Experiences of frontline Pakistani emigrant physicians combating COVID-19 in the United Kingdom: a qualitative phenomenological analysis

Background: This study aims to explore the experiences, beliefs, feelings, and challenges faced by Pakistani migrant doctors working in the United Kingdom in times of the COVID-19 pandemic. The qualitative study aims to explore the lived experiences, beliefs, feelings, and challenges faced by Pakistani migrant physicians working in the United Kingdom during the COVID-19 pandemic. Methods: An exploratory phenomenological approach was used to collate data on experiences expressed during the COVID-19 pandemic. Purposive and snowball sampling was used to target participants, which were doctors of Pakistani origin involved in the direct care and management of COVID-19 patients in different NHS hospitals of the United Kingdom. Semi-structured, in-depth telephonic interviews were conducted with study participants in May 2020. Data analysis was done parallel with data collection by using an inductive qualitative approach. Results: We recruited ten frontline physicians. Four theme categories emerged from the data analysis: 1) Working across borders and cultures, 2) Role of beliefs for coping with stress and fear, 3) Passion and profession, and 4) Scaffolding the Pakistani health system. Overall, the results show that the participants received limited professional support, in terms of counseling and psychological rehabilitation. Instead, they had to use self-management strategies to cope with the situation. Conclusion: The intensive work exhausted participants physically and emotionally. They were holding a lot of grief and hurt inside, but still, healthcare professionals showed the spirit of professional dedication to overcome difficulties. Although currently coping with their emotional problems, comprehensive professional support should be made available to cater to the wellbeing of frontline physicians

Developmental delay and its predictors among children under five years of age with uncomplicated severe acute malnutrition: a cross-sectional study in rural Pakistan

Background: In developing countries, malnutrition in children and developmental delays are two major challenges for public health. To achieve the vision of the Sustainable Development Goals from the broader perspective of child health, early identification of developmental delays and timely intervention are crucial. The aim of this study is to assess the prevalence of suspected developmental delay and their predictors in children under the age of 5 years with uncomplicated severe acute malnutrition in rural areas of Pakistan. Methods: A multicentre cross-sectional study was conducted among 185 children with uncomplicated severe acute malnutrition. We screened children aged 6-59months for their nutritional status and clinical complications. Children fulfilling the inclusion criteria underwent the Denver Development Screening Tool II (DDST-II). The children's global developmental profile was calculated according to the established protocols of DDST-II, which are based on four important domains of development: personal and social behaviour, language, gross motor adaptive skills and fine motor adaptive skills. A pretested questionnaire was used to collect data on socio-demographic and nutritional factors for assessing predictors of developmental delay, which were analysed using a multivariate logistic regression model. Results: Out of 177 children with severe acute malnutrition, 69 (38.9%) had normal global development and 108 (61.1%) had delayed global development. Significant associations were found between global developmental delay and younger children (6-24months vs. 25-59months; AOR=4.53, 95% CI: 1.56-13.10, p<0.01), children who were not exclusively breastfed (AOR=3.07, 95% CI: 1.24-7.56, p=0.01), and a history of contact with a tuberculosis smear-positive adult (AOR=2.67, 95% CI: 1.30-5.49, p<0.01). Conclusion: About two thirds of the study participants showed delayed or unstable global development. Thus, according to DDST-II-established protocols, there is a high prevalence of suspected developmental delay among children under the age of five years with uncomplicated severe acute malnutrition in rural areas of Pakistan. Children in their first 2 years of life were at particularly high risk due to insufficient breastfeeding. This emphasizes the need to provide adequate infrastructure and information to parents for the prevention of developmental delay in remote areas

Comparative analysis of developmental profile between normal and severe acute malnourished under-five children in Pakistan: a multicentre cross-sectional study

Objectives: This study aims to compare the developmental profile of severe acute malnourished (SAM) and normal under-five children and to find sociodemographic determinants accountable for their developmental disabilities. Setting: We conducted a multi-centre cross-sectional study in three basic health units and one rural health centre in Pakistan. Participants: 200 children (SAM and healthy) aged 6-59 months. Primary and secondary measures: We screened for nutritional status and clinical complications. Children underwent for developmental assessment by Denver Development Screening Tool II. A pretested structured questionnaire on sociodemographic characteristics and nutrition was used for collecting data about determinants of developmental delay. Results: We observed statistically significant differences in anthropometric measurements among SAM compared with normal nourished in weight, height, mid-upper arm circumference and weight-for-height z-scores. SAM serves as a significant risk factors (p<0.001) for delayed personal or social development (69% vs 11%; OR (95% CI)=18.01 (8.45 to 38.37)), delayed fine motor development (39% vs 8%; OR (95% CI)=7.35 (3.22 to 16.81)), delayed language development (32% vs 8%; OR (95% CI)=5.41 (2.35 to 12.48)), delayed gross motor development (34% vs 10%; OR (95% CI)=4.64 (2.14 to 10.05)) and delayed global development (66% vs 20%; OR (95% CI)=7.77 (4.09 to 14.74)). Applying logistic regression, personal or social development (p<0.001) and language development (p<0.05), under-five siblings was a risk factor, while among gross motor development, mother's educational status (p<0.05) was a significant risk factor for developmental delay. Conclusions Our analysis indicates that children with malnutrition have a high frequency of developmental delays. Missing maternal education and a higher number of under-five siblings are also potential risk factors for developmental delay

Benefits of physical activity on reproductive health functions among polycystic ovarian syndrome women: a systematic review

BackgroundPolycystic ovary syndrome (PCOS) is among the predominant endocrine disorders of reproductive-aged women. The prevalence of PCOS has been estimated at approximately 6–26%, affecting 105 million people worldwide. This systematic review aimed to synthesize the evidence on the effects of physical activity on reproductive health functions among PCOS women.MethodsThe systematic review includes randomization-controlled trials (RCTs) on physical exercise and reproductive functions among women with PCOS. Studies in the English language published between January 2010 and December 2022 were identified via PubMed. A combination of medical subject headings in terms of physical activity, exercise, menstrual cycle, hyperandrogenism, reproductive hormone, hirsutism, and PCOS was used.ResultsOverall, seven RCTs were included in this systematic review. The studies investigated interventions of physical activity of any intensity and volume and measured reproductive functions and hormonal and menstrual improvement. The inclusion of physical activity alone or in combination with other therapeutic interventions improved reproductive outcomes.ConclusionThe reproductive functions of women with PCOS can be improved with physical activity. Furthermore, physical activity can also reduce infertility, as well as social and psychological stress among women

Evaluation of occupational exposure to heat stress and working practices in the small and mid-sized manufacturing industries of Lahore, Pakistan

Background: Climate change is evident around the globe causing heat stress as an emerging public health problem for people working in tropical and subtropical areas. Occupational heat stress can impact the health and productivity of small and mid-sized enterprise workers.Objective: This study aimed to profile the indoor thermal environmental conditions and modify the working practices by recommending the work/rest cycle according to the international organization for standardization 7243.Study Design: This cross-sectional study design included eight industrial (Iron spare parts manufacturing) small and mid-size enterprises in Lahore, Pakistan. The indoor thermal environment, including globe temperature, natural wet bulb temperature, ambient temperature, relative humidity, and air velocity, were recorded during summer to measure the wet bulb globe temperature (WBGT). Quest heat stress meter (model 2500), modified Testo loggers (177-T4), and EL-USB-2-LCD data loggers were placed at different working stations to measure these thermal environmental parameters. A self-administered questionnaire was used to measure the workers’ demographic characteristics and working practices. The International Organization for Standardization 7243 reference was used to estimate and recommend the work/rest cycle.Results: 138 workers aged 28.59 ± 10.46 years participated in this study. Continuous work of 8.8 ± 1.5 hours per day with a conventional resting period of 30-60 minutes was recorded on a typical working day. The indoor wet bulb globe temperature ranged from 26.8°C to 36.4°C. The workers were registered for low (72.5%), moderate (18.1%), and high (9.4%) metabolic rates according to the International Organization for Standardization 7243 reference values.Conclusion: A high wet bulb globe temperature was recorded in the selected small and mid-sized enterprises making these workers vulnerable to heat stress and related illnesses. Work/rest cycle evaluation suggested that the workers were required to improve their cool-down time by avoiding continuous exposure to high temperatures and reducing the metabolic rate

Double-Blind Parallel Treatment Randomized Controlled Trial of Prebiotics’ Efficacy for Children Experiencing Severe Acute Malnutrition in Southern Punjab, Pakistan

The prevalence of malnutrition among children under five is alarmingly high in Pakistan. However, there are ready-to-use therapeutic foods (RUTF) available which may be used to treat children with severe acute malnutrition (SAM). This study aims to assess the efficacy of prebiotics as a synergistic additive to RUTF to enhance blood parameters and anthropometric measurements in children with uncomplicated SAM living in Southern Punjab, Pakistan. A double-blind parallel treatment randomized controlled trial was conducted on 204 children aged 6–59 months. Participants were randomized and allocated to the placebo (n = 102) or experimental arms (n = 102) in a 1:1 ratio. One group of children was provided with RUTF and 4 g prebiotics, while the other group was given RUTF and starch as a placebo. Participants recruited for both arms were given treatment for eight weeks, and then their biochemical and anthropometric outcomes were evaluated. A substantial difference between the mean weight, mid-upper-arm circumference, haemoglobin, haematocrit, platelet count, mean corpuscular volume, mean corpuscular haemoglobin, and albumin was revealed. During the two-month follow-up phase of the trial, children who were enrolled in the treatment group gained about 20% of their initial weight (pre-study mean weight = 5.44 ± 1.35 kg; post-study mean weight = 6.53 ± 1.45 kg). The analysis showed a significant difference (p &lt; 0.005) between the control and treatment groups for MUAC and complete blood counts. Conclusively, supplementation with RUTF and prebiotics has proven to be an efficient, effective, and safe therapy for children suffering from SAM to improve their growth and development indicators and reduce the dangers of malnutrition in comparison to RUTF alone.<br/

The Interplay of AI Adoption, IoT Edge, and Adaptive Resilience to Explain Digital Innovation: Evidence from German Family-Owned SMEs

This study aims to discover how artificial intelligence adoption in notion (AI) plays a role in digital innovation using the theoretical foundation of diffusion of innovations and effectuation theories. The current research also investigates the moderating role of other edge Internet of Things (IoT) and the mediating role of adaptive resilience. The data collection is performed using a survey conducted among employees of family-owned SMEs. The findings reveal that AI forecasts digital innovation through adaptive resilience. The results also confirm the moderating role of threat to IoT edge and the mediating role of adaptive resilience, but moderated mediating is not supported. We conclude that family-owned SMEs intend to adopt AI, but SMEs face challenges using IoT edge. This study has implications for family firms specifically and technology adopters in general

GC/GCMS analysis of the petroleum ether and dichloromethane extracts of M oringa oleifera roots

Objective: To explore the phytochemical constituents from petroleum ether and dichloromethane extracts of Moringa oleifera (M. oleifera) roots using GC/GC-MS. Methods: A total of 5.11 kg fresh and undried crushed root of M. oleifera were cut into small pieces and extracted with petroleum ether and dichloromethane (20 L each) at room temperature for 2 d. The concentrated extracts were subjected to their GC-MS analysis. Results: The GC-MS analysis of the petroleum ether and dichloromethane extracts of M. oleifera roots, which showed promising biological activities, has resulted in the identification 102 compounds. These constituents belong to 15 classes of compounds including hydrocarbons, fatty acids, esters, alcohols, isothiocyanate, thiocyanate, pyrazine, aromatics, alkamides, cyanides, steroids, halocompounds, urea and N-hydroxyimine derivatives, unsaturated alkenamides, alkyne and indole. GC/GC-MS studies on petroleum ether extract of the roots revealed that it contained 39 compounds, belonging to nine classes. Cyclooctasulfur S8 has been isolated as a pure compound from the extract. The major compounds identified from petroleum ether extract were trans-13-docosene (37.9%), nonacosane (32.6%), cycloartenol (28.6%) nonadecanoic acid (13.9%) and cyclooctasulfur S8 (13.9%). Dichloromethane extract of the roots was composed of 63 compounds of which nasimizinol (58.8%) along with oleic acid (46.5%), N-benzyl-N-(7-cyanato heptanamide (38.3%), N-benzyl-N-(1-chlorononyl) amide (30.3%), bis [3-benzyl prop-2-ene]-1-one (19.5%) and N, N-dibenzyl-2-ene pent 1, 5-diamide (11.6%) were the main constituents. Conclusions: This study helps to predict the formula and structure of active molecules which can be used as drugs. This result also enhances the traditional usage of M. oleifera which possesses a number of bioactive compounds

Relationship of stunting with water, sanitation, and hygiene (WASH) practices among children under the age of five: a cross-sectional study in Southern Punjab, Pakistan

Abstract Background Reasons for undernutrition are food insufficiency, impaired child care, limited access to healthcare, and maternal lack of health literacy. In addition, there are several environmental factors, such as drinking water quality, poor sanitation, and hygienic practices that can lead to poor nutritional status in children. The present study aimed to compare household-associated risk factors, including water, sanitation, and hygiene (WASH) practices of mothers, with children’s stunting under the age of five. Methods A face-to-face cross-sectional survey was conducted with mothers of children under the age of five in the Dera Ghazi Khan district in southern Punjab, Pakistan. World Health Organization criteria for stunting were used to identify the participants. A sociodemographic questionnaire was used to collect information from consented parents/guardians on children’s age, feeding, and WASH practices. Pearson’s chi-square, simple regression, and hierarchical regression models were applied for data analysis. Results A total of 204 mothers of children of both genders participated in this study. The children’s mean (SD) age was 15.67 (± 10.2) months, their weight was 5.44 (± 1.45) kg, their height was 67.69 (± 10.05), and their mid-upper arm circumference was 9.75 (± 1.30) cm. Children’s stunting was mild (z-score > -2) at 17.6%, moderate (z-score − 2 to -3) at 16.7%, and severe (z-score < -3) at 65.7% of participants. A simple regression model showed a strong association, r2 = 0.062, p = 0.013, with age as the most significant sociodemographic factor. The hierarchical regression model showed a combined value of r2 = 0.0128, p = 0.027, with hand pump and tank water as the significant source of drinking water that was related to stunting among children. Conclusion Stunting can be associated with several risk factors, including WASH parameters. This study concluded that children aged under five years are susceptible to stunting in southern Punjab, Pakistan. The contamination of hand pumps and tank water resources was found to be the major contributing factor to stunting

Effectiveness of Ready-to-Use Therapeutic Food in Improving the Developmental Potential and Weight of Children Aged under Five with Severe Acute Malnourishment in Pakistan: A Pretest-Posttest Study

The objective of this study was to assess whether the standard therapy of ready-to-use therapeutic food in the treatment of uncomplicated severe acute malnutrition (SAM) is effective in improving developmental potential and weight gain in children aged under five years. A multicenter pretest-posttest study was conducted among 91 children aged under five with uncomplicated SAM in Pakistan. Study participants completed their eight weeks’ therapy of ready-to-use therapeutic food according to the World Health Organization’s (WHO) standard guidelines. The study outcome was the proportion of children with improved developmental potential in all domains in comparison with the pretreatment status and children gaining &gt;15% of their baseline weight; mean weight-for-height/length z-score after completing eight weeks’ therapy of ready-to-use therapeutic food. The Denver Development Screening Tool II was used for developmental screening. Significant changes (p &lt; 0.05) were observed for developmental status milestones in terms of gross motor, fine motor, and personal/social milestones, as well as language and global development milestones. There was a strong positive correlation (r = 0.961) between initial weight and weight at the last visit (p &lt; 0.001). Ready-to-use therapeutic food is effective in improving development potential as well as promoting weight gain in children aged under five with uncomplicated SAM if provided according to WHO guidelines