Reasons for betel quid chewing amongst dependent and non-dependent betel quid chewing adolescents: a school-based cross-sectional survey

Background: Betel quid (BQ) chewing in children is initiated in their adolescence. It is pivotal to understand adolescents’ reasons behind chewing BQ. In this study, we aimed to evaluate the reasons for BQ chewing amongst adolescents using reasons for betel quid chewing scale (RBCS) and their associated dependency on it. Methods: This is a cross-sectional school based survey. Out of 2200 adolescents from 26 schools of Karachi, 874 BQ chewers were assessed for their reasons of BQ chewing and dependency on it. Regression analyses were employed to report crude and adjusted (after adjusting for all reasons of BQ chewing) effect sizes with 95% confidence interval and P-value was set significant at < 0.05. Results: Students who believed that BQ chewing relaxes them (stimulation construct) were twice as likely to be dependent on BQ (OR = 2.36, 95% CI (1.20–4.65) as compared with others. Participants who thought it eases their decision making (stimulation construct), were sizably more likely to be dependent on BQ (OR = 9.65, 95% CI (4.15–22.43) than those who did not consider ease in decision making important. Adolescents who considered not chewing as rude (social/cultural construct), were thrice more likely to be dependent on BQ (OR = 2.50, 95% CI (1.11–5.63) than others. Conclusions: Stimulation remained fundamental chewing reason followed by social/cultural trigger amongst adolescents. Any future intervention may get favorable results if it addresses ways to overcome stimulation and social/cultural barriers that are strongly associated with BQ chewing and dependency

Impact of Community Service Learning on the Social Skills of Students

Nowadays many high schools and universities are promoting community service-learning program by making it a part of the admission process; therefore, students participate in community service learning program to get admission in an institution of their choice. However, after completing the community service program, they see themselves as more socially responsible citizens. This qualitative study aimed to explore the impact of community service learning on the social skills of students. The study employed a qualitative method by randomly selecting twenty-five students for the focused group interviews from five different O- level schools situated in middle socio-economic locality. The results revealed that a community service-learning program has a positive impact on the social skills of O-level students.  Besides, students had also a positive learning experience. Findings of the study indicated that the awareness to encourage community service in schools is grounded on the acceptance that it does not only give students extra credit points but serving others or one’s community also makes them better citizens. Based on the advantages and positive experiences of students, the study recommends to include a more inclusive model of service-learning to a school curriculum.

Betel quid dependency and associated intrapersonal, interpersonal, and environmental factors among adolescents: a school-based cross-sectional survey

Background: Betel quid (BQ) is one of the fourth most commonly used substance globally. Though BQ is a psycho-active substance, yet little has been explored regarding dependency on it particularly among adolescents. Objectives: Therefore, in this study, we aimed to determine adolescents' dependency on BQ, along with their intrapersonal, interpersonal and environmental determinants of dependency. Methods: This cross-sectional study focused on 2200 school-going adolescents of Karachi, Pakistan in 2016. Primary outcome was dependency on BQ among adolescents. Both univariate and multivariate regressions were used to estimate crude and adjusted odds ratios (after adjustments for all intrapersonal, interpersonal, and environmental factors) with 95% confidence level. Results: Out of 2200 students, 874 (39.7%) were found to be BQ users amongst whom 69 (7.9%) were dependent on BQ. Comparing the groups with only areca nut users as reference category, betel quid with tobacco additives chewers were considerably dependent (OR = 14.08, 95% CI 3.64–54.16). The individuals who chewed >5 chews per day (OR = 1.87, 95% CI 1.08–3.29) and chronic users (>1year) (OR = 2.02, 95% CI 1.09–3.74) were more likely to be dependent. Older students (>12 years) (OR = 2.12, 95% CI 1.06–4.23), and who studied in government schools were significantly dependent (OR = 3.32, 95% CI 1.80–6.10) than those who studied in private schools. Conclusions: In conclusion, intrapersonal characteristics like more than 5 chews per day, chronic chewers of more than a year, BQ with tobacco chewers, older adolescents and children studying in government schools were significantly associated with BQ dependency

Outcomes of Left Main Percutaneous Coronary Intervention

Objective: To study the outcomes of left main percutaneous coronary artery (LMCA) revascularisation. Study Design: A descriptive study. Place and Duration of Study: The Aga Khan University Hospital (AKUH), Karachi, from February till July 2016. Methodology: The study included all adult patients aged 18 years or more, who underwent percutaneous LMCA revascularisation at study centre from April 2006 till April 2015. In-hospital outcomes were ascertained of patients via charts along with telephonic follow-up for outcome ascertainment at 1-year and 5-year. Results were expressed in terms of means and standard deviation for quantitative variables and percentages for qualitative variables. Results: Of the 86 patients, the mean age was 66.05 ±12.6 years and 69% (59 cases, n=86) of them were males. Sixteen (18.6%) patients presented with cardiogenic shock and 17.4% (15 cases, n=86) required mechanical ventilation upon arrival. Among the 86 patients, 23.3% (20 patients, n=86) underwent PCI because of unstable condition for CABG and refusal by the surgeons. Mean follow up time for participants was 40.5 ±25.7 months with mean length of hospital stay of 4.36 ±2.4 days. In-hospital mortality was 12.8%, while mortality at 1-year and at mean follow-up was 7.3% and 6.9%, respectively. Conclusion: LM percutaneous coronary intervention is a viable option for patients who are hemodynamicaly unstable and require urgent revascularisation or for patients denying bypass surgery due to other reasons in Pakistan. Prospective studies in future may be required to evaluate the role of PCI for LM lesions in elective setting in contrast to existing treatment options

Individual, social and environmental determinants of smokeless tobacco and betel quid use amongst adolescents of Karachi: a school-based cross-sectional survey

Background: With 600 million people using betel quid (BQ) globally, and smokeless tobacco (SLT) use being more wide-spread; the duo is an uphill public health concern in South Asian countries. SLT and/or BQ use increases the risk for morbidity and mortality from oral cancer. Because SLT and/or BQ use is initiated during adolescence, it renders this group more vulnerable; and particular attention is needed to curb SLT and/or BQ use to reduce related disease burden. We aimed to observe the differential individual, social and environmental features amongst SLT and/or BQ users to determine the key influencers of its use in adolescents. Methods: This study was a cross-sectional survey of 2140 adolescents from secondary schools of Karachi, Pakistan. The main outcome measure was SLT and/or BQ use based on their consumption in the past 30 days. Univariate and multivariate regression binary logistic analyses were employed while reporting results in both crude form and adjusted odds ratio (after adjusting for all remaining individual, social and environmental level variables) with 95% confidence level. A p-value of < .05 was considered significant for all analyses. Results: The overall prevalence of SLT and/or BQ use was 42.6% (n = 912) of the total sample. The SLT and/or BQ consumer group had more males than females. A significant proportion of user (n = 558, 61.2%) was found in co-education schools. Students whose peers (OR = 6.79, 95% CI 4.67–9.87, p-value <0.001) and/or either of the parents (OR = 2.16, 95% CI 1.73–2.65, p-value <0.001) used SLT and/or BQ, alongside, adolescents who had not attended knowledge based sessions in schools regarding harmful effects of SLT and/or BQ were more likely to consume it. It’s availability with outside school hawkers increased the odds of its use by 6 times, as indicated by both univariate and multivariate models after adjusting for the remaining variables. Conclusion: In conclusion, students studying in co-education, parents and peers use, lack of knowledge based sessions on harmful health effects of SLT and/or BQ, and easy availability of the product from hawkers outside school all contribute towards enhanced risk of SLT and/or BQ use in adolescents

Severity of Chest Pain among Acute Myocardial Infarction Patients with Diagonal Branch Vessel Disease: A Pilot Study

Introduction: Acute myocardial infarction (AMI) patients present with variable clinical manifestations such as shortness of breath, nausea, etc. among which chest pain is the most common. Previous studies have reported that the clinical presentation of AMI patients with branch vessel disease is indistinguishable from epicardial coronary vessel disease. However, our experience suggests patients with branch vessel disease experience severe chest pain, especially those with a diagonal branch. Therefore, we aim to study the association of chest pain severity with isolated diagonal branch vessel disease as a culprit vessel in AMI patients. Methods: It is a retrospective case-control design, where 10 cases and 40 historic controls were recruited in the study. Cases were patients with isolated diagonal branch disease, whereas controls were patients with epicardial vessel disease in AMI. We reviewed Coronary Angiograms of adult patients who presented with acute myocardial infarction and had undergone coronary angiography at Aga Khan University Hospital, Karachi (AKUH). Information on pain scores was measured using the Numeric Pain Rating Scale (NRS) before administration of analgesics. Other relevant variables were also recorded on a pre-structured questionnaire. Results: The mean age of all the participants in the study was 60 ± 11.0 years, with 16% of the patients being women. Among all AMI patients, the intensity of chest pain in patients with isolated diagonal branch vessel disease was 2.6 units higher as compared to those with other epicardial coronary vessel diseases (p-value: \u3c0.001; 95% CI: 1.67 - 3.46). Conclusion: This preliminary study indicates severe chest pain can be a differentiating symptom in AMI patients with diagonal branch disease. It emphasizes clinicians to look for a possibility of a diagonal branch as a culprit vessel in AMI for better judgment, as it is often overlooked. future studies may be conducted at multiple centers for larger sample size and better generalizability

Association between environmental tobacco smoke and dental caries amongst 5-14 years old children in Karachi, Pakistan.

Objective:To determine the association between environmental tobacco smoke and dental caries.Methods:This cross-sectional study was conducted in peri-urban and urban areas of Karachi, from February to August 2014, and comprised children aged 5-14 years. A pre-coded questionnaire for environmental tobacco smoke and food frequency questionnaire for dietary habits were used. Dental examination of children was done to detect caries. Cox-proportional hazard algorithm was used to measure the association of environmental tobacco smoke with dental caries at multivariable level. STATA version 12.0 was used for statistical analysis.Result:Of the 500 children, 250(50%) each were from peri-urban and urban localities. The prevalence of dental caries was 336(67.2%).Family members of 154(30.8%) participants reported smoking. After adjusting for junk food intake, in-between meals, age, plaque index, dental visits and socio-economic status, the association between environmental tobacco smoke and dental caries remained statistically significant (p30 minutes of environmental tobacco smoke exposure, respectively.Conclusions:Environmental tobacco smoke was found to be associated with dental caries

Geo-spatial reporting for monitoring of household immunization coverage through mobile phones: Findings from a feasibility study

Background: The addition of Global Positioning System (GPS) to a mobile phone makes it a very powerful tool for surveillance and monitoring coverage of health programs. This technology enables transfer of data directly into computer applications and cross-references to Geographic Information Systems (GIS) maps, which enhances assessment of coverage and trends.Objective: Utilization of these systems in low and middle income countries is currently limited, particularly for immunization coverageassessments and polio vaccination campaigns. We piloted the use of this system and discussed its potential to improve the efficiency of field-based health providers and health managers for monitoring of the immunization program.Methods: Using 30×7 WHO sampling technique, a survey of children less than five years of age was conducted in random clusters of Karachi, Pakistan in three high risk towns where a polio case was detected in 2011. Center point of the cluster was calculated by the application on the mobile. Data and location coordinates were collected through a mobile phone. This data was linked with an automated mHealth based monitoring system for monitoring of Supplementary Immunization Activities (SIAs) in Karachi. After each SIA, a visual report was generated according to the coordinates collected from the survey.Result: A total of 3535 participants consented to answer to a baseline survey. We found that the mobile phones incorporated with GIS maps can improve efficiency of health providers through real-time reporting and replacing paper based questionnaire for collection of data at household level. Visual maps generated from the data and geospatial analysis can also give a better assessment of the immunizationcoverage and polio vaccination campaigns.Conclusion: The study supports a model system in resource constrained settings that allows routine capture of individual level data through GPS enabled mobile phone providing actionable information and geospatial maps to local public health managers, policy makers and study staff monitoring immunization coverage

Impact of Community Service Learning on the Social Skills of Students

Recently, many high schools and universities have promoted community service learning program by making it part of the admission process; therefore, students participate in community service learning program to get admission in an institution of their choice. Moreover, after completing the community service program, they see themselves as more socially responsible citizens. This qualitative study aimed to explore the impact of community service learning on the social skills of students. The study employed a qualitative method by randomly selecting twenty five male and female students for focused group interviews from five different O- level schools situated in a middle socio-economic locality. The results revealed that community service learning program has a positive impact on the social skills of O-level students. Besides, students had also a positive learning experience. The findings of the study indicated that the awareness to encourage community service in schools is grounded on the acceptance that it does not only give students extra credit points, but serving others or one’s own community also makes them better citizens. Based on the advantages and positive experiences of students, the study recommends to include a more inclusive model of service learning in school curriculum

School-based behavioral intervention to reduce the habit of smokeless tobacco and betel quid use in high-risk youth in Karachi: A randomized controlled trial.

There have been recent surges in the use of smokeless tobacco (SLT) and betel quid (BQ) chew among adolescents in South East Asian countries, with an increase, on average, of 7% to 15% between 2004 and 2013, necessitating interventional investigations to modify this behavior. The current intervention was aimed towards changing adolescents' perceptions regarding the harmful effects of SLT and BQ use and encouraging them to quit. This randomized control trial involved 2140 adolescents from 26 private and public-sector schools in Karachi, Pakistan. After randomization, 1185 individuals were placed in the intervention group and administered a behavior changing intervention (BCI), while 955 individuals constituted the control group. A generalized estimating equation was employed to measure differences in repeated measures for both groups. The beta coefficients were reported after adjusting the covariates with the 95% confidence interval, and the p-value was considered significant at <0.050. Cohen's d was employed to report the effect size of the intervention. The BCI resulted in a 0.176-unit (95% CI 0.078-0.274, p-value <0.001) increase in knowledge scores regarding the health hazards of SLT and BQ, a 0.141-unit (95% CI 0.090-0.192, p-value <0.001) increase in use perception scores, and a 0.067-unit (95% CI 0.006-0.129, p-value 0.031) increase in quit perception scores in the intervention group compared with those in the control group. A knowledge related module (p-value 0.024) and quit preparation module (p-value 0.005) were found to be helpful by adolescents in either changing their perceptions regarding SLT and/or BQ chew use or in quitting. The role of BCI is promising in improving adolescents' knowledge and changing their perceptions in a positive manner regarding their harmful SLT and BQ use. Convincing results may be achieved if interventions are tailored, with an emphasis on the identification of the products that are used by adolescents in addition to highlighting their ill effects and how students may manage to quit them. If included in the schools' curricula, this BCI method may help in developing schools that are free of SLT and BQ use. Trial registration: ClinicalTrials.gov NCT03488095