Perceptions of stakeholders about the role of health system in suicide prevention in Ghizer, Gilgit-Baltistan, Pakistan

Background: Suicide is a serious global public health problem, with more than 800,000 people dying by suicide worldwide every year. 79% of suicides happen in Low and Middle-Income Countries (LMICs), where lack of national suicide prevention programs coupled with inadequate MH facilities for early identification and treatment of mental disorders add to seriousness of the problems. Although there is paucity of research, studies suggest that the rate of suicide in district Ghizer, Gilgit-Baltistan (GB), in northern Pakistan may be higher compared to rest of the country.Methods: This study aimed to explore the perceptions of stakeholders about the role of the health system at District Ghizer, GB using a qualitative descriptive exploratory research design. A total of 12 face to face in-depth interviews were conducted from the stakeholders using purposive sampling technique.Results: The study results led to three broad themes, 1) Suicide as A Social Issue, 2) Role of Health System in Suicide Prevention, and 3) Challenges for Health System in Suicide Prevention. Theme one was sub-categorized into; a) Perceived situations contributing to suicide, b) Environmental factors. Theme two was subdivided into; a) Major hurdles for Health system, b) Lack of MH services in the available health system. Theme three was subdivided into; a) Lack of collaboration across-sectors, b) Unavailability of MH professionals, and c) Financial issues. The study findings reveal that there are multiple challenges for health system including, lack of awareness on mental issues, shortage of resources and lack of collaboration in the community. Moreover, existing policies or strategies need to be modified to overcome the existing challenges for the effective prevention.Conclusion: This study emphasized creating awareness about MH issues, introduction of school health programs, parental counseling session and strengthening of the health system by allocating suitable budget for MH issues and suicide prevention strategies

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Perceptions of stakeholders about the role of health system in suicide prevention in Ghizer, Gilgit-Baltistan

Perceptions of the Stakeholders about the role of the Health System in Suicide Prevention in Ghizer, Gilgit-Baltistan Background: Suicide is becoming an alarming public health issue, every 40 seconds an individual lost a life by committing suicide worldwide. The rate of suicide is 14.5/100,000 populations, 8.0 for females and 15.0 for males of the total prevalence of suicide. Whereas, Low and Middle- Income Countries (LMICs) carry 78% of the suicide burden due to inadequate mental health facilities early identification or diagnosis and timely treatment. The rate of suicide in district Ghizer, Gilgit-Baltistan is drastically high as compared to other provinces in Pakistan. The crude suicide-rate for females is 14.89 per 100,000 population and the annual age-specific death rate for adolescents (15 to 24 years of age) is 61.07 per 100,000 population. It is a very complex issue; the collective action of the society is needed for the prevention. The World Health Organization (WHO) also, has emphasized the inter-sectoral prevention strategy for suicide prevention. Purpose of the Study: The purpose of this study was to explore the perceptions of the stakeholders about the role of the health system at district Ghizer, Gilgit-Baltistan. Methodology: This study used a qualitative descriptive exploratory research design to explore the perceptions of stakeholders regarding the role of the health system in suicide prevention in Ghizer. A total of twelve stakeholders were recruited for this study, using a purposive sampling technique. Face to face interviews was conducted to obtain the data using a self-developed in-depth interview guide. A manual content-analysis was done, using Creswell\u27s six steps of data analysis. Findings: The study results led to three broad themes, 1) Suicide as A Social Issue, 2) Role of Health System in Suicide Prevention, and 3) Challenges for Health System in Suicide Prevention. Theme one was sub-categorized into; a) Perceived situations contributing to suicide, b) Environmental factors. Theme two was subdivided into; a) Major hurdles for Health system, b) Lack of mental health services in the available health system. Theme three was subdivided into; a) Lack of collaboration across-sectors, b) Unavailability of mental health professionals, and c) Financial issues. Conclusion: The study findings reveal that the role of the health system is lacking in suicide prevention in Ghizer. There are multiple challenges for health system including, lack of awareness on mental issues, shortage of human or financial resources and lack of collaboration in the community, which require dire attention. Moreover, there is a need of modification of existing policies or strategies to overcome the existing challenges for the effective prevention of suicide in the area. This study emphasized on creating awareness about mental health issues, the introduction of school health programs, parent counseling session and strengthening of the health system by allocating the suitable amount of budget for mental health issues and suicide prevention strategies

“BOL”BY SHOAB MANSOOR PORTRYAL OF THIRD GENDER IN COMTEMPORARY CINEMA

This research paper throwsspotlight on theproblems of third gender people as depicted in the modern cinema with exclusive background to the Pakistani filmBol. This film highlightspublicdemeanor in Eastern society with them especially because of their gender identity.Its varioustraits are carefully chosen to search the height of the difficulties faced by transgender people in the chosen movie. Discourse analysis technique is adapted as a tool to create the rationale of the study. The selection of movie isgrounded withinEastern society as portrayed in the cinema. Theattitude of society with this marginalized group is the main cause that generateshostile environment in the lifespan of Saifi, who meetsterrible death by the hands of his father. It is because of lack of awareness about transgender people in the eastern environment; they are poorly treated as if they are not even human beings. So the major issues  hereare how the world perceivesthem in the society, and how he will be accepted in the society? To elucidate the problems of transgender, discriminatory behaviors adopted by the society towards Saifi(a transgender child), the main causes of Saifi’s death and the consequences of his death on other transgender community are discussed in this paper.Byemploying qualitative research methodologyit is revealed thatSaifi is betrothed in a struggle for life; his character is found weak which causes failure to save himself from societal disdain. Actually struggle for survival was a challenging task to show the viewers other side of a coin in case of transgender’s issues in all over the world

“BOL” BY SHOAIB MANSOOR PORTRAYAL OF THIRD GENDER IN CONTEMPORARY CINEMA

This research paper throws spotlight on the difficulties of the transgendered people as portrayed in the cotemporary cinema with special reference to the Pakistani movie Bol. The community behavior with them because of their gender identity is highlighted in Eastern society. Its different aspects are selected to explore the height of the difficulties faced by transgender people in the chosen movie. Discourse analysis is used to establish the rationale of the study. The selected movie is analyzed within the framework of Eastern society as portrayed in the cinema. The role of society is the major cause that creates pessimistic environment in the life of Saifi, who meets tragic death by the hands of his father. In eastern societies due to the lack of awareness and education about transgender, they are badly treated as if they are not even human beings. So the major issues are how the world perceives him in the society, and how he will be accepted in the society? To elucidate the problems of transgender, discriminatory behaviors adopted by the society towards Saifi (a transgender child), the main causes of Saifi’s death and the consequences of his death on other transgender community are discussed in this paper. By employing qualitative research methodology it is revealed thatSaifi is betrothed in a struggle for life; his character is found weak which causes failure to save himself from societal disdain. Actually struggle for survival was a challenging task to show the viewers  other side of a coin in case of transgender’s issues in all over the world

“CALL ME MALCOLM” A TRUE DESIGN OF LOOKING GLASS SELF-THEORY IN WESTERN CULTURE

This research paper is an attempt to explore difficulties of the transgendered people as portrayed in the Holly wood documentary “Call Me Malcolm” with special reference to the Charles Horton Cooley‟s looking glass self-theory. The direction and Production are given by Joseph Parlagreco in 2004 and released in March, 2007 in USA. The communal behavior with transgendered people, due to their gender identity is highlighted in Western society. The “role of society” is the major component of looking glass design that creates pessimistic environment in the life of Malcolm, who suffers a lot in life. Various aspects of the theory are carefully chosen to observe the height of difficulties faced by transgender people in the selected documentary and are analyzed within the framework of Qualitative methodology. Transgender are poorly treated as it is portrayed in the context of western society. They are not accepted in the society. To elucidate the problems of transgender, discriminatory behaviors adopted by the society due to odd physical condition towards Malcolm (a transgender child), on other transgender community and audience is discussed in this paper. By analyzing the dialogues from original text call me Malcolm it is concluded that Malcolm is struggling for existence; He fights and ultimately able to survive Although his culture and ethics are strong, but struggle for survival was a perplexing task to bridge the gap between transgender and a common man in the western world

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc