Wellness enhancement or health promotion is a resource driven approach to primary prevention of disorders. This paper describes the development of a promotive intervention (Programme for Promotion of Wellness in Preschoolers-PPWP) focusing on both parenting and child behaviour in preschoolers from a lesser privileged social context. The PPWP was developed on the premise of wellness enhancement and normal child development. Culturally relevant didactic material and aids were developed for the study. The efficacy of the intervention was assessed among 60 mother child dyads, 30 dyads who received the intervention and 30 dyads that were controls. Baseline, post intervention and six month follow up assessments were conducted. Participants were screened using Preschool Behaviour Checklist and Screening tool for home environment and psychosocial development. Parenting practices and disciplining style of mothers was assessed. Teacher's rated the social behaviour of children. Children were assessed for attachment style, behaviour problems, pro-social behaviour and pre-academic abilities. Results show that authoritative parenting, disciplining style, mother report of child's behaviour problems and pre-academic skills have all changed in the desired direction in the intervention group with large effect sizes. Implications of the study to establish models for wellness enhancement to enhance child and family functioning have been discussed.

Background: Outcome following Acute Disseminated Encephalomyelitis (ADEM) is variable and there are only limited studies from India. Aim: The study aims to evaluate the predictors of functional outcome in a cohort of patients with ADEM. Setting: Tertiary-care teaching hospital. Materials and Methods: Patients admitted with the diagnosis of ADEM from 1999 to 2004 have been included. Clinical features and radiological findings were evaluated. Functional outcome at discharge was scored using modified Rankin Scale and patients were followed up regularly. Statistical Analysis: Chi-Square test or Fishers exact test, and Students t test for comparison of categorical and continuous variables, respectively, and logistic regression for multivariate analysis. Results: Sixty-one patients were evaluated (mean age 2215.9 years, 1-65). Fifty-two patients had preceding febrile illness or vaccination with mean 9.112.5 days interval to first neurological symptom. Non-specific febrile illnesses were the commonest trigger. Commonest findings were motor signs (n=41), impaired consciousness (n=33), bladder symptoms (n=21), ataxia (n=15), and seizures (n=14). Between adult (mean age 30.113.1 years, 13-65, n=38), and pediatric (mean age 6.22.8 years, 1-12, n=23) patients, language disturbances were more common in the latter (P=0.047). MR imaging (n=35) demonstrated lesions mostly in frontoparietal white matter (n=23) and thalamus (n=15). Nine patients expired. Patients with poor functional outcome at discharge more often had impaired consciousness (P=0.038) and seizures (P=0.06). At follow-up (n=25), deficits included motor signs (n=15) and bladder symptoms (n=5). Conclusions: ADEM has a wide range of neurological presentations and language disturbances are more common in pediatric patients. The presence of impaired consciousness, and possibly seizures, predict poor functional outcome at hospital discharge.

Background: Confirmation of tuberculous meningitis (TBM) and initiation of treatment are often delayed due to limitations in isolating Mycobacterium tuberculosis from cerebrospinal fluid (CSF). Objectives: To evaluate the role of the BACTEC radiometric method in a clinical setting for the early diagnosis of TBM. Materials and Methods: Patients meeting criteria for clinically probable TBM over a 3 year period were included. Clinical features, results of CSF investigations (protein, glucose, cell count, Ziehl-Neelsen staining, culture in Löwenstein-Jensen (LJ) medium and BACTEC) and brain CT imaging were reviewed. Drug sensitivity was tested using BACTEC. Patients were started on standard treatment and functional outcome, and response at discharge and follow-up were assessed. Patients were divided according to whether or not M. tuberculosis was isolated by BACTEC and the clinical, radiological, and laboratory features compared. Results: Sixty patients were evaluated. The mean age was 30 years ± 11.7 years. Headache and fever were the most common symptoms and the mean duration was 26 days. CT findings were hydrocephalus (n=21), basal exudates (n=16), and tuberculoma (n=14). In 40 patients, M. tuberculosis was isolated by BACTEC and average 15 days was required for detection, whereas it was 30 days in LJ medium. Results of drug-sensitivity testing (n=32) were obtained average 7 days after isolation. Patients from whom M. tuberculosis had been isolated by BACTEC more often had tuberculomas in CT imaging (P=0.018). Conclusion: Use of the BACTEC method allows early confirmation in patients with clinically probable TBM. It can guide clinicians in the rational use of anti-tuberculosis treatment by confirming diagnosis and identifying drug- sensitivity.

Background Lower urinary tract dysfunction (LUTD) in multiple sclerosis has been well documented. However, its occurrence and outcome in acute disseminated encephalomyelitis (ADEM) has only been variably reported. Objective To evaluate LUTD in ADEM, correlation with other neurological deficits, and outcome. Methods Patients with ADEM having significant LUTD were evaluated. LUTD was evaluated by symptom analysis, ultrasonography, and urodynamics. Storage symptoms were managed using antimuscarinics and significant voiding dysfunction by catheterization. Results Of 61 patients, 20 (33%) had LUTD. Voiding dysfunction was more common and 16 patients were in urinary retention. Cystometry demonstrated detrusor overactivity in four patients and underactivity in four patients. Incontinence was reported more often in patients with frontoparietal white matter changes in MR imaging. LUTD was found to be associated with occurrence of paraparesis or tetraparesis, though did not predict functional outcome at discharge. At 3 months follow up, five patients continued to have LUTD and urgency and hesitancy were commonest symptoms. Conclusion LUTD is common in ADEM, especially in patients with lower limb pyramidal involvement and its causes multifactorial. Presence of LUTD does not influence the functional outcome of patients with ADEM. Recovery may be incomplete and symptoms may persist even after recovery of other neurological deficits.

The aim of the current study was to compare the Wechsler Intelligence Scale for Children - Third Edition, UK adaptation (WISC-IIIuk) scores of Indian primary school children when Indian and UK norms are used. The sample consisted of 300 primary school children, within the age range of 6 years to 10 years and 11 months. The children were assessed using Children's Behaviour Questionnaire (CBQ), NIMHANS Index for Specific Learning Disabilities and WISC-IIIuk. The children scored 16, 21 and 20 points lower on Verbal, Performance and Full Scale scales, respectively when UK norms were used. The findings emphasize the need to establish national/regional norms for assessing intelligence of children in India.

BACKGROUND & OBJECTIVE:There are limited data on child mental health needs in our country. Therefore, an epidemiological study to determine the prevalence rates of child and adolescent psychiatric disorders was initiated as a two-centre (Bangalore and Lucknow) study by the Indian Council of Medical Research. It also aimed to study the psychosocial correlates of the psychiatric disorders. We present here the findings of Bangalore Centre.METHODS:In Bangalore, 2064 children aged 0-16 yr, were selected by stratified random sampling from urban middle-class, urban slum and rural areas. The screening stage was followed by a detailed evaluation stage. The ICD-10 DCR criteria were used to reach a penta-axial diagnosis.RESULTS:The results indicated a prevalence rate of 12.5 per cent among children aged 0-16 yr. There were no significant differences among prevalence rates in urban middle class, slum and rural areas. The psychiatric morbidity among 0-3 yr old children was 13.8 per cent with the most common diagnoses being breath holding spells, pica, behaviour disorder NOS, expressive language disorder and mental retardation. The prevalence rate in the 4-16 yr old children was 12.0 per cent. Enuresis, specific phobia, hyperkinetic disorders, stuttering and oppositional defiant disorder were the most frequent diagnoses. When impairment associated with the disorder was assessed, significant disability was found in 5.3 per cent of the 4-16 yr group. Assessment of felt treatment needs indicated that only 37.5 per cent of the families perceived that their children had any problem. Physical abuse and parental mental disorder were significantly associated with psychiatric disorders.INTERPRETATION & CONCLUSION:Prevalence rates of psychiatric morbidity in 0-16 yr old children in India were found to be lower than Western figures. Middle class urban areas had highest and urban slum areas had lowest prevalence rates. The implications for clinical training, practice and policy initiatives are discussed.

Some times, the clinician / researcher may be looking for time or interval before the next event occurs, as in the case of an epileptic fit. The statistical method used for such analysis is life table analysis or survival analysis. This method allows the researcher to use data from patients who drop out/die during the follow up period as well as those who may not experience the event at the end of the study. Thus it is possible to compute the amount of risk of occurrence at a particular time point. In this review an attempt is made to introduce the topic popularly known as survival analysis along with two illustrations.

This study examined the factor structure of the Mental Health Professionals Stress Scale (MHPSS) and its reliability and validity in a sample of 116 clinical psychologists in India. Principal component analysis of the MHPSS identified four factors that accounted for 42.2% of the total variance. These 4 factors reflected 6 of the 7 original subscales.The subscale 'Client-related difficulties' did not emerge as a distinct factor. The authors attribute this to cultural differences in the therapist-patient relationship. The MHPSS correlated negatively with measures of professional role satisfaction and subjective well being. It was concluded that the MHPSS is a reliable and valid tool to measure sources of occupational stress experienced by mental health professionals.

Stroke is a leading cause of morbidity and mortality. A significant proportion of stroke victims in India are below the age of 40 years and may have specific risk factors. 101 patients (42 less than 40 years of age) of ischaemic stroke were studiedat NIMHANS to estimate the relative risk of various contributing factors. Hypercholesterolaemia, hyperglycaemia and hypertension were more common in elderly group, while smoking, alcohol and tobacco abuse were more prevalent in younger age group (relative risk 1.2, 1.9 and 1.5 respectively). A better understanding of these risk factors may play a key role in the prevention of stroke in young.

Cerebro-vascular disease in an important and a frequent cause of dementia. However, the prevalence and magnitude of global cognitive dysfunction in acute stroke has not been studied. Folstein′s mini mental state examination (MMSE) is 2 sensitive and reliable test and may serve as a simple tool for screening dementia. Fifty consecutive patients with first ever completed stroke in life and no past history of cognitive disturbances were administered MMSE at least 10 days after the onset of stroke. Cranial CT scans were done in all after 48 hours of stroke. CT scans were blindly analysed and graded for number, location and volume of infarctions, white matter leukoaraiosis (WMLA) and cortical and sub cortical atrophy. The radiological parameters of those with MMSE score of 23 or less on MMSE. Of all the conventional risk factors, only age of the patients was significantly higher in the "demented" group. Of the radiological parameters namely-number and volume of infarcts, WMLA, bi-frontal ratio (BFR), 3rd ventricular ratio (3 VR), cella media index (CMI) and cortical index (CI), only cortical index was significantly more among patients with lower MMSE scores. Prevalence of global cerebral dysfunction first ever ischaemic stroke was 46% in this study. Advanced age and cortical atrophy appear to contribute to the low scores on MMSE. Though, volume and number of infarctions were higher among patients with low score, the differences were not statistically significant.

Morbidity and mortality in puerperal cerebral venous thrombosis (CVT) can be reduced by arresting the progression of thrombosis using heparin. However, conventional dose of heparin requires monitoring of coagulation parameters and carries a risk of haemorrhage. The present study involved 56 patients of puerperal CVT with CT evidence of haemorrhagic infarction. Twenty nine of these patients received low dose heparin till 30th post-partum day or symptomatic relief. Their clinical features and severity were similar to 27 patients who did not receive heparin. The mortality and morbidity at discharge was significantly less (P < 0.001) in heparin treated group. There were no haemorrhagic complications. Low dose heparin is safe and effective in cerebral venous thrombosis, even with haemorrhagic infarction.

One hundred and one. patients with completed stroke, 50 patients of TIA were compared with 75 age and sex matched healthy controls for various clinical and biochemical risk factors of stroke. Of the seventeen factors studied eight factors were statistically different amongst the three groups. Using multiple discriminant function analysis it was observed that systolic blood pressure, HDL cholesterol, and sedentary life were the variables influencing the stroke group and higher age at onset, elevated total cholesterol were the variables important in the TIA group.

Among the 153 patients fulfilling NINDS criteria for Guillain Barre' Syndrome (GBS) seen over 5.5 yrs, there were 47 (M:F 38.9) critically ill patients (age range 4 to 60 years). Antecedent event was recorded in 25 patients and the peak deficit was attained over a mean period of 9.5 days. Besides severe motor paralysis other salient features were: bulbar paralysis--42, sensory symptoms or signs--21, dysautonomia 31 and requirement for ventilatory assistance 45. CSF protein was raised in 63% cases. All the 17 patients who underwent electromyography had abnormalities of nerve conduction paramentes. Mean stay on the ventilator was 29.6 days and was not influenced by corticosteroid. Complications were frequent: pulmonary and urinary tract infection, dysautonomia, electrolyte disturbances, haemetmesis, bleeding from tracheostomy site and hepatic and renal failure. Mortality in steroids treated group (13/27) and the conservatively managed group (5/20) did not differ significantly. No discriminant factor emerged between survivors and non-survivors. Age and sex of the patients, presence of antecedent event, onset to peak interval and CSF protein level did not predict the need for ventilatory assistance, although these patients at admission had more frequent weakness of facial, bulbar, trunk, neck and proximal muscles of upper limbs and autonomic disturbances. Course of GBS remains unpredictable at the onset of the disease, warrants close supervision and meticulous supportive care and remains a therapeutic challenge.

Life events, l ife strains and coping behaviours were compared in psycologically distressed and non -distressed college students (N = 421). Approximately 21% of the students had non specific psychological distress. Distressed individuals exper~enced greater number of l ife events, l ife strains and subjective distress associated with these when compared with non distressed .individuals. Differential use of coping behaviours was observed. The results and implications of the study are discussed. In recent years, researchers have shown increasing interest in the study of stress and factors that modify i ts influence. A majority of people who are exposed to stressful l i fe events do not develop emotional disorder. Investigators have attempted to identify variables-the vulnerability or resistance factorsthat may influence individual reactivity to stressful l i fe experiences. Some of the variables studied are coping processes, social supports and personality. Conceptualisations of stress have emphasised the importance of "transitions" or periods of change and adaptation (Felner ,Farber & Primavera, 1,083). College students are i n such a transitional phase. This is a period of adjustment t o changing patterns of life and social expectations. Students are expected to play new roles, develop new attitudes, interest and values. The l i fe style they develop now w i l l set the future pattern of their lives. Problems faced by college students and their mental health havenot received much attention in India. Although there is not much work on l i fe events, life strains and coping behaviour, a few studies have been done on adjustment and mental morbidity (Chandrasekhar, 1979, Gowri Priyadarshini, 1980; Bhatt, 1980). Prabbu (1 975) highlighted the need for researchers t o focus attention on the mental health of college students. The present study was an attempt in this direction.

A chronic neurotic syndrome among Muslim women in India with predominantly somatic multiple symptomatology is briefly described. It is suggested that the syndrome is distinctive in its clinical features and in the cultural background of the patients. Pending resolution of its nosological status it is referred to as Somatic neurosis. In an attempt to determine its nature a group of 20 Muslim women with the syndrome were compared on 6 variables with 20 women with anxiety neurosis and 20 with depressive neurosis. With the exception of age, on which they were similar to Depressive neurosis group, the Muslim group was significantly different from the comparison groups. It is concluded that the syndrome is distinctive enough to merit an intensive sociocultural study.

The aim of the current study was to compare the Wechsler Intelligence Scale for Children - Third Edition, UK adaptation (WISC-III uk ) scores of Indian primary school children when Indian and UK norms are used. The sample consisted of 300 primary school children, within the age range of 6 years to 10 years and 11 months. The children were assessed using Children's Behaviour Questionnaire (CBQ), NIMHANS Index for Specific Learning Disabilities and WISC-III uk . The children scored 16, 21 and 20 points lower on Verbal, Performance and Full Scale scales, respectively when UK norms were used. The findings emphasize the need to establish national/ regional norms for assessing intelligence of children in India.