Effectiveness of helmets in preventing severe injuries in a setting with poorly enforced quality standards

Helmets save lives, yet many countries do not have laws about their quality assessment or how they should be worn. We assessed the effectiveness of helmet use in preventing injuries in such a setting. The data were extracted from a large road traffic injury surveillance study in Karachi, Pakistan. We assessed the association of wearing helmets with several injury outcomes including deaths, injury severity (via New Injury Severity Score, NISS ≥ 9) and moderate or severe injury (via Abbreviated Injury Score, AIS ≥ 2) to head, face, or other regions of the body. The data about helmet use was available for about 109,210 riders injured between January 2007 and December 2013. Only 6% of riders wore helmets, whereas this proportion was less than one percent in pillion riders and women. The rates were also lower among those aged 18 years or younger (1%) and those aged 18 to 25 years (4%). About 2% of riders died; 34% had an injury to the head region, 30% to face, 1% to chest, 5% to abdominal, 46% to extremities, and 61% to external body regions. Likelihood of dying was low among helmet users (adjusted odds ratio [aOR] = 0.37, 95% confidence interval [CI] = 0.28 to 0.50). Helmets reduced the likelihood of moderate to severe injuries to the head (aOR = 0.68, 95% CI = 0.58 to 0.80) but not to the face region (aOR = 1.37, 95%CI = 1.17 to 1.62). Helmet users also had severer injuries in other body regions except for chest injuries. Helmets prevented deaths and severe head injuries but had limited effectiveness in preventing facial injuries in this setting with poor helmet use standards. More work is needed to understand the helmet wearing and rider behaviours in helmet users in this setting

Emergency care of traumatic brain injuries in Pakistan: a multicenter study

Background: This study assessed factors associated with emergency care outcomes and out-of-pocket treatment costs in traumatic brain injury (TBI) patients in Pakistan. Methods: Data on TBI patients were extracted from a four-month surveillance study conducted in the emergency departments (ED) of seven large teaching hospitals. Emergency care access to physicians and imaging facilities were compared with respect to ED outcomes (discharged, admitted or dead). Out-of-pocket treatment costs (in United States dollars [USD]) were compared among different patient strata. Results: ED outcomes were available for 1,787 TBI patients. Of them, most were males (79%), aged \u3c25 years (46%) and arrived by ambulances (32%). Nurses or paramedical staff saw almost all patients (95%). Physicians with practice privileges (medical officers, residents or consultants) saw about half (55%) of them. Computerized tomography (CT) scans were performed in two of five patients (40%). Of all, 26% (n = 460) were admitted and 3% died (n = 52). Emergency care factors significantly associated with being admitted or died were arriving by ambulance (adjusted odds ratio [aOR] = 2.37, 95% confidence interval (CI) [95%CI] = 1.78-3.16); seen by medical officer/residents (aOR = 2.11; 95%CI = 1.49-2.99); and had CT scan (aOR = 2.93; 95%CI = 2.25-3.83). Out-of-pocket treatment costs at the ED were reported in 803 patients. Average costs were USD 8, (standard deviation [SD] = 23). Costs were twice as high in those arriving in ambulances (USD 20, SD = 49) or who underwent CT scans (USD 16, SD = 37). Conclusion: TBI patients\u27 access to ambulance transport, experienced physicians, and imaging facilities during emergency care needs to be improved in Pakistan

Association of depression with treatment outcomes in Type 2 Diabetes Mellitus: A cross-sectional study from Karachi, Pakistan

Background: To assess the associations of depression with glycemic control and compliance to self-care activities in adult Patients with Type 2 Diabetes Mellitus. Methods: This cross-sectional study was conducted at a tertiary-care hospital in Karachi (Aga Khan University Hospital). Equal numbers of depressed and non-depressed Patients were consecutively recruited from the diabetic clinic. Information on demographic and clinical characteristics was collected in face-to-face interviews and from medical records. Hospital Anxiety Depression Scale (HADS) was used to measure depression. Associations of depressed status (HADS \u3e= 8) with poor glycemic control (Hemoglobin A1c level \u3e= 7%) and compliance to self-care activities were assessed by logistic regression analyses. Results: A total of 286 Patients were included in this study with a male-female ratio of 1.2:1. Mean age was 52 years and in 64.7% of them, the duration of diabetes was more than 3 years. Depressed Patients were more likely to be female (adjusted odds ratio [OR] = 1.88, 95% confidence interval [95% CI] = 1.07-3.31), had a family history of diabetes (OR = 2.64, 95% CI = 1.26-5.55), and poor glycemic control (OR = 5.57, 95% CI = 2.88-10.76) compared with non-depressed Patients. Depression was also associated with low compliance to self-care activities such as taking dose as advised (OR = 0.32, 95% CI = 0.14-0.73), dietary restrictions (OR = 0.45, 95% CI = 0.26-0.79) and foot care (OR = 0.38, 95% CI = 0.18-0.83). Conclusions: Adult Patients with Type 2 Diabetes who have depression were more likely to have poor glycemic control and lower compliance to self-care activities, and they might need particular attention during follow-up visits

School-based injury outcomes in children from a low-income setting: results from the pilot injury surveillance in Rawalpindi city, Pakistan

Background School-based injuries account for one in five unintentional childhood injuries. Little is known about the epidemiology of school-based injuries in low-income settings. The objective of our study was to compare emergency department (ED) outcomes of the school-based injuries with respect to age, sex, and injury mechanisms in a Pakistani urban setting. Findings A pilot injury surveillance study was conducted at the EDs of three major tertiary-care hospitals of Rawalpindi city from July 2007 to June 2008 and included children of less than 15 years injured at school. The World Health Organization’s questionnaire for injury surveillance was used. There were 923 school injury cases. Mean age of children involved was 8.3 years (SD ± 3.3) with male female ratio 2.9:1. Most injuries occurred while playing 85.6% (n = 789); of which the most common mechanism was falls (n = 797, 86.4%). Nineteen of twenty cases were directly discharged home from the ED (N = 861). Compared to ED discharged cases, injury characteristics overrepresented in hospital admitted cases (n = 46) were age 10–14 years (65.2% vs. 40.9%, p = 0.005), male (88.6% vs. 25.9%), involved in educational activities (39.1% vs. 5.3%), injured from fire/heat (37.8% vs. 0.6%), had burns (39.5% vs. 0.9%) and head injuries (27.9% vs. 6.4%). Conclusion Falls while playing are the commonest injury mechanism in school-based injuries reported in our ED sample. School officials need to prevent these injuries. Studying injury hazards present in school environment in Pakistan might facilitate developing specific prevention strategies

Road traffic injuries in Rawalpindi city, Pakistan.

Data on road traffic accident (RTA) injuries and their outcome are scarce in Pakistan. This study assessed patterns of RTA injuries reported in Rawalpindi city using standard surveillance methods. All RTA injury patients presenting to emergency departments of 3 tertiary care facilities from July 2007 to June 2008 were included. RTA injuries (n = 19 828) accounted for 31.7% of all injuries. Among children aged 0-14 years females suffered twice as many RTA injuries as males (21.3% versus 11.4%), whereas this trend reversed for the age group 15-24 years (41.9% versus 21.7%). One-fifth of injuries were either fractures or concussion. Severity and outcome of injuries were worse for the age group 45 years and older. For every road traffic death in Rawalpindi city, 29 more people were hospitalized and 177 more received emergency department care. These results suggest the need for better RTA injury surveillance to identify preventive and control measures for the increasingly high road disease burden in this city

Differences in Reporting of Violence and Deliberate Self Harm Related Injuries to Health and Police Authorities, Rawalpindi, Pakistan

Background: The aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan. Methods/Principal Findings: Study setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital\u27s ED, or both in Rawalpindi city from July 1, 2007 to June 30, 2008 were included. In Rawalpindi city, 1 016 intentional injury victims reported to police whereas 3 012 reported to ED. Comparing violence related fatality estimates (N = 56, 95% CI: 46–64), police reported 75.0% and ED reported 42.8% of them. Comparing violence related injury estimates (N = 7 990, 95% CI: 7 322–8 565), police reported 12.1% and ED reported 33.2% of them. Comparing DSH related fatality estimates (N = 17, 95% CI: 4–30), police reported 17.7% and ED reported 47.1% of them. Comparing DSH related injury estimates (N = 809, 95% CI: 101–1 516), police reported 0.5% and ED reported 39.9% of them. Conclusion: In Rawalpindi city, police records were more likely to be complete for violence related deaths as compared to injuries due to same mechanism. As compared to ED, police reported DSH related injuries and deaths far less than those due to other types of violence

Spatial variations in COVID-19 risk perception and coping mechanism in Pakistan

The outbreak of novel coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization, which instigated governments to impose lockdowns across their countries. Amidst the lockdown in Pakistan, this study comprised measures of the COVID-19 risk perception, coping mechanism, and spatial variations. The data from 40 selected indicators was collected using an online questionnaire and grouped into domains (4 risk perception and 3 coping mechanisms domains). The results revealed the spatial variations and the levels of risk perception and coping mechanisms within the study area. Relative to each other, overall risk perception was highest in Northern Areas (Gilgit-Baltistan and Azad Jammu and Kashmir) and Islamabad, and lowest in Balochistan province. Very little spatial variation was observed in terms of coping mechanisms. Age, gender, and marital status influenced the risk perception associated with COVID-19. The findings suggest spatial variation in risk perception, implying the need for localized and modified COVID-19 risk communication and risk reduction strategies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s41324-022-00498-7

The impact of psychological distance to climate change and urban informality on adaptation planning

Climate change adaptation planning involves adjusting to the impacts of climate change and taking action to mitigate its adverse effects. Psychological distance, the separation between one's self-perception and actual events, can play a significant role in an individual's readiness to adapt to climate change impacts. This study aims to investigate the socioeconomic factors associated with psychological distance to climate change in formal and informal settlements of Lahore, Pakistan. Using a literature review, data indicators were selected and grouped into the psychological distance dimensions of spatial, temporal, social, and hypothetical. A questionnaire survey was conducted in the study area, resulting in a total of 400 responses. Descriptive statistics and sampled paired t-tests were used to measure differences between responses from formal and informal communities, and multivariate regression models were developed to identify socioeconomic factors associated with psychological distance to climate change. The results of the study indicate a significant difference between formal and informal settlements in spatial distance and hypothetical dimensions. Additionally, household size, average household income, number of children, and past experiences with extreme weather conditions were found to be significant factors. The study recommends that these factors be taken into account when engaging with the public, communicating risks, and devising relevant policies for effective adaptation planning