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Re: [defencepeds] more on the study planned

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  • Madhuri Kanitkar
    good idea suprita and Vivek, but since it is questionaire based and we want numbers I think it would be wise to leave Hb out for the first survey. Suprita
    Message 1 of 14 , Mar 31 5:59 PM
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      good idea suprita and Vivek, but since it is questionaire based and we want numbers I think it would be wise to leave Hb out for the first survey. Suprita please get going on the proforma so we could all contribute and fine tune the final version.Hope babay wont mind!! Also may be easier to just enumerate supplemental foods and not try to work out calories since it will be easier and errors related to calculations will be minimal
      . Thereafter lets get all interested to contibute actively. Any pediatrician who can provide completed data on more than 50 cases will be acknowledged in the fianl publication/presentation. All hospitals with interns can use this to get the interns involved in data collection too
      On Thu, Mar 31, 2011 at 2:51 PM, vivek gupta <vkg3679@...> wrote:
       


      nice idea suprita first of all congratulations saw the photos
      few points
      1. it would be retrospective observational study probably we could do at around 1 year of age.
      2. we could probably do one Hb level/PBS  to know wether anemic or not and type of anemia.
      3. this would also help in knowing the cultural practices at various places.
      4. we could incorporate evidence of malnutrition /micronutrient deficiencies.
      5. best age would be at 12-15 months probably as they come for immunisation.
      Sqn Ldr vivek kumar 
      MD DNB 
      Graded Specialist pediatrics 
      12 Air Force Hospital Gorakhpur


      From: suprita kalra <kalrasuprita@...>
      To: defencepeds <defencepeds@yahoogroups.com>
      Sent: Wed, 30 March, 2011 1:29:16 PM
      Subject: [defencepeds] more on the study planned [1 Attachment]

       

      sorry for the longish delay in putting this up but have been just
      blessed with a son & truthfully speaking have been quite overwhelmed
      by all the work that goes in looking after a newborn. will probably
      have to start once I join back but anyone interested is most welcome &
      lets see what our data tells us
      Aim of the study:
      1) To collect important data related to nutrition of <2y olds with regards to:
      a) Percentage of children exclusively breastfed till 6 months of age
      b) Common foods with which complement feeding was started with
      c) Whether child put on Bottle feeds at any time
      d) Important foods taken through the day by the child
      d) Approximate calories & proteins taken in a day & whether they are
      appropriate for age
      2) To compare growth as defined by weight, height & head circumference
      at 6 months of age between infants exclusively breastfed till 6 months
      of age & those who were not
      3) To determine the percentage of children with undernutrition & short
      stature as defined by weight for height & height for age as per WHO
      standards respectively.

      Materials & methods: the study will be a one time observational study
      with filling of all dietary & anthropometric data at first visit to
      OPD of all children <2y old done over a period of 6 months.

      Problems envisaged: study has to be be a one time observational study
      as it will be unethical not to counsel the parents regarding
      appropriate foods & the correct amounts to be given to the children
      once we identify the problem areas.
      Secondly the study would be relevant only if we have a large sample
      size collected across preferably multiple centres.




      --
      Col Madhuri Kanitkar
      Senior Advisor Pediatrics and Pediatric Nephrology
      Base Hospital Delhi Cantt &
      Prof & HOD Pediatrics
      Army College of Medical Sciences
      New Delhi 110010 India
    • sanjeev khera
      Dear Suprita, though the idea seems simple eough, the other problems which i foresee- 1. What are we trying to prove? Is exclusive breast feed better ? I think
      Message 2 of 14 , Apr 2, 2011
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        Dear Suprita, though the idea seems simple eough, the other problems which i foresee-
        1. What are we trying to prove? Is exclusive breast feed better ? I think that is proven beyond doubt.
        2. We in armed forces certaily have a selection bias, as all the faujis represent at least upper middle strata. So our data would not be representative of population.
        3. Whats new in the study? 
        4. The sample size has to be HUGE!!!! As you have already pointed out.
         
        I think at the end of the day we would again be doing just another MULTICENTRIC study may be good enough to be published in MJAFI
         
                                                                           Maj Sanjeev Khera
                                                                          Clinical Tutor Pediatrics
                                                                           AFMC
      • vivek gupta
        sanjeev few comments 1. u have to see clientele in gorakhpur they donot represent upper middle strata 2. we would just do an observational study over a period
        Message 3 of 14 , Apr 2, 2011
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          sanjeev few comments
          1. u have to see clientele in gorakhpur they donot represent upper middle strata
          2. we would just do an observational study over a period of time.
          3. this study would or may show the incidence of malnutrition in our population drawn from various parts of our country. this would be unique.
          4. this would be simple not much statistical jargon required

          Sqn Ldr vivek kumar
                  Pediatrician 12 AFH Gorakhpur



          From: sanjeev khera <kherakherakhera@...>
          To: defencepeds@yahoogroups.com
          Sent: Sat, 2 April, 2011 6:58:57 PM
          Subject: Re: [defencepeds] more on the study planned

           

          Dear Suprita, though the idea seems simple eough, the other problems which i foresee-
          1. What are we trying to prove? Is exclusive breast feed better ? I think that is proven beyond doubt.
          2. We in armed forces certaily have a selection bias, as all the faujis represent at least upper middle strata. So our data would not be representative of population.
          3. Whats new in the study? 
          4. The sample size has to be HUGE!!!! As you have already pointed out.
           
          I think at the end of the day we would again be doing just another MULTICENTRIC study may be good enough to be published in MJAFI
           
                                                                             Maj Sanjeev Khera
                                                                            Clinical Tutor Pediatrics
                                                                             AFMC
        • Madhuri Kanitkar
          We could use the data to plan IEC activities and try to see if there is an urban/rural difference regarding child rearing practices for people in the armed
          Message 4 of 14 , Apr 3, 2011
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            We could use the data to plan IEC activities and try to see if there is an urban/rural difference regarding child rearing practices for people in the armed forces. It may not be high end research but may have a service interest to educate families right from the antenatal and obstetric wards to well baby clinics which in most hospitals is only run by SHO and sister giving vaccines. Peiaitricians need to be more involved and this study may help us know the magnitude of the problem
            MK

            On Sat, Apr 2, 2011 at 6:58 PM, sanjeev khera <kherakherakhera@...> wrote:
             

            Dear Suprita, though the idea seems simple eough, the other problems which i foresee-
            1. What are we trying to prove? Is exclusive breast feed better ? I think that is proven beyond doubt.
            2. We in armed forces certaily have a selection bias, as all the faujis represent at least upper middle strata. So our data would not be representative of population.
            3. Whats new in the study? 
            4. The sample size has to be HUGE!!!! As you have already pointed out.
             
            I think at the end of the day we would again be doing just another MULTICENTRIC study may be good enough to be published in MJAFI
             
                                                                               Maj Sanjeev Khera
                                                                              Clinical Tutor Pediatrics
                                                                               AFMC




            --
            Col Madhuri Kanitkar
            Senior Advisor Pediatrics and Pediatric Nephrology
            Base Hospital Delhi Cantt &
            Prof & HOD Pediatrics
            Army College of Medical Sciences
            New Delhi 110010 India
          • krish010@yahoo.com
            What about. Correlation of maternal education with child rearing practices and nutritional outcomes? Connected by DROID on Verizon Wireless ... From: vivek
            Message 5 of 14 , Apr 3, 2011
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              What about. Correlation of maternal education with child rearing practices and nutritional outcomes?

              Connected by DROID on Verizon Wireless


              -----Original message-----
              From: vivek gupta <vkg3679@...>
              To:
              defencepeds@yahoogroups.com
              Sent:
              Sun, Apr 3, 2011 18:26:28 GMT+00:00
              Subject:
              Re: [defencepeds] more on the study planned

               

              sanjeev few comments
              1. u have to see clientele in gorakhpur they donot represent upper middle strata
              2. we would just do an observational study over a period of time.
              3. this study would or may show the incidence of malnutrition in our population drawn from various parts of our country. this would be unique.
              4. this would be simple not much statistical jargon required

              Sqn Ldr vivek kumar
                      Pediatrician 12 AFH Gorakhpur



              From: sanjeev khera <kherakherakhera@...>
              To: defencepeds@yahoogroups.com
              Sent: Sat, 2 April, 2011 6:58:57 PM
              Subject: Re: [defencepeds] more on the study planned

               

              Dear Suprita, though the idea seems simple eough, the other problems which i foresee-
              1. What are we trying to prove? Is exclusive breast feed better ? I think that is proven beyond doubt.
              2. We in armed forces certaily have a selection bias, as all the faujis represent at least upper middle strata. So our data would not be representative of population.
              3. Whats new in the study? 
              4. The sample size has to be HUGE!!!! As you have already pointed out.
               
              I think at the end of the day we would again be doing just another MULTICENTRIC study may be good enough to be published in MJAFI
               
                                                                                 Maj Sanjeev Khera
                                                                                Clinical Tutor Pediatrics
                                                                                 AFMC
            • suprita kalra
              Point noted Khera Sir but idea was to collect data on how much is practiced by our patients from what we preach,to collect data that tells us that how many r
              Message 6 of 14 , Apr 5, 2011
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                Point noted Khera Sir but idea was to collect data on how much is practiced by our patients from what we preach,to collect data that tells us that how many r really exclusively breastfed & how many get adequate complement feeds & have no malnutrition despite our apparent upper middle class status,this would give us data from armed forces & we can see how it stands against national data where incidence of anaemia has been shown to be 80% & PEM beig 66%.

              • suprita kalra
                Thanks Madhuri Ma am,had attached proforma ,please go through it & will be grateful for suggestions,ma am your point is valid that includind Hb will complicate
                Message 7 of 14 , Apr 5, 2011
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                  Thanks Madhuri Ma'am,had attached proforma ,please go through it & will be grateful for suggestions,ma'am your point is valid that includind Hb will complicate things so maybe we can leave it out but can we add cliical evidence of malnutrition/micronutrient defi?also we can leave calculation of calories if it is too cumbersome & I think it would be a great idea as Krishnamurthy sir has said to see if maternal education status correlates with incidence of PEM ,so how do we do that,say in educational status we take in 3 levels..women educated upto 8th std & below,then upto 12th std,& finally more than that,
                • krish010@yahoo.com
                  You may hypothesize thus maternal education and cultural influences are more important than family income as predictor of healthy child rearing practices and
                  Message 8 of 14 , Apr 5, 2011
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                    You may hypothesize thus" maternal education and cultural influences are more important than family income as predictor of healthy child rearing practices and nutritional outcome. The advantage is your entire study population has uniform access to healthcare and you have access to accurate data on family income. There is enough diversity in maternal education in the fauji populaion. Yes you are studying folks who have a steady job and healthcare. Your research will say whether maternal education is important in this context. I think most of you have a pretty good idea about the answer. This is good population based research. Even if your data are negative, they are important. There is no reason to be diffident. I agree with Madhuri. Anything that you do systematically to understand your client population is not a waste. The service chiefs should be interested in this data and so should AFWWA/AWWA. There is no reason why every child on a fauji base should not be enrolled in the study. I suggest the following:
                    1. Formalize your study protocol. Study team and data collection forms
                    2. Get buy in from senior consultants/Advisors in med, peds everywhere.
                    3. Get buy in from chiefs of AFWWA/AWWA in delhi and then at every base.
                    Don't let the momentum die. Nobody can sabotage you except yourselves.

                    Connected by DROID on Verizon Wireless


                    -----Original message-----
                    From: Madhuri Kanitkar <mkanitkar15@...>
                    To:
                    defencepeds@yahoogroups.com
                    Sent:
                    Sun, Apr 3, 2011 18:25:31 GMT+00:00
                    Subject:
                    Re: [defencepeds] more on the study planned

                     

                    We could use the data to plan IEC activities and try to see if there is an urban/rural difference regarding child rearing practices for people in the armed forces. It may not be high end research but may have a service interest to educate families right from the antenatal and obstetric wards to well baby clinics which in most hospitals is only run by SHO and sister giving vaccines. Peiaitricians need to be more involved and this study may help us know the magnitude of the problem

                    MK

                    On Sat, Apr 2, 2011 at 6:58 PM, sanjeev khera <kherakherakhera@...> wrote:
                     

                    Dear Suprita, though the idea seems simple eough, the other problems which i foresee-
                    1. What are we trying to prove? Is exclusive breast feed better ? I think that is proven beyond doubt.
                    2. We in armed forces certaily have a selection bias, as all the faujis represent at least upper middle strata. So our data would not be representative of population.
                    3. Whats new in the study? 
                    4. The sample size has to be HUGE!!!! As you have already pointed out.
                     
                    I think at the end of the day we would again be doing just another MULTICENTRIC study may be good enough to be published in MJAFI
                     
                                                                                       Maj Sanjeev Khera
                                                                                      Clinical Tutor Pediatrics
                                                                                       AFMC




                    --
                    Col Madhuri Kanitkar
                    Senior Advisor Pediatrics and Pediatric Nephrology
                    Base Hospital Delhi Cantt &
                    Prof & HOD Pediatrics
                    Army College of Medical Sciences
                    New Delhi 110010 India
                  • krish010@yahoo.com
                    Also, you may want to co-opt UPS folks. There are some smart epidemiologists in that field Sam they have a lot of clout. Of fours you will have to find. Good
                    Message 9 of 14 , Apr 5, 2011
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                      Also, you may want to co-opt UPS folks. There are some smart epidemiologists in that field Sam they have a lot of clout. Of fours you will have to find. Good guys to work with.

                      Connected by DROID on Verizon Wireless


                      -----Original message-----
                      From: vivek gupta <vkg3679@...>
                      To:
                      defencepeds@yahoogroups.com
                      Sent:
                      Sun, Apr 3, 2011 18:26:28 GMT+00:00
                      Subject:
                      Re: [defencepeds] more on the study planned

                       

                      sanjeev few comments
                      1. u have to see clientele in gorakhpur they donot represent upper middle strata
                      2. we would just do an observational study over a period of time.
                      3. this study would or may show the incidence of malnutrition in our population drawn from various parts of our country. this would be unique.
                      4. this would be simple not much statistical jargon required

                      Sqn Ldr vivek kumar
                              Pediatrician 12 AFH Gorakhpur



                      From: sanjeev khera <kherakherakhera@...>
                      To: defencepeds@yahoogroups.com
                      Sent: Sat, 2 April, 2011 6:58:57 PM
                      Subject: Re: [defencepeds] more on the study planned

                       

                      Dear Suprita, though the idea seems simple eough, the other problems which i foresee-
                      1. What are we trying to prove? Is exclusive breast feed better ? I think that is proven beyond doubt.
                      2. We in armed forces certaily have a selection bias, as all the faujis represent at least upper middle strata. So our data would not be representative of population.
                      3. Whats new in the study? 
                      4. The sample size has to be HUGE!!!! As you have already pointed out.
                       
                      I think at the end of the day we would again be doing just another MULTICENTRIC study may be good enough to be published in MJAFI
                       
                                                                                         Maj Sanjeev Khera
                                                                                        Clinical Tutor Pediatrics
                                                                                         AFMC
                    • krish010@yahoo.com
                      Vivek, I like the point you make about the impact of region of origin. Perhaps , the child rearing practices are different in. People originating from madurai
                      Message 10 of 14 , Apr 5, 2011
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                        Vivek,
                        I like the point you make about the impact of region of origin. Perhaps , the child rearing practices are different in. People originating from madurai or muzaffarabad or malegaon or manipur. There is free GIS software (Geocode) that can help you map out individuals on a map of India.
                        Sincerely,
                        Krish
                        Connected by DROID on Verizon Wireless


                        -----Original message-----
                        From: vivek gupta <vkg3679@...>
                        To:
                        defencepeds@yahoogroups.com
                        Sent:
                        Sun, Apr 3, 2011 18:26:28 GMT+00:00
                        Subject:
                        Re: [defencepeds] more on the study planned

                         

                        sanjeev few comments
                        1. u have to see clientele in gorakhpur they donot represent upper middle strata
                        2. we would just do an observational study over a period of time.
                        3. this study would or may show the incidence of malnutrition in our population drawn from various parts of our country. this would be unique.
                        4. this would be simple not much statistical jargon required

                        Sqn Ldr vivek kumar
                                Pediatrician 12 AFH Gorakhpur



                        From: sanjeev khera <kherakherakhera@...>
                        To: defencepeds@yahoogroups.com
                        Sent: Sat, 2 April, 2011 6:58:57 PM
                        Subject: Re: [defencepeds] more on the study planned

                         

                        Dear Suprita, though the idea seems simple eough, the other problems which i foresee-
                        1. What are we trying to prove? Is exclusive breast feed better ? I think that is proven beyond doubt.
                        2. We in armed forces certaily have a selection bias, as all the faujis represent at least upper middle strata. So our data would not be representative of population.
                        3. Whats new in the study? 
                        4. The sample size has to be HUGE!!!! As you have already pointed out.
                         
                        I think at the end of the day we would again be doing just another MULTICENTRIC study may be good enough to be published in MJAFI
                         
                                                                                           Maj Sanjeev Khera
                                                                                          Clinical Tutor Pediatrics
                                                                                           AFMC
                      • krish010@yahoo.com
                        It would be reasonable if some of you found my enthusiasm for what can be achieved by defence pediatricians unrealistic, hypocritical or somewhat grating.
                        Message 11 of 14 , Apr 5, 2011
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                          It would be reasonable if some of you found my enthusiasm for what can be achieved by defence pediatricians unrealistic, hypocritical or somewhat grating. After all, I prematurely quit the fauj and the country. What right do I have to be even part of the discussion? I offer the following in explanation:
                          1. While, as a young man I was convinced of the inevitability of my professional demise, watching the trajectory of my seniors (AVM Raghu),  classmates( Mukti), friends (Sheila, Daljit) and my own travels have convinced me that life has a way of working out, if you just make use of one day at a time. This is the source of my enthusiasm.
                          2. I have been impressed by the power of cooperative groups and the value of population based studies. There are many examples of simple well designed population based studies that have generated important insights.
                          3. I would like to give something back to my teachers and mentors who gave me a great education. If I can help one young Pediatrician, it would be a source of great satisfaction.
                          Thanks for letting me be an honorary member of your group.
                          Sincerely
                          Krish
                          Connected by DROID on Verizon Wireless


                          -----Original message-----
                          From: vivek gupta <vkg3679@...>
                          To:
                          defencepeds@yahoogroups.com
                          Sent:
                          Sun, Apr 3, 2011 18:26:28 GMT+00:00
                          Subject:
                          Re: [defencepeds] more on the study planned

                           

                          sanjeev few comments
                          1. u have to see clientele in gorakhpur they donot represent upper middle strata
                          2. we would just do an observational study over a period of time.
                          3. this study would or may show the incidence of malnutrition in our population drawn from various parts of our country. this would be unique.
                          4. this would be simple not much statistical jargon required

                          Sqn Ldr vivek kumar
                                  Pediatrician 12 AFH Gorakhpur



                          From: sanjeev khera <kherakherakhera@...>
                          To: defencepeds@yahoogroups.com
                          Sent: Sat, 2 April, 2011 6:58:57 PM
                          Subject: Re: [defencepeds] more on the study planned

                           

                          Dear Suprita, though the idea seems simple eough, the other problems which i foresee-
                          1. What are we trying to prove? Is exclusive breast feed better ? I think that is proven beyond doubt.
                          2. We in armed forces certaily have a selection bias, as all the faujis represent at least upper middle strata. So our data would not be representative of population.
                          3. Whats new in the study? 
                          4. The sample size has to be HUGE!!!! As you have already pointed out.
                           
                          I think at the end of the day we would again be doing just another MULTICENTRIC study may be good enough to be published in MJAFI
                           
                                                                                             Maj Sanjeev Khera
                                                                                            Clinical Tutor Pediatrics
                                                                                             AFMC
                        • DALJIT SINGH
                          Dear Krish Sir, It is a privilege to have you as part of us. Daljit
                          Message 12 of 14 , Apr 5, 2011
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                            Dear Krish Sir,
                            It is a privilege to have you as part of us.
                            Daljit

                            On 4/5/11, krish010@... <krish010@...> wrote:
                            > It would be reasonable if some of you found my enthusiasm for what can be
                            > achieved by defence pediatricians unrealistic, hypocritical or somewhat
                            > grating. After all, I prematurely quit the fauj and the country. What right
                            > do I have to be even part of the discussion? I offer the following in
                            > explanation:
                            > 1. While, as a young man I was convinced of the inevitability of my
                            > professional demise, watching the trajectory of my seniors (AVM Raghu),
                            > classmates( Mukti), friends (Sheila, Daljit) and my own travels have
                            > convinced me that life has a way of working out, if you just make use of one
                            >
                            > day at a time. This is the source of my enthusiasm.
                            > 2. I have been impressed by the power of cooperative groups and the value of
                            >
                            > population based studies. There are many examples of simple well designed
                            > population based studies that have generated important insights.
                            > 3. I would like to give something back to my teachers and mentors who gave
                            > me a great education. If I can help one young Pediatrician, it would be a
                            > source of great satisfaction.
                            > Thanks for letting me be an honorary member of your group.
                            > Sincerely
                            > Krish
                            > Connected by DROID on Verizon Wireless
                            >
                            > -----Original message-----
                            > From: vivek gupta <vkg3679@...>
                            > To: defencepeds@yahoogroups.com
                            > Sent: Sun, Apr 3, 2011 18:26:28 GMT+00:00
                            > Subject: Re: [defencepeds] more on the study planned
                            >
                            > sanjeev few comments
                            > 1. u have to see clientele in gorakhpur they donot represent upper middle
                            > strata
                            > 2. we would just do an observational study over a period of time.
                            > 3. this study would or may show the incidence of malnutrition in our
                            > population
                            > drawn from various parts of our country. this would be unique.
                            > 4. this would be simple not much statistical jargon required
                            >
                            > Sqn Ldr vivek kumar
                            > Pediatrician 12 AFH Gorakhpur
                            >
                            >
                            >
                            >
                            > ________________________________
                            > From: sanjeev khera <kherakherakhera@...>
                            > To: defencepeds@yahoogroups.com
                            > Sent: Sat, 2 April, 2011 6:58:57 PM
                            > Subject: Re: [defencepeds] more on the study planned
                            >
                            >
                            > Dear Suprita, though the idea seems simple eough, the other problems which i
                            >
                            >
                            > foresee-
                            > 1. What are we trying to prove? Is exclusive breast feed better ? I think
                            > that
                            > is proven beyond doubt.
                            > 2. We in armed forces certaily have a selection bias, as all the faujis
                            > represent at least upper middle strata. So our data would not be
                            > representative
                            > of population.
                            > 3. Whats new in the study?
                            > 4. The sample size has to be HUGE!!!! As you have already pointed out.
                            >
                            > I think at the end of the day we would again be doing just another
                            > MULTICENTRIC
                            > study may be good enough to be published in MJAFI
                            >
                            >
                            > Maj
                            > Sanjeev
                            > Khera
                            > Clinical
                            > Tutor
                            > Pediatrics
                            >
                            >
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