Addressing Depression among Women through Action on the Social Determinants of Health in Pakistan: A Literature Review

Depressive disorders constitute a substantial proportion of the global disease burden. These disorders are a major public health concern for both developed and developing countries, with particularly high prevalence observed in Pakistan, especially among women. Despite recognition of the social determinants (SDH) of depression to address mental health globally, Pakistan is lagging behind with poorly implemented mental health policies. This literature review examines the association of the SDH and depression among women in Pakistan. This review confirms a high prevalence of depression among women linked to SDH including poverty, illiteracy, unemployment, lack of social support and housing, inadequate health care access and poor mental health facilities with stigma attached to mental disorders. The findings also reveal a need for a comprehensive mental health policy to integrate mental health services into primary health care and to target mental health care towards underprivileged and marginalised women.  A key component of an integrated approach to address the SDH associated with the growing burden of depression amongst women in Pakistan is a focus on mental health literacy among underprivileged and marginalized women

Associations Between Stress and Resourcefulness Among Parents of Children at Risk for Autism Spectrum Disorder and Developmental Delays

Parents who are rearing a child with a developmental disability have higher stress than parents raising typically developing children. Protective factors, such as optimism and social support, are associated with psychological well-being among parents of children with and without disabilities. However, little is known about when this pattern of elevated stress among parents with developmental disabilities emerges; associations between parents’ level of stress and resilience prior to their child’s initial diagnostic evaluation has yet to be thoroughly researched. Resourcefulness refers both to internal processes to handle stress and external help-seeking behaviors that contribute to resilience. It is related to psychological adjustment in adults, but it has never been examined among parents whose children demonstrate risk for developmental disability prior to a clinical evaluation. This study utilizes a strengths-based approach to investigate how parents’ resourcefulness relates to child functioning and parent stress during the time leading up to an evaluation. The sample included 119 parents of toddlers at-risk for autism spectrum disorder and other developmental delays who were referred for diagnostic evaluation. Parents completed the Perceived Stress Scale (Cohen, Kamarch, & Mermelstein, 1983) and Resourcefulness Scale (Zauszniewski, Lai, & Tithiphontumrong, 2006). Diagnostic outcomes included autism spectrum disorder (n=37), language disorder and other developmental delays (n=55), and no diagnosis (n = 27). Specifically, moderation analyses were conducted to examine whether resourcefulness moderates the relation between child functioning (i.e., adaptive behavior, autism symptom severity) and parents’ stress, as well as to assess whether child’s diagnostic outcome moderated the relation between parents’ resourcefulness and stress. Results indicated a significant moderating effect of resourcefulness on the relation between children’s autism symptom severity and parents’ stress, such that among parents with low levels of resourcefulness, high severity of autism symptoms was associated with high stress. Clinical implications, including future screening to detect parents who might be at risk for elevated stress and poor mental health functioning following diagnosis of their child’s developmental disability, are discussed, as well as considerations for parent-directed stress management interventions. Limitations regarding study methodology are also explored

Effectiveness of early pregnancy ultrasound in diagnosing fetal abnormalities in high risk women

Objective: To assess the efficacy of 11-14 weeks ultrasound in the diagnosis of fetal abnormalities in high risk women.Methods: Prospective study conducted at a teaching hospital in Karachi, Pakistan. One hundred ultrasound (mini-anomaly) scans were performed on 97 high-risk women, between 11-14 weeks of gestation.Results: The most common indication for the ultrasound scan in the study, was previous history of structural or chromosomal abnormalities (40%) followed by advanced maternal age (22%). Out of 100 ultrasounds performed, two were found to have structural abnormalities at the time of mini-anomaly scan performed at 11-14 weeks. None of the ultrasound scans found to be normal at 11-14 weeks showed an abnormality on the subsequent scans.Conclusion: Ultrasound scan performed between 11-14 weeks of pregnancy is effective in diagnosing major fetal abnormalities in the high-risk population. It can complement the anomaly scan performed in the second trimester, as some of the abnormalities become evident later in pregnancy

Self-glucose monitoring and glycaemic control at a tertiary care university hospital, Karachi, Pakistan

OBJECTIVE: To explore the association between Self Monitoring of Blood Glucose (SMBG) levels and improved glycemic control (HbA1c level) among type 2 diabetic patients, receiving oral hypoglycaemic agents and insulin, and to ascertain the factors influencing SMBG. METHOD: Using Comparative cross sectional study design five hundred Type 2 diabetes patients through convenient sampling between 30-70 years were interviewed through a structured questionnaire in year 2006 and 2007 at AKUH Ambulatory setting. These 500 subjects were divided as 250 in case (doing SMBG) and 250 in control (not doing SMBG) groups. RESULTS: We identified that HbA1c value was maintained at good and fair levels in case (56%) as compared to controls (p=0.002). There was a high association of SMBG with education level, as graduate and above were monitoring SMBG at high level as evident by (p=0.005). Furthermore, there was a high association of SMBG with duration of diabetes as subjects having diabetics more than 5 years were monitoring their blood glucose level at frequent intervals (p=0.001). In case, 96.8% subjects had knowledge about the target of fasting and random blood glucose in comparison to 91.6% subjects in controls. The frequency of blood sugar checking varied among all subjects in case group such as 55% checked their blood sugar occasionally, 26% monitored daily, and 13% twice a day and 3% checked their blood sugar before and after each meal. Conclusion: Self-monitoring of blood glucose levels was associated with clinically and statistically better glycaemic control regardless of diabetes type or therapy. Therefore, healthcare personnel must increase awareness on the importance of SMBG and strongly promote this practice among diabetic patients

Knowledge Sharing Practices Among Visually Impaired Students at Aligarh Muslim University, Aligarh, India

The study is conducted with the purpose to determine the attitude, perception and the pattern of knowledge sharing among visually impaired students of Aligarh Muslim University, Aligarh, India. Appropriate pattern was formulated for data collection wherein schedule was used to gather data from 76 visually impaired students, the data so collected was analysed using SPSS (ver.23). The results formulated out of the analysis confirms that the visually impaired students consider knowledge sharing as a best practice as they frequently practicing it among their peer groups through various channels of communication e.g. audio material, URLs of websites, etc. The purposes of KS, the reasons which motivate and those which reduce the practices of so were also highlighted. In addition, the study also provides suggestive measures which will improve knowledge sharing practices among these students. Further, it is anticipated that the present study will help in developing a general understanding and awareness regarding knowledge-sharing behaviour of visually impaired students. Moreover, the study is a good contribution to literature because of dearth on the current topic

Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study.

Background:Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan. Methods: At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated, surveillance data from 2002 to 2007 was analyzed and compared with various risk factors. Results: During study period 1382 incidents were reported. Junior doctors sustained highest number of injuries (n = 394, 28.5%) followed by registered nurses (n = 283, 20.4%). Highest number of incidents was reported during blood collection (19%). An increasing trend was observed in the pre intervention years (2002-04). However noticeable fall was noted in the post intervention period that is in year 2006 and 2007. Major decline was noted among nurses (from 13 to 5 NSI/100 FTE/year). By relating and comparing the rates with various activities directly linked with the use of syringes a significant reduction in incidents were found including, hospital admissions (p-value 0.01), surgeries and procedures performed (p = 0.01), specimens collected in the laboratory (p = 0.001) and Patients visits in clinics (p = 0.01). Conclusion: We report significant reduction in needle stick injuries especially during post intervention study period. This is being achieved by constant emphasis on improving awareness by regular educational sessions, implemented as a quality improvement project

Knowledge Resources for Visually Impaired Persons: An Indian Perspective

The purpose of the study is to identify the sources provided by the universities of India to visually impaired persons to cater their educational requirements. There are 49 Central Universities in India, out of which 15 were selected for the study. The data from selected university libraries was collected using bilateral approach i.e. questionnaire and telephonic interview. It was found that central universities of India are not providing appropriate sources to their visually impaired users to fulfill their educational requirements. Though some universities had taken initiatives in providing the information resources and services, but still there are many aspects which should be looked upon for modification and improvisation. The present study is confined to the central universities of India as it would be difficult to identify each university in India who have started or are in urge to start the services to visually impaired users. It is anticipated that the study would be of immense importance not only for the academic institutions but also for the agencies/organizations working for this user community. The study thus puts light on the situations those are prevailing in academia allied to inclusive education for visually impaired persons and it also provides the way out to overcome such situations. The present study is devoted to particular user community and thus useful for professionals pursuing understanding about the library and information services for these users. Furthermore, the research highlights the present status regarding the availability of the library services for visually impaired users in central universities of India