Prevalence of Depression among Households in Three Capital Cities of Pakistan: Need to Revise the Mental Health Policy

BACKGROUND: Pakistan, among the other developing countries, has a higher prevalence rate of depression because of the current social adversities. There is, thus, a great need for systematic studies on prevalence of depression. The current study aims at exploring the prevalence of depression among households in three capital cities of Pakistan. METHODOLOGY AND PRINCIPAL FINDINGS: A sample of N = 820 was randomly selected, and a cross sectional telephone-based study was conducted for a duration of six months. It was found that there was a regional variation in prevalence rates for depression among the three cities. Lahore had the highest number of depressives (53.4%), as compared to Quetta (43.9%) and Karachi (35.7%). Middle age, female gender and secondary school level of education were significantly associated with depression among the study group. CONCLUSIONS/SIGNIFICANCE: The different rates of prevalence among the three cities could be attributed to local cultural influence, geographical locations and social adversities. There is a need for revision of existing health policy by the government

Efficacy of long-term psychotherapy in the management of persons living with HIV/AIDS

Background -- Since recognition of acquired immunodeficiency syndrome (AIDS) in 1981, an estimated 60 million people, worldwide, have been infected with HIV, and an estimated 25 million people have died of AIDS. In Canada almost 50,000 people are believed to be HIV positive, and each year over 2000 new infections are reported to the Centre for Infectious Disease Prevention and Control (CIDPC). -- It is unknown whether long-term psychotherapy can prevent psychological dysfunction in HIV/AIDS patients. -- The objective of this randomized controlled trial (RCT) was to determine the impact of long-term psychotherapy on depression, the primary outcome measure, hopelessness, coping skills, and CD4 counts in a group of HIV positive subjects who were heterogeneous in respect to their HIV infection, and level of psychological health. -- Methods -- HIV positive adults at a tertiary referral centre were randomly assigned to receive either long-term psychotherapy (N=16), or no psychotherapy with crisis intervention (N=14), irrespective of initial psychological health. -- Results -- The mean age was 30 years, Beck Depression Inventory (BDI) score 22 and CD4 count (cells/μL) 277. At 0, 6 and 12 months, the mean BDI scores were 20, 18 and 26 in the control group, compared to 23 (P = 0.34), 13 (P = 0.016), and 9 (P = 0.006) in the intervention group. -- Mean Beck Hopelessness Scale scores (BHS) were 10, 11 and 13 vs. 10 (P = 0.968), 7(P = 0.027), and 6 (P = 0.005). -- Coping Inventory for Stressful Situations (CISS) scores were: Task, 52, 53 and 55 vs. 52, (P = 0.906), 55 (P = 0.654) and 59 (P = 0.214); Emotion, 50, 46, 49 vs. 51, (P = 0.846), 49 (P = 0.374) and 43 (P - 0.059); Avoidance, 49, 46 and 46 vs. 51 (P = 0.426), 46, (P = 0.036) and 52 (P = 0.062); Distraction, 25, 23 and 24 vs. 24, (P = 0.708), 25 (P = 0.221) and 25 (P = 0.331); Social Diversion, 15,14 and 13 vs. 15, (P = 0.640), 17 (P = 0.031) and 17 (P = 0.031). -- CD4 counts were 333, 243 and 346 vs. 232 (P = 0.25), 262 (P - 0.09), and 259 (P = 0.764). -- Conclusion -- Long-term psychotherapy ameliorates depression and hopelessness in persons living with HIV/AIDS. It may also have a preventative effect

Figure 1

<p>Map of Pakistan.</p

Comparison of subjects with and without depression/depressive symptoms

*<p>Adjusted for City, Age, Gender and Education</p

Population characteristics of (N = 820)

<p>Population characteristics of (N = 820)</p

Vital information about Pakistan

<p>Vital information about Pakistan</p

Figure 2

<p>Showing frequency of depression as compared to no depression in the three cities of Pakistan.</p

Physicians’ attitudes and practice toward treating injection drug users infected with hepatitis C virus: Results from a national specialist survey in Canada

BACKGROUND: In Canada, more than 70% of new cases of hepatitis C virus (HCV) infection per year involve injection drug users (IDUs) and, currently, there is no consensus on how to offer them medical care. OBJECTIVE: To examine the characteristics of Canadian specialist physicians and their likelihood to provide treatment to HCV patients who are IDUs. METHODS: A nationwide, cross-sectional study was conducted in the specialty areas of hepatology, gastroenterology and infectious diseases to examine HCV services. The questionnaire requested information regarding basic demographics, referral pathways and opinions (yes/no), and examined how a physician’s treatment regimen is influenced by factors such as treatment eligibility, HCV care management and barriers to providing quality service. RESULTS: Despite the fact that the majority of prevalent and incident cases of HCV are associated with injection drug use, very few specialist physicians actually provide the necessary therapy to this population. Only 19 (19.79%) comprehensive service providers were likely to provide treatment to a current IDU who uses a needle exchange on a regular basis. The majority of comprehensive service providers (n=86 [89.58%]) were likely to provide treatment to a former IDU who was stable on substitution therapy. On bivariate analysis, factors associated with the likelihood to provide treatment to current IDUs included physicians’ type, ie, infectious disease specialists compared with noninfectious specialists (OR 3.27 [95% CI 1.11 to 9.63]), and the size of the community where they practice (OR 4.16 [95% CI 1.36 to 12.71] [population 500,000 or greater versus less than 500,000]). Results of the multivariate logistic regression analysis were largely consistent with the results observed in the bivariate analyses. After controlling for other confounding variables, only community size was significantly associated with providing treatment to current IDUs (OR 3.89 [95% CI 1.06 to 14.26] [population 500,000 or greater versus less than 500,000]). CONCLUSION: The present study highlighted the reluctance of specialists to provide treatment to current IDUs infected with HCV. Providing treatment services for HCV-infected substance abusers is challenging and there are many treatment barriers. However, effective delivery of treatment to this population will help to limit the spread of HCV. The present study clearly identified a need for improved HCV treatment accessibility for IDUs

Patterns and Correlates of Cannabis Use among Individuals with HIV/AIDS in Maritime Canada

BACKGROUND: The prevalence of cannabis use in HIV-infected individuals is high and its long-term effects are unclear. METHODS: The prevalence, perceived benefits and consequences, and predictors of cannabis use were studied using a cross-sectional survey in two immunodeficiency clinics in Maritime Canada. RESULTS: Current cannabis use was identified in 38.5% (87 of 226) of participants. Almost all cannabis users (85 of 87 [97.7%]) acknowledged its use for recreational purposes, with 21.8% (19 of 87) reporting medicinal cannabis use. The majority of patients enrolled in the present study reported mild or no symptoms related to HIV (n=179). Overall, 80.5% (70 of 87) of the cannabis-using participants reported a symptom-relieving benefit, mostly for relief of stress, anorexia or pain. Participants consumed a mean (± SD) of 18.3±21.1 g of cannabis per month and spent an average of $105.15±109.87 on cannabis per month. Cannabis use was associated with rural residence, lower income level, driving under the influence of a substance, and consumption of ecstasy and tobacco. Income level, ecstasy use and tobacco use were retained as significant predictors in regression modelling. Cannabis use was not associated with adverse psychological outcomes. DISCUSSION: Prolonged previous cannabis consumption and the substantial overlap between recreational and medicinal cannabis use highlight the challenges in obtaining a tenable definition of medicinal cannabis therapy

Effect of vaginal self-sampling on cervical cancer screening rates: a community-based study in Newfoundland

Background Cervical cancer is highly preventable and treatable if detected early through regular screening. Women in the Canadian province of Newfoundland & Labrador have relatively low rates of cervical cancer screening, with rates of around 40 % between 2007 and 2009. Persistent infection with oncogenic human papillomavirus (HPV) is a necessary cause for the development of cervical cancer, and HPV testing, including self-sampling, has been suggested as an alternative method of cervical cancer screening that may alleviate some barriers to screening. Our objective was to determine whether offering self-collected HPV testing screening increased cervical cancer screening rates in rural communities. Methods During the 2-year study, three community-based cohorts were assigned to receive either i) a cervical cancer education campaign with the option of HPV testing; ii) an educational campaign alone; iii) or no intervention. Self-collection kits were offered to eligible women at family medicine clinics and community centres, and participants were surveyed to determine their acceptance of the HPV self-collection kit. Paired proportions testing for before-after studies was used to determine differences in screening rates from baseline, and Chi Square analysis of three dimensional 2 × 2 × 2 tables compared the change between communities. Results Cervical cancer screening increased by 15.2 % (p < 0.001) to 67.4 % in the community where self-collection was available, versus a 2.9 % increase (p = 0.07) in the community that received educational campaigns and 8.5 % in the community with no intervention (p = 0.193). The difference in change in rates was statistically significant between communities A and B (p < 0.001) but not between communities A and C (p = 0.193). The response rate was low, with only 9.5 % (168/1760) of eligible women opting to self-collect for HPV testing. Of the women who completed self-collection, 15.5 % (26) had not had a Pap smear in the last 3 years, and 88.7 % reported that they were somewhat or very satisfied with self-collection. Conclusions Offering self-collected HPV testing increased the cervical cancer screening rate in a rural NL community. Women who completed self-collection had generally positive feelings about the experience. Offering HPV self-collection may increase screening compliance, particularly among women who do not present for routine Pap smears