Cost effectiveness of screening of all newly recruited employees for diabetes at a tertiary care hospital

Diabetes Mellitus is a disease which remains asymptomatic for long duration of time and usually diagnosed either when gets complicated or by routine or opportunistic screening. The practice of universal screening is not recommended, particularly in constraint resources . However, we embarked with a study to assess the yield of recommended screening for Type 2 diabetes in all the newly recruited employees at a tertiary care hospital in Karachi. Methods: All the information required for this study was collected from medical records of all newly recruited employees of nursing services department of a tertiary care hospital of Karachi, Pakistan, over a period of 5 months (August 2004 to December 2004). Out of 360 subjects , 326, whose information was found to be complete, were included for final analysis. Results: Mean age of the study subjects was 25.3 ± 4.7 years and their mean casual plasma glucose level was 99.1 ± 16.3 mg/dl. 315 (96.6%) study subjects had casual plasma glucose level of 139 mg/dl or less. Only 10 (3.1%) study subjects had casual plasma glucose levels between 140 to 199 mg/dl. Just one employee, 41 years old, was found to have casual plasma glucose level of 213 mg/dl. Conclusion: In this study, screening of all individuals for diabetes had a very low yield. Recommendation of universal screening for diabetes does not represent a good use of resources and perhaps not costeffective. However, periodic screening of high risk individuals should be warranted

Family physicians understanding about Mantoux test: A survey from a high endemic TB country

<p>Abstract</p> <p>Background</p> <p>Tuberculosis is a global health emergency and is a big challenge to diagnose and manage it. Family physicians being first contact health persons should be well competent to diagnose and manage the patients with tuberculosis.</p> <p>Aims</p> <p>This study was aimed to assess the level of understanding about Mantoux Test amongst Family Physicians in Karachi, Pakistan and to determine the difference of level of understanding by gender and number of tuberculosis patients seen in a month.</p> <p>Methods</p> <p>A cross sectional survey was conducted among 200 Family Physicians working in Karachi; the largest city and economic hub of Pakistan. Family Physicians who attended Continuous Medical Education sessions were approached after taking consent. Pre-tested, self administered questionnaire was filled consisting of: basic demographic characteristics, questions regarding knowledge about Mantoux Test, its application and interpretation. Data of 159 questionnaires was analyzed for percentages, as rest were incomplete. Chi square test was used to calculate the difference of understanding levels between various groups.</p> <p>Results</p> <p>Almost two thirds of respondents were males and above 35 years of age. Majority of Family Physicians were private practitioners and seeing more than five tuberculosis patients per month. Overall, a big gap was identified about the knowledge of Mantoux Test among study participants. Only 18.8% of Family Physicians secured Excellent (≥ 80% correct responses). This poor level of understanding was almost equally distributed in all comparative groups (Male = 20.8% versus Female = 15.9%; p - 0.69) and (Seen < 5 tuberculosis patients per month = 18.6% versus seen ≥ 5 tuberculosis patients per month = 19.3%; p - 0.32). A huge majority of Family Physicians (92%) however, showed keen interest in obtaining further knowledge regarding Mantoux Test and amongst them 72% suggested Continued Medical Education sessions as preferable mode of updating themselves.</p> <p>Conclusion</p> <p>Our study revealed an overall major deficit in understanding and interpretation of Mantoux Test amongst Family Physicians which needs to be addressed. Continues Medical Education sessions for Family Physicians should be organized in regular basis for upgrading their knowledge in this regards.</p

Women\u27s beliefs regarding food restrictions during common childhood illnesses: a hospital based study

Background: Malnutrition continues to be a major problem in Pakistan. Inadequate nutrition contributes substantially to childhood death and disease. Restriction of diet during common childhood illnesses further compromises the nutritional status of the child. The present study aims to determine the beliefs and practices regarding food restrictions during common childhood illnesses.Methods: A cross-sectional survey was conducted at Community Health Centre (CHC), of The Aga Khan University Hospital, Karachi to understand the beliefs and practices regarding food restrictions in common childhood illnesses. Four hundred adult females were interviewed from July-September 2000. A self-administered questionnaire was filled by the respondent.Results: Major sources of information about restriction of various foods during different illnesses were relatives. Sixty five percent of the respondents believed that heavy food should be restricted during diarrhoea and oily food during jaundice. Sixty six percent of the respondents believed that cold food should be restricted during cold/cough and twenty three percent believed that oily food should be restricted during typhoid.CONCLUSION: Beliefs\u27 regarding food restrictions during illnesses plays a very important role on the nutrition status. Surprisingly, medical doctors and other health care givers were also the source of information for advising food restrictions in certain childhood illnesses. Therefore there is a need for educating the physicians and other health care workers along with the mothers about food concepts and feeding practices during health and diseases. Protein energy malnutrition can be reduced to some extent if wrong dietary beliefs about child feeding practices in a community can be removed with health education programme

Impact of postpartum anxiety and depression on child’s mental development from two peri-urban communities of Karachi, Pakistan: a quasi-experimental study

Background Postpartum anxiety and depression has detrimental effects on the overall mental development of children. This study aims to assess the impact of postpartum anxiety and depression on children’s mental development on all sub-scales in a Pakistani population. Methods A quasi-experimental study was conducted in two peri-urban communities of Karachi, a mega city of Pakistan, to assess the impact of postpartum anxiety and depression on children’s growth and mental development. A total of 420 women were enrolled, who had given consent out of 651 pregnant women identified, during February 2004 to December 2005. Data for socio-demographic, home environment and family relationship variables were collected between 36 weeks of pregnancy and within 10 days of childbirth. Mother’s levels of anxiety and depression were assessed at 1, 2, 6, 12, 18, 24, and 30 months of childbirth. An indigenous, validated screening instrument- Aga Khan University Anxiety and Depression scale was used and diagnostic confirmation was done through a psychologist’s interview, based on DSM IV criteria. Children’s growth and development was monitored in the same sequence using an Early Childhood Development tool that consists of five subscales; socio emotional, language, cognitive, gross motor and fine motor development. Physical growth was monitored by measuring height and weight of the child. Data was analyzed using SAS 9.2. Multivariable Generalized Estimating Equations (GEE) logistic regression was conducted to identify association of postpartum anxiety and depression with each early childhood development indicator, adjusting for parental and child factors. Results A significant association of postpartum anxiety and depression with delayed development on all five subscales of children’s mental development was found in our study. Interestingly, our study found that higher maternal age had adverse effects on child’s emotional whereas positive impact on child’s cognitive development. Children’s stunting had an adverse impact on all five subscales of children’s development. Male children were at higher risk for delayed language and gross motor development relative to female children. Conclusions Our study found that postpartum anxiety and depression is associated with adverse outcomes regarding children’s mental development on all sub-scales. The impact was accentuated by low family income or child’s increasing age

Retrospective Analysis of Metabolic syndrome: Prevalence and Distribution in Executive Population in Urban Pakistan.

Background. Metabolic Syndrome (MetS) is a major public health concern. Objective. The aim of this study was to estimate the frequency of MetS, its components, and factors associated with MetS amongst apparently healthy individuals in Pakistan. Methods. A retrospective cross-sectional study was conducted at the executive Clinics of Aga Khan Hospital, Pakistan. Medical records of patients aged ≥18 years visiting the clinics from July 2011 to December 2011 were consecutively reviewed. Records in which either MetS components data or 10% of overall data was missing were excluded. A total of 1329 participants’ records was included in final analysis. Data was analyzed using SPSS version 19 and multivariable logistic regression was used to identify the factors associated with MetS. Results. A total of 847 (63.7%) participants had MetS; mean age of the participants were 47.6 ± 11.6 years. About 70.4% were males and 29.6% were females. Approximately 70% of participants had BMI ≥25 kg/m2. MetS was associated with male gender (AOR = 2.1; 95% C.I: 1.6–3.2) and history of diabetes among parents (AOR = 3.0; 95% C.I: 1.6–6.0). Conclusion. This study shows that a large proportion of population has MetS and is overweight or obese. This requires urgent interventions on part of health care providers’ especially family physicians. Educating masses about life style factors can make a difference. Further researches on this issue are warranted

Frequency and associated factors for anxiety and depression in pregnant women: a hospital-based cross-sectional study.

Antepartum anxiety and/or depression is a major public health problem globally. The aim of this study was to estimate the frequency of antepartum anxiety and/or depression among pregnant women. This was a cross-sectional study conducted in a tertiary care hospital among pregnant women. A total of 165 pregnant women were interviewed by a clinical psychologist using HADS for assessing anxiety and/or depression and also collected information regarding sociodemographic, obstetric, family relationships, and home environment. Out of the total of 165 pregnant women about 70 percent of them were either anxious and/or depressed. The increasing age of women (P-value = 0.073), not having any live birth (P-value = 0.036), adverse pregnancy outcome in past including death of a child, stillbirth or abortion (P-value = 0.013), participant\u27s role in household decision making (P-value = 0.013), and domestic violence (verbal or physical abuse towards mother or children by any family member) (P-value = 0.123). Our study highlights that anxiety and/or depression is quite common among pregnant women. Therefore, there is a need to incorporate screening for anxiety and depression in the existing antenatal programs and development of strategies to provide practical support to those identified

Sleep and its relation with academic performance among adolescents: An analytical cross sectional study in Gulshan town, Karachi

Objective: To determine the prevalence of sleep patterns and their relationship with academic performance among adolescents.Methods: The analytical cross-sectional study was conducted from March to August 2015 in Gulshan Town of Karachi and comprised students in grades 6 to 8 who were selected from six government and private schools. Data was collected regarding their sleeping time, wake-up time, sleep latency and total sleep duration. Paediatric Daytime Sleepiness Scale was administered to calculate daytime sleepiness. Academic performance of students was taken from school academic records. Data was analysed using SPSS 22.Results: Of the 440 subjects, 234 (53.2%) were boys and 206 (46.8%) were girls. The overall age range was 11-16 years. A total of 280 (63.6%) students had abnormal sleep patterns, 182(41.4%) suffered from daytime sleepiness, 41 (9.3%) had abnormal sleep latency and 201 (45.7%) scored below 60% in their exams. Among poor sleepers, 157 (56.1%) scored below 60% in their exams.Conclusions: More than half the subjects were found to be sleeping less than required, which eventually affected their academic performance