Objective: To investigate the association of parental consanguinity and delayed development in terms of gross motor, fine motor, speech and social aspects in their children.Methods: One hundred and seventy seven children (age 15 days--72 months) were evaluated for their developmental status utilizing the Denver Developmental Screening Test (DDST). An unmatched case-control study design was used. Case group consisted of 94 children and control group 83 children. Odds ratios were calculated for parental consanguinity and delay in gross and fine motor, speech and social development in their children, for cases and controls, utilizing Binary Multiple Logistic Regression Analysis. Acquired delay was excluded through detailed birth history in both cases and control group respectively.Results: Univariate analysis showed high significant Odds ratios for all areas of developmental delay (viz. gross and fine motor, speech and social development), between cases and controls (p \u3c .001). At the multivariate analysis level however, our results showed no increased risk of parental consanguinity on delayed gross and fine motor, speech and social development in their children.Conclusion: Our results show no increased risk of parental consanguinity on delayed gross and fine motor, speech or social development (as measured by the DDST), in their children

Ahmed, R

Azam, I S

Habib, Z

Hyder, S

Ibrahim, S

English

eCommons@AKU

eCommons@AKUDepartment of Paediatrics and Child Health Division of Woman and Child HealthDecember 2001Parental [correction of Perinatal] consanguinity: arisk factor for developmental delay in PakistanichildrenS IbrahimAga Khan University, shahnaz.ibrahim@aku.eduZ HabibAga Khan UniversityS HyderAga Khan UniversityI S. AzamAga Khan UniversityR AhmedAga Khan University, rashida.ahmed@aku.eduFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatrPart of the Pediatrics CommonsRecommended CitationIbrahim, S., Habib, Z., Hyder, S., Azam, I. S., Ahmed, R. (2001). Parental [correction of Perinatal] consanguinity: a risk factor fordevelopmental delay in Pakistani children. Journal of Pakistan Medical Association, 51(12), 418-422.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/576Hormone Replacement Therapy menopause with a BetterFuture - A survey of views on Hormone Replacement Therapy(HRT)S. Shafi,Z. Samad,S. Syed,A. Sharif,M. A. U. Khan,U. S. Nehal,A. R. Siddiqui ( Department of Community HealthSciences, The Aga Khan University Hospital. Karachi. ) AbstractObjective: To assess the views and prescribing practices of doctors regarding hormone replacementtherapy (HRT).Methods: In April 1999,103 doctors from a teaching hospital participated in a survey. Using a self-administered questionnaire, subjects were contacted at the departments of Internal Medicine, FamilyMedicine, Obstetrics and Gynaecology, and Orthopaedics.Results: Seventy-two percent were below 40 years of age and 67% of the respondents were male. Mostdoctors believed that HRT decreases the risk of subsequent osteoporosis (97%), ischaemic heart disease(77%) and depression associated with menopause (64%). Doctors generally considered menopausalsymptoms (90%), premature menopause (87%), surgical menopause (85%) and osteoporotic fracture(77%) as clear indications for hormone replacement therapy. Absolute contraindications to the therapywere stated as recent breast cancer (82%) and recent endometrial cancer (84%). Among the specialtiescovered, there were differing views on proposed duration of HRT. It was generally believed that apelvic examination, cervical smear and mammography were pre-requisites when initiating andmonitoring HRT. Majority (69%) felt that HRT should be offered to all menopausal women, assumingno contraindications and most (73%) did discuss HRT with their patients. However, less than 10% ofthe menopausal patients under their care were using HRT. Those doctors not in favor of universaloffering of HRT (31%) considered unreliable patient folio w up to be the main reason. Females weretwo times more likely to discuss HRT with their patients (p= .08). Doctors who discussed HRT withtheir patients were four times more likely to consider HRT for themselves or their spouses (p= .13).Gynecologists were eight times more likely to prescribe HRT than non-gynecologists (p= .001).Conclusion: Doctors are positively disposed to the universal offering, and use of HRT. Further studiesare needed to understand a possible gap between perceived and actual prescribing practice (JPMA51:450,2001).Introduction Hormone Replacement Therapy (HRT) consists of treatment with estrogen or a combination ofestrogen plus progestin. There is extensive data suggesting that HRT is effective in alleviating theeffects of the menopause and in protecting against the chronic cardiovascular and cerebrovascularconsequences of estrogen deficiency1-4. The consensus amongst specialists is that contraindications toHRT are few and less than those associated with oral contraceptives5. The American College ofPhysicians recommends that all women, regardless of race, should consider HRT6. Despite this fact, thecurrent use of HRT is still low. An international survey indicated current rate of use of HRT in womenaged 40-69 to be 7% in UK7 and 9% in Scotland8, 30% in USA, 21% in Sweden and 25% in France9.According to Ringa10 the difference between the prevalence of climacteric complaints and HRT userates may be attributed to unwillingness on the part of women to use HRT, or the part of physicians toprescribe it. HRT use is strongly related to interactions with the physicians; women are likely to usewritten materials as a source of information in making decisions about HRT, and most women feel thatthe amount of information received about HRT is inadequate”. A recommendation by a doctor is one ofthe major factors determining compliance with subsequent prescription for HRT. About 75% of non-users of HRT would consider HRT if so recommended by their doctor. The doctor’s attitude was foundto be a factor in encouraging compliance12.Bryce and Lilford13 found that the approach of general practitioners (GP) to prescribing HRT wasguarded with regard to both frequency and duration. The study carried out by Wilkes and Meade14showed that there was considerable doubt among GPs as to the balance between the beneficial andharmful effects of HRT in the long term. However, other studies found that the GPs surveyed weregenerally able to recognize the menopause by its complaints and that they had a positive attitudetowards treatment , but many were skeptical of its chronic use and use in women with cardiovascularconditions15,16 Doctors differed in opinion as to who should initiate therapy, gynecologists or GPs.However, the studies concerned were conducted in developed countries and the situation could bedifferent in Pakistan. This study reports the views of doctors about prescribing HRT in a tertiary carehospital.Methods This cross-sectional survey, was conducted in April 1999 at The Aga Khan University Hospital(AKUH), Karachi. As a convenient sample, we chose the doctors working at AKUH in the departmentsof internal medicine, gynecology, orthopedics, and family medicine, A self-administered questionnairewas distributed amongst 125 doctors (consultants, residents, and medical officers), who were present intheir departments. units or wards .The questionnaire was pre-tested on 15 doctors.EPI-INFO 6 was used to calculate sample size. With a confidence interval of 95%, a power of 80 and apositive attitude of at least 40% towards HRT, we estimated the sample size to be 96.Data was coded before entry and it was analyzed using EPI INFO 6 statistical program software. Oddsratio was used as a measure of association. Levels of significance used were confidence interval of95%.Results Of the 125 questionnaires, 103 were returned completed, making a response rate of 82%.Figure shows The majority of responders (72%) were below 40 years of age and 67% responders weremale. Most doctors believed that HRT decreases the risk of osteoporosis (97%), ischemic heart disease(77%) and depression (64%) subsequent to menopause. 62% felt that the use of HRT does not decreasethe risk of hypertension. Regarding prevention of cerebrovascular accident (CVA), 32% felt that HRTdecreased the risk, 44% disagreed, and 18% did not know.Doctors generally considered menopausal symptoms. premature menopause, surgical menopause, andosteoporotic fracture as clear indications for hormone replacement therapy. (Table 1).Regarding contraindications to HRT, the majority considered recent breast cancer (82%) and recentendometrial cancer (84%) as absolute contraindications. More than half of the respondents (54%)considered a family history of breast cancer to be a relative contraindication. Fifty nine percentrespondents felt that HRT should be given for more than 10 years. Almost half of the gynecologists(54%) felt that HRT should be prescribed indefinitely. In orthopedics, a shorter duration was preferred,that is. 55% believed in URT for less than five years.Table 2 shows the investigations that doctors considered necessary before starting HRT. It wasgenerally believed that a pelvic examination, cervical smear and mammography were specificallyindicated when initiating and monitoring HRT. Breast examination and measurement of blood pressurewere also considered necessary for monitoring HRT. Thirty-five percent of the respondents feltcomfortable prescribing HRT themselves whereas the rest (61 .2%) referred to gynecologists.Gynecologists were found to be 8 times more likely to prescribe HRT then non-gynecologists (Oddsratio (OR) 8.5; 95% Cl: 1.93 - 43.98). The majority of family medicine practitioners felt at ease whileprescribing HRT (67%). Among other specialties, the general trend was to refer.Among non-Gynecologists, doctors in family medicine were 15 times more likely to prescribe HRT, ascompared to cardiologists, orthopedic surgeons, and internists. (OR=15; 95%Cl: 4.41 - 55.9).Only 32% of doctors had patients on HR’T, however, these patients comprised less than 10% of themenopausal patients under their care. 14% of doctors did not respond, 25% did not know and 18% ofdoctors had no patients on HRT.The majority of the doctors (69%) favored universal offering of HRT assuming no contraindicationsand most doctors (73%) did discuss HRT with their patients.Majority of gynaecologists (100%) and family practitioners (90%) discussed HRT with their patients,whereas only 54% of internists did so.Those doctors who were not in favor of universal offering of HRT (31%), considered the following tobe their main reasons: unreliable patient follow up, risks of HRT outweigh it’s benefits, unwillingpatients and the need for further research on the subject. Lack of availability of HRT, a time consumingscreening process, that HRT interfered with a natural phenomenon and that it is not a priority for adeveloping country were not considered to be important reasons.Female doctors were two times more likely to discuss HRT with their patients, as compared to maledoctors. People who discussed HRT with their patients were 4 times more likely to consider HRT forthemselves or their spouses. Current medical literature was the primary source for 71% of the doctors.Discussion This study indicated that the doctors at this hospital are fairly aware and positively disposed towardsHRT. There was possibly a disproportionate response from young doctors, who might be morepositively inclined to HRT than their older colleagues.The doctors are positively disposed to HRT, regarding its role in ischemic heart disease, osteoporosis,depression and treatment of menopausal symptoms, premature menopause and surgical menopause.Reservations exist over the role of HRT in the prophylaxis of cerebrovascular accident andHypertension. While estrogen therapy has little control on blood pressure there is data that it can reducesignificantly mortality of ischemic heart disease2. Data indicating a relative risk of 0.53 of death fromstroke following estrogen therapy3 differ with more recent data17, which show no reduction (orincrease) in risk of stroke. The bulk of evidence now suggests that in contrast to the combined oralcontraceptive, HRT does not cause or aggravate essential hypertension18,19. However, 23% of thedoctors in our study, considered even treated hypertension to be an absolute or relative contraindicationto HRT.An over guarded approach, or investigations and monitoring that are too invasive and expensive maydaunt women from opting for HRT. There is no evidence to link cervical abnormality to HRT16 but themajority of the doctors’ required cervical smears before HRT. Regarding duration of therapy, themaximum benefits of therapy in reducing risk for coronary heart disease and osteoporotic fractures aremore likely to be achieved with long-term therapy (10 to 20 years or more). 40% of the respondents inthis study felt that HRT should be given for less then 10 years. Family practitioners and gynecologistswere comfortable with prescribing HRT, while in other specialties the trend was to refer.Most of the doctors favored universal offering of HRT and almost all of them thought that everywomen should be educated about HRT. Unreliable patient follow up, unwillingness on the part of thepatients and likely risks versus benefits were cited as important reasons for not offering HRT. Financialcost, cost in time for supervision and monitoring and concern about the pharmacological approach towhat is seen as a natural process in humans were not considered important reasons for not offeringHRT as opposed to other studies13.On the basis of the results of this study, one might get the notion that there was no major reluctance onthe part of the doctors to use HRT. However, less than 10% of the menopausal patients under their carewere using HRT. A possible justification is that the unwillingness to use HRT may come primarily fromthe women in our setting. Whether or not women really are hesitant to use HRT would require furtherinvestigation.We recommend that guidelines in keeping with the most recent literature should be formulated andmade available to all doctors. Furthermore, seminars and workshops should be held to highlight thepreventive role of HRT during and after the climacteric phase of life.Acknowledgements We would like to thank Dr. Nadeem Zuberi, Mr. Raheem Makani and the Departments of CommunityHealth Sciences, Family Medicine, Medicine, Obstetrics and Gynaecology and Orthopaedics for theirsupport and cooperation.References 1.Grady D, Rubin SM. Petitti DB Hormone therapy to prevent disease and prolong life inpostinenopausal women, Ann. Intern. Med., 1992. 117:1016, 37.2.Henderson BE, Paganini -Hill, Ross RK. Estrogen replacement therapy and protection frommyocardial infarction. Am. J. Obstet. Gynecol., 1986: 159; 3 12-17.3.Paganini-Hilt. Ross RK, Henderson B. Postmenopausal oestrogen treatment and stroke; a prospectivestudy Br. Med. J., 1988: 297:519-22.4.Falkeborn M, Persson 1, Adami HO. et al The risk of acute myocardial infarction after oestrogen-progestogen replacement. Br. J Obstet Gynecol., 1992; 99821.28.5.Studd JWW. Complications of hormone replacement therapy tn postmenopausal women, J. Roy. Soc.Med., 1992: 85:376-78.6,American College of Physicians. Guidelines for counseling postmenopausal women about preventivehormone therapy. Ann. Inter. Med., 1992. 117:1038,41.7.Odenns BJ, Boulet Mi, Lehert P, et al. Has the climacteric been medicalized? A study on the use ofmedications for climactenc complaints on four countries. Maturitas.. 1992; 15:171-81.8.Sinclain HK, Bond CM, ‘raylor RJ. HRT: A study of women’s knowledge and attitudes. Br J GenePrac., 1993; 43365-70.9.Lars-Ake, Stadberg E, Milson, L.. Management of hormone replacement therapy; the Swedishexperience. Eur. J. Obstet. Gynecol Reprod. Biol., 1996: 64 (Sttppl 1) :S3-S5.10.Ringa V, Ledesert B, Gueguen R, et al. Determinants of hormonal replacement therapy in recentlypostmenopausal women. Eur. J. Obstet. Gynecol. Reprod Biol., 1990: 37:55-61.11Newton KM. Lacroix AZ, et al. The physician’s role in women’s decision Making about hormonereplacement therapy. Obstet. Gynecol., 1998: 92:580-84.12.Ferguson Ki, Hoegh C, Johnson A. Estrogen replacement therapy: A survey of women’s knowledgeand attitudes, Arch. Int, Med., 1989: 149; 133-36.13.Bryce FC, Lilford RJ. General practitioners views of hormone-replacement therapy in Yorkshire.Eur. J. Obstet. Gynecol. Reprod. Biol., 1990: 37: 55-61.14.Wilkes HC, Meade TW. Hormone replacement therapy in general practice: a survey of doctors inthe MRC’s general practice research framework. Br. Med. J., 1991;302: 1317-20.15,Stouthamer N, Visser AP,, Oddens BJ,et al. Dutch general practitioners’ attitudes towards theclimacteric and its treatment, Eur. J. Obstet, Gynecol Reprod. Biol.,1993; 50: 147-52.16.Norman SG. Studd JWW. A survey of views on hormone replacement therapy. Br. J. Obstet.Gynecol.,1994;101: 879-87.1 7,Stampfer Mi, Colditz GA, Willett WC. et al. Postmenopausal estrogen therapy and cardiovasculardisease. N. EngI J. Med.,1991, 325:756-62.18,Laragh JH., Scaly JE., Ledingham JG, et al. Oral contraceptives: renin, aldosterone and high bloodpressure. J. Am. Med. Assoc., 1967; 201; 918-22.19Eggersscn R. Influence on blood pressure of oestrogen substitution therapy in the menopause. Sand.J. Prim. Health. Care., 1987; 5: 51-53.

Parental [correction of Perinatal] consanguinity: a risk factor for developmental delay in Pakistani children

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Parental [correction of Perinatal] consanguinity: a risk factor for developmental delay in Pakistani children

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