Abuse among school going adolescents in three major cities of Pakistan: is it associated with school performances and mood disorders?

Objective: To assess the proportion of various types of abuses and their association with school performances and psychological stress among adolescents from three major cities of Pakistan. Methods: The cross-sectional school survey was conducted from March to September 2009, comprising adolescent students at six schools in Karachi, Lahore and Quetta. Data was collected using a self-administered and pre-tested questionnaire by trained medical students. SPSS 16 was used for statistical analysis.. Results: Of the 414 subjects in the study, there were 223(54%) boys and 191(46%) girls with an overall mean age of 14.36 ±1.08 years. In all, 140(33.7%) participants were physically abused and 236(57%) participants were verbally abused in the preceding 12 months. Besides, 245(59.2%) were involved in physical fight and 195(47.1%) had suffered injury during the preceding year. There were 171(41.4%) subjects having suffered bullying during the same period. Verbal abuse (p=0.05), physical fight (p=0.05) and bullying (p\u3c0.001) were significantly associated with poor school performances among adolescents. Physical abuse (p=0.05), verbal abuse (p=0.003), injury (p=0.02) and bullying (p\u3c0.001) were significantly associated with psychological stress. Conclusion: Various types of abuse were quite prevalent in adolescents that were significantly associated with poor school performance and poor mental health

Equipping community health workers with digital tools for pandemic response in LMICs

Background: Community health workers (CHWs) are well-positioned to play a pivotal role in fighting the pandemic at the community level. The Covid-19 outbreak has led to a lot of stress and anxiety among CHWs as they are expected to perform pandemic related tasks along with the delivery of essential healthcare services. In addition, movement restrictions, lockdowns, social distancing, and lack of protective gear have significantly affected CHWs\u27 routine workflow and performance. To optimize CHWs\u27 functioning, there is a renewed interest in supporting CHWs with digital technology to ensure an appropriate pandemic response.Discussion: The current situation has necessitated the use of digital tools for the delivery of Covid-19 related tasks and other essential healthcare services at the community level. Evidence suggests that there has been a significant digital transformation to support CHWs in these critical times such as remote data collection and health assessments, the use of short message service and voice message for health education, use of digital megaphones for encouraging behavior change, and digital contract tracing. A few LMICs such as Uganda and Ethiopia have been successful in operationalizing digital tools to optimize CHWs\u27 functioning for Covid-19 tasks and other essential health services.Conclusion: Yet, in most LMICs, there are some challenges concerning the feasibility and acceptability of using digital tools for CHWs during the Covid-19 pandemic. In most cases, CHWs find it difficult to adopt and use digital health solutions due to lack of training on new digital tools, weak technical support, issues of internet connectivity, and other administrative related challenges. To address these challenges, engaging governments would be essential for training CHWs on user-friendly digital health solutions to improve routine workflow of CHWs during the Covid-19 pandemic

Morning cortisol as an alternative to Short Synecthan test for the diagnosis of primary adrenal insufficiency

Objective: To determine 7-9 am serum cortisol less than 5mcg/dl is an independent reliable confirmatory test for the diagnosis of primary adrenal insufficiency (PAI). Methods: A total of 164 patients who visited the outpatient or inpatient department of Aga Khan University Hospital from June 2011 to June 2017 were included for the study. All those patients whose levels came out less than 5mcg/dl were recruited for the study and they all underwent SST. Other demographic and laboratory data were also recorded. Results: The sensitivity of morning cortisol for diagnosis of PAI is 100% if levels are \u3c1mcg/dl and decreases to 71.88% if levels are up to 5mcg/dl. Conclusion: Morning cortisol is sensitive enough as an alternative to SST if levels are \u3c1mcg/dl (100%). However, if the levels are increased from \u3e 1mcg/dl to \u3c 5 mcg/dl, the sensitivity decreases gradually from 98% to 71%