Early detection and intervention for young children with early developmental disabilities in Western Uganda: a mixed-methods evaluation.

BACKGROUND: Early support for children with developmental disabilities is crucial but frequently unavailable in low-resource settings. We conducted a mixed-methods evaluation to assess the feasibility, acceptability, and impact of a programme of early detection and intervention for young children with developmental disabilities in Western Uganda. METHODS: Early child development training for healthcare workers (HCWs) was implemented in three rural districts, and attendance was tracked. HCW knowledge and confidence were assessed pre-/post-intervention, and referral numbers tracked to evaluate impact. Facilitators were trained and mentored to deliver a participatory, group, early intervention programme (EIP) for young children with developmental disabilities and their families. Facilitators were tracked as they were identified, trained, and delivered the intervention, and attendance of families was tracked. Pre-/post-intervention assessments evaluated changes in family quality of life (PedsQL 2.0, Family Impact Module), and child nutritional outcomes. Focus group discussions with stakeholders also assessed feasibility, acceptability and impact. RESULTS: Overall, 93 HCWs from 45 healthcare facilities received training. In the pre-/post-evaluation, median knowledge and confidence scores increased significantly (from 4.0 to 7.0 and from 2.7 to 4.7, respectively (p < 0.001)). HCWs reported feeling empowered to refer and offer care for families with a young child with disability. Referral rates increased significantly from 148 to 251 per annum (70%; p = 0.03). Eleven EIP facilitators were trained, and all delivered the intervention; 84 families were enrolled, of which 78% attended at least 6 out of 10 modules. Amongst those with paired pre-/post-intervention data (n = 48), total family quality of life scores increased significantly (21%, p < 0.001). Improvements were seen across all domains of quality of life, with the largest impacts on emotional functioning and social functioning (p < 0.001). The programme was acceptable to caregivers and facilitators. Caregivers reported improved knowledge, family relationships, hope, emotional wellbeing, and reduced self-stigma. CONCLUSIONS: A programme of early detection and intervention for children with early developmental disabilities and their families was feasible and acceptable in a rural community-based Ugandan setting. HCW training positively impacted knowledge, confidence, attitudes, and referral rates. Families enrolled to the EIP reported significant improvements in quality of life. Important programmatic barriers identified included geographical spread, poverty, gender inequality, and stigma.

Accuracy of morphological diagnosis of lung cancer in a department of respiratory medicine.

In view of the importance of determination of cell type in patients with bronchial carcinoma who are to be given chemotherapy a series of 140 histologically proved cases was analysed to assess the accuracy of pretreatment diagnosis by cytology and bronchial biopsy. Final histological diagnosis was made after thoracotomy (131 cases) or necropsy (9 cases). Before treatment, malignancy was diagnosed in 71% of cases with 91% accuracy in cell typing. Diagnostic yield was greatest in squamous carcinoma (81%) and least with adenocarcinoma (50%). Large-celled and small-celled anaplastic carcinomas gave yields of 61% and 68% respectively. Accuracy of cell typing was high (90-97%) except for large-celled anaplastic carcinoma (71%). All diagnostic methods were not employed in every case. In patients supplying samples the diagnosis was made by sputum cytology in 57%, by rigid bronchoscopy cytology in 57%, by fibreoptic bronchoscopy cytology in 71% and biopsy in 53%. Causes of diagnostic failures and possible means of increasing accuracy of pretreatment diagnosis were discussed.

The prognostic significance of dysrhythmias in the healthy elderly.

Fifty healthy, elderly subjects in whom a cardiovascular assessment, including 24-hour ambulatory electrocardiography had been performed, have been followed until death, or if surviving, for five years. Eight patients have died and 88 per cent of the survivors have had repeated 24-hour electrocardiography. Coronary death and the development of cardiovascular or neurological symptoms were not related to the presence in the original recording of significant dysrhythmias including frequent ventricular and supraventricular premature beats, R on T phenomena or sinus arrest. Treatment of these and other dysrhythmias in the asymptomatic elderly individual to prevent development of serious clinical sequelae is not justified.

Assessment of factors influencing the result of sputum cytology in bronchial carcinoma.

In a retrospective study of 377 patients with bronchial carcinoma, sputum had been reported positive or suspicious for malignant cells in 59.7%. The most important factors contributing to a positive result were the histological cell type and the site of the tumour as assessed at bronchoscopy. Significantly more positive results were obtained in epidermoid tumours and those with a visible bronchoscopic abnormality. A higher proportion of positive results also occurred in large tumours, lower lobe tumours, and those associated with collapse and consolidation. The physical condition of the patient and the presence of infection in the sputum were not important factors contributing to a negative result. Although adequate numbers of sputum samples were collected the predominant problem was the large number of unsatisfactory sputum specimens. The preparation of the sputum specimens in the laboratory is important and is also a potential source of error.

Blood donorship and psychological reactance.

Research in social psychology suggests that expressing urgent need in requests for blood donation may result in less volunteering to help, not more. In addition, there is evidence that requests for several donations over a period of time are more likely to meet with refusal than requests for only one donation. These issues were investigated within the framework of a social psychological theory known as reactance theory.

Undisclosed self-medication--a clinical pitfall.

Over-the-counter medication may produce side-effects or precipitate hospital admission. Our patient's self-medication, initially not admitted, led to much mental and physical morbidity.

Bronchial carcinoma: factors influencing postoperative survival.

In a retrospective survey of 337 patients who had a resection for bronchial carcinoma data were obtained on 14 preoperative and two operative variables. Factors significantly adversely influencing survival were weight loss, chest pain, raised erythrocyte sedimentation rate, tumour larger than 5 cm, cell type other than squamous, pneumonectomy and tumour spread to hilar lymph nodes. Multiple regression analysis showed that four variables, weight loss, pain, tumour size and cell type had significant independent effects on survival. From the regression equations predicted median (50%) survival, varying from 9 to 95 months was calculated and tested on a series of 49 patients undergoing resection since completion of the survey. The correlation between overall observed and predicted median survival was highly significant (P less than 0.001). The prediction equation was more accurate for patients with a predicted survival of less than 30 months if cell type was known. Classification using the prediction equations may improve patient selection for surgery.

Bronchocentric granulomatosis: a review and thoughts on pathogenesis.

Bronchocentric granulomatosis has no specific clinical, radiological or immunological features, the diagnosis remains that of morphology on biopsy or resected lung tissue. The morphological features of bronchocentric granulomatosis can occur in a variety of situations and we believe this pathology reflects one of the limited ways in which bronchi can respond to injury, the essential requirement for its development being a sustained and/or intense inflammatory insult within the bronchial lumen.

Malignant pericardial effusion managed with Vinblastine.

A 69-year old man with a known bronchial carcinoma developed a malignant pericardial effusion, and signs of subacute tamponade. Single agent chemotherapy with intravenous Vinblastine resulted in complete resolution of the effusion without untoward side effects.

Enzyme induction with rifampicin; lipoproteins and drug binding to alpha 1-acid glycoprotein.

Hepatic enzyme induction has been reported to increase lignocaine binding, alpha 1-acid glycoprotein concentration and high density lipoprotein (HDL) cholesterol. In eight volunteers treated with rifampicin for 3 weeks there was no significant alteration in these three variables although their antipyrine clearance was significantly increased. In 10 patients with pulmonary tuberculosis treated with rifampicin (mean 5 months) the degree of serum protein binding of lignocaine, alpha 1-acid glycoprotein and HDL-cholesterol concentration was not different from that of matched control patients. These results suggest that differential induction of these variables may occur.

Clinical aspects of tracheobronchopathia osteochondroplastica.

Two patients with tracheobronchopathia osteochondroplastica are described, both presenting with features suggestive of bronchial carcinoma. They had a long standing history of recurrent haemoptysis. The characteristic bronchoscopic, radiological and histological features of the condition are illustrated and the clinical problems in diagnosis discussed.

Dysrhythmias in apparently healthy elderly subjects.

Using 24-hour ambulatory electrocardiographic (ECG) monitoring, the incidence of cardiac dysrhythmias was investigated in 50 apparently healthy elderly subjects aged over 60 years. There was a high incidence of both ventricular and supraventricular ectopic beats, supraventricular tachycardia and sinus arrest. First- and second-degree block were also noted. The incidence of dysrhythmias bore no obvious relationship to age over 60, sex, blood presssure, cigarette smoking, caffeine and theophylline ingestion or resting 12-lead ECG abnormalities.

Alteration of pharmacokinetics after halving a slow-release theophylline tablet.

A study was carried out in 10 healthy volunteers to determine the effects on the bioavailability of theophylline from a biconvex-shaped, slow-release 400 mg theophylline tablet formulation when the tablet was taken whole or as two separate halves in a single dose. The subjects took one or other dosage regimen on different occasions separated by a 7-day washout period. The results showed that absorption was faster and plasma levels were higher when the 400 mg tablet was taken as 2 halves.

The effect of astemizole on exercise-induced asthma.

Astemizole, a new oral long acting antihistamine devoid of significant central, sedative or anticholinergic effects, was studied in nine patients with exercise-induced asthma. Most patients received some protection with the active drug after 1 week of treatment (10 mg daily) and all showed less of a fall in FEV1 on exercise 1 week after stopping the drug compared with an initial placebo period (P less than 0.01). A significant reduction in histamine-induced skin reaction (weal size) was also demonstrated (P less than 0.01).

Peripheral nerve function in patients with bronchial carcinoma. Comparison with matched controls and effects of treatment.

Clinical examination of 80 patients with bronchial carcinoma showed minor neurological abnormalities but in only a few cases were these considered to be due to neuromyopathy. Spontaneous activity in the EMG was shown in 35%, consistent with a mild degree of partial denervation; when 50 of the patients were matched with 50 controls the patients showed a small but significant impairment of nerve conduction velocity in comparison with the controls. These findings accord with subclinical neuropathy in a high proportion of patients with bronchial carcinoma consistent with primary axonal change. Thirty patients participated in a prospective study of the effects of treatment. Of these nine were reassessed following surgery or radiotherapy. Although there was a trend towards improvement in sensory conduction there was no consistent change in the electromyographic findings.