This alarming revelation warrants the need for enrichment of glaucoma awareness programs.
BibTeX:
@article{NageebN2015,
  author = {Nageeb N, Kulkarni UD},
  title = {Glaucoma Awareness and Self-Care Practices among the Health Professionals in a Medical College Hospital.},
  journal = {J Clin Diagn Res.},
  year = {2015},
  volume = {9(12)},
  doi = {http://dx.doi.org/10.7860/JCDR/2015/13923.6984}
}
Panda B, Pati S, Nallala S, Chauhan AS, Anasuya A, Som M, Zodpey S How supportive supervision influences immunization session site practices: a quasi-experimental study in Odisha, India. 2015 Glob Health Action.
Vol. 8 
article DOI  
Abstract: BACKGROUND:
Routine immunization (RI) is a key child survival intervention. Ensuring acceptable standards of RI servicedelivery is critical for optimal outcomes. Accumulated evidences suggest that 'supportive supervision' improves the quality ofhealth care services in general. During 2009-2010, the Government of Odisha and UNICEF jointly piloted this strategy in four districts to improve RI program outcomes. The present study aims to assess the effect of this strategy on improvement of skills and practices at immunization session sites.
DESIGN:
A quasi-experimental 'post-test only' study design was adopted to compare the opinion and practices of frontline healthworkers and their supervisors in four intervention districts (IDs) with two control districts (CDs). Altogether, we interviewed 111 supervisor-supervisee (health worker) pairs using semi-structured interview schedules and case vignettes. We also directly observed health workers' practices during immunization sessions at 111 sites. Data were analyzed with SPSS version 16.0.
RESULTS:
The mean knowledge score of supervisors in CDs was significantly higher than in intervention groups. Variegated responses were obtained on case vignettes. The control group performed better in solving certain hypothetically asked problems, whereas the intervention group scored better in others. Health workers in IDs gave a lower rating to their respective supervisors' knowledge, skill, and frequency of supervision. Logistics and vaccine availability were better in CDs.
CONCLUSION:
Notwithstanding other limitations, supportive supervision may not have independent effects on improving the quality of immunization services. Addressing systemic issues, such as the availability of essential logistics, supply chain management, timely indenting, and financial resources, could complement the supportive supervision strategy in improving immunization service delivery.
BibTeX:
@article{PandaB2015,
  author = {Panda B, Pati S, Nallala S, Chauhan AS, Anasuya A, Som M, Zodpey S},
  title = {How supportive supervision influences immunization session site practices: a quasi-experimental study in Odisha, India.},
  journal = {Glob Health Action.},
  year = {2015},
  volume = {8},
  doi = {http://dx.doi.org/10.3402/gha.v8.25772}
}
Dubey D, Amritphale A, Sawhney A, Amritphale N, Dubey P, Pandey A Smart phone applications as a source of information on stroke. 2014 J Stroke.
Vol. 16(2), pp. 86-90 
article DOI  
Abstract: BACKGROUND AND PURPOSE:
Smartphone applications have been increasingly identified as a novel platform for dissemination of healthcare related information. However, there have been no studies done to evaluate the availability and content of stroke related apps.
PURPOSE:
This study aims to identify and analyze stroke-related applications available on the Apple iTunes and Android Google Play Store.
METHODS:
The Apple iTunes store and Android Google Play Store were searched for stroke-related applications on July 27, 2013 using keywords: stroke, brain attack, intracranial hemorrhage, subarachnoid hemorrhage, cerebral infarction. The content of the applications was analyzed by two independent investigators.
RESULTS:
A total of 93 relevant applications (46.2% android and 53.8% iPhone) were identified of which 47.3% were available free of cost. 92% of apps were identified as useful by users and over 60% had scientifically valid information. There is a significant participation of healthcare agencies in dissemination of stroke related information through apps with 47.3% apps being uploaded by them. Over half of all stroke related apps were aimed towards health care workers (51.6%), 75% of which could be utilized as bedside tools for patient care and remainder had information related to recent research advances. The difference in scientific validity between the apps aimed at general population versus healthcare professionals was statistically significant (P<0.01). There was no statistical association between cost of app and scientific validity or usefulness.
CONCLUSIONS:
Smartphone apps are a significant source of information related to stroke. An increasing participation of healthcare agencies should be encouraged to promote dissemination of scientifically valid information.
BibTeX:
@article{DubeyD2014,
  author = {Dubey D, Amritphale A, Sawhney A, Amritphale N, Dubey P, Pandey A},
  title = {Smart phone applications as a source of information on stroke.},
  journal = {J Stroke.},
  year = {2014},
  volume = {16(2)},
  pages = {86-90},
  doi = {http://dx.doi.org/10.5853/jos.2014.16.2.86}
}
Krishnamurthy J Manpower planning in public health: opportunities and challenges for India. 2014 Indian J Public Health.
Vol. 58(2), pp. 135-6 
article DOI  
BibTeX:
@article{J2014,
  author = {Krishnamurthy J},
  title = {Manpower planning in public health: opportunities and challenges for India.},
  journal = {Indian J Public Health.},
  year = {2014},
  volume = {58(2)},
  pages = {135-6},
  doi = {http://dx.doi.org/10.4103/0019-557X.132293}
}
Krishnan L, Akande T, Shankar AV, McIntire KN, Gounder CR, Gupta A, Yang WT Gender-related barriers and delays in accessing tuberculosis diagnostic and treatment services: a systematic review of qualitative studies. 2014 Tuberc Res Treat.  article DOI  
Abstract: Background. Tuberculosis (TB) remains a significant global public health problem with known gender-related (male versus female) disparities. We reviewed the qualitative evidence (written/spoken narrative) for gender-related differences limiting TB service access from symptom onset to treatment initiation. Methods. Following a systematic process, we searched 12 electronic databases, included qualitative studies that assessed gender differences in accessing TB diagnostic and treatment services, abstracted data, and assessed study validity. Using a modified "inductive coding" system, we synthesized emergent themes within defined barriers and delays limiting access at the individual and provider/system levels and examined gender-related differences. Results. Among 13,448 studies, 28 studies were included. All were conducted in developing countries and assessed individual-level barriers; 11 (39%) assessed provider/system-level barriers, 18 (64%) surveyed persons with suspected or diagnosed TB, and 7 (25%) exclusively surveyed randomly sampled community members or health care workers. Each barrier affected both genders but had gender-variable nature and impact reflecting sociodemographic themes. Women experienced financial and physical dependence, lower general literacy, and household stigma, whereas men faced work-related financial and physical barriers and community-based stigma. Conclusions. In developing countries, barriers limiting access to TB care have context-specific gender-related differences that can inform integrated interventions to optimize TB services.
BibTeX:
@article{KrishnanL2014,
  author = {Krishnan L, Akande T, Shankar AV, McIntire KN, Gounder CR, Gupta A, Yang WT},
  title = {Gender-related barriers and delays in accessing tuberculosis diagnostic and treatment services: a systematic review of qualitative studies.},
  journal = {Tuberc Res Treat.},
  year = {2014},
  doi = {http://dx.doi.org/10.1155/2014/215059}
}
Kumar MS, Goud BR, Joseph B A study of occupational health and safety measures in the Laundry Department of a private tertiary care teaching hospital, Bengaluru. 2014 Indian J Occup Environ Med.
Vol. 18(1), pp. 13-20 
article DOI  
Abstract: INTRODUCTION:
The Laundry Department plays an important role in preventing the spread of infection and continuously supplying clean linen to various departments in any hospital.
OBJECTIVES OF THE STUDY:
To identify existing practices and occupational safety and health (OSH) measures in the Laundry Department and to assess the use of personal protective equipments (PPEs) among health care workers.
MATERIALS AND METHODS:
A cross-sectional study was carried out in a private tertiary care teaching hospital. An observation checklist was developed, which was partially based on occupational hazard checklist of OSHA for Laundry Department. This was field tested and validated for applicability for this study.
RESULTS:
The potential biological hazards are infections through exposure to aerosols, spills and splashes during various activities, fungal infection due to wet clothes and environment and infections through fomites. The potential physical hazards are injuries due to slips and falls, exposure to heat, humidity, dust, noise, and vibration. The potential chemical hazards are contact dermatitis and allergic asthma due to exposure to detergents, phenyl solution, bleaching powder, and soap oil solution. The potential ergonomic hazards are musculoskeletal diseases and repetitive stress injuries at the shoulder, elbow, and small joints of the hands. PPEs were not used consistently in most areas of the department.
BibTeX:
@article{KumarMS2014,
  author = {Kumar MS, Goud BR, Joseph B},
  title = {A study of occupational health and safety measures in the Laundry Department of a private tertiary care teaching hospital, Bengaluru.},
  journal = {Indian J Occup Environ Med.},
  year = {2014},
  volume = {18(1)},
  pages = {13-20},
  doi = {http://dx.doi.org/10.4103/0019-5278.134951}
}
Kumar N, Tiwari VK, Kumar K, Nair KS, Raj S, Nandan D Evolving social health scheme for workers in unorganized sector: key evidences from study of cycle rickshaw pullers in Delhi, India. 2014 Int J Health Plann Manage.  article DOI  
Abstract: BACKGROUND:
In view of high out-of-pocket costs and low spending even for basic healthcare for the poor employed in the unorganized sector, policy makers in India have turned their attention to developing a financing mechanism for social health insurance with the desire to provide quality care to the poor and economically disadvantaged.
OBJECTIVES:
This study aims to assess and determine the disease profile, treatment expenditure and willingness to pay for health insurance among rickshaw pullers in Delhi.
METHODS:
The study was conducted among 500 rickshaw pullers from five zones of the Municipal Corporation of Delhi, taking a sample of 100 from each zone.
RESULTS:
The average cost of treatment was Rs.505 for outpatient and Rs. 3200 for inpatient care. To finance the treatment expenditure, 27.5% of the respondents spent from their household savings, and 43% had to borrow funds. Any "spell of sickness" and "total expenditure on acute illness" were significantly (p?CONCLUSION:
The study provides the evidence for the need for urgent policy development by introducing a social health insurance package including wage losses for the vulnerable groups such as rickshaw pullers in the unorganized sector in India, which significantly contribute to pollution free and cheap transportation of community, tourists and commercial goods as well. Copyright © 2014 John Wiley & Sons, Ltd.
BibTeX:
@article{KumarN2014,
  author = {Kumar N, Tiwari VK, Kumar K, Nair KS, Raj S, Nandan D},
  title = {Evolving social health scheme for workers in unorganized sector: key evidences from study of cycle rickshaw pullers in Delhi, India.},
  journal = {Int J Health Plann Manage.},
  year = {2014},
  doi = {http://dx.doi.org/10.1002/hpm.2244}
}
Shadab M, Agrawal DK, Aslam M, Islam N, Ahmad Z Occupational Health Hazards among Sewage Workers: Oxidative Stress and Deranged Lung Functions. 2014 J Clin Diagn Res.
Vol. 8(4) 
article DOI  
Abstract: BACKGROUND:
Sewage workers, because of their occupation, are exposed to different types of dusts, bio-aerosols, fumes and gases like methane, hydrogen sulfide, sulphur dioxide, etc, which contribute towards oxidative stress and detrimental effects on various body functions, especially lung functions.
AIMS AND OBJECTIVES:
This study was carried out on sewage workers (who had been working for more than five years). We wanted to study the role of oxidative stress in development of impaired lung functions among sewage workers.
MATERIALS AND METHODS:
This cross sectional study was done in a tertiary care hospital (J.N. Medical College) in Aligarh, U.P. Study was done from March 2008 to December 2009. The study group comprised of 62 sewage workers who had been working for more than five years (32 non-smokers and 30 smokers) and 60 control subjects (30 smokers and 30 non-smokers). The pulmonary functions of these workers were assessed by using a MIR (Medical International Lab) Spiro Lab II Spirometer, with subjects in sitting position. Valid written consents were obtained from all the subjects. Malondialdehyde (MDA) is produced as a result of the action of reactive oxygen species (ROS) on the lipids present in the membranes of the cells, especially, contracting muscle cells. Serum MDA levels were assessed as an indirect measure of oxidative stress in these sewage workers and they were compared with serum MDA levels of control subjects. Appropriate statistical tests were applied for analysis of the data which was generated.
OBSERVATION AND RESULTS:
There were statistically significant decreases in Peak Expiratory Flow Rate (PEFR), Forced Expiratory Volume in first second (FEV1) and FEV1/FVC percent ratio (<80%) and Forced Expiratory Flow at 25%-75% of volume as percentage of Vital Capacity (FEF 25%-75%). Also, we found statistically significant increased levels of serum MDA in these sewage workers as compared to those in control subjects (with a p-value of <0.05 with a confidence interval of 95%).
CONCLUSION:
Our study found that the occupational exposure of the sewage workers to harmful dust, fumes, gases and bio-aerosols contributed to oxidative stress among them. This oxidative stress was one of the mechanisms which led to the development of obstructive impairment of lung functions in these sewage workers.
BibTeX:
@article{ShadabM2014,
  author = {Shadab M, Agrawal DK, Aslam M, Islam N, Ahmad Z},
  title = {Occupational Health Hazards among Sewage Workers: Oxidative Stress and Deranged Lung Functions.},
  journal = {J Clin Diagn Res.},
  year = {2014},
  volume = {8(4)},
  doi = {http://dx.doi.org/10.7860/JCDR/2014/5925.4291}
}
Singh K, Oates C, Plant J, Voulvoulis N Undisclosed chemicals--implications for risk assessment: a case study from the mining industry. 2014 Environ Int.
Vol. 68, pp. 1-15 
article DOI  
Abstract: Many of the chemicals used in industry can be hazardous to human health and the environment, and some formulations can have undisclosed ingredients and hazards, increasing the uncertainty of the risks posed by their use. The need for a better understanding of the extent of undisclosed information in chemicals arose from collecting data on the hazards and exposures of chemicals used in typical mining operations (copper, platinum and coal). Four main categories of undisclosed chemicals were defined (incomplete disclosure; chemicals with unspecific identities; relative quantities of ingredients not stated; and trade secret ingredients) by reviewing material safety data sheet (MSDS) omissions in previous studies. A significant number of chemicals (20% of 957 different chemicals) across the three sites had a range of undisclosed information, with majority of the chemicals (39%) having unspecific identities. The majority of undisclosed information was found in commercially available motor oils followed by cleaning products and mechanical maintenance products, as opposed to reagents critical to the main mining processes. All three types of chemicals had trade secrets, unspecific chemical identities and incomplete disclosures. These types of undisclosed information pose a hindrance to a full understanding of the hazards, which is made worse when combined with additional MSDS omissions such as acute toxicity endpoints (LD50) and/or acute aquatic toxicity endpoints (LC50), as well as inadequate hazard classifications of ingredients. The communication of the hazard information in the MSDSs varied according to the chemical type, the manufacturer and the regulations governing the MSDSs. Undisclosed information can undermine occupational health protection, compromise the safety of workers in industry, hinder risk assessment procedures and cause uncertainty about future health. It comes down to the duty of care that industries have towards their employees. With a wide range of chemicals increasingly used, there is a balance that needs to be reached between disclosure requirements, trade secret provisions and definitions of hazardous ingredients for market needs, and the information required to protect the health of their workers.
BibTeX:
@article{SinghK2014,
  author = {Singh K, Oates C, Plant J, Voulvoulis N},
  title = {Undisclosed chemicals--implications for risk assessment: a case study from the mining industry.},
  journal = {Environ Int.},
  year = {2014},
  volume = {68},
  pages = {1-15},
  doi = {http://dx.doi.org/10.1016/j.envint.2014.02.012}
}
George A. 'By papers and pens, you can only do so much': views about accountability and human resource management from Indian government health administrators and workers. 2009 Int J Health Plann Manage.
Vol. 24(3), pp. 205-24 
article DOI  
Abstract: Although accountability drives in the Indian health sector sporadically highlight egregious behaviour of individual health providers, accountability needs to be understood more broadly. From a managerial perspective, while accountability functions as a control mechanism that involves reviews and sanctions, it also has a constructive side that encourages learning from errors and discretion to support innovation. This points to social relationships: how formal rules and hierarchies combine with informal norms and processes and more fundamentally how power relations are negotiated. Drawing from this conceptual background and based on qualitative research, this article analyses the views of government primary health care administrators and workers from Koppal district, northern Karnataka, India. In particular, the article details how these actors view two management functions concerned with internal accountability: supervision and disciplinary action. A number of disjunctures are revealed. Although extensive information systems exist, they do not guide responsiveness or planning. While supportive supervision efforts are acknowledged and practiced, implicit quid-pro-quo bargains that justify poor service delivery performance are more prevalent. Despite the enactment of numerous disciplinary measures, little discipline is observed. These disjunctures reflect nuanced and layered relationships between health administrators and workers, as well as how power is negotiated through corruption and elected representatives within the broader political economy context of health systems in northern Karnataka, India. These various dimensions of accountability need to be addressed if it is to be used more equitably and effectively.
BibTeX:
@article{A.2009,
  author = {George A.},
  title = {'By papers and pens, you can only do so much': views about accountability and human resource management from Indian government health administrators and workers.},
  journal = {Int J Health Plann Manage.},
  year = {2009},
  volume = {24(3)},
  pages = {205-24},
  doi = {http://dx.doi.org/10.1002/hpm.986}
}
George A. Ethics, rights and strike of health workers. 1998 Issues Med Ethics.
Vol. 6(3):73, pp. 103 
article  
Abstract: Abstract not available.
BibTeX:
@article{A.1998,
  author = {Jesani A.},
  title = {Ethics, rights and strike of health workers.},
  journal = {Issues Med Ethics.},
  year = {1998},
  volume = {6(3):73},
  pages = {103}
}
Sharma A, Gur R and Bhalla P Study on prevalence of needle stick injury among health care workers in a tertiary care hospital in New Delhi: a two-year review. 2012 Indian J Public Health.
Vol. 56(1):, pp. 101-3. 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{AbhaSharma12012,
  author = {Abha Sharma1, Renu Gur2, P Bhalla1},
  title = {Study on prevalence of needle stick injury among health care workers in a tertiary care hospital in New Delhi: a two-year review.},
  journal = {Indian J Public Health.},
  year = {2012},
  volume = {56(1):},
  pages = {101-3.},
  doi = {http://dx.doi.org/10.4103/0019-557X.96987}
}
Agrawal PK et al. Effect of knowledge of community health workers on essential newborn health care: a study from rural India. 2012 Health Policy Plan.
Vol. 27(2):, pp. 115-26 
article DOI  
Abstract: BACKGROUND:
This study explored the relationship between the knowledge of community health workers (CHWs)-anganwadi workers (AWWs) and auxiliary nurse midwives (ANMs)-and their antenatal home visit coverage and effectiveness of the visits, in terms of essential newborn health carepractices at the household level in rural India.
METHODS:
We used data from 302 AWWs and 86 ANMs and data from recently delivered women (RDW) (n=13,023) who were residents of the CHW catchment areas and gave birth to a singleton live baby during 2004-05. Using principal component analysis, knowledge scores for preventive care and danger signs were computed separately for AWWs and ANMs and merged with RDW data. A multivariate logistic regression model was used to estimate the adjusted effect of knowledge level. A generalized estimating equation (GEE) was used to account for clustering.
RESULTS:
Coverage of antenatal home visits and newborn care practices were positively correlated with the knowledge level of AWWs and ANMs. Initiation of breastfeeding in the first hour of life (odds ratio 1.97; 95% confidence interval (CI): 1.55-2.49 for AWW, and odds ratio 1.62; 95% CI: 1.25-2.09 for ANM), clean cord care (odds ratio 2.03; 95% CI: 1.64-2.52 for AWW, and odds ratio 1.43; 95% CI: 1.17-1.75 for ANM) and thermal care (odds ratio 2.16; 95% CI: 1.64-2.85 for AWW and odds ratio 1.88; 95% CI: 1.43-2.48 for ANM) were significantly higher among women visited by AWWs or ANMs who had better knowledge compared with those with poor knowledge.
CONCLUSION:
CHWs' knowledge is one of the crucial aspects of health systems to improve the coverage of community-based newborn health careprogrammes as well as adherence to essential newborn care practices at the household level.
BibTeX:
@article{AgrawalPK2012,
  author = {Agrawal PK, Agrawal S, Ahmed S, Darmstadt GL, Williams EK, Rosen HE, Kumar V, Kiran U, Ahuja RC, Srivastava VK, Santosham M, Black RE, Baqui AH.},
  title = {Effect of knowledge of community health workers on essential newborn health care: a study from rural India.},
  journal = {Health Policy Plan.},
  year = {2012},
  volume = {27(2):},
  pages = {115-26},
  doi = {http://dx.doi.org/10.1093/heapol/czr018}
}
Sharma AK Manpower planning in public health: what do we need to do? 2013 Indian J Public Health.
Vol. 57(2):, pp. 57-8 
article DOI  
Abstract: No abstract available.
BibTeX:
@article{AK.2013,
  author = {Sharma AK.},
  title = {Manpower planning in public health: what do we need to do?},
  journal = {Indian J Public Health.},
  year = {2013},
  volume = {57(2):},
  pages = {57-8},
  doi = {http://dx.doi.org/10.4103/0019-557X.114980}
}
Alam K, Khan JA, Walker DG Impact of dropout of female volunteer community health workers: an exploration in Dhaka urban slums. 2012 BMC Health Serv Res.
Vol. 12, pp. 260 
article DOI  
Abstract: BACKGROUND:
The model of volunteer community health workers (CHWs) is a common approach to serving the poor communities in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in this area, has been using female CHWs as core workers in its community-based healthprograms since 1977. After 25?years of implementing of the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through a community-based maternal health intervention. However, BRAC experiences high dropout rates among CHWs suggesting a need to better understand the impact of their dropout which would help to reduce dropout and increase program sustainability. The main objective of the study was to estimate impact of dropout of volunteer CHWs from both BRAC and community perspectives. Also, we estimated cost of possible strategies to reduce dropout and compared whether these costs were more or less than the costs borne by BRAC and the community.
METHODS:
We used the 'ingredient approach' to estimate the cost of recruiting and training of CHWs and the so-called 'friction cost approach' to estimate the cost of replacement of CHWs after adapting. Finally, we estimated forgone services in the community due to CHW dropout applying the concept of the friction period.
RESULTS:
In 2009, average cost per regular CHW was US$ 59.28 which was US$ 60.04 for an ad-hoc CHW if a CHW participated a three-week basic training, a one-day refresher training, one incentive day and worked for a month in the community after recruitment. One month absence of a CHW with standard performance in the community meant substantial forgone health services like health education, antenatal visits, deliveries, referrals of complicated cases, and distribution of drugs and health commodities. However, with an additional investment of US$ 121 yearly per CHW BRAC could save another US$ 60 invested an ad-hoc CHW plus forgone services in the community.
CONCLUSION:
Although CHWs work as volunteers in Dhaka urban slums impact of their dropout is immense both in financial term and forgone services. High cost of dropout makes the program less sustainable. However, simple and financially competitive strategies can improve the sustainability of the program.
BibTeX:
@article{AlamK2012,
  author = {Alam K, Khan JA, Walker DG.},
  title = {Impact of dropout of female volunteer community health workers: an exploration in Dhaka urban slums.},
  journal = {BMC Health Serv Res.},
  year = {2012},
  volume = {12},
  pages = {260},
  doi = {http://dx.doi.org/10.1186/1472-6963-12-260}
}
Anand K et al. Development of a validated clinical case definition of generalized tonic-clonic seizures for use by community-based health care providers. 2005 Epilepsia.
Vol. 46(5), pp. 743-50 
article  
Abstract: PURPOSE:
To develop and test a clinical case definition for identification of generalized tonic-clonic seizures (GTCSs) by community-based health care providers.
METHODS:
To identify symptoms that can help identify GTCSs, patients with history of a jerky movements or rigidity in any part of the body ever in life were recruited from three sites: the community, secondary care hospital, and tertiary care hospital. These patients were administered a 14-item structured interview schedule focusing on the circumstances surrounding the seizure. Subsequently, a neurologist examined each patient and, based on available investigations, classified them as GTCS or non-GTCS cases. A logistic regression analysis was performed to select symptoms that were to be used for case definition of GTCSs. Validity parameters for the case definition at different cutoff points were calculated in another set of subjects.
RESULTS:
In total, 339 patients were enrolled in the first phase of the study. The tertiary care hospital contributed the maximal number of GTCS cases, whereas cases of non-GTCS were mainly from the community. At the end of phase I, the questionnaire was shortened from 14 to eight questions based on statistical association and clinical judgment. After phase II, which was conducted among 170 subjects, three variables were found to be significantly related to the presence of GTCSs by logistic regression: absence of stress (13.1; 4.1-41.3), presence of frothing (13.7; 4.0-47.3), and occurrence in sleep (8.3; 2.0-34.9). As a case definition using only three variables did not provide sufficient specificity, three more variables were added based on univariate analysis of the data (incontinence during the episode and unconsciousness) and review of literature (injury during episode). A case definition consisting of giving one point to an affirmative answer for each of the six questions was tested. At a cutoff point of four, sensitivity was 56.9 (47.4-66.0) and specificity, 96.3 (86.2-99.4). Among the 197 GTCS and 26 new non-GTCS patients recruited from hospitals from select SEAR Member Countries, in phase III, the sensitivity of this clinical case definition was 72% and specificity, 100%. A stratified analysis by gender in all the three phases did not show any differences between the sexes.
CONCLUSIONS:
Based on these criteria, we recommend that all patients with a history of two or more episodes of jerking or rigidity of limbs, having a score of > or =4 in the case definition, be identified as having GTCSs and started on antiepileptic medications. This clinical case definition can be very useful for community-based health care providers to identify and manage cases of GTCSs in the community. This should play a major role in the reduction of treatment gap for epilepsy in developing countries.
BibTeX:
@article{AnandK12005,
  author = {Anand K1, Jain S, Paul E, Srivastava A, Sahariah SA, Kapoor SK.},
  title = {Development of a validated clinical case definition of generalized tonic-clonic seizures for use by community-based health care providers.},
  journal = {Epilepsia.},
  year = {2005},
  volume = {46(5)},
  pages = {743-50}
}
Ananthakrishnan N et al. Is there need for a transformational change to overcome the current problems with postgraduate medical education in India? 2012 Natl Med J India.
Vol. 25(2), pp. 101-8 
article  
Abstract: In spite of the existence of a dual system of postgraduation, one under the Medical Council of India (MCI) and the other on a parallel track under the National Board of Examinations, postgraduate medical education in India is beset with several problems. For example, the curriculum has not been revised comprehensively for several decades. The diploma course under the MCI has become unpopular and is largely a temporary refuge for those who do not get admission to degree courses. The level of skills of the outgoing graduate is falling and the increase in the number of seats is taking place in a haphazard manner, without reference to the needs. In spite of increase in seats, there is a shortage of specialists at the secondary and tertiary care levels, especially in medical colleges, to share teaching responsibilities. Further, the distribution of specialists is skewed, with some states having far more than others. To remedy these ills and fulfil the requirements of the country over the next two decades, a working group appointed by the erstwhile governors of the MCI was asked to suggest suitable modifications to the existing postgraduate system. After an extensive review of the lacunae in the present system, the needs at various levels and the pattern of postgraduate education in other countries, it was felt that a competency-based model of a 2-year postgraduate course across all specialties, the use of offsite facilities for training and a criterion-based evaluation system entailing continuous monitoring would go a long way to correct some of the deficiencies of the existing system. The details of the proposal and its merits are outlined for wider discussion and to serve as a feedback to the regulatory agencies engaged in the task of improving the medical education system in India. We feel that the adoption of the proposed system would go a long way in improving career options, increasing the availability of teachers and dissemination of specialists to the secondary and primary levels, and improving the quality of outgoing postgraduates.
BibTeX:
@article{AnanthakrishnanN2012,
  author = {Ananthakrishnan N, Arora NK, Chandy G, Gitanjali B, Sood R, Supe A, Nagarajan S},
  title = {Is there need for a transformational change to overcome the current problems with postgraduate medical education in India?},
  journal = {Natl Med J India.},
  year = {2012},
  volume = {25(2)},
  pages = {101-8}
}
Armstrong G et al. A mental health training program for community health workers in India: impact on knowledge and attitudes. 2011 Int J Ment Health Syst.
Vol. 5(1):, pp. 17 
article DOI  
Abstract: BACKGROUND:
Unmet needs for mental health treatment in low income countries are pervasive. If mental health is to be effectively integrated into primary health care in low income countries like India then grass-roots workers need to acquire relevant knowledge and skills to be able to recognise, refer and support people experiencing mental disorders in their own communities. This study aims to provide a mental health training intervention to community health workers in Bangalore Rural District, Karnataka, India, and to evaluate the impact of this training on mental health literacy.
METHODS:
A pre-test post-test study design was undertaken with assessment of mental health literacy at three time points; baseline, completion of the training, and three month follow-up. Mental health literacy was assessed using the interviewer-administered Mental Health Literacy Survey. The training intervention was a four day course based on a facilitator's manual developed specifically for community health workers in India.
RESULTS:
70 community health workers from Doddaballapur, Bangalore Rural District were recuited for the study. The training course improved participants' ability to recognize a mental disorder in a vignette, and reduced participants' faith in unhelpful and potentially harmful pharmacological interventions. There was evidence of a minor reduction in stigmatizing attitudes, and it was unclear if the training resulted in a change in participants' faith in recovery following treatment.
CONCLUSION:
The findings from this study indicate that the training course demonstrated potential to be an effective way to improve some aspects of mental health literacy, and highlights strategies for strengthening the training course.
BibTeX:
@article{ArmstrongG2011,
  author = {Armstrong G, Kermode M, Raja S, Suja S, Chandra P, Jorm AF.},
  title = {A mental health training program for community health workers in India: impact on knowledge and attitudes.},
  journal = {Int J Ment Health Syst.},
  year = {2011},
  volume = {5(1):},
  pages = {17},
  doi = {http://dx.doi.org/10.1186/1752-4458-5-17}
}
Ashat M et al. Needle stick injury and HIV risk among health care workers in North India. 2011 Indian J Med Sci.
Vol. 65(9):, pp. 371-8 
article DOI  
Abstract: OBJECTIVES:
To determine the occurrence of needle stick injuries among various categories of health care workers (HCWs), the causal factors, and the circumstances under which these occur. 2. To explore the possibilities of measures to prevent these through improvement in knowledge, attitude, and practice.
MATERIALS AND METHODS:
The study was conducted in two government tertiary level hospitals. Study sample comprised 107 HCWs, providing medical care in two government tertiary level hospitals of Chandigarh. Subjects were enquired about their exposure to needle prick injuries during patient management in the last 6 months and also the action taken following exposure. The statistical tools employed were: ratio, proportions, and other basic methods of data interpretation.
RESULTS:
The study among 107 HCWs included 27 doctors (25.2%), 68 nurses (63.5%), and 12 paramedics (11.2%), with 87 (81.3%) being females. The prevalence of needle stick injury and exposure to blood was reported by 73 (68.2%) participants. The main factor ascribed for this exposure was heavy patient load (42.5%). The maximum accidents occurred during emergency care (30.1%). Most common action following exposure was cleaning with spirit (46.3%). Only 51 (47.7%) of HCWs admitted following universal precautions. Among those exposed, only 10 (13.7%) persons had undergone HIV testing.
CONCLUSION:
Two-thirds of HCWs were exposed to needle stick injuries. Lack of awareness about post-exposure prophylaxis (PEP) was found.
BibTeX:
@article{AshatM2011,
  author = {Ashat M, Bhatia V, Puri S, Thakare M, Koushal V.},
  title = {Needle stick injury and HIV risk among health care workers in North India.},
  journal = {Indian J Med Sci.},
  year = {2011},
  volume = {65(9):},
  pages = {371-8},
  doi = {http://dx.doi.org/10.4103/0019-5359.108947}
}
Awasthi S, Verma T, Agarwal M Danger signs of neonatal illnesses: perceptions of caregivers and health workers in northern India. 2006 Bull World Health Organ.
Vol. 84(10), pp. 819-26 
article  
Abstract: OBJECTIVE:
To assess household practices that can affect neonatal health, from the perspective of caregivers and health workers; to identify signs in neonates leading either to recognition of illness or health-care seeking; and to ascertain the proportion of caregivers who recognize the individual items of the integrated management of neonatal and childhood illnesses (IMNCI) programme.
METHODS:
The study was carried out in a rural community in Sarojininagar Block, Uttar Pradesh, India, using qualitative and quantitative research designs. Study participants were mothers, grandmothers, grandfathers, fathers or "nannies" (other female relatives) caring for infants younger than 6 months of age and recognized health-care providers serving the area. Focus group discussions (n = 7), key informant interviews (n = 35) and structured interviews (n = 210) were conducted with these participants.
FINDINGS:
Many household practices were observed which could adversely affect maternal and neonatal health. Among 200 caregivers, 70.5% reported home deliveries conducted by local untrained nurses or relatives, and most mothers initiated breastfeeding only on day 3. More than half of the caregivers recognized fever, irritability, weakness, abdominal distension/vomiting, slow breathing and diarrhoea as danger signs in neonates. Seventy-nine (39.5%) of the caregivers had seen a sick neonate in the family in the past 2 years, with 30.38% in whom illness manifested as continuous crying. Health care was sought for 46 (23%) neonates. Traditional medicines were used for treatment of bulging fontanelle, chest in-drawing and rapid breathing.
CONCLUSION:
Because there is no universal recognition of danger signs in neonates, and potentially harmful antenatal and birthing practices are followed, there is a need to give priority to implementing IMNCI, and possible incorporation of continuous crying as an additional danger sign.
BibTeX:
@article{AwasthiS12006,
  author = {Awasthi S1, Verma T, Agarwal M.},
  title = {Danger signs of neonatal illnesses: perceptions of caregivers and health workers in northern India.},
  journal = {Bull World Health Organ.},
  year = {2006},
  volume = {84(10)},
  pages = {819-26}
}
Bairwa A, Meena KC, Gupta PP Knowledge, attitude and practice of health workers in immunization. 1995 Indian Pediatr.
Vol. 32(1), pp. 107-8 
article  
Abstract: Abstract not available.
BibTeX:
@article{BairwaA1995,
  author = {Bairwa A, Meena KC, Gupta PP.},
  title = {Knowledge, attitude and practice of health workers in immunization.},
  journal = {Indian Pediatr.},
  year = {1995},
  volume = {32(1)},
  pages = {107-8}
}
Balagopal P Kamalamma N, P.T.M.R. A community-based participatory diabetes prevention and management intervention in rural India using community health workers. 2012 Diabetes Educ.
Vol. 38(6):, pp. 822-34 
article DOI  
Abstract: PURPOSE:
The purpose of this study was to test the effectiveness of a 6-month community-based diabetes prevention and management program in rural Gujarat, India.
METHODS:
A community-based participatory research method was used to plan and tailor the intervention by engaging trained community healthworkers as change agents to provide lifestyle education, serve as community advocates, and collect data from 1638 rural Indians (81.9% response rate). Ten culturally and linguistically appropriate health education messages were provided in face-to-face individual and group sessions (demonstrations of model meals and cooking techniques).
RESULTS:
Mean age was 41.9 � 15.9 years. Overall point prevalence of diabetes, prediabetes, obesity, and hypertension were 7.2%, 19.3%, 16.7%, and 28%, respectively, with significant differences between the low socioeconomic status (SES) participants (agricultural workers) and the high SES participants (business community) due to differing diet and activity levels. The intervention significantly reduced blood glucose levels by 5.7 and 14.9 mg/dL for individuals with prediabetes and diabetes, respectively, and systolic and diastolic blood pressure by 8 mm Hg and 4 mm Hg, respectively, in the overall population. Knowledge of diabetes and cardiovascular disease improved by 50% in the high SES group and doubled in the low SES group; general and abdominal obesity also decreased by ? 1%. High rates of undiagnosed hypertension (26.1%) were surprising. Among individuals with diabetes, metabolic complications such as diabetic nephropathy and chronic kidney disease were noted.
CONCLUSIONS:
Through collective engagement of the community, participatory programs can serve as a prototype for future prevention and management efforts, which are rare and underutilized in India.
BibTeX:
@article{BalagopalP2012,
  author = {Balagopal P, Kamalamma N, Patel TG, Misra R},
  title = {A community-based participatory diabetes prevention and management intervention in rural India using community health workers.},
  journal = {Diabetes Educ.},
  year = {2012},
  volume = {38(6):},
  pages = {822-34},
  doi = {http://dx.doi.org/10.1177/0145721712459890}
}
Balaji M et al. The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India. 2012 BMC Health Serv Res.
Vol. 12, pp. 42 
article DOI  
Abstract: BACKGROUND:
Care for schizophrenia in low and middle income countries is predominantly facility based and led by specialists, with limited use of non-pharmacological treatments. Although community based psychosocial interventions are emphasised, there is little evidence about their acceptability and feasibility. Furthermore, the shortage of skilled manpower is a major barrier to improving access to these interventions. Our study aimed to develop a lay health worker delivered community based intervention in three sites in India. This paper describes how the intervention was developed systematically, following the MRC framework for the development of complex interventions.
METHODS:
We reviewed the lierature on the burden of schizophrenia and the treatment gap in low and middle income countries and the evidence for community based treatments, and identified intervention components. We then evaluated the acceptability and feasibility of this package of carethrough formative case studies with individuals with schizophrenia and their primary caregivers and piloted its delivery with 30 families.
RESULTS:
Based on the reviews, our intervention comprised five components (psycho-education; adherence management; rehabilitation; referral to community agencies; and health promotion) to be delivered by trained lay health workers supervised by specialists. The intervention underwent a number of changes as a result of formative and pilot work. While all the components were acceptable and most were feasible, experiences of stigma and discrimination were inadequately addressed; some participants feared that delivery of care at home would lead to illness disclosure; some participants and providers did not understand how the intervention related to usual care; some families were unwilling to participate; and there weredelivery problems, for example, in meeting the targeted number of sessions. Participants found delivery by health workers acceptable, and expected them to have knowledge about the subject matter. Some had expectations regarding their demographic and personal characteristics, for example, preferring only females or those who are understanding/friendly. New components to address stigma were then added to the intervention, the collaborative nature of service provision was strengthened, a multi-level supervision system was developed, and delivery of components was made more flexible. Criteria were evolved for the selection and training of the health workers based on participants' expectations.
CONCLUSIONS:
A multi-component community based intervention, targeting multiple outcomes, and delivered by trained lay health workers, supervised by mental health specialists, is an acceptable and feasible intervention for treating schizophrenia in India.
BibTeX:
@article{BalajiM2012,
  author = {Balaji M, Chatterjee S, Koschorke M, Rangaswamy T, Chavan A, Dabholkar H, Dakshin L, Kumar P, John S, Thornicroft G, Patel V.},
  title = {The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India.},
  journal = {BMC Health Serv Res.},
  year = {2012},
  volume = {12},
  pages = {42},
  doi = {http://dx.doi.org/10.1186/1472-6963-12-42}
}
Balarajan Y, Selvaraj S, Subramanian SV Health care and equity in India. 2011 Lancet.
Vol. 377(9764), pp. 505-15 
article DOI  
Abstract: In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population.
BibTeX:
@article{BalarajanY2011,
  author = {Balarajan Y, Selvaraj S, Subramanian SV.},
  title = {Health care and equity in India.},
  journal = {Lancet.},
  year = {2011},
  volume = {377(9764)},
  pages = {505-15},
  doi = {http://dx.doi.org/10.1016/S0140-6736(10)61894-6}
}
Bali NK et al. Knowledge, attitude, and practices about the seasonal influenza vaccination among healthcare workers in Srinagar, India. 2013 Influenza Other Respir Viruses.
Vol. 7(4):, pp. 540-5 
article DOI  
Abstract: BACKGROUND:
Healthcare workers (HCWs) universally have a poor uptake of influenza vaccination. However, no data are available from India.
OBJECTIVE:
To explore knowledge, attitudes, and practices associated with influenza vaccination in HCWs in a temperate climate area in northernIndia.
PATIENTS AND METHODS:
A self-administered questionnaire was offered to all HCWs in three major hospitals of Srinagar and information sought on motivations, perceptions, preferences and practices regarding influenza vaccination.
RESULTS:
Of the 1750 questionnaires received, 1421 (81%) were returned. Only 62 (4�4%) HCWs had ever received influenza vaccination even as 1348 (95%) believed that influenza poses adverse potential consequences for themselves or their contacts; 1144 (81%) were aware of a vaccine against influenza and 830 (58%) of its local availability. Reasons cited by 1359 participants for not being vaccinated included ignorance about vaccine availability (435; 32%), skepticism about efficacy (248; 18%), busy schedule (166; 12%), fear of side effects (70; 4%), and a perception of not being-at-risk (82; 6%). Sixty-one percent (865) believed that vaccine programs are motivated by profit. Eighty-eight percent opined for mandatory vaccination for HCWs caring for the high-risk patients, as a part of 'employee health program'. Most of the participants intended to get vaccinated in the current year even as 684 (48%) held that vaccines could cause unknown illness and 444 (31%) believed their adverse effects to be underreported.
CONCLUSION:
Influenza vaccination coverage among HCWs is dismally low in Srinagar; poor knowledge of vaccine availability and misperceptions about vaccine effectiveness, fear of adverse effects and obliviousness to being-at-risk being important barriers. Multifaceted, adaptable measures need to be invoked urgently to increase the coverage.
Published 2012. This article is a US Government work and is in the public domain in the USA.
BibTeX:
@article{BaliNK2013,
  author = {Bali NK, Ashraf M, Ahmad F, Khan UH, Widdowson MA, Lal RB, Koul PA.},
  title = {Knowledge, attitude, and practices about the seasonal influenza vaccination among healthcare workers in Srinagar, India.},
  journal = {Influenza Other Respir Viruses.},
  year = {2013},
  volume = {7(4):},
  pages = {540-5},
  doi = {http://dx.doi.org/10.1111/j.1750-2659.2012.00416.x}
}
Banerjee SK et al. Evaluation of a network of medical abortion providers in two districts of Maharashtra, India. 2011 Glob Public Health.
Vol. 6(3), pp. 283-92 
article DOI  
Abstract: The objective of this study was to examine experiences and service delivery of private medical doctors participating in a professional network designed to improve knowledge and service quality of medical abortion (MA) procedures. A cross-sectional assessment of 87 Medical Abortion Provider Network (MAPnet) participants was conducted between December 2006 and January 2007 to describe participants' service delivery and network experiences. After participating in MAPnet, providers reported a statistically significant amount of more MA services (92%), national protocol adherence for timing of drug administration (93%) and drug dosage protocols (82%) when compared to their reports before MAPnet affiliation. In addition, MAPnet providers offered contraceptive counselling (100%) and pain management (54%). Nearly three-quarters of providers were interested in continuing their association with the network initiatives. However, the network failed to adequately facilitate inter-network sharing of knowledge and experiences. These findings suggest that establishing and nurturing a network of private medical doctors can improve availability and quality of safe and early abortion services through MA.
BibTeX:
@article{BanerjeeSK2011,
  author = {Banerjee SK, Andersen K, Tank J, Parihar M, Shah M, Thanwala U.},
  title = {Evaluation of a network of medical abortion providers in two districts of Maharashtra, India.},
  journal = {Glob Public Health.},
  year = {2011},
  volume = {6(3)},
  pages = {283-92},
  doi = {http://dx.doi.org/10.1080/17441692.2010.516758}
}
Berry BS, Devapitchai KS and Raju MS Knowledge about persons with disability act (1995) among health care professionals dealing with persons affected by disabilities. 2009 Indian J Lepr.
Vol. 81(1), pp. 5-11 
article  
Abstract: To assess the level of awareness about the different provisions of the persons with Disability Act (1995) among the health care professionals, 201 health care professionals dealing with the disabled persons from different parts of India were interviewed using structured interview checklist. The data were analysed through statistical package of social sciences software. Chi-square test were applied on the variables and the Pvalues were ascertained. The results show that 48.3% knew about administration hierarchy, 53.7% of respondents were aware of the free education available for the disabled, 68.5% were aware of the employment scheme, 62.7% about poverty alleviation schemes, 59.2% know about the traveling benefits, 56.2% of professionals were aware of the benefits for people with low vision. Only 29.9% of respondents knew about provisions to overcome architectural barriers. 43.8% of them knew about the least disability percentage whereas only 28.4% were aware of research and manpower schemes. Regarding affirmative action, 32.17% told correctly and 52.7% of the professionals responded correctly with respectto non- discrimination schemes. The level of awareness among the professionals working in rural regions is lower with regard to administration hierarchy and poverty alleviation schemes. Informations regarding disabled friendly environments and research and manpower development were found to be low among respondents of all professions which need to be effectively intervened. Gender did not show any influence with respect to the components of the act. The study showed that there is an ample need for educational interventions among the health care professionals in all socio-demography. Inclusion of PWD Act in the curriculum of medical schools as a topic in conferences and workshops for health care professionals are suggested.
BibTeX:
@article{BerryBS12009,
  author = {Berry BS1, Devapitchai KS, Raju MS.},
  title = {Knowledge about persons with disability act (1995) among health care professionals dealing with persons affected by disabilities.},
  journal = {Indian J Lepr.},
  year = {2009},
  volume = {81(1)},
  pages = {5-11}
}
Bhargava A et al. Assessment of knowledge, attitude and practices among healthcare workers in a tertiary care hospital on needle stick injury. 2013 Int J Health Care Qual Assur.
Vol. 26(6):, pp. 549-58. 
article  
Abstract: PURPOSE:
The study aims to assess healthcare workers' needle-stick injury (NSI) knowledge, attitudes and practices (KAP).
DESIGN/METHODOLOGY/APPROACH:
A cross-sectional study was conducted in a 600-bedded hospital throughout six months. The data were collected using an anonymous, self-reporting questionnaire. Participants were various healthcare workers (HCW) drawn through stratified random sampling and their knowledge, attitude and practice regarding NSI were assessed.
FINDINGS:
There is significant difference in the mean knowledge, attitude and practice scores among healthcare workers. Even though scores are better for doctors and nurses, practice scores were better for technical staff. Healthcare workers, who had better practice scores, had suffered fewer NSIs. Since this study is a cross-sectional, the population's NSI incidence could not be calculated.
PRACTICAL IMPLICATIONS:
This study emphasizes that applying knowledge to practice is required to prevent NSIs. Various recommendations to help prevent and deal with NSIs are made.
ORIGINALITY/VALUE:
This study analyses healthcare workers' NSI knowledge, attitude and practices, and also assesses their correlation with NSI incidence, which has not been done previously.
BibTeX:
@article{BhargavaA2013,
  author = {Bhargava A, Mishra B, Thakur A, Dogra V, Loomba P, Gupta S.},
  title = {Assessment of knowledge, attitude and practices among healthcare workers in a tertiary care hospital on needle stick injury.},
  journal = {Int J Health Care Qual Assur.},
  year = {2013},
  volume = {26(6):},
  pages = {549-58.}
}
Bhasin SK et al. Knowledge and attitudes of Anganwadi workers about infant feeding in Delhi. 1995 Indian Pediatr.
Vol. 32(3), pp. 346-50 
article  
Abstract: Abstract not available.
BibTeX:
@article{BhasinSK11995,
  author = {Bhasin SK1, Kumar R, Singh S, Dubey KK, Kapil U.},
  title = {Knowledge and attitudes of Anganwadi workers about infant feeding in Delhi.},
  journal = {Indian Pediatr.},
  year = {1995},
  volume = {32(3)},
  pages = {346-50}
}
Bhasin SK, Kumar R, Singh S, Dubey KK, Kapil U Knowledge of Anganwadi workers about growth monitoring in Delhi. 1995 Indian Pediatr.
Vol. 32(1), pp. 73-6. 
article  
Abstract: Abstract not available.
BibTeX:
@article{BhasinSK11995a,
  author = {Bhasin SK1, Kumar R, Singh S, Dubey KK, Kapil U.},
  title = {Knowledge of Anganwadi workers about growth monitoring in Delhi.},
  journal = {Indian Pediatr.},
  year = {1995},
  volume = {32(1)},
  pages = {73-6.}
}
Biswal M et al. Adherence to hand hygiene in high-risk units of a tertiary care hospital in India. 2013 Am J Infect Control.
Vol. 41(11), pp. 1114-5 
article DOI  
Abstract: To improve the compliance to hand hygiene in our health care workers, 3 hand hygiene awareness weeks have been conducted over the past one-and-a-half years in our hospital. This observational audit conducted from October 2011 to March 2012 was planned to assess the impact of the above awareness drives. Although overall compliance increased significantly in 7 intensive care units from 23.1% to 41.2% (P < .0001), several deficiencies were noticed both in technique used as well as during specific opportunities of hand hygiene.
BibTeX:
@article{BiswalM2013,
  author = {Biswal M, Singh NV, Kaur R, Sebastian T, Dolkar R, Appananavar SB, Singh G, Taneja N.},
  title = {Adherence to hand hygiene in high-risk units of a tertiary care hospital in India.},
  journal = {Am J Infect Control.},
  year = {2013},
  volume = {41(11)},
  pages = {1114-5},
  doi = {http://dx.doi.org/10.1016/j.ajic.2013.05.026}
}
Biswas AB et al. Skill of frontline workers implementing integrated management of neonatal and childhood illness: experience from a district of West Bengal, India. 2011 J Trop Pediatr.
Vol. 57(5):, pp. 352-6 
article DOI  
Abstract: A cross-sectional study was conducted in Purulia district, West Bengal, India, to assess the skill of 155 frontline workers implementing Integrated Management of Neonatal and Childhood Illness (IMNCI) and the logistic support thereof. The skills of counting respiratory rate, assessing immunization status in both age groups, assessment of breastfeeding in young infants and plotting of weight in a growth chart in case of children aged 2-59 months were acquired by majority of workers. Around two-thirds workers synthesized correct classification and nearly 60% gave appropriate management of at least one subgroup. In 30-40% cases, carers received feeding advices. Around 50% casesheets were complete and timely report submission rate was nearly 70%. Necessary equipments were available with majority of workers except the utensils for preparation of ORS. The supply of essential drugs varied from 33.5 to 71.6%. These findings suggest that IMNCI program offered a scope for capacity-building and infrastructure strengthening of the health system.
BibTeX:
@article{BiswasAB2011,
  author = {Biswas AB, Mukhopadhyay DK, Mandal NK, Panja TK, Sinha N, Mitra K.},
  title = {Skill of frontline workers implementing integrated management of neonatal and childhood illness: experience from a district of West Bengal, India.},
  journal = {J Trop Pediatr.},
  year = {2011},
  volume = {57(5):},
  pages = {352-6},
  doi = {http://dx.doi.org/10.1093/tropej/fmq106}
}
Hegde BM Medicine in the next millennium--manpower needs. 1999 J Assoc Physicians India.
Vol. 47(11), pp. 1089-91 
article  
Abstract: Abstract not available.
BibTeX:
@article{BM.1999,
  author = {Hegde BM.},
  title = {Medicine in the next millennium--manpower needs.},
  journal = {J Assoc Physicians India.},
  year = {1999},
  volume = {47(11)},
  pages = {1089-91}
}
Buch NA1, B.S. Medical practitioners and their practices in acute diarrhea. 1997 Indian Pediatr.
Vol. 34(6), pp. 530-4 
article  
Abstract: Abstract not available.
BibTeX:
@article{BuchNA11997,
  author = {Buch NA1, Bashir SA.},
  title = {Medical practitioners and their practices in acute diarrhea.},
  journal = {Indian Pediatr.},
  year = {1997},
  volume = {34(6)},
  pages = {530-4}
}
Morrison C India's mobile health teams set pace for progress in urban communities. 1996 Popul Concern News.
Vol. (11):3 
article  
Abstract: Abstract not available.
BibTeX:
@article{C.1996,
  author = {Morrison C.},
  title = {India's mobile health teams set pace for progress in urban communities.},
  journal = {Popul Concern News.},
  year = {1996},
  volume = {(11):3}
}
Chang LW et al. Evaluation of a multimodal, distance learning HIV management course for clinical care providers in India. 2012 J Int Assoc Physicians AIDS Care (Chic).
Vol. 11(5):, pp. 277-82 
article  
Abstract: Distance learning is an important tool for training HIV health workers. However, there is limited evidence on design and evaluation of distance learning HIV curricula and tools. We therefore designed, implemented, and evaluated a distance learning course on HIV management for clinical care providers in India. After course completion, participant scores rose significantly from a pretest (78.4% mean correct) compared with the posttest (87.5%, P < .001). After course completion, participants were more likely to be confident in starting an initial antiretroviral (ARV) regimen, understanding ARV toxicities, encouraging patient adherence, diagnosing immune reconstitution syndrome, and monitoring patients on ARV medications (P ? .05). All participants (100%) strongly agreed/agreed that they would recommend this course to others, and most of them (96%) strongly agreed/agreed that they would take a course in this format again. A pragmatic approach to HIV curriculum development and evaluation resulted in reliable learning outcomes, as well as learner satisfaction and improvement in knowledge.
BibTeX:
@article{ChangLW2012,
  author = {Chang LW, Kadam DB, Sangle S, Narayanan S, Borse RT, McKenzie-White J, Bowen CW, Sisson SD, Bollinger RC.},
  title = {Evaluation of a multimodal, distance learning HIV management course for clinical care providers in India.},
  journal = {J Int Assoc Physicians AIDS Care (Chic).},
  year = {2012},
  volume = {11(5):},
  pages = {277-82}
}
Chaudhary N, Mohanty PN and Sharma M Integrated management of childhood illness (IMCI) follow-up of basic health workers. 2005 Indian J Pediatr.
Vol. 72(9), pp. 735-9 
article  
Abstract: OBJECTIVE:
To assess the practice of skills learnt by basic health workers for 4 - 8 weeks and one year after IMCI training, and to identify the gaps in practices due to various constraints.
METHODS:
The Anganwadi Workers (AWWS) and the supervisory staff were given 5 days IMCI training using WHO package. The supervisors gave follow up visits to AWWs using standardized follow up forms adapted from WHO material. The supervisors gave follow up visit to the 1st batch of AWWs 1 year after training in IMCI and a second visit was given 4-8 weeks after the 1st visit. The 2nd batch of AWWs was followed up 4-8 weeks after training in IMCI.
RESULTS:
The performance on correct treatment of cases by AWWs weeks were trained 4-6 weeks prior to follow up was better than group followed up one year after the completion of training (81.8% and 47.9% respectively). At the same time, the performance on correct treatment showed significant improvement during the second follow up (47.9% and 83.8% respectively). Performance on counseling improved from 15.6% during 1st follow up to 52.1% during 2nd follow up visit. The average number of cases seen by AWWs increased from 6.6 in 1st follow up to 9.3 during second follow up of the same AWWs.
CONCLUSION:
The basic health workers (AWWs) are capable of correct case management of sick children using the IMCI guidelines. The first follow up visit should not be delayed as delay leads to loss of skills. The health workers benefit from frequent and regular follow up by supervisors. Provision of requisite supplies is essential for practice of skills after training in IMCI by basic health worker.
BibTeX:
@article{ChaudharyN12005,
  author = {Chaudhary N1, Mohanty PN, Sharma M.},
  title = {Integrated management of childhood illness (IMCI) follow-up of basic health workers.},
  journal = {Indian J Pediatr.},
  year = {2005},
  volume = {72(9)},
  pages = {735-9}
}
Christopher DJ et al. Tuberculosis infection among young nursing trainees in South India. 2010 PLoS One.
Vol. 5(4):e, pp. 10408 
article DOI  
Abstract: BACKGROUND:
Among healthcare workers in developing countries, nurses spend a large amount of time in direct contact with tuberculosis (TB) patients, and are at high risk for acquisition of TB infection and disease. To better understand the epidemiology of nosocomial TB among nurses, we recruited a cohort of young nursing trainees at Christian Medical College, a large, tertiary medical school hospital in Southern India.
METHODOLOGY/PRINCIPAL FINDINGS:
Among 535 nursing students enrolled in 2007, 468 gave consent to participate, and 436 underwent two-step tuberculin skin testing (TST). A majority (95%) were females, and almost 80% were under 22 years of age. Detailed TB exposure information was obtained using interviews and clinical log books. Prevalence of latent TB infection (LTBI) was estimated using Bayesian latent class analyses (LCA). Logistic regression analyses were done to determine the association between LTBI prevalence and TB exposure and risk factors. 219 of 436 students (50.2%, 95% CI: 45.4-55.0) were TST positive using the 10 mm or greater cut-off. Based on the LCA, the prevalence of LTBI was 47.8% (95% credible interval 17.8% to 65.6%). In the multivariate analysis, TST positivity was strongly associated with time spent in health care, after adjusting for age at entry into healthcare.
CONCLUSIONS:
Our study showed a high prevalence of LTBI even in young nursing trainees. With the recent TB infection control (TBIC) policy guidance from the World Health Organization as the reference, Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement TBIC interventions, and enhance capacity for TBIC at the country level. Young trainees and nurses, in particular, will need to be targeted for TBIC interventions.
BibTeX:
@article{ChristopherDJ12010,
  author = {Christopher DJ1, Daley P, Armstrong L, James P, Gupta R, Premkumar B, Michael JS, Radha V, Zwerling A, Schiller I, Dendukuri N, Pai M.},
  title = {Tuberculosis infection among young nursing trainees in South India.},
  journal = {PLoS One.},
  year = {2010},
  volume = {5(4):e},
  pages = {10408},
  doi = {http://dx.doi.org/10.1371/journal.pone.0010408}
}
Cooperman NA et al. HIV Prevalence, Risk Behavior, Knowledge, and Beliefs Among Women Seeking Care at a Sexually Transmitted Infection Clinic in Mumbai, India. 2013 Health Care Women Int.  article  
Abstract: Three hundred women presenting to a sexually transmitted infection (STI) clinic in Mumbai, India were surveyed and HIV tested. Thirty-nine percent were HIV infected; 80% were current sex workers, and HIV infection was not significantly associated with past-year sex work. Only 44% always used condoms with their noncommercial sex partners. Most believed that condom preparation is a male responsibility (58%); that condom use is a sign that partner trust is lacking (84%); and that if a woman asks her partner to use a condom, he will lose respect for her (65%). All women at STI clinics in India need HIV testing and culturally sensitive risk interventions.
BibTeX:
@article{CoopermanNA2013,
  author = {Cooperman NA, Shastri JS, Shastri A, Schoenbaum E.},
  title = {HIV Prevalence, Risk Behavior, Knowledge, and Beliefs Among Women Seeking Care at a Sexually Transmitted Infection Clinic in Mumbai, India.},
  journal = {Health Care Women Int.},
  year = {2013}
}
D'Adamo M, Short Fabic M, and Ohkubo S Meeting the health information needs of health workers: what have we learned? 2012 J Health Commun.
Vol. 17 Suppl 2, pp. 23-9 
article DOI  
Abstract: The information challenges facing health workers worldwide include lack of routine systems for seeking and sharing information, lack of high-quality and current health information, and lack of locally relevant materials and tools. This issue of Journal of Health Communication presents three studies of health information needs in India, Senegal, and Malawi that demonstrate these information challenges, provide additional insight, and describe innovative strategies to improve knowledge and information sharing. Results confirm that health workers' information needs differ on the basis of the level of the health system in which a health worker is located, regardless of country or cultural context. Data also reveal that communication channels tailored to health workers' needs and preferences are vital for improving information access and knowledge sharing. Meetings remain the way that most health workers communicate with each other, although technical working groups, professional associations, and networks also play strong roles in information and knowledge sharing. Study findings also confirm health workers' need for up-to-date, simple information in formats useful for policy development, program management, and service delivery. It is important to note that data demonstrate a persistent need for a variety of information types--from research syntheses, to job aids, to case studies--and suggest the need to invest in multifaceted knowledge management systems and approaches that take advantage of expanding technology, especially mobile phones; support existing professional and social networks; and are tailored to the varying needs of health professionals across health systems. These common lessons can be universally applied to expand healthworkers' access to reliable, practical, evidence-based information.
BibTeX:
@article{DAdamoM2012,
  author = {D'Adamo M, Short Fabic M, Ohkubo S.},
  title = {Meeting the health information needs of health workers: what have we learned?},
  journal = {J Health Commun.},
  year = {2012},
  volume = {17 Suppl 2},
  pages = {23-9},
  doi = {http://dx.doi.org/10.1080/10810730.2012.666626}
}
Dash S and Jagadishchandran A Professional satisfaction of doctors working in a super-speciality hospital in Bangalore. 1996 World Hosp Health Serv.
Vol. 32(1), pp. 14-8 
article  
Abstract: The doctors' assessment of their jobs provides an insight into those facets of the profession which need attention. This study assessed the professional satisfaction of 80 doctors who responded to the 80 item multifaceted questionnaire. Although the doctors were generally satisfied with the various facets of their jobs and career, variation in the level of satisfaction was noted. Personal background revealed that 80% of doctors had good academic and family background. The most satisfied group of doctors were the consultants with a performance based pay scale. Housekeeping, interpersonal relationship among doctors, nursing care and the pay scale of junior doctors are areas to which the administration should pay special attention if the professional satisfaction of doctors is to be improved.
BibTeX:
@article{DashS1996,
  author = {Dash S, Jagadishchandran A.},
  title = {Professional satisfaction of doctors working in a super-speciality hospital in Bangalore.},
  journal = {World Hosp Health Serv.},
  year = {1996},
  volume = {32(1)},
  pages = {14-8}
}
Datta SS et al. Knowledge, attitude and practices regarding swine flu among para-medical workers in a tertiary care hospital in Pondicherry. 2011 J Commun Dis.
Vol. 43(1):, pp. 1-9 
article  
Abstract: Abstract not available.
BibTeX:
@article{DattaSS2011,
  author = {Datta SS, Kuppuraman D, Boratne AV, Abraham SB, Singh Z.},
  title = {Knowledge, attitude and practices regarding swine flu among para-medical workers in a tertiary care hospital in Pondicherry.},
  journal = {J Commun Dis.},
  year = {2011},
  volume = {43(1):},
  pages = {1-9}
}
De Costa A et al. Where are healthcare providers? Exploring relationships between context and human resources for health Madhya Pradesh province, India. 2009 Health Policy.
Vol. 93(1), pp. 41-7 
article DOI  
Abstract: OBJECTIVE:
In India, heterogeneous healthcare providers in the public and dominant private sectors serve a diverse population, including those from vulnerable groups, the scheduled castes and tribes. We explored relationships between the distribution of different categories of healthcare providers (public and private); and contextual socioeconomic and demographic variables. Access to healthcare providers for scheduled castes and tribes was specifically studied.
METHOD:
Set in Madhya Pradesh province (60.4 million), India. Dependent variables included district-wise densities of physicians and paramedics (public and private separately); and unqualified providers (private). Contextual variables included infrastructure, urbanization, economy, female literacy and proportion of scheduled castes and tribes.
RESULTS:
Urbanization was strongly correlated with private physician density; and negatively with paramedical density (public and private). Private paramedical density variation was partially explained by economy. Public physician and paramedical density were positively correlated to district proportions of scheduled tribes. All provider densities (public and private) were negatively related to proportions of scheduled castes.
CONCLUSIONS:
Overall density of qualified providers was low. Qualified physicians tended to be more densely situated in the relatively more urban districts. Access to healthcare providers for scheduled castes and tribes is different. More targeted approaches are necessary for improving access for scheduled castes.
BibTeX:
@article{DeCostaA12009,
  author = {De Costa A1, Al-Muniri A, Diwan VK, Eriksson B.},
  title = {Where are healthcare providers? Exploring relationships between context and human resources for health Madhya Pradesh province, India.},
  journal = {Health Policy.},
  year = {2009},
  volume = {93(1)},
  pages = {41-7},
  doi = {http://dx.doi.org/10.1016/j.healthpol.2009.03.015}
}
Dubey A, Sonker A, Chaudhary RK Evaluation of health care workers' knowledge and functioning of blood centres in north India: A questionnaire based survey. 2013 Transfus Apher Sci.
Vol. 49(3):, pp. 565-70 
article DOI  
Abstract: For quality, safety and efficacy of blood components, adequate infrastructure and trained manpower are essential requirements. Objective of this study is to analyse existing systems of transfusion services in north India, various testing methodologies practiced and to assess the level of knowledge of health care professionals working at these centres. Participants included laboratory technicians and nurses whose knowledge and various practices at blood centres were assessed using a questionnaire. Knowledge of those having more experience, working at urban blood centres and received an additional training was significantly higher. Only a few blood centres are performing all mandatory tests on donors' samples.
BibTeX:
@article{DubeyA2013,
  author = {Dubey A, Sonker A, Chaudhary RK.},
  title = {Evaluation of health care workers' knowledge and functioning of blood centres in north India: A questionnaire based survey.},
  journal = {Transfus Apher Sci.},
  year = {2013},
  volume = {49(3):},
  pages = {565-70},
  doi = {http://dx.doi.org/10.1016/j}
}
Duseja A et al. Hepatitis B and C virus--prevalence and prevention in health care workers. 2002 Trop Gastroenterol.
Vol. 23(3), pp. 125-6 
article  
Abstract: BACKGROUND:
Hepatitis B and C viruses are important causes of liver related morbidity and mortality. We aimed at determining the presence of hepatitis B and C virus infections in the health care workers (HCWs) and their compliance for the HBV vaccination.
METHODS:
Three thousand five hundred and fifty six health care workers were screened for HBsAg and 115 for anti-HCV by ELISA. HBsAg negative individual were offered HBV vaccination and record of their compliance was kept. Anti-HBs titers were determined one month after 2nd or 3rd dose of vaccine in 273 subjects.
RESULTS:
Out of 3556 health care workers, 61 (1.7%) were found to be positive for HBsAg. One out of 115 HCWs (0.87%) was found to be positive for anti-HCV. Fifteen percent of HCWs received only one dose, 26% received two doses 59% received three doses and 2.5% also received the booster dose of the HBV vaccine. All those tested had anti-HBs titers more than 10 mUI/ml.
CONCLUSION:
In HCWs, HBsAg and anti-HCV prevalence was found to be 1.7% and 0.87% respectively. HCWs in our hospital, despite the awareness on HBV and HCV infection are noncompliant for HBV vaccination.
BibTeX:
@article{DusejaA12002,
  author = {Duseja A1, Arora L, Masih B, Singh H, Gupta A, Behera D, Chawla YK, Dhiman RK.},
  title = {Hepatitis B and C virus--prevalence and prevention in health care workers.},
  journal = {Trop Gastroenterol.},
  year = {2002},
  volume = {23(3)},
  pages = {125-6}
}
Fidler K, Costello A The role of doctors in influencing infant feeding practices in South India. 1995 Trop Doct.
Vol. 25(4), pp. 178-80 
article  
Abstract: Infant feeding practices are influenced by many factors including culture, household income, literacy, advice from health care workers and advertising. In South India doctors play a very significant role in influencing a mother's decision about when or whether to supplement breastfeeding with formula feeds. Doctors exert their influence on mothers both directly and indirectly, and they are increasingly targeted by commercial infant food companies. Doctors need continuing education about nutrition education, lactation management, and a greater awareness about the influence of inappropriate promotional practices by companies.
BibTeX:
@article{FidlerK11995,
  author = {Fidler K1, Costello A.},
  title = {The role of doctors in influencing infant feeding practices in South India.},
  journal = {Trop Doct.},
  year = {1995},
  volume = {25(4)},
  pages = {178-80}
}
Ahmed FU Public health manpower: an alternative model. 2010 Indian J Public Health.
Vol. 54(3), pp. 137-44 
article DOI  
Abstract: The Bhore committee observed that "if nation's health is to be built, the health program should be developed on the foundation of preventive health work and that such activities should proceed side by side with the treatment of patients." The committee defined two categories of workforce: one for the personal care and the other for the public health namely, public health nurses and sanitary inspectors for public health and nurse, midwife, and pharmacist for personal care. Recommendations of successive health committees lead to amalgamation of personal care services and public health services. Single focus programs and amalgamation of different cadre of Grassroots staff lead to dilution of public health services and more focused on different program-based personal care services. To carry out public health services, we need a sufficiently knowledgeable, well-skilled and competent mid-level supervisory public health workforce who can support and strengthen the performance of the existing multipurpose workers. Increased understanding of the influence of different determinants on health and well-being and also scientific progress to combat the environmental and biological effects on health has widened the gap between the actual need of human resources and expanding public health services needs. Keeping in view of the above and meet the challenges, a 3-year course of Bachelor in Public Health is conceived by the Indian Academy of Public Health. Professional responsibilities expected from this new cadre of workforce are also discussed in this article.
BibTeX:
@article{FU.2010,
  author = {Ahmed FU.},
  title = {Public health manpower: an alternative model.},
  journal = {Indian J Public Health.},
  year = {2010},
  volume = {54(3)},
  pages = {137-44},
  doi = {http://dx.doi.org/10.4103/0019-557X.75736}
}
Fusilier MR and Durlabhji S Health care workers' AIDS attitudes and willingness to provide care--India. 1997 J Health Hum Serv Adm.
Vol. 20(2), pp. 145-58. 
article  
Abstract: Although AIDS is a world-wide pandemic, relatively little has been published on health care workers' attitudes and intentions to provide AIDS care outside of the U.S. This is a critical omission concerning countries such as India which is predicted to have tremendous increases in AIDS cases. Such information is important for health care administrators attempting to cope with disease transmission on a global level. The present research explored Indian health care workers' attitudes, knowledge, and willingness to provide AIDS care. A majority of those in the sample indicated a willingness to care for patients with AIDS. These intentions, however, were not predicted by health care workers' attitudes or knowledge of the disease.
BibTeX:
@article{FusilierMR11997,
  author = {Fusilier MR1, Durlabhji S.},
  title = {Health care workers' AIDS attitudes and willingness to provide care--India.},
  journal = {J Health Hum Serv Adm.},
  year = {1997},
  volume = {20(2)},
  pages = {145-58.}
}
Mudur G Indian plan for rural healthcare providers encounters more resistance. 2013 BMJ., pp. 346  article DOI  
Abstract: Abstract not available.
BibTeX:
@article{G.2013,
  author = {Mudur G.},
  title = {Indian plan for rural healthcare providers encounters more resistance.},
  journal = {BMJ.},
  year = {2013},
  pages = {346},
  doi = {http://dx.doi.org/10.1136/bmj.f1967}
}
{Radhakrishnan G. Mental health knowledge and multi-purpose health workers. 2005 Nurs J India.
Vol. 96(12), pp. 273-5 
article  
Abstract: Abstract not available.
BibTeX:
@article{G.2005,
  author = {Radhakrishnan G.},
  title = {Mental health knowledge and multi-purpose health workers.},
  journal = {Nurs J India.},
  year = {2005},
  volume = {96(12)},
  pages = {273-5}
}
Ganju SA and Goel A Prevalence of HBV and HCV infection among health care workers (HCWs). 2000 J Commun Dis.
Vol. 32(3), pp. 228-30 
article  
Abstract: Hepatitis B virus along with hepatitis C virus infection form a major cause of morbidity and mortality. In order to know the present status in Indira Gandhi Medical College, Shimla, a total of 400 samples were screened from Feb'98 to Jan'99. Two hundred samples from HCWs and the same number of samples from the apparently healthy population which served as the control group were collected. They were screened for the presence of hepatitis B surface antigen (HBsAg) and anti-HCV antibodies by the third generation ELISA. HBsAg was positive in 5% of HCWs while amongst the control group seropositivity was 3.5%. Amongst the HCWs, the laboratory technicians showed highest seropositivity which was 40%. Anti-HCV antibody was not detected in any of the HCWs screened. HCWs form a major risk group for contracting HBV infection. It is therefore of utmost importance to take strict universal precautions and also the need for implementation of immunisation against HBV among HCWs.
BibTeX:
@article{GanjuSA12000,
  author = {Ganju SA1, Goel A.},
  title = {Prevalence of HBV and HCV infection among health care workers (HCWs).},
  journal = {J Commun Dis.},
  year = {2000},
  volume = {32(3)},
  pages = {228-30}
}
Garces A et al. Home birth attendants in low income countries: who are they and what do they do? 2012 BMC Pregnancy Childbirth., pp. 12:34  article DOI  
Abstract: BACKGROUND:
Nearly half the world's babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites.
METHODS:
Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or out-of-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia).
RESULTS:
A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator). Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home.
CONCLUSIONS:
Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality.
BibTeX:
@article{GarcesA2012,
  author = {Garces A, McClure EM, Chomba E, Patel A, Pasha O, Tshefu A, Esamai F, Goudar S, Lokangaka A, Hambidge KM, Wright LL, Koso-Thomas M, Bose C, Carlo WA, Liechty EA, Hibberd PL, Bucher S, Whitworth R, Goldenberg RL.},
  title = {Home birth attendants in low income countries: who are they and what do they do?},
  journal = {BMC Pregnancy Childbirth.},
  year = {2012},
  pages = {12:34},
  doi = {http://dx.doi.org/10.1186/1471-2393-12-34}
}
Gargano LM et al. Attitudes of pediatricians and primary health center physicians in India concerning routine immunization, barriers to vaccination, and missed opportunities to vaccinate. 2012 Pediatr Infect Dis J.
Vol. 31(2):e, pp. 37-42 
article DOI  
Abstract: India has some of the lowest immunization rates in the world. The objective of this study was to determine the attitudes and practices of pediatricians and physicians working in primary health centers (PHCs) regarding routine immunization and identify correlates of missed opportunities to vaccinate children. We focused on Uttar Pradesh and Bihar, which has faced some of the greatest challenges to achieving high routine immunization coverage.
METHODS:
A sample of pediatricians from Uttar Pradesh and Bihar was selected from the national membership of the Indian Academy of Pediatrics to participate in either a phone or mail survey. For the sampling frame, the PHCs within selected blocks were enumerated to provide a list from which individuals could be randomly sampled. In all, 614 PHCs in Uttar Pradesh and 159 PHCs were selected for in-person surveys.
RESULTS:
The response rate for pediatricians was 47% (238/505) and 93% for PHC physicians (719/773). The greatest barrier to vaccinating children with routine immunizations, reported by both pediatricians (95.7%) and PHC physicians (95.1%), was parents' lack of awareness of their importance. Correlates of missing an opportunity to vaccinate for PHC physicians included holding other health care workers responsible for vaccination. PHC physicians were 50% to 70% less likely to vaccinate a child themselves if they thought another type of health care worker was responsible.
CONCLUSIONS:
Future interventions to increase vaccination coverage should address parental knowledge about the importance of vaccines. Understanding and addressing factors associated with missed opportunities to vaccinate may help improve vaccine coverage in Uttar Pradesh and Bihar.
BibTeX:
@article{GarganoLM2012,
  author = {Gargano LM, Thacker N, Choudhury P, Weiss PS, Pazol K, Bahl S, Jafari HS, Arora M, Orenstein WA, Hughes JM, Omer SB.},
  title = {Attitudes of pediatricians and primary health center physicians in India concerning routine immunization, barriers to vaccination, and missed opportunities to vaccinate.},
  journal = {Pediatr Infect Dis J.},
  year = {2012},
  volume = {31(2):e},
  pages = {37-42},
  doi = {http://dx.doi.org/10.1097/INF.0b013e3182433bb3}
}
Garg S, Singh R and Grover M India's health workforce: current status and the way forward. 2012 Natl Med J India.
Vol. 25(2):, pp. 111-3 
article  
Abstract: No abstract available
BibTeX:
@article{GargS2012,
  author = {Garg S, Singh R, Grover M.},
  title = {India's health workforce: current status and the way forward.},
  journal = {Natl Med J India.},
  year = {2012},
  volume = {25(2):},
  pages = {111-3}
}
Garg S, Singh R and Grover M Bachelor of rural health care: do we need another cadre of health practitioners for rural areas? 2011 Natl Med J India.
Vol. 24(1), pp. 35-7 
article  
Abstract: Abstract not available.
BibTeX:
@article{GargS12011,
  author = {Garg S1, Singh R, Grover M.},
  title = {Bachelor of rural health care: do we need another cadre of health practitioners for rural areas?},
  journal = {Natl Med J India.},
  year = {2011},
  volume = {24(1)},
  pages = {35-7}
}
Goel A et al. End-of-Life Care Attitudes, Values, and Practices Among Health Care Workers. 2013 Am J Hosp Palliat Care.  article  
Abstract: Introduction: This study aims to ascertain attitudes of health care workers on end-of-life care (EOLC) issues and to highlight the disparity that exists in countries with different backgrounds. METHODS: It is a cross-sectional questionnaire survey across heterogeneous health care providers in India, Chile, the United Kingdom, and the Netherlands using an indigenously prepared questionnaire considering regional variations, covering different areas of EOLC. RESULTS: Of the 109 participants, 68 (62.4%) felt that cardiopulmonary resuscitation should be done selectively, 25 (22.9%) had come in contact with at least 1 patient who had asked them to hasten death, and 36 (33%) felt that training was insufficient to prepare them for skills in issues of EOLC. Conclusion: To avoid cumbersome through well-meant interventions, it is important that the caregiving team is aware of the patient's own wishes with respect to EOLC issues.
BibTeX:
@article{GoelA2013,
  author = {Goel A, Chhabra G, Weijma R, Solari M, Thornton S, Achondo B, Pruthi S, Gupta V, Kalantri SP, Ramavat AS, Kalra OP.},
  title = {End-of-Life Care Attitudes, Values, and Practices Among Health Care Workers.},
  journal = {Am J Hosp Palliat Care.},
  year = {2013}
}
Gogia S and Sachdev HS Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review. 2010 Bull World Health Organ.
Vol. 88(9), pp. 658-666B 
article DOI  
Abstract: OBJECTIVE:
To determine whether home visits for neonatal care by community health workers can reduce infant and neonatal deaths and stillbirths in resource-limited settings.
METHODS:
We conducted a systematic review up to 2008 of controlled trials comparing various intervention packages, one of them being home visits for neonatal care by community health workers. We performed meta-analysis to calculate the pooled risk of outcomes.
FINDINGS:
Five trials, all from south Asia, satisfied the inclusion criteria. The intervention packages included in them comprised antenatal home visits (all trials), home visits during the neonatal period (all trials), home-based treatment for illness (3 trials) and community mobilization efforts (4 trials). Meta-analysis showed a reduced risk of neonatal death (relative risk, RR: 0.62; 95% confidence interval, CI: 0.44-0.87) and stillbirth (RR: 0.76; 95% CI: 0.65-0.89), and a significant improvement in antenatal and neonatal practice indicators (>?1 antenatal check-up, 2 doses of maternal tetanus toxoid, clean umbilical cord care, early breastfeeding and delayed bathing). Only one trial recorded infant deaths (RR: 0.41; 0.30-0.57). Subgroup analyses suggested a greater survival benefit when home visit coverage was ??50% (P?CONCLUSION:
Home visits for antenatal and neonatal care, together with community mobilization activities, are associated with reduced neonatal mortality and stillbirths in southern Asian settings with high neonatal mortality and poor access to facility-based health care.
BibTeX:
@article{GogiaS12010,
  author = {Gogia S1, Sachdev HS.},
  title = {Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review.},
  journal = {Bull World Health Organ.},
  year = {2010},
  volume = {88(9)},
  pages = {658-666B},
  doi = {http://dx.doi.org/10.2471/BLT.09.069369}
}
Gopinath KG et al.. Tuberculosis among healthcare workers in a tertiary-care hospital in South India. 2004 J Hosp Infect.
Vol. 57(4), pp. 339-42. 
article  
Abstract: It is possible that tuberculosis is transmitted from patients to healthcare workers (HCWs). However, there are few data on this from developing countries. The object of this study was to document the incidence of tuberculosis among HCWs in the Christian Medical College (CMC), Vellore, India during a 10-year period (January 1992-December 2001). Data were collected from records maintained in the staff and students health services of CMC. A total of 125 cases were diagnosed during the period of study. The overall incidence of sputum positive cases was similar to that observed in the general population, during most years. However, it appears that focal outbreaks occur with transmission between HCWs. The chance of developing extra-pulmonary tuberculosis was higher in HCWs compared with the general population.
BibTeX:
@article{GopinathKG12004,
  author = {Gopinath KG1, Siddique S, Kirubakaran H, Shanmugam A, Mathai E, Chandy GM.},
  title = {Tuberculosis among healthcare workers in a tertiary-care hospital in South India.},
  journal = {J Hosp Infect.},
  year = {2004},
  volume = {57(4)},
  pages = {339-42.}
}
Gosain A, Rahullal, Mishra B, Mandal A Hand washing in healthcare workers--a challenge that can be met? 2004 J Assoc Physicians India.
Vol. 52, pp. 164 
article  
Abstract: Abstract not available.
BibTeX:
@article{GosainA2004,
  author = {Gosain A, Rahullal, Mishra B, Mandal A.},
  title = {Hand washing in healthcare workers--a challenge that can be met?},
  journal = {J Assoc Physicians India.},
  year = {2004},
  volume = {52},
  pages = {164}
}
Goyal R, Das S and Mathur M Colonisation of methicillin resistant Staphylococcus aureus among health care workers in a tertiary care hospital of Delhi. 2002 Indian J Med Sci.
Vol. 56(7), pp. 321-4 
article  
Abstract: Methicillin resistant strains of Staphylococcus aureus have been responsible for many nosocominl epidemics. Colonised employees of hospital such as asymptomatic nasal and hand carriers act as reservoirs for the spread of this organism within hospital. During a period of three months 150 HCW were screened for nasal and hand colonisation by MRSA. 6.6% (10) HCW were colonised by MRSA and 50% of these were carrying MRSA on both hands and anterior nares. 30% (3) of MRSA strains were multidrug resistant and 60% (6) were resistant to ciproflox. Whether the eradication of MRSA carrier state will lead to decreased rate of MRSA infection is yet to be documented.
BibTeX:
@article{GoyalR12002,
  author = {Goyal R1, Das S, Mathur M.},
  title = {Colonisation of methicillin resistant Staphylococcus aureus among health care workers in a tertiary care hospital of Delhi.},
  journal = {Indian J Med Sci.},
  year = {2002},
  volume = {56(7)},
  pages = {321-4}
}
GGramling JJ and Nachreiner N Implementing a sharps injury reduction program at a charity hospital in India. 2013 Workplace Health Saf.
Vol. 61(8), pp. 339-45 
article DOI  
Abstract: Health care workers in India are at high risk of developing bloodborne infections from needlestick injuries. Indian hospitals often do not have the resources to invest in safety devices and protective equipment to decrease this risk. In collaboration with hospital staff, the primary author implemented a sharps injury prevention and biomedical waste program at an urban 60-bed charity hospital in northern India. The program aligned with hospital organizational objectives and was designed to be low-cost and sustainable. Occupational health nurses working in international settings or with international workers should be aware of employee and employer knowledge and commitment to occupational health and safety.
BibTeX:
@article{GramlingJJ2013,
  author = {Gramling JJ, Nachreiner N.},
  title = {Implementing a sharps injury reduction program at a charity hospital in India.},
  journal = {Workplace Health Saf.},
  year = {2013},
  volume = {61(8)},
  pages = {339-45},
  doi = {http://dx.doi.org/10.3928/21650799-20130716-07}
}
Griffiths UK et al. Incremental costs of introducing jet injection technology for delivery of routine childhood vaccinations: comparative analysis from Brazil, India, and South Africa. 2011 Vaccine.
Vol. 29(5), pp. 969-75 
article DOI  
Abstract: BACKGROUND:
Disposable-syringe jet injectors (DSJIs) have the potential to deliver vaccines safely and affordably to millions of children around the world. We estimated the incremental costs of transitioning from needles and syringes to delivering childhood vaccines with DSJIs in Brazil, India, and South Africa.
METHODS:
Two scenarios were assessed: (1) DSJI delivery of all vaccines at current dose and depth; (2) a change to intradermal (ID) delivery with DSJIs for hepatitis B and yellow fever vaccines, while the other vaccines are delivered by DSJIs at current dose and depth. The main advantage of ID delivery is that only a small fraction of the standard dose may be needed to obtain an immune response similar to that of subcutaneous or intramuscular injection. Cost categories included were vaccines, injection equipment, waste management, and vaccine transport. Some delivery cost items, such as training and personnel were excluded as were treatment cost savings caused by a reduction in diseases transmitted due to unsafe injections.
RESULTS:
In the standard dose and depth scenario, the incremental costs of introducing DSJIs per fully vaccinated child amount to US$ 0.57 in Brazil, US$ 0.65 in India and US$ 1.24 in South Africa. In the ID scenario, there are cost savings of US$ 0.11 per child in Brazil, and added costs of US$ 0.45 and US$ 0.76 per child in India and South Africa, respectively. The most important incremental cost item is jet injector disposable syringes.
CONCLUSION:
The incremental costs should be evaluated against other vaccine delivery technologies that can deliver the same benefits to patients, health care workers, and the community. DSJIs deserve consideration by global and national decision-makers as a means to expand access to ID delivery and to enhance safety at marginal additional cost.
BibTeX:
@article{GriffithsUK2011,
  author = {Griffiths UK, Santos AC, Nundy N, Jacoby E, Matthias D.},
  title = {Incremental costs of introducing jet injection technology for delivery of routine childhood vaccinations: comparative analysis from Brazil, India, and South Africa.},
  journal = {Vaccine.},
  year = {2011},
  volume = {29(5)},
  pages = {969-75},
  doi = {http://dx.doi.org/10.1016/j.vaccine.2010.11.038}
}
Gupta E et al.. Unsafe injection practices: a potential weapon for the outbreak of blood borne viruses in the community. 2013 Ann Med Health Sci Res.
Vol. 3(2):, pp. 177-81 
article DOI  
Abstract: BACKGROUND:
Unsafe injection practices are common in developing nations. Such practices, through contaminated needles and syringes, place injection recipient, healthcare workers and the community at large at risk of infection with blood borne viruses.
AIM:
An attempt was made to briefly describe an acute hepatitis outbreak that occurred in Gujarat, India, due to unsafe injection practices with a brief review of the literature.
SUBJECTS AND METHODS:
An outbreak of acute hepatitis occurred in February-March 2009 in the Sabarkantha district of Gujarat in India. Blood samples were collected randomly from 25 cases, admitted in the local hospital during the ongoing outbreak. Screening was done using an immunoassay analyzer (Cobas e411; Roche Diagnostics, Indianapolis, IN, USA) for hepatitis B surface antigen (HBsAg), IgM and total antibodies to hepatitis B core antigen (HBc), hepatitis B e antigen (HBeAg) and antibody to HBe, antibodies to HCV, HIV and IgM antibodies to hepatitis A virus (HAV), as per the manufacturer's protocol.
RESULTS:
Gross and continuous use of contaminated needle and syringes were responsible for this outbreak as all the patients gave history of receiving injections about 2-3 months prior to the development of clinical signs and symptoms, from one particular doctor. Mean age of the patients was 33.4 years (SD 12.9 years). Seventeen of these patients were males and eight were females. All patients were hepatitis B surface antigen positive, with median levels as 35,450 IU/mL (IQR 450-2,49,750 IU/mL). IgM HBc was positive in 22/25 (88%). HBe Ag was positive in 11 patients (44%). The median HBV DNA level was 2.6 � 10(4) IU/mL (IQR 1.18 � 10(2) to 6.7 � 10(6) IU/mL). No significant co-infection with other hepatitis viruses existed. All isolates were genotype D.
CONCLUSIONS:
The findings emphasize the role of unsafe injection practices in the community outbreak of hepatitis B infection, need to start routine surveillance system and increase awareness in health care workers regarding safe injection practices.
BibTeX:
@article{GuptaE2013,
  author = {Gupta E, Bajpai M, Sharma P, Shah A, Sarin S.},
  title = {Unsafe injection practices: a potential weapon for the outbreak of blood borne viruses in the community.},
  journal = {Ann Med Health Sci Res.},
  year = {2013},
  volume = {3(2):},
  pages = {177-81},
  doi = {http://dx.doi.org/10.4103/2141-9248.113657}
}
Gupta V and Das P Medical tourism in India. 2012 Clin Lab Med.
Vol. 32(2):, pp. 321-5 
article DOI  
Abstract: The term 'medical tourism' is under debate because health care is a serious business and rarely do patients combine the two. India is uniquely placed by virtue of its skilled manpower, common language, diverse medical conditions that doctors deal with, the volume of patients, and a large nonresident Indian population overseas. Medical tourism requires dedicated services to alleviate the anxiety of foreign patients. These include translation, currency conversion, travel, visa, posttreatment care system,and accommodation of patient relatives during and after treatment.
BibTeX:
@article{GuptaV2012,
  author = {Gupta V, Das P.},
  title = {Medical tourism in India.},
  journal = {Clin Lab Med.},
  year = {2012},
  volume = {32(2):},
  pages = {321-5},
  doi = {http://dx.doi.org/10.1016/j.cll.2012.04.007}
}
Katrak H Measuring the shortage of medical practitioners in rural and urban areas in developing countries: a simple framework and simulation exercises with data from India. 2008 Int J Health Plann Manage.
Vol. 23(2), pp. 93-105 
article  
Abstract: This paper suggests a simple framework to estimate the shortage of medical practitioners in rural and urban areas in developing countries. Shortages are defined with respect to four main considerations. The overall numbers and also the different categories of practitioners in the rural and urban areas, the relatively greater difficulties of access in the rural areas (which reduce the number of accessible practitioners) and the greater health hazards in those areas (which lead to greater need for medical treatment). The quantitative effect of these factors is examined by undertaking simulation exercises with data for the Ujjain district in Madhya Pradesh state, India and also data for that state. The simulations turned up the following results. The un-weighted total number of practitioners, per head of population, is relatively greater in the rural areas; this is because of the relatively large numbers of the unqualified doctors in those areas. On the other hand, a 'quality adjusted' total, with lower weights for the unqualified doctors, found little overall difference between the rural and urban areas. Third, allowance for rural-urban differences in the difficulties of access showed that the number of accessible practitioners is much lower in the rural areas. Fourth, rural-urban differences in the incidence of health hazards and estimates of the need for medical treatment also showed a marked shortage of practitioners in the rural areas. The main implication of the results is that developmental efforts in the rural areas, including improvements in transport facilities and reduction of health hazards, would help to greatly reduce the shortage of practitioners in those areas. Training programmes to improve the quality of practitioners in the rural areas are also required.
BibTeX:
@article{H.2008,
  author = {Katrak H.},
  title = {Measuring the shortage of medical practitioners in rural and urban areas in developing countries: a simple framework and simulation exercises with data from India.},
  journal = {Int J Health Plann Manage.},
  year = {2008},
  volume = {23(2)},
  pages = {93-105}
}
Hagopian A, Mohanty MK, Das A, House PJ Applying WHO's 'workforce indicators of staffing need' (WISN) method to calculate the health worker requirements for India's maternal and child health service guarantees in Orissa State. 2012 Health Policy Plan.
Vol. 27(1):, pp. 11-8 
article DOI  
Abstract: OBJECTIVE:
In one district of Orissa state, we used the World Health Organization's Workforce Indicators of Staffing Need (WISN) method to calculate the number of health workers required to achieve the maternal and child health 'service guarantees' of India's National Rural Health Mission (NRHM). We measured the difference between this ideal number and current staffing levels.
METHODS:
We collected census data, routine health information data and government reports to calculate demand for maternal and child healthservices. By conducting 54 interviews with physicians and midwives, and six focus groups, we were able to calculate the time required to perform necessary health care tasks. We also interviewed 10 new mothers to cross-check these estimates at a global level and get assessments of quality ofcare.
FINDINGS:
For 18 service centres of Ganjam District, we found 357 health workers in our six cadre categories, to serve a population of 1.02 million. Total demand for the MCH services guaranteed under India's NRHM outpaced supply for every category of health worker but one. To properly serve the study population, the health workforce supply should be enhanced by 43 additional physicians, 15 nurses and 80 nurse midwives. Those numbers probably under-estimate the need, as they assume away geographic barriers.
CONCLUSIONS:
Our study established time standards in minutes for each MCH activity promised by the NRHM, which could be applied elsewhere in India by government planners and civil society advocates. Our calculations indicate significant numbers of new health workers are required to deliver the services promised by the NRHM.
BibTeX:
@article{HagopianA2012,
  author = {Hagopian A, Mohanty MK, Das A, House PJ.},
  title = {Applying WHO's 'workforce indicators of staffing need' (WISN) method to calculate the health worker requirements for India's maternal and child health service guarantees in Orissa State.},
  journal = {Health Policy Plan.},
  year = {2012},
  volume = {27(1):},
  pages = {11-8},
  doi = {http://dx.doi.org/10.1093/heapol/czr007}
}
Hazarika I Medical tourism: its potential impact on the health workforce and health systems in India. 2010 Health Policy Plan.
Vol. 25(3), pp. 248-51 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{I.2010,
  author = {Hazarika I.},
  title = {Medical tourism: its potential impact on the health workforce and health systems in India.},
  journal = {Health Policy Plan.},
  year = {2010},
  volume = {25(3)},
  pages = {248-51},
  doi = {http://dx.doi.org/10.1093/heapol/czp050}
}
Elliott J. India considers allowing expatriate doctors to practise back home. 2012 BMJ.
Vol. 344:e, pp. 3235 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{J.2012,
  author = {Elliott J.},
  title = {India considers allowing expatriate doctors to practise back home.},
  journal = {BMJ.},
  year = {2012},
  volume = {344:e},
  pages = {3235},
  doi = {http://dx.doi.org/10.1136/bmj.e3235}
}
Varghese J The new rural doctor: qualified quack or appropriate healthcare provider? 2010 Indian J Med Ethics.
Vol. 7(2), pp. 70-2 
article  
Abstract: Abstract not available.
BibTeX:
@article{J.2010,
  author = {Varghese J.},
  title = {The new rural doctor: qualified quack or appropriate healthcare provider?},
  journal = {Indian J Med Ethics.},
  year = {2010},
  volume = {7(2)},
  pages = {70-2}
}
Jain S and Parwar V Rabies: Post exposure prophylaxis for the health care workers. 2009 Indian J Pediatr.
Vol. 76(12), pp. 1276-7 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{JainS2009,
  author = {Jain S, Parwar VR.},
  title = {Rabies: Post exposure prophylaxis for the health care workers.},
  journal = {Indian J Pediatr.},
  year = {2009},
  volume = {76(12)},
  pages = {1276-7},
  doi = {http://dx.doi.org/10.1007/s12098-009-0325-5}
}
Jarhyan P et al. Private rural health providers in Haryana, India: profile and practices. 2012 Rural Remote Health.
Vol. 12, pp. 1953 
article  
Abstract: INTRODUCTION:
Despite a widespread public health system, the private healthcare sector is the major provider of health care in rural India. This study describes the profile and medical practices of private rural health providers (PRHPs) in rural Haryana, India.
METHODS:
A cross-sectional study was conducted among PRHPs practicing in the villages of Comprehensive Rural Health Services Project (CRHSP) at Ballabgarh block located in the Faridabad district of Haryana State. The CRHSP is an Intensive Field Practice Area (IFPA) of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi.
RESULTS:
Eighty PRHPs participated in this study (response rate 93%). The majority (96%) did not possess a qualification in any formal system of medicine. Half of the PRHPs had a separate space (private area) for the examination of patients. Almost all had stethoscopes, thermometers and blood pressure apparatus. The PRHPs were involved in a wide range of practices, such as dispensing medicines (98.7%), providing injections (98.7%) and intravenous fluids (98.7%), and conducting minor surgery (78.5%). Dumping biomedical waste was a common practice among these practitioners. Some PRHPs (8.7%) were involved in national health programs.
CONCLUSIONS:
Unqualified PRHPs provide substantial outpatient healthcare services in rural Ballabgarh, India. Their biomedical waste disposal practices are inadequate. There is a need for training in waste disposal practices and monitoring of safe injection techniques among PRHPs. Consideration should be given to utilising PRHPs in important public health programs such as disease surveillance.
BibTeX:
@article{JarhyanP2012,
  author = {Jarhyan P, Singh B, Rai SK, Nongkynrih B.},
  title = {Private rural health providers in Haryana, India: profile and practices.},
  journal = {Rural Remote Health.},
  year = {2012},
  volume = {12},
  pages = {1953}
}
Jayanth ST et al. Needle stick injuries in a tertiary care hospital. 2009 Indian J Med Microbiol.
Vol. 27(1), pp. 44-7 
article  
Abstract: BACKGROUND:
Accidental needle stick injuries (NSIs) are an occupational hazard for healthcare workers (HCWs). A recent increase in NSIs in a tertiary care hospital lead to a 1-year review of the pattern of injuries, with a view to determine risk factors for injury and potential interventions for prevention.
METHODS:
We reviewed 1-year (July 2006-June 2007) of ongoing surveillance of NSIs.
RESULTS:
The 296 HCWs reporting NSIs were 84 (28.4%) nurses, 27 (9.1%) nursing interns, 45 (21.6%) cleaning staff, 64 (21.6%) doctors, 47 (15.9%) medical interns and 24 (8.1%) technicians. Among the staff who had NSIs, 147 (49.7%) had a work experience of less than 1 year (n = 230, 77.7%). In 73 (24.6%) of the NSIs, the patient source was unknown. Recapping of needles caused 25 (8.5%) and other improper disposal of the sharps resulted in 55 (18.6%) of the NSIs. Immediate post-exposure prophylaxis for HCWs who reported injuries was provided. Subsequent 6-month follow-up for human immunodeficiency virus showed zero seroconversion.
CONCLUSION:
Improved education, prevention and reporting strategies and emphasis on appropriate disposal are needed to increase occupational safety for HCWs.
BibTeX:
@article{JayanthST12009,
  author = {Jayanth ST1, Kirupakaran H, Brahmadathan KN, Gnanaraj L, Kang G.},
  title = {Needle stick injuries in a tertiary care hospital.},
  journal = {Indian J Med Microbiol.},
  year = {2009},
  volume = {27(1)},
  pages = {44-7}
}
Jesudas CD and Thangakunam B Tuberculosis risk in health care workers. 2013 Indian J Chest Dis Allied Sci.
Vol. 55(3), pp. 149-54 
article  
Abstract: Risk to health care workers (HCW) is of paramount importance in the global fight against tuberculosis (TB). There is mounting evidence that they are at increased risk of contracting TB infection as well as developing the disease. This occupational risk is at alarming proportions in the low- and middle-income countries (LMIC), because of increased exposure and lack of preventive measures. Although tuberculin skin test has been used for a long time to detect latent TB infection (LTBI), it has significant drawbacks. Interferon-gamma release assays arrived with a lot of promise, but the expected benefit of more specific diagnosis has not yet been proved. The treatment of LTBI is an area, which is not well studied in LMIC. Effective environmental and personal protective measures along with education to the patients and the HCW needs to be carried out expeditiously, to reduce the occupational risk of TB.
BibTeX:
@article{JesudasCD12013,
  author = {Jesudas CD1, Thangakunam B2.},
  title = {Tuberculosis risk in health care workers.},
  journal = {Indian J Chest Dis Allied Sci.},
  year = {2013},
  volume = {55(3)},
  pages = {149-54}
}
Jha AK et al. Hepatitis B infection in microbiology laboratory workers: prevalence, vaccination, and immunity status. 2012 Hepat Res Treat.
Vol. 2012, pp. 520362 
article DOI  
Abstract: The risk of contracting HBV by health care workers (HCW) is four-times greater than that of general adult population. Studies have demonstrated that vaccine-induced protection persists at least 11 years. High risk groups such as HCWs should be monitored and receive a booster vaccination if their anti-HBsAb levels decrease below 10?mIU/mL. In view of the above this study was undertaken to assess the HBV vaccination of the HCWs and their immunological response. Seventy-two HCWs of the Department of Microbiology, Maulana Azad Medical College, New Delhi, India, were recruited and blood sample was drawn for serological tests (HBSAg, anti-HCV, anti-HBsAb, anti-HBeAb, and anti-HBcAb). Anti-HBs titers of >10?mIU/mL were considered protective. Thirty-four (47.3%) of the participants were completely vaccinated with three doses. 25 (73.5%) of the participants with complete vaccination had protective anti-HBsAb levels as against 8 (53.3%) of those with incomplete vaccination and 9 (39.1%) of those who were not vaccinated at all. One of our participants was acutely infected while 29 participants were susceptible to infection at the time of the study. All HCWs should receive three doses of the vaccine and be monitored for their immune status after every five years. Boosters should be administered to those who become susceptible.
BibTeX:
@article{JhaAK2012,
  author = {Jha AK, Chadha S, Bhalla P, Saini S.},
  title = {Hepatitis B infection in microbiology laboratory workers: prevalence, vaccination, and immunity status.},
  journal = {Hepat Res Treat.},
  year = {2012},
  volume = {2012},
  pages = {520362},
  doi = {http://dx.doi.org/10.1155/2012/520362}
}
Jindal N et al. Seroprevalence of hepatitis C virus (HCV) in health care workers of a tertiary care centre in New Delhi. 2006 Indian J Med Res.
Vol. 123(2), pp. 179-80 
article  
Abstract: Hepatitis C virus (HCV) is a parenterally transmitted virus that poses an occupational hazard to the health care workers (HCWs). No significant data are available regarding the prevalence of HCV in health care workers in India. The present study was designed to determine the seroprevalence of HCV infection in health care workers in a tertiary care centre in New Delhi. The subjects (n=100) were divided according to the duration of employment and the unit where they were working. Blood samples were collected from all the subjects and sera were tested for anti-HCV antibodies. The seroprevalence of anti-HCV was found to be 4 per cent. The duration of occupational exposure was not a significant risk factor for HCV infection and prevalence of anti-HCV antibodies were highest in HCWs working in haemodialysis units. The seroprevalence of HCV in health care workers was considerably higher than that reported in the general population, and needs to be evaluated on a larger sample.
BibTeX:
@article{JindalN12006,
  author = {Jindal N1, Jindal M, Jilani N, Kar P.},
  title = {Seroprevalence of hepatitis C virus (HCV) in health care workers of a tertiary care centre in New Delhi.},
  journal = {Indian J Med Res.},
  year = {2006},
  volume = {123(2)},
  pages = {179-80}
}
Lakshmi JK Less equal than others? Experiences of AYUSH medical officers in primary health centres in Andhra Pradesh. 2012 Indian J Med Ethics.
Vol. 9(1):, pp. 18-21 
article  
Abstract: The National Rural Health Mission (NRHM) includes, inter alia, the establishment of an AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) component (practitioner, trained assistants, drugs and equipment) in every primary health centre (PHC). However, five years following the launch of the NRHM, the AYUSH mainstreaming scenario is below expectations, riddled with ethical and governance issues. Accounts from AYUSH practitioners at PHCs in various regions of the state of Andhra Pradesh reveal enormous lacunae in implementation: unfilled positions, inequitable emoluments, inadequate or absent infrastructure, assistance and supplies, unethical interpersonal arrangements, and limited support from non-AYUSH personnel. The widespread negative impact of these conditions undermines the value of AYUSH, demotivating both practitioners and patients, and failing to provide the intended support to the public health system.
BibTeX:
@article{JK.2012,
  author = {Lakshmi JK.},
  title = {Less equal than others? Experiences of AYUSH medical officers in primary health centres in Andhra Pradesh.},
  journal = {Indian J Med Ethics.},
  year = {2012},
  volume = {9(1):},
  pages = {18-21}
}
Joel D et al. Explanatory models of psychosis among community health workers in South India. 2003 Acta Psychiatr Scand.
Vol. 108(1), pp. 66-9 
article  
Abstract: OBJECTIVE:
To examine commonly held indigenous beliefs about mental illness, which often differ markedly from the biomedical models, among community health workers in rural South India.
METHOD:
Indigenous beliefs about chronic psychosis were elicited from community health workers. The Short Explanatory Model Interview formed the basis of the interview.
RESULTS:
A variety of indigenous beliefs, which contradicted the biomedical model, were elicited. A significant proportion of health workers did not recognize chronic psychosis as a disease condition, believing that it was caused by black magic, evil spirits and poverty, and felt that doctors could not help.
CONCLUSION:
The results of the study suggest that training programmes should elicit and discuss local beliefs prior to the teaching of the biomedical model of mental disorders.
BibTeX:
@article{JoelD12003,
  author = {Joel D1, Sathyaseelan M, Jayakaran R, Vijayakumar C, Muthurathnam S, Jacob KS.},
  title = {Explanatory models of psychosis among community health workers in South India.},
  journal = {Acta Psychiatr Scand.},
  year = {2003},
  volume = {108(1)},
  pages = {66-9}
}
Johnson SE, Green J and Maben J A suitable job?: A qualitative study of becoming a nurse in the context of a globalizing profession in India. 2013 Int J Nurs Stud.
Vol. pii: S0020-7489(13), pp. 00270-8 
article DOI  
Abstract: BACKGROUND:
Research on Indian nurses has focused on their participation as global migrant workers for whom opportunities abroad act as an incentive for many to migrate overseas. However, little is known about the careers of Indian nurses, or the impact of a globalized health care market on nurses who remain and on the profession itself in India.
OBJECTIVES:
To explore nurses' accounts of entry into nursing in the context of the globalisation of the nursing profession in India, and the salience of 'migration' for nurses' individual careers.
DESIGN:
Qualitative interview study (n=56).
SETTINGS AND PARTICIPANTS:
The study drew on interviews with 56 nurses from six sites in Bangalore, India. These included two government hospitals, two private hospitals, a Christian mission hospital, a private outpatient clinic and two private nursing colleges. Participants were selected purposively to include nurses from Christian and Hindu backgrounds, a range of home States, ages and seniority and to deliberately over-recruit (rare) male nurses.
METHODS:
Interviews covered how and why nurses entered nursing, their training and career paths to date, plans for the future, their experiences of providing nursing care and attitudes towards migration. Data analysis drew on grounded theory methods.
RESULTS:
Nursing is traditionally seen as a viable career particularly for women from Christian communities in India, where it has created inter-generational 'nurse families'. In a globalizing India, nursing is becoming a job 'with prospects' transcending traditional caste, class and gender boundaries. Almost all nurses interviewed who intended seeking overseas employment envisaged migration as a short term option to satisfy career objectives - increased knowledge, skills and economic rewards - that could result in long-term professional and social status gains 'back home' inIndia. For others, migration was not part of their career plan: yet the increases in status that migration possibilities had brought were crucial to framing nursing as a 'suitable job' for a growing number of entrants.
CONCLUSIONS:
The possibility of migration has facilitated collective social mobility for Indian nurses. Migration possibilities were important not only for those who migrate, but for improving the status of nursing in general in India, making it a more attractive career option for a growing range of recruits.
BibTeX:
@article{JohnsonSE2013,
  author = {Johnson SE, Green J, Maben J.},
  title = {A suitable job?: A qualitative study of becoming a nurse in the context of a globalizing profession in India.},
  journal = {Int J Nurs Stud.},
  year = {2013},
  volume = {pii: S0020-7489(13)},
  pages = {00270-8},
  doi = {http://dx.doi.org/10.1016/j.ijnurstu.2013.09.009}
}
Joseph NM et al. Role of intensive care unit environment and health-care workers in transmission of ventilator-associated pneumonia. 2010 J Infect Dev Ctries.
Vol. 4(5), pp. 282-91 
article  
Abstract: BACKGROUND:
Pseudomonas aeruginosa and Acinetobacter baumannii have been reported to cause outbreaks of ventilator-associated pneumonia (VAP) in several studies. The high prevalence of these pathogens prompted us to study the different strains of these pathogens prevailing in our intensive care units (ICUs) and determine the role of ICU environment and health-care workers (HCWs) in the transmission of infection.
METHODOLOGY:
A prospective study was performed over a period of 15 months in two ICUs of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. Surveillance samples were collected from the HCWs and the ICU environment. Quantitative antibiogram typing and PCR-RFLP were used for comparison of the isolates from the surveillance samples and VAP patients.
RESULTS:
Pseudomonas aeruginosa and Acinetobacter baumannii were the most common potential VAP pathogens isolated from the surveillance cultures. Eight strains of Pseudomonas aeruginosa were present in our ICUs, but multi-drug resistant (MDR) strain 2 and strain 4 were the most prevalent strains. Six strains of Acinetobacter baumannii were found in our ICUs, of which MDR strain 1 and strain 3 were the most common. The strains of Pseudomonas aeruginosa and Acinetobacter baumannii observed in the VAP patients were also found in the ICU milieu. Only one HCW was found to be the carrier of a Pseudomonas aeruginosa strain present in a VAP patient.
CONCLUSIONS:
The ICU environment was observed to be the potential reservoir for VAP pathogens; therefore, strict adherence to environmental infection control measures is essential to prevent health-care-associated infections.
BibTeX:
@article{JosephNM12010,
  author = {Joseph NM1, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC.},
  title = {Role of intensive care unit environment and health-care workers in transmission of ventilator-associated pneumonia.},
  journal = {J Infect Dev Ctries.},
  year = {2010},
  volume = {4(5)},
  pages = {282-91}
}
Joshi R et al. Prevalence of abnormal radiological findings in health care workers with latent tuberculosis infection and correlations with T cell immune response. 2007 PLoS One.
Vol. 2(8):e, pp. 805 
article  
Abstract: BACKGROUND:
More than half of all health care workers (HCWs) in high TB-incidence, low and middle income countries are latently infected with tuberculosis (TB). We determined radiological lesions in a cohort of HCWs with latent TB infection (LTBI) in India, and determined their association with demographic, occupational and T-cell immune response variables.
METHODOLOGY:
We obtained chest radiographs of HCWs who had undergone tuberculin skin test (TST) and QuantiFERON-TB Gold In Tube (QFT), an interferon-gamma release assay, in a previous cross-sectional study, and were diagnosed to have LTBI because they were positive by either TST or QFT, but had no evidence of clinical disease. Two observers independently interpreted these radiographs using a standardized data form and any discordance between them resolved by a third observer. The radiological diagnostic categories (normal, suggestive of inactive TB, and suggestive of active TB) were compared with results of TST, QFT assay, demographic, and occupational covariates.
RESULTS:
A total of 330 HCWs with positive TST or QFT underwent standard chest radiography. Of these 330, 113 radiographs (34.2%) were finally classified as normal, 206 (62.4%) had lesions suggestive of inactive TB, and 11 (3.4%) had features suggestive of active TB. The mean TST indurations and interferon-gamma levels in the HCWs in these three categories were not significantly different. None of the demographic or occupational covariates was associated with prevalence of inactive TB lesions on chest radiography.
CONCLUSION/SIGNIFICANCE:
In a high TB incidence setting, nearly two-thirds of HCWs with latent TB infection had abnormal radiographic findings, and these findings had no clear correlation with T cell immune responses. Further studies are needed to verify these findings and to identify the causes and prognosis of radiologic abnormalities in health care workers.
BibTeX:
@article{JoshiR12007,
  author = {Joshi R1, Patil S, Kalantri S, Schwartzman K, Menzies D, Pai M.},
  title = {Prevalence of abnormal radiological findings in health care workers with latent tuberculosis infection and correlations with T cell immune response.},
  journal = {PLoS One.},
  year = {2007},
  volume = {2(8):e},
  pages = {805}
}
Kapadia-Kundu N et al. Understanding health information needs and gaps in the health care system in Uttar Pradesh, India. 2012 J Health Commun.
Vol. 17 Suppl 2, pp. 30-45 
article DOI  
Abstract: Health information and the channels that facilitate the flow and exchange of this information to and among health care providers are key elements of a strong health system that offers high-quality services,yet few studies have examined how health care workers define, obtain, and apply information in the course of their daily work. To better understand health information needs and barriers across all of levels of the health care system, the authors conducted a needs assessment in Lucknow, Uttar Pradesh, India. Data collection consisted of 46 key informant interviews and 9 focus group discussions. Results of the needs assessment pointed to the following themes: (a) perceptions or definitions of health information related to daily tasks performed at different levels of the health system; (b) information flow in the public health structure; (c) need for practical information; and (d) criteria for usability of information. This needs assessment found that health information needs vary across the health system in Uttar Pradesh. Information needs are dynamic and encompass programmatic and service delivery information. Providing actionable information across all levels is a key means to strengthen the health system and improve the quality of services. An adequate assessment of health information needs, including opportunities, barriers, and gaps, is a prerequisite to designing effective communication of actionable information.
BibTeX:
@article{Kapadia-KunduN2012,
  author = {Kapadia-Kundu N, Sullivan TM, Safi B, Trivedi G, Velu S.},
  title = {Understanding health information needs and gaps in the health care system in Uttar Pradesh, India.},
  journal = {J Health Commun.},
  year = {2012},
  volume = {17 Suppl 2},
  pages = {30-45},
  doi = {http://dx.doi.org/10.1080/10810730.2012.666625}
}
Kardam P, Mehendiratta M, Rehani S and Kumar M Seroprevalence and vaccination status of hepatitis B amongst dental health-care workers in North India. 2013 Indian J Gastroenterol.  article  
Abstract: No abstract available
BibTeX:
@article{KardamP2013,
  author = {Kardam P, Mehendiratta M, Rehani S, Kumra M.},
  title = {Seroprevalence and vaccination status of hepatitis B amongst dental health-care workers in North India.},
  journal = {Indian J Gastroenterol.},
  year = {2013}
}
Kermode M et al. HIV-related knowledge, attitudes and risk perception amongst nurses, doctors and other healthcare workers in rural India. 2005 Indian J Med Res.
Vol. 122(3), pp. 258-64 
article  
Abstract: BACKGROUND AND OBJECTIVE:
People with HIV in India frequently encounter discrimination while seeking and receiving healthcare services. The knowledge and attitudes of healthcare workers (HCWs) influences the willingness and ability of people with HIV to access care, and the quality of the care they receive. Previous studies of HIV-related knowledge and attitudes amongst Indian HCWs have been conducted primarily in large urban hospitals. The objective of this study was to asses HIV-related knowledge, attitudes and risk perception among a group of rural north Indian HCWs, and to identify predictors of willingness to provide care for patients with HIV infection.
METHODS:
A cross-sectional survey of 266 HCWs (78% female) from seven rural north Indian health settings was undertaken in late 2002. A self-administered written questionnaire was made available in English and Hindi, and the response rate was 87 per cent. Information was gathered regarding demographic details (age, sex, duration of employment, job category); HIV-related knowledge and attitudes; risk perception; and previous experience caring for HIV-positive patients. Logistic regression modelling was undertaken to identify factors associated with willingness to care for patients with HIV.
RESULTS:
The HCWs in this study generally had a positive attitude to caring for people with HIV. However, this was tempered by substantial concerns about providing care, and the risk of occupational infection with HIV was perceived by most HCWs to be high. After controlling for confounding, HCWs willingness to provide care for patients with HIV was strongly associated with having previously cared for patients with HIV (P = 0.001). Knowledge of HIV transmission and perception of risk were not associated with willingness to provide care.
INTERPRETATION AND CONCLUSION:
The findings of this study showed a general willingness of HCWs to provide care for patients with HIV, tempered by concerns regarding provision of such care. Strategies to address HCWs concerns are likely to ameliorate the discrimination experienced by people with HIV when accessing healthcare services. These include the development of programmes to promote occupational safety of HCWs and involving people with HIV in awareness training of HCWs.
BibTeX:
@article{KermodeM12005,
  author = {Kermode M1, Holmes W, Langkham B, Thomas MS, Gifford S.},
  title = {HIV-related knowledge, attitudes and risk perception amongst nurses, doctors and other healthcare workers in rural India.},
  journal = {Indian J Med Res.},
  year = {2005},
  volume = {122(3)},
  pages = {258-64}
}
Kermode M et al. Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. 2005 Am J Infect Control.
Vol. 33(1), pp. 34-41 
article  
Abstract: BACKGROUND:
Approximately 3 million health care workers (HCWs) experience percutaneous exposure to bloodborne viruses (BBVs) each year. This results in an estimated 16,000 hepatitis C, 66,000 hepatitis B, and 200 to 5000 human immunodeficiency virus (HIV) infections annually. More than 90% of these infections are occurring in low-income countries, and most are preventable. Several studies report the risks of occupational BBV infection for HCWs in high-income countries where a range of preventive interventions have been implemented. In contrast, the situation for HCWs in low-income countries is not well documented, and their health and safety remains a neglected issue.
OBJECTIVE:
To describe the extent of occupational exposure to blood and the risk of BBV infection among a group of HCWs in rural north India.
METHODS:
A cross-sectional survey of HCWs from 7 rural health settings gathered data pertaining to occupational exposure to blood and a range of other relevant variables (eg, demographic information, compliance with Universal Precautions, perception of risk, knowledge of BBVs). A mass action model was used to estimate the risk of occupational BBV infection for these HCWs over a 10-year period.
RESULTS:
A total of 266 HCWs returned questionnaires (response rate, 87%). Sixty-three percent reported at least 1 percutaneous injury (PI) in the last year (mean no. = 2.3) and 73% over their working lifetime (mean no. = 4.2). Predictors of PI during the last year were hospital site, job category, perception of risk, and compliance with Universal Precautions.
CONCLUSION:
The high level of occupational exposure to blood found among this group of rural north Indian HCWs highlights the urgent need for interventions to enhance their occupational safety to prevent unnecessary nosocomial transmission of BBVs.
BibTeX:
@article{KermodeM12005a,
  author = {Kermode M1, Jolley D, Langkham B, Thomas MS, Crofts N.},
  title = {Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings.},
  journal = {Am J Infect Control.},
  year = {2005},
  volume = {33(1)},
  pages = {34-41}
}
Kermode M et al.. Compliance with Universal/Standard Precautions among health care workers in rural north India. 2005 Am J Infect Control.
Vol. 33(1), pp. :27-33 
article  
Abstract: BACKGROUND:
Universal Precautions (UPs) and more recently Standard Precautions have been widely promoted in high-income countries to protect health care workers (HCWs) from occupational exposure to blood and the consequent risk of infection with bloodborne pathogens. In low-income countries, the situation is very different: UPs are often practiced partially, if at all, thereby exposing the HCWs to unnecessary risk of infection. The aim of this study is to describe rural north Indian HCWs knowledge and understanding of UPs and identify predictors of compliance to target intervention programs appropriately.
METHODS:
A cross-sectional survey was undertaken, involving 266 HCWs (response rate, 87%) from 7 rural north Indian health care settings. Information was gathered regarding compliance with UPs and a range of other relevant variables that potentially influence compliance (eg, demographic information, perception of risk, knowledge of bloodborne pathogen transmission, perception of safety climate, and barriers to safe practice).
RESULTS:
Knowledge and understanding of UPs were partial, and UPs compliance was suboptimal, eg, only 32% wore eye protection when indicated, and 40% recapped needles at least sometimes. After controlling for confounding, compliance with UPs was associated with being in the job for a longer period, knowledge of bloodborne pathogen transmission, perceiving fewer barriers to safe practice and a strong commitment to workplace safety climate.
CONCLUSION:
Interventions to improve UPs compliance among HCWs in rural north India need to address not only their knowledge and understanding but also the safety climate created by the organizations that employ them.
BibTeX:
@article{KermodeM12005b,
  author = {Kermode M1, Jolley D, Langkham B, Thomas MS, Holmes W, Gifford SM.},
  title = {Compliance with Universal/Standard Precautions among health care workers in rural north India.},
  journal = {Am J Infect Control.},
  year = {2005},
  volume = {33(1)},
  pages = {:27-33}
}
Khayyam KU et al. Tuberculosis among health care workers in a tertiary care institute for respiratory diseases in New Delhi. 2010 Indian J Tuberc.
Vol. 57(4), pp. 192-8 
article  
Abstract: BACKGROUND:
LRS Institute of Tuberculosis and Respiratory Diseases, a tertiary care pulmonary institute in Delhi, India.
AIMS:
To find out the risk of tuberculosis disease among health care workers (HCWs) of LRS Institute.
METHODS:
Retrospective study, where all members of the staff working in this hospital were interviewed regarding development of tuberculosis after joining this institute.
RESULTS:
A total of 40 cases of tuberculosis were reported by the health care workers between March 1999 to March 2008 yielding an overall risk of 727 per 1,00,000 population per year which is four times higher than the reported national average. Among these 40 cases, 25 (62.5%) were pulmonary and 15 (37.5%) were extra-pulmonary tuberculosis.
CONCLUSION:
This institute's health care workers have to deal with a large number of tuberculosis patients, the risk of exposure is more in them and thus having the disease. Multi-centric studies are needed to evaluate the true prevalence of tuberculosis among HCWs and effective intervention strategies are required to reduce nosocomial transmission.
BibTeX:
@article{KhayyamKU12010,
  author = {Khayyam KU1, Patra S, Sarin R, Behera D.},
  title = {Tuberculosis among health care workers in a tertiary care institute for respiratory diseases in New Delhi.},
  journal = {Indian J Tuberc.},
  year = {2010},
  volume = {57(4)},
  pages = {192-8}
}
Khoo EM et al. Somatisation disorder and its associated factors in multiethnic primary care clinic attenders. 2012 Int J Behav Med.
Vol. 19(2), pp. 165-73 
article DOI  
Abstract: BACKGROUND:
Somatisation disorder (SD) has been reported as common in all ethnic groups, but the estimates of its prevalence have varied and the evidence for its associated factors has been inconsistent.
PURPOSE:
This study seeks to determine the prevalence of SD and its associated factors in multiethnic primary care clinic attenders.
METHODS:
This cross-sectional study was on clinic attenders aged 18 years and above at three urban primary care clinics in Malaysia. The operational definition of SD was based on ICD-10 criteria for SD for research, frequent attendance, and excluded moderate to severe anxiety and depression. The instruments used were the ICD-10 symptom list, the Hospital Anxiety and Depression Scale, a semi-structured questionnaire, and SF-36.
RESULTS:
We recruited 1,763 patients (response rate 63.8%). The mean age of respondents was 44.7?�?15.8 years, 807 (45.8%) were male; there were 35.3% Malay, 30.1% Chinese and 34.6% Indian. SD prevalence was 3.7%; the prevalence in Malay was 5.8%, Indian 3.0% and Chinese 2.1%. Significant associations were found between SD prevalence and ethnicity, family history of alcoholism, blue-collar workers and the physical component summary (PCS) score of SF-36. Multivariate analysis showed that SD predictors were Malay ethnicity (OR 2.7, 95% CI 1.6, 4.6), blue-collar worker (OR 2.0, 95% CI 1.2, 3.5) and impaired PCS score of SF-36 (OR 0.92, 95% CI 0.90, 0.95).
CONCLUSION:
The prevalence of SD was relatively uncommon with the stringent operational criteria used. SD preponderance in blue-collar workersmay be attributable to secondary gain from getting sickness certificates and being paid for time off work.
BibTeX:
@article{KhooEM2012,
  author = {Khoo EM, Mathers NJ, McCarthy SA, Low WY.},
  title = {Somatisation disorder and its associated factors in multiethnic primary care clinic attenders.},
  journal = {Int J Behav Med.},
  year = {2012},
  volume = {19(2)},
  pages = {165-73},
  doi = {http://dx.doi.org/10.1007/s12529-011-9164-7}
}
Kardam P, Mehendiratta M, Rehani S, Kumar M Health Care Workers and Universal Precautions: Perceptions and Determinants of Non-compliance. 2010 Indian J Community Med.
Vol. 35(4), pp. 526-8. 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{KotwalA12010,
  author = {Kotwal A1, Taneja D.},
  title = {Health Care Workers and Universal Precautions: Perceptions and Determinants of Non-compliance.},
  journal = {Indian J Community Med.},
  year = {2010},
  volume = {35(4)},
  pages = {526-8.},
  doi = {http://dx.doi.org/10.4103/0970-0218.74373}
}
Jacob KS Health, health workers and human rights: Dr Binayak Sen and the silence of the medical fraternity in India. 2009 Natl Med J India.
Vol. 22(1), pp. 35-7 
article  
Abstract: Abstract not available.
BibTeX:
@article{KS.2009,
  author = {Jacob KS.},
  title = {Health, health workers and human rights: Dr Binayak Sen and the silence of the medical fraternity in India.},
  journal = {Natl Med J India.},
  year = {2009},
  volume = {22(1)},
  pages = {35-7}
}
Kulkarni V et al. Awareness of medical students in a medical college in Mangalore, Karnataka, India concerning infection prevention practices. 2013 J Infect Public Health.
Vol. 6(4):, pp. 261-8 
article DOI  
Abstract: BACKGROUND:
Healthcare-associated infections (HCAIs) are an important public health problem. It is estimated that approximately 1 out of every 20 hospitalized patients will contract an HCAI. The risk is substantial not only to patients but also to healthcare workers, who may contract deadly blood-borne infectious diseases. Hence, it is essential for healthcare professionals to have adequate knowledge regarding infection prevention practices (IPPs) to reduce the burden of these illnesses among patients seeking care.
METHODS:
This cross-sectional study was conducted among 268 medical students at Kasturba Medical College, Mangalore. Information regarding important IPPs such as hand hygiene (HH), needle-stick injuries (NSIs), and standard precautions (SPs) was collected using a semi-structured questionnaire. The collected information was analyzed using SPSS v.11. Fisher's exact test was used to test the association between variables of interest.
RESULTS:
Overall, knowledge levels regarding HH were low in aspects such as healthcare workers' hands as sources of infection (40%) and the minimum time needed to apply hand rubs (45.7%), whereas knowledge levels were high in aspects such as indications for using HH. Regarding NSI prevention, knowledge levels were low in aspects such as activities with the highest NSI risk (56%). However, knowledge levels were high in relation to SPs.
CONCLUSION:
The knowledge levels regarding infection practices were not adequate among the participants, particularly in the case of hand hygiene methods. Other important aspects, such as needle-stick injuries and use of standard precautions, were better understood, although many aspects still require improvement. These findings suggest the need to consider strengthening the training related to IPPs as a separate entity in the existing curriculum.
BibTeX:
@article{KulkarniV2013,
  author = {Kulkarni V, Papanna MK, Mohanty U, Ranjan R, Neelima V, Kumar N, Prasanna Mithra P, Upadhyay RP, Unnikrishnan B.},
  title = {Awareness of medical students in a medical college in Mangalore, Karnataka, India concerning infection prevention practices.},
  journal = {J Infect Public Health.},
  year = {2013},
  volume = {6(4):},
  pages = {261-8},
  doi = {http://dx.doi.org/10.1016/j.jiph.2013.02.006}
}
Kumar D, Aggarwal AK and Kumar R The effect of interrupted 5-day training on Integrated Management of Neonatal and Childhood Illness on the knowledge and skills of primary health care workers. 2009 Health Policy Plan.
Vol. 24(2), pp. 94-100 
article DOI  
Abstract: The conventional 8-day Integrated Management of Neonatal and Childhood Illness (IMNCI) training package poses several operational constraints, particularly due to its long duration. A 5-day training package was developed and administered in an interrupted mode of 3 days and 2 days duration with a break of 4 days in-between, in a district of Haryana state in northern India. Improvement in the knowledge and skills of 50 primary health care workers following the interrupted 5-day training was compared with that of 35 primary health care workers after the conventional 8-day IMNCI training package. The average score increased significantly (P < 0.05) from 46.3 to 74.6 in 8-day training and from 40.0 to 73.2 in 5-day training. Knowledge score improved for all health conditions, like anaemia, diarrhoea, immunization, malnutrition, malaria, meningitis and possible severe bacterial infection, and for breastfeeding in 8-day as well as in 5-day training. Average skills score for respiratory problems increased from 38 to 57 in 8-day training and from 41 to 91 in 5-day training. Corresponding increases in skill scores for diarrhoea assessment were from 28 to 67 and 48 to 75, and for breastfeeding assessment from 33 to 84 and 42 to 86 in 8-day and 5-day training, respectively. Average counselling skill score also rose from 42 to 89 in 8-day and from 37 to 70 in 5-day training. A direct cost saving of US$813 for a batch of 25 trainees and an indirect cost saving of 3 days per trainee and resource person makes the interrupted 5-day IMNCI training more cost-effective.
BibTeX:
@article{KumarD12009,
  author = {Kumar D1, Aggarwal AK, Kumar R.},
  title = {The effect of interrupted 5-day training on Integrated Management of Neonatal and Childhood Illness on the knowledge and skills of primary health care workers.},
  journal = {Health Policy Plan.},
  year = {2009},
  volume = {24(2)},
  pages = {94-100},
  doi = {http://dx.doi.org/10.1093/heapol/czn051}
}
Kwon HJ, Ramasamy R, Morgan A "How Often? How Much? Where From?" Knowledge, Attitudes, and Practices of Mothers and Health Workers to Iron Supplementation Program for Children Under Five in Rural Tamil Nadu, South India. 2013 Asia Pac J Public Health  article DOI  
Abstract: Iron deficiency anemia (IDA) affects 70% of under-5 children in India. The primary prevention strategy is regular iron supplementation. Little is known about what helps families adhere to daily iron supplementation. Our study explored the knowledge, attitudes, and practices of mothers and villagehealth workers (VHWs) involved in a community health program in one hill district of Tamil Nadu. We conducted 30 semistructured interviews and 3 group discussions involving mothers, VHWs, and community stakeholders. Knowledge of IDA was widespread, yet no children were receiving the iron supplementation as recommended. The main determinants to adherence included the perception of its need, the ease of access, and the activity of VHWs. Preventive care requiring daily supplements is challenging. Our study suggests that increasing community awareness of mild anemia, simplifying dosage instructions, and further strengthening the supportive environment for VHWs would help in reducing the prevalence of IDA.
BibTeX:
@article{KwonHJ2013,
  author = {Kwon HJ, Ramasamy R, Morgan A.},
  title = {"How Often? How Much? Where From?" Knowledge, Attitudes, and Practices of Mothers and Health Workers to Iron Supplementation Program for Children Under Five in Rural Tamil Nadu, South India.},
  journal = {Asia Pac J Public Health},
  year = {2013},
  doi = {http://dx.doi.org/10.1093/tropej/fmt057}
}
Lakra GJ et al. Motivation and job satisfaction among multipurpose health workers in hilly and non-hilly areas of Jashpur District, Chhattisgarh: an exploratory study. 2012 Southeast Asian J Trop Med Public Health.
Vol. 43(5):, pp. 1262-72 
article  
Abstract: It is essential to have a capable and motivated health workforce for building an effective, responsive health system and in turn achieve national healthgoals. The present cross sectional study was conducted in Chhattisgarh, India to assess the level of motivation and job satisfaction among multipurpose health workers (MPWs) and to study factors influencing them. A pre-tested semistructured questionnaire was used to obtain information about the respondents' perceived importance of various job characteristics and perceived job satisfaction. The majority of MPWs were not satisfied with their existing job conditions. Motivators or satisfiers like career advancement and achievement had low scores for all the participants. Working conditions and salary were found to be the dissatisfiers with low scores. The present study suggests that, although financial incentives are important, they are not sufficient to motivate personnel to perform better.
BibTeX:
@article{LakraGJ2012,
  author = {Lakra GJ, Kadam S, Hussain MA, Pati S, Sharma K, Zodpey S.},
  title = {Motivation and job satisfaction among multipurpose health workers in hilly and non-hilly areas of Jashpur District, Chhattisgarh: an exploratory study.},
  journal = {Southeast Asian J Trop Med Public Health.},
  year = {2012},
  volume = {43(5):},
  pages = {1262-72}
}
Liu A et al. Community health workers in global health: scale and scalability. 2011 Mt Sinai J Med.
Vol. 78(3):, pp. 419-35 
article DOI  
Abstract: Community health worker programs have emerged as one of the most effective strategies to address human resources for health shortages while improving access to and quality of primary healthcare. Many developing countries have succeeded in deploying community health worker programs in recognition of the potential of community health workers to identify, refer, and in many cases treat illnesses at the household level. However, challenges in program design and sustainability are expanded when such programs are expanded at scale, particularly with regard to systems management and integration with primary health facilities. Several nongovernmental organizations provide cases of innovation on management of community health worker programs that could support a sustainable system that is capable of being expanded without being stressed in its functionality nor effectiveness--therefore, providing for stronger scalability. This paper explores community health worker programs that have been deployed at national scale, as well as scalable innovations found in successful nongovernmental organization-run community health worker programs. In exploration of strategies to ensure sustainable community health worker programs at scale, we reconcile scaling constraints and scalable innovations by mapping strengths of nongovernmental organizations' community health worker programs to the challenges faced by programs currently deployed at national scale.
BibTeX:
@article{LiuA2011,
  author = {Liu A, Sullivan S, Khan M, Sachs S, Singh P.},
  title = {Community health workers in global health: scale and scalability.},
  journal = {Mt Sinai J Med.},
  year = {2011},
  volume = {78(3):},
  pages = {419-35},
  doi = {http://dx.doi.org/10.1002/msj.20260}
}
Loiselle CG and Sterling MM Views on death and dying among health care workers in an Indian cancer care hospice: balancing individual and collective perspectives. 2012 Palliat Med.
Vol. 26(3):, pp. 250-6 
article DOI  
Abstract: In providing palliative and end-of-life care, professional and lay hospice workers alike attend to patient and family needs to encourage a dignified death. However, there are few comparative inquiries documenting how differential workplace preparation affects the processes and outcomes related to being confronted to death and dying. This qualitative study explores and compares these experiences among a diverse sample of health workers (N = 25) in a grassroots cancer care hospice in Bangalore, India. Our findings underscore how personal views, socio-economic status, beliefs and values, occupational experience, and workplace interventions interact to shape 'worldviews' about death and dying. Whereas health workers report conflicting feelings of relief and sadness when confronted with the death of their patients, these mixed emotions are often lessened through open dialogue among newly trained and more experienced health workers. Moreover, experienced hospice workers wished to ensure that less experienced ones are provided with the necessary workplace support to lessen psychological 'hardening' that may occur with repeated exposure to death. In dealing with the diverse needs of hospice workers, both individual and collective needs must be considered to ensure an optimal workplace climate. Future work should study how hospice workers' views on death and dying evolve with time and experience.
BibTeX:
@article{LoiselleCG2012,
  author = {Loiselle CG, Sterling MM.},
  title = {Views on death and dying among health care workers in an Indian cancer care hospice: balancing individual and collective perspectives.},
  journal = {Palliat Med.},
  year = {2012},
  volume = {26(3):},
  pages = {250-6},
  doi = {http://dx.doi.org/10.1177/0269216311400931}
}
Loomba PS et al. Post vaccination status in health care workers. 2007 J Commun Dis.
Vol. 39(3), pp. 205-7 
article  
Abstract: Abstract not available.
BibTeX:
@article{LoombaPS2007,
  author = {Loomba PS, Thakur A, Mishra B, Dogra V.},
  title = {Post vaccination status in health care workers.},
  journal = {J Commun Dis.},
  year = {2007},
  volume = {39(3)},
  pages = {205-7}
}
Louis D, Kumar P, Gupta A. Knowledge and practices of healthcare providers about essential newborn care and resuscitation in a district of Haryana. 2013 J Indian Med Assoc.
Vol. 111(2), pp. 114-7. 
article  
Abstract: In India, institutionalisation of deliveries is happening at a fast pace. Evaluating the knowledge and practices of healthcare providers in these institutions is a priority in this current scenario. The objective of this study was to assess the knowledge and practices regarding essential newborncare and resuscitation among healthcare providers in Panchkula district of Haryana. A cross-sectional questionnaire based survey of healthcare personnel working in one district hospital, 2 community health centres, 5 primary health centres and 2 subcentres, each with at least 100 deliveries per year, was done. Fifty-eight medical personnel comprising of 27 staff nurses, 11 auxiliary nurse midwives, 15 doctors and 5 multipurpose healthworkers were interviewed. Of them, 33 (57%) had received training in newborn care, but only 9 (16%) knew all the initial steps of resuscitation. Twenty-eight (48%) had knowledge of positive pressure ventilation while 8 (13%) could provide chest compression or drugs during resuscitation. Thirty-three (57%) practiced holding the baby upside down after delivery. Early and exclusive breastfeeding including colostrum was advised by all. All practiced hand washing prior to delivery and kept the cord clean anddry. At least one danger sign was told to the mother at the time of discharge by 48 (83%). However, kangaroo mother care was rarely advised to mothers of preterm babies. It was found that majority of healthcare personnel had good awareness about breastfeeding and clean practices while conducting delivery. In contrast, knowledge about neonatal resuscitation and some aspects of essential newborn care was poor.
BibTeX:
@article{LouisD2013,
  author = {Louis D, Kumar P, Gupta A.},
  title = {Knowledge and practices of healthcare providers about essential newborn care and resuscitation in a district of Haryana.},
  journal = {J Indian Med Assoc.},
  year = {2013},
  volume = {111(2)},
  pages = {114-7.}
}
Simon LP Prevention and management of needlestick injury in Delhi. 2009 Br J Nurs.
Vol. 18(4), pp. 252-6 
article  
Abstract: Needlestick and sharps injuries are the most common cause by which blood borne pathogens are transmitted between patients and health-care workers. A study was conducted to assess the knowledge and existing practices of staff nurses regarding needlestick injuries (NSIs) and evaluate the effectiveness of guidelines developed for the prevention and management of NSIs in a selected government hospital of Delhi. The study revealed that 70% of staff nurses had sustained NSI. The majority 24 (68%) got NSI with a hollow-bore needle. There was lack of awareness among staff nurses regarding prevention and management of NSIs. Among the nurses who sustained NSI, the majority (71%) did not report it. The developed guidelines regarding prevention and management of NSI was found to be effective in enhancing the knowledge and improving the practices of staff nurses. It is useful for British nurses to be able to compare their experience of NSI with that of nurses in Delhi, to see if lessons can be learnt that can be applied British nursing.
BibTeX:
@article{LP.2009,
  author = {Simon LP.},
  title = {Prevention and management of needlestick injury in Delhi.},
  journal = {Br J Nurs.},
  year = {2009},
  volume = {18(4)},
  pages = {252-6}
}
Chaudhuri M New mid-grade health workers for rural areas are to start training in 2013. 2012 BMJ., pp. 345  article DOI  
Abstract: Abstract not available.
BibTeX:
@article{M.2012,
  author = {Chaudhuri M.},
  title = {New mid-grade health workers for rural areas are to start training in 2013.},
  journal = {BMJ.},
  year = {2012},
  pages = {345},
  doi = {http://dx.doi.org/10.1136/bmj.e8206}
}
Dobe M Awareness on AIDS among health care professionals. 1995 Indian J Public Health.
Vol. 39(3), pp. 105-8 
article  
Abstract: Abstract not available.
BibTeX:
@article{M.1995,
  author = {Dobe M.},
  title = {Awareness on AIDS among health care professionals.},
  journal = {Indian J Public Health.},
  year = {1995},
  volume = {39(3)},
  pages = {105-8}
}
Prakasamma M. ANM. Her role in 'health for all by 2000 A.D.' Auxiliary Nurse Midwife. 1997 Nurs J India.
Vol. 88(3), pp. 523-4 
article  
Abstract: Abstract not available.
BibTeX:
@article{M.1997,
  author = {Prakasamma M.},
  title = {ANM. Her role in 'health for all by 2000 A.D.' Auxiliary Nurse Midwife.},
  journal = {Nurs J India.},
  year = {1997},
  volume = {88(3)},
  pages = {523-4}
}
Mahapatra P et al. Availability of doctors at primary health centres of Andhra Pradesh, India. 2012 Natl Med J India.
Vol. 25(4):, pp. 230-3 
article  
Abstract: BACKGROUND:
Availability of doctors at primary health centres (PHCs) is a major concern. We measured the operational availability of doctors in PHCs and examined the effect of residential distance and private practice.
METHODS:
Thirty-six health centres, consisting of six randomly selected PHCs from six purposively chosen districts in Andhra Pradesh were studied. Cross-sectional data on residential distance, private practice and attendance pattern of 38 operationally available medical officers were analysed.
RESULTS:
About 80% of doctors residing within 20 km attended their PHC on all 6 days of a week, compared with only 33% for those staying >40 km away. Among those staying >20 km away from their PHC, the odds of absenteeism by privately practising doctors was 3-24 times more than for those not practising privately.
CONCLUSION:
Residential distance seems to affect the operational availability of doctors. Private practice by doctors living within 20 km from the PHC does not seem to affect their operational availability. However, private practice by doctors staying >20 km away from their PHC may affect their availability.
BibTeX:
@article{MahapatraP2012,
  author = {Mahapatra P, Thota D, George CK, Reddy NS.},
  title = {Availability of doctors at primary health centres of Andhra Pradesh, India.},
  journal = {Natl Med J India.},
  year = {2012},
  volume = {25(4):},
  pages = {230-3}
}
Mahesh C B, Ramakant B K, Jagadeesh V S The prevalence of inducible and constitutive clindamycin resistance among the nasal isolates of staphylococci. 2013 J Clin Diagn Res.
Vol. 7(8):, pp. 1620-2 
article DOI  
Abstract: Context: One of the important sources of Staphylococci which causes nosocomial infections, is the nasal carriage of Staphylococci among Health Care Workers (HCWs). The commonest antibiotic which is preferred for the treatment of the methicillin and multi drug resistant Staphylococcal infections is clindamycin. The inducible clindamycin resistance in Staphylococci is not detected by the routine antibiotic susceptibility testing and it results in treatment failures. Aim: The present study was undertaken to know the prevalence of constitutive and inducible clindamycin resistance and its correlation with the methicillin resistance among the nasal isolates of Staphylococci which were obtained from different HCWs. Material and Methods: Nasal swabs were collected from 206 HCWs and they were processed. The Staphylococci which were isolated were tested for methicillin resistance by using cefoxitin (30 ?g) discs. The inducible clindamycin resistance was tested by using erythromycin (15 ?g) and clindamycin (2?g) discs and the D test according to the CLSI guidelines. Results: Inducible clindamycin resistance was seen in 21(16.40%) of the S.aureus and 14 (7.56%) of the coagulase negative Staphylococcal isolates. Constitutive clindamycin resistance was seen in 23(17.96%) of the S.aureus and 43(23.24%) of the coagulase negative Staphylococcal isolates. The inducible and constitutive clindamycin resistance was more common among the methicillin resistant Staphylococcal isolates. Conclusion: The prevalence of inducible and constitutive clindamycin resistance in the nasal Staphylococcal isolates which were obtained from the HCWs was high, especially among the methicillin resistant Staphylococci. The D test which is recommended by the CLSI should be routinely done to detect inducible clindamycin resistance, to prevent treatment failures.
BibTeX:
@article{MaheshCB2013,
  author = {Mahesh C B, Ramakant B K, Jagadeesh V S.},
  title = {The prevalence of inducible and constitutive clindamycin resistance among the nasal isolates of staphylococci.},
  journal = {J Clin Diagn Res.},
  year = {2013},
  volume = {7(8):},
  pages = {1620-2},
  doi = {http://dx.doi.org/10.7860/JCDR/2013/6378.3223}
}
Mala R, Santhosh KM, Anshul A, Aarthy R Ethics in human resource management: potential for burnout among healthcare workers in ART and community care centres. 2010 Indian J Med Ethics.
Vol. 7(3), pp. 146-51 
article  
Abstract: This paper examines ethical dilemmas in providing care for people with HIV/AIDS. Healthcare providers in this sector are overworked, particularly in the high prevalence states. They are faced with the dual burden of the physical and the emotional risks of providing this care. The emotional risks result from their inability to control their work environment, while having to deal with the social and cultural dimensions of patients' experiences. The physical risk is addressed to some extent by post exposure prophylaxis. But the emotional risk is largely left to the individual and there is little by way of institutional responsibility for minimising this. The guidelines for training workers in care and support programmes do not include any detailed institutional mechanisms for reducing workplace stress. This aspect of the programme needs to be examined for its ethical justification. The omission of institutional mechanisms to reduce the emotional risks experienced by healthcare providers in the HIV/AIDS sector could be a function of lack of coordination across different stakeholders in programme development. This can be addressed in further formulations of the programme. Whatever the reasons may be for overlooking these needs, the ethics of this choice need to be carefully reviewed.
BibTeX:
@article{MalaR12010,
  author = {Mala R1, Santhosh KM, Anshul A, Aarthy R.},
  title = {Ethics in human resource management: potential for burnout among healthcare workers in ART and community care centres.},
  journal = {Indian J Med Ethics.},
  year = {2010},
  volume = {7(3)},
  pages = {146-51}
}
Malaviya AN and Gogia SB Development, implementation and benefits of a rheumatology-specific electronic medical record application with automated display of outcome measures. 2010 Int J Rheum Dis.
Vol. 13(4), pp. 347-60 
article DOI  
Abstract: OBJECTIVES:
To make a rheumatology-specific electronic medical record (EMR) application for easy clinical data entry, automated display of outcome measures in real-time that generates well laid-out print-outs; and provides an easily retrievable database for clinical analysis and research.
METHODS:
Highly labour-intensive 'MS-WORD ' template used earlier provided the basic framework for developing rheumatology-EMR applications. The authors, a rheumatologist and a soft tissue surgeon with expertise in developing medical software, successfully created a rheumatology-EMR application over a period of 2� years using the same basic flow of work as used in the old 'MS-WORD ' template.
RESULTS:
The resulting EMR application form has a standard medical record documenting demographic data, complete diagnosis, appropriate dates, visit number, disease status, history, physical examination, investigations, follow-up and prescription page (with automatic updates wherever applicable). Mathematical calculations required for outcome measures (DAS, DAS28, CDAI, SDAI, AS-DAS, BASDAI, BASFI, BASMI, SLE-DAI and others) are embedded in the software, with automated updating as the examination of the musculoskeletal system proceeds in real time. Following implementation of this EMR application, more patients are being seen, patient waiting lists have been reduced; more time is available for academic and teaching work, without compromising the quality of notes, and print-outs for patients. Data retrieval has simplified clinical research with increased numbers of abstracts being presented and research papers being published.
CONCLUSION:
Healthcare workers with understanding of the basic principles of computers and softwares should interact with software engineers who are either themselves medical doctors or are familiar with the workflow and clinical evaluation processes to create an efficient speciality-specific EMR application.
BibTeX:
@article{MalaviyaAN12010,
  author = {Malaviya AN1, Gogia SB.},
  title = {Development, implementation and benefits of a rheumatology-specific electronic medical record application with automated display of outcome measures.},
  journal = {Int J Rheum Dis.},
  year = {2010},
  volume = {13(4)},
  pages = {347-60},
  doi = {http://dx.doi.org/10.1111/j.1756-185X.2010.01551.x}
}
Malaviya P et al. Village health workers in Bihar, India: an untapped resource in the struggle against kala-azar. 2013 Trop Med Int Health.
Vol. 18(2):, pp. 188-93 
article DOI  
Abstract: No abstract available.
BibTeX:
@article{MalaviyaP2013,
  author = {Malaviya P, Hasker E, Singh RP, Van Geertruyden JP, Boelaert M, Sundar S.},
  title = {Village health workers in Bihar, India: an untapped resource in the struggle against kala-azar.},
  journal = {Trop Med Int Health.},
  year = {2013},
  volume = {18(2):},
  pages = {188-93},
  doi = {http://dx.doi.org/10.1111/tmi.12031}
}
Mani A, Shubangi AM, Saini R Hand hygiene among health care workers. 2010 Indian J Dent Res.
Vol. 21(1), pp. 115-8 
article DOI  
Abstract: Healthcare-associated infections are an important cause of morbidity and mortality among hospitalized patients worldwide. Transmission of health care associated pathogens generally occurs via the contaminated hands of health care workers. Hand hygiene has long been considered one of the most important infection control measures to prevent health care-associated infections. For generations, hand washing with soap and water has been considered a measure of personal hygiene. As early as 1822, a French pharmacist demonstrated that solutions containing chlorides of lime or soda could eradicate the foul odor associated with human corpses and that such solutions could be used as disinfectants and antiseptics. This paper provides a comprehensive review of data regarding hand washing and hand antisepsis in healthcare settings. In addition, it provides specific recommendations to uphold improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in healthcare settings. This article also makes recommendations and suggests the significance of hand health hygiene in infection control.
BibTeX:
@article{ManiA12010,
  author = {Mani A1, Shubangi AM, Saini R.},
  title = {Hand hygiene among health care workers.},
  journal = {Indian J Dent Res.},
  year = {2010},
  volume = {21(1)},
  pages = {115-8},
  doi = {http://dx.doi.org/10.4103/0970-9290.62810}
}
Mathai E, Allegranzi B, Kilpatrick C, Pittet D Prevention and control of health care-associated infections through improved hand hygiene. 2010 Indian J Med Microbiol.
Vol. 28(2), pp. 100-6 
article DOI  
Abstract: Determined actions are required to address the burden due to health care-associated infections worldwide and improve patient safety. Improving hand hygiene among health care workers is an essential intervention to achieve these goals. The World Health Organization (WHO) First Global Patient Safety Challenge, Clean Care is Safer Care, pledged to tackle the problem of health care-associated infection at its launch in 2005 and has elaborated a comprehensive set of guidelines for use in both developed and developing countries worldwide. The final version of the WHO Guidelines on Hand Hygiene in Health Care was issued in March 2009 and includes recommendations on indications, techniques, and products for hand hygiene. In this review, we discuss the role of hands in the transmission of health care-associated infection, the benefits of improved compliance with hand hygiene, and the recommendations, implementation strategies and tools recommended by WHO. We also stress the need for action to increase the pace with which these recommendations are implemented in facilities across India.
BibTeX:
@article{MathaiE12010,
  author = {Mathai E1, Allegranzi B, Kilpatrick C, Pittet D.},
  title = {Prevention and control of health care-associated infections through improved hand hygiene.},
  journal = {Indian J Med Microbiol.},
  year = {2010},
  volume = {28(2)},
  pages = {100-6},
  doi = {http://dx.doi.org/10.4103/0255-0857.62483}
}
Mathanraj S et al. Screening for methicillin-resistant Staphylococcus aureus carriers among patients and health care workers of a tertiary care hospital in south India. 2009 Indian J Med Microbiol.
Vol. 27(1), pp. 62-4 
article  
Abstract: A total of 200 subjects were screened for carriage of methicillin-resistant Staphylococcus aureus (MRSA) at different sites using oxacillin blood agar and mannitol salt agar with oxacillin. Overall carriage rate was 8.5%, with the highest rate in inpatients (15.6%) while the lowest was seen in health care workers (1.8%). The commonest site of colonization was the anterior nares. Oxacillin blood agar was found to be superior to mannitol salt agar with oxacillin for the isolation of MRSA. Male sex and prolonged hospital stay were found to be the major risk factors for MRSA colonization.
BibTeX:
@article{MathanrajS12009,
  author = {Mathanraj S1, Sujatha S, Sivasangeetha K, Parija SC.},
  title = {Screening for methicillin-resistant Staphylococcus aureus carriers among patients and health care workers of a tertiary care hospital in south India.},
  journal = {Indian J Med Microbiol.},
  year = {2009},
  volume = {27(1)},
  pages = {62-4}
}
Mathew A et al. Risk factors for tuberculosis among health care workers in South India: a nested case-control study. 2013 J Clin Epidemiol.
Vol. 66(1):, pp. 67-74 
article DOI  
Abstract: OBJECTIVE:
The epidemiology of tuberculosis (TB) among health care workers (HCWs) in India remains under-researched. This study is a nested case-control design assessing the risk factors for acquiring TB among HCWs in India.
STUDY DESIGN AND SETTINGS:
It is a nested case-control study conducted at a tertiary teaching hospital in India. Cases (n = 101) were HCWs with active TB. Controls (n = 101) were HCWs who did not have TB, randomly selected from the 6,003 subjects employed at the facility. Cases and controls were compared with respect to clinical and demographic variables.
RESULTS:
The cases and controls were of similar age. Logistic regression analysis showed that body mass index (BMI) <19 kg/m(2) (odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.49-5.87), having frequent contact with patients (OR: 2.83, 95% CI: 1.47-5.45) and being employed in medical wards (OR: 12.37, 95% CI: 1.38-110.17) or microbiology laboratories (OR: 5.65, 95% CI: 1.74-18.36) were independently associated with increased risk of acquiring TB.
CONCLUSION:
HCWs with frequent patient contact and those with BMI <19 kg/m(2) were at high risk of acquiring active TB. Nosocomial transmission of TB was pronounced in locations, such as medical wards and microbiology laboratories. Surveillance of high-risk HCWs and appropriate infrastructure modifications may be important to prevent interpersonal TB transmission in health care facilities.
BibTeX:
@article{MathewA2013,
  author = {Mathew A, David T, Thomas K, Kuruvilla PJ, Balaji V, Jesudason MV, Samuel P.},
  title = {Risk factors for tuberculosis among health care workers in South India: a nested case-control study.},
  journal = {J Clin Epidemiol.},
  year = {2013},
  volume = {66(1):},
  pages = {67-74},
  doi = {http://dx.doi.org/10.1016/j.jclinepi.2011.12.010}
}
Mathur GP et al. Detection and prevention of childhood disability with the help of Anganwadi workers. 1995 Indian Pediatr.
Vol. 32(7), pp. 773-7 
article  
Abstract: OBJECTIVES:
To evaluate the role of Anganwadi Workers (AWW) for detection and prevention of disability in children below 6 years of age.
DESIGN:
Cross sectional and longitudinal follow up.
SETTING:
Ten Anganwadi Centers in ICDS Urban Project.
METHODS:
Trained AWWs identified disabilities and instituted preventive measures like immunization and supplementary nutrition. Simultaneous independent verification by pediatricians. Repeat survey after 6 mo of follow-up. Results: Amongst the 1545 children, AWW identified disability in 126 subjects which were verified in 118 cases by pediatricians. The disability rate was 7638 per 100,000 population. Visual, mental, orthopedic, speech and hearing disabilities rates were 4790, 2654, 583, 518 and 453 per 100,000 population, respectively. In the repeat survey, 35 of the 74 children with visual disability (mostly xerophthalmia), 4 of the 9 with orthopedic disability and 3 of the 7 with hearing disability could be managed satisfactorily.
CONCLUSIONS:
AWW can help in early detection and appropriate management of incipient and preventable childhood disabilities.
BibTeX:
@article{MathurGP11995,
  author = {Mathur GP1, Mathur S, Singh YD, Kushwaha KP, Lele SN.},
  title = {Detection and prevention of childhood disability with the help of Anganwadi workers.},
  journal = {Indian Pediatr.},
  year = {1995},
  volume = {32(7)},
  pages = {773-7}
}
Misra BK and Misra B New India. 2013 World Neurosurg.
Vol. 79(5-6):, pp. 629-31 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{MisraBK2013,
  author = {Misra BK, Misra B.},
  title = {New India.},
  journal = {World Neurosurg.},
  year = {2013},
  volume = {79(5-6):},
  pages = {629-31},
  doi = {http://dx.doi.org/10.1016/j.wneu.2013.03.030}
}
Jose MM Lived experiences of internationally educated nurses in hospitals in the United States of America. 2011 Int Nurs Rev.
Vol. 58(1), pp. 123-9 
article DOI  
Abstract: AIM:
The overall goal of this study was to elicit and describe the lived experiences of internationally educated nurses (IENs) who work in a multi-hospital medical centre in the urban USA.
BACKGROUND:
Since World War Two, US health care agencies have addressed the nursing shortage by hiring IENs. While other countries have produced substantial research findings about their IENs, much less research has been done about IENs in the USA. Findings from the limited US studies suggest that more research is needed and first-hand reports of lived experiences must be added.
METHODS:
Using a phenomenology of practice study design and Giorgi's principles of data analysis, narratives from the guided interviews with 20 new immigrant IENs who had migrated from the countries of the Philippines, Nigeria and India to the USA, were collected and studied for themes.
FINDINGS AND DISCUSSION:
Six themes that emerged from the stories of IENs together describe a trajectory of lived experiences that the IENs encountered during their adjustments to living and working in the USA. The emergent themes were dreams of a better life, a difficult journey, a shocking reality, rising above the challenges, feeling and doing better and ready to help others. Study findings are similar to studies done in other countries and highlight the needs of IENs.
CONCLUSION:
The study findings provide important first-hand insights from the subjective perspectives of the IENs in US hospitals and will guide recruitment and retention of a diverse nursing workforce. Findings will enrich orientation and transition programs for IENs as well as strengthen the cohesiveness of a diverse nursing workforce in the USA.
BibTeX:
@article{MM.2011,
  author = {Jose MM.},
  title = {Lived experiences of internationally educated nurses in hospitals in the United States of America.},
  journal = {Int Nurs Rev.},
  year = {2011},
  volume = {58(1)},
  pages = {123-9},
  doi = {http://dx.doi.org/10.1111/j.1466-7657.2010.00838.x}
}
Modi A et al. Gynecological Morbidity Among Grass-root Level Health Care Providers in an Urban Setup. 2012 J Obstet Gynaecol India.
Vol. 62(2):, pp. 184-7 
article DOI  
Abstract: OBJECTIVES:
The study of health status of grass-root level health care providers may help us understand the delivery gaps from the programmatic point of view.
METHODS:
A detailed interview of 313 Anganwadi workers (AWW) was taken in a predesigned, pretested questionnaire, and their clinical examination and Pap smear study were arranged at New Civil Hospital, Surat during November 2007-April 2008. All AWWs were accompanied for follow up and examination. Data were analyzed using Epi-Info Software.
RESULTS:
Mean age of menarche and menopause was 14.3 and 44 years, respectively. Among 73 women having menopause, 53 (72. 6%) had natural menopause. On taking history, only 9.5 % gave positive findings, while 42.3 % had positive clinical signs on examination. Inflammation was reported in 43.4 % Pap smear, while 2.8 % had cervical dysplasia of varying grades.
CONCLUSIONS:
All women should be advised to undergo complete pelvic examination including Pap Smear for the detection of gynecological morbidity.
BibTeX:
@article{ModiA2012,
  author = {Modi A, Moitra M, Verma R, Patel B, Jarag MA, Kantharia SL.},
  title = {Gynecological Morbidity Among Grass-root Level Health Care Providers in an Urban Setup.},
  journal = {J Obstet Gynaecol India.},
  year = {2012},
  volume = {62(2):},
  pages = {184-7},
  doi = {http://dx.doi.org/10.1007/s13224-012-0170-8}
}
Moorthy M et al. Risk of pandemic (H1N1) 2009 virus infection among healthcare workers caring for critically ill patients with pandemic (H1N1) 2009 virus infection. 2011 J Hosp Infect.
Vol. 77(4), pp. 365-6 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{MoorthyM2011,
  author = {Moorthy M, Chacko B, Ramakrishna K, Samuel P, Karthik G, Kalki RC, Abraham AM, Akhuj A, Valsan A, Abraham OC, Peter JV.},
  title = {Risk of pandemic (H1N1) 2009 virus infection among healthcare workers caring for critically ill patients with pandemic (H1N1) 2009 virus infection.},
  journal = {J Hosp Infect.},
  year = {2011},
  volume = {77(4)},
  pages = {365-6},
  doi = {http://dx.doi.org/10.1016/j.jhin.2010.12.001}
}
Mukhopadhyay DK et al. Status of birth preparedness and complication readiness in Uttar Dinajpur District, West Bengal. 2013 Indian J Public Health.
Vol. 57(3):, pp. 147-54 
article DOI  
Abstract: CONTEXT:
Birth Preparedness and Complication Readiness (BPCR) is crucial in averting maternal morbidity and mortality.
OBJECTIVES:
To find out awareness and practices regarding BPCR among pregnant and recently delivered women in Uttar Dinajpur, West Bengal.
MATERIALS AND METHODS:
This is a cross-sectional, community-based, mixed methods study. Two-stage, 40 cluster sampling technique was used to select three pregnant and six recently delivered women separately. Information on socio-demographic variables as well as awareness and practices regarding BPCR were collected through semi-structured interview. In-depth interviews with one respondent per cluster were also conducted. For statistical analysis Z test was used.
RESULTS:
Around 50% of the respondents planned for first antenatal check-up (ANC) within 12 weeks, four or more ANCs and institutional delivery. Proportion of women aware of at least one key danger sign each of pregnancy, labor, postpartum, and newborn ranged from 12.1% to 37.2%, whereas 58.3% knew at least one key component of essential newborn care. Around two-thirds and one-third of women, respectively, especially those from backward and below poverty line (BPL) families knew about cash incentive and referral transport schemes. Proportions of women with first ANC within 12 weeks, four or more ANCs, institutional delivery, saving money, identifying transport, and blood donor were 50.4%, 33.6%, 46.2%, 40.8%, 27.3%, and 9.6%, respectively. Hindu religion, backward castes, BPL status, and education ? 5 years influenced the practices except for two regarding ANC. Overall BPCR index of the study population was 34.5.
CONCLUSION:
Preparedness in health system, ensuring competence, and motivation of workers are needed for promoting BPCR among the study population.
BibTeX:
@article{MukhopadhyayDK2013,
  author = {Mukhopadhyay DK, Mukhopadhyay S, Bhattacharjee S, Nayak S, Biswas AK, Biswas AB.},
  title = {Status of birth preparedness and complication readiness in Uttar Dinajpur District, West Bengal.},
  journal = {Indian J Public Health.},
  year = {2013},
  volume = {57(3):},
  pages = {147-54},
  doi = {http://dx.doi.org/10.4103/0019-557X.119827}
}
Muralidhar S, Taneja A and Ramesh V Patient safety culture-perception of health care workers in a tertiary care hospital. 2012 Int J Risk Saf Med.
Vol. 24(4):, pp. 191-9. 
article DOI  
Abstract: BACKGROUND AND OBJECTIVES:
Patient safety is a discipline that emphasizes the reporting, analysis and prevention of medical errors leading to adverse events. Many patients are harmed from health care, resulting in permanent injury, increased hospital stay or even death. This study attempts to gain knowledge on the practices and attitude existing for patient safety and indicate knowledge gaps, to help improve the situation.
METHODS:
The study was carried out using an anonymous, self reporting questionnaire structured to analyse the scenario of patient safety in the hospital and the attitude of 100 Healthcare workers towards safety.
RESULTS:
Of the subjects included in the study, only 55% knew of the existence of an infection control policy in the institution. A large majority of respondents (94%) believed that reporting of errors will help in reducing their incidence. Top reasons for adverse events were high workload (82%) and incomplete information from patients (71%).
INTERPRETATION AND CONCLUSIONS:
Patient safety is still in its infant stages in India, despite the emphasis by WHO. The problem areas, including high work load, lack of communication by supervisory staff and recording of 'near-miss' and adverse events with feedback, if addressed, would minimise harm to patients and cut costs.
BibTeX:
@article{MuralidharS2012,
  author = {Muralidhar S, Taneja A, Ramesh V.},
  title = {Patient safety culture-perception of health care workers in a tertiary care hospital.},
  journal = {Int J Risk Saf Med.},
  year = {2012},
  volume = {24(4):},
  pages = {191-9.},
  doi = {http://dx.doi.org/10.3233/JRS-2012-0575}
}
Muralidhar S et al. Needle stick injuries among health care workers in a tertiary care hospital of India. 2010 Indian J Med Res.
Vol. 131, pp. 405-10 
article  
Abstract: BACKGROUND & OBJECTIVES:
Percutaneous injuries caused by needlesticks, pose a significant risk of occupational transmission of bloodborne pathogens. Their incidence is considerably higher than current estimates, and hence a low injury rate should not be interpreted as a non existent problem. The present study was carried out to determine the occurrence of NSI among various categories of health care workers (HCWs), and the causal factors, the circumstances under which these occur and to, explore the possibilities of measures to prevent these through improvements in knowledge, attitude and practice.
METHODS:
The study group consisted of 428 HCWs of various categories of a tertiary care hospital in New Delhi, and was carried out with the help of an anonymous, self-reporting questionnaire structured specifically to identify predictive factors associated with NSIs.
RESULTS:
The commonest clinical activity to cause the NSI was blood withdrawal (55%), followed by suturing (20.3%) and vaccination (11.7%). The practice of recapping needles after use was still prevalent among HCWs (66.3%). Some HCWs also revealed that they bent the needles before discarding (11.4%). It was alarming to note that only 40 per cent of the HCWs knew about the availability of PEP services in the hospital and 75 per cent of exposed nursing students did not seek PEP.
INTERPRETATION & CONCLUSIONS:
The present study showed a high occurrence of NSI in HCWs with a high rate of ignorance and apathy. These issues need to be addressed, through appropriate education and other interventional strategies by the hospital infection control committee.
BibTeX:
@article{MuralidharS12010,
  author = {Muralidhar S1, Singh PK, Jain RK, Malhotra M, Bala M.},
  title = {Needle stick injuries among health care workers in a tertiary care hospital of India.},
  journal = {Indian J Med Res.},
  year = {2010},
  volume = {131},
  pages = {405-10}
}
Wig N HIV: awareness of management of occupational exposure in health care workers. 2003 Indian J Med Sci.
Vol. 57(5), pp. 192-8 
article  
Abstract: BACKGROUND:
There is need for safe working environment in both government and private hospitals for the safety of health-care workers (HCWs). The present study was conducted to know the present knowledge regarding occupational exposure to HIV amongst doctors in non-governmental hospitals and clinics across Delhi.
METHODS:
Seventy doctors from different medical and surgical specialties in various non-government hospitals/nursing homes in Delhi were given a structured questionnaire.
RESULTS:
Majority of them have suffered needle stick injuries. Many had also experienced splash over face, eyes. Some participants were still recapping needles most of times. 85.7% of participants were fully vaccinated for hepatitis B. 44.2% didn't know if they were responders to hepatitis B vaccine or not. Most of them didn't report the needle stick injuries. In majorities of incidents source patient was not tested for blood born infections. Many of participants were not aware of post exposure prophylactic measures to be taken if there is an occupational exposure to the blood of HIV positive patient. Awareness that drugs for postexposure prophylaxis are to be started immediately was low (36%).
CONCLUSIONS:
The study highlights the low awareness of postexposure prophylaxis measures amongst HCWs. Many HCWs were also not aware if they were responders to hepatitis B vaccine or not. Most of the needle stick injuries were neither reported nor investigated.
BibTeX:
@article{N.2003,
  author = {Wig N.},
  title = {HIV: awareness of management of occupational exposure in health care workers.},
  journal = {Indian J Med Sci.},
  year = {2003},
  volume = {57(5)},
  pages = {192-8}
}
Nair M and Webster P Health professionals' migration in emerging market economies: patterns, causes and possible solutions. 2013 J Public Health (Oxf).
Vol. 35(1), pp. 157-63 
article DOI  
Abstract: BACKGROUND:
About a third of the countries affected by shortage of human resources for health are the emerging market economies (EMEs). The greatest shortage in absolute terms was found to be in India and Indonesia leading to health system crisis. This review identifies the patterns of migration of health workers, causes and possible solutions in these EMEs.
METHODS:
A qualitative synthesis approach based on the 'critical review' and 'realist review' approaches to the literature review was used.
RESULTS:
The patterns of migration of health professionals' in the EMEs have led to two types of discrepancies between health needs and healthcare workers: (i) within country (rural-urban, public-private or government healthcare sector-private sector) and (ii) across countries (south to north). Factors that influence migration include lack of employment opportunities, appropriate work environment and wages in EMEs, growing demand in high-income countries due to demographic transition, favourable country policies for financial remittances by migrant workers and medical education system of EMEs. A range of successful national and international initiatives to address health workforce migration were identified.
CONCLUSIONS:
Measures to control migration should be country specific and designed in accordance with the push and pull factors existing in the EMEs.
BibTeX:
@article{NairM2013,
  author = {Nair M, Webster P},
  title = {Health professionals' migration in emerging market economies: patterns, causes and possible solutions.},
  journal = {J Public Health (Oxf).},
  year = {2013},
  volume = {35(1)},
  pages = {157-63},
  doi = {http://dx.doi.org/10.1093/pubmed/fds087}
}
Nair MK et al. ARSH 7: Community adolescent health care and education: experience of an innovative approach. 2013 Indian J Pediatr.
Vol. 80 Suppl 2, pp. S229-33 
article DOI  
Abstract: OBJECTIVE:
The main objective of the project was to create a community adolescent health care and education initiative with an innovative approach of educating all community stakeholders involved in promoting adolescent health.
METHODS:
Step 1: Conceptualization and strategy planning for combined training; Step II: Preparation of teaching module, flip charts and pamphlets in local language; Step III: Hands on training of community trainers; Step IV: Sensitization of the stakeholder leadership to ensure the cooperation of all stakeholders; Step V: Formation of Teen clubs; Step VI: The combined health education programs at community outlets; Step VII: Detection of adolescent health issues by ASHA and anganwadi workers; Step VIII: Setting up of Saturday adolescent clinics at CHCs as a community referral facility.
RESULTS:
Under 1,060 programs, 34,851 community stakeholders could be trained together including 15,777 mothers, 14,565 adolescents, 2,236 ASHA workers, 2,021 anganwadi workers, and 252 community leaders. The concept of combined training of community stakeholders was found to be feasible and acceptable to the participants.
CONCLUSIONS:
The experience of the CDC-NRHM-AHDP project has shown that ASHA workers and anganwadi workers could be important link persons between adolescents and the health providers.
BibTeX:
@article{NairMK2013,
  author = {Nair MK, Leena ML, George B, Menon P, Jameela PK, Sudhakar Russell PS.},
  title = {ARSH 7: Community adolescent health care and education: experience of an innovative approach.},
  journal = {Indian J Pediatr.},
  year = {2013},
  volume = {80 Suppl 2},
  pages = {S229-33},
  doi = {http://dx.doi.org/10.1007/s12098-013-1148-y}
}
Nair V et al. Changing roles of grass-root level health workers in Kerala, India. 2001 Health Policy Plan.
Vol. 16(2), pp. 171-9 
article  
Abstract: OBJECTIVE:
Multipurpose health workers (MPWs) are envisioned as key personnel in the delivery of primary health care. We evaluated their role and participation in implementing different national health programmes in Kerala, INDIA:
DESIGN:
Cross-sectional, community-based survey.
PARTICIPANTS:
We selected three out of the 14 districts in KERALA: Three-hundred and twenty-six MPWs (95 male and 231 female) from 44 randomly selected primary health centres from the three districts were questioned using a structured pre-tested questionnaire that sought information regarding the provision of health services by the MPWs to eligible beneficiaries in the community. We randomly selected 90 subcentres (30 from each district) and 750 households using a cluster sampling technique, and conducted household surveys to compare the actual delivery of services at the doorstep with that reported by the MPWS: Work sampling of MPWs was also performed to examine the fieldwork time spent by them on implementing individual national health programmes. These data were supplemented with focus group discussions and personal interviews of MPWs and household members.
RESULTS:
MPWs consistently 'over-reported' their performance when self-reported information was compared with that obtained from household surveys. Male MPWs concentrated on the National Malaria Eradication Programme and health education while female workers focused on the family welfare and immunization programmes. Key national health programmes (such as for tuberculosis and acute respiratory infection) were neglected by all MPWS: MPWs were aware of health problems of the elderly, but were not adequately trained nor officially expected to deliver any services in these fields.
CONCLUSIONS:
Grass-root level workers apportion more time to select national health programmes to the detriment of other health programmes, thereby negating their multipurpose role. Our study emphasizes the need for interventions to derive 'multipurpose benefits' from the MPWS:
BibTeX:
@article{NairV12001,
  author = {Nair V1, Thankappan K, Sarma P, Vasan R.},
  title = {Changing roles of grass-root level health workers in Kerala, India.},
  journal = {Health Policy Plan.},
  year = {2001},
  volume = {16(2)},
  pages = {171-9}
}
Naznin E et al. Human resource assessment for scaling up VL active case detection in Bangladesh, India and Nepal. 2013 Trop Med Int Health.
Vol. 18(6):, pp. 734-42 
article DOI  
Abstract: OBJECTIVES:
To determine whether medical staff at PHC level would have the time to take up additional activities such as 1-day fever camps for active VL case detection.
METHODS:
This article assessed the workload of health staff of different professional categories working at health facilities in Bangladesh, India and Nepal. Data were collected from different sites in high endemic VL areas. The study population was the health staff of government health facilities at all levels. Workload indicators of staffing need (WISN) software were adopted to carry out the analysis of staff workload and their availability in the selected health facility. The WISN difference and WISN ratio for a particular health facility were calculated from actual staffing available and calculated staffing requirement.
RESULTS:
The results showed a mixed picture of the availability of health workers. In most settings of Bangladesh and India, physicians with or without laboratory technicians would have time for active case detection. In Nepal, this would be performed by trained nurses and paramedical personnel.
CONCLUSION:
If all vacant posts were filled, active case detection could be performed more easily. The elimination programme can be scaled up with the current staffing levels in the endemic areas with some short training if and when necessary.
BibTeX:
@article{NazninE2013,
  author = {Naznin E, Kroeger A, Siddiqui NA, Sundar S, Malaviya P, Mondal D, Huda MM, Das P, Karki P, Banjara MR, Dreesch N, Gedik G.},
  title = {Human resource assessment for scaling up VL active case detection in Bangladesh, India and Nepal.},
  journal = {Trop Med Int Health.},
  year = {2013},
  volume = {18(6):},
  pages = {734-42},
  doi = {http://dx.doi.org/10.1111/tmi.12124}
}
Olness K et al. Training of health care professionals on the special needs of children in the management of disasters: experience in Asia, Africa, and Latin America. 2005 Ambul Pediatr.
Vol. 5(4), pp. 244-8 
article  
Abstract: BACKGROUND:
Although children are the most vulnerable group in any disaster, limited information exists regarding their unique needs in complex humanitarian emergencies.
OBJECTIVE:
To review the experiences gained in designing and implementing a training course for international health care professionals in disaster management focused on the needs of children.
METHODS:
The format, content, learning objectives, teaching methods, course evaluation, and feedback of a training course on managing complex humanitarian emergencies with a focus on the special needs of children were reviewed.
RESULTS:
The 5-day course was first conducted at Case Western Reserve University in 1996. Since then, it has been replicated 15 times, annually in the United States, and in 7 overseas venues, including Thailand, Pakistan, Ethiopia, Nicaragua, Panama, Syria, and India. Voluntary US and international faculty used a problem-based learning method to train health care workers from developing countries in providing rapid quality care to child disaster victims. The courses were well received in every venue, as evidenced by active participation of local medical professionals, who organized logistics, recruited participants, and led the process of adapting the course to local needs. A remarkable outcome of this training course has been the development of an international group of highly motivated professionals involved in disseminating information to relief workers at a local level and providing a supportive network among themselves.
CONCLUSION:
A comprehensive training program targeted for health care professionals, conducted by mutually respectful local and international faculty, is an effective instrument for disseminating information and enhancing competence to help children in disasters.
BibTeX:
@article{OlnessK12005,
  author = {Olness K1, Sinha M, Herran M, Cheren M, Pairojkul S.},
  title = {Training of health care professionals on the special needs of children in the management of disasters: experience in Asia, Africa, and Latin America.},
  journal = {Ambul Pediatr.},
  year = {2005},
  volume = {5(4)},
  pages = {244-8}
}
Chaudhuri P Experiences of sexual harassment of women health workers in four hospitals in Kolkata, India. 2007 Reprod Health Matters.
Vol. 15(30), pp. 221-9 
article  
Abstract: In 1997, the Supreme Court of India recognised sexual harassment in the workplace as a violation of human rights. However, little is known about the extent or persistence of sexual harassment. To obtain an understanding of women's experiences of sexual harassment in the health sector, an exploratory study was undertaken in 2005-2006 among 135 women health workers, including doctors, nurses, health care attendants, administrative and other non-medical staff working in two government and two private hospitals in Kolkata, West Bengal, India. Four types of experiences were reported by the 77 women who had experienced 128 incidents of sexual harassment: verbal harassment (41), psychological harassment (45), sexual gestures and exposure (15), and unwanted touch (27). None of the women reported rape, attempted rape or forced sex but a number of them knew of other women health workers who had experienced these. The women who had experienced harassment were reluctant to complain, fearing for their jobs or being stigmatised, and most were not aware of formal channels for redress. Experiences of sexual harassment reflected the obstacles posed by power imbalances and gender norms in empowering women to make a formal complaint, on the one hand, and receive redress on the other.
BibTeX:
@article{P.2007,
  author = {Chaudhuri P.},
  title = {Experiences of sexual harassment of women health workers in four hospitals in Kolkata, India.},
  journal = {Reprod Health Matters.},
  year = {2007},
  volume = {15(30)},
  pages = {221-9}
}
Thomas P The international migration of Indian nurses. 2006 Int Nurs Rev.
Vol. 53(4), pp. 277-83 
article  
Abstract: AIM:
To identify the factors responsible for the international migration of Indian nurses.
METHODS:
The paper is based on the responses of 448 nurse practitioners, nurse educators and nurse administrators to a questionnaire administered to them in December 2004-January 2005. Key factors were identified by the analysis of contingency tables.
DISCUSSION:
Apart from economic factors, dissatisfaction with working conditions and unhappiness with prevalent social attitudes towards nurses were identified as being of crucial importance for the international migration of Indian nurses. It was found that nurses working in the private sector and from some linguistic and religious groups were particularly prone to migration. Nurses working in the government sector seemed to be more worried about being unable to adjust to working conditions abroad, and therefore less keen to migrate. The fact that they enjoyed better pay scales, a more relaxed work atmosphere and more facilities may have also played a part here. What seemed to be vital to the decision to migrate for a large number of government sector nurses belonging to the so-called 'Forward' and 'Middle' Castes was that they were being crowded out of promotional avenues as a result of the government's policy of Reservations in Promotions for Scheduled Castes and Tribes.
CONCLUSION:
Health policy-makers in India need to take a serious look at the growing migration of nurses to foreign countries. While such migration leads to inflow of foreign exchange, it also implies the loss of medical personnel vital for the fulfilment of national goals.
BibTeX:
@article{P.2006,
  author = {Thomas P.},
  title = {The international migration of Indian nurses.},
  journal = {Int Nurs Rev.},
  year = {2006},
  volume = {53(4)},
  pages = {277-83}
}
Pai M et al. Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a whole-blood interferon gamma assay with tuberculin skin testing. 2005 JAMA.
Vol. 293(22), pp. 2746-55 
article  
Abstract: CONTEXT:
Mycobacterium tuberculosis infection in health care workers has not been adequately studied in developing countries using newer diagnostic tests.
OBJECTIVES:
To estimate latent tuberculosis infection prevalence in health care workers using the tuberculin skin test (TST) and a whole-blood interferon gamma (IFN-gamma) assay; to determine agreement between the tests; and to compare their correlation with risk factors.
DESIGN, SETTING, AND PARTICIPANTS:
A cross-sectional comparison study of 726 health care workers aged 18 to 61 years (median age, 22 years) with no history of active tuberculosis conducted from January to May 2004, at a rural medical school in India. A total of 493 (68%) of the health care workers had direct contact with patients with tuberculosis and 514 (71%) had BCG vaccine scars.
INTERVENTIONS:
Tuberculin skin testing was performed using 1-TU dose of purified protein derivative RT23, and the IFN-gamma assay was performed by measuring IFN-gamma response to early secreted antigenic target 6, culture filtrate protein 10, and a portion of tuberculosis antigen TB7.7.
MAIN OUTCOME MEASURES:
Agreement between TST and the IFN-gamma assay, and comparison of the tests with respect to their association with risk factors.
RESULTS:
A large proportion of the health care workers were latently infected; 360 (50%) were positive by either TST or IFN-gamma assay, and 226 (31%) were positive by both tests. The prevalence estimates of TST and IFN-gamma assay positivity were comparable (41%; 95% confidence interval [CI], 38%-45% and 40%; 95% CI, 37%-43%, respectively). Agreement between the tests was high (81.4%; kappa = 0.61; 95% CI, 0.56-0.67). Increasing age and years in the health profession were significant risk factors for both IFN-gamma assay and TST positivity. BCG vaccination had little impact on TST and IFN-gamma assay results.
CONCLUSIONS:
Our study showed high latent tuberculosis infection prevalence in Indian health care workers, high agreement between TST and IFN-gamma assay, and similar association between positive test results and risk factors. Although TST and IFN-gamma assay appear comparable in this population, they have different performance and operational characteristics; therefore, the decision to select one test over the other will depend on the population, purpose of testing, and resource availability.
BibTeX:
@article{PaiM12005,
  author = {Pai M1, Gokhale K, Joshi R, Dogra S, Kalantri S, Mendiratta DK, Narang P, Daley CL, Granich RM, Mazurek GH, Reingold AL, Riley LW, Colford JM Jr.},
  title = {Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a whole-blood interferon gamma assay with tuberculin skin testing.},
  journal = {JAMA.},
  year = {2005},
  volume = {293(22)},
  pages = {2746-55}
}
Pai M et al Serial testing of health care workers for tuberculosis using interferon-gamma assay. 2006 Am J Respir Crit Care Med.
Vol. 174(3), pp. 349-55 
article  
Abstract: RATIONALE:
Although interferon-gamma (IFN-gamma) assays are promising alternatives to the tuberculin skin test (TST), their serial testing performance is unknown.
OBJECTIVE:
To compare TST and IFN-gamma conversions and reversions in healthcare workers.
METHODS:
We prospectively followed-up 216 medical and nursing students in India who underwent baseline and repeat testing (after 18 mo) with TST and QuantiFERON-TB Gold In-Tube (QFT). TST conversions were defined as reactions greater than or equal to 10 mm, with increments of 6 or 10 mm over baseline. QFT conversions were defined as baseline IFN-gamma less than 0.35 and follow-up IFN-gamma greater than or equal to 0.35 or 0.70 IU/ml. QFT reversions were defined as baseline IFN-gamma greater than or equal to 0.35 and follow-up IFN-gamma less than 0.35 IU/ml.
RESULTS:
Of the 216 participants, 48 (22%) were TST-positive, and 38 (18%) were QFT-positive at baseline. Among 147 participants with concordant baseline negative results, TST conversions occurred in 14 (9.5%; 95% confidence interval [CI] = 5.3-15.5) using the 6 mm increment definition, and 6 (4.1%; 95% CI = 1.5-8.7) using the 10 mm increment definition. QFT conversions occurred in 17/147 participants (11.6%; 95% CI = 6.9-17.9) using the definition of IFN-gamma greater than or equal to 0.35 IU/ml, and 11/147 participants (7.5%; 95% CI = 3.8-13.0) using IFN-gamma greater than or equal to 0.70 IU/ml. Agreement between TST (10 mm increment) and QFT conversions (>or= 0.70 IU/ml) was 96% (kappa = 0.70). QFT reversions occurred in 2/28 participants (7%) with baseline concordant positive results, as compared with 7/10 participants (70%) with baseline discordant results (p < 0.001).
CONCLUSIONS:
IFN-gamma assay shows promise for serial testing, but repeat results need to be interpreted carefully. To meaningfully interpret serial results, the optimal thresholds to distinguish new infections from nonspecific variations must be determined.
BibTeX:
@article{PaiM12006,
  author = {Pai M1, Joshi R, Dogra S, Mendiratta DK, Narang P, Kalantri S, Reingold AL, Colford JM Jr, Riley LW, Menzies D.},
  title = {Serial testing of health care workers for tuberculosis using interferon-gamma assay.},
  journal = {Am J Respir Crit Care Med.},
  year = {2006},
  volume = {174(3)},
  pages = {349-55}
}
Pandey S, Kushwaha AS, Mahen A H1N1 vaccination profile of health care workers & medical students. 2013 Indian J Med Res.
Vol. 137(2):, pp. 388-90. 
article  
Abstract: No abstract available.
BibTeX:
@article{PandeyS2013,
  author = {Pandey S, Kushwaha AS, Mahen A.},
  title = {H1N1 vaccination profile of health care workers & medical students.},
  journal = {Indian J Med Res.},
  year = {2013},
  volume = {137(2):},
  pages = {388-90.}
}
Parthasarathi V and Thilagavathi G Developing antiviral surgical gown using nonwoven fabrics for health care sector. 2013 Afr Health Sci.
Vol. 13(2), pp. 327-32 
article DOI  
Abstract: BACKGROUND:
Healthcare workers' uniforms including surgical gowns are used as barriers to eliminate the risk of infection for both doctor and patient. The prevalence of human immunodeficiency virus, hepatitis B and C viruses in the patient population is very common.
OBJECTIVES:
To develop antiviral surgical gown comprising of Polypropylene nonwoven as outer layer, Polytetrafluroethylene (PTFE) film as middle layer and polyester nonwoven as inner layer and the surgical gown with a basic weight of 70 g/m(2).
METHODS:
The titanium dioxide (TiO2) nano dispersion was prepared with methylene blue and urea as a reacting medium. These nano particles have an average size of 9 nm which was revealed by High resolution transmission electron microscope. The nonwoven fabric pore size was characterised by using digital image analyzer. The polypropylene nonwoven fabrics were treated with nano dispersion by pad-dry-cure method and trilaminate fabric was formed using fusing machine. The presence of nano particle on the surface of the non woven fabric was confirmed by Scanning Electron microscope.
RESULTS:
The trilaminate surgical gown has passed ASTM 1671 viral penetration test which is mandatory for healthcare facilities. The average pore size of inner, middle and outer layer were found as 0.187, 0.4 and 0.147 micron respectively. The tensile strength of the trilaminate fabric in both machine and cross direction was 145 N and 94 N respectively. The tearing strength of the trilaminate fabric in direction I and II was 10 N and 4 N respectively. The hydrostatic and index puncture resistance of the trilaminate fabric was 2930 mmwc and 58.8 N respectively. The moisture vapour permeability of the fabric was exhibited as 585.7 g/m(2)/day.
CONCLUSIONS:
The surgical gown exhibits antiviral property which can protect the health care people from human immunodeficiency virus.
BibTeX:
@article{ParthasarathiV2013,
  author = {Parthasarathi V, Thilagavathi G.},
  title = {Developing antiviral surgical gown using nonwoven fabrics for health care sector.},
  journal = {Afr Health Sci.},
  year = {2013},
  volume = {13(2)},
  pages = {327-32},
  doi = {http://dx.doi.org/10.4314/ahs.v13i2.18}
}
Patel V et al. Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months. 2011 Br J Psychiatry.
Vol. 199(6):, pp. 459-66 
article DOI  
Abstract: BACKGROUND:
Depressive and anxiety disorders (common mental disorders) are the most common psychiatric condition encountered in primary healthcare.
AIMS:
To test the effectiveness of an intervention led by lay health counsellors in primary care settings (the MANAS intervention) to improve the outcomes of people with common mental disorders.
METHOD:
Twenty-four primary care facilities (12 public, 12 private) in Goa (India) were randomised to provide either collaborative stepped care or enhanced usual care to adults who screened positive for common mental disorders. Participants were assessed at 2, 6 and 12 months for presence of ICD-10 common mental disorders, the severity of symptoms of depression and anxiety, suicidal behaviour and disability levels. All analyses were intention to treat and carried out separately for private and public facilities and adjusted for the design. The trial has been registered with clinical trials.gov (NCT00446407).
RESULTS:
A total of 2796 participants were recruited. In public facilities, the intervention was consistently associated with strong beneficial effects over the 12 months on all outcomes. There was a 30% decrease in the prevalence of common mental disorders among those with baseline ICD-10 diagnoses (risk ratio (RR) = 0.70, 95% CI 0.53-0.92); and a similar effect among the subgroup of participants with depression (RR = 0.76, 95% CI 0.59-0.98). Suicide attempts/plans showed a 36% reduction over 12 months (RR=0.64, 95% CI0.42�0.98) among baseline ICD-10 cases. Strong effects were observed on days out of work and psychological morbidity, and modest effects on overall disability [corrected]. In contrast, there was little evidence of impact of the intervention on any outcome among participants attending private facilities.
CONCLUSIONS:
Trained lay counsellors working within a collaborative-care model can reduce prevalence of common mental disorders, suicidal behaviour, psychological morbidity and disability days among those attending public primary care facilities.
BibTeX:
@article{PatelV2011,
  author = {Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, Bhat B, Araya R, King M, Simon G, Verdeli H, Kirkwood BR.},
  title = {Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months.},
  journal = {Br J Psychiatry.},
  year = {2011},
  volume = {199(6):},
  pages = {459-66},
  doi = {http://dx.doi.org/10.1192/bjp.bp.111.092155}
}
Pati NT et al. Decrease in CD4+ T lymphocyte proliferation responses and enhanced CD150 cell expression in health care workers non-responsive to HBV vaccine. 2007 Vaccine.
Vol. 25(10), pp. 1848-55 
article  
Abstract: The non-response to hepatitis B vaccine in health care workers (HCWs) is reported to vary between 5 and 40%. The underlying cellular and molecular events for unresponsiveness to HBV vaccine have not yet been characterized at any great extent. In the current study, we examined the CD150 surface expression levels and its association with polyclonally activated and HBV specific stimulated cellular proliferations in responders and non-responders. CD150 was identified as upregulated expression marker with suppressive regulatory cell function on all activated T cells by gene chip analysis. We found the overall weak cellular proliferation in response to specific and non-specific agents in non-responders. This is significantly associated with enhanced surface expression of CD150 in the non-responders. A strong expression of CD150 with weak cellular proliferation could be used as a predictive marker for non-responsiveness.
BibTeX:
@article{PatiNT12007,
  author = {Pati NT1, Sukriti, Hissar S, Agrawal K, Rani R, Sarin SK.},
  title = {Decrease in CD4+ T lymphocyte proliferation responses and enhanced CD150 cell expression in health care workers non-responsive to HBV vaccine.},
  journal = {Vaccine.},
  year = {2007},
  volume = {25(10)},
  pages = {1848-55}
}
Peters DH et al. Can computers improve patient care by primary health care workers in India? 2006 Int J Qual Health Care.
Vol. 18(6), pp. 437-45 
article  
Abstract: OBJECTIVE:
The objective was to test whether a decision support technology for non-physicians can increase health care utilization and quality.
DESIGN:
Before and after measurements were taken from a systematic random sample of patients and staff at randomly assigned intervention and control facilities.
SETTING:
The study took place at primary health facilities in rural Tamil Nadu, India.
PARTICIPANTS:
One thousand two hundred and eighty-six patients and 82 staff were interviewed.
INTERVENTION:
A computer-assisted decision support technology was introduced to assist with patient screening.
MAIN OUTCOME MEASURES:
Outcome measures included new patient visits per month, a Global Patient Assessment of Care Index, and health worker attitude variables.
RESULTS:
There was a difference of difference of 430 new patient visits per month at the intervention sites (P = 0.005), an increase from baseline of 18% at intervention sites compared with a decline of 5% at control sites. The intervention was associated with significant improvements in a Global Patient Assessment of Care Index (mean difference of difference 7.9, P < 0.001). The largest gains were made in patient communication, technical quality, and general satisfaction with care. The attitudes of public health workers toward the new technology and their jobs did not change.
CONCLUSIONS:
Decision support technologies have considerable potential to improve coverage and quality of health care for the poor and where there is no doctor, but the unreceptive attitude of public health workers would need to be overcome. Application of these technologies should take advantage of their popularity with patients and the opportunity to work through the private sector.
BibTeX:
@article{PetersDH12006,
  author = {Peters DH1, Kohli M, Mascarenhas M, Rao K.},
  title = {Can computers improve patient care by primary health care workers in India?},
  journal = {Int J Qual Health Care.},
  year = {2006},
  volume = {18(6)},
  pages = {437-45}
}
Dutta PK Need of training for health professionals on National Rural Health Mission. 2005 Indian J Public Health.
Vol. 49(3), pp. 133-7 
article  
Abstract: Training plays a key role in health manpower development and management of health care system. Since NRHM is a new concept, due weight-age has to be given to various components of the Mission. For the efficient and effective performance of medical and paramedical workers a certain level of competence in the form of knowledge, skill and attitude are essential. Various aspects of training activities to be included in training programmes have been discussed in the paper.
BibTeX:
@article{PK.2005,
  author = {Dutta PK.},
  title = {Need of training for health professionals on National Rural Health Mission.},
  journal = {Indian J Public Health.},
  year = {2005},
  volume = {49(3)},
  pages = {133-7}
}
Praveen D et al. A multifaceted strategy using mobile technology to assist rural primary healthcare doctors and frontline healthworkers in cardiovascular disease risk management: protocol for the SMARTHealth India cluster randomised controlled trial. 2013 Implement Sci.
Vol. 8:137 
article DOI  
Abstract: Blood Pressure related disease affected 118 million people in India in the year 2000; this figure will double by 2025. Around one in four adults in rural India have hypertension, and of those, only a minority are accessing appropriate care. Health systems in India face substantial challenges to meet these gaps in care, and innovative solutions are needed.
METHODS:
We hypothesise that a multifaceted intervention involving capacity strengthening of primary healthcare doctors and non-physician healthcare workers through use of a mobile device-based clinical decision support system will result in improved blood pressure control for individuals at high risk of a cardiovascular disease event when compared with usual healthcare. This intervention will be implemented as a stepped wedge, cluster randomised controlled trial in 18 primary health centres and 54 villages in rural Andhra Pradesh involving adults aged ?40 years at high cardiovascular disease event risk (approximately 15,000 people). Cardiovascular disease event risk will be calculated based on World HealthOrganisation/International Society of Hypertension's region-specific risk charts. Cluster randomisation will occur at the level of the primary healthcentres. Outcome analyses will be conducted blinded to intervention allocation.
EXPECTED OUTCOMES:
The primary study outcome is the difference in the proportion of people meeting guideline-recommended blood pressure targets in the intervention period vs. the control period. Secondary outcomes include mean reduction in blood pressure levels; change in other cardiovascular disease risk factors, including body mass index, current smoking, reported healthy eating habits, and reported physical activity levels; self-reported use of blood pressure and other cardiovascular medicines; quality of life (using the EQ-5D); and cardiovascular disease events (using hospitalisation data). Trial outcomes will be accompanied by detailed process and economic evaluations.
SIGNIFICANCE:
The findings are likely to inform policy on a scalable strategy to overcome entrenched inequities in access to effective healthcare for under-served populations in low and middle income country settings.
BibTeX:
@article{PraveenD2013,
  author = {Praveen D, Patel A, McMahon S, Prabhakaran D, Clifford GD, Maulik PK, Joshi R, Jan S, Heritier S, Peiris D.},
  title = {A multifaceted strategy using mobile technology to assist rural primary healthcare doctors and frontline healthworkers in cardiovascular disease risk management: protocol for the SMARTHealth India cluster randomised controlled trial.},
  journal = {Implement Sci.},
  year = {2013},
  volume = {8:137},
  doi = {http://dx.doi.org/10.1186/1748-5908-8-137}
}
Prinja S et al. Cost of Delivering Child Health Care Through Community Level Health Workers: How Much Extra Does IMNCI Program Cost? 2013 J Trop Pediatr.
Vol. 59(6), pp. 489-95 
article  
Abstract: Background and methods: In the setting of a cluster randomized study to assess impact of the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) program in the district of Faridabad in India, we randomly selected auxiliary nurse midwives (ANM), anganwadi workers (AWW) and accredited social health activists (ASHA) from intervention and control areas to collect cost data using an economic perspective. Bootstrap method was used to estimate 95% confidence interval. Results: The annual per-child cost of providing health services through an ANM, AWW and ASHA is INR 348 (USD 7.7), INR 588 (USD 13.1) and INR 87 (USD 1.9), respectively. The annual per-child incremental cost of delivering IMNCI is INR 124.8 (USD 2.77), INR 26 (USD 0.6) and INR 31 (USD 0.7) at the ANM, AWW and ASHA level, respectively. Conclusion: Implementation of IMNCI imposes additional costs to the health system. A comprehensive economic evaluation of the IMNCI is imperative to estimate the net cost implications in India.
BibTeX:
@article{PrinjaS2013,
  author = {Prinja S, Mazumder S, Taneja S, Bahuguna P, Bhandari N, Mohan P, Hombergh H, Kumar R},
  title = {Cost of Delivering Child Health Care Through Community Level Health Workers: How Much Extra Does IMNCI Program Cost?},
  journal = {J Trop Pediatr.},
  year = {2013},
  volume = {59(6)},
  pages = {489-95}
}
Pruthi S, Aggarwal A, and Goel A Disaster management in India: a road ahead. 2013 Prehosp Disaster Med.
Vol. 28(1):, pp. 82 
article DOI  
Abstract: No abstract available.
BibTeX:
@article{PruthiS2013,
  author = {Pruthi S, Aggarwal A, Goel A.},
  title = {Disaster management in India: a road ahead.},
  journal = {Prehosp Disaster Med.},
  year = {2013},
  volume = {28(1):},
  pages = {82},
  doi = {http://dx.doi.org/10.1017/S1049023X12001616}
}
Kumar R Involvement of young doctors in the rural health services of India. 2012 Indian J Public Health.
Vol. 56(1):, pp. 1-3 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{R.2012,
  author = {Kumar R.},
  title = {Involvement of young doctors in the rural health services of India.},
  journal = {Indian J Public Health.},
  year = {2012},
  volume = {56(1):},
  pages = {1-3},
  doi = {http://dx.doi.org/10.4103/0019-557X.96947}
}
Sankaranarayanan R Health care auxiliaries in the detection and prevention of oral cancer. 1997 Oral Oncol.
Vol. 33(3), pp. 149-54 
article  
Abstract: Oral cancer is one among the few human cancers with a vast potential for prevention. One of the operational strategies considered to translate preventive measures into practice in developing countries has been the use of community health workers and other health auxiliaries of the primary health care system to disseminate anti-tobacco health education messages and to provide mouth examinations in high-risk individuals during their routine home visits and community meetings. Studies conducted in India and Sri Lanka to address the role of the above approach indicate that it is feasible to train community health workers and other health auxiliaries in primary prevention and early detection of oral cancer and precancerous lesions. However, no evidence of the efficacy of such an approach in reducing the incidence and mortality from oral cancer is yet available. Sufficient evidence in terms of efficacy and cost effectiveness is needed to justifiably convince health administrators for the inclusion of non-communicable disease control in general and oral cancer screening in particular as part of the primary health care delivery by community health workers and other health auxiliaries especially when considering the burden of already existing work responsibilities. The need for studies in this direction is very obvious. However, the opportunities for 'case-finding' and health education should be utilised when encountering high-risk subjects both in primary
BibTeX:
@article{R.1997,
  author = {Sankaranarayanan R.},
  title = {Health care auxiliaries in the detection and prevention of oral cancer.},
  journal = {Oral Oncol.},
  year = {1997},
  volume = {33(3)},
  pages = {149-54}
}
Rajasundari TA et al. Immune status of health care personnel & post vaccination analysis of immunity against rubella in an eye hospital 2006 Indian J Med Res.
Vol. 124(5), pp. 553-8 
article  
Abstract: BACKGROUND & OBJECTIVES:
Congenital rubella syndrome (CRS) accounts for a significant amount of mortality and morbidity in India. Rubella vaccination is not included in our national immunization programme. Occupational exposure of the health care personnel to rubella infection is well known. This study aims to assess the serological status of health care workers against rubella virus in Aravind Eye Care System, Madurai and to follow the immune response in the seronegative individuals after vaccination.
METHODS:
A total of 500 female and 81 male workers were enrolled in the study. Blood sample was collected for the analysis of rubella specific IgM and IgG antibodies. The seronegative individuals were vaccinated with monovalent rubella vaccine, RA 27/3. The post-vaccination samples were analysed for the antibody levels and their avidity using enzyme immunoassay.
RESULTS:
Of the 581 volunteers, 493 were seropositive with good protective immunity and 22 had both IgM and IgG antibodies. Sixty six volunteers (59 females and 7 males) were found to be seronegative to rubella. The seroconversion was observed in all the sixty vaccinated individuals, as seen by the appearance of anti-rubella IgG antibodies by fourth week, reaching the peak protective levels (>20 IU/ml) by third month. There was also a progressive increase in the avidity after vaccination.
INTERPRETATION & CONCLUSION:
Nearly 11.4 per cent of the health care workers were found to be seronegative for rubella virus and after vaccination, these volunteers developed a good protective immunity, thereby reducing the risk of contracting the hospital based rubella infection. Therefore, rubella vaccination may be instituted in hospitals for the benefit of health care workers.
BibTeX:
@article{RajasundariTA12006,
  author = {Rajasundari TA1, Chandrasekar K, Vijayalakshmi P, Muthukkaruppan V.},
  title = {Immune status of health care personnel & post vaccination analysis of immunity against rubella in an eye hospital},
  journal = {Indian J Med Res.},
  year = {2006},
  volume = {124(5)},
  pages = {553-8}
}
Rajesh G, Pai MB, Shenoy R and Priya H Willingness to participate in disaster management among Indian dental graduates. 2012 Prehosp Disaster Med.
Vol. 27(5):, pp. 439-44 
article DOI  
Abstract: INTRODUCTION:
India has been the focal point of various disasters, and has suffered considerable losses due to the same. Manpower shortage can impede disaster management; hence, including dental professionals in disaster management in India can be crucial.
HYPOTHESIS/PROBLEM:
To assess willingness to participate in disaster management among Indian dental graduates; to assess the objective knowledge, attitude, behavior and perceived knowledge regarding disaster management among Indian dental graduates.
METHODS:
All the interns in Manipal College of Dental Sciences, Mangalore, Karnataka were included in the present study. Their willingness to participate in disaster management and their objective knowledge, attitude, behavior and perceived knowledge related to disaster management were assessed using a questionnaire.
RESULTS:
A total of 86 study subjects participated. A majority (98.8%) of respondents were willing to participate in disaster management. Mean objective knowledge, attitude, behavior and perceived knowledge scores were 48.65%, 80.26%, 29.85% and 60.80% respectively. Males reported higher perceived knowledge than females (P = .008), and respondents residing in hostels reported higher perceived knowledge than those not residing in hostels (P = .02). Gender showed significant correlations with attitude (r = 4.076, P = .044) and behavior (r = 3.722, P = .054), and residence with behavior of respondents (r = 5.690, P = .017).
CONCLUSIONS:
A high degree of willingness to provide assistance during disasters was observed among undergraduate dental students. High attitude coupled with low knowledge and behavior scores regarding disaster management was also observed. Gender was associated with attitude and behavior, and residence with behavior of respondents regarding disaster management. Including disaster management in dental curricula and involvement of dental professionals in disaster management might be crucial for disaster management in India.
BibTeX:
@article{RajeshG2012,
  author = {Rajesh G, Pai MB, Shenoy R, Priya H.},
  title = {Willingness to participate in disaster management among Indian dental graduates.},
  journal = {Prehosp Disaster Med.},
  year = {2012},
  volume = {27(5):},
  pages = {439-44},
  doi = {http://dx.doi.org/10.1017/S1049023X12001069}
}
Raj S, Goel S, Sharma VL, Goel NK Short-term impact of oral hygiene training package to Anganwadi workers on improving oral hygiene of preschool children in North Indian City. 2013 BMC Oral Health.
Vol. 13:67 
article DOI  
Abstract: Globally, dental caries is categorized in the list of public health problems in preschool children. In India, lack of availability and affordability of oral health enhances the cost of treatment and care. Empowering community workers like anganwadi workers (AWWs) in oral health, and providing basic oral health awareness to the mothers through them can be feasible model. So, the present study was conducted to evaluate the short-term impact of Oral Hygiene Training Package (OHTP) to AWWs on improving oral hygiene of preschool children.
METHODS:
This before and after comparison field trial was done in Anganwadi centres (AWCs) of Chandigarh city, India. 534 children aged 36-72 months attending 21 AWCs were examined before and after imparting trainings to AWWs. OHTP was administered to AWWs, which consisted of power-point presentation and demonstrated the skills like proper brushing technique, plaque disclosure, flossing technique, gum massaging etc. The AWWs later imparted training to mothers in their respective AWCs. Post intervention data was collected after three months.Outcome measures were improvement in oral health status (plaque, debris, gingival health), oral habits (brushing, rinsing) and decrease in caries activity (Snyder test).
RESULTS:
Prevalence of dental caries was found to be 48.3%. Only 4.1% of the population reported brushing twice which increased significantly to 9.9% post-intervention (p = 0.000). There was a significant decrease in debris (78.3% to 54.1%), and stage-1 plaque (75.5 to 66.5%) in the oral cavity. Caries activity by Snyder's test decreased from 48.2% to 31.2% (p = 0.01) post-intervention.
CONCLUSIONS:
Controlled trials of using AWWs to improve oral hygiene appear to be justified.
BibTeX:
@article{RajS2013,
  author = {Raj S, Goel S, Sharma VL, Goel NK.},
  title = {Short-term impact of oral hygiene training package to Anganwadi workers on improving oral hygiene of preschool children in North Indian City.},
  journal = {BMC Oral Health.},
  year = {2013},
  volume = {13:67},
  doi = {http://dx.doi.org/10.1186/1472-6831-13-67}
}
Raju MS and Dongre VV Integration of the leprosy programme into primary health care: a case study of perceptions of primary health care workers. 2003 Indian J Lepr.
Vol. 75(3), pp. 243-58 
article  
Abstract: Integration of the vertical leprosy programme into the existing horizontal health programme poses various administrative and operational challenges to programmers. In order to understand the preparedness of the PHC workers for integration of leprosy into primary health care services, 71 PHC workers were interviewed using a structured interview schedule. The results showed that about 42% of the staff have heard of the concept of integration earlier and 90% of the PHC staff are willing to treat leprosy patients in the primary health care centre, but only 72% were in favour of integration. The reasons for favouring integration were (1) wider coverage with MDT, (2) frequent field visits by the worker, (3) better rapport with the community, (4) timely treatment and (5) cost-effectiveness. About 28% of the staff members did not favour integration for the reasons that the leprosy programme would suffer, targets cannot be met, supervision would be difficult, knowledge of the staff was inadequate and importance cannot be given to leprosy as family planning is always a priority in PHC centres. About 43% of the staff felt that the performance of the leprosy programme would be better after integration. With regard to workload, 60% of the sample felt that there would be increase in the workload in the field, record maintenance and supervision. The difficulties foreseen by the workers were grouped into 6 categories, viz., administrative, managerial, technical, personnel, social and miscellaneous. It is worth noting that 91% of the staff that included all categories said they were not afraid of leprosy, but needed training in leprosy work. About 50% of the staff expected increase in salaries and promotions if integration took place.
BibTeX:
@article{RajuMS12003,
  author = {Raju MS1, Dongre VV.},
  title = {Integration of the leprosy programme into primary health care: a case study of perceptions of primary health care workers.},
  journal = {Indian J Lepr.},
  year = {2003},
  volume = {75(3)},
  pages = {243-58}
}
Ramani S et al. For more than love or money: attitudes of student and in-service health workers towards rural service in India. 2013 Hum Resour Health.
Vol. 11:58 
article DOI  
Abstract: While international literature on rural retention is expanding, there is a lack of research on relevant strategies from pluralistic healthcare environments such as India, where alternate medicine is an integral component of primary care. In such contexts, there is a constant tug of war in national policy on "Which health worker is needed in rural areas?" and "Who can, realistically, be got there?" In this article, we try to inform this debate by juxtaposing perspectives of three cadres involved in primary care in India-allopathic, ayurvedic and nursing-on rural service. We also identify key incentives for improved rural retention of these cadres.
METHODS:
We present qualitative evidence from two states, Uttarakhand and Andhra Pradesh. Eighty-eight in-depth interviews with students and in-service personnel were conducted between January and July 2010. Generic thematic analysis techniques were employed, and the data were organized in a framework that clustered factors linked to rural service as organizational (salary, infrastructure, career) and contextual (housing, children's development, safety).
RESULTS:
Similar to other studies, we found that both pecuniary and non-pecuniary factors (salary, working conditions, children's education, living conditions and safety) affect career preferences of health workers. For the allopathic cadre, rural primary care jobs commanded little respect; respondents from this cadre aimed to specialize and preferred private sector jobs. Offering preferential admission to specialist courses in exchange for a rural stint appears to be a powerful incentive for this cadre. In contrast, respondents from the Ayurvedic and nursing cadres favored public sector jobs even if this meant rural postings. For these two cadres, better salary, working and rural living conditions can increase recruitment.
CONCLUSIONS:
Rural retention strategies in India have predominantly concentrated on the allopathic cadre. Our study suggests incentivizing rural service for the nursing and Ayurvedic cadres is less challenging in comparison to the allopathic cadre. Hence, there is merit in strengthening rural incentive strategies for these two cadres also. In our study, we have developed a detailed framework of rural retention factors and used this for delineating India-specific recommendations. This framework can be adapted to other similar contexts to facilitate international cross-cadre comparisons.
BibTeX:
@article{RamaniS2013,
  author = {Ramani S, Rao KD, Ryan M, Vujicic M, Berman P.},
  title = {For more than love or money: attitudes of student and in-service health workers towards rural service in India.},
  journal = {Hum Resour Health.},
  year = {2013},
  volume = {11:58},
  doi = {http://dx.doi.org/10.1186/1478-4491-11-58}
}
Randive B, Chaturvedi S and Mistry N Contracting in specialists for emergency obstetric care- does it work in rural India? 2012 BMC Health Serv Res.
Vol. 12, pp. 485 
article DOI  
Abstract: BACKGROUND:
Contracting in private sector is promoted in developing countries facing human resources shortages as a challenge to reduce maternal mortality. This study explored provision, practice, performance, barriers to execution and views about contracting in specialists for emergency obstetric care (EmOC) in rural India.
METHODS:
Facility survey was conducted in all secondary and tertiary public health facilities (44) in three heterogeneous districts in Maharashtra state of India. Interviews (42) were conducted with programme managers and district and block level officials and with public and private EmOC specialists. Locations of private obstetricians in the study districts were identified and mapped.
RESULTS:
Two schemes, namely Janani Suraksha Yojana and Indian Public Health standards (IPHS) provided for contracting in EmOC specialists. The IPHS provision was chosen for use mainly due to greater sum for contracting in (US $ 30/service episode vs.300 US$/month). The positions of EmOC specialists were vacant in 83% of all facilities that hence had a potential for contracting in EmOC specialists. Private specialists were contracted in at 20% such facilities. The contracting in of specialists did not greatly increase EmOC service outputs at facilities, except in facilities with determined leadership. Contracting in specialists was useful for non emergency conditions, but not for obstetric emergencies. The contracts were more of a relational nature with poor monitoring structures. Inadequate infrastructure, longer distance to private specialists, insufficient financial provision for contracting in, and poor management capacities were barriers to effective implementation of contracting in. Dependency on the private sector was a concern among public partners while the private partners viewed contracting in as an opportunity to gain experience and credibility.
CONCLUSIONS:
Density and geographic distribution of private specialists are important influencing factors in determining feasibility and use of contracting in for EmOC. Local circumstances dictate balance between introduction or expansion of contracts with private sector and strengthening public provisions and that neither of these disregard the need to strengthen public systems. Sustainability of contracting in arrangements, their effect on increasing coverage of EmOC services in rural areas and overlapping provisions for contracting in EmOC specialists are issues for future consideration.
BibTeX:
@article{RandiveB2012,
  author = {Randive B, Chaturvedi S, Mistry N.},
  title = {Contracting in specialists for emergency obstetric care- does it work in rural India?},
  journal = {BMC Health Serv Res.},
  year = {2012},
  volume = {12},
  pages = {485},
  doi = {http://dx.doi.org/10.1186/1472-6963-12-485}
}
Rao M et al Human resources for health in India. 2011 Lancet.
Vol. 377(9765), pp. 587-98 
article DOI  
Abstract: India has a severe shortage of human resources for health. It has a shortage of qualified health workers and the workforce is concentrated in urban areas. Bringing qualified health workers to rural, remote, and underserved areas is very challenging. Many Indians, especially those living in rural areas, receive care from unqualified providers. The migration of qualified allopathic doctors and nurses is substantial and further strains the system. Nurses do not have much authority or say within the health system, and the resources to train them are still inadequate. Little attention is paid during medical education to the medical and public health needs of the population, and the rapid privatisation of medical and nursing education has implications for its quality and governance. Such issues are a result of underinvestment in and poor governance of the health sector--two issues that the government urgently needs to address. A comprehensive national policy for human resources is needed to achieve universal health care in India. The public sector will need to redesign appropriate packages of monetary and non-monetary incentives to encourage qualified health workers to work in rural and remote areas. Such a policy might also encourage task-shifting and mainstreaming doctors and practitioners who practice traditional Indian medicine (ayurveda, yoga and naturopathy, unani, and siddha) and homoeopathy to work in these areas while adopting other innovative ways of augmenting human resources for health. At the same time, additional investments will be needed to improve the relevance, quantity, and quality of nursing, medical, and public health education in the country.
BibTeX:
@article{RaoM2011,
  author = {Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T.},
  title = {Human resources for health in India.},
  journal = {Lancet.},
  year = {2011},
  volume = {377(9765)},
  pages = {587-98},
  doi = {http://dx.doi.org/10.1016/S0140-6736(10)61888-0}
}
Rasool F et al. Surgeon and human immunodeficiency virus infection. 2009 Int J Health Sci (Qassim).
Vol. 3(2), pp. :253-5 
article  
Abstract: HIV infection has attained extraordinary attention among surgeons and other health care workers as a potential source of occupational infection. Disease is usually blood-borne and transmissible, and due to the nature of surgical work, surgical community has become involved and is developing sterile surgical barriers, and improved surgical techniques and procedures.
BibTeX:
@article{RasoolF12009,
  author = {Rasool F1, Lone RA, Rasool I, Shah S, Shah M, Rasool I, Lateef WM, Mir IA, Rasool R, Rasool A, Arif S, Nizami F.},
  title = {Surgeon and human immunodeficiency virus infection.},
  journal = {Int J Health Sci (Qassim).},
  year = {2009},
  volume = {3(2)},
  pages = {:253-5}
}
Rath K et al. Peripheral health workers' knowledge and practices related to filarial lymphedema care: a study in an endemic district of Orissa, India. 2005 Am J Trop Med Hyg.
Vol. 72(4), pp. 430-3 
article  
Abstract: The Global Program to Eliminate Lymphatic Filariasis (GPELF), which includes alleviation of disability and suffering of patients, is run primarily in India by the primary health care system. The present study assessed the knowledge and practices related to lymphedema care among peripheral health workers of the primary health care system in a filarial-endemic district of Orissa, India. A total of 41 health workers sampled across the district were subjected to in-depth interviews. The results showed that many lymphedema patients visit the peripheral health institutions mostly for the treatment of acute episodes of lymphangitis. Many health workers do not know the concept of foot care and its importance in lymphedema management. However, a few health workers advised the patients to follow some components of foot care. The knowledge levels and practices of peripheral health workers are not at desirable levels. The medical and paramedical staff of the peripheral health institutions should be oriented about the management of lymphedema and peripheral health workers should promote the foot care practices. For the GPELF as a whole to prove successful, the patients who already have lymphedema need to be cared for and have their morbidity relieved as much as possible.
BibTeX:
@article{RathK12005,
  author = {Rath K1, Swain BK, Mishra S, Patasahani T, Kerketta AS, Babu BV.},
  title = {Peripheral health workers' knowledge and practices related to filarial lymphedema care: a study in an endemic district of Orissa, India.},
  journal = {Am J Trop Med Hyg.},
  year = {2005},
  volume = {72(4)},
  pages = {430-3}
}
Rathore H et al. Shift work--problems and its impact on female nurses in Udaipur, Rajasthan India. 2012 Work.
Vol. 41 Suppl 1, pp. 4302-14 
article DOI  
Abstract: Abstract : There is good evidence that shift work has negative effects on workers health, safety and performance. It is quite appropriate that attention is paid to this very important feature of socio-technical systems, which may adversely affect mental and physical health, social life and safety of shiftworkers. Research into the impact of shift work on professionals has consistently identified a range of negative outcomes in physical, psychological, and social domains (Akerstedt, 1988; Costa, Lievore, Casaletti, Gaffuri, & Folkard, 1989; Kogi, 2005; Paley & Tepas, 1994). Hospitals, the biggest employer in the health care field, employ more night shift workers than any other industry. It can therefore be inferred that in medical domain high percentage of workforce may be affected by problems related to shift work. Thus the present study will provide knowledge base for the problems faced by the female nurses. The present study was undertaken with an objective of getting an insight into the problems faced by female nurses in shift work. . It was found that the female nurses in India worked on roaster pattern of change in shift every seven days. They did not have a say in the change of duties, it could only be done on mutual grounds. Partners of younger group did not much adjust to their shift pattern this created stress among the nurses.The results showed that the female nurses in both the age groups i.e. 30-45 years and 45-60 years faced many problems related to health and well being, fatigue, social and domestic situations. They could not give much time to their children in particular. Travelling in nights was risky for them. Common problem was the insufficient sleep during night shifts. The nurses had to cater to the needs of the family, children in particular along with the adjustments to be made due to shift work. They had to sometimes do the night duties and attend social functions as a part of their duty. Children and husband in some cases did not cooperate this lead to frustration. When asked as to whether they would could shift job if they get regular one more than 50 % said yes this means that there need to be come training and intervention for the shift workers and their family so that the problems faced and their impact on personal health of the female nurses could be reduced.
BibTeX:
@article{RathoreH2012,
  author = {Rathore H, Shukla K, Singh S, Tiwari G.},
  title = {Shift work--problems and its impact on female nurses in Udaipur, Rajasthan India.},
  journal = {Work.},
  year = {2012},
  volume = {41 Suppl 1},
  pages = {4302-14},
  doi = {http://dx.doi.org/10.3233/WOR-2012-0725-4302}
}
Ravishekar N et al. Acceptance of vaccination against the 2009 pandemic influenza a among health-care workers in Pune, Maharashtra. 2013 Indian J Public Health.
Vol. 57(1):, pp. 48-9. 
article  
Abstract: No abstract available.
BibTeX:
@article{RavishekarNHiremath12013,
  author = {Ravishekar N Hiremath1, SM Atul Kotwal2, Renuka Kunte3, Sandhya Hiremath4, Dasarath Basannar5, Sandeep Bhalla6},
  title = {Acceptance of vaccination against the 2009 pandemic influenza a among health-care workers in Pune, Maharashtra.},
  journal = {Indian J Public Health.},
  year = {2013},
  volume = {57(1):},
  pages = {48-9.}
}
Rele M, Mathur M and Turbadkar D Risk of needle stick injuries in health care workers - a report. 2002 Indian J Med Microbiol.
Vol. 20(4), pp. 206-7 
article  
Abstract: Health care workers (HCW) are at a risk of occupational acquisition of Human Immunodeficiency Virus (HIV) infection, primarily due to accidental exposure to infected blood and body fluids. In our general public hospital, over a period of one year (June 2000 - 2001) a total number of 38 self reported incidences of needlestick injuries and other exposures to patient's blood and body fluids were reported by HCWs. A greater incidence of occupational exposure was seen in surgery residents as compared to medicine residents. Till date, i.e. in one and a half-year follow up period, no seroconversion was seen in any of the reported accidental injury cases. This data emphasizes, that needle stick injuries present the single greatest risk to medical personnel and the importance of increased awareness and training in universal safety precautions (USP), for prevention of nosocomial infection.
BibTeX:
@article{ReleM12002,
  author = {Rele M1, Mathur M, Turbadkar D.},
  title = {Risk of needle stick injuries in health care workers - a report.},
  journal = {Indian J Med Microbiol.},
  year = {2002},
  volume = {20(4)},
  pages = {206-7}
}
Richard VS et al. Should health care workers in the tropics be immunized against varicella? 2001 J Hosp Infect.
Vol. 47(3), pp. 243-5 
article  
Abstract: In tropical regions, chickenpox affects both adults and children. Therefore, healthcare workers in the tropics are vulnerable to hospital-acquired varicella infection and they may transmit infection to susceptible hospitalized individuals. Although the varicella vaccine is safe and effective, its cost is a deterrent to its use in routine immunization programmes. In order to assess whether vaccination of susceptible healthcare workers to prevent hospital-acquired transmission may be justified, we have documented the frequency of varicella among healthcare workers in our hospital. There were 96 admissions for varicella during the 1993-1997 period; staff and student nurses accounted for 76%. The peak season of admission was from February to April. The attack rate in staff and student nurses was 0.78 and 1.54 per 100 person-years, respectively. While community outbreaks of varicella occur in this region once in 4-5 years, hospital outbreaks of varicella occurred every year. This poses the risk of transmission to hospitalized patients, with serious consequences among immunocompromized individuals. Therefore, we recommend systematic selective vaccination of susceptible healthcare workers to break this cycle of annual varicella outbreaks among hospital personnel.
BibTeX:
@article{RichardVS12001,
  author = {Richard VS1, John TJ, Kenneth J, Ramaprabha P, Kuruvilla PJ, Chandy GM.},
  title = {Should health care workers in the tropics be immunized against varicella?},
  journal = {J Hosp Infect.},
  year = {2001},
  volume = {47(3)},
  pages = {243-5}
}
Richard VS et al. Preventing transmission of blood-borne pathogens to health care workers. 2000 Natl Med J India.
Vol. 13(2), pp. 82-5 
article  
Abstract: Health care workers are exposed to blood-borne pathogens, mainly the human immunodeficiency virus, hepatitis B virus and hepatitis C virus. Infection by these viruses leads to chronic or fatal illnesses which are expensive and difficult to treat. Individuals who harbour these viruses may be asymptomatic and hence all patients should be assumed to harbour a blood-borne pathogen. All health care workers should take adequate precautions (a set of guidelines termed 'universal precautions'). Methods of preventing transmission of blood-borne pathogens include vaccination against hepatitis B virus, following universal precautions and taking adequate post-exposure prophylaxis.
BibTeX:
@article{RichardVS12000,
  author = {Richard VS1, Kenneth J, Cherian T, Chandy GM.},
  title = {Preventing transmission of blood-borne pathogens to health care workers.},
  journal = {Natl Med J India.},
  year = {2000},
  volume = {13(2)},
  pages = {82-5}
}
Sinha RK Perception of young doctors towards service to rural population in Bihar. 2012 J Indian Med Assoc.
Vol. 110(8), pp. 530-4. 
article  
Abstract: With the launch of National Rural Health Mission (NRHM), rural health is being given more attention than ever before but health of the rural population is still in the hands of handful of qualified doctors. To know the willingness of young doctors to serve rural population and factors associated with their decision, 176 participants (101 students and 75 interns) of a medical college of Bihar were interviewed during the period July 2005 to December 2006. Only 9.1% participants showed their willingness to serve in rural area despite the fact that 38.6% of them had a rural background, parent(s) of 19.9% had rural occupation and 30.1% subjects had their primary schooling in villages. Rural background (X2 = 22.54, df = 1, p < 0.001) and primary schooling in villages (p = 0.004) were found to be associated significantly with those willing to serve rural population. Whereas land and house property in village (87.5%), village located near towns (81.2%), less competition (62.5%) and need for a job (56.2%) were prime factors in willing medicos, poor living conditions in rural area and lack of professional future (96%), priority for postgraduation (90.6%) and tough working conditions (89.4%) were found to be main factors for reluctance. No significant difference (X2 = 0.929, df = 1, p = 0.335) was seen in the perception of students and interns. Willingness in young doctors to serve rural population is dismal in the present situation. To make them work for rural health, effective efforts to redress all the factors are urgently needed.
BibTeX:
@article{RK.2012,
  author = {Sinha RK.},
  title = {Perception of young doctors towards service to rural population in Bihar.},
  journal = {J Indian Med Assoc.},
  year = {2012},
  volume = {110(8)},
  pages = {530-4.}
}
Rongpharpi SR, Hazarika NK, Kalita H The prevalence of nasal carriage of Staphylococcus aureus among healthcare workers at a tertiary care hospital in assam with special reference to MRSA. 2013 J Clin Diagn Res.
Vol. 7(2), pp. 257-60 
article DOI  
Abstract: Background: The recent years have witnessed the increasing resistance of Staphylococcus aureus to many antimicrobial agents. The most notable example is the emergence of Methicillin-resistant Staphylococcus aureus (MRSA), which was reported just one year after the launch of methicillin. The ecological niches of the S. aureus strains are the anterior nares. The identification of Staphylococcus aureus by using a proper antibiogram and the detection of methicillin resistant Staphylococcus aureus greatly contribute towards the effective treatment of the patients. Aims and objectives: To isolate Staphylococcus aureus from the nasal swabs of healthcare workers (HCWs) and to study their antimicrobial susceptibility patterns, which include methicillin resistance. Materials and methods: Nasal swabs were collected from the healthcare workers of various clinical departments of the hospital over a period of one year. The isolation of Staphylococcus aureus and their antimicrobial susceptibility patterns were carried out by standard bacteriological procedures. Results: Staphylococcus aureus was isolated in 70 cases (22.22%). The prevalence of the S.aureus nasal carriage was higher among the male HCWs (54.28%) than among the female HCWs (45.71%). The carriage rate was the highest in the orthopaedics department, followed by those in the surgery and the gynaecology departments. All the Staphylococcus aureus isolates were sensitive to vancomycin and linezolid (100%). Penicillin and ampicillin were the most resistant, (90% and 88.6%) respectively. Methicillin resistance was seen in11.43% of the S.aureus isolates, both by the disc diffusion test and by the Oxacillin Resistance Screen Agar (ORSA) test. Conclusions: The compliance with the sanitary and the antibacterial guidelines of the health professionals is the single most important factor in preventing nosocomial infections. Simple preventive measures like hand washing before and after the patient examination, the use of sterile aprons and masks in the postoperative wards, awareness during the examination of the immunocompromised patients, and avoiding touching one's nose during work, can reduce the disease transmission rate considerably.
BibTeX:
@article{RongpharpiSR2013,
  author = {Rongpharpi SR, Hazarika NK, Kalita H.},
  title = {The prevalence of nasal carriage of Staphylococcus aureus among healthcare workers at a tertiary care hospital in assam with special reference to MRSA.},
  journal = {J Clin Diagn Res.},
  year = {2013},
  volume = {7(2)},
  pages = {257-60},
  doi = {http://dx.doi.org/10.7860/JCDR/2013/4320.2741}
}
Kumar RP Latex allergy in clinical practice. 2012 Indian J Dermatol.
Vol. 57(1):, pp. 66-70. 
article DOI  
Abstract: A continuous exposure or contact to latex products may sensitize the human body by causing mild to fatal reactions. Despite the availability of the literature, medical personnel are still unaware of the implications of the use of latex materials. The increased awareness to prevent the transmission of infectious blood borne pathogens has lead to increased usage of medical gloves among health care workers. This increased usage of medical gloves, along with improved methods in diagnosing latex allergy, has been the reason for the rise in the number of reported cases. This has lead to recognition of latex allergy as a serious medical concern. Patients in high-risk groups must be assessed carefully, so that appropriate protocols can be used to protect them from contact with latex.
BibTeX:
@article{RP.2012,
  author = {Kumar RP.},
  title = {Latex allergy in clinical practice.},
  journal = {Indian J Dermatol.},
  year = {2012},
  volume = {57(1):},
  pages = {66-70.},
  doi = {http://dx.doi.org/10.4103/0019-5154.92686}
}
Vasan RS Community health workers and tuberculosis control. 1997 Natl Med J India.
Vol. 10(6), pp. 283-4 
article  
Abstract: Abstract not available.
BibTeX:
@article{RS.1997,
  author = {Vasan RS.},
  title = {Community health workers and tuberculosis control.},
  journal = {Natl Med J India.},
  year = {1997},
  volume = {10(6)},
  pages = {283-4}
}
Shivkumar S. More health professionals for rural India. 2012 BMJ., pp. ;345  article DOI  
Abstract: Abstract not available.
BibTeX:
@article{S.2012,
  author = {Shivkumar S.},
  title = {More health professionals for rural India.},
  journal = {BMJ.},
  year = {2012},
  pages = {;345},
  doi = {http://dx.doi.org/10.1136/bmj.e8339}
}
Seda S. Role of health supervisors/female health workers or auxiliary nurse midwives in reproductive child health, safe motherhood and breastfeeding promotion--a report. 2001 Nurs J India.
Vol. 92(2), pp. 35-7 
article  
Abstract: Abstract not available.
BibTeX:
@article{S.2001,
  author = {Seda S.},
  title = {Role of health supervisors/female health workers or auxiliary nurse midwives in reproductive child health, safe motherhood and breastfeeding promotion--a report.},
  journal = {Nurs J India.},
  year = {2001},
  volume = {92(2)},
  pages = {35-7}
}
Tandon S Challenges to the oral health workforce in India. 2004 J Dent Educ.
Vol. 68(7 Suppl), pp. 28-33 
article  
Abstract: Abstract not available.
BibTeX:
@article{S.2004,
  author = {Tandon S.},
  title = {Challenges to the oral health workforce in India.},
  journal = {J Dent Educ.},
  year = {2004},
  volume = {68(7 Suppl)},
  pages = {28-33}
}
Saini NK, Sharma R, Roy R, Verma R What impedes working in rural areas? A study of aspiring doctors in the National Capital Region, India. 2012 Rural Remote Health.
Vol. 12, pp. 1967 
article  
Abstract: INTRODUCTION:
The rural health system in India has long been disadvantaged by a shortage of health staff, including doctors. Providing medical students with a rural clinical placement has been suggested as one strategy to overcome this shortage. This study examined the attitudes of and inclination to rural healthcare careers among medical students.
METHODS:
A cross-sectional study was performed on 201 students (147 males and 54 females) from two medical colleges in the National Capital Region (NCR) of India. A pre-tested semi-open-ended questionnaire was used to obtain information about students' socio-demographic characteristics and their views about a rural health career. Students' open-ended responses were collated and coded into broad categories.
RESULTS:
Of the respondents, 160 (79.6%) had a rural background. The current status of rural health services in India was rated as unsatisfactory by 178 students (88.6%). In total 110 (54.7%) indicated an interest in working in a rural area after graduation with 68 (33.8%) willing to set up their practice in a rural area. Students with a rural background were more likely to be willing to practice in a rural area. Those whose parents were highly qualified (postgraduate education or higher) were significantly less likely to practice in a rural area (p=0.004). Potential benefits of working in a rural area included 'health services for the poor/ benefit for the nation', and 'gain of knowledge about rural people and their diseases'. Potential drawbacks included 'lack of infrastructural facilities', 'less salary' and 'low standard of living'. A majority of the students believe the undergraduate medical curriculum needed modification to improve student awareness of rural needs.
CONCLUSION:
The medical students surveyed had a positive view of the importance of rural health care. However, factors such as infrastructure and salary were perceived as potential barriers to a career in rural health. The findings are a starting point to understanding the attitude of medical students towards rural health care and designing specific strategies to overcome the shortage of rural doctors in India.
BibTeX:
@article{SainiNK2012,
  author = {Saini NK, Sharma R, Roy R, Verma R.},
  title = {What impedes working in rural areas? A study of aspiring doctors in the National Capital Region, India.},
  journal = {Rural Remote Health.},
  year = {2012},
  volume = {12},
  pages = {1967}
}
Salelkar S et al. Study of needle stick injuries among health care workers at a tertiary care hospital. 2010 Indian J Public Health.
Vol. 54(1), pp. 18-20 
article DOI  
Abstract: A cross-sectional study was conducted among health care workers at a tertiary care hospital in Goa to study the problem of needle stick injuries. A structured questionnaire was used to interview the study participants at their work place. Participants were asked to recall needle stick injuries in the preceding 12 months. Factors such as work experience, type of procedure, action taken following injury etc were also studied. Statistical analysis was done with SPSS software. Around 34.8% (200/575) of the Health care workers had experienced a needle stick injury in the last one year. Needle stick injuries were equally distributed across different work experience periods. Hollow bore needles were responsible for 77.5% of needle stick injuries followed by suturing needles (19.2%). As far as use of personal protection was concerned only 58% of the health care workers were wearing gloves at the time of the injury. There is therefore an urgent need at the hospital level to have a uniform needle stick injuries policy covering safe work practices, safe disposal of sharps, procedures in event of needle stick injury, training including pre-employment training, monitoring and evaluation of needle stick injuries and procedures for reporting needle stick injuries.
BibTeX:
@article{SalelkarS12010,
  author = {Salelkar S1, Motghare DD, Kulkarni MS, Vaz FS.},
  title = {Study of needle stick injuries among health care workers at a tertiary care hospital.},
  journal = {Indian J Public Health.},
  year = {2010},
  volume = {54(1)},
  pages = {18-20},
  doi = {http://dx.doi.org/10.4103/0019-557X.70540}
}
Saxena S et al. Bacterial colonization of rings and cell phones carried by health-care providers: are these mobile bacterial zoos in the hospital? 2011 Trop Doct.
Vol. 41(2), pp. 116-8 
article DOI  
Abstract: Our objective was to assess the presence of pathogenic organisms on the rings (worn on fingers) and cell phones carried by health-care workers(HCWs) and the public. Forty-two percent of mobile phones carried by HCWs and 18% carried by the general public were found to carry one or more organisms; 82% of the rings worn by HCWs and 36% of those worn by the general public were found to be positive for the presence of at least one type of microbe.
BibTeX:
@article{SaxenaS2011,
  author = {Saxena S, Singh T, Agarwal H, Mehta G, Dutta R.},
  title = {Bacterial colonization of rings and cell phones carried by health-care providers: are these mobile bacterial zoos in the hospital?},
  journal = {Trop Doct.},
  year = {2011},
  volume = {41(2)},
  pages = {116-8},
  doi = {http://dx.doi.org/10.1258/td.2010.100186}
}
Scott K and Shanker S Tying their hands? Institutional obstacles to the success of the ASHA community health worker programme in rural north India. 2010 AIDS Care.
Vol. 22 Suppl 2, pp. 1606-12 
article DOI  
Abstract: This paper is a contribution to the growing literature on how best to design and support community health worker (CHW) programmes to maximise their positive impact. CHWs are laypeople trained to promote health among their peers. To do so they are commonly tasked with providing basic curative services, promoting the use of existing health services, facilitating cultural mediation between communities and healthcare providers and encouraging critical reflection and dialogue on social health issues. This paper presents a case study of a CHW project in rural Uttarakhand, north India, called the Accredited Social Health Activist (ASHA) programme. While the ASHA programme is not specifically targeting HIV/AIDS, CHW programmes have been flagged as a key means of addressing health resource shortages in poor countries, especially in relation to HIV/AIDS. This study of the ASHA programme provides insights into how best to support CHW programmes in general, including those focused on HIV/AIDS. The research involved 25 interviews and five focus groups with ASHAs, health professionals and community members as well as over 100 hours of non-participant observation at public health centres. The research investigated contextual features of the programme that are hindering the ASHAs' capacity to increase quantitative health outcomes and act as cultural mediators and agents of social change. Research found that ASHAs were institutionally limited by: (1) the outcome-based remuneration structure; (2) poor institutional support; (3) the rigid hierarchical structure of the health system; and (4) a dearth of participation at the community level. The conclusion suggests that progressive policy on CHW programmes must be backed up by concrete institutional support structures to enable CHWs to fulfil their role.
BibTeX:
@article{ScottK12010,
  author = {Scott K1, Shanker S.},
  title = {Tying their hands? Institutional obstacles to the success of the ASHA community health worker programme in rural north India.},
  journal = {AIDS Care.},
  year = {2010},
  volume = {22 Suppl 2},
  pages = {1606-12},
  doi = {http://dx.doi.org/10.1080/09540121.2010.507751}
}
Setia S et al.. Attitudes and Awareness Regarding Hepatitis B and Hepatitis C Amongst Health-care Workers of a Tertiary Hospital in India. 2013 Ann Med Health Sci Res.
Vol. 3(4):, pp. 551-8 
article DOI  
Abstract: BACKGROUND:
Hepatitis is an inflammatory disease of the liver. In sever cases, it may lead to permanent liver damage including liver cirrhosis or hepato-cellular carcinoma and may ultimately lead to death. Health-care workers (HCWs), due to their regular contact with patients are at a high-risk of acquiring this disease.
AIM:
The aim of this study was to assess the knowledge and attitude toward hepatitis B and C infection among the health-care interns and correlate the level of awareness to the attitude they behold toward the disease.
SUBJECTS AND METHODS:
A closed ended questionnaire consisting of questions to evaluate the knowledge regarding hepatitis B and C infection and attitude of the (HCWs/interns) was duly filled by 255 participants including, 100 dental, 100 medical, and 55 nursing interns. Statistical analysis was carried out using the Chi-square test, ANOVA test, post-hoc test and Pearson's correlation.
RESULTS:
Although most of the interns were aware of the existence of hepatitis B and C infection, the level of awareness regarding the modes of transmission and vaccination was found to be dissatisfactory. Awareness level regarding the infection among nursing interns was statistically significantly lower than the dental and medical interns. A direct positive correlation as found between awareness score and behavior score, which reveals that interns with better awareness level had better attitudes toward the infection and prevention of its transmission.
CONCLUSION:
There is an urgent need to increase the level and quality of training among HCWs to prevent the spread of hepatitis B virus and hepatitis C virus.
BibTeX:
@article{SetiaS2013,
  author = {Setia S, Gambhir R, Kapoor V, Jindal G, Garg S, Setia S},
  title = {Attitudes and Awareness Regarding Hepatitis B and Hepatitis C Amongst Health-care Workers of a Tertiary Hospital in India.},
  journal = {Ann Med Health Sci Res.},
  year = {2013},
  volume = {3(4):},
  pages = {551-8},
  doi = {http://dx.doi.org/10.4103/2141-9248.122105}
}
Sharma A, Gur R and Bhalla P Study on prevalence of needle stick injury among health care workers in a tertiary care hospital in New Delhi: a two-year review. 2012 Indian J Public Health.
Vol. 56(1):, pp. 101-3 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{SharmaA2012,
  author = {Sharma A, Gur R, Bhalla P.},
  title = {Study on prevalence of needle stick injury among health care workers in a tertiary care hospital in New Delhi: a two-year review.},
  journal = {Indian J Public Health.},
  year = {2012},
  volume = {56(1):},
  pages = {101-3},
  doi = {http://dx.doi.org/10.4103/0019-557X.96987}
}
Sharma A Sharma V, S.S.S.P. Awareness of biomedical waste management among health care personnel in jaipur, India. 2013 Oral Health Dent Manag.
Vol. 12(1):, pp. 32-40 
article  
Abstract: AIMS:
The study aimed to determine the following among the workforce of the Jaipur Dental College, India: their awareness regarding biomedical (BM) waste management policy and practices, their attitude towards biomedical waste management, and their awareness regarding needle-stick injury and its prevalence among different categories of health care providers.
METHODS:
A cross-sectional study was conducted using a questionnaire with closed-ended questions. It was distributed to 144 dentists, nurses, laboratory technicians and Class IV employees (cleaners and maintenance personnel) at Jaipur Dental College. The questionnaire was used to assess their knowledge of biomedical medical waste disposal. The resulting answers were graded and the percentage of correct and incorrect answers for each question from all the participants was obtained.
RESULTS:
Of the 144 questionnaires, 140 were returned and the answers graded. The results showed that there was a poor level of knowledge and awareness of biomedical waste generation hazards, legislation and management among health care personnel. It was surprising that 36% of the nurses had an extremely poor knowledge of biomedical waste generation and legislation and just 15% of the Class IV employees had an excellent awareness of biomedical waste management practice.
CONCLUSIONS:
It can be concluded from the present study that there are poor levels of knowledge and awareness about BM waste generation hazards, legislation and management among health care personnel in Jaipur Dental College. Regular monitoring and training are required at all levels.
BibTeX:
@article{SharmaA2013,
  author = {Sharma A, Sharma V, Sharma S, Singh P.},
  title = {Awareness of biomedical waste management among health care personnel in jaipur, India.},
  journal = {Oral Health Dent Manag.},
  year = {2013},
  volume = {12(1):},
  pages = {32-40}
}
Sharma R, Rasania S, Verma A, Singh S Study of Prevalence and Response to Needle Stick Injuries among Health Care Workers in a Tertiary Care Hospital in Delhi, India. 2010 Indian J Community Med.
Vol. 35(1), pp. 74-7 
article DOI  
Abstract: BACKGROUND:
Because of the environment in which they work, many health care workers are at an increased risk of accidental needle stick injuries (NSI).
OBJECTIVE:
To study prevalence and response to needle stick injuries among health care workers.
MATERIALS AND METHODS:
STUDY DESIGN:
Cross-sectional study.
SETTING:
A tertiary care hospital in Delhi.
PARTICIPANTS:
322 resident doctors, interns, nursing staff, nursing students, and technicians. Statistical Analysis: Proportions and Chi-square test.
RESULTS:
A large percentage (79.5%) of HCWs reported having had one or more NSIs in their career. The average number of NSIs ever was found to be 3.85 per HCW (range 0-20). 72 (22.4%) reported having received a NSI within the last month. More than half (50.4%) ascribed fatigue as a cause in their injury. Most of the injuries (34.0%) occurred during recapping. In response to their most recent NSI, 60.9% washed the site of injury with water and soap while 38 (14.8%) did nothing. Only 20 (7.8%) of the HCWs took post-exposure prophylaxis (PEP) against HIV/AIDS after their injury.
CONCLUSIONS:
The occurrence of NSI was found to be quite common. Avoidable practices like recapping of needles were contributing to the injuries. Prevention of NSI is an integral part of prevention programs in the work place, and training of HCWs regarding safety practices indispensably needs to be an ongoing activity at a hospital.
BibTeX:
@article{SharmaR12010,
  author = {Sharma R1, Rasania S, Verma A, Singh S.},
  title = {Study of Prevalence and Response to Needle Stick Injuries among Health Care Workers in a Tertiary Care Hospital in Delhi, India.},
  journal = {Indian J Community Med.},
  year = {2010},
  volume = {35(1)},
  pages = {74-7},
  doi = {http://dx.doi.org/10.4103/0970-0218.62565}
}
Sharma S, Gupta A and Arora A. Knowledge, attitude and practices on needle-stick and sharps injuries in tertiary care cardiac hospital: a survey. 2010 Indian J Med Sci.
Vol. 64(9), pp. 396-401. 
article  
Abstract: AIMS:
One of the potential hazards for health care workers (HCWs) is needle-stick and sharp injuries (NSSIs). The objective of the study was to assess the knowledge and attitude of health care workers about the NSSIs.
SETTINGS AND DESIGN:
This was a cross-sectional survey conducted in the tertiary care cardiac center. The participants were health care workers including doctors, nurses, technicians, and housekeeping staff from the different areas of the hospital.
METHODS AND MATERIALS:
This cross-sectional survey was conducted in the institute using a self-administered validated questionnaire. The participants consisted of a total of 190 HCWs namely doctors, nurses, technicians, and housekeeping staff.
STATISTICAL ANALYSIS USED:
Nil.
RESULTS:
Results showed maximum participant were in the age group of 20-30 years. 94.7% were aware about standard precautions. 91.5% knew about the procedure for reporting of NSSIs. Only 50.2% HCWs gave correct answers regarding disease transmission through needle stick and sharp injury. The prevalence of NSSIs was highest among nurses (38.4%), and needle on the disposable syringe (76.9%) was the most common source of NSSIs.
CONCLUSIONS:
The survey revealed few gaps in the knowledge amongst HCWs about NSSIs like risks associated with needle-stick injuries and use of preventive measures, disassembling of needles prior to disposal. These gaps can be addressed by extensive education. As nurses were the most affected victim for the NSSIs, more emphasis should be given towards them for reducing the NSSIs.
BibTeX:
@article{SharmaS12010,
  author = {Sharma S1, Gupta A, Arora A.},
  title = {Knowledge, attitude and practices on needle-stick and sharps injuries in tertiary care cardiac hospital: a survey.},
  journal = {Indian J Med Sci.},
  year = {2010},
  volume = {64(9)},
  pages = {396-401.}
}
Sheikh K and Porter JD "It's 100% for me": hospital practitioners' perspectives on mandatory HIV testing. 2009 Indian J Med Ethics.
Vol. 6(3), pp. 132-7 
article  
Abstract: This article explores the thinking of medical practitioners working in nine hospitals spread across five cities in India, on a contested subject--mandatory HIV testing of patients prior to surgery. We used in-depth interviews with practitioners and an interpretive analytical approach to understand their decisions to conduct mandatory tests. While many in the public health community see mandatory testing as an unacceptable violation of patient autonomy, the practitioners widely regarded it as a valuable cost-saving innovation for obviating transmission of infection during surgery. These conceptions are rooted in the day-to-day logic of practice which defines practitioners' actions--imperative of personal security, investment in core occupational roles and the importance of harmonious relations with co-workers. The experiences of hospitals with contrasting policies on mandatory HIV testing shows how an approach that balances patients' needs with an appreciation of practitioners' perspectives may result in more workable solutions for field-level ethical dilemmas.
BibTeX:
@article{SheikhK12009,
  author = {Sheikh K1, Porter JD.},
  title = {"It's 100% for me": hospital practitioners' perspectives on mandatory HIV testing.},
  journal = {Indian J Med Ethics.},
  year = {2009},
  volume = {6(3)},
  pages = {132-7}
}
Shewade HD, Jeyashree K, Tripathy JP Attracting doctors to rural health services of India. 2012 Natl Med J India.
Vol. 25(6), pp. 374 
article  
Abstract: No abstract available.
BibTeX:
@article{ShewadeHD2012,
  author = {Shewade HD, Jeyashree K, Tripathy JP.},
  title = {Attracting doctors to rural health services of India.},
  journal = {Natl Med J India.},
  year = {2012},
  volume = {25(6)},
  pages = {374}
}
Shinde N et al. Managing HIV/hepatitis positive patients: present approach of dental health care workers and students. 2012 J Contemp Dent Pract.
Vol. 13(6):, pp. 882-5. 
article  
Abstract: People with HIV/HBsAg in India frequently encounter discrimination while seeking and receiving health care services. The knowledge and attitudes ofhealth care workers (HCWs) influences the willingness and ability of people with HIV/HBsAg to access care, and the quality of the care they receive. The objective of this study was to asses HIV/HBsAg-related knowledge, attitudes and risk perception among students and dental HCWs. A cross-sectional survey was conducted on 250 students and 120 dental HCWs in the form of objective questionnaire. Information was gathered regarding demographic details (age, sex, duration of employment, job category); HIV/ HBsAg-related knowledge and attitudes; risk perception; and previous experience caring for HIV-positive patients. The HCWs in this study generally had a positive attitude to care for the people with HIV/HBsAg. However, this was tempered by substantial concerns about providing care, and the fear of occupational infection with HIV/HBsAg. A continuing dental education program was conducted to resolve all the queries found interfering to provide care to HIV/HBsAg patients. But even after the queries were resolved thecare providing capability was not attained. These findings show that even with advanced knowledge and facilities the attitude of dental HCWs and students require more strategic training with regards to the ethics and moral stigma associated with the dreaded infectious diseases (HIV/HBsAg).
BibTeX:
@article{ShindeN2012,
  author = {Shinde N, Baad R, Nagpal DK, Prabhu PR, Surekha LC, Karande P.},
  title = {Managing HIV/hepatitis positive patients: present approach of dental health care workers and students.},
  journal = {J Contemp Dent Pract.},
  year = {2012},
  volume = {13(6):},
  pages = {882-5.}
}
Shriraam V et al. Awareness of gestational diabetes mellitus among antenatal women in a primary health center in South India. 2013 Indian J Endocrinol Metab.
Vol. 17(1):, pp. 146-8 
article DOI  
Abstract: BACKGROUND:
Gestational diabetes mellitus (GDM) is a perfect window of opportunity for the prevention of DM in two generations, and its incidence is increasing in our country. Awareness of the condition among antenatal women will translate into prevention and early diagnosis of the disease. This study was done to determine the awareness of GDM among all the antenatal women who attend a Primary Health Center (PHC) for antenatal care.
MATERIALS AND METHODS:
A pretested questionnaire consisting of details on background characteristics, 12 questions focusing on Type 2 DM and GDM, and a question on the source of knowledge was administered to all women attending the antenatal clinic. Their responses were scored and the women were graded as having good, fair, or poor knowledge about GDM.
RESULTS:
One hundred and twenty antenatal women participated in the study. Mean age of the women was 23.8 years (SD: 2.94). Overall, 17.5% women had good knowledge, 56.7% had fair knowledge, and 25.8% women had poor knowledge about GDM. The major sources of awareness of GDM were reported to be television/radio, neighbors/friends, and family members.
DISCUSSION:
Only a small proportion of rural antenatal women had good knowledge about GDM. The awareness that untreated GDM may pose a risk to the unborn child was high among the study women. Health care workers have to play a greater role in bringing about awareness about GDM among antenatal women.
BibTeX:
@article{ShriraamV2013,
  author = {Shriraam V, Rani MA, Sathiyasekaran BW, Mahadevan S.},
  title = {Awareness of gestational diabetes mellitus among antenatal women in a primary health center in South India.},
  journal = {Indian J Endocrinol Metab.},
  year = {2013},
  volume = {17(1):},
  pages = {146-8},
  doi = {http://dx.doi.org/10.4103/2230-8210.107861}
}
Shrivastava SR and Shrivastava PS Evaluation of trained Accredited Social Health Activist (ASHA) workers regarding their knowledge, attitude and practices about child health. 2012 Rural Remote Health.
Vol. 12(4):, pp. 2099 
article  
Abstract: INTRODUCTION:
In India, with the introduction of Accredited Social Health Activist (ASHA) workers under the National Rural Health Mission (NRHM) from 2005 to 2006, utilization of healthcare services at the peripheral level has improved. This study was conducted with the purpose of evaluating knowledge, attitudes and practices of ASHA workers in relation to child health.
METHODS:
A cross-sectional study was conducted at Palghar Taluka in the Thane district of Maharashtra for a period of 3 months from January 2011 to March 2011, inclusive, with the study participants all being trained ASHA workers working in the various primary health centres of Palghar Taluka. A total of 150 ASHA workers were working in the area, of which four workers were untrained and thus excluded from the study. The study was conducted by the authors after receiving permission from the medical officer in charge of the primary health centres. Each of the ASHA workers was then contacted individually by the authors and had the study explained to them, after which they were interviewed face to face. Informed consent was taken from each of the study participants. A pre-tested semi-structured questionnaire was designed for ASHA workers regarding child health after thoroughly studying the ASHA Training Module 2, which was then translated into their local language (ie Marathi).
RESULTS:
A total of 70 (47.9%) workers were from the under 25 years age group; 67 (45.9%) had received less than a secondary level education. A total of 67.1% of ASHA workers were not aware of the correct preventive measures for vitamin A deficiency. Twenty-nine (19.9%) of the ASHAs did not feel the need for referral for a child with diarrhoea who is unable to drink or breast feed. Similarly, in acute respiratory tract infections, 35 (23.9%) of ASHAs did not know to refer a child with fast breathing. Fifty-nine ASHAs (50.4%) considered a baby crying for more than 3 hours following immunization not worth referring to a first referral unit. The oral contraceptive pill was the most frequently advised temporary contraceptive measure for females in the reproductive age group (15-45 years).
CONCLUSION:
Despite the training given to ASHAs, lacunae still exists in their knowledge regarding various aspects of child health morbidity. Monthly meetings can be used as a platform for the reinforcement of various aspects of child health. Periodical refresher training should be conducted for all of the recruited ASHA workers. In the future training sessions, more emphasis should be given to high risk cases requiring prompt referral.
BibTeX:
@article{ShrivastavaSR2012,
  author = {Shrivastava SR, Shrivastava PS.},
  title = {Evaluation of trained Accredited Social Health Activist (ASHA) workers regarding their knowledge, attitude and practices about child health.},
  journal = {Rural Remote Health.},
  year = {2012},
  volume = {12(4):},
  pages = {2099}
}
Shrivastava SR, Shrivastava PS, Ramasamy J Notification of tuberculosis cases in India: Moving ahead in Revised National Tuberculosis Control Program. 2013 Infect Ecol Epidemiol.
Vol. 3 
article DOI  
Abstract: Tuberculosis (TB) is currently the leading cause of death from a curable infectious disease accounting for 8.7 million new cases and 1.4 million deaths in the year 2011. From the year 2012, TB is a notifiable disease in India which means that all cases of TB diagnosed by any means has to be reported to the public health authorities. This would help policy makers to make rational decisions with regard to strengthening of existing infrastructure and scaling-up of TB control activities in the country. Employment of multiple measures directed towards different stakeholders can be strategically implemented to intensify and fast-track the process of TB notification. In conclusion, the Indian Government's decision to specify TB as a notifiable disease is a historical and a much awaited step in the TB control activities. However to obtain the desired results, program managers along with the health care workers have to work in an integrated and collaborative manner so that the burden of TB can be reduced in years to come.
BibTeX:
@article{ShrivastavaSR2013,
  author = {Shrivastava SR, Shrivastava PS, Ramasamy J.},
  title = {Notification of tuberculosis cases in India: Moving ahead in Revised National Tuberculosis Control Program.},
  journal = {Infect Ecol Epidemiol.},
  year = {2013},
  volume = {3},
  doi = {http://dx.doi.org/10.3402/iee.v3i0.23006}
}
Shriyan A et al. Incidence of occupational exposures in a tertiary health care center. 2012 Indian J Sex Transm Dis.
Vol. 33(2):, pp. 91-7 
article DOI  
Abstract: INTRODUCTION:
Occupational exposure to Hepatitis B virus (HBV), human immunodeficiency virus (HIV) and Hepatitis C virus (HCV) infection is a cause of concern to all health care workers (HCWs), especially those, in hospitals. Among the HCWs, nurses, interns, technicians, resident doctors and housekeeping staff have the highest incidence of occupational exposure.
AIMS:
To analyze the cases of needle stick injuries and other exposures to patient's blood or body fluids among health care workers.
MATERIALS AND METHODS:
A detailed account of the exposure is documented which includes incidence of needle stick injuries (NSI) and implementation of post-exposure prophylaxis (PEP) as per the hospital guidelines. We report a two-year continuing surveillance study where 255health care workers (HCWs) were included. PEP was given to HCWs sustaining NSI or exposures to blood and body fluids when the source is known sero-positive or even unknown where the risk of transmission is high. Follow-up of these HCW's was done after three and six months of exposure.
RESULTS:
Of the 255 HCWs, 59 sustained needle stick injuries and two were exposed to splashes. 31 of the NSI were from known sources and 28 from unknown sources. From known sources, thirteen were seropositive; seven for HIV, three for HCV and three for HBV. Nineteen of them sustained needle stick during needle re-capping, six of them during clean up, six of them while discarding into the container, 17 during administration of injection, eight of them during suturing, two occurred in restless patient, 17 during needle disposal.
CONCLUSION:
So far, no case of sero-conversion as a result of needle stick injuries was reported at our center.
BibTeX:
@article{ShriyanA2012,
  author = {Shriyan A, Roche R, Annamma.},
  title = {Incidence of occupational exposures in a tertiary health care center.},
  journal = {Indian J Sex Transm Dis.},
  year = {2012},
  volume = {33(2):},
  pages = {91-7},
  doi = {http://dx.doi.org/10.4103/0253-7184.102111}
}
Sigh A et al. Risk factors for oral diseases among workers with and without dental insurance in a national social security scheme in India. 2013 Int Dent J.  article DOI  
Abstract: OBJECTIVES:
The target population for this cross sectional study comprises subjects with and without social security in a national social security scheme. The study aimed to compare and assess the risk factors for oral diseases among insured (organised sector) and non-insured workers(unorganised sector) in New Delhi, India.
METHODS:
The sample comprised a total of 2,752 subjects. Of these, 960 workers belonged to the formal or organised sector with a social security and dental health insurance and 1,792 had no social security or dental insurance from the informal or unorganised sector.
RESULTS:
Significant differences were noted between the two groups for literacy levels, between-meal sugar consumption, tobacco-related habits and utilisation of dental care. Bleeding/calculus and periodontal pockets were present among 25% and 65.4% of insured workers, respectively. Similarly, 13.6% and 84.5% of non-insured workers had bleeding/calculus and periodontal pockets, respectively. The mean DMFT (decayed, missing, filled teeth) value among the insured workers and non-insured workers was 3.27 � 1.98 and 3.75 � 1.80, respectively. The association between absence of health insurance and dental caries was evident with an odds ratio (OR) of 1.94. Subjects with below graduate education were more prone to dental caries (OR = 1.62). Subjects who cleaned their teeth two or more times a day were less likely to have dental caries (OR = 1.47). Utilisation of dental care was inversely related to dental caries (OR = 1.25).
CONCLUSION:
The major risk factors for oral diseases in both the groups with similar socio-economic status were the lack of social security andhealth insurance, low literacy levels, high tobacco consumption and low levels of dental care utilisation.
BibTeX:
@article{SighA2013,
  author = {Sigh A, Purohit BM, Masih N, Kahndelwal PK.},
  title = {Risk factors for oral diseases among workers with and without dental insurance in a national social security scheme in India.},
  journal = {Int Dent J.},
  year = {2013},
  doi = {http://dx.doi.org/10.1111/idj.12067}
}
Simratvir M et al. Evaluation of caries experience in 3-6-year-old children, and dental attitudes amongst the caregivers in the Ludhiana city. 2009 J Indian Soc Pedod Prev Dent.
Vol. 27(3), pp. 164-9 
article DOI  
Abstract: Early Childhood Caries (ECC) is a lifestyle disease that begins when the child's teeth erupt in the oral cavity. The distinctive pattern of decay rapidly spreads from one tooth to another and involves the surfaces of teeth that are usually not at risk. Detection of disease is crucial to control the oral condition using preventive and therapeutic regimes. The aim of this study was to determine the prevalence of caries in children of age 3-6 years in Ludhiana and to examine the relationship between age and caries experience. A total of 609 children in the age group of 3-6 years were examined using def index. To determine dental care seeking attitude, 105 caregivers were interviewed. Results revealed that 52.87% of children in the age group of 3-3.11 years, 45.1% of children in the age group of 4-4.11 years and 58.55% of children in 5-5.11 age groups suffered from caries. The mean def index was 1.82, 1.57 and 2.21, respectively. Interview of caregivers of children revealed that out of 105 only 12 (11.4%) children had previously been to a general dentist. None of them knew about Pedodontics as a specialty. The results of the present study can be used mainly for screening child populations in need of treatment, helping public workers and planners to develop dental health programs to aid early intervention and prevention.
BibTeX:
@article{SimratvirM12009,
  author = {Simratvir M1, Moghe GA, Thomas AM, Singh N, Chopra S.},
  title = {Evaluation of caries experience in 3-6-year-old children, and dental attitudes amongst the caregivers in the Ludhiana city.},
  journal = {J Indian Soc Pedod Prev Dent.},
  year = {2009},
  volume = {27(3)},
  pages = {164-9},
  doi = {http://dx.doi.org/10.4103/0970-4388.57097}
}
Singal A and Sonthalia S Leprosy in post-elimination era in India: difficult journey ahead. 2013 Indian J Dermatol.
Vol. 58(6), pp. 443-6 
article DOI  
Abstract: Leprosy is a chronic inflammatory disease of skin and peripheral nerves. Elimination of leprosy as a public health problem was reached at the global level in the year 2000 and by India on 31(st) December, 2005. Thereafter, leprosy services in India have been integrated with General Health-CareSystem resulting in reduced focus and funds. Sustaining the gains made so far in controlling leprosy is a big challenge and there is no time for complacency. Pockets of high endemicity with prevalence rate of > 1 still exist in many states. Our data from a tertiary care center indicates poor epidemiological control and ongoing disease transmission. To combat this, dermatologists all over India should continue to play a central role in capacity building and training of undergraduate and post-graduate students, medical officers, and field workers.
BibTeX:
@article{SingalA2013,
  author = {Singal A, Sonthalia S.},
  title = {Leprosy in post-elimination era in India: difficult journey ahead.},
  journal = {Indian J Dermatol.},
  year = {2013},
  volume = {58(6)},
  pages = {443-6},
  doi = {http://dx.doi.org/10.4103/0019-5154.119952}
}
Singh A and Purohit BM Addressing oral health disparities, inequity in access and workforce issues in a developing country. 2013 Int Dent J.
Vol. 63(5), pp. 225-9 
article DOI  
Abstract: The health sector challenges in India like those in other low and middle income countries are formidable. India has almost one-third of the world's dental schools. However, provisions of oral health-care services are few in rural parts of India where the majority of the Indian population resides. Disparities exist between the oral health status in urban and rural areas. The present unequal system of mainly private practice directed towards a minority of the population and based on reparative services needs to be modified. National oral health policy needs to be implemented as a priority, with an emphasis on strengthening dental care services under public health facilities. A fast-changing demographic profile and its implications needs to be considered while planning for the future oral health-care workforce. Current oral health status in developing countries, including India, is a result of government public health policies, not lack of dentists. The aim of the article is to discuss pertinent issues relating to oral health disparities, equity in health-care access, dental workforce planning and quality concerns pertaining to the present-day dental education and practices in India, which have implications for other developing countries.
BibTeX:
@article{SinghA2013,
  author = {Singh A, Purohit BM},
  title = {Addressing oral health disparities, inequity in access and workforce issues in a developing country.},
  journal = {Int Dent J.},
  year = {2013},
  volume = {63(5)},
  pages = {225-9},
  doi = {http://dx.doi.org/10.1111/idj.12035}
}
Singh A et al. Inequalities in advice provided by public health workers to women during antenatal sessions in rural India. 2012 PLoS One.
Vol. 7(9):e, pp. 44931 
article DOI  
Abstract: OBJECTIVES:
Studies have widely documented the socioeconomic inequalities in maternal and child health related outcomes in developing countries including India. However, there is limited research on the inequalities in advice provided by public health workers on maternal and child health during antenatal visits. This paper investigates the inequalities in advice provided by public health workers to women during antenatal visits in rural India.
METHODS AND FINDINGS:
The District Level Household Survey (2007-08) was used to compute rich-poor ratios and concentration indices. Binary logistic regressions were used to investigate inequalities in advice provided by public health workers. The dependent variables comprised the advice provided on seven essential components of maternal and child health care. A significant proportion of pregnant women who attended at least four ANC sessions were not advised on these components during their antenatal sessions. Only 51%-72% of the pregnant women were advised on at least one of the components. Moreover, socioeconomic inequalities in providing advice were significant and the provision of advice concentrated disproportionately among the rich. Inequalities were highest in the case of advice on family planning methods. Advice on breastfeeding was least unequal. Public health workers working in lower level health facilities were significantly less likely than their counterparts in the higher level healthfacilities to provide specific advice.
CONCLUSION:
A significant proportion of women were not advised on recommended components of maternal and child health in rural India. Moreover, there were enormous socioeconomic inequalities. The findings of this study raise questions about the capacity of the public health caresystem in providing equitable services in India. The Government of India must focus on training and capacity building of the public health workers in communication skills so that they can deliver appropriate and recommended advice to all clients, irrespective of their socioeconomic status.
BibTeX:
@article{SinghA2012,
  author = {Singh A, Pallikadavath S, Ram F, Ogollah R.},
  title = {Inequalities in advice provided by public health workers to women during antenatal sessions in rural India.},
  journal = {PLoS One.},
  year = {2012},
  volume = {7(9):e},
  pages = {44931},
  doi = {http://dx.doi.org/10.1371/journal.pone.0044931}
}
Singhal V, Bora D and Singh S Hepatitis B in health care workers: Indian scenario. 2009 J Lab Physicians.
Vol. 1(2), pp. 41-8 
article DOI  
Abstract: Healthcare workers have a high risk of occupational exposure to many blood-borne diseases including HIV, Hepatitis B, and Hepatitis C viral infections. Of these Hepatitis B is not only the most transmissible infection, but also the only one that is preventable by vaccination. In developing countries, Hepatitis B vaccination coverage among healthcare workers is very low for various reasons, including awareness, risk assessment, and low priority given by the health managements of both government and private hospitals. Most of the hospitals lack post-exposure management strategies including the coordination among various departments for reporting, testing, and vaccination. This review, therefore, focuses on the current situation of Hepatitis B vaccine status in the healthcare workers of India, and provides updated guidelines to manage the accidental exposure to hepatitis B virus-infected biological materials in healthcare workers. The review also emphasizes on what options are available to a healthcare worker, in case of exposure and how they can respond to the standard vaccination schedules, besides the need to educate the healthcare workers about Hepatitis B infection, available vaccines, post-vaccine immune status, and post-exposure prophylaxis.
BibTeX:
@article{SinghalV12009,
  author = {Singhal V1, Bora D, Singh S.},
  title = {Hepatitis B in health care workers: Indian scenario.},
  journal = {J Lab Physicians.},
  year = {2009},
  volume = {1(2)},
  pages = {41-8},
  doi = {http://dx.doi.org/10.4103/0974-2727.59697}
}
Singh MP et al. Rubella seronegativity among health care workers in a tertiary care north Indian hospital: implications for immunization policy. 2013 Indian J Pathol Microbiol.
Vol. 56(2), pp. 148-50 
article DOI  
Abstract: BACKGROUND:
Rubella is traditionally considered a childhood disease but has the potential to cause outbreaks in hospital set ups. It is important to know the susceptibility status of health care workers (HCWs) as to frame guidelines for their immunization and thus prevent hospital outbreaks.
PARTICIPANTS:
The rubella susceptibility status of 313 HCWs working in the institute was assessed. This study was initiated after we reported an outbreak due to rubella among HCWs of our institute.
MATERIALS AND METHODS:
The serum samples were tested to determine Rubella IgG titres by enzyme linked immunosorbent assay (ELISA).
RESULTS:
Overall, 48 (15.3%) subjects were found to be negative, thereby indicating their susceptibility to infection. Out of them, 29 (60.5%) were in contact with pregnant women during the course of their employment. There is a risk of nosocomial transmission of rubella from affected HCWs to their contacts especially pregnant women as many of the rubella infections are asymptomatic.
CONCLUSION:
Hence, we stress the need for vaccinating the HCWs at the start of their employment to contain the spread of infection and also to reduce the risk of outbreaks in work place.
BibTeX:
@article{SinghMP2013,
  author = {Singh MP, Chatterjee SS, Singh R, Goyal K, Ratho RK.},
  title = {Rubella seronegativity among health care workers in a tertiary care north Indian hospital: implications for immunization policy.},
  journal = {Indian J Pathol Microbiol.},
  year = {2013},
  volume = {56(2)},
  pages = {148-50},
  doi = {http://dx.doi.org/10.4103/0377-4929.118704}
}
Singh T, Moust J and Wolfhagen I Needs and priorities of faculty development for medical teachers in India: a Delphi study. 2010 Natl Med J India.
Vol. 23(5), pp. 297-301 
article  
Abstract: BACKGROUND:
The models of faculty development (FD) currently in use in India are not based on any needs assessment of teachers working in Indian medical schools. We did this study to identify pedagogic themes that should be included in FD programmes in India and to ascertain the relative importance of these themes as perceived by experienced teachers.
METHODS:
A questionnaire containing themes relating to FD was developed from a review of the literature and the content of current FD programmes in India. The themes to be included in the questionnaire were piloted with the help of 3 senior teachers. We then conducted a 3-round normative Delphi technique to identify which of these themes were considered the most important for FD programmes in India.
RESULTS:
Of 32 teachers from both clinical and non-clinical departments who agreed to rate the themes, 26 completed the entire process. There was a significant decrease in the standard deviation of the ratings in round 3 as compared to rounds 1 and 2. Themes related to instruction and assessment were rated the highest. Curriculum-related themes received lower priority. There was no significant difference in the ratings provided by clinical and non-clinical teachers.
CONCLUSIONS:
We prioritized the themes for FD programmes in India on the basis of the felt needs of teachers. These identified themes need to be given priority when planning FD programmes.
BibTeX:
@article{SinghT12010,
  author = {Singh T1, Moust J, Wolfhagen I.},
  title = {Needs and priorities of faculty development for medical teachers in India: a Delphi study.},
  journal = {Natl Med J India.},
  year = {2010},
  volume = {23(5)},
  pages = {297-301}
}
Singru SA et al.. Study of susceptibility towards varicella by screening for the presence of IgG antibodies among nursing and medical students of a tertiary care teaching hospital in pune, India. 2011 J Glob Infect Dis.
Vol. 3(1), pp. 37-41 
article DOI  
Abstract: BACKGROUND:
It is believed that all suffer from chickenpox infection in their childhood. Many studies abroad and some in India clearly indicate that many individuals escape the infection in childhood, and thus, remain susceptible in adulthood. Adulthood chickenpox is a more serious infection than childhood. Prior screening of health care workers for the presence of IgG antibodies against Varicella will not only prevent hospital outbreaks but also economic and academic loss faced by the students. This will also have an important implication in terms of patient care as there is a threat of spreading Varicella to immuno-compromised patients. Definite history of prior infection of chickenpox is considered as an indicator for immunity towards the same. However, the reliability of this needs to be tested.
AIM:
A study to assess the susceptibility of nursing and medical students towards Varicella infection by screening for IgG antibodies against Varicella virus and to identify any risk factors for the same. Settings and design: A hospital-based cross-sectional study in nursing and medical students.
MATERIALS AND METHODS:
Total 78 nursing and medical students participated in the study. They were given prestructured and pretested questionnaires. After obtaining informed consent, blood sample was collected and screened for the presence of IgG antibodies against Varicella by Enzyme Linked Immunosorbent Assay (ELISA) by using a commercial kit. Statistical analysis: Epi_info 2002 was used for analysis. Age of the study subjects were summarized as mean age and standard deviation. Susceptibility was analyzed as percentage with 95% confidence interval and Chi Square test was used to find association of susceptibility status with sex and region of residence in childhood. Relevance of definite history as an indicator for immunity was assessed by calculating sensitivity, specificity, positive and negative predictive values with 95% confidence interval.
RESULTS:
Twenty males (25.6%) and 58 females (74.4%) participated in the study from medical and nursing students. The mean age � standard deviation of mean was 19.4 � 1.42 years for female students and 20.8 � 2.13 years for male students. Total 20 (25.6%) students were found to be susceptible to Varicella with the confidence interval ranging from 15.8% to 35.4%. With respect to the gender of the students, the difference between the susceptibility percentage in female students (32%) and in male students (14.3%) was only a numerical difference and not statistically significant (?(2) = 2.098, P=0.147, d.f. = 2). Also, the susceptibility was seen significantly more among Keralite students (Pearson Chi-Square=16.736, d.f=6, P=0.008; Likelihood Ratio=15.086, d.f=6, P=0.035; Fisher's Exact Test=13.569, p=0.022). The sensitivity of definite history of prior chickenpox infection as an indicator of immunity was only 55.17%, with C.I ranging from 43.9% to 66.4%, specificity was 80%, with C.I. ranging from 70.9% to 86%, and positive predictive value was 88.8% with C.I of 81.7% to 89% and negative predictive value of history of 66.6% with C.I. of 56% to 77.2%.
CONCLUSION:
Total 20 (25.6%) students were found to be susceptible to Varicella with the confidence interval ranging from 15.8% to 35.4%. Thus, there is a need for vaccination of all susceptible individuals. Definite history of prior chickenpox infection is not a reliable indicator of immunity against the same. The investigators recommend screening for IgG antibodies against Varicella of all students selected for the M.B.B.S. (Bachelor of Medicine and Bachelor of Surgery) and nursing course, and vaccination for susceptible individuals to prevent institutional outbreak and academic loss.
BibTeX:
@article{SingruSA2011,
  author = {Singru SA, Tilak VW, Gandham N, Bhawalkar JS, Jadhav SL, Pandve HT.},
  title = {Study of susceptibility towards varicella by screening for the presence of IgG antibodies among nursing and medical students of a tertiary care teaching hospital in pune, India.},
  journal = {J Glob Infect Dis.},
  year = {2011},
  volume = {3(1)},
  pages = {37-41},
  doi = {http://dx.doi.org/10.4103/0974-777X.77294}
}
Singru SA, Banerjee A Occupational exposure to blood and body fluids among health care workers in a teaching hospital in mumbai, India. 2008 Indian J Community Med.
Vol. 33(1), pp. 26-30 
article DOI  
Abstract: OBJECTIVE:
Exposure to blood and body fluids is one of the hidden hazards faced by health care workers (HCWs). The objective of the present study was to estimate the incidence of such exposure in a teaching hospital.
MATERIALS AND METHODS:
A cross-sectional study among a random sample of residents, interns, nurses and technicians (n = 830) was carried out in a teaching hospital to estimate the incidence of exposure to blood and body fluids in the preceding 12-month period. Self-reported occurrence and the circumstances of the same were recorded by face-to-face interviews using a semi-structured questionnaire.
RESULTS:
The response rate to the study was 89.76%. Occupational exposure to blood and body fluids in the preceding 12 months was reported by 32.75% of the respondents. The self-reported incidence was the highest among the nurses. Needle-stick injury was the most common mode of such exposures (92.21% of total exposures). Index finger and thumb were the commonest sites of exposure. Only 50% of the affected individuals reported the occurrence to concerned hospital authorities. Less than a quarter of the exposed persons underwent post-exposure prophylaxis (PEP) against HIV, although the same was indicated in about 50% of the affected HCWs based on the HIV status of the source patient.
CONCLUSIONS:
Occupational exposure to blood and body fluids was a common occurrence in the study sample. There was gross under-reporting of such incidents leading to a lack of proper PEP against HIV in 50% of those in whom the same appeared to be indicated.
BibTeX:
@article{SingruSA12008,
  author = {Singru SA1, Banerjee A.},
  title = {Occupational exposure to blood and body fluids among health care workers in a teaching hospital in mumbai, India.},
  journal = {Indian J Community Med.},
  year = {2008},
  volume = {33(1)},
  pages = {26-30},
  doi = {http://dx.doi.org/10.4103/0970-0218.39239}
}
Sinha S, David S, Gerdin M, Roy N Vulnerabilities of Local Healthcare Providers in Complex Emergencies: Findings from the Manipur Micro-level Insurgency Database 2008-2009. 2013 PLoS Curr.
Vol. 24;5, pp. pii: ecurrents.dis.397bcdc6602b84f9677fe49ee283def7. 
article DOI  
Abstract: BACKGROUND:
Research on healthcare delivery in zones of conflict requires sustained and systematic attention. In the context of the South Asian region, there has been an absence of research on the vulnerabilities of health care workers and institutions in areas affected by armed conflict. The paper presents a case study of the varied nature of security challenges faced by local healthcare providers in the state of Manipur in the North-eastern region of India, located in the Indo-Myanmar frontier region which has been experiencing armed violence and civil strife since the late 1960s. . The aim of this study was to assess longitudinal and spatial trends in incidents involving health care workers in Manipur during the period 2008 to 2009.
METHODS:
We conducted a retrospective database analysis of the Manipur Micro-level Insurgency Database 2008-2009, created by using local newspaper archives to measure the overall burden of violence experienced in the state over a two year period. Publicly available press releases of armed groups and local hospitals in the state were used to supplement the quantitative data. Simple linear regression was used to assess longitudinal trends. Data was visualized with GIS-software for spatial analysis.
RESULTS:
The mean proportion of incidents involving health care workers per month was 2.7% and ranged between 0 and 6.1% (table 2). There was a significant (P=0.037) month-to-month variation in the proportion of incidents involving health care workers, as well as a upward trend of about 0.11% per month. Spatial analysis revealed different patterns depending on whether absolute, population-adjusted, or incident-adjusted frequencies served as the basis of the analysis.
CONCLUSIONS:
The paper shows a small but steady rise in violence against health workers and health institutions impeding health services in Manipur's pervasive violence. More evidence-building backed by research along with institutional obligations and commitment is essential to protect the health-systems Keywords: India, Manipur, insurgency, healthcare, security, ethnic strife.
BibTeX:
@article{SinhaS2013,
  author = {Sinha S, David S, Gerdin M, Roy N.},
  title = {Vulnerabilities of Local Healthcare Providers in Complex Emergencies: Findings from the Manipur Micro-level Insurgency Database 2008-2009.},
  journal = {PLoS Curr.},
  year = {2013},
  volume = {24;5},
  pages = {pii: ecurrents.dis.397bcdc6602b84f9677fe49ee283def7.},
  doi = {http://dx.doi.org/10.1371/currents.dis.397bcdc6602b84f9677fe49ee283def7}
}
Acharya SK Does the level of hepatitis B virus vaccination in health-care workers need improvement? 2008 J Gastroenterol Hepatol.
Vol. 23(11), pp. 1628-31 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{SK.2008,
  author = {Acharya SK.},
  title = {Does the level of hepatitis B virus vaccination in health-care workers need improvement?},
  journal = {J Gastroenterol Hepatol.},
  year = {2008},
  volume = {23(11)},
  pages = {1628-31},
  doi = {http://dx.doi.org/10.1111/j.1440-1746.2008.05584.x}
}
Sodhi K, Shrivastava A, Arya M, Kumar M Knowledge of infection control practices among intensive care nurses in a tertiary care hospital. 2013 J Infect Public Health.
Vol. 6(4):, pp. 269-75 
article DOI  
Abstract: BACKGROUND:
The threat of hospital-acquired infections persists despite advances in the health care system. A lack of knowledge regarding infection control practices among health care workers decreases compliance with these practices. We conducted a study to assess the knowledge of infection control practices among nursing professionals at our hospital.
METHODS:
In total, 100 nurses in the intensive care units at our hospital were given a questionnaire with 40 multiple choice questions, including 10 questions each regarding hand hygiene, standard and transmission-based precautions, care bundles and general infection control practices. The responses were scored as percentages.
RESULTS:
The overall knowledge and awareness regarding different infection control practices were excellent (>90% positive responses) in 5% of the nursing professionals, good (80-90% positive responses) in 37%, average (70-80% positive responses) in 40% and below average (<70% positive responses) in 18%.
CONCLUSION:
The infection control knowledge among the nurses was fairly good; however, there is still a wide scope of improvement with regular educational programs and in-house training.
BibTeX:
@article{SodhiK2013,
  author = {Sodhi K, Shrivastava A, Arya M, Kumar M.},
  title = {Knowledge of infection control practices among intensive care nurses in a tertiary care hospital.},
  journal = {J Infect Public Health.},
  year = {2013},
  volume = {6(4):},
  pages = {269-75},
  doi = {http://dx.doi.org/10.1016/j.jiph.2013.02.004}
}
de Souza R. A Qualitative Study of Roles Performed by Peer Workers in the Context of HIV in India. 2013 J Assoc Nurses AIDS Care.  article DOI  
Abstract: While peer interventions have been shown to be effective in HIV prevention and support amongst intravenous drug users, women, youth, and other high-risk populations, less is known about the particular roles peers play in disenfranchised and non-Western contexts. This study examined the various roles peer workers played in the context of HIV in Karnataka, a southern Indian state. In-depth interviews were conducted with HIV-infected peer workers engaged in providing counseling, outreach, and health education to other people living with HIV. Grounded analysis revealed five roles: role model, persuader, maven, going the extra mile, and micro-level advocacy. In the Discussion section, these roles are used to explore the relationship between peer work and empowerment. Findings showed that in addition to personal empowerment, peers were crucial to building social capital and challenging existing social norms in the community.
BibTeX:
@article{SouzaR.2013,
  author = {de Souza R.},
  title = {A Qualitative Study of Roles Performed by Peer Workers in the Context of HIV in India.},
  journal = {J Assoc Nurses AIDS Care.},
  year = {2013},
  doi = {http://dx.doi.org/10.1016/j.jana.2013.01.004}
}
Agarwal SP Health sector in India--progress, challenges and the way forward. 2005 J Indian Med Assoc.
Vol. 103(12), pp. 692, 694, 696-8 
article  
Abstract: Health is a priority goal in its own right and a central input into economic development and poverty reduction. Significant achievements have been made in a number of areas which include health parameters, legislation, research and technology and disease control. The life expectancy has gone up by 17% since 1981. In disease control significant achievements are in sight. Some new programmes have been introduced with the changes in disease profile. Significant progress can be seen in leprosy control, blindness control, TB control and iodine deficiency disorder control. Some legislations were also enacted to protect life and personal liberty as the constitution holds the right to healthcare as a fundamental one. Immediate medical relief and preventing major outbreak following disasters is another area to fight with. There are some challenges to face with like propulation stabilisation, to reduce infant and maternal matality, mobilisationof funds on health, to increase manpower, to increase female literacy and so on. Control of some diseases like HIV/AIDS, vector borne ones, cancer, cardiovascular diseases, diabetes, trauma related injuries, mental disorders is another point to improve healthcare delivery. To meet challenges to the health system the way forward has to be multipronged, focusing on finance, manpower, research and social factors like sanitation, drainking water availability, female literacy, etc.
BibTeX:
@article{SP.2005,
  author = {Agarwal SP.},
  title = {Health sector in India--progress, challenges and the way forward.},
  journal = {J Indian Med Assoc.},
  year = {2005},
  volume = {103(12)},
  pages = {692, 694, 696-8}
}
Sri B S, Sarojini N, Khanna R An investigation of maternal deaths following public protests in a tribal district of Madhya Pradesh, central India. 2012 Reprod Health Matters.
Vol. 20(39):, pp. 11-20 
article DOI  
Abstract: Since 2005, the Government of India has initiated several interventions to address the issue of maternal mortality, including efforts to improve maternity services and train community health workers, and to give cash incentives to poor women if they deliver in a health facility. Following local protests against a high number of maternal deaths in 2010 in Barwani district in Madhya Pradesh, central India, we undertook a fact-finding visit in January 2011 to investigate the 27 maternal deaths reported in the district from April to November 2010. We found an absence of antenatal caredespite high levels of anaemia, absence of skilled birth attendants, failure to carry out emergency obstetric care in obvious cases of need, and referrals that never resulted in treatment. We present two case histories as examples. We took our findings to district and state health officials and called for proven means of preventing maternal deaths to be implemented. We question the policy of giving cash to pregnant women to deliver in poor quality facilities without first ensuring quality of care and strengthening the facilities to cope with the increased patient loads. We documented lack of accountability, discrimination against and negligence of poor women, particularly tribal women, and a close link between poverty and maternal death.
BibTeX:
@article{SriBS2012,
  author = {Sri B S, Sarojini N, Khanna R.},
  title = {An investigation of maternal deaths following public protests in a tribal district of Madhya Pradesh, central India.},
  journal = {Reprod Health Matters.},
  year = {2012},
  volume = {20(39):},
  pages = {11-20},
  doi = {http://dx.doi.org/10.1016/S0968-8080(12)39599-2}
}
Subhashraj K and Subramaniam B Awareness of the specialty of oral and maxillofacial surgery among health care professionals in Pondicherry, India. 2008 J Oral Maxillofac Surg.
Vol. 66(11), pp. 2330-4 
article DOI  
Abstract: PURPOSE:
The aim of this study is to establish the level of knowledge among dental, medical, and paramedical professionals of the hospital, regarding the role of oral and maxillofacial surgery in health care. This study also aims to highlight the perception of the medical professionals and what they think an oral and maxillofacial surgeon does.
MATERIALS AND METHODS:
A survey was done at Jawaharlal Institute of Postgraduate Medical and Research Institute, Pondicherry, India, in 2006.
RESULTS:
The result showed that out of 100, only 41% of the medical students, 76% of the medical practitioners, and 58% of the paramedical workers have heard of the name of the specialty.
CONCLUSION:
While the dental professionals realize the scope of the specialty to a larger extent, medical professionals are not fully aware of the expertise the specialty has to offer.
BibTeX:
@article{SubhashrajK12008,
  author = {Subhashraj K1, Subramaniam B.},
  title = {Awareness of the specialty of oral and maxillofacial surgery among health care professionals in Pondicherry, India.},
  journal = {J Oral Maxillofac Surg.},
  year = {2008},
  volume = {66(11)},
  pages = {2330-4},
  doi = {http://dx.doi.org/10.1016/j.joms.2007.04.025}
}
Suchitra JB and Lakshmi Devi N Impact of education on knowledge, attitudes and practices among various categories of health care workers on nosocomial infections. 2007 Indian J Med Microbiol.
Vol. 25(3), pp. 181-7 
article  
Abstract: PURPOSE:
To assess the knowledge, attitudes and practices among the different health care workers (HCWs) on nosocomial infections.
METHODS:
A total of 150 HCWs, doctors (n=50), nurses (n=50) and ward aides (n=50) were included. A questionnaire was administered to the HCWs to assess their knowledge, attitudes and practices on nosocomial infections. A scoring system was devised to grade those (KAP score). They were further subjected to a series of similar questionnaires at intervals of 6, 12 and 24 months after an education module. Subjects in each category of staff (n=10) were observed for compliance to hand washing practices in the ward in the post-education period. Statistical analysis was done using statistical software.
RESULTS:
The study showed an increase in the number of subjects in each category scoring good and excellent in the post-education questionnaire; however this declined with the progress of time. It was observed that the compliance level to hand washing practices differed among the different HCWs. Total compliance was 63.3% and ward aides were most compliant 76.7% (adjusted Wald 95% CI= 58.80-88.48).
CONCLUSIONS:
Education has a positive impact on retention of knowledge, attitudes and practices in all the categories of staff. There is a need to develop a system of continuous education for all the categories of staff. In order to reduce the incidence of nosocomial infections, compliance with interventions are mandatory.
BibTeX:
@article{SuchitraJB12007,
  author = {Suchitra JB1, Lakshmi Devi N.},
  title = {Impact of education on knowledge, attitudes and practices among various categories of health care workers on nosocomial infections.},
  journal = {Indian J Med Microbiol.},
  year = {2007},
  volume = {25(3)},
  pages = {181-7}
}
Sukriti et al.. Low levels of awareness, vaccine coverage, and the need for boosters among health care workers in tertiary care hospitals in India. 2008 J Gastroenterol Hepatol.
Vol. 23(11), pp. 1710-5 
article DOI  
Abstract: BACKGROUND AND AIM:
The risk of acquiring hepatitis B virus (HBV) infection through exposure to blood or its products is highest amongst health care workers (HCWs). Despite potential risks, a proportion of HCWs never get vaccinated. India is second to China in the numbers of people with chronic HBV. This study aimed to investigate the vaccination practices and the prevalence of HBV infection in HCWs in India.
METHODS:
A total of 2162 HCWs were screened for the presence of serological markers of HBV and hepatitis C virus (HCV). Occult HBV infection was tested by detection of HBV-DNA for surface and core regions by nested polymerase chain reaction in HBsAg-negative and IgG anti-hepatitis core antigen-positive subjects.
RESULTS:
Only 1198 (55.4%) of the 2162 HCWs screened had been vaccinated; and 964 (44.6%) were not vaccination-status conscious; of these HCWs, 600 (27.7%) had never been vaccinated and 364 (16.4%) were unaware of their vaccination status. Protective (> 10 IU/mL) anti-hepatitis B surface (anti-HBs) antigen titers were seen in only 61.7%. The anti-HBs titers were found to be lower with the passage of time; the median anti-HBs titers in subjects who were vaccinated > 10 years ago were significantly lower than those who had been vaccinated < 5 years ago (P < 0.001). One percent of HCWs were HBsAg-positive, and 24.7% of 700 HCWs screened had past exposure (IgG-anti-HBc-positive). Occult HBV was detected in 5% of 120 positive subjects with past exposure; all had anti-HBs titers > 10 IU/mL.
CONCLUSIONS:
Even today, 28% HCWs in India are unvaccinated and 17% are unaware of their vaccination status. This data suggests that use of hepatitis B immune globulin be mandatory in needle-pricked HCWs in India, and that implementation of awareness strategies is urgent. Since the anti-HBs titers decline in a fair proportion, there is justification for giving a booster dose of vaccine 10 years after primary vaccination to HCWs in India.
BibTeX:
@article{Sukriti12008,
  author = {Sukriti1, Pati NT, Sethi A, Agrawal K, Agrawal K, Kumar GT, Kumar M, Kaanan AT, Sarin SK.},
  title = {Low levels of awareness, vaccine coverage, and the need for boosters among health care workers in tertiary care hospitals in India.},
  journal = {J Gastroenterol Hepatol.},
  year = {2008},
  volume = {23(11)},
  pages = {1710-5},
  doi = {http://dx.doi.org/10.1111/j.1440-1746.2008.05483.x}
}
Sundararaman T and Gupta G Indian approaches to retaining skilled health workers in rural areas. 2011 Bull World Health Organ.
Vol. 89(1), pp. 73-7 
article DOI  
Abstract: PROBLEM:
The lack of skilled service providers in rural areas of India has emerged as the most important constraint in achieving universal health care. India has about 1.4 million medical practitioners, 74% of whom live in urban areas where they serve only 28% of the population, while the rural population remains largely underserved.
APPROACH:
The National Rural Health Mission, launched by the Government of India in 2005, promoted various state and national initiatives to address this issue. Under India's federal constitution, the states are responsible for implementing the health system with financial support from the national government.
LOCAL SETTING:
The availability of doctors and nurses is limited by a lack of training colleges in states with the greatest need as well as the reluctance of professionals from urban areas to work in rural areas. Before 2005, the most common strategy was compulsory rural service bonds and mandatory rural service for preferential admission into post-graduate programmes.
RELEVANT CHANGES:
Initiatives under the National Rural Health Mission include an increase in sanctioned posts for public health facilities, incentives, workforce management policies, locality-specific recruitment and the creation of a new service cadre specifically for public sector employment. As a result, the National Rural Health Mission has added more than 82,343 skilled health workers to the public health workforce.
LESSONS LEARNT:
The problem of uneven distribution of skilled health workers can be solved. Educational strategies and community health worker programmes have shown promising results. Most of these strategies are too recent for outcome evaluation, although this would help optimize and develop an ideal mix of strategies for different contexts.
BibTeX:
@article{SundararamanT2011,
  author = {Sundararaman T, Gupta G.},
  title = {Indian approaches to retaining skilled health workers in rural areas.},
  journal = {Bull World Health Organ.},
  year = {2011},
  volume = {89(1)},
  pages = {73-7},
  doi = {http://dx.doi.org/10.2471/BLT.09.070862}
}
Jacobs TA Rethinking hard-to-reach communities in the realm of global pediatrics: the urban poor and community health workers. 2010 Arch Pediatr Adolesc Med.
Vol. 164(3), pp. 294-6 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{TA.2010,
  author = {Jacobs TA.},
  title = {Rethinking hard-to-reach communities in the realm of global pediatrics: the urban poor and community health workers.},
  journal = {Arch Pediatr Adolesc Med.},
  year = {2010},
  volume = {164(3)},
  pages = {294-6},
  doi = {http://dx.doi.org/10.1001/archpediatrics.2009.294}
}
Taneja N et al. Working awareness of healthcare workers regarding sterilisation, disinfection, and transmission of bloodborne infections and device-related infections at a tertiary care referral centre in north India. 2010 J Hosp Infect.
Vol. 75(3), pp. 244-5 
article DOI  
Abstract: Abstract not available.
BibTeX:
@article{TanejaN2010,
  author = {Taneja N, Gill SS, Biswal M, Kumar A, Gupta AK, Parwej S, Sharma M.},
  title = {Working awareness of healthcare workers regarding sterilisation, disinfection, and transmission of bloodborne infections and device-related infections at a tertiary care referral centre in north India.},
  journal = {J Hosp Infect.},
  year = {2010},
  volume = {75(3)},
  pages = {244-5},
  doi = {http://dx.doi.org/10.1016/j.jhin.2009.11.019}
}
Tewari A et al. Does our sleep debt affect patients' safety? 2011 Indian J Anaesth.
Vol. 55(1), pp. 12-7 
article DOI  
Abstract: The provision of anaesthesia requires a high level of knowledge, sound judgement, fast and accurate responses to clinical situations, and the capacity for extended periods of vigilance. With changing expectations and arising medico-legal issues, anaesthesiologists are working round the clock to provide efficient and timely health care services, but little is thought whether the "sleep provider" is having adequate sleep. Decreased performance of motor and cognitive functions in a fatigued anaesthesiologist may result in impaired judgement, late and inadequate responses to clinical changes, poor communication and inadequate record keeping, all of which affect the patient safety, showing without doubt the association of sleep debt to the adverse events and critical incidents. Perhaps it is time that these issues be promptly addressed to prevent the silent perpetuation of a problem that is pertinent to our health and our profession. We endeavour to focus on the evidence that links patient safety to fatigue and sleepiness of health care workers and specifically on anaesthesiologists. The implications of sleep debt are deep on patient safety and strategies to prevent this are the need of the hour.
BibTeX:
@article{TewariA2011,
  author = {Tewari A, Soliz J, Billota F, Garg S, Singh H.},
  title = {Does our sleep debt affect patients' safety?},
  journal = {Indian J Anaesth.},
  year = {2011},
  volume = {55(1)},
  pages = {12-7},
  doi = {http://dx.doi.org/10.4103/0019-5049.76572}
}
Thacker N et al. Attitudes and practices of auxiliary nurse midwives and accredited social health activists in Uttar Pradesh and Bihar regarding polio immunization in India. 2013 J Trop Pediatr.
Vol. 59(4), pp. 266-73 
article DOI  
Abstract: Although India was removed from the list of polio endemic countries in January 2012, maintaining the focus on polio vaccination is critically important to prevent reintroduction of the virus. In 2009-2010, we conducted a study to assess the attitudes and practices of frontline health workers in Indiaregarding polio immunization in Uttar Pradesh and Bihar. More than 95% of auxiliary nurse midwives (ANMs) and accredited social health activists (ASHAs) agreed that polio supplementary immunization campaigns helped in increasing acceptance of all vaccines. The majority of ANMs (60-70%) and ASHAs (56-71%) believed that polio immunization activities benefitted or greatly benefitted other activities they were carrying out. Less than 5% of ANMs and ASHAs felt they were very likely to face resistance when promoting or administering polio vaccine. This study provides information that may be useful for programs in other countries for polio eradication and in India for measles elimination.
BibTeX:
@article{ThackerN2013,
  author = {Thacker N, Choudhury P, Gargano LM, Weiss PS, Pazol K, Vashishtha VM, Bahl S, Jafari HS, Kumar A, Arora M, Venczel L, Orenstein WA, Omer SB, Hughes JM.},
  title = {Attitudes and practices of auxiliary nurse midwives and accredited social health activists in Uttar Pradesh and Bihar regarding polio immunization in India.},
  journal = {J Trop Pediatr.},
  year = {2013},
  volume = {59(4)},
  pages = {266-73},
  doi = {http://dx.doi.org/10.1093/tropej/fmt008}
}
Thakur V, Pati NT, Gupta RC, Sarin SK Efficacy of Shanvac-B recombinant DNA hepatitis B vaccine in health care workers of Northern India. 2010 Hepatobiliary Pancreat Dis Int.
Vol. 9(4), pp. 393-7 
article  
Abstract: BACKGROUND:
Health care workers (HCWs) constitute a high-risk population of HBV infection. There are limited data on the efficacy of vaccination in HCWs in India. This study was to evaluate the efficacy of indigenous recombinant hepatitis B vaccine, Shanvac-B, in HCWs.
METHODS:
In 597 HCWs screened before the vaccination, 216 (36.2%) showed the presence of at least one of the markers of HBV/HCV infection. Of the remaining 381 (63.8%) HCWs who were considered for vaccination, only 153 (age 18-45 years; 48 males and 105 females) were available for final assessment. These HCWs received 20 microg of vaccine at 0, 1 and 6 months. They were asked for the reactogenicity and monitored for the seroprotective efficacy of the vaccination. Anti-HBs titres were measured after vaccination at 1, 2 and 7 months. The presence of anti-HBs titers equal to 1 MIU/ml was considered as seroconversion and that of titres greater than 10 MIU/ml as seroprotection.
RESULTS:
After vaccination, 32 males (67%) and 76 females (72%) showed seroconvertion; finally 12 (25%) of the males and 47 (45%) of the females were seroprotected. Seroprotection at 2 and 7 months was more dominant in the females than in the males (96% vs. 56%, P=0.001, 100% vs. 85%, P=0.0001), respectively. Geometric mean titres of anti-HBs after vaccination were also higher in the females than in the males (257+/-19.7 vs. 29+/-1.88 MIU/ml, P=0.01, 1802+/-35.2 vs. 306+/-13.6 MIU/ml, P< or =0.05, 6465+/-72 vs. 2142+/-73.6 MIU/ml, P<0.05). Seven male HCWs showed unsatisfactory response, non-response (n=3, 6%) and hypo-response (< or =10 MIU/ml, n=4, 8%) at the end of vaccination. Smoking and alcoholism were significantly correlated with unsatisfactory response. No significant adverse effects of vaccination were observed in any HCW.
CONCLUSIONS:
The presence of HBsAg in HCWs indicates that a high proportion of HCWs are infected with HBV and HCV in India. Recombinant indigenous vaccine Shanvac-B is highly efficacious in HCWs, and its immunogenicity is significantly higher in females than in males. However, pre-vaccination screening of HCWs is strongly recommended in India.
BibTeX:
@article{ThakurV12010,
  author = {Thakur V1, Pati NT, Gupta RC, Sarin SK.},
  title = {Efficacy of Shanvac-B recombinant DNA hepatitis B vaccine in health care workers of Northern India.},
  journal = {Hepatobiliary Pancreat Dis Int.},
  year = {2010},
  volume = {9(4)},
  pages = {393-7}
}
Timilshina N, Ansari MA and Dayal V Risk of infection among primary health workers in the Western Development Region, Nepal: knowledge and compliance. 2011 J Infect Dev Ctries.
Vol. 5(1), pp. 18-22. 
article  
Abstract: INTRODUCTION:
Without protective practices such as antiseptic hand washing, the use of sterile/surgical gloves, safe needles, sterile equipment, and safe instrument and waste disposal procedures outlined in universal precaution guidelines, basic health workers (BHWs) are at substantial risk of blood-borne infections.
METHODOLOGY:
This paper draws on research conducted in 28 primary health care centers in two districts of the Western Development Region, Nepal, between 2003 and 2004. Interviews were conducted to identify the infection control knowledge and practice compliance of basic healthworkers.
RESULTS:
Of 100 BHWs studied, only 22% had correct knowledge of universal precautions and 73% said they follow universal precaution guidelines. A total of 62% reported that they regularly used protective gloves while handling patients and 72% reported that they never used high-level disinfection to eliminate all microorganisms (bacteria, viruses, fungi, and parasites, including bacterial endospores) from instruments and other items that would come into contact with broken skin or intact mucous membranes. Reasons for noncompliance included irregular supply of materials (31%); lack of an autoclave and other high-level disinfection equipment (50%); lack of knowledge and insufficient technical skills regarding universal precaution procedures (20%).
CONCLUSION:
Results showed that poor knowledge and an irregular supply of materials, equipment, and instruments prevented BHWs from using infection control measures. Formal training in universal precautions is urgently needed, and protective equipment must be provided and use must be monitored. Compliance to infection control procedures must be improved at primary health care units, especially among the basic health workers.
BibTeX:
@article{TimilshinaN2011,
  author = {Timilshina N, Ansari MA, Dayal V.},
  title = {Risk of infection among primary health workers in the Western Development Region, Nepal: knowledge and compliance.},
  journal = {J Infect Dev Ctries.},
  year = {2011},
  volume = {5(1)},
  pages = {18-22.}
}
Tiwari RR, Sharma K and Zodpey SP Situational analysis of nursing education and work force in India. 2013 Nurs Outlook.
Vol. 61(3), pp. 129-36 
article DOI  
Abstract: Nursing care has been mentioned in the Indian culture from the times of the Vedas. However, according to World Health Organization, the nursing workforce in India is still insufficient to meet the needs of the country. The purpose of this article is to examine the status of nursing education and the nursing workforce in India and the challenges faced by the profession. Data supporting the statements made in the article were obtained from the Nursing Council of India, the Ministry of Health and Family Welfare, the Government of India Web sites, printed journals and communication with experts in the field. In India, there is a need to train approximately a million nurses to meet the current shortfall of health workers in the country. The nursing "brain drain" suggests that it may be one of the factors responsible for this shortfall. Further, nursing education faces challenges, such as streamlining nursing education, enriching the curriculum, strengthening faculty development and increasing the use of innovative teaching and learning techniques.
BibTeX:
@article{TiwariRR2013,
  author = {Tiwari RR, Sharma K, Zodpey SP.},
  title = {Situational analysis of nursing education and work force in India.},
  journal = {Nurs Outlook.},
  year = {2013},
  volume = {61(3)},
  pages = {129-36},
  doi = {http://dx.doi.org/10.1016/j.outlook.2012.07.012}
}
Tripathi R, Rathore AM and Sachdeva J Emergency contraception: knowledge, attitude, and practices among health care providers in North India. 2003 J Obstet Gynaecol Res.
Vol. 29(3), pp. 142-6 
article  
Abstract: AIMS:
The present study was conducted to assess knowledge, attitude, and practice of emergency contraception in health care providers and users in North India.
METHODS:
A survey was carried out with the help of a predesigned questionnaire comprising of two groups of clients (abortion seekers at Family Welfare center, and non-medical college students (prospective clients)); and 4 groups of health care providers (gynecologists, general practitioners, paramedical workers, and medical students).
RESULTS:
Practically none of the clients were familiar with the concept of emergency contraception and so the rest of the information could not be obtained from them and hence this was excluded from further analysis. Many providers (84.8% gynecologists, 41.0% general practitioners, 2.7% paramedical workers, and 64.4% medical students) were vaguely familiar with the concept of emergency contraception, very few knew accurately about timing and doses. The majority of these thought it to be an essential component of contraceptive services but preferred distribution through health care providers only. The practice of emergency contraception as reported in the present survey was inconsistent. Yuzpe regimen was the most commonly used method and nausea/vomiting were the commonest side-effects. The question of efficacy of emergency contraception was not answered reliably by the health care providers.
CONCLUSIONS:
Awareness about emergency contraception among the general population and paramedical workers studied is practically nonexistent. Precise knowledge about emergency contraception among doctors (both gynecologists and general practitioners) is also inadequate. Prescription practices can improve by generating demand and training of health care providers.
BibTeX:
@article{TripathiR12003,
  author = {Tripathi R1, Rathore AM, Sachdeva J.},
  title = {Emergency contraception: knowledge, attitude, and practices among health care providers in North India.},
  journal = {J Obstet Gynaecol Res.},
  year = {2003},
  volume = {29(3)},
  pages = {142-6}
}
Tulenko K et al. Community health workers for universal health-care coverage: from fragmentation to synergy. 2013 Bull World Health Organ.
Vol. 91(11):, pp. 847-52 
article DOI  
Abstract: To achieve universal health coverage, health systems will have to reach into every community, including the poorest and hardest to access. Since Alma-Ata, inconsistent support of community health workers (CHWs) and failure to integrate them into the health system have impeded full realization of their potential contribution in the context of primary health care. Scaling up and maintaining CHW programmes is fraught with a host of challenges: poor planning; multiple competing actors with little coordination; fragmented, disease-specific training; donor-driven management and funding; tenuous linkage with the health system; poor coordination, supervision and support, and under-recognition of CHWs' contribution. The current drive towards universal health coverage (UHC) presents an opportunity to enhance people's access to health services and their trust, demand and use of such services through CHWs. For their potential to be fully realized, however, CHWs will need to be better integrated into national health-care systems in terms of employment, supervision, support and career development. Partners at the global, national and district levels will have to harmonize and synchronize their engagement in CHW support while maintaining enough flexibility for programmes to innovate and respond to local needs. Strong leadership from the public sector will be needed to facilitate alignment with national policy frameworks and country-led coordination and to achieve synergies and accountability, universal coverage and sustainability. In moving towards UHC, much can be gained by investing in building CHWs' skills and supporting them as valued members of the health team. Stand-alone investments in CHWs are no shortcut to progress.
BibTeX:
@article{TulenkoK2013,
  author = {Tulenko K, M�gedal S, Afzal MM, Frymus D, Oshin A, Pate M, Quain E, Pinel A, Wynd S, Zodpey S.},
  title = {Community health workers for universal health-care coverage: from fragmentation to synergy.},
  journal = {Bull World Health Organ.},
  year = {2013},
  volume = {91(11):},
  pages = {847-52},
  doi = {http://dx.doi.org/10.2471/BLT.13.118745}
}
Venkatachalam J et al. Knowledge and skills of primary health care workers trained on integrated management of neonatal and childhood illness: follow-up assessment 3 years after the training. 2011 Indian J Public Health.
Vol. 55(4):, pp. 298-302 
article DOI  
Abstract: BACKGROUND:
The primary health care workers of a district in northern India were trained in the year 2006 for Integrated Management of Neonatal and Childhood Illness (IMNCI) using two different training methods: conventional 8-day training and new interrupted 5-day training. Knowledge and skills may decline over a period of time. Rate of decline may be associated with the type of training. A study was thus conducted to see the retention of knowledge and skills in the two training groups, 3 years after the initial training.
MATERIALS AND METHODS:
This study was done in the Panchkula district of Haryana state in northern India. In the year 2006, 50 primary health care workers were given new interrupted 5-day training and another 35 workers were given conventional 8-day training on IMNCI. Knowledge and skills of the same workers were evaluated in the year 2009, using the same methodology and tools as were used in the year 2006. Data analysis was done to see the extent of decline in knowledge and skills in these 3 years and whether decline was more in any particular training group.
RESULTS:
Compared to post-training score in the year 2006, composite knowledge and skill scores for Auxilliary Nurse Midwives (ANMs) and Anganwari workers (AWWs) together declined significantly in the year 2009 from 74.6 to 58.0 in 8-day training group and from 73.2 to 57.0 in 5-day training group (P < 0.001). Follow-up composite scores in the two training groups were similar. Whereas the decline was more for knowledge scores in 8-day training group and for skill score in 5-day training group, the pattern of decline was inconsistent for different health conditions and among ANMs and AWWs.
CONCLUSION:
Long-term retention of knowledge and skills in 5-day group was equivalent to that in 8-day training group. Refresher trainings may boost up the decline in the knowledge and skills.
BibTeX:
@article{VenkatachalamJ2011,
  author = {Venkatachalam J, Kumar D, Gupta M, Aggarwal AK.},
  title = {Knowledge and skills of primary health care workers trained on integrated management of neonatal and childhood illness: follow-up assessment 3 years after the training.},
  journal = {Indian J Public Health.},
  year = {2011},
  volume = {55(4):},
  pages = {298-302},
  doi = {http://dx.doi.org/10.4103/0019-557X.92410}
}
Vijayakumaran P et al. Utilizing primary health care workers for case detection. 1998 Indian J Lepr.
Vol. 70(2), pp. 203-10 
article  
Abstract: Under the National Leprosy Elimination Programme it takes at least one year for the paramedical worker to survey the allotted population for case detection. An alternative strategy in warranted for States like Bihar still having a high case load and poorly functioning leprosy programme. An intensive case finding programme using Primary Health Care (PHC) workers was organized in Bhojpur district, Bihar State, India. The whole population (3, 173, 701 in 1996) of the district was screened within a period of four days and confirmation of suspected cases was carried out in four days. During this screening procedure, 1586 new leprosy cases were detected (NCDR = 5 cases per 10,000) and all were started on MDT. The new cases constituted 26.4% of active cases existing on record before the screening. After this experience, the prevalence rate of active cases increased from 19 to 24 10,000. If such rapid screening programmes are done at least twice a year, it will greatly hasten the process of elimination of leprosy.
BibTeX:
@article{VijayakumaranP11998,
  author = {Vijayakumaran P1, Reddy NB, Krishnamurthy P, Ramanujam R.},
  title = {Utilizing primary health care workers for case detection.},
  journal = {Indian J Lepr.},
  year = {1998},
  volume = {70(2)},
  pages = {203-10}
}
Vyas KJ et al. A comparison in HIV-associated stigma among healthcare workers in urban and rural Gujarat. 2010 SAHARA J.
Vol. 7(2), pp. 71-5 
article  
Abstract: The present study measures levels of stigma within health care settings in urban and rural Gujarat, in an attempt to understand how this may have contributed to the state's increasing HIV incidence. Two sites were studied: a rural hospital in Bardoli and an urban hospital in Surat. HIV-associated stigma among healthcare workers (N=170) was assessed using a Stigma Index. Overall, analyses suggest an increase in medical education was found to be associated with higher stigmatisation (p<0.001). Furthermore, a statistically significant difference between stigma scores of HCWs in rural and urban Gujarat was not observed.
BibTeX:
@article{VyasKJ12010,
  author = {Vyas KJ1, Patel GR, Shukla D, Mathews WC.},
  title = {A comparison in HIV-associated stigma among healthcare workers in urban and rural Gujarat.},
  journal = {SAHARA J.},
  year = {2010},
  volume = {7(2)},
  pages = {71-5}
}
Das D and Silva YJ. The physician workforce--underemployment and unemployment. 1997 Natl Med J India.
Vol. 10(1), pp. 38-9 
article  
Abstract: Abstract not available.
BibTeX:
@article{YJ.1997,
  author = {Das Dores Silva YJ.},
  title = {The physician workforce--underemployment and unemployment.},
  journal = {Natl Med J India.},
  year = {1997},
  volume = {10(1)},
  pages = {38-9}
}
Silva YJ Too many doctors! Not enough resources! 1995 Natl Med J India.
Vol. 8(2), pp. 84-5 
article  
Abstract: Abstract not available.
BibTeX:
@article{YJ.1995,
  author = {Silva YJ.},
  title = {Too many doctors! Not enough resources!},
  journal = {Natl Med J India.},
  year = {1995},
  volume = {8(2)},
  pages = {84-5}
}
Zwerling A et al. Trajectories of tuberculosis-specific interferon-gamma release assay responses among medical and nursing students in rural India. 2013 J Epidemiol Glob Health.
Vol. 3(2), pp. 105-17 
article DOI  
Abstract: BACKGROUND:
Interferon gamma release assays (IGRAs) have been shown to be highly dynamic tests when used in serial testing for TB infection. However, there is little information demonstrating a clear association between TB exposure and IGRA responses over time, particularly in high TB incidence settings.
OBJECTIVES:
To assess whether QuantiFERON-TB Gold In-Tube (QFT) responses are associated with occupational TB exposures in a cohort of young health care trainees in India.
METHODS:
All medical and nursing students at Mahatma Gandhi Institute of Medical Sciences were approached. Participants were followed up for 18 months; QFT was performed 4 times, once every 6 months. Various modeling approaches were used to define IFN-gamma trajectories and correlations with TB exposure.
RESULTS:
Among 270 medical and nursing trainees, high rates of conversions (6.3-20.9%) and reversions (20.0-26.2%) were found depending on the definitions used. Stable converters were more likely to have had TB exposure in hospital pre-study. Recent occupational exposures were not consistently associated with QFT responses over time.
CONCLUSION:
IFN-gamma responses and rates of change could not be explained by occupational exposure investigated. High conversion and subsequent reversion rates suggest many health care workers (HCWs) would revert in the absence of treatment, either by clearing the infection naturally or due to fluctuations in the underlying immunological response and/or poor assay reproducibility. QFT may not be an ideal diagnostic test for repeated screening of HCWs in a high TB incidence setting.
BibTeX:
@article{ZwerlingA2013,
  author = {Zwerling A, Joshi R, Kalantri SP, Dakshinamoorthy G, Reddy MV, Benedetti A, Schwartzman K, Menzies D, Pai M.},
  title = {Trajectories of tuberculosis-specific interferon-gamma release assay responses among medical and nursing students in rural India.},
  journal = {J Epidemiol Glob Health.},
  year = {2013},
  volume = {3(2)},
  pages = {105-17},
  doi = {http://dx.doi.org/10.1016/j.jegh.2013.03.003}
}
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