The utilization of services of health care providers among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan

Objective: To study the utilization of services of Health care providers among patients presenting to Family Physicians in a teaching hospital in Karachi.Methodology: It was a cross sectional study. A questionnaire was developed to collect patient’s utilization of services of health care providers. The investigators administered the questionnaire to 387 patients, after purpose of the study was explained, written consent was taken and confidentiality was assured. Results: The study population included more females than males, with average age of 32.6 years. The majority were married, well educated, in private and government service, were students or housewives. We found that 383(99%), 141(36.4%), 88(22.7%) and 45(11.6%) of the respondents had used services of allopaths, homeopaths, hakims and spiritual healers respectively. It is important to consider that these patients had come for allopathic treatment, thus exhibiting preference for it. The five main ailments for consulting health care providers differed, suggesting the perception in the mind of patients that certain ailments are better treated by particular system of treatment than the others. Studies are needed to explore this area further. The main reasons for consultation with particular health care provider were the recommendation of others or the perceived effectiveness of the practitioners. The reasons cited for non-consultation with health care providers were the lack of belief in them or lack of effectiveness of their treatment. Three hundred seventy nine (98%), 259 (67%), 174 (45%) and 249 (64.4%) of patients were willing to consult allopaths, homeopaths, hakims and spiritual healers again respectively, if unwell in future Conclusion: We found a substantial utilization of services of complimentary medicine practitioners among the utilization and organization of services offered by patients seeking allopathic treatment. Further study on health care providers is required (JPMA 52:269; 2002)

The transformative effect of training in counselling and its application, on the community counsellors themselves

Objective: To identify the changes in community counsellors\u27 own level of anxiety and depression as a result of learning counselling skills and to explore their subjective experiences after learning and providing counselling.Design: Quantitative: Repeated Measures. / Qualitative: Focus Group Discussions.SETTING: A lower middle class semi urban community of Karachi, Pakistan.PARTICIPANTS: Twenty-one self selected women from the community.Results: Reduction was seen in the post training scores of anxiety and/or depression in the trainees. As a result of learning and then providing counselling the community counsellors\u27 self esteem, self confidence and sense of competence were enhanced and they developed a more positive attitude towards life.CONCLUSION: A minimal level of training in counselling skills and their application led to significant positive changes in the community counsellors themselves, though self-selection and information bias cannot be ruled out

Biological activities of a new compound isolated from the aerial parts of Vitex agnus castus L.

A new compound trivially named vitexcarpan was isolated from the ethyl acetate fraction of Vitex agnus castus. The structure of compound was elucidated with the help of spectroscopic techniques: 13C NMR, 1H NMR, heteronuclear multiple bond correlation (HMBC), heteronuclear multiple quantum coherence (HMQC), nuclear overhauser effect spectroscopy (NOESY) and correlation spectroscopy (COSY). The isolated compound was screened for possible urease, chymotrypsin and anti-inflammatory activities. The results showed that the compound possess moderate inhibitory activity against urease (43.3 %) and chymotrypsin (39.8 %) enzymes. Vitexcarpan also showed moderate (48 %) in vitro antiinflammatory activity using activated human neutrophils.Keywords: Vitex agnus castus, vitexcarpan urease, chymotrypsin, anti-inflammator

Are our people health conscious? results of a patients survey in Karachi, Pakistan

BACKGROUND: Life style is known to influence health and may be responsible for certain diseases. There is a need to document the life style on health among the Pakistani population. METHODS: The study was conducted on patients visiting the Family Practice Center, the Aga Khan University, Karachi. A questionnaire was used to collect information on the demographic profile, and the life style on health. The ethical requirements for conducting the study were met. RESULTS: 393 patients were surveyed. The majority were young married men, in either private or government service. Preference for consumption of fats/oils, sweets, spicy foods, salt, fruits/vegetables, tea, coffee, cola drinks and alcohol was found among 103 (26%), 84 (22%), 86 (22%), 110 (28%), 239 (61%), 319 (81%), 117 (30%), 253 (64%) and 13 (03%) respondents respectively. Hand washing after defecation, before eating food and after work was seen among 341 (87%), 296 (75%) and 256 (65%) respondents respectively. Brushing of teeth after eating food, before breakfast and bedtime was seen in 56 (14%), 346 (88%) and 176 (45%) respondents respectively. Preventive dental check-up was practiced by 102 (26%) of the respondents. Sleep of less than 6 hours per day among 74 (19%), water consumption of less than 1 liter daily among 84 (21%) and fish consumption on once a week basis among 173 (44%) respondents was found. Tobacco and betel nuts use was found among 69 (17%) and 79 (20%) respondents. CONCLUSIONS: We have documented a clear need to raise public awareness on the issue of life style on health. There is a need and we strongly recommend debate and further research, along with interventional strategies in line with the available evidence on healthy life style

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

Psychosocial factors of deliberate self-harm in Afghanistan: A hospital based, matched case-control study

Background: Deliberate self-harm is not only a major global public health problem but also an important index of psychological distress and a risk factor for suicide.Aims: We aimed to determine the psychosocial risk factors for deliberate self-harm in patients aged ≥ 16 years presenting to tertiary care hospitals in Kabul, Afghanistan.Methods: A matched case-control study was conducted from February 2015 to May 2015. We recruited 185 cases (patients with deliberate self-harm) and 555 age- and sex-matched controls (patients with general medical conditions) from 4 tertiary care hospitals in Kabul. We developed a questionnaire to record the sociodemographic characteristics of the participants, history of domestic violence, drug abuse and details about the act of deliberate self-harm, including the methods used. To assess depression and anxiety, we used the WHO self-reporting questionnaire (SRQ-20). Matched odds ratios with 95% confidence interval using conditional logistic regression were used to determine statistically significant associations between psychosocial factors and deliberate self-harm.Results: Family conflicts, domestic violence, interpersonal arguments and living in extended families were found to be significantly associated with deliberate self-harm.Conclusions: In Afghanistan, deliberate self-harm appears to be predominately related to interpersonal problems and family conflicts. About two-thirds of females and more than half of males scored positive for depression, yet none were receiving treatment for this. These findings have important policy implications for mental health and suicide prevention programmes in the country

A non-randomized study of safety and efficacy of heparin for DVT prophylaxis in intracerebral haemorrhage

Objective: To evaluate the safety and efficacy of subcutaneous heparin for deep venous thrombosis (DVT) prophylaxis in patients with intracerebral haemorrhage (ICH) during acute phase in comparison to elastic stockings. Methods: The diagnosis of ICH was based on imaging (CT or MRI) and DVT was based on Doppler ultrasound. Results: A total of 458 patients were identified over a period of 5 years (1997-2001). Median age was 59 years (range:12-99 years). Two hundred (44%) patients received heparin (heparin group) in addition to elastic stockings and 258 (56%) patients were only given elastic stockings (stockings group). These two groups were not randomized. Heparin was administered subcutaneously (SQ) in doses of 2500-5000 international units twice daily. Two groups were matched for age (p=0.5), sex (p=0.28), presence of diabetes mellitus (p=0.14), cigarette smoking (p=0.045) and presence of hydrocephalus or midline shift on CT/MRI (p= 0.87). One patient developed DVT in control group while none developed DVT in heparin group (p=0.18). One patient had worsening of ICH on repeat CT scan in Heparin group. This worsening was non fatal. Systemic haemorrhagic complications (non fatal) were seen in 7 (14%) patients receiving heparin. Twenty five patients (12%) in heparin group and 52 (20%) in control group died (p=0.02). Conclusion: Subcutaneous heparin in doses of 2500-5000 units twice daily during acute phase in patients with ICH may be safe for DVT prophylaxis. It was not superior to elastic stockings in a non-randomized comparison to prevent DVT (JPMA 58:362;2008)

A Dynamical Study of Risk Factors in Intracerebral Hemorrhage using Multivariate Approach

The purpose of this study is to investigate the effects of clinical covariates to the outcome of Intracerebral Hemorrhage (ICH) patients in terms of best fitted and excellent discriminate model of binary response variable. Clinical data of 985 patients with ICH have collected using the International classification of diseases, Ninth revision codes. The diagnosis of ICH was confirmed by neuro-imaging in all patients. Univariate analysis revealed that out of 88 covariates 46 were found to be significant (p\u3c0.05). The multivariable analysis using multiple logistic regressions, exhibited a significant negative relationship between ICH and hypertension. The improvement among ICH patients having hypertension was 0.5 (p=0.001, ARR=0.5, 95% C.I. 0.3 – 0.8). The improvement among ICH patients using antihypertensive medicine was 1.3 (p = 0.016, ARR=1.3, 95% C.I. 1.1 – 1.5). Thus present study showed that ICH has strong relationship with use of antihypertensive medicine. The improvement of patients who were using antihypertensive medicine at the time of discharge was 3.0 times (p \u3c 0.0001, ARR=3.0, 95% C.I. 2.7 – 3.2) as compared to those who did not use antihypertensive medicine. The change in ARR from 1.3 to 3.0 times shows that the use of antihypertensive medicine and ICH outcome variable are positively associated. The change in ARR of hypertensive range of SBP also indicates that the blood pressure range and ICH outcome variable are negatively associated. The neurological symptomatology, slurred speech and double vision are important factors of proposed statistical models. Moreover, a clear decrease was found in mental status from normal to coma in applicable model. Surgery is an important part of recovery, and estimated that the improvement among the ICH patients, who were treated with surgery, was 1.4 times with significant p-value in best fitted models. The complication of pneumonia during treatment of ICH subjects has highly significant negative association with outcome variable. Present Model has 0.892 area under the curve with sensitivity (0.852), specificity (0.793) and p-value (0.204). This indicates that the model gives the impression to fit quite well for predictive performance of the ICH outcome variable and the model is excellent model

Quality of life after stroke in Pakistan

Background: There is very little information about the quality of life (QOL) of stroke survivors in LMIC countries with underdeveloped non communicable health infrastructures, who bear two thirds of the global stroke burden. Methodology: We used a sequential mix methods approach. First, a quantitative analytical cross-sectional study was conducted on 700 participants, who constituted 350 stroke survivor and their caregiver dyads. QOL of stroke survivor was assessed via Stroke Specific Quality of Life Scale (SSQOLS) whereas QOL of caregivers was assessed through RAND-36. In addition; we assessed complications, psychosocial and functional disability of stroke survivors. Following this quantitative survey, caregivers were qualitatively interviewed to uncover contextually relevant themes that would evade quantitative surveys. Multiple linear regression technique was applied to report adjusted β-coefficients with 95% C.I. Results: The QOL study was conducted from January 2014 till June 2014, in two large private and public centers. At each center, 175 dyads were interviewed to ensure representativeness. Median age of stroke survivors was 59(17) years, 68% were male, 60% reported depression and 70% suffered post-stroke complications. The mean SSQOLS score was 164.18 ± 32.30. In the final model severe functional disability [adjβ -33.77(-52.44, -15.22)], depression [adjβ- 23.74(-30.61,-16.82)], hospital admissions [adjβ-5.51(-9.23,-1.92)] and severe neurologic pain [adjβ -12.41(-20.10,-4.77)] negatively impacted QOL of stroke survivors (P \u3c 0.01). For caregivers, mean age was 39.18 ± 13.44 years, 51% were female and 34% reported high stress levels. Complementary qualitative study revealed that primary caregivers were depressed, frustrated, isolated and also disappointed by health services. Conclusion: The QOL of Stroke survivors as reported by SSQOLS score was better than compared to those reported from other LMIC settings. However, Qualitative triangulation revealed that younger caregivers felt isolated, depressed, overwhelmed and were providing care at great personal cost. There is a need to develop cost effective holistic home support interventions to improve lives of the survivor dyad as a unit