Antenatal care and the occurrence of Low Birth Weight delivery among women in remote mountainous region of Chitral, Pakistan

Objective: Low birth weight (LBW) is closely associated with perinatal morbidity and bears an increased risk for subsequent infant morbidity. The study aimed to assess low birth weight delivery factors among women in Chitral, Pakistan. Methodology: Mixed Methodology was adopted. Structured data collection tool was used to collect information from medical records of 1316 mothers, followed by interviews and focus group discussions to understand the causes and their remedies. The main outcome measure was infants born with low birth weight LBW (\u3c2.5kg). Result: There was a significant association between the occurrence of low birth weight and maternal education, paternal education, and paternal occupation. Mothers who received antenatal care were more likely to deliver normal weight babies compared to those who did not. Women with more than four antenatal visits were six times as likely to deliver normal weight babies. Key facilitators for using antenatal services include information received from health center staff during home visits, advice from mothers and mother in-laws, and programs on media. Barriers include high cost for antenatal care, non-availability of transport, particularly in emergencies, and lack of awareness about benefits of antenatal care. Conclusion: The study suggested proper strategies for antenatal care to increase the awareness among women living in remote locations. The limitations are needed to be identified and considered when designing interventions to reduce LBW deliveries in Pakistan

Effectiveness of health education in promoting the use of iodized salt in Lotkoh, tehsil Chitral, Pakistan

Introduction: We evaluated the effect of health education on the use of iodized salt in a remote region.Methods: We randomly selected 31 villages in teh Lotkoh tehsil of district Chitral in the North West Frontier Province of Pakistan. We then randomly selected 7 households from each village and inteviewed the eldest women of the family. We also tested samples of salt for iodine concentration at the user\u27s level.Results: Eighty-five percent of families (184/217) used iodized salt exclusively. Among the samples population, the Aga Khan Health Services (AKHS) informed 67% about the importance of iodized salt. Shopkeepers and neighbors informed 25%. People informed by AKHS were more likely to know the volatile nature of iodine (76% vs 55%, p \u3c 0.001) and the advantages of iodized salt (91% vs. 75%, p = 0.001) than persons informed by other sources. People who could name any single advantage of iodized salt were more likely to use iodized salt (97%) compared to those who could not name any advantages (62%) (p \u3c 0.001) Iodine concentration in 78% (141/183) samples was acceptable (\u3e or = 15 ppm). One specific brand of salt consistently had sufficient iodine concentration (91%) compared to all others (47%) (p \u3c 0.001).CONCLUSION: Health education has been effective in promoting the use of iodized salt in these isolated rural communities. A joint effort by the government, local NGOs and the community can substitute the role of mass media in such areas. Regular evaluation of iodized salt brands should be considered

FAT DEPOTS WITHIN AND AROUND THE SKELETAL MUSCLE IN RHEUMATOID ARTHRITIS AND THEIR ROLE IN PHYSICAL FUNCTION

Altered body composition towards greater body fat mass and lower lean mass is a well-known manifestation of Rheumatoid Arthritis (RA). However, there is limited information on fat accumulation in and around the skeletal muscles, and whether they contribute to functional limitations and low physical activity levels that persist in this population despite well-controlled disease. The main objectives of this dissertation were to 1) characterize accumulation of skeletal muscle fat (SMF), intermuscular adipose tissue (IMAT) and subcutaneous adipose tissue (SAT) in individuals with RA and determine the associations of SMF, IMAT and SAT with physical function and physical activity measures; and 2) compare SMF, IMAT and SAT between individuals with RA and healthy individuals. This cross-sectional ancillary study used data from previously conducted studies in adults with RA and healthy adults. SMF, IMAT and SAT were measured from computed tomography images of the mid-thigh region. Physical function in the RA cohort was measured using self-report and performance-based tests, and physical activity was assessed using an accelerometer-based activity monitor. Associations between each fat depot, and physical function and activity were assessed by multiple linear regression models. To compare SMF, IMAT and SAT in RA and non-RA subjects, those with RA were matched in sex and BMI to healthy adults of same age and to older healthy adults who were 10-20 years older. The differences between groups were assessed using related samples tests. In subjects with RA, higher SMF significantly contributed to lower physical function and activity (R2Δ range=.08-.25, p<0.05), whereas IMAT and SAT accumulation were not associated with physical function or activity. Individuals with RA had significantly higher SMF (10% difference, p < 0.05) whereas IMAT and SAT accumulation were similar to healthy individuals of same age. There were no differences in SMF, IMAT and SAT between the RA and matched older healthy groups. Study findings demonstrate that SMF accumulation is an important contributor to low physical function and activity, and accumulates more in RA. These results provide preliminary evidence for future longitudinal studies to investigate the impact of SMF on disability and promote health in individuals with RA

Health promotion, disease prevention and periodic health checks: perceptions and practice among family physicians in eastern Mediterranean region

Introduction: The aim of this study was to identify the current practices and perceptions of family physicians regarding health promotion, disease prevention including periodic screening and health checks in Eastern Mediterranean Region. Methods: A multi-country cross-sectional study was conducted in six countries of EMR, from September 2014 to March 2015. Family Physicians who were currently practicing in different countries of EMR were invited to participate in the study through email. A pre-tested structured questionnaire was used for data collection. Data was entered and analyzed on SPSS 19 and logistic regression analysis was performed. Results: A total of 100 physicians data was included in the final analysis. The majority were female physicians (76%): 63% were 25 to 35 years of age. Approximately 53% of Family physicians always recommend periodic screening and health checks to their patients. The common screening question asked to patients in medical history was related to their blood pressure (86%). Almost all (99%) of the Family physicians believe they should conduct periodic health checks. Those who had postgraduate training in Family Medicine (OR: 0.5; 95% CI: 0.39-1.67) and attended CME sessions regularly (OR: 0.11; 95% CI: 0.01-0.93), are more likely to recommend periodic screening and health checks to their patients. Conclusion: Periodic screening and health check is an important strategy to prevent disease and maintain health. It is an underutilized practice and a great need exists for its implementation in family practice

Tobacco control efforts in the Gulf cooperation council countries: achievements and challenges

This paper reports a review into the current state of tobacco use, governance and national commitment for control, and current intervention frameworks in place to reduce the use of tobacco among the populations of the Gulf Cooperation Council (GCC) member states and Yemen. It further reviews structured policy-oriented interventions (in line with the MPOWER package of 6 evidence-based tobacco control measures) that represent government actions to strengthen, implement and manage tobacco control programmes and to address the growing epidemic of tobacco use. Our findings show that tobacco control in the GCC countries has witness real progress over the past decades. These are still early days but they indicate steps in the right direction. Future investment in implementation and enforcement of the Framework Convention on Tobacco Control, production of robust tobacco control legislation and the establishment of universally available tobacco cessation services are essential to sustain and strengthen tobacco control in the GCC region

Are we ready for a person-centered care model for patient- physician consultation? A survey from family physicians and their patients of East Mediterranean Region

Background: Person-centered care has long been identified as a key component of health systems and one of the six domains of quality. This study aimed to identify the perceptions of patients and physicians regarding person-centered care in the Eastern Mediterranean Region (EMR). Methods: A multicountry, cross-sectional study was conducted in 6 countries of EMR during July 2012 to September 2012. From each country, an expert Family Physician (FP) was identified and invited for the study. During the first phase, 190 FPs practising for at least 6 months were recruited. In the second phase, the recruited FPs approached 300 patients aged > 18 years with 1 or more recurring problems. Data analysis was conducted using SPSS version 19. Results: Of a total of 360 patients, 53% were between 25-40 years of age and the majority 55.7% were females. Among physicians, 66.8% were females and 72.1% had undergone specialization in Family Medicine from EMR. About 36% of the patients, while 62.6% of the physicians, preferred a person-centered care model of care. Among physicians, field of specialization (AOR= 0.7; 95% C.I: 0.3-0.9) and regularity in continuing medical education sessions (AOR= 0.3; 95% C.I: 0.1-0.5) were significant factors for preferring a person-centered care model. Educational status (AOR= 3.0; 95% C.I: 1.1- 7.9) was associated with a preference for person-centered care among patients. Conclusion: The results of the study highlight that a majority of physicians prefer person-centered care, while patients prefer a mix of both patient- and physician-centered care. Strategies should be developed that will help physicians and patients to embrace person-centered care practices

Catalytic Performance of Calcium-Lanthanum co-doped Ceria (Ce0.85-xLa0.15CaxO2-δ) in Partial Oxidation of Methane

In this study, Ce0.85-xLa0.15CaxO2-δ was synthesized using sol-gel combustion method and appliedfor partial oxidation of methane (POM). The physicochemical properties of catalyst were analyzed using X-ray diffraction (XRD), scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS) and thermogravimetric analysis (TGA). Material shows a pure cubical structure and is highly stable up to 850 °C. The performance testing indicated the conversion of CH4 is 65% and selectivity of H2 and CO are 28% and 8%, respectively. The performance indicated the catalyst has a potential to be used for partial oxidation of methane on a larger scale. Copyright © 2021 by Authors, Published by BCREC Group. This is an open access article under the CC BY-SA License (https://creativecommons.org/licenses/by-sa/4.0).

Knowledge, attitudes, and practices among nurses in Pakistan towards diabetic foot

Introduction: Diabetic foot ulcers are a pressing complication of diabetes mellitus. Wound care requires a significant proportion of healthcare resources. It is imperative, therefore, for healthcare professionals to possess sound knowledge of the disease along with a positive attitude to ensure better clinical practice. Our literature search revealed a scarcity of data pertaining to diabetic foot ulcers. Therefore, this study aims to evaluate the knowledge and attitudes of nurses regarding diabetic foot care. Methods: A cross-sectional study design was employed, a pre-validated and pre-tested questionnaire was used to collect data from a sample size of 250 nurses working at two tertiary care hospitals in Karachi, Pakistan. The study was conducted over a period of three months (January to March 2018) and included all nurses who possessed at least one year of clinical experience in diabetic ulcer care. The statistical software employed was SPSS version 19 (IBM Corp., Armonk, NY, US). Non-parametric tests and descriptive statistics were used for data analysis and statistical significance was assumed at a p-value of less than 0.5. Results: Only 54% of the nurses in our study possessed adequate knowledge of diabetic foot ulcers. The mean score of knowledge was 74.9 (±9.5). Macdonald’s standard criteria for learning outcomes was used to gauge the knowledge levels of our study population. Nurses performed best in the domain of ulcer care with 65.3% of the participants possessing good knowledge of the topic. The overall attitude of nurses towards patients with diabetic ulcers was positive. Conclusion: This study highlights important gaps in nurses’ knowledge and sheds light on the lack of evidence-based practice. Poor knowledge can compromise healthcare standards, even with the presence of positive attitudes. Hence, a comprehensive revision of nursing curricula across local tertiary hospitals for allowing nurses to update their knowledge is warrante

The Spread of HIV in Pakistan: Bridging of the Epidemic between Populations

In the last two decades, ‘concentrated epidemics’ of human immunodeficiency virus (HIV) have established in several high risk groups in Pakistan, including Injecting Drug Users (IDUs) and among men who have sex with men (MSM). To explore the transmission patterns of HIV infection in these major high-risk groups of Pakistan, 76 HIV samples were analyzed from MSM, their female spouses and children, along with 26 samples from a previously studied cohort of IDUs. Phylogenetic analysis of HIV gag gene sequences obtained from these samples indicated a substantial degree of intermixing between the IDU and MSM populations, suggesting a bridging of HIV infection from IDUs, via MSM, to the MSM spouses and children. HIV epidemic in Pakistan is now spreading to the female spouses and offspring of bisexual MSM. HIV control and awareness programs must be refocused to include IDUs, MSM, as well as bisexual MSM, and their spouses and children