Unequal Representation of Persons with Disabling Mental Health Conditions in the Quota-Based Employment Reservations Notified by a Public Service Commission

Introduction

The Rights of Persons with Disabilities (RPwD) Act 2016 of India intends to achieve greater representation of persons with benchmark disabilities (PwBD) at government establishments and reserve at least 4% of employment vacancies for PwBD. Of this 4%, 1% is reserved for PwBD with disabling mental health conditions (PwBD-MHC) and multiple disabilities, and 1% each for PwBD due to other disabling conditions like blindness, hearing, and locomotor impairment.

Methods

We analyzed all the employment vacancy announcements (EVAs) made by the Indian union public service commission (UPSC) during the calendar year 2020 for their adherence to quota-based employment reservations (QBER).

Results

Eighteen vacancy advertisements made during the year 2020, for a total of 1370 posts under various departments, announced a total of 57 posts as reserved for PwBD under the QBER system, satisfying the minimum 4% quota. However, none of these posts is reserved for PwBD-MHC. Further, only 7 out of 1370 were described as suitable for PwBD-MHC, implying that 1363 are not suitable for them.

Conclusions

The QBER system and the subdivision of quotas are well-intended to achieve the minimum representation of PwBD across all categories of jobs. However, the EVAs by UPSC in the year 2020 did not reserve any posts for PwBD-MHC and perhaps inadvertently excluded them from consideration for the majority of posts announced even under the unreserved category.

Comparison of the effect of in vitro and in vivo exposure on cadaveric anxiety among first year medical and nursing students

BACKGROUND

Human anatomy instruction is mostly focused on cadaver dissection and prosected specimen examination. Exposure to cadaver dissection can be a stressful experience that may cause a wide variety of symptoms among students of health sciences. To compare and evaluate the effect of in-vitro and in-vivo exposure on cadaveric anxiety, disgust propensity and sensitivity, and attitude toward death and dying among 1^st-year medical and nursing students.

MATERIALS AND METHODS

An open-label randomized trial (matched-control experimental design) was conducted among 127 1^st-year Medical and Nursing students from a selected Institute of National Importance, Bhopal, India during 2015. The participants were divided into an experimental and control group based on matched trait anxiety scores using the Trait Anxiety Inventory. Followed by preassessment, video demonstration with cadaver dissection (in vitro exposure) was then administered to the experimental group, while the control group had direct exposure to cadaver dissection (in vivo exposure).

RESULTS

The study showed that there was a statistically significant difference in state anxiety related to cadaver dissection in the experimental group (P = 0.01). However, video-demonstration of cadaver dissection did not have any effect on disgust propensity and sensitivity and attitude toward death and dying.

CONCLUSION

The findings provided evidence that video-demonstration of cadaver dissection reduced anxiety, although it did not have any effect on disgust and attitudes of death. The dissection hall experience may evoke feelings of anxiety and disgust that need to be addressed through advanced preparedness and coping strategies, especially among medical and nursing students.

Profile of recipients of holistic health counselling in a psychiatric OPD in South India

BACKGROUND OF THE STUDY

Persons with mental illness (PwMI) are prone to weight gain as a side effect of antipsychotics. Health counselling on diet, physical activity, medication adherence, expressed emotions and technology use, by health professionals, can help in managing these side-effects.

AIM

The aim of this study was to identify the pre-counselling profile of the subjects such as body mass index (BMI), diet, physical activity, medication adherence, expressed emotions and technology use among PwMI; to attend the Holistic Health Clinic as part of follow-up services in the psychiatry Outpatient Department (OPD) as well as to find correlation and association between the study variables.

METHODS

The study involved a cross-sectional descriptive design based on convenience sampling. The sample consists of 56 patients who are receiving antipsychotics under symptom control (self-reported) and were overweight. Data were collected with a patient assessment proforma and analysed using SPSS-22.

RESULTS

The patients referred to the holistic health counselling (HHC) had abnormal weight and BMI. The mean and SD of weight was 74.48 ± 14.07 and BMI 29.51 ± 5.15. All the participants received counselling on diet, 87.5% on physical activity, 62.5% on sleep hygiene, 55.4% on medication adherence, 8.9% on family emotional climate and only 5.4% on healthy use of technology. Weight has shown significant relation with gender (male = 80.84 ± 17.71, female = 71.09 ± 10.52, t = -2.52, p = .015) and near to significant relationship (χ² = 7.685, p = .053) with educational status.

CONCLUSION

Patients receiving second-generation antipsychotics (SGA) have lesser extra pyramidal side-effects; however, they are more prone to gain weight. Proper screening and counselling during the follow-up visit in the outpatient setting can help in identification, prevention and management of the obesity-related metabolic syndrome and cardiovascular disease (CVD), and motivate them to adopt healthy behaviours.

Supported employment programme for persons with severe mental disorders in India: A feasibility study

BACKGROUND

A number of persons with severe mental illnesses are unable to prepare for, find or keep a job due to factors linked to their illness as well as psychosocial issues.

AIM

To test the feasibility of a supported employment programme to help persons with severe mental disorders obtain and sustain employment.

METHODS

A supported employment programme was developed for persons with severe mental disorders with components of (a) assessment of vocational potential, (b) vocational counselling, (c) networking and liaison with prospective employers, (d) job-related training and placement and (e) continued support for 6 months. Job placement status, social occupational functioning and disability (quantitative data) and benefits of enrolling in the employment programme (qualitative data) were assessed.

RESULTS

A total of 40 employers were liaised with for providing job placement and reasonable accommodation. Out of 63 participants recruited into the study, 32 (50.8%) participants were placed in competitive jobs, placement was actively attempted for 17 (27.0%) participants, 7 (11.1%) were referred for skill training and 7 (11.1%) dropped out from the study. The disability score significantly reduced and socio-occupational functioning significantly improved in those who were placed over a period of 6 months.

CONCLUSION

The supported employment programme was found to be feasible as it showed good placement rates and improvement in socio-occupational functioning and disability scores.

Direct versus indirect transfer for traumatic brain injury to James Cook University Hospital: a retrospective study

INTRODUCTION

Patients with traumatic brain injury are referred to the neurosurgical unit at James Cook University Hospital, Middlesbrough, either from local accident and emergency departments (direct transfer from the scene) or from other hospitals (indirect transfer). This study looked at the outcome in both groups.

MATERIAL AND METHODS

This was a retrospective observational study using trauma audit research network data for patients treated for traumatic brain injury at the neurosurgery department at the neurosurgical unit at James Cook University Hospital.

RESULTS

A total of 356 patients with traumatic brain injury were admitted under the care of neurosurgeons; 143 (40%) of these patients had a neurosurgical procedure. Of the patients undergoing a neurological procedure, 111 patients were transferred directly while 32 were indirect transfers; 213 patients were managed conservatively. Of those managed conservatively, 165 were transferred directly while 48 were indirect transfers. We compared the length of hospital stay and Glasgow Outcome Scale score for the patients based on whether they were conservatively managed or required surgery in the direct and indirect transfer groups. The difference in the length of stay in the surgical and conservative groups following direct and indirect transfer was insignificant (p = 0.07). The time to the operation in direct and indirect transfer was also not statistically significant (p = 0.06).

CONCLUSION

Patients are as safe, if not safer, by reaching the nearest trauma unit with facilities for resuscitation and imaging.

The National Mental Health Survey of India (2016): Prevalence, socio-demographic correlates and treatment gap of mental morbidity

BACKGROUND

Recognizing the need for good quality, scientific and reliable information for strengthening mental health policies and programmes, the National Mental Health Survey (NMHS) of India was implemented by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, in the year 2015-2016.

AIM

To estimate the prevalence, socio-demographic correlates and treatment gap of mental morbidity in a representative population of India.

METHODS

NMHS was conducted across 12 Indian states where trained field investigators completed 34,802 interviews using tablet-assisted personal interviews. Eligible study subjects (18+ years) in households were selected by a multi-stage, stratified, random cluster sampling technique. Mental morbidity was assessed using MINI 6. Three-tier data monitoring system was adopted for quality assurance. Weighted and specific prevalence estimates were derived (current and lifetime) for different mental disorders. Mental morbidity was defined as those disorders as per the International Statistical Classification of Diseases, Tenth Revision Diagnostic Criteria for Research (ICD-10 DCR). Multivariate logistic regression was conducted to examine risk for mental morbidity by different socio-demographic factors. Survey was approved by central and state-level institutional ethical committees.

RESULTS

The weighted lifetime prevalence of 'any mental morbidity' was estimated at 13.67% (95% confidence interval (CI) = 13.61, 13.73) and current prevalence was 10.56% (95% CI = 10.51, 10.61). Mental and behavioural problems due to psychoactive substance use (F10-F19; 22.44%), mood disorders (F30-F39; 5.61%) and neurotic and stress-related disorders (F40-F48; 3.70%) were the most commonly prevalent mental morbidity in India. The overall prevalence was estimated to be higher among males, middle-aged individuals, in urban-metros, among less educated and in households with lower income. Treatment gap for overall mental morbidity was 84.5%.

CONCLUSION

NMHS is the largest reported survey of mental morbidity in India. Survey estimated that nearly 150 million individuals suffer from one or the other mental morbidity in India. This information is to be used for planning, delivery and evaluating mental health programming in the country.

Amelogenesis Imperfecta: 1 Family, 2 Phenotypes, and 2 Mutated Genes

Amelogenesis imperfecta (AI) is a clinically and genetically heterogeneous group of diseases characterized by enamel defects. The authors have identified a large consanguineous Moroccan family segregating different clinical subtypes of hypoplastic and hypomineralized AI in different individuals within the family. Using targeted next-generation sequencing, the authors identified a novel heterozygous nonsense mutation in COL17A1 (c.1873C>T, p.R625*) segregating with hypoplastic AI and a novel homozygous 8-bp deletion in C4orf26 (c.39_46del, p.Cys14Glyfs*18) segregating with hypomineralized-hypoplastic AI in this family. This study highlights the phenotypic and genotypic heterogeneity of AI that can exist even within a single consanguineous family. Furthermore, the identification of novel mutations in COL17A1 and C4orf26 and their correlation with distinct AI phenotypes can contribute to a better understanding of the pathophysiology of AI and the contribution of these genes to amelogenesis.

Psychosis in a Patient with Davidoff-Dyke-Masson Syndrome

OBJECTIVES

To report the finding of psychosis in a patient with Davidoff-Dyke-Masson Syndrome.

METHOD

Case report.

CONCLUSIONS

Right-sided hemiatrophy may be an addition to the list of neuro-developmental and structural cerebral anomalies associated with psychotic disorders including schizophrenia.

Potential use of Caulerpa fastigiata biomass for removal of lead: kinetics, isotherms, thermodynamic, and characterization studies

The present study attempts to analyze the biosorption trend of biosorbent Caulerpa fastigiata (macroalgae) biomass for removal of toxic heavy metal ion Pb (II) from solution as a function of initial metal ion concentration, pH, temperature, sorbent dosage, and biomass particle size. The sorption data fitted with various isotherm models and Freundlich model was the best one with correlation coefficient of 0.999. Kinetic study results revealed that the sorption data on Pb (II) with correlation coefficient of 0.999 can best be represented by pseudo-second-order. The biosorption capacity (q e ) of Pb (II) is 16.11 ± 0.32 mg g(-1) on C. fastigiata biomass. Thermodynamic studies showed that the process is exothermic (ΔH° negative). Free energy change (ΔG°) with negative sign reflected the feasibility and spontaneous nature of the process. The SEM studies showed Pb (II) biosorption on selective grains of the biosorbent. The FTIR spectra indicated bands corresponding to -OH, COO(-), -CH, C = C, C = S, and -C-C- groups were involved in the biosorption process. The XRD pattern of the C. fastigiata was found to be mostly amorphous in nature.

Potential use of leaf biomass, Araucaria heterophylla for removal of Pb+2

The present investigation attempt to analyze the biosorption behavior of novel biosorbent, Araucaria heterophylla (green plant) biomass, for removal of Pb(+2) from solution as the function of initial metal ion concentration, pH, temperature, sorbent dosage and biomass particle size. The maximum biosorption was found to be 95.12% at pH 5 and biosorption capacity (q(e)) of Cd(+2) is 9.643 mg/g. The Langmuir and Freundlich equilibrium adsorption isotherms were studied and observed that Freundlich model is best fit than the Langmuir model with correlation coefficient of 0.9927. Kinetic studies indicated that the biosorption process of Cd(+2) followed well pseudo second order model with R2 0.999. The process is exothermic and, spontaneous. The chemical functional groups -OH, CH2 stretching vibrations, C=O of alcohol, C=O of amide, P=O stretching vibrations, -CH, were involved in the process. The XRD pattern of the A. heterophylla was found to be mostly amorphous in nature. The SEM studies showed Pb(+2) biosorption on selective grains of the biosorbent. It was concluded that A. heterophylla leaf powder can be used as an effective, low cost, and environmentally friendly biosorbent for the removal of Pb(+2) from aqueous solution.

Electroconvulsive therapy (ECT) in bipolar disorder: A narrative review of literature

In many countries including India electroconvulsive therapy (ECT) is frequently used to treat different phases of bipolar disorder. The response to ECT is impressive in mania, depression and in mixed affective states. Preliminary evidence also suggests benefit from maintenance ECT in bipolar disorder. However, most of the literature on efficacy and adverse effects comes from case series, retrospective reports and open trials - controlled trials have been few and far between. Official guidelines recommend the use of ECT only when there is a dire emergency or when all other options have been exhausted. Concurrent use of lithium and antiepileptic drugs along with ECT is common in clinical practice. While such practice appears to be largely safe, one should be mindful about dose of lithium and possible interference of antiepileptic drugs with efficacy of ECT. The use of suprathreshold bilateral ECT and bifrontal placement of electrodes may confer some advantage over other methods.

Inter-rater reliability of Hamilton depression rating scale using video- recorded interviews - Focus on rater-blinding

BACKGROUND

Hamilton depression rating scale (Ham-D) is the most widely used clinician rating scale for depression. There has been no Indian study that has examined the inter-rater reliability (IRR) of video-recorded interviews of the 21-item Ham-D.

AIM

To study the IRR of scoring video-recorded interviews for 21-item Ham-D.

MATERIALS AND METHODS

Eighteen subjects with major depressive disorder involved in a larger study were interviewed using the semi-structured clinical interview of the 21-item Ham-D by a primary rater after informed consent. These interviews were video-recorded and portions edited to ensure rater blinding. Subsequently, the video-recorded interviews were rated by a "blind" rater. Both rated the different sub-domains of Ham-D according to Rhoades and Overall (1983). IRR was evaluated using intra-class correlation coefficient.

RESULTS

Excellent IRR was observed (0.9891) between the two raters. This was true for each of the primary factors and super-factors.

CONCLUSION

Video recorded 21-item Ham-D has excellentIRR. Video-recorded interviews of Ham-D can be reliably used to blind raters in research.

Hospital readmissions: patient, carer and clinician views

To explore patients, carers, and clinician views and identify factors, which affect the likelihood of hospital readmission. Methods A cross sectional retrospective study of adult medical patients readmitted to hospital within 28 days of discharge. Medical and nursing records were reviewed and patients and their carers were interviewed regarding their views about their discharge and readmission. Data were collected regarding demographic, social and medical profiles. Results Seventy-seven patients were readmitted over a five-week period out of 1289 patients discharged during the previous five weeks, representing a 6% readmission rate. Mean (SD) age of readmitted patients was 71.3 (14.6) years. Forty patients (51.9%) were aged =75 and 39 (50.6%) were males. Mean (SD) number of comorbidities was 3.68 (1.82). Mean (SD) number of medications was 7.79 (4.14). Most common reasons for readmission were exacerbation of chronic obstructive pulmonary disease and acute coronary syndrome. Mean (SD) time to readmission was 11.6 (8.2) days. Fifty (64.9%) patients were readmitted within 14 days of discharge. Forty eight (62.3%) patients were readmitted with the same medical condition as their previous discharge. Fifty (64.9%) patients and 45 (66.2%) carers felt that discharge was appropriate. Forty five (58.0%) patients and 44 (57.0%) carers thought that readmission was unavoidable. Clinicians considered 56 (72.7%) discharges appropriate and 55 (71.5%) readmissions unavoidable. A trend towards higher readmission rate among patients = 75 years was noted (7.2% vs 5.1%, p=0.1). Conclusion Although the majority of discharges are appropriate, up to a third of readmissions may be avoidable in the views of carers, patients and clinicians. Patients and carers should be consulted regarding readiness for discharge before leaving hospital.

Comparison of caudal tramadol vs bupivacaine for post-operative analgesia in children undergoing hypospadias surgery

In a prospective double-blind study, 40 children scheduled for hypospadias repair were allocated randomly to receive either caudal tramadol (1 mg/kg) or 0.25% plain bupivacaine (0.5 ml/kg). Postoperative pain score, side-effects and oxygen saturation (SaO2) were recorded during 24-hour observation period. The results point toward a significantly lower pain scores with caudal bupivacaine in the immediate postoperative period, whereas caudal tramadol caused a significantly lower pain score in the late postoperative period. Total consumption of rescue analgesics was significantly higher in bupivacaine group as compared to tramadol group during the study period (p < 0.001). The incidence of side-effects such as vomiting was more frequent with caudal tramadol, but there was no detectable difference in SaO2. We conclude that caudal tramadol can safely be used for postoperative analgesia with a longer duration as compared to caudal bupivacaine.

Legionnaires' disease in elderly people: the first sign of an outbreak in the community?

Legionella pneumophila is responsible for up to 5% of cases of community-acquired pneumonia and mainly affects people aged over 50 years. The confirmation of legionellosis in two elderly patients living close to each other prompted a search for other cases. A total of eleven subjects with legionnaires' disease was recognized. The clinical findings are described and the diagnosis of legionellosis is discussed. Environmental investigations pointed to a cooling tower in the local town centre as the probable source of infection.