Journal of Biomedical Sciences <p>Official journal of the Nepal Health Research Society.</p> <p>JBS is currently accepting submissions by Email – <a href=""></a></p> <p><strong>Publication fee 3000 NPR for Nepalese citizens, others all countries $30.</strong></p> Nepal Health Research and Welfare Society en-US Journal of Biomedical Sciences 2676-1343 Why do people attempt suicide? A mixed-methods research from south India <p><strong>Background</strong><strong>: </strong>Suicide is a major public health problem and a leading cause of death worldwide. In 2009, the suicide rate in Tamil Nadu and in Pondicherry was 21.5 per lakh and 47.2 per lakh population respectively. This is more than four times the rate as compared to the national level. Suicidal attempts are 20 times higher than the completed suicides. Mixed-method design gives better understanding of the complexity of the path from suicide ideation to suicidal attempt.&nbsp;</p> <p><strong>Materials and methods</strong><strong>: </strong>A (QUAN – QUAL) Sequential Explanatory design was used. Among 200 patients admitted for attempted suicide in JIPMER and Indira Gandhi Government Hospital and Post Graduate Institute Pondicherry were assessed for the reasons for attempting suicide using a semi-structured questionnaire. For a subsample of 40(20%) In-depth interview was done to explore and understand the reasons and the undermined situation associated with attempted suicide at their residence.</p> <p><strong>Results</strong><strong>: </strong>Among the study subjects (n = 200), more than half were in the age group of 20-29 years, mean (± standard deviation) age of suicide attempt was 26 ± 9.1 years. Commonest reason (precipitating factor) for attempting suicide was verbal abuse, most often by parents (31.9%). Other precipitating factors were physical abuse, illness, marital conflict, family related problem, etc. On IDI, it was found that there were several, background factors (like chronic ill health; loss of family member, delayed marriage, alcoholism, and heavy debt), aggravating factors (like verbal or physical abuse, neighborhood influence, guilt), and protective factor (like religious affiliation, motherhood feel, caring and loving parents). A conceptual diagram was generated depicting the imbalance between the protective and aggravating factors acting on the background factors before the execution of a suicide attempt. In the presence of background factor, the suicidal ideation progressed to suicidal intention and ended in attempt. Not all suicide attempts were preceded with suicidal intention or ideation. Some attempts occurred as an impulsive thought or to threaten the family member.</p> <p><strong>Conclusion: </strong>There is lot of scope to reduce the suicidal attempts in our country. Opportunistic screening should be done to identify any psycho-social issues among patients attending OPD. Strong social support and enabling environment should be provided for counseling individuals with suicidal ideation and intentions.</p> P. Purushothaman K.C Premaraian J. Ramakrishnan S. Thyagarajan S. Lakshminarayanan L. Debasish ##submission.copyrightStatement## 2019-12-23 2019-12-23 1 1 10.3126/jbs.v6i3.26818 A study to assess the effectiveness of mind mapping technique vs lecture method regarding psychological test on knowledge among nursing students at St. James College of Nursing, Chalakudy <p><strong>Background: </strong>Mind maps are highly effective visual aids that enable students to group together different ideas and enable teachers to present ideas visually and assess their students’ conceptual development and understanding. The present study was to assess effectiveness of mind mapping technique vs lecture method regarding psychological test on knowledge among nursing students at St. James College of Nursing Chalakudy. The study included 50 first year B.Sc. nursing students, 25 in lecture group and 25 in mind mapping group.</p> <p><strong>Materials and methods: </strong>A Quasi-experimental non randomized control group design was adopted and nonprobability convenient sampling technique was used to select the samples. Structured teaching programme regarding psychological test was administered on both group and knowledge level of the students was evaluated immediately after the teaching (‘0 day’) and 7<sup>th</sup> day to assess the retention of knowledge. Data collected by using structured questionnaire and analysed by using descriptive and inferential statistics. &nbsp;</p> <p><strong>Results:</strong>The study revealed that the mean post test knowledge score of students on ’0’day in mind mapping group is (13.52) higher than the lecture group (9). The calculated t value (7.66) is higher than the table value (6.06) at 0.05 level of significance. The mean of the post test knowledge of students on 7<sup>th</sup> day by using mind map score is 13.32, it is higher than mean of the lecture method knowledge score (8.80). The calculated t value is (7.92) is greater than the table value (2.60) at 0.05 level of significance.</p> <p><strong>Conclusion: </strong>There for it can be concluded that the mind mapping teaching method is very effective than lecture method among the nursing student on psychological test. The study shows that mind mapping technique help the student to learn, recall, organize and make information meaningful. So they can perform and get good result in examination by using mind mapping technique.</p> Christy Antony ##submission.copyrightStatement## 2019-12-23 2019-12-23 2 2 10.3126/jbs.v6i3.26820 Clinical disparity of oxidative stress with blood pressure <p><strong>Background: </strong>Cardiovascular disease is one of the leading causes of mortality and morbidity in India and worldwide. Hypertension is a major public health problem because of its high frequency and concomitant risk of cardiovascular disease, kidney disease, and stroke. World Health Organization named it a Silent killer as hypertension is asymptomatic during its clinical course. Experimental evidence supports a role for oxidative stress in vascular injury and hypertension. This study was undertaken, to compare the serum levels of malondialdehyde (MDA) and super-oxide dismutase (SOD) among normotensive, prehypertensive and hypertensive subjects.</p> <p><strong>Materials and methods</strong>: In this cross-sectional study, 34 normotensives, 44 prehypertensive and 45 hypertensive subjects were included. The participants were subjected to selection protocol consisting of physical examination and biochemical analysis. All subjects underwent blood pressure measurement, total cholesterol, and oxidative stress marker estimation, especially SOD and MDA. The comparison of parameters between the group was carried out using One Way ANOVA. The correlation between the parameter was analyzed by Karl Pearson Correlation Coefficient using SPSS 20.0.</p> <p><strong>Result</strong> : The MDA (nmol/ml) in normotensive, prehypertensive and hypertensive patients was 2.55±0.072, 3.43±0.44 and 4.01±0.37 respectively. SOD (U/ml) level in normotensive, prehypertensive and hypertensive patients was 13.47±1.96, 11.57±0.81, and 8.52±1.78 respectively. Systolic and diastolic blood pressure had a negative correlation with SOD. MDA levels show a positive correlation with systolic blood pressure and diastolic blood pressure. Total cholesterol had no significant with SOD and MDA.</p> <p><strong>Conclusion: </strong>The present study showed a strong association of oxidative stress with systolic and diastolic blood pressure.</p> Elsa Mathew J.K. Mukkadan ##submission.copyrightStatement## 2019-12-23 2019-12-23 3 3 10.3126/jbs.v6i3.26821 Cognitive impairment as a function of sleep quality and gender <p><strong>Background: </strong>The study aims at finding whether there is any significant difference between sub-groups classified on the basis of sleep quality (good sleep quality and poor sleep quality) and gender in the performance of various cognitive functioning tests like Visual N Back Test (N Back 1and N Back 2 test) for working memory, Triad test for divided attention, Digit Vigilance Test for sustained attention and Reaction time test (simple reaction time and choice reaction time).</p> <p><strong>Materials and methods</strong><strong>: </strong>The sample consisted of 30 participants, both males (N=13) and females (N=17) in the age range between 18 to 30 years, randomly drawn from Thiruvananthapuram and Kollam districts of Kerala. The participants of the study are screened and categorized into two groups of 15 members each on the basis of the scores obtained in the Pittsburgh Sleep Quality Index (PSQI). t-test and two-way ANOVA were performed to test the significance of the hypotheses.</p> <p><strong>Results: </strong>The results showed that the participants with poor sleep quality significantly differed from those with good sleep quality and committed more number of errors in the triad test of divided attention and took more time and committed more errors in the completion of the digit vigilance test of sustained attention.</p> <p><strong>Conclusion: </strong>A gender advantage favoring females was seen on the test of working memory, test for sustained attention and the test for choice reaction time. An interaction between sleep quality and gender was noticed only on the test of divided attention. It was seen that males with poor sleep quality are more impaired in divided attention tasks than females with poor sleep quality.</p> R. Akhil B.P. Nair ##submission.copyrightStatement## 2019-12-23 2019-12-23 4 4 10.3126/jbs.v6i3.26822 Compare the effect of art therapy and play therapy in reducing anxiety among hospitalized preschool children in selected hospitals <p><strong>Background: </strong>Children are very precious being. The multidimensional refinement occurs during preschool period. Hospitalizations lead to anxiety and strain for children. Play and art are tremendous method of communication, expansion of social</p> <p>relationship, express emotion and eventually lead to a new value added life styles.</p> <p><strong>Material and methods: </strong>This study focus on comparing the effect of art therapy and play therapy in reducing anxiety among hospitalized preschool children in selected hospitals of Bhubaneswar by quantitative experimental research approach of True experimental pretest – posttest only design. 60 preschool children were selected by using simple random sampling technique. Data collected through Self-structured Questionnaire on sociodemographic and Self-structured hospitalization anxiety scale. Collected data analyzed by using descriptive and inferential statistics.</p> <p><strong>Result: </strong>The study findings revealed that 75% children had moderate anxiety, whereas 5% had mild anxiety among hospitalized preschool children. There was significant difference observed between pre-test and post-test mean score of anxiety level both in art and play therapy at p&lt;0.0001. In comparison of post-test result by Anova of anxiety level between art therapy play therapy and control group showed that mean score of post-test of play therapy (1.95), art therapy (2.1) and control group (2.25) of anxiety level. The significance value is 0.025 (i.e., p = .025), which is below 0.05, therefore, there is statistically significant difference in the anxiety level between the different groups. Play therapy is more effective than art therapy. Chi-square statistics was used, there was notable association between duration of hospitalization and anxiety level at χ2 =10.</p> <p><strong>Conclusion: </strong>It concludes that hospitalization creates a negative impact on the development of the child. Art therapy and Play therapy is more acceptable and can include in normal routine activities. It is cost effective, convenient, requires less skills.</p> S.R. Dalei G.R. Nayak ##submission.copyrightStatement## 2019-12-23 2019-12-23 5 5 10.3126/jbs.v6i3.26823 Defense mechanisms of persons with locomotor disabilities <p><strong>Background: </strong>According to World Health Organization 1, billion people -15% of the World population lives with various disabilities. Disabilities restricts individual’s participation of social life and this create limiting the maximum utilization of resources and hence the person crippled with psychological issues. Persons with disabilities were used various defense mechanisms as coping strategies to survive and compensate with their disabilities. The present study investigates the types of defense mechanisms used by persons with locomotor disabilities.</p> <p><strong>Materials and methods: </strong>The total sample consists of 100 participants which include 50 males and 50 females. Among them 46 participants were congenitally disabled and 54 were acquired disabled. The participant’s age ranges between 18-60 years. The descriptive survey method was used for the present study and purposive sampling method adopted for sample selection. Defensive Behaviour Rating Scale (Sathya Giri Rajan, 1991) was used for data collection. The data was analysed by using Statistical Package for Social Sciences (SPSS) Version 16 for windows. &nbsp;</p> <p><strong>Results: </strong>Female participants with locomotor disability have reported more reaction formation than male participants with locomotor disability.&nbsp; In the comparison of defense mechanisms of participants with locomotor disability with respect to their gender, male participants have reported more compensation, projection, identification, belittling and reaction formation and significantly lower repression than females. Females have reported significantly more daydreaming than males. Persons with congenital disability have higher sublimation than persons with an acquired disability.</p> <p><strong>Conclusion: </strong>Researchers have long been fascinated by man’s defense mechanisms. Defense mechanisms are commonly used to protect the sense of self and help to defend people from painful emotions. In the present study, the investigator attempts to find out defense mechanisms of persons with locomotor disability and evaluation were made how they cope with the situation in relation to their nature of disability. The present study found that people with locomotor disability use both adaptive and maladaptive defense mechanisms, predominantly maladaptive defenses.</p> Boban Eranimos Surya Thankappan ##submission.copyrightStatement## 2019-12-23 2019-12-23 6 6 10.3126/jbs.v6i3.26824 Developmental disabilities: Barriers in early identification <p><strong>Background: </strong>A healthy active child is a promise for healthy and productive future generation. But sometimes a baby is born with apparent defects or develop disturbances in intellectual, motor and social functioning in early childhood.&nbsp; This may be due to due to impaired development of the nervous system. It is estimated that in India 2.21% of the population is affected with disabilities out of which a major portion is contributed by disabilities of childhood origin. Developmental disabilities include limitations in function resulting from disorders of the developing nervous system. These limitations manifest during infancy&nbsp;&nbsp; or childhood&nbsp;&nbsp; as delays in reaching developmental milestones or lack of function in one or multiple domains including cognition, motor performance, vision, hearing and behavior. Early identification of the disabilities combined with initiation of appropriate medical, educational, social and psychological interventions can maximize the health outcome and minimize the impact of disability. This paper discusses the barriers identified in early intervention of developmental disabilities.</p> <p><strong>Materials and methods: </strong>Qualitative Sample:&nbsp; Parents of children affected with developmental disabilities, Primary School Teachers, Special Educators, Nursing personnel working in the clinical setting. Sample subjects were selected from local schools, and hospital by purposive sampling. Method of data collection:&nbsp; Focus group discussion. Instruments used: Self developed questionnaire to conduct discussion.</p> <p><strong>Results: </strong>The major themes evolved as the barriers in adoption of early intervention programmes were grouped under 7 categories namely intellectual, attitudinal, social, cultural, technological, political and economic barriers.&nbsp;</p> <p><strong>Conclusion: </strong>The study findings suggest direction regarding possible steps to facilitate enhancement of early intervention services by an exploration of the role played by different barriers.</p> Rincymol Mathew ##submission.copyrightStatement## 2019-12-23 2019-12-23 7 7 10.3126/jbs.v6i3.26825 Effect of guideline on positioning of neonates in the neonatal intensive care unit <p><strong>Background: </strong>Developmentally Supportive Care is a broad category of interventions that is designed to minimize the stress of the NICU environment which include care such as control of external stimuli, clustering of nursery care activities, and positioning or swaddling of the preterm infant so as to provide a sense of containment similar to the intrauterine experience. The preterm neonates often lack adequate muscle tone and are at risk for developing abnormal movement pattern as well as skeleton deformation. Positioning is one of the important aspects of Developmentally Supportive Care to keep the baby comfortable. It is a basic neonatal nursing care and includes keeping the baby in supine, prone and side lying. As postural stability is a foundational milestone for motor development and premature infants are unable to exhibit postural stability without support, standardizing the definition of optimal positioning will lead to consistency in practice.&nbsp; A neonatal positioning guideline implemented in NICU will help in the growth and development of preterm neonates.</p> <p><strong>Materials and Methods: </strong>A prospective study was conducted in NICU of a tertiary medical College Hospital, Bangalore. It was an experimental study. Neonatal nurses who were involved in preterm infants care were selected by purposive sampling. Sample size was calculated based on the study by Jeansonetal. Pretest and posttest practices were assessed by taking the average of two observations for each nurse using infant positioning Assessment tool (IPAT). The nurses were trained by lecture followed by practical demonstration of neonatal positioning guidelines. After one week post test was repeated. Paired T test was used for comparing the positioning in pre and post intervention.</p> <p><strong>Results: </strong>Pre-test practice concludes that100% (25) of the staff nurses were in the category of ‘need for repositioning’ and 100% (25) of the nurses were in the category of ‘acceptable positioning’ in post-test (P &lt;0.001) with respect to all the positioning parameters. The mean Pretest score was 4.14 ±1.02 and post test mean score was 10.17 ± 0.57(P &lt;0.001). There was a significant association in practice score with respect to years of experience in NICU (P&lt;0.05).</p> <p><strong>Conclusion: </strong>There was a significant improvement in the infant positioning scores in the post test after introducing the positioning guidelines and training the nurses, compared to the pretest scores.</p> P.S. Soniya ##submission.copyrightStatement## 2019-12-24 2019-12-24 8 8 10.3126/jbs.v6i3.26840 Effect of Lamaze method on pain perception, anxiety, fatigue and labour outcome among primi mothers during labour process <p><strong>Background: </strong>Labour pain is the most severe pain a woman might ever experience in her life. Severity of pain and duration of labour psychologically affects a mother. It may lower the confidence, self-esteem and increase the level of anxiety and fatigue. The main purpose of the study was to evaluate the effectiveness of video based Lamaze Nursing care intervention on pain perception, anxiety, fatigue and labour outcome among Primigravida women admitted during childbirth. The conceptual framework for the study was developed based on Ernestine Wiedenbach’s helping art of clinical nursing theory.</p> <p><strong>Materials and methods: </strong>Quantitative Post-test only control group design was used. The sample size was 200 primigravida mothers, 37 to 40 weeks of gestation (100 in each group) and the study was conducted in first stage of labour room cosmopolitan hospital, Trivandrum.</p> <p><strong>Results: </strong>The study findings shows that Lamaze method and the techniques used in it were effective in reducing the pain, anxiety and fatigue during child birth and leads to a fine labour outcome Pain perception in experimental group was less when compared to control group, t=4.11(.01), anxiety in experimental group was lower when compared to control group, t value=6.44(.01), Fatigue was less among the experimental group when compared to control group, t value=9.09(.00) was significant. It was inferred that labour outcome in experimental group was better when compared to control group. t=5.17 significant at 0.01level. It was also depicted that there was association between pain perception, anxiety and fatigue and selected demographic variable like age, education duration of marital life, onset of labour</p> <p><strong>Conclusion: </strong>The findings of this study indicated that Lamaze nursing care intervention helped the women to cope up with the birthing process. It is a simple, easy to implement and most acceptable way to tackle pain, anxiety and fatigue among parturient mothers. Nurses and childbirth educators must be willing to provide comprehensive childbirth education that introduces women to a variety of pain management options. The excavator results supported that the incorporation of Lamaze method in nursing care is one of the best intervention to cope up with labour process.</p> Sindhu Kuruvilla ##submission.copyrightStatement## 2019-12-24 2019-12-24 9 9 10.3126/jbs.v6i3.26841 Effect of selected nursing interventions in the reduction of after-pains and involution of uterus among post-natal mothers in selected hospitals <p><strong>Background: </strong>The wonder of motherhood is the enjoyable journey that is felt only by the mother after giving birth. During postnatal period, the mother experiences problems like afterpain, back pain, pain in leg, breast engorgement, perineal discomfort, fatigue etc.</p> <p><strong>Material and methods: </strong>This study focus on finding the effect of selected nursing interventions such as ambulation, emptying&nbsp; bladder, deep breathing exercise, fundal massage, alternate leg raising and Kegel’s exercise in reducing afterpain and improving involution of uterus among postnatal mother in selected hospitals of Bhubaneswar by quantitative experimental research approach of Quasi experimental non randomized control group design. Purposive sampling technique was used to select the 60 postnatal mothers. Data were collected through Self-structured Questionnaire on socio-demographic, standardized numeric pain intensity scale on after pain and Self-structured rating scale on assessing involution of uterus. Descriptive and inferential statistics were used for analyzed the collected data.</p> <p><strong>Results: </strong>The study findings revealed that 83.3% of postnatal mothers had no pain and 96.7% had fundal height bellow umbilicus. After pain level in experimental group with the ‘t’ value was 20.79 at p value 0.05 level, which is statistically significant. There was significant difference observed between pre and post test mean score of after pain level and involution of uterus at p&lt;0.0001. There was notable association between parity of mother and afterpain level at χ2= 10.44.</p> <p><strong>Conclusion: </strong>It conclude that rendering of planned nursing interventions to the postnatal mothers were helpful in dropping the level of after pains and improves in involution of uterus. Therefore, the investigator felt that more importance should be given to assess the post partum afterpain and involution of uterus experienced by the mother and measures should be taken seriously in order to reduce the afterpain and improves involution of uterus.</p> Monalisa Mall T. Pravati K. Pratibha ##submission.copyrightStatement## 2019-12-24 2019-12-24 10 10 10.3126/jbs.v6i3.26842 Effectiveness of Entonox use in pain and comfort level of parturient mothers during first stage of labor <p><strong>Background: </strong>Natural childbirth is a beautiful experience with many safe options and benefits. Labor pain is widely viewed as being nothing more than the perception of unpleasant sensation. Many methods have been used for pain relief which constitutes non-pharmacological methods such as relaxation therapy and others are by pharmacological agents. Entonox, homogenous gas mixture of 50:50 nitrous oxide and oxygen, a form of inhalation analgesia is very effective in reducing pain and thereby progressing to painless vaginal delivery. The usage of Entonox is known worldwide, however its usage in Kerala is comparably very less<strong>. </strong>The objective of the study was to assess the effectiveness of inhalation analgesia (Entonox) in pain and comfort during first stage of labor among parturient mothers.</p> <p><strong>Materials and methods: </strong>A quasi-experimental pretest – posttest control group with 60 mothers (30 each in experimental and control) was the adopted design with parturient mothers in 37-40 weeks of gestation from selected hospitals in Kollam, Kerala. Demographic proforma, visual analogue scale and comfort assessment checklist were the tools used. The statistically significant relationships were identified by descriptive and inferential statistics. Ethical clearance was granted by the committee in Kollam, Kerala.</p> <p><strong>Results: </strong>Out of 60, 45% of the mothers were in the age group of 24-29 years, 35 % had undergone upper primary education, 61.7% were primi gravidae and 55% of them were in the gestational age of 39-40 weeks. The mean post interventional pain score of the experimental group was lower than that of control group (4.07/9.93, p &lt; 0.05). Also, the mean post interventional comfort score of the experimental group was lower than that of control group (7.37/15.77, p &lt; 0.05).</p> <p><strong>Conclusion: </strong>Entonox&nbsp;provides significant pain relief and improves comfort and it can be quickly implemented during painful&nbsp;labor. By further exploration and research studies would help the mothers be free to choose the harmless Entonox during labor.</p> Sruthi James ##submission.copyrightStatement## 2019-12-24 2019-12-24 11 11 10.3126/jbs.v6i3.26843 Gender differences in self care in type 2 diabetes in rural Kerala <p><strong>Background: </strong>Noncommunicable Diseases (NCDs) were estimated to have contributed to almost 60% of deaths in the world and 43% of the global burden of disease in 1999. NCDs are rapidly becoming a major public health threat in the developing world. The W.H.O fact file on NCDs states that healthy diet, regular physical activity, maintaining a normal body weight (self-care) are ways to prevent or delay the onset of type 2 diabetes or its complications. Thus, self-care in diabetes is the corner stone in achieving good glycemic control, thereby preventing the onset of diabetes complications which increases the morbidity and mortality of the disease. This study was undertaken to understand the effect of self-care on HbA1C (blood sugar control) among males and females with Type -2 diabetes in a rural population in Kerala. The study tries to draw out the differences in self-care among males and females taking into consideration the patriarchal nature of the society and to understand the gender differences in approaches to self-care. Sex- based differences should be considered when developing awareness and treatment programs for people with diabetes, more precisely in NCD preventive measures specifically for the Indian subcontinent.</p> <p><strong>Materials and methods: </strong>A cross sectional study was conducted in a stratified random sample of diabetes patients belonging to the three religious groups found in the study area, in a diabetes treatment center in Kanjirapally taluk of Kottayam district. Based on pilot study, a sample of 300 is chosen with 138 males and 162 females. For part 1 of the questionnaire, demographic details were entered by the researcher and the medical records were accessed to record the relevant details like height, weight, A1C, B.M.I., F.B.S. and chronic conditions of the patients. The selfcare activity of the patients were assessed with the SDSCAS (Summary of diabetes self-care activity scale). It</p> <p>consists a core set of 12 questions to assess the dietary habits, exercise regimen, blood sugar testing, foot care and smoking status for the past 7 days. &nbsp;</p> <p><strong>Results: </strong>Since the representative sample is not made of equal number of males and females, comparison of blood sugar control (HbA1C) based on self-care activities for males and females were calculated. The independent sample t-test is highly significant at 0.01 level with respect to general diet, specific diet, dietary adherence and podiatric care. The t-test again shows significance at 0.05 level with respect to physical activities on comparison. &nbsp;</p> <p><strong>Conclusions: </strong>The self-care activities varied greatly between males and females. The self-care activities of the females were very poor when compared with the males. The poor self-care activities of the females could be attributed to behaviour conditioned by gender relations prevalent in the society. Women seem to assimilate or internalize the patriarchal subjectivity of the society. But this is a feature of most households not only in the study area but of the country as a whole. This gender difference in self-care can be annihilated by stringent awareness and health education campaigns. NCD prevention strategies should include gender sensitive health promotion measures to achieve the WHO Global Strategy for the Prevention and Control of Noncommunicable Diseases (NCD Action Plan).</p> Maria Cheryl Morris M.S. John ##submission.copyrightStatement## 2019-12-24 2019-12-24 12 12 10.3126/jbs.v6i3.26844 Interplay between glycaemic status, lipid peroxidation and hyperlipidaemia in subjects with varying glucose metabolism <p><strong>Background</strong>: Diabetes is one of the largest global health emergencies of the 21st century. About 425 million people worldwide or 8.8% of adults between the ages of 20-79 years are estimated to have diabetes. There are evidences which show that higher blood glucose and cholesterol levels have an association with free radical-mediated lipid peroxidation. The aim of the study was to compare and correlate glycosylated haemoglobin (HbA1c), lipid peroxidation marker malondialdehyde (MDA), lipid profile, and antioxidant enzyme superoxide dismutase (SOD) activity in subjects with varying levels of glucose metabolism.</p> <p><strong>Materials and methods</strong>: This was a cross sectional study. Based on fasting plasma glucose and HbA1c, subjects were divided into diabetic patients (n= 40), pre-diabetic patients (n=38) and normal patients (n=41). Subjects were tested for lipid profile, MDA, and SOD activity. The comparison of parameter between the groups was carried out using one-way ANOVA followed by tukey’s multiple comparison test. The correlation between parameter was analyzed by Karl Pearson correlation coefficient using SPSS 20.0.</p> <p><strong>Results</strong>: The serum MDA levels (nmol/ml) were significantly higher in pre-diabetes (3.11±0.40) and diabetes mellitus (3.55±0.88) compared to normal controls (2.04±0.99). The SOD activity(U/ml) were lower in diabetes (7.69±3.83) and pre-diabetic subjects (8.13±2.15) compared to normal subjects (11.16±3.61). MDA has significant positive correlation with HbA1c and total cholesterol level. SOD has significant negative correlation with HbA1c and Total cholesterol/High Density Lipoprotein (TC/ HDL) ratio.</p> <p><strong>Conclusion</strong>: The findings strongly confirmed that there is a continuous interplay between glycemic status, lipid peroxidation and hyperlipidemia in which one factor perpetuates another leading to the progression of disease.</p> Remva Paul J.K. Mukkadan ##submission.copyrightStatement## 2019-12-24 2019-12-24 13 13 10.3126/jbs.v6i3.26845 Is isometrics effective on pain perception, functional mobility and anxiety of geriatric clients with osteoarthritis at Pathanamthitta District, Kerala <p><strong>Background: </strong>Osteoarthritis is a major cause of many medical conditions and disability in people above 50’s and leads to reduced activity in older people. Global statistics revels that over 100 million people worldwide suffers from Osteoarthritis.</p> <p><strong>Materials and methods: </strong>A quasi experimental pretest - posttest control group design was used. 200 geriatric clients with osteoarthritis residing in selected geriatric homes at Pathanamthitta were selected and assessed by using a Numerical Pain Intensity Scale, an Observational check list and a three point rating scale for pain, functional mobility and anxiety.</p> <p><strong>Results: </strong>There was a significant difference between the mean pain score( t = 10.758 p = 0.01, df – 198), functional mobility ( t = 7.73 p = 0.01, df – 198) and anxiety (t = 7.665 ,df –198, p=0.01in experimental and control group after intervention ( t = 10.758 p = 0.01, df – 198).Statistically no significant association was found between pain, functional mobility and anxiety with variables such as gender, religion, marital status, number of children’s and duration of stay.The pain and anxiety correlation value was ‘r’ = 0.89. The functional mobility and anxiety correlation value was ‘r’ = 0.80. The functional mobility and pain correlation value was ‘r’ = 0.83. It shows that statistically positive correlation is present between the geriatric clients’ pain and anxiety, functional mobility and anxiety and functional mobility and pain at p&lt;0.05% level of significance.</p> <p><strong>Conclusion: </strong>Exercise is one of the best methods to treat Osteoarthritis. This study proved that isometric exercises are beneficial to improve the functional mobility of joints in old age people. When the mobility increases, intensity of joint pain decreases.</p> M.D. Nisha ##submission.copyrightStatement## 2019-12-24 2019-12-24 14 14 10.3126/jbs.v6i3.26846 Mixed methods approach and its implications in acute care research <p><strong>Background: </strong>The acute care settings have the potential to facilitate robust epidemiological and public health research necessary for evidence-based system. The methods in emergency research are well suited for mixed methods research. Despite the use of quantitative and qualitative data in emergency settings, mixed methods studies in this field are limited to help researchers to address health care issues. Therefore, we aim to assess the prospects and implications of mixed methods approach in acute care settings. &nbsp;</p> <p><strong>Materials and Methods: </strong>We have reviewed the published English literature using the research databases (PubMed, Medline, CINHAL and Google Scholar) related to the implications of mixed methods in emergency research, in order to understand and broaden the scope of patient care in time critical conditions.</p> <p><strong>Results: </strong>Basically, there are four mixed method approaches which integrate qualitative and quantitative methods (such as Triangulation, Embedded, Explanatory and Exploratory design) which can be selected depending upon the research question. In a single study, appropriate selection of mixed method approach enables quality research which involves understanding of the different aspects of human interaction and paradigms to characterize complex healthcare systems from societal standpoint. So, the combination approach may answer key issues in emergency settings which enriches and enhances the healthcare practice that may influence patient outcomes. Notably, emergency research has wider range of parameters which not only benefit the patients but also help in overcoming system-related clinical challenges. Of note, the ethical conduct of study is crucial in a complex emergency situation which remains challenging for recruitment and obtaining informed consent from subject or their nest of kin. Another impediment is the lack of trained emergency researcher to support the research activities and data collection in the emergent settings.</p> <p><strong>Conclusion: </strong>Application of mixed approach is of great importance in emergency medicine to enhance our understanding of critical care research that may add valuable insight on various aspects of human behavior. Therefore, appropriate planning and integration of study design may help researchers to explore newer avenues to improve patients care in emergency settings.</p> Mohammad Asim A. Mekkodathil M. Ibnas B. Sathian ##submission.copyrightStatement## 2019-12-24 2019-12-24 15 15 10.3126/jbs.v6i3.26847 Poly cystic ovarian disease (PCOD) - a modifiable risk factor of infertility: A quasi-experimental research from South India <p><strong>Background: </strong>India has a population of 1.2 billion, nearly 30 million couples in the country suffer from infertility, in which female infertility is caused mainly by PCOD (40%). In Kerala, adolescent girls’ population comprises 7% and the prevalence is 15% (Annual vital report of statistics report 2015). The unhealthy eating habits and lack of exercise leads to PCOD. Therefore, as a nurse, the investigator has a pivotal role in creating awareness about the modification of lifestyle and prevention of future complications. The investigator observed that many students are diagnosed with PCOD during their physical training screening.</p> <p><strong>Materials and methods: </strong>Quantitative research approach, using quasi-experimental one group pre-test – post- test design was adopted to collect data by non-probability convenient sampling from 48 adolescent girls between 17-20 years those who were studying first year B.Sc. nursing in a private nursing college, Kerala. Demographic characteristics were age, religion, weight, family history, previous knowledge and knowledge questionnaire consisted of 30 questions with 4 options regarding poly cystic ovarian disease.</p> <p><strong>Results:</strong> Out of 48 subjects, majority (79.2%) were in the age group of 19-20 years, 47.9% were in the group of weight from 50-60 kg and 33.3% had menstrual problems. Majority 89.6% were not having family history and only 38.3% had previous knowledge. Pre- test&nbsp; showed that majority (97.91%) had average level of score, whereas in the post test majority (91.6%) adolescents had good knowledge regarding poly cystic ovarian disease. The calculated t value 19.79 at 0.05 level of significance indicated that the structured teaching programme was effective. The chi- square value was lower than the table value at 0.05 level showed that there was no significant association between knowledge and their selected demographic variables.</p> <p><strong>Conclusion: </strong>Structured teaching programme regarding had improved the knowledge level of adolescent girls about poly cystic ovarian disease.</p> K.D. Betty ##submission.copyrightStatement## 2019-12-24 2019-12-24 16 16 10.3126/jbs.v6i3.26848 Potential challenges in conducting clinical trials with mixed methods approach <p><strong>Background: </strong>Clinical trial is being conducted to assess the safety, efficacy and/or dosage regimen of a drug or therapeutic intervention in human subjects which are carefully selected on predetermined criteria. On the other hand, qualitative research is open-ended focuses on the depth of understanding of issues that are beyond the scope of quantitative analysis. Although, quantitative method is predominated in clinical research; over the past decade qualitative approach is being recognized for its value and unique contributions and is increasingly incorporated in clinical research. The combination of these two approaches in a single study is referred as Mixed Method design. Herein, we aim to explore the major challenges and pitfalls in conducting clinical trials with mixed method approach.</p> <p><strong>Materials and methods</strong><strong>: </strong>We reviewed the published literature in English language through the research engines (PubMed and Google Scholar) involving clinical trials/studies with mixed method approach to look for the potential challenges and issues identified during the conduct of mixed method research (MMR).</p> <p><strong>Results: </strong>There are various issues in conducting clinical trials with mixed methods approach as it is time consuming, requires expertise, skills and methodological training for both quantitative and qualitative research. Also, there are a number of challenges observed while conducting MMR, such as obtaining informed consent, safety events reporting, data retrieval, study documentation, data confidentiality and storage, inappropriate integration and interpretation of the data as well as incorrect ordering, preferences and objective of each method.</p> <p><strong>Conclusion: </strong>Use of hybrid approach in clinical trial can provide deeper understanding and insights of research question with higher validity and reliability. MMR has certain challenges which can be overcome by in-depth methodological training and collaboration. Therefore, strong collaboration between clinical and social scientists in necessary to design a competitive funding grant for mixed method research. Finally, integration and implementation of MMR is crucial for conducting pragmatic trials.</p> Muhamed Ibnas M. Asim B. Sathian ##submission.copyrightStatement## 2019-12-24 2019-12-24 17 17 10.3126/jbs.v6i3.26849 Prevalence and factors influencing behavioral problems among adolescents in selected high schools of Bhubaneswar: A survey in Odisha <p><strong>Background: </strong>Adolescent health and well-being are important for the health of future generation. Adolescence is a period of complex amalgamation of emotional, physical and social development leading to functional independence of the individual. It is also a period when behavioral problems could adversely impact the mental health. Timely identification and utilization of support system could lead better adjustment and less emotional and behavioral problems in adolescents. The objective of the present study was to identify the prevalence and the factors influencing behavioral problems among adolescents.</p> <p><strong>Materials and methods: </strong>Behavioral problems such as depression, substance abuse, suicidal tendency and conduct disorder were surveyed in schools. A total of 300 adolescents (150 boys and 150 girls) responded to the survey questions. Beck’s depression inventory, adolescent alcohol and drug involvement scale, suicidal behavioral questionnaire revised were used to examine depression, substance abuse and suicidal tendency respectively. Self structured questionnaire were used to evaluate conduct disorder and the factors influencing behavioral problems. The self designed tools were validated by seven multi disciplinary experts from pediatric, nursing, psychology and psychiatrics.</p> <p><strong>Results: </strong>Prevalence of various conditions is reported, depression was reported by 36%, drug abuse is 16%, conduct disorder was observed in 45% and 27% risk of suicide. Age, class and gender have a strong association with behavioral problems. In this study it has shown that females are more affected by behavioral problems than males and more problems are reported in higher class’s students. Attitude of mother has a strong impact on behavior of an adolescent. Overall, the current study highlights the prevalence and the factors that impact behavioral conditions in adolescents.</p> <p><strong>Conclusion: </strong>It concludes that behavioral problems among adolescents are common. They are often under recognized. Identification and recognition through proper assessment is needed to give them right referral.</p> Eliza Rath K. Javakrishnan ##submission.copyrightStatement## 2019-12-24 2019-12-24 18 18 10.3126/jbs.v6i3.26850 Problem relating to framing of hypothesis in legal research <p>A hypothesis is the starting point of any investigation or inquiry in the process of legal research. For any research to begin, it is always initiated with a problem of inquiry. It is called a tentative statement or generation or assumption or proposition. Whatever it may be, it has to be very clear, simple and definite without any creeping ambiguity therein. The condition attached to it that a hypothesis must be empirically verifiable, testable and comparable with the observed facts regarding a phenomenon or an experience. The formulation of a hypothesis gives direction to arrange the facts. In fact, a hypothesis occupies indispensable portion for any investigation or inquiry. It gives direction in regarding to collection of evidence. It makes observation and experiment possible. It proceeds in a direction to find out answer to the problem saving time, money and energy. Three things are very much essential knowledge, experience and capacity. A researcher has to form hypothesis based on them. We cannot admit anything as valid knowledge until a satisfactory test of the validity of the hypothesis. A researcher cannot satisfy even with results in which he still finds the same occurrence. In a certain place, for example delinquency is found in another area the hypothesis that delinquency in general is due to poverty is false, since other factors than poverty are operative in the production of delinquency among the wealthy. Undoubtedly the test in the first area was correct for that area at the particular time. But delinquency in general cannot be assumed to be due to poverty. So testing of hypothesis is big problem in legal research. If the testing of hypothesis is wrong there ends the research.</p> P.V. Gigi ##submission.copyrightStatement## 2019-12-24 2019-12-24 19 19 10.3126/jbs.v6i3.26851 Quality of life of children with cerebral palsy living in Kerala, India <p><strong>Background</strong>: The present study aimed at capturing the quality of life of children with cerebral palsy living in Kerala using the culturally adapted version of an international tool, CPQOL- child.</p> <p><strong>Materials and methods: </strong>Adopting multistage cluster sampling, data from 252 children was collected by telephonic interview coupled with mail survey. Data was analyzed with the help of IBM SPSS 21.0.</p> <p><strong>Results: </strong>The first and the best output of the study was CPQOL-child (Malayalam), the locally adapted version of an international tool valid for use among children with CP living in Kerala. Child’s means of communication, severity of CP, gross motor function, parental wellbeing and family health were found to be the significant determinants of QOL. Parent stress was found to have a significant effect on parent reported QOL scores of children with cerebral palsy (r=-.574, p&lt;.001). Parent’s perceived level of happiness (β=.40, p&lt;.001), being the most significant predictor of the model of overall QOL of children with CP calls for efforts to ensure parental wellbeing as the most effective way to ensure child’s QOL.</p> <p><strong>Conclusion: </strong>Family health (R<sup>2</sup>=.498) explained about half of the variability in QOL scores of children with CP living in Kerala calls for immediate tailor made interventions for family centered care.</p> Anu George Varghese S.M. Lucitta ##submission.copyrightStatement## 2019-12-24 2019-12-24 20 20 10.3126/jbs.v6i3.26852 Quality of life of children with nephrotic syndrome- development of a tool <p><strong>Background: </strong>Quality of life is an individual’s perception of their position of life in the context of their culture and value systems in which they live and, in their goals, expectations, standards and concerns. (WHO). Though various tools to measure the generic quality of life of paediatric clients are available, a disease specific tool that is culturally adaptive to assess the quality of life of children with nephrotic syndrome is unavailable. The aim of the study was to develop a valid and reliable tool to assess the quality of life of children with nephrotic syndrome.</p> <p><strong>Materials and methods: </strong>In-depth interview of twenty children with nephrotic syndrome and their mothers, review of literature and discussion with experts in health sector to formulate preliminary form of the tool. Tool is evaluated by 11 experts to ensure the content validity. Tool is then administered to 100 children with nephrotic syndrome. Item analysis was done to finalize the items in the scale and reliability estimated with split half technique (r= 0.93).</p> <p><strong>Results: </strong>Nephrotic Syndrome Paediatric Quality of Life (NSPQOL) assessment scale was finalized with 35 item using four-point rating scale.</p> <p><strong>Conclusion: </strong>The findings of the study suggest that the tool has potential for use as both a clinical as well as a research instrument.</p> M. Jacob Elsheba Mathew ##submission.copyrightStatement## 2019-12-24 2019-12-24 21 21 10.3126/jbs.v6i3.26854 Quality of life patients on hemodialysis in Kerala <p><strong>Background: </strong>End Stage Renal Disease (ESRD) is on the rise in the recent years which carries with it emotional, physical, psychological, social, and existential burdens that impact their Quality of life (QOL). The QOL describes life satisfaction and life concerns and are affected by health and illness. Maintenance of QOL with the effects of chronic illness is a challenging, multifaceted, complex endeavour for patients, their families and the health professionals. Objective: To assess the kidney disease related quality of life in patients with ESRD, its association with selected demographic, socio economic, disease and treatment related characteristics of ESRD patients.</p> <p><strong>Materials and methods: </strong>Descriptive survey was conducted on 112 participants diagnosed with ESRD and on hemodialysis at least for a minimum duration of 1 month, were recruited from both government and private hospitals through purposive sampling as per the inclusion and exclusion criteria. The Kidney Disease Quality of Life (KDQOLTM-36) and Personal Data Sheet were used to assess the QOL and to obtain information as per the objectives. Descriptive analysis and Chi square test were used to analyze the data.</p> <p><strong>Results: </strong>Majority of the ESRD subjects had poor quality of life in all the domains, higher proportion being in the burden of illness (71.4%) and effects of illness (68.8%) domains. There was a significant association between the burden of illness and marital status(p=.01), type of bystander(p=.01); symptom and type of bystander(p=.03)</p> <p><strong>Conclusion: </strong>Majority of the ESRD patients had low KDQOL scores indicating poor quality of life in all the domains requiring intervention. This emphasizes the need to identify as well as manage QOL among them and develop appropriate intervention</p> Tessy Grace Mathews E. Mathew ##submission.copyrightStatement## 2019-12-24 2019-12-24 22 22 10.3126/jbs.v6i3.26855 Relationship between fasting blood glucose and body mass index among students of a medical college <p><strong>Background: </strong>Obesity is one of the most important modifiable risk factors in the pathogenesis of lifestyle diseases like atherosclerosis, hypertension and type 2 diabetes mellitus. Overweight or obese adolescents are at an increased risk of developing diabetes and hypertension in future. A study was done to determine the relationship between body mass index and fasting blood glucose among students of a tertiary care teaching hospital.</p> <p><strong>Materials and methods: </strong>A cross sectional analytical study was carried out among all medical students in a tertiary care teaching hospital in Kerala who consented to participate after obtaining approval from Institutional Research and Ethics Committee. The study tools used were standardized weighing machine, stadiometer, Accu-check glucometer and strips, disposable needles and pre-designed questionnaire.</p> <p><strong>Results: </strong>Among the 254 study participants, 67% were females. The prevalence of impaired fasting glucose is 18.11% in the study population. No significant correlation was found between fasting blood glucose and body mass index. There was an increase in median FBS as the BMI increases, though not statistically significant (p=0.08). In the linear regression model, the statistic R2 explains that 7.9% of the variability in fasting blood glucose is explained by body mass index.</p> <p><strong>Conclusion: </strong>The prevalence of prediabetes among the study participants was very high and it was higher among those who were overweight. The need of the hour is to identify the high-risk group in the community right from the young age and initiate trials or intervention studies to prevent or delay the onset of diabetes.</p> Saritha Susan Vargese T.M. Joseph E. Mathew ##submission.copyrightStatement## 2019-12-24 2019-12-24 23 23 10.3126/jbs.v6i3.26857 Retirement time planning of Indian expatriate in Umm Al Quwain region, a quasi experimental study from UAE <p><strong>Background: </strong>United Nations (2015) projected that the numbers of older persons (60+) grow from 901 million to 1.4 billion by 2030 and reach 2.1 billion in 2050 (WHO). Help Age India reported that the elderly population will reach to 143 million by 2021. Kerala has highest percentage of elderly almost 12.6 per cent of the population (Ministry of statics, 2016). Today’s changed work-life, youngster’s attitude, family and social structures, emigration of young family members has resulted in exclusion and emotional deprivation among the elderly forced to lead a lonely life. The survey was an attempt to investigate the Expatriate Keralite Individual attitude on their post retirement time planning.</p> <p><strong>Materials and methods: </strong>A quasi-experimental study was used to assess the attitudes of post retirement time plans among the 20 selected expatriate Keralite by using interview technique.</p> <p><strong>Result: </strong>Only 35% of the sample feels that it is necessary to plan for our retirement period. Half of the sample works for private firms and there is no security for them once they leave their job. Even though there is a need for planning their post retirement period they have not even think about it because they perceived that their family members feel sad to hear that they are coming back because they are only the source of income for their dependents. Ninety percentage of the sample did not realized that they have completed almost half part of their life and it is time for them to think wisely to plan ahead for their time left out to live.</p> <p><strong>Conclusion: </strong>Majority had not even started to think on about changes in life styles, activities and relationships. They need to be counseled to plan their time in post-retirement by time calculator and Middle age is the correct period to start planning what he or she will do in their second half of life.</p> Smitha J. Thundiparampil ##submission.copyrightStatement## 2019-12-24 2019-12-24 24 24 10.3126/jbs.v6i3.26858 Smart mobile phone usage pattern by students of professional colleges and it’s dependence: A comparative profile <p><strong>Background: </strong>Mobile phones have become an indispensable part of modern human life. With the ever-increasing utilization of smart phones, several psychological &amp; behavioural problems have emerged. Excessive use of smart phones has also led to poor academic performance among students. Keeping all these points in mind, a study was conducted in professional colleges to obtain base line data. Objectives: To assess the usage pattern of smart mobile phone among students of professional colleges and to evaluate the mobile phone dependence in students of professional colleges.</p> <p><strong>Materials and methods: </strong>In Visakhapatnam, a cross-sectional study was conducted among 100 Medical &amp; 100 Engineering students selected by random sampling technique. Data were collected using a pre-designed&amp; pre-tested questionnaire from October 2018 to November 2018. SAS-SV Scale was used to assess the mobile phone dependence. Collation of data was done using inferential statistical methods.</p> <p><strong>Results: </strong>The study population of Medical group consisted of 32% males &amp; 68% females; of these 45% were Day scholars &amp; 55% were residents of hostels. The study population of Engineering group consisted of 63% males&amp; 37% females; of these 76% were Day scholars &amp; 24% were residents of hostels. The majority of students in both the professional groups were of the age group of 19 years. While assessing mobile phone usage pattern, it was found that age of initiation of mobile phone use was above15 years in 88.5 % in both the groups. 75%. of students in both the groups were using mobile phone between 1-6 hours a day. 45% of students were using mobile phone at home while 55%were using while on move. While 32% students had Addiction scale more than SAS-SV: cut off 31; factors like daily life Disturbance, withdrawal, cyber space-orientation relationship, overuse etc. 33% students were in the range of being at risk group (SAS-SV: 20 to 30). Out of 19 % Medical &amp; 32% Engineering students who attended calls while driving, 26% &amp; 25% continued conversation while still driving in both the groups respectively.131students often woke up from their sleep to check whether they had a Notification or a Missed call or SMS (P=&lt;0.01). False perception of mobile phone ringing was present among 12% of Medical and 14% of engineering students.</p> <p><strong>Conclusion: </strong>The study showed an increased dependence of mobile phone use among Medical &amp; Engineering students, which imparts a negative effect on physical and mental health &amp; also poor academic performance.</p> R.D. Ramesh A. De K. Vijaya ##submission.copyrightStatement## 2019-12-24 2019-12-24 25 25 10.3126/jbs.v6i3.26859 Solution focused brief therapy: Concerns of school psychologists dealing with adolescents <p><strong>Background: </strong>A shift from the psychodynamic perspectives in psychotherapy to the solution-focused "brief" techniques is a boon to the school system where constraints of time are a serious issue. SFBT is a strength-based approach. According to its assumptions, most clients want to change, they have the competence to envision the change and make it happen. At the same time, breakthrough revelations about the functioning of the adolescent brain have catapulted old beliefs in the competence of a typical adolescent to use his rational regions of the brain as situations demand. Latest neuroscientific techniques can predict not only the "kind" of changes but the pace with which changes are happening in different regions of the brain. The immature pre-frontal cortex of adolescent stand in vis-a-vis to the assumption of the SFBT that client has the competence to resolve the issue. Adding to this, a huge repository of research literature asserts that contextual factors do have an important role in the mental health of adolescents. Early shifting into solution talk during the therapeutic process may overlook contextual factors or unconscious impulses which actively collude to sustain the problem. So the purported co-construction of solution occurring between the client and therapist need not always result in intended changes and cases of relapses are common.</p> <p><strong>Objectives:</strong> The present study was an attempt to seek clarification for the doubts and misgivings usually occur in the minds of school psychologists dealing with adolescent clients. Certain questions were framed to have an orientation in the review process. How far SFBT's assumptions are compatible with the bio-psycho-social disposition of adolescence? Given the latest neuro-scientific facts about adolescent brain functioning, how congruent is SFBT's strength-based approaches with adolescents' not so competent brain dynamics? Shift to “solution talk” ---how far it is practical when the adolescent client’s issues lay interwoven with many psycho-social factors? What past research has to say about the process of SFBT rather than the outcome of SFBT?</p> <p><strong>Materials and methods: </strong>Sixty-seven papers comprising empirical studies, meta-analyses, conceptual papers dealing with various aspects of SFBT were reviewed for the purpose. ERIC, Psych INFO, Google, Medline, and PUBMED were the major database depended for retrieving the literature. Aspects of SFBT such as "briefness", focus on the solution (rather than the problem), therapeutic alliance, adherence to the trust in positive-strengths of the client ---all these were explored for their compatibility with the unique developmental characteristics of adolescence.</p> <p><strong>Conclusion: </strong>Worldwide efforts are in place to elicit novel ways of understanding and working with adolescents. SFBT technique must be customized to meet and unique needs and characteristic of the adolescent group. There are a host of researchers and therapists who believe that adolescent and child treatments will be more effective if the frame and structure of the therapy are tailored to the developmental level and characteristics of the clients. The present review about SFBT reached the same conclusions and has tentatively produced suggestions (with proper rationale) for re-orientation.</p> Jeny Rapheal ##submission.copyrightStatement## 2019-12-24 2019-12-24 26 26 10.3126/jbs.v6i3.26860 The effectiveness of attention improving multimedia package on selective attention of children with ADHD <p><strong>Background: </strong>The aim of present study is to improve the selective attention of children with attention deficit hyperactivity disorder (ADHD), using a computer application.</p> <p><strong>Materials and methods: </strong>The investigator developed a computer assisted program (Attention Improving Multimedia Package) to improve the selective attention of children with ADHD. The training package consists of performance based and timed activities aimed to improve the accuracy, concentration and speed of work of children with ADHD. After developing the tool, the investigator approached the school authorities. The purpose and need of the study were explained to the Principals and teachers. The samples were selected by assessing the students using ADHDSRS. The school rater option was used. The investigator selected 20 students who had been screened as “at risk” and “high risk’’ of ADHD in school rater option as explained in the&nbsp;&nbsp; ADHD- SRS manual. The investigator selected 20 students who are “at risk” and “high risk” of ADHD from both sexes. The subjects were the 5th, 6th and 7th grade students aged 10, 11 and 12 selected from Govt. H S S, Puthoor. Then the samples were randomly assigned to experimental and control group. Each group consisted of 10 subjects. Both the experimental and control group were assessed to understand their baseline performance. The d2 test of attention was administered to both groups. Before administering the test, the procedure and purpose were explained. Socio- demographic details were noted in the space given. After completing the d2 test of attention, filled recording blanks were collected and checked whether it is completed or not. Then the AIMP were given to the experimental group in a separate classroom individually. Before administering the AIMP, a rapport was created with subject. The procedures and importance of AIMP was explained to the subjects. The subjects were allowed to sit comfortably in front of the computer and the room was free from any disturbances.</p> <p>After the successful completion of the intervention, a post- test was conducted for both experimental and control group. To find out the sustainability of attention after the intervention, the investigator conducted a delayed post-test after one week of post-test. There were 5 sessions. In the first session the subjects were asked to complete LEVEL 1 activity. In the second session, the subject was informed to complete the LEVEL 1 at first and then the LEVEL 2 activities. The third, fourth and fifth sessions were administered by starting from the LEVEL 1. By repeating the activities, the subject could easily complete the previous level of activities faster than earlier. The time taken to complete was recorded on each session, so the administer can observe the improvement of subject.</p> <p><strong>Results: </strong>The mean rank and Wilcoxon Z value of pre-test and post- test scores on accuracy of performance of experimental group are 3.00 and 2.121 respectively. The Z value of experimental group is significant at 0.05 level.</p> <p><strong>Conclusion: </strong>Hence, the null hypothesis, “there is no significant difference in the accuracy of performance of experimental group before and after intervention” is rejected and is concluded that there is a significant improvement in accuracy after intervention.</p> P.T. Baburaj Princy George K.S. Anjaly ##submission.copyrightStatement## 2019-12-24 2019-12-24 27 27 10.3126/jbs.v6i3.26861 Web-based self-care management program of patients with type 2 diabetes mellitus <p><strong>Background: </strong>The purpose of the study is to determine the effectiveness of web-based self-care management program for type 2 diabetes mellitus through sharing evidenced-based information about Diabetes through the use of a web-based module.</p> <p><strong>Materials and methods: </strong>The study used the quasi-experimental pre and posttest design to determine the effectiveness of a web-based self-care management program in the management of patients with type 2 Diabetes mellitus (DM). The study was conducted in three phases and acquired 30 purposively selected type 2 DM adult patients. The study used a web-based self-care management program that included basic information about Type 2 Diabetes mellitus using three designed modules specifically for diet, exercise and drug management.</p> <p><strong>Results: </strong>The patient status during the pre and post-intervention phase is an FBS reading of 152 mg/dl or diabetes stage to pre-diabetes stage (119 mg/dl), normal BMI (22), low risk for obesity WHR and barely satisfactory to satisfactory level of knowledge to diabetes and DM management. There is very significant difference (p=&lt;000) in the pre and post FBS reading of patients and the level of knowledge to diabetes and DM management after the web based DSME while there is no significant difference in the BMI and WHR. There is very significant difference (p=&lt;000) in the RBS readings of the patients during the 1st, 2nd and 3rd phases of the intervention of .web based DSME (p=&lt;000) post hoc analysis with Wilcoxon Signed Rank Test revealed that there is very significant difference (p=&lt;000) between groups.</p> <p><strong>Conclusion: </strong>The use of web-based self-care management program is effective in improving FBS/RBS and level of knowledge to diabetes and DM management of patients with type 2 diabetes mellitus but needed longer intervention to improve BMI and WHR .Nurses as part of the DSME group and as health educator may use technology in giving health education to patients to improve patients self-management to diabetes.</p> Maraeh Angela Mancha B.R.G. Marie E.C. Ela Shyr Racquel Tayor - Cruz J. Calvin D. Leon M. Josephine ##submission.copyrightStatement## 2019-12-24 2019-12-24 28 28 10.3126/jbs.v6i3.26862