Pediatric Dentistry Training for Dentists in Pakistan

OBJECTIVE: In the last decade, a rapid growth has been observed in the number of dentists due to establishment of number of dental colleges in Karachi, Pakistan. There is an acute dearth of Pediatric Dentistry faculty in Pakistani dental institutions. Similarly, no post graduate Pediatric Dentistry fellowship program exists in the country. The objectives of this study are to map the pattern of pediatric dentistry services provided by the clinicians in teaching institutions and private practices of Karachi. METHODOLOGY: A cross sectional study conducted at dental departments of academic institutions and selected dental practices in different parts of Karachi. The sample comprised of 71 subjects in the teaching while 97 subjects in the non-teaching group. Stratified random sampling was carried out. Data were obtained using a structured, self administered questionnaire. Chi square test was used to asses, if pattern of services are different between dentists in the two groups. RESULTS: The response rate in teaching group was 94.67% (71 out of 75) while in the practitioners group it was 44.1% (97 out of 220). The groups were different regarding the use of topical fluoride, fissure sealants, and planning for primary teeth root canal treatment. CONCLUSIONS: There is a statistically significant difference in preferences, selection of dental materials and pattern of pediatric dentistry services provided by the teaching dentists as compared to the private dental practitioners. Both the teaching and non-teaching dentists need to update themselves in provision of Pediatric Dentistry services such as fluoride application and fissure sealant placement

The Need of Paediatric Dentistry Specialists in Pakistan

In the last decade, a rapid increase has been observed in the number of dentists due to establishment of a number of dental colleges in Pakistan. Very few of these institutions have Paediatric Dentistry Department. Similarly, no postgraduate Paediatric Dentistry training program exists in the two major provinces of the country. The objectives of this study were to map the pattern of paediatric dentistry services provided by the clinicians in teaching institutions and private practices. A cross-sectional study was conducted at dental departments of academic institutions and selected dental practices in Karachi. There was a statistically significant difference in preferences, selection of dental materials and pattern of paediatric dentistry services provided by the teaching dentists compared to the private practitioners. Both the teaching and non-teaching dentists need to update themselves in the provision of Paediatric Dentistry services such as fluoride application and fissure sealant placement

Peer pressure and family smoking habits influence smoking uptake in teenage boys attending school: multilevel modeling of survey data.

Introduction: Among young teens, about one in five smokes worldwide. Adolescents spend a considerable amount of their time in school, and the school environment is therefore important for child health practices and outcomes. Objectives: We aimed to investigate the impact on smoking behavior of the school environment and the personal characteristics of male teenage students attending schools in Pakistan, taking into account the survey sampling structure. Methods: A two-stage cluster sampling with stratification was employed, and we interviewed 772 male secondary school students. We adopted random effect and generalizing estimating equation models. Results: Peer pressure in particular had a strong influence on adolescents smoking; those whose friends smoked were up to 6 times more likely to smoke. Family smoking was also significantly associated with adolescents smoking, but those students whose mother was educated were 50% less likely to smoke. The fitted random effect model indicated that the between school variability was significant (p-value \u3c 0.01), indicating differences in smoking habits between schools. A random coefficient model showed that variability among schools was not significantly different for public and private schools. Conclusion: Public health campaigns for smoking cessation should target not only the individual but also the families of adolescents attending schools

Ventricular depolarisation vectors in exercise induced myocardial ischaemia

Ischaemia reduces membrane excitability and conduction of myocardial depolarisation. This would alter the synergy of electromotive forces that contribute to a resultant force at any instant. Changes in magnitude and direction of resultant forces are reflected in electrocardiographic signals. Here we show a method for obtaining the coordinates of resultant electrical forces during exercise derived from a bipolar orthogonal lead system for calculation of electrical vectors in three planes. In a trial, analysis of changes in vectors indicated that the extent of reduction in magnitude with exercise was significantly greater in groups of patients categorized by impaired effort tolerance and signs of ischaemia. Measurement of changes in the spectrum of depolarisation vectors during exercise has the potential for non-invasive assessment of myocardial ischaemia. This could be the basis of a portable, low-cost tool for investigation of patients with symptoms suggestive of coronary artery disease

Multilevel modeling of binary outcomes with three-level complex health survey data.

Complex survey designs often involve unequal selection probabilities of clus-ters or units within clusters. When estimating models for complex survey data, scaled weights are incorporated into the likelihood, producing a pseudo likeli-hood. In a 3-level weighted analysis for a binary outcome, we implemented two methods for scaling the sampling weights in the National Health Survey of Pa-kistan (NHSP). For NHSP with health care utilization as a binary outcome we found age, gender, household (HH) goods, urban/rural status, community de-velopment index, province and marital status as significant predictors of health care utilization (p-value \u3c 0.05). The variance of the random intercepts using scaling method 1 is estimated as 0.0961 (standard error 0.0339) for PSU level, and 0.2726 (standard error 0.0995) for household level respectively. Both esti-mates are significantly different from zero (p-value \u3c 0.05) and indicate consid-erable heterogeneity in health care utilization with respect to households and PSUs. The results of the NHSP data analysis showed that all three analyses, weighted (two scaling methods) and un-weighted, converged to almost identical results with few exceptions. This may have occurred because of the large num-ber of 3rd and 2nd level clusters and relatively small ICC. We performed a sim-ulation study to assess the effect of varying prevalence and intra-class correla-tion coefficients (ICCs) on bias of fixed effect parameters and variance components of a multilevel pseudo maximum likelihood (weighted) analysis. The simulation results showed that the performance of the scaled weighted estimators is satisfactory for both scaling methods. Incorporating simulation into the analysis of complex multilevel surveys allows the integrity of the results to be tested and is recommended as good practice

Impact of postpartum anxiety and depression on child’s mental development from two peri-urban communities of Karachi, Pakistan: a quasi-experimental study

Background Postpartum anxiety and depression has detrimental effects on the overall mental development of children. This study aims to assess the impact of postpartum anxiety and depression on children’s mental development on all sub-scales in a Pakistani population. Methods A quasi-experimental study was conducted in two peri-urban communities of Karachi, a mega city of Pakistan, to assess the impact of postpartum anxiety and depression on children’s growth and mental development. A total of 420 women were enrolled, who had given consent out of 651 pregnant women identified, during February 2004 to December 2005. Data for socio-demographic, home environment and family relationship variables were collected between 36 weeks of pregnancy and within 10 days of childbirth. Mother’s levels of anxiety and depression were assessed at 1, 2, 6, 12, 18, 24, and 30 months of childbirth. An indigenous, validated screening instrument- Aga Khan University Anxiety and Depression scale was used and diagnostic confirmation was done through a psychologist’s interview, based on DSM IV criteria. Children’s growth and development was monitored in the same sequence using an Early Childhood Development tool that consists of five subscales; socio emotional, language, cognitive, gross motor and fine motor development. Physical growth was monitored by measuring height and weight of the child. Data was analyzed using SAS 9.2. Multivariable Generalized Estimating Equations (GEE) logistic regression was conducted to identify association of postpartum anxiety and depression with each early childhood development indicator, adjusting for parental and child factors. Results A significant association of postpartum anxiety and depression with delayed development on all five subscales of children’s mental development was found in our study. Interestingly, our study found that higher maternal age had adverse effects on child’s emotional whereas positive impact on child’s cognitive development. Children’s stunting had an adverse impact on all five subscales of children’s development. Male children were at higher risk for delayed language and gross motor development relative to female children. Conclusions Our study found that postpartum anxiety and depression is associated with adverse outcomes regarding children’s mental development on all sub-scales. The impact was accentuated by low family income or child’s increasing age

A comparison of treatments offered to patients with nonalcoholic steatohepatitis

OBJECTIVE: To compare various treatment options provided to patients with Nonalcoholic Steatohepatitis (NASH) and assess improvement in liver status via reduction in serum Alanine Aminotransferase (ALT) levels. STUDY DESIGN: Retrospective cohort study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from April 2000 to April 2007. METHODOLOGY: All available records of patients aged between 20-70 years, fatty liver on ultrasound, elevated serum ALT and having at least one follow-up, after a baseline visit were included. The patients had variable number of follow-ups and a maximum of 3 follow-ups were considered. Information was collected on demographic and clinical characteristics of the subjects. The treatment options were categorized as weight reduction alone, with statins, and with other medications. Serum ALT level was the main outcome measured in IU/l. Repeated-measures ANOVA, using a mixed model approach was performed with treatment options as between subject factor, and follow-up as within subject factor and p-value \u3c 0.05 was considered significant. RESULTS: Sixty-nine records of subjects, consisting of 50 males and 19 females were selected. The mean (+/- SD) age was 40+/-12 years. Thirty-one subjects (45%) were advised weight reduction only, and experienced a 72% reduction in serum ALT levels, over the mean follow-up time of 9+/-3 months. Twelve subjects (17%) received statins along with weight reducing advice, and experienced a 56% reduction in mean ALT over the mean follow-up of 11+/-7 months. Twenty-six subjects (38%) received other medications along with advice for weight reduction and experienced a 73% reduction in serum ALT levels over the mean time of 10+/-4 months. The mean ALT declined at follow-up times, irrespective of the prescribed treatment, and that the decline with time was different for males and females. CONCLUSION: Serum ALT levels among patients with NASH decreased with time, regardless of the provided treatment, and the decrease was different for males and females

Frequency and determinants of vaginal infection in postpartum period: a cross sectional survey from low socioeconomic settlements, Karachi, Pakistan

Objective: To determine the frequency and factors associated with perceived vaginal infections among married women in their postpartum period. Methods: A cross-sectional study was conducted from July 2000 to October 2000 in five squatter settlements of Karachi, Pakistan. These squatter settlements were selected on the basis of an existing surveillance system run by female community health workers for maternal and child healthcare which identified women who had delivered 42-56 days prior to the date of interview. Vaginal infection was considered present when a mother perceived foul smelling vaginal discharge during the postpartum period. Mothers were interviewed to gain insight into socioeconomic and demographic variables, materials used to staunch lochia, duration of labour, personal and perineal hygiene and past obstetric history. Results: A total of 525 women were interviewed. The estimated prevalence of perceived vaginal infection was 5.1%. Factors associated with perceived vaginal infections included, delivery conducted by a non-medical personnel (AOR 3.5, CI 1.3-9.5) and use of unhygienic cloth or cotton for staunch of lochia (AOR 2.7, CI 1.1-6.2). Conclusion: Among women who reported perceived vaginal infection, a higher proportion were delivered by non-medical personnel, and used unhygienic material (cloth or cotton) for staunch of lochia as compared to women who did not perceive vaginal infection. We recommend deliveries to be conducted by trained personnel and provision of health education for persons who conduct delivery and women to use hygienic material for staunch of lochia during post partum period (JPMA 56:99;2006)

Changes in ventricular depolarisation vectors during exercise caused by regional myocardial ischaemia

Research at the Aga Khan University for several years has been directed to find a reliable, low-cost, portable, non-invasive method for identification of coronary artery disease, its location and extent. A new method has been devised to measure the magnitude and direction of cardiac electrical vectors in three perpendicular planes during physical exercise to identify reduction in myocardial excitability as the electrophysiological marker of hypoxia. This report shows that changes in electrical forces due to exercise-induced regional hypoxia serve as indicators of reversible myocardial ischaemia. Changes in the magnitude and direction of vectors at stages of the Bruce protocol were measured in healthy volunteers, and patients undergoing the same exercise protocol for distribution of a radioactive tracer injected intravenously at peak exercise and after recovery (myocardial perfusion scan). Alterations in the magnitude and direction of resultant vectors during exercise were scored to enable analysis. Analysis identified slow progression of myocardial depolarisation as the electrophysiological marker of regional hypoxia relative to physical work. Compared with myocardial perfusion scan the sensitivity and specificity of electrical vectors for identification of ischaemia were 88% and 71%, respectively. Accuracy of ischaemia shown by electrical vectors is being assessed in patients undergoing elective coronary angiography

Case-control study of suicide in Karachi, Pakistan

Background: In recent years suicide has become a major public health problem in Pakistan. Aims: To identify major risk factors associated with suicides in Karachi, Pakistan. Method: A matched case-control psychological autopsy study. interviews were conducted for 100 consecutive suicides, which were matched for age, gender and area of residence with 100 living controls. Results: Both univariate analysis and conditional logistic regression model results indicate that predictors of suicides in Pakistan are psychiatric disorders (especially depression), marital status (being married), unemployment, and negative and stressful life events. only a few individuals were receiving treatment at the time of suicide. None of the victims had been in contact with a health professional in the month before suicide. Conclusions: Suicide in Pakistan is strongly associated with depression, which is under-recognised and under-treated, The absence of an effective primary healthcare system in which mental health could be integrated poses unique challenges for suicide prevention in Pakistan