Theory of Mind Understanding in Narration: A Study among Children from Different Socioeconomic Backgrounds in India

This study investigates the theory of mind understanding as reflected in the narratives of children from families of low as well as high socioeconomic-status (SES). A group of 30 Hindi-speaking children from six to seven years of age and their mothers participated in this study. Children were asked to narrate six stories prompted by pictures and standard verbal probes. In addition, they were also administered false-belief tasks to assess their theory of mind understanding. Later, their mothers were asked to narrate three stories to their children. Content analysis of the stories indicated the frequency of occurrence of words referring to mental states such as emotion, intention, thought, belief, etc. The low and high SES children differ in their reference to the mental state of the protagonist in the stories narrated by them. The result was interpreted concerning the landscape of action and landscape of consciousness discussed by Bruner (1986). Interestingly, even though all the children could refer to mental states in their narratives, approximately 50% of the children from low SES backgrounds failed in the false-belief task, indicating a lack of understanding of theory of mind. The narration by the mothers from high SES families was more elaborate with significant reference to the mental state of the protagonist as compared to the narration of the mothers from low SES families. A significant relationship between mothers’ narration/theory of mind understanding and children’s narration/theory of mind understanding was also observed

Infertility and Obesity: A Cross-Sectional Study in North Indian Women

The present study assessed the relationship between primary infertility and obesity in women of Delhi, India, independently, and in light of various demographic trait, lifestyle and reproductive variables. The present study was a part of a major project funded by the National Commission for Women of India, Government of India. The data were collected from 334 women, including 167 fertile and 167 infertile individuals. A two-part pretested modified quantitative interview schedule was used to collect data. The first part of the interview schedule included demographic traits, reproductive profile and lifestyle variables. The second part consisted of anthropometric measurements for BMI which were taken using an anthropometric rod (height) and digital weighing scale (weight). All the data were analysed through SPSS 22.0. The results revealed a higher prevalence of obesity and underweight among infertile women. There is a clear-cut indication that usual risk factors of obesity like physical inactivity, increasing age, higher age at marriage, and infertility-related biological issues seem to be promoting obesity in combination with infertility. Public health education is needed to increase awareness about the age at marriage. As physical inactivity leads to obesity among infertile women, counselling, awareness raising or improvement of lifestyle factors should be considered in the infertility treatment protocol

Self-reported perceived stress, depression, and generalized anxiety disorder among Kathak dancers and physically active non-dancers of North India

The aim of the present paper was to study the various common mental disorders in a sample of Kathak dancers and non-dancers of North India. 206 female Kathak dancers and 235 healthy controls, aged 18–45 years completed questionnaires assessing perceived stress (PSS-10), depressive symptoms (PHQ-9), and generalized anxiety (GAD-7). Pearson correlations assessed the association between perceived stress, depression, generalized anxiety, age, and years of dancing, and binary logistic regression identified the risk of developing depression and generalized anxiety disorder in Kathak dancers and non-dancers. The prevalence of perceived stress was similar among Kathak dancers and non-dancers. Kathak dancers reported significantly lower depressive symptoms compared to controls. Non-dancers with elevated perceived stress levels were 4 times more likely to report depressive symptoms and 7 times more likely to report anxiety symptoms, relative to dancers. The adjusted odds of reporting depressive symptoms along with generalized anxiety were higher among non-dancers compared to dancers. Kathak can be developed into a very effective psychotherapeutic tool for mitigating the risk of developing depression and generalized anxiety disorder

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Development of Hindi Pragmatic Language Skills in Indian Children

The use of language within context is pragmatics. Since, there is no tool to assess Hindi pragmatics among Indian children, the present research aimed to develop a task to asses the same. In phase one, naturalistic observation, expert interviews, and text analysis of Hindi storybooks were conducted to understand the use of pragmatics. In phase two, Hindi Pragmatic language story narration (HPSN) and Hindi Pragmatic language video tasks (HPVT 1.0 and 2.0) were constructed to assess pragmatics. These were refined to develop Kids pragmatics Hindi videos (KPHV), used in phase three to investigate age and gender differences, further relationship with theory of mind was also examined. Children became significantly better in pragmatics with age. A significant relationship between pragmatics and theory of mind was also found. No significant effect of gender on pragmatics was observed. The findings of the study are useful for development of rehabilitation programs for children with Social Pragmatic Disorder (SPD). Keywords: Linguistics; Psychology; Development; Language development; Theory of Mind; Field studies; Statistics

Fighting cancer is half the battle... living life is the other half

PURPOSE: The purpose of this study was to explore the psychological and social problems the terminally ill are facing in India. Another objective of this study was to explore the Locus of Control and Depression. AIMS: The study was conducted on an incidentally available sample of fifteen terminally ill patients at the Pain Clinic, I.R.C.H., AIIMS, ranging from young adults (30-35 years), to middle aged (40-50 years), to the elderly (55-65 years). MATERIALS AND METHODS: A thematic and narrative analysis was done using semi-structured interview. After the semi-structured interview, two standardized inventories were administered. The two inventories used were Multidimensional Health Locus of Control, and Beck\u2032s Depression Inventory. The statements from the two inventories were translated into Hindi and then asked. The inventories were not given as a questionnaire to be filled; rather they were asked orally and marked by the investigator. RESULTS: The co-relation between Internal Health Locus of Control and Depression was found to be significant below the 0.05 level. Statistics also revealed that a large number of participants were either severely depressed (33.33%) or extremely depressed (20%). The seven common themes running through all the narratives were identified; Concern for physical pain; Anxiety and Depression; Body-image problems; Social withdrawal; Disease viewed as bad \u2032karma\u2032; Desire for hastened death; and lastly Hope. CONCLUSION: This article would create greater awareness among all the concerned people working with cancer patients on what intervention strategies should be utilized to help the patients, as well as, how the belief in karma can help gain a more positivistic outlook towards death and the core role spirituality and the belief in karma can play in the counseling of the patients and their families

Fighting cancer is half the battle... living life is the other half

PURPOSE: The purpose of this study was to explore the psychological and social problems the terminally ill are facing in India. Another objective of this study was to explore the Locus of Control and Depression. AIMS: The study was conducted on an incidentally available sample of fifteen terminally ill patients at the Pain Clinic, I.R.C.H., AIIMS, ranging from young adults (30-35 years), to middle aged (40-50 years), to the elderly (55-65 years). MATERIALS AND METHODS: A thematic and narrative analysis was done using semi-structured interview. After the semi-structured interview, two standardized inventories were administered. The two inventories used were Multidimensional Health Locus of Control, and Beck′s Depression Inventory. The statements from the two inventories were translated into Hindi and then asked. The inventories were not given as a questionnaire to be filled; rather they were asked orally and marked by the investigator. RESULTS: The co-relation between Internal Health Locus of Control and Depression was found to be significant below the 0.05 level. Statistics also revealed that a large number of participants were either severely depressed (33.33%) or extremely depressed (20%). The seven common themes running through all the narratives were identified; Concern for physical pain; Anxiety and Depression; Body-image problems; Social withdrawal; Disease viewed as bad ′karma′; Desire for hastened death; and lastly Hope. CONCLUSION: This article would create greater awareness among all the concerned people working with cancer patients on what intervention strategies should be utilized to help the patients, as well as, how the belief in karma can help gain a more positivistic outlook towards death and the core role spirituality and the belief in karma can play in the counseling of the patients and their families