Better Social-emotional Behavior in Young Nepali Children is Associated with Household Wealth, Child Age, and Family Participation in a Community Development Intervention.

Background Mental health and behavior problems are under-recognized in low- and middleincome countries, especially in young children. Early identification of these problems could encourage governments to address the shortages of child mental health professionals and promote early intervention programs to help children achieve their full developmental potential. Objective Describe the social-emotional development of young rural Nepali children; explore risk factors for poor development. Method The study was embedded in a longitudinal intervention trial comparing control households with those who received training in family nutrition+livestock management (Partial Package) or family nutrition+livestock management+community mobilization (Full Package). At midline, enumerators completed a 145-item household questionnaire, child anthropometry, and Administered the Ages and Stages Questionnaire-Social-Emotional (ASQ-SE) to all enrolled children age 33-47 months (n=310). Bivariate and regression analyses examined the relationship of child and household risk factors to administered the Ages and Stages QuestionnaireSocial-Emotional scores. Result Administered the Ages and Stages Questionnaire-Social-Emotional scores were below age cutoffs in 24% of children, suggesting worse social-emotional development. In bivariate analyses and the adjusted linear regression model, older child age, greater household wealth, and Full Package Intervention status were all associated with better social-emotional development scores. Partial Package Intervention status was associated with worse scores. Conclusion The Administered the Ages and Stages Questionnaire-Social-Emotional is a potential tool to assess child social-emotional development in the context of household and community level interventions. Further work is necessary to validate the administered the Ages and Stages Questionnaire-Social-Emotional and similar tools in Nepal, and to better understand the prevalence of challenges to optimal socialemotional development in young children in order to use this information to design and monitor needed interventions.

Assessment of tear secretion and tear film instability in cases with pterygium and normal subjects.

INTRODUCTION: Dry eye is a common disorder affecting a significant percentage of the population. MATERIALS AND METHODS: This study is a prospective, hospital-based, case-controlled study conducted between January 2009 and May 2010. Seventy-six pterygium cases and 152 age-and- sex matched controls presenting to the OPD of Manipal Teaching Hospital were included. The TBUT Schirmer's test and basal tear secretion were estimated in all patients. A TBUT of less than 10 seconds and a Schirmer's test of less than 10 mm were considered abnormal. RESULTS: Pterygium was bilateral in 15 (19.7 % ) and unilateral in 61 (80.3 %) patients. Ninety-two (92.1 %) pterygium patients reported either one or more of the six dry eye symptoms. Redness was the most common (67 %) symptom reported. The mean Schirmer's test I, mean basal secretion and mean TBUT values were 16.19 mm, 10.01 mm and 10.56 seconds in pterygium cases and 20.22 mm,13.25 mm and 26.25 seconds in the control group respectively. There was a statistically significant difference in the dry eye results between the pterygium cases and the control group (p value less than 0.05). The odds ratio between pterygium and dry eye was 3.28. Dry eye was present in 26 % of the normal patients and in 54 % of the pterygium cases. CONCLUSION: There is a strong relationship between dry eye and pterygium.

Assessment of characteristics of patient with delirium tremens.

Delirium tremens is the severe form of alcohol withdrawal. It carries a certain degree of mortality and there has been and advancement in the understanding of pathophysiology and risk factors for the development of the condition. This prospective study is carried out to study the characteristic of the patient of delirium tremens in our setting using ICD-10 diagnostic criteria. Thirty seven cases of delirium tremens with majority of males and of all hill origin people were identified. Patients with delirium tremens has been using alcohol for average of 24.8 years with an average intake of around 2.2 litres per day. Most of the patient has seizure and similar episodes in past and using alcohol from morning time.

Proficiency panel testing--a reliable tool in external quality assessment of sputum smear microscopy services in Gujarat, India.

OBJECTIVE: To assess the proficiency of Senior TB Laboratory Supervisors (STLSs) and district level Laboratory Technicians (LTs) in sputum smear microscopy. METHOD: Intermediate Reference Laboratory (IRL), Ahmedabad had manufactured and validated Proficiency Panel Testing slides from sputum samples, made On Site Evaluation (OSE) visits of District TB Centres (DTCs) in two rounds, and conducted Proficiency Panel Testing of STLSs & DTC-LTs from January 2005 to June 2009. RESULTS: High level of concordance in Z-N smear grading was found between Microbiologist and district laboratory staff. DTC readers reported overall consistency level of more than 98% in Z-N grade agreement during both the IRL, EQA, OSE visits. The tendency to over-grade the panel slides was much higher (more than 22%) as compared to under-grade (less than 2%) them in "correct slides". High False Positive (HFP) error was not observed in the present study. CONCLUSION: Laboratory supervisor's proficiency can be quickly assessed by Proficiency Panel Testing, under multi-level quality assurance network system of sputum smear microscopy in public health programmes like the RNTCP. Proficiency Panel Testing is highly replicable and reproducible tool for quick and reliable assessment of proficiency of the staff and it can be made more effective by raising the proportion of lower grade positive slides in panel set of each reader. DTC readers' overall agreement level of more than 98% in Z-N grade suggests high level of precision and excellent consistency during both the IRL, EQA, OSE rounds. It is concluded that even for a large network of sputum smear microscopy centres under public health programmes like the RNTCP in order to take corrective action, Proficiency Panel Testing can be effectively used for quick identification of suboptimal- technical performance of the supervisory staff.

Hepatitis A vaccination in chronic liver disease: is it really required in a tropical country like India?

Vaccination against hepatitis A virus (HAV) has been recommended in patients with chronic liver disease to prevent any decompensation due to superinfection. This may not hold good in high endemic areas for hepatitis A like India. The aim of this study was to find out the seroprevalence of anti-HAV antibodies in patients with chronic liver disease and to justify the need for vaccination against hepatitis A virus in these patients. One hundred and thirty three consecutive patients with cirrhosis of liver attending Gastroenterology department of our Institute between June 2004 and June 2005 were enrolled. Seventy-five healthy persons were taken as controls. The diagnosis of cirrhosis was based on clinical profile, biochemical, radiological (ultrasound abdomen) and endoscopic findings. The etiology of cirrhosis was based on presence of viral markers, history of significant alcohol consumption, autoimmune and metabolic workup. All patients and controls were tested for antiHAV (total) antibodies using commercially available enzyme-linked immunosorbent assay kits. Data from patients and control group were compared by unpaired 't' test and Chi square test. All subjects were in the age group 11 to 75 years. Etiology of chronic liver disease was as follows: HBV- 29.3%, HCV - 14.28%, HBV+HCV dual -1.5%, alcohol- 21.8%, Cryptogenic -23.3%, Wilson"s Disease -1.5% and Budd chiari -1.5%. The prevalence of HAV was 93.2% in patients with cirrhosis of liver and 94.6% in controls. The prevalence was almost similar irrespective of the etiology. In view of high seroprevalence of HAV antibodies among cirrhotic patients in our study and the high cost of the vaccine, the hepatitis A vaccination may not be routinely required in this part of the world.

Oral antibiotics: are the old still gold?

Most common infections in ambulatory care can be treated effectively and safely with conventional antibiotics. A rational approach using such antibiotics as primary choices and reserving newer antibiotics for selected, more difficult-to-treat infections will result in substantial cost savings and may help to prevent the rapid development of drug resistance.

An assessment of intraocular pressure during fractionated peribulbar anaesthesia.

This study of 20 patients undergoing elective cataract surgery was performed to investigate the change in intraocular pressure that accompanies extraconal peribulbar anaesthesia. We have demonstrated that each injection during peribulbar anaesthesia causes a small rise in intraocular pressure. The routine use of conventional external ocular compression overcomes this pressure rise and safely provides a satisfactory and progressive reduction in intraocular pressure prior to surgery. Our findings suggest that the volumes of anaesthetic solutions used in fractional peribulbar anaesthesia, if used in conjunction with external compression devices, result in intraocular pressures acceptable for intraocular surgery.

Hospitalized teens. Ambulatory care utilization patterns.

Twelve- to eighteen-year-olds enrolled in a federally qualified HMO in Central Massachusetts who had an admission to a hospital with a diagnosis of trauma or mental health problems were identified. Routine and episodic health care utilization for a 24-month period of each study case was determined and compared with the same for a comparison group matched for age, sex and length of enrollment. Although information on health habits and lifestyle was often missing from the charts, it was determined that the study cases were less likely to be in school and living with their parents and used episodic care more frequently, especially in the 6 months prior to admission. Both hospitalized and non-hospitalized youth had a higher average number of visits to office-based providers than their national counterparts. The study suggests that (1) greater awareness of morbidity and health care utilization patterns and risk behaviors may enhance prevention efforts; (2) use of instruments to capture more information on health habits and lifestyle may facilitate preventive interventions; (3) collaborations among pediatric primary care providers, the Information Services (IS) and Quality Management (QM) departments may facilitate this type of research in a managed care setting.

The human T-cell receptor beta-chain repertoire: longitudinal fluctuations and assessment in MHC matched populations.

The influence of the environment and of the major histocompatibility complex (MHC) in shaping the human T-cell receptor beta-chain variable region (TCRBV) repertoire has not been systematically studied. Here, expression of TCRBV gene families was estimated by a sensitive polymerase chain reaction (PCR)-based method. Serial studies of peripheral blood, performed at 2-week intervals over a 3-month period, revealed that fluctuation in the expression of many TCRBV genes occurred in healthy individuals and in the absence of clinically evident infections. Fluctuation of TCRBV4, TCRBV5.2, TCRBV9, and TCRBV13.1 genes were present in all subjects. Additional TCRBV genes fluctuated in some but not in other individuals. Comparison of the TCRBV repertoire between these unrelated individuals indicated differences in the mean expression of TCRBV5.1, TCRBV9, TCRBV11, TCRBV15, TCRBV17, and TCRBV20 genes. For any TCRBV gene, intersubject differences were generally of a magnitude of twofold or less. Larger differences characterized the TCRBV repertoire of CD4 compared to CD8 cells. Some differences, for example over-representation of TCRBV2 and TCRBV5.1 on CD4, and TCRBV10, TCRBV14, and TCRBV16 on CD8 cells, were present in most subjects. Individuals homozygous for DR2- or DR3-bearing extended MHC haplotypes displayed similar individual variability of TCRBV expression. These data indicate that the circulating TCRBV repertoire in humans is both dynamic and diverse. Both environment and MHC effects contribute to the diversity of TCRBV expression.

Adolescent fathers: an approach for intervention.

Many myths exist concerning the needs and problems confronting adolescent fathers. Research on adolescent pregnancy has proliferated in the last decade. We now have a substantial body of empirically-based findings in this area. Unfortunately, few substantive findings are available on adolescent fathers, yet the magnitude of this problem has reached epidemic proportion. This article will provide an overview of current research on adolescent fathers and their needs and offer suggestions for appropriate intervention.

PIP: An overview of current findings on and suggestions for appropriate intervention for adolescent fathers are discussed. Topics are identified as follows: adolescent pregnancy and demographic factors; adolescent fathers and sexuality ad contraception, attitudes toward abortion, psychological correlates, the role of and commitments and concerns, competency in parenting, infant development, problems, and needs; and needs for research and services. Adolescent fathers are trapped by low levels of educational attainment and family instability. Judgmental behavior of families, schools, and providers is a further hindrance. Minorities are prominently involved and their futures are not promising. In order to strengthen the role and position of minority men within the family, the community, and society, strategies need to be developed that must involve family members, peers, health care services, schools, and organizations such as the Urban League, Planned Parenthood, and churches. Important components of programs are the teaching and modeling of responsibility along with sustaining group identity. Research needs to be conducted to go beyond the limitations of prior studies which 1) are based on small, biased samples recruited through pregnant or parenting females, 2) are cross-sectional observations of social and psychological factors of only teen fathers in a crisis situation, and 3) lack standardized measurement of the social and behavioral characteristics. Suggested future research should emphasize studies 1) with a longitudinal format and adequate samples that have predictive value; 2) of sexual attitudes, contraceptive knowledge, and behavior; 3) of adolescent couples and contraceptive intentions; 4) of gender differences in parenting and responsibility; 5) of what constitutes competent functioning for the teenage male; 6) of the role and influence of parents in the adolescent decision to continue or not to continue the pregnancy; and 7) of the nature and extent of father and infant play which facilitates infant development. Since males receive most of their sexual and contraceptive information from schools and the media, schools adopt curricula on family planning and sexuality. comprehensive health care services and evaluation should be provided by schools in a manner that supports abstention and contraception. Service programs need to involve males in prenatal and parenting classes, and maternity wards must meet adolescent fathers' needs in basic caretaking. Infant development and caretaking training classes in some school or other location need to involve adolescent males. Paternity leave is a must.

Saving environment for human survival.

PIP: The environmental crisis is complex, requiring many solutions. However, it is the responsibility of the State Government to protect and improve the environment. This can not be accomplished by merely writing legislation but by enforcing measures to save the natural world. The world environmental crisis has resulted in the ubiquitous poverty of developing nations (called the "pollution of poverty"). The growing control of resources has allowed a small consortium of powerful countries the ability to enjoy Earth's resources while other developing countries suffer in the abyss of the crisis. A redistribution of power and resources shared by the entire global community is needed. Although measures such as the Environmental Protection Act of 1986 have begun to set standards for a higher quality of living, not all industries have been regulated by the act, and no effective method of monitoring industrial pollution has been established in India. Factors such as depleting jungles, the squandering of natural resources such as soil, water and air and rapid urbanization have accelerated the need for stronger environmental laws and greater awareness and actions. A philosophy that emphasizes the inter-dependence of man and nature most be adopted globally if the augmenting crisis is to be abated.^ieng

Population problem in third world.

PIP: Since numerous variables influence this growth rate, a holistic approach to the problem is mandatory. Fertility rates in developing countries remain high, not as a result of irrational behavior on the part of the people living in these countries, but as a result of their rational response to high infant mortality rates. Fertility rates will remain high unless the educational, health, and social environment in which these families live is improved. Economic development and population growth are intimately related. Development reduces the death rate resulting in increased population growth, which in turn reduces per capita income. In the developed nations, economic development occurred along with the development of new technologies and the reduction in mortality; therefore, population growth created an effective demand which further stimulated economic development. In developing countries the situation is different. Reduced mortality, the introduction of labor saving technology, and the high consumption aspirations derived from contact with capitalistic countries, have preceded economic development. Given the highly complex nature of the population problem, efforts must be made on many fronts including: 1) family planning promotion; 2) improvements in education, health, and social conditions for high fertility populations; 3) enhancement of worker skills; 4) rapid progress in technology; 5) greater capital accumulation and 5) economic reorganization.^ieng