Dysfunction among Families of Children with Intellectual Disability in India Using Systems Model: Prevalence, Pattern, and Severity of Impairment

OBJECTIVES

Family dysfunction is observed in families with children with intellectual disability (ID). We study the prevalence, pattern of dysfunction, and severity of impairment in these special families using Systems approach.

METHODS

Sixty-two special families (a child with ID) and 62 typical families (all children with typical development) were included in the present study. The presence of ID was confirmed and quantified with the Binet-Kamat Scale of intelligence or Gesell's Developmental Schedule and Vineland Social Maturity Scales among the special families. In the typical families, brief ID scale was used to rule out ID. Prevalence, pattern, and severity of family dysfunction were assessed using Family Apgar Scale, Chicago Youth Development Study Family Assessment Scale and Global Assessment of Relational Functioning Scale, respectively. Appropriate bivariate analyses were used.

RESULTS

About 53% of special families and 19% of typical families had family dysfunction. About 21% of special families and 71% of typical families had the satisfactory relational unit. Areas of adaptability, partnership, growth, affection, resolve, beliefs about family, beliefs about development, beliefs about purpose, cohesion, deviant beliefs, support, organization, and communication were significantly different between special and typical families. The functional impairment was significantly more in the special families.

CONCLUSION

Family dysfunction is more prevalent among special families in India using systems approach. These families should be screened for dysfunction, and family therapy be prescribed when required.

Correlation of the ethmoid infundibulum to the medial orbital wall in maxillary sinus hypoplasia: "infundibular lateralization" a diagnostic CT finding

In patients with chronic rhinosinusitis, the presence of maxillary sinus hypoplasia (MSH) may be obscured by extensive mucosal disease or nasal polyposis. Recognition of MSH and its effect on adjacent anatomic structures is of utmost clinical significance in endoscopic sinus surgery. Failure to recognize the impact that MSH has on the position of the ethmoid infundibulum relative to the medial orbital wall could lead to inadvertent damage to the wall during surgery. We conducted a prospective study of 75 patients with clinically and endoscopically proven chronic rhinosinusitis to evaluate the prevalence of MSH. We found that MSH was present in 12 patients (16.0%); 7 of the 75 patients (9.3%) had bilateral disease, and 5 (6.7%) had unilateral disease. We then correlated the relationship of the ethmoid infundibulum to the medial orbital wall as determined by computed tomography in patients with and without MSH. We found that in most cases of MSH, the ethmoid infundibulum was displaced lateral to the medial wall of the orbit; the correlation between MSH status and displacement was statistically significant (p < 0.05). We propose the term "infundibular lateralization" to describe this consistent radiologic finding in MSH.

Screening for HIV infection by health professionals in India

BACKGROUND

Stigma and discrimination, particularly in access to healthcare, remains a major problem for people Infected with HIV in most parts of India.

METHODS

We did a multicentre study (n = 10) with a cross-sectional survey design using a standardized, interviewer-administered questionnaire.

RESULTS

A total of 2200 healthcare providers participated. The knowledge, attitude and practice (KAP) related to HIV service delivery were very poor with a mean overall KAP score of only 49.7% (CI: 49.1-50.3). Only 5%, 5% and 1% of the participants scored more than 75% separately for the dimensions of knowledge, attitude and practice, respectively. Only 24.4% and 36.7% of responders knew that HIV screening was not recommended prior to surgery and pre-employment check-up. Many doctors (19.4%) had refused treatment to people living with HIV/AIDS (PLHA) at least some of the time and nearly half (47.2%) identified and labelled them; 23.9% isolated them in separate care areas and 13.3% postponed or changed treatment based on the patient's HIV status. Screening for HIV prior to elective surgery was done by 67% of providers. While 64.7% of responders were aware of the existence of national guidelines on and recommendations for HIV testing, only 38.4% had read the policy document.

CONCLUSION

There is a growing need to provide care, support and treatment to a large number of PLHA. The capacity of healthcare providers must be urgently built up so as to improve their knowledge of and attitude to HIV to enable them to deliver evidence-based and compassionate care to PLHA in various healthcare settings.

Estimation of length of calcaneum and talus from their bony markers

Since hardly a report is available on estimation of length of calcaneum and talus from a fragment of them, a fresh study was made on a present day south Indian population. A total of 110 calcanei (55 right and 55 left), and 70 tali (35 right and 35 left), all unpaired, dry, and devoid of gross pathology, were used. Maximum anteroposterior length of the bone was measured in millimeter using an anthropometric board, and linear measurements of the other bony markers were measured in millimeter using a sliding caliper. Bony markers of calcaneum were maximum anteroposterior length, maximum transverse width, length, width and depth of groove on the sustentaculum tali, and length, width, and depth of the sulcus calcanei. Bony markers of talus were maximum anteroposterior length, maximum transverse width, length and width of articular surface for the lateral malleolus, length and width of articular surface for the medial malleolus, vertical width and transverse width of articular surface of the head, width and depth of groove for tendon of the flexor hallucis longus, and length, width, and depth of the sulcus tali. Simple regression suggested that maximum length of the calcaneum regressed significantly with maximum transverse width, length, width and depth of groove on the sustentaculum tali, and length, width, and depth of the sulcus calcanei and that maximum length of the talus regressed significantly with maximum transverse width, length and width of the lateral articular surface, length of the medial articular surface, vertical and transverse diameters of the head, and depth of the sulcus tali. Maximum length of calcaneum and talus is derived from the regression values, to predict the stature of the person from available stature equations in the literature.

Significance of the role of self-study and group discussion

The study of anatomy is experiencing a reduction in course duration and content, lecture and dissection hours, and number of lectures and examinations. This necessitates that medical students develop skills for self-study. Toward that end, a self-study module in basic anatomy was tested. Fifty-seven new entrants were given a pretest (Pretest A) containing a questionnaire on basic anatomy. Then, in three groups each of 11 and two groups each of 12, they learned basic anatomy from recommended books in the library by self-study for 2 hours. They discussed what they had learned among their group members during a practical exercise, followed by a posttest (Posttest A). A control group of 57 new entrants during another year was given the same pretest (Pretest B) and a lecture on basic anatomy. Then, without opportunity for self-study, they were given a posttest (Posttest B). The answers were scored out of 40. The students' mean mark in Pretest A was poor. All the groups performed well in the practical exercise. In Posttest A, the mean mark increased significantly (P < 0.001), by 9.4. It shows that self-study and group discussions significantly helped the students in construction of core anatomical knowledge as well as the acquisition, assimilation, and application of anatomical concepts and content. The mean mark in Pretest B was also poor. In Posttest B, the mean mark increased significantly (P < 0.001), by 14.2. This indicates that the traditional teaching session is also useful and serves to advance student knowledge. Thus our innovative study module can create a positive learning environment and can become an alternative to traditional instruction in teaching anatomical terminology and basic anatomy.

Handedness identification from intertubercular sulcus of the humerus by discriminant function analysis

The accurate determination of skeletal handedness is a critical requirement in physical anthropology and forensic science. To differentiate handedness, discriminant function analysis is applied using the parameters of right and left intertubercular sulci. A total of 200 matched unpaired adult humeri (100 right and 100 left), collected from the Department of Anatomy, were used to measure four parameters of the intertubercular sulcus namely, width (X1), depth (X2), angle of medial wall (X3) and angle of lateral wall (X4) and to note the presence of supratubercular ridge of Meyer (X5). The discriminant function obtained with the significant variables, angle of medial wall (X3), angle of lateral wall (X4) and presence of the supratubercular Meyer (X5) is: Y = 0.093X3 + 0.056X4 + 0.775X5 - 13.46. The accuracy of correct classification using the discriminant function is 89% which is the best starting point for handedness determination approach. The methodology of using discriminant function can be crucial for medicolegal jurisprudence.

A 5-yr prospective epidemiological study of chronic obstructive pulmonary disease in rural south India

In a prospective epidemiological study from 1981 to 1986 in four villages belonging to the KV Kuppam block of North Arcot Ambedkar district in Tamil Nadu, we detected 328 patients of chronic obstructive pulmonary disease (COPD) amongst the 9946 inhabitants who were aged 30 yr or more. Majority of the population was from the lower income group and they were agricultural workers residing in these villages which were generally free from atmospheric pollution. Of the 328 patients with COPD, 198 were males and 130 were females showing an overall age specific prevalence of 33.0/1,000 with a prevalence of 40.8/1,000 for males and 25.5/1,000 for females, respectively. In nearly half of the patients who had chest radiography, changes consistent with COPD were observed; only one patient had clinical, radiological and electrocardiographic evidence of cor-pulmonale. Peak expiratory flow rate (PEFR) along with height (cm) were measured in 258 patients and compared to the predicted normal values. Most of those tested showed evidence of airways obstruction; severe defect was observed in 106 patients. Among the males, 122 gave a history of smoking; majority of the heavy smokers amongst them had severe impairment of PEFR. Females from these villages denied any history of smoking. Cooking for long hours using firewood and cowdung cakes could have contributed to the development of COPD in these village women.

Intertubercular sulcus of the humerus as an indicator of handedness and humeral length

Measurements of the maximum width and depth of the intertubercular sulcus (ITS), angles of the medial and lateral walls with the floor of the ITS, as well as the length of the humerus in 100 right and 100 left matched, unpaired dry humeri of 100 adults were statistically analyzed. Since 90-95% of the general population is right handed, on the basis of altered size of the dimensions of the right ITS relative to the left, it is proposed that greater width and smaller angles of the medial and lateral walls of the ITS of one side are indicative of handedness on that side. Handedness can further be deduced by the presence of a < 50 degrees angle of the medial wall and of a supratubercular ridge of Meyer on that side. The length of the humerus correlated with the width and depth of the ITS (P < 0.001). Regression equations of the length of the humerus on width, depth, as well as width and depth of the ITS have been derived.

Epidemiology of pulmonary eosinophilia in rural south India--a prospective study, 1981-86

STUDY OBJECTIVE

The study aimed to determine the prevalence and incidence of pulmonary eosinophilia, with special reference to tropical pulmonary eosinophilia, in a rural community.

DESIGN

This was a five year prospective study from 1981-86.

SETTING

The study was conducted in four villages of Tamil Nadu in south India.

SUBJECTS

The study population consisted of 24,950 subjects.

MEASUREMENTS AND MAIN RESULTS

After being questioned about pulmonary symptoms, the selected subjects had peripheral blood examined for total leukocyte and eosinophil counts; stools for ova, cysts, and parasites; sputum for acid-fast bacilli, and chest radiography. Subjects with blood eosinophilia of > or = 2000/mm3 were classified as having pulmonary eosinophilia. One of the 200 asymptomatic control subjects had blood eosinophilia > 2000/mm3. Twenty two (7.7%) of a further 286 subjects selected at random were found to have microfilaraemia. Between 1981 and 1984 the annual incidences of pulmonary eosinophilia were estimated at 4.1, 3.1, and 2.7/1000 while the prevalence rates were 6.4, 9.3, and 11.9/1000 respectively. This rising prevalence over time occurring simultaneously with a falling incidence suggests that the final incidence rate (2.7/1000) was likely to be the most accurate of the three estimated. At resurvey in 1986, 314 cases were classified as pulmonary eosinophilia giving a prevalence rate of 12.6/1000. Altogether 214 of them also had intestinal worm infestations, including 58 in whom eosinopenic remission was recorded after deworming alone. Eosinopenic remission was documented in 135 of 182 cooperative patients who were considered to have tropical pulmonary eosinophilia and agreed to be treated with diethylcarbamazine.

CONCLUSIONS

This study found that tropical pulmonary eosinophilia, either alone or with worm infestation, was a major cause or morbidity in this rural population.