Mitasha Singh

Prevalence of autism spectrum disorder among rural, urban, and tribal children (1–10 Years of Age)

Introduction: Studies on autism spectrum disorders (ASDs) have largely focused on children in specific settings. The current scenario of research in ASDs is limited largely to clinic-based case reports, case series, and retrospective chart reviews. The present study is the first population-based prevalence study conducted across rural, urban, and tribal populations in India. Materials and Methods: A cross-sectional two-phase study was conducted covering children in the age group of 1–10 years of age across geographical regions representing rural, urban, and tribal populations. The first phase (screening phase) involved administration of the Hindi version of the Indian Scale for Assessment of Autism. Those identified as suspected of ASD and 10% of all classified as nonsuspects for autism were also evaluated by the clinical team in second phase (evaluation phase). Results: Forty-three children out of a total of 28,070 children in rural, urban, and tribal area in the age group of 1–10 years were diagnosed as cases of ASD yielding a prevalence of 0.15% (95% confidence interval [CI] =0.15–0.25). Logistic regression analysis showed a two times significantly higher risk of diagnosing ASD in rural area as compared to tribal (odds ratio [OR]; 95% CI = 2.17 [1.04–4.52], P = 0.04). Male sex and upper socioeconomic group of head of family/father had a higher risk of getting diagnosed as autism as compared to lower socioeconomic group (OR; 95% CI - 3.23; 0.24–44.28, P = 0.38). Conclusions: Estimation of true prevalence of ASD in India is going to improve policies on developmental disabilities.

Malnutrition as a cause of mental retardation: A population-based study from Sub-Himalayan India

Background: Mental retardation is one of the most common disabilities of childhood. The research on childhood malnutrition and its relationship with cognitive functioning suggests that malnutrition alone does not cause mental retardation. Objective: To identify the relation between malnutrition and cognition among children from a Sub-Himalayan state in North India. Materials and Methods: A two-phase cross-sectional study was conducted in the rural, urban, and slum area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1–10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase, a door-to-door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for clinical examination to confirm mental retardation. Anthropometric assessment of all study children was done by measuring weight and height. The nutritional assessment was done by categorizing them according to Waterlow classification for malnutrition. Results: Out of the total 5300 children, 1.7% were diagnosed as mentally retarded. No positive association was reported with different types of malnutrition and mental retardation. A weakly positive association existed between nutritional status and mental retardation (correlation coefficient-0.04). Children who were both wasted and stunted had the highest risk (odds ratio, 95% confidence interval - 5.57, 2.29–10.36) of mental retardation as compared to normal. Conclusion: Malnutrition may be one of the causes but certainly not the only cause of mental retardation. Other causes may be contributing more significantly toward it.

Using multistate observational studies to determine role of hypertension and diabetes as risk factors for dementia

Background: Evidence suggests that modifiable risk factors which can be targeted by prevention are vascular diseases, such as diabetes, midlife hypertension (HTN), midlife obesity, midlife cholesterol, mid- and late-life depression as well as lifestyle factors such as smoking, physical inactivity, and poor diet. Methods: A comprehensive search of the National Library of Medicines PubMed database and Google Scholar was conducted. A combinations of medical subject headings and free text words that included search terms related to the exposure (e.g., prevalence, HTN, raised BP, high BP, diabetes, high blood sugar, DM, India, state), were combined with search terms related to the outcomes (e.g., prevalence, disease burden, estimate, dementia, India). The filters included were English for the language category and humans for the study category. Results: The PubMed search initially identified 269 references, and a total of 204 abstracts were screened by inclusion criteria. Full-text assessment of 136 articles on prevalence of dementia resulted in 20 relevant articles from which the different regions of the country were identified. Based on the search conducted according to the regions; 287abstracts of the prevalence of HTN and 577 on the prevalence of diabetes mellitus were screened. There were 43 full-text articles on the prevalence of HTN and diabetes from the regions where the prevalence of dementia was available. Of these potentially relevant articles were 14 in number. Conclusion: Despite the uncertainty in the role, the data analysis, therefore, points to a role in the prevention of HTN and diabetes to prevent dementia.

Predictors of Tobacco Use among Youth in India: GATS 2009-2010 Survey.

BACKGROUND Tobacco use among youth in India is an increasingly rising burden. It is affected by various socio-demographic factors, which form predictors of use. Focus on these predictors can help policy makers in curbing the major morbidity and mortality due to tobacco among youth. OBJECTIVE To study the various socio- demographic variables associated with tobacco use among youth in India. MATERIALS AND METHODS The study was a secondary analysis of data from the Global Adult Tobacco Survey, India 2009-10, in the age group of 15-24 years. Predictors of smoking and smokeless tobacco were analysed using data on occupation, education, and other sociodemographic factors place of living. Epi Info used for conducting the analysis. RESULTS The total population interviewed in GATS India -2010 was 69,926. Of these the youth population between 15- 24. The total number of tobacco users (smokers and smokeless) was 2,969 (22.%). There were 11 (3.05%) dual users. Smokeless form of tobacco (15.1%) was used more than smoked form among youth. Males and urban youth preferred smoked form of tobacco over smokeless form. Smoking among youth had an inverse relation with increasing education level. Majority of smokeless form of tobacco users and dual users belonged to poor economic classes. CONCLUSIONS This productive age group is more susceptible to tobacco addiction, especially smokeless tobacco. Rural youth, students, female sex and poor socio-economic strata prefer smokeless whereas urban, male and lesser educated youth preferred smoked form of tobacco. Efforts should be directed towards discouraging tobacco use initiation among the young population in India.

Pattern of reporting and practices for the management of traumatic brain injury: An overview of published literature from India

Background: Published literature regarding the demographics and mechanism of injury for traumatic brain injury (TBI) in India has not been analyzed in an organized sample. Objectives: The objective of this systematic review was to organize the published literature from India related to TBI and analyze it in a very specific sample to identify the specific patterns of injury and associated mortality. Materials and Methods: A search strategy with specific inclusion criteria was performed in PubMed, Cochrane, Web of Science, and the World Health Organisation (WHO) Global Health Library. The process included an additional search within the indexed literature and the website-based population survey reports. Results: Our review identified 72 studies from 300 potentially relevant articles based on the broad criteria that defined the demographics of the patients suffering from TBI and the details of trauma sustained, including the mechanism of injury as well as its diagnosis, management, and outcome. Changes in demographic patterns, the patterns of the body regions involved, the associated injuries, the clinical presentation, the follow-up status of patients suffering from TBI, who may or may not have shown clinical improvement, the overall outcome, as well as the mortality and disability status reported in the literature were analyzed. A high incidence of TBI in the productive population is of serious concern. Extremes of ages are more vulnerable to severe injury and a poor outcome. Conclusion: Quantitative analysis of injuries and outcomes of TBI victims shows a bigger health impact in the economically active population and in patients in the extremes of age groups.

Game change in Indian Health Care System through reforms in medical education curriculum focusing on primary care- Recommendations of a joint working group

Despite the stated aim of Medical Council of India (body regulating medical education in India) to produce an Indian Medical Graduate with requisite knowledge, skills, attitudes, values and responsiveness, so that he or she may function appropriately and effectively as a doctor of first contact of the community while being globally relevant, it appears that we failed. The joint working group extensively consisting of medical teachers have come up with suggestions which may work as the game changer in Indian Health care system. The key is to dedicate medical education towards primary care.

Inequality in the immunization schedules of different states of the same Country: Are we aware?

With Universal Immunization Programme in India incorporating newer vaccines, the immunization schedule has been changing rapidly, varying from one state to another. The number of diseases being protected against has increased from 6 to 14 in the past few years. The immunization schedules of the states of Delhi, Himachal Pradesh, and Haryana were compared among themselves and also with the schedule recommended by the Indian Academy of Pediatrics. Variations were observed. The migrants, service providers, and those users switching between private and public sector many a time are affected due to this variation among the immunization schedules.

Safety of Doctors at their Workplace in India Perspectives and Issues

The sincerity and diligence of health care providers regarding their timely interventions for the spectrum of ailments at all levels of stressful occupational environments even in the usual infrastructure poor compromised health care facilities of hospitals in our country is appreciable. In last one decade the scenarios evidently showed that integrity and trustworthiness of health care providers are being questioned by the health care seekers in spite of well known fact of widespread deficiency of basic amenities. As the downstream effects, all the unfulfilled expectations of receiving comprehensive public health care are being vented out as the wrath to the doctors leading to series of attacks on doctors and creating chaos in the health care facilities of all levels across the country. The source of this intolerance towards health care providers stems from higher expectations (? magic cure for all morbidities) from doctors on one hand and the limited health awareness, education of patients and their caregivers (attendants and bystanders) on the other hand. There is multifactorial causation of this sensitive issue that is increasing at an alarming momentum as the doctors are treated as ‘soft targets’. The primary aim of this article is to sensitize stakeholders and policy makers regarding barbaric attacks on the modesty of doctors; secondly to strengthen the awareness of first contact physicians of the legal and administrative safety measures to protect themselves from the unpredicted situations of outrage and distrust.

Determinants of exclusive breastfeeding among lactating women in sub-Himalayan region

Introduction: Trend of faltering growth in children begins in the critical period of first 2 years of life, and a major cause is due to faulty feeding practices. Breastfeeding is one of the most important determinants of child survival, birth spacing, and prevention of childhood infections. Aim: To determine factors influencing exclusive breastfeeding (EBF). Methodology: The Multiple Indicator Cluster Survey technique with thirty clusters proposed by the World Health Organization was used for the purpose of this study. Results: EBF was reported by 48.1% (101/210) of mothers. Among the 55% who initiated breastfeed in an hour of birth, 56.5% were EBF as compared to 43.5% were non-EBF and this difference was statistically significant (P - 0.01). As the education status of mothers increased from primary to matriculate the proportion of EBF decreased. Conclusions: Poor feeding practices are present across all socioeconomic groups, and a significant difference was observed with the age of mother, education status of both parents, occupation of father, and time of initiation of breastfeeding.

Study of menopausal symptoms in the nursing staff and female attendants in a rural medical college

Introduction: Menopause is defined as complete cessation of menstruation for 12 months or more. It is characterized by various symptoms such as hot flushes, irritability, sweating, anxiety, and depressive mood. Menopausal symptoms can be assessed by several tools and can be influenced by various sociodemographic factors. The study was planned with the aim to assess the commonly reported menopausal symptoms among women using the Menopause Rating Scale (MRS). Methodology: A cross-sectional study was undertaken at Dr. Rajendra Prasad Government Medical College (DRPGMC) Kangra at Tanda. The study was conducted in the month of November 2013, over a period of 3 weeks. The study population was nursing staff of DRPGMC Tanda and female attendants of patients in the age group 40–60 years. Convenience sampling was used, and the study sample was 200. The psychosomatic, somatic, and urogenital complaints were assessed in this group using the MRS. Results: Two hundred questionnaires were distributed among the nurses and female attendants of whom 180 women responded, a response rate of 90%. 103 of these women had attained menopause. The mean age of study participants was 49.4 ± 4.8 years. The average age of menarche was 14.8 years and mean age of menopause was 45.2 ± 4.7 years. Average MRS score was 11.67 with a maximum score of 31 and minimum score 2. The highest dimensional mean score was 5.48 for the psychosomatic symptoms. Conclusions: Common menopausal symptoms in this study are physical and mental exhaustion, irritability and joint and muscular discomfort.