Background Hydrocephalus is a common neurological disorder in children caused by an imbalance between cerebrospinal fluid production and absorption. Early recognition of its clinical presentation is essential for timely diagnosis and management. Objective To assess the clinical presentation of pediatric patients diagnosed with hydrocephalus admitted to the neurosurgery units of a tertiary care hospital. Methods A descriptive cross-sectional study was conducted among 85 pediatric patients with hydrocephalus admitted from July to December 2022, using total enumeration. Data were collected through caregiver interviews using a structured schedule covering sociodemographic characteristics, clinical profile, and presenting complaints. Results Aqueductal stenosis (41.2%) was the leading cause of hydrocephalus, followed by meningitis (29.4%), brain tumors (15.3%), and myelomeningocele (14.1%). Most patients (80.0%) underwent right medium-pressure ventriculoperitoneal shunt surgery. Increased head circumference (82.5%) and vomiting (50.6%) were the most common presenting complaints. Conclusion Clinical presentation varied across age groups. Early recognition of symptoms and timely referral may improve outcomes and reduce complications in pediatric hydrocephalus.
Objectives To apply the heart failure disease management (HFDM) framework while providing nonpharmacological interventions for heart failure patients in a tertiary-level hospital in northern India. Methods A pre-experimental study was carried out on 101 heart failure patients having an ejection fraction less than or equal to 40%. Participants were chosen purposively during their outpatient department visits. Baseline information about sociodemographic, clinical characteristics, exercise capacity, self-management, quality of life, medication adherence, health-related depression, and activities of daily living was obtained. Participants were provided with a one-to-one demonstration and educational session about self-monitoring and maintenance. These sessions were supplemented with one educational booklet on aspects of heart failure management, especially the individualized exercise protocol as per the New York Heart Association functional class. Telephonic encouragement was provided twice, that is, on day 15 and at 1 month. They were physically followed up at 3 months of baseline visit. Results Significant improvement was noticed in signs/symptoms like breathing difficulty ( p = .028), heart murmurs ( p = .002), activity intolerance ( p = .013), mild ascites ( p = .016), self-care adequacy ( p = .001), and quality of life ( p = .001). Conclusion Protocolized management of heart failure via the HFDM framework was effective in improvement of symptoms, self-care adequacy, and the overall quality of life of patients suffering from heart failure.
Background The evidence suggests that the midwifery care model is associated with better outcomes in the labour and birth process, although the debate is already heated. Aim To verify the variation in the duration of the labour process among low-risk pregnant women cared for within different assistance midwifery models and to measure any variation in maternal and neonatal outcomes. Methods A single-centre cross-sectional observational study was conducted in a second-level hospital (hub) in accordance with the STROBE guidelines (Strengthening the Reporting of OBservational studies in Epidemiology), including 272 pregnant women. Findings The standard care with ‘regional analgesia’ and ‘one-to-one with regional analgesia’ models are linked to longer labour durations, identifying analgesia as a variable that affects both assistance types. The ‘one-to-one’ model and the ‘one-to-one’ model with water were correlated with a reduction in gynaecologist consultations due to unexpected worsening in the clinical labour conditions compared to the ‘standard’ model, while being multiparous, age group and birth weight were not related to an increased risk. Discussion When midwifery care during labour was prolonged, as in the ‘one-to-one’ model, some outcomes, such as lacerations, episiotomies, postpartum haemorrhage and gynaecologist consultation, improved. These outcomes can be considered midwifery-sensitive outcomes . Conclusion The ‘midwifery care-led’ model promotes the personalisation of assistance, allowing the woman to have the birth experience she prefers, guaranteeing safety.
Background The COVID-19 pandemic disrupted routine immunization services, creating missed opportunities for childhood vaccination and threatening progress toward Sustainable Development Goal (SDG) targets 3.2, 3.3, and 3.B. Objectives To assess the missed routine immunizations among children in India during the pandemic and examine parental experiences of accessing services. Methods This cross-sectional study was conducted at a tertiary-level pediatric hospital. Using convenience sampling, parents of all children who had visited the pediatric vaccination room over 3 months, from June to August 2021, for routine immunization services were eligible to participate in this study. Enrollment was done only after written and informed consent was taken from the parents or legal guardians. In-person interviews and an online survey using Google Forms were conducted to collect data as per participants’ convenience. Results Of 350 parents approached, 316 participated (response rate, 90.3%). The mean age of the children was 4.01 ± 4.0 years (range: 0–16). Overall, complete vaccination coverage was 62.3% ( n = 197). Coverage was highest for the at-birth Bacillus Calmette-Guérin-oral polio vaccine-hepatitis B dose (285, 90.2%) and lowest for the Td dose at 10 years (17, 54.8%). Government health facilities were preferred by 91% of parents. Reasons for missed vaccinations included child-related health issues (46, 38.6%), COVID-19-related barriers (43, 36.1%), and a lack of awareness or forgetfulness (19, 15.9%). Conclusion These missed opportunities may undermine child survival, the control of vaccine-preventable diseases, and equitable access to vaccines, thereby jeopardizing progress toward SDG targets nationally and globally.
Background Type 1 diabetes (juvenile diabetes) is a chronic metabolic disorder that causes the pancreas to make little or no insulin in children. Symptoms of juvenile diabetes can develop in just a few months. It has a major impact on the quality of life of children and the lived experiences of their parents, particularly mothers. Methodology A mixed-method convergent parallel design was used, and a sample size of 60 children with type 1 diabetes was selected for the quantitative approach. A semi-structured focus group interview was conducted with 20 mothers to assess the lived experiences of mothers of children with diabetes. Socio-demographic data, the clinical profile of type 1 DM children and PedsQL™ Generic Core Scale were used for the quantitative approach. Result Almost equal proportions (38%) of children had good and average quality of life, as per children’s self-reports and parent proxy reports. However, about 18% of children reported that they had a poor quality of life, while 13% of parents reported that their children had a poor quality of life. Three themes were extracted from the lived experiences of mothers: sharing experiences of care; personal, psychosocial, and schooling concerns; and barriers to quality care for diabetic children. Conclusion In the present study, the majority of diabetic children diagnosed with type 1 diabetes had a good quality of life, as per diabetic children’s self-reports and parents’ proxy reports. Quality of life was found to be good in the social domain in comparison with other domains. Mothers of children with diabetes dealt with the challenges of managing physical symptoms, had concerns about their children’s future, and faced various personal, psychosocial, and financial management issues. Therefore, by identifying these experiences and challenges, we can say that mothers of diabetic children need a unique and flexible program on diabetes management.
