Factors associated with intimate partner violence against women in a mega city of South-Asia: multi-centre cross-sectional study

Objectives: To assess the proportion of women subjected to intimate partner violence and the associated factors, and to identify the attitudes of women towards the use of violence by their husbands. Design: Cross-sectional study. Setting: Family practice clinics at a teaching hospital in Karachi, Pakistan. Participants: A total of 520 women aged between 16 and 60 years were consecutively approached to participate in the study and interviewed by trained data collectors. Overall, 401 completed questionnaires were available for analysis. Multivariate logistic regression analysis was used to identify the association of various factors of interest. Results: In all, 35% of the women reported being physically abused by their husbands in the last 12 months. Multivariate analysis showed that experiences of violence were independently associated with women\u27s illiteracy (adjusted odds ratio=5.9; 95% confidence interval, 1.8-19.6), husband\u27s illiteracy (3.9; 1.4-10.7), smoking habit of husbands (3.3; 1.9-5.8), and substance use (3.1; 1.7-5.7). Conclusion: It is imperative that intimate partner violence be considered a major public health concern. It can be prevented through comprehensive, multifaceted, and integrated approaches. The role of education is greatly emphasised in changing the perspectives of individuals and societies against intimate partner violence

Types of refractive errors in northern Pakistan: a hospital-based survey

Background: The World Health Organisation (WHO) reports that about 314 million people are visually impaired worldwide, and in 153 million of them the impairment is due to uncorrected refractive errors. Hence, uncorrected refractive error is one of the leading causes of blindness around the globe. The aim of this study is to assess the prevalence and patterns of different types of refractive errors among the people attending the eye clinic in Northern Pakistan. Material and methods: A hospital-based retrospective audit was done on patients who presented to the Ophthalmology Outpatients Department of Ayub Medical Complex Abbottabad between 1st June 2017 and 31st July 2017. The data of 662 patients were analysed using IBM SPSS Statistics v. 22.0. Results: Refractive errors were found in 487 (73.5%) of the total participants. The crude prevalence of myopia, hyperopia, and astigmatism was found to be 33.5%, 21.9%, and 18.1%, respectively. The refractive error status was found to be independent of gender (p = 0.075), but it varied among different age groups (p = 0.000). Conclusion: Myopia seems to be the most common refractive error in northern Pakistan, followed by hyperopia. The results of our study can be useful for the planning of eye care services in our country so that we can achieve the goal of VISION 2020 with proper care and planning

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

Arginine Reverses Ethanol-Induced Inflammatory and Fibrotic changes in Liver despite continued Ethanol Administration

We investigated the potential of arginine to reverse pathological changes in alcohol-induced liver injury. Four groups (six rats/group) of male Wistar rats were fed a fish oil-ethanol diet for 6 (group 2) or 8 (group 1) weeks. Rats in group 3 were fed fish oil-ethanol for 6 weeks, after which they were administered arginine with fish oil-ethanol for an additional 2 weeks. Rats in group 4 were fed fish oil-dextrose for 8 weeks. Liver samples were analyzed for histopathology, lipid peroxidation, cytochrome P4502E1 activity, nuclear factor-κB, and levels of messenger RNA for tumor necrosis factor-α, cyclooxygenase-2, and inducible nitric oxide synthase. Concentrations of endotoxin were measured in plasma. The most severe inflammation and fibrosis was detected in groups 1 and 2, as were the highest levels of endotoxin, lipid peroxidation, cytochrome P450 2E1 activity, activation of nuclear factor-κB, and mRNA levels for tumor necrosis factor-α, cyclooxygenase-2, and inducible nitric oxide synthase. Plasma nitric oxide was also increased as was nitrotyrosine in liver. After arginine was administered, there was marked improvement in the pathological changes accompanied by decreased levels of endotoxin, lipid peroxidation, activation of nuclear factor-κB, tumor necrosis factor-α, cyclooxygenase-2, inducible nitric oxide, and nitrotyrosine staining. The therapeutic effects of arginine are probably secondary to increased levels of nitric oxide but other effects of arginine cannot be excluded

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

Toll-like receptor-2 deficiency enhances non-alcoholic steatohepatitis

<p>Abstract</p> <p>Background</p> <p>Previously we reported that mice deficient in toll-like receptor 4 (TLR-4) signalling were protected from diet-induced non-alcoholic steatohepatitis (NASH). Another member of the toll-like receptor family, TLR-2, has been shown to play a role in lipid trafficking via uptake of diacylated lipoproteins. However, a role for TLR-2 in NASH has not been elucidated. The objectives of the current study were to examine the influence of dietary fat quality and TLR-2 on NASH pathogenesis.</p> <p>Methods</p> <p>Steatohepatitis was induced in male Db, C57BL/6 and TLR-2^-/-mice by feeding an L-amino acid-defined diet that was deficient in methionine and choline (MCDD). Mice fed the base diet supplemented with methionine and choline (control diet; CD) were used as controls. To determine the role of fat quality, MCDD was enriched with polyunsaturated corn oil (PUFA) or coconut oil that is comprised mostly of saturated fat (SAFA); the total amount of each fat was 112.9 g/kg of diet. After 8 weeks of feeding CD or MCDD, hepatic steatosis, inflammation and necrosis were evaluated in histological sections. Total RNA was extracted from frozen liver samples and mRNA expression of TNFα, collagen α1, IL-10, peroxisome proliferator-activated receptor-γ (PPAR-γ), TLR-4, and CD14, was analyzed via real-time PCR. Protein levels of TLR-2 were analyzed by western blot.</p> <p>Results</p> <p>Panlobular macrovessicular steatosis and diffuse leukocyte infiltration were noted in PUFA-fed Db mice. Histological scores demonstrated significantly less steatosis, inflammation and necrosis in SAFA-fed mice of all mouse strains. However, compared to wild type mice, hepatocellular damage was notably more severe in TLR-2^-/-mice. Consistent with histological findings, mRNA expression of TNFα was elevated by approximately 3-fold in TLR-2^-/-mice; PPAR-γ expression was blunted in this strain compared to wild type. Expression of the matrix protein collagen αI was also significantly higher in TLR-2^-/-mice, indicating a pro-fibrogenic state. Sensitivity to steatohepatitis due to dietary fat or TLR-2 deficiency correlated significantly with alterations in the expression of TLR-4 as well as the co-receptor CD-14.</p> <p>Conclusions</p> <p>Our findings suggest that dietary saturated fat plays a protective role against MCDD-induced steatohepatitis, whereas TLR-2 deficiency exacerbated NASH. The mechanism underlying the response to dietary fat and TLR-2 likely involves altered signalling via the TLR-4 pathway.</p

Climate change and epilepsy: time to take action

Climate change is the biggest challenge facing humanity today. The associated global warming and humidification, increases in the severity and frequency of extreme climate events, extension of the ranges of vector‐borne diseases, and the consequent social and economic stresses and disruption will have major negative consequences on many aspects of health care. People whose resilience to change is already impaired may suffer disproportionately from these environmental changes, which are of unprecedented reach and magnitude. There has been little connection made so far between climate change and epilepsy. We briefly review the history of climate change science and the subsequent response of the global scientific com-munity. We consider how climate change effects might in general affect health and disease. We consider some of the underlying complex interactions that, for example, favor the spread of vector‐borne diseases and how climate models operate and may help plan for global and local changes. We then speculate specifically on how these generic ideas may apply specifically to epilepsy. We consider these impacts at levels from molecular to the epidemiological. Data are sparse, and there is undoubtedly a need for more information to enable better estimation of possible effects of climate change on care in epilepsy. We also consider how the professional activities of those involved in epilepsy health care might contribute to global carbon emissions, for example, through flying for conference attendance. Healthcare organizations across the world are already considering, and responding to, many of these issues. We argue for more research in this area, but also for action today. Actions today are likely to generate cobenefits for health care, including care in epilepsy, resulting from efforts to decarbonize, mitigate effects of climate change that has already happened, and plan for adaptation to climate change

Neonatal Androgenization Exacerbates Alcohol-Induced Liver Injury in Adult Rats, an Effect Abrogated by Estrogen

Alcoholic liver disease (ALD) affects millions of people worldwide and is a major cause of morbidity and mortality. However, fewer than 10% of heavy drinkers progress to later stages of injury, suggesting other factors in ALD development, including environmental exposures and genetics. Females display greater susceptibility to the early damaging effects of ethanol. Estrogen (E2) and ethanol metabolizing enzymes (cytochrome P450, CYP450) are implicated in sex differences of ALD. Sex steroid hormones are developmentally regulated by the hypothalamic-pituitary-gonadal (HPG) axis, which controls sex-specific cycling of gonadal steroid production and expression of hepatic enzymes. The aim of this study was to determine if early postnatal inhibition of adult cyclic E2 alters ethanol metabolizing enzyme expression contributing to the development of ALD in adulthood. An androgenized rat model was used to inhibit cyclic E2 production. Control females (Ctrl), androgenized females (Andro) and Andro females with E2 implants were administered either an ethanol or isocalorically-matched control Lieber-DeCarli diet for four weeks and liver injury and CYP450 expression assessed. Androgenization exacerbated the deleterious effects of ethanol demonstrated by increased steatosis, lipid peroxidation, profibrotic gene expression and decreased antioxidant defenses compared to Ctrl. Additionally, CYP2E1 expression was down-regulated in Andro animals on both diets. No change was observed in CYP1A2 protein expression. Further, continuous exogenous administration of E2 to Andro in adulthood attenuated these effects, suggesting that E2 has protective effects in the androgenized animal. Therefore, early postnatal inhibition of cyclic E2 modulates development and progression of ALD in adulthood