Frequency and Risk Factors of Depression among Medical Students: A Cross-Sectional Study in Karachi

OBJECTIVES The study aimed to determine the frequency of depression among medical students and to identify the different risk factors associated with depression. METHODOLOGY A cross-sectional study was conducted among medical students at a private medical college in Karachi. The study was initiated after approval was taken from the ethical committee. Consent was taken before the data collection after explaining the details of the study. Students were selected for this study as per inclusion criteria. They were provided with the PHQ-9 questionnaire in which they were inquired about the factors for depression. The total students with depression positive were presented by their frequencies with a 95% confidence interval. RESULTSThree hundred seventy medical students participated, and 207 (56%) tested positive for depression. Notably, depression was more prevalent among final-year students, with 80% affected. Additionally, the severity of depression gradually increased with advancing medical years, reaching the highest level in the final year, where 61 students (80%) reported significant depression. The most frequent causes of depression were living away from home and facing the challenges of a demanding curriculum. CONCLUSION The study findings revealed a higher likelihood of depression among medical students, particularly in their final year. This vulnerability was exacerbated by the stress associated with extensive coursework and peer pressure to achieve excellent exam grades

The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain

Chronic postsurgical pain (CPSP), an often unanticipated result of necessary and even life-saving procedures, develops in 5–10% of patients one-year after major surgery. Substantial advances have been made in identifying patients at elevated risk of developing CPSP based on perioperative pain, opioid use, and negative affect, including depression, anxiety, pain catastrophizing, and posttraumatic stress disorder-like symptoms. The Transitional Pain Service (TPS) at Toronto General Hospital (TGH) is the first to comprehensively address the problem of CPSP at three stages: 1) preoperatively, 2) postoperatively in hospital, and 3) postoperatively in an outpatient setting for up to 6 months after surgery. Patients at high risk for CPSP are identified early and offered coordinated and comprehensive care by the multidisciplinary team consisting of pain physicians, advanced practice nurses, psychologists, and physiotherapists. Access to expert intervention through the Transitional Pain Service bypasses typically long wait times for surgical patients to be referred and seen in chronic pain clinics. This affords the opportunity to impact patients’ pain trajectories, preventing the transition from acute to chronic pain, and reducing suffering, disability, and health care costs. In this report, we describe the workings of the Transitional Pain Service at Toronto General Hospital, including the clinical algorithm used to identify patients, and clinical services offered to patients as they transition through the stages of surgical recovery. We describe the role of the psychological treatment, which draws on innovations in Acceptance and Commitment Therapy that allow for brief and effective behavioral interventions to be applied transdiagnostically and preventatively. Finally, we describe our vision for future growth.Joel Katz is supported by Canadian Institutes of Health Research Canada Research Chair in Health Psychology at York University. Hance Clarke is supported by a Merit Award from the Department of Anesthesia, University of Toronto and received funding from the Ontario Ministry of Health and Long Term Care, Medically Complex Patients Demonstration Project Program for a project entitled “The Transitional Pain Service Demonstration Project”

Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme

Abstract Background In 2006, 4 years of planning was started by the Ministry of Health, Malaysia (MOH), to implement the HPV (human papillomavirus) vaccination programme. An inter-agency and multi-sectoral collaborations were developed for Malaysia’s HPV school-based immunisation programme. It was approved for nationwide school base implementation for 13-year-old girls or first year secondary students in 2010. This paper examines how the various strategies used in the implementation over the last 7 years (2010–2016) that unique to Malaysia were successful in achieving optimal coverage of the target population. Methods Free vaccination was offered to school girls in secondary school (year seven) in Malaysia, which is usually at the age of 13 in the index year. All recipients of the HPV vaccine were identified through school enrolments obtained from education departments from each district in Malaysia. A total of 242,638 girls aged between 12 to 13 years studying in year seven were approached during the launch of the program in 2010. Approximately 230,000 girls in secondary schools were offered HPV vaccine per year by 646 school health teams throughout the country from 2010 to 2016. Results Parental consent for their daughters to receive HPV vaccination at school was very high at 96–98% per year of the programme. Of those who provided consent, over 99% received the first dose each year and 98–99% completed the course per year. Estimated population coverage for the full vaccine course, considering also those not in school, is estimated at 83 to 91% per year. Rates of adverse events reports following HPV vaccination were low at around 2 per 100,000 and the majority was injection site reactions. Conclusion A multisectoral and integrated collaborative structure and process ensured that the Malaysia school-based HPV immunisation programme was successful and sustained through the programme design, planning, implementation and monitoring and evaluation. This is a critical factor contributing to the success and sustainability of the school-based HPV immunisation programme with very high coverage

The composition of demand for newly launched vaccines: results from the pneumococcal and rotavirus vaccine introductions in Ethiopia and Malawi

U radu je obrađen i analiziran sustav za metalizaciju varistora. Obrađen je kompletan proces od stavljanja samog varistora u „TCP kalup“ do same metalizacije i sušenja komada također kao i automatizacija cijelog procesa. Tijekom prakse promatran je rad stroja i njegove funkcije i crtan je nosač kalupa (TCP) u solidworks-u koji se stavlja u stroj. Obrađen je samo dio cijele proizvodnje i postupka metalizacije točnije obrađen je dio metalizacije (vakumsko uranjanje) srebrom. Tijekom prakse promatran je rad stroja i njegove funkcije. Promatranjem je utvrđeno kako se sam proces izvodi i radi te koliko je automatizacija olakšala rad čovjeku. Zbog ograničenja i privatnosti tvrtke Selk d.d., postavljene su fotografije i određeni dijelovi posla koji su bili odobreni od strane mentora.The paper deals with the analysis of the varistor metallization system. The entire process was processed, from the insertion of the varistor itself into the "TCP mold" to the metallization and drying of the piece itself, as well as the automation of the whole process. During the practice, the operation of the machine and its function was observed and a mold carrier (TCP) was drawn in solidworks to be inserted into the machine. Only a part of the entire production and process of metallization were processed, more precisely the part of metallization (vacuum immersion) with silver was processed. During the practice, the operation of the machine and its function were observed. Observation determined how the process itself works and works and how much automation has made it easier for humans to work. Due to the limitations and privacy of Selk d.d., photographs were also posted of certain pieces of work that were approved by the mentor