Facilitators and barriers in access to mental health services for women with depression in Karachi, Pakistan

BACKGROUND: Women in Pakistan experience a high prevalence of depression; yet make negligible use of mental health services. Information about the barriers and facilitators to mental health services for women is scarce. The present study explored the barriers and facilitators in accessing mental health services and potential strategies to increase the access for women in Karachi. METHODS: A qualitative study was conducted with the help of 78 interviews. Women from primary care were screened for depression and thirty in-depth interviews were conducted with those who were not accessing mental health services. Twenty-nine interviews were conducted with women accessing mental health services for depression at mental health clinics. Nineteen key informant interviews were conducted with various stakeholders. Interviews were transcribed verbatim and coded for thematic analysis. RESULTS: Themes elicited were categorized into family and household, health services, and socio-cultural levels. At family and household level, lack of awareness, normalization of depression, lack of empowerment, burden of looking after children and threats of divorce discouraged women from seeking professional care. Stigma, discouragement to seek mental health care and religious interpretations of depression were reported as broader socio-cultural issues, driving many to visit faith healers instead. Gaps in medical education, general practitioners’ case overload, and poor quality of health care, gender bias, poor resource allocation and dearth of referral systems were highlighted as barriers at health services level. For facilitators themes of awareness, concern for children, the severity of the symptoms, family support, receiving a referral, affordability and organizational support were identified as factors that enabled women to access services. Both women and key-informants suggested that providing community-based interventions could be a viable option to increase the access. CONCLUSION: Study findings suggest that providing mental health services in communities, and reforming medical education through the training of health workers can improve access to mental health services for women. An intervention is proposed to provide mental health services through community based lady health workers in Karachi. This may provide more accessible, and potentially cost effective, mental health services to better address the mental health needs of the population.2018-12-08T00:00:00

Optimum Average Silhouette Width Clustering Methods

Cluster analysis is the search for groups of alike instances in the data. The two major problems in cluster analysis are: how many clusters are present in the data? And how can the actual clustering solution be found? We have developed a unified approach to estimate number of clusters and clustering solution mutually. This work is about theory, methodology and algorithm developed of newly proposed approach. // Average silhouette width (ASW) is a well-known index for measuring the clustering quality and for the estimation of the number of clusters. The index is in wide use across disciplines as standard practice for these tasks. In this work the clustering methodolo- gies is proposed that can itself estimate number of clusters on the fly, as well as produce the clustering against this estimated number by optimizing the ASW index. The performance of the ASW index for these two tasks are meticulously investigated. // ASW based clustering functions are proposed for the two most popular clustering domains i.e., hierarchical and non-hierarchical. The performance comparison for clustering solutions obtained from the proposed methods with a range of clustering methods has been done for the quality evaluation. // The performance comparison for the estimation of the number of clusters of the proposed methods has been made using a wide spectrum of cluster estimation indices and methods. For this, large scale studies for the estimation of the number of clusters have been conducted with well-reputed clustering methods to find out each method’s estimation performance with different indices/methods for various kinds of clustering structures. // Developing mathematical and theoretical aspects for clustering is a relatively new and challenging avenue. Recently this research domain has received considerable attention due to the present need and importance of theory of clustering. The purpose behind the theory development for clustering is to make the general nature of clustering more understandable without assuming particular data generating structures and independently from any clustering algorithm/functions. Lastly, a considerable amount of attention has been drawn towards the theory development of the ASW index in the latter part of the thesis

Social-ecological resurgence through farmers’ traditional knowledge and agroecology in Pakistan

There is an urgent need to transform global food systems. Basic food supply chains have been disrupted due to the structural vulnerabilities within the dominant food system. Scholars, ecologists, smallholder farmers, economists and activists are increasingly advocating for agroecology as part of a path forward, emphasizing the importance of drawing on the latest agricultural research while harnessing farmers’ traditional knowledge to drive social-ecological resurgence. Farmers’ traditional knowledge is essential to agroecology and social-ecological systems. The basic understanding that humans are an integral part of the natural world, interwoven with the environment, rather than separate from it, is necessary for comprehending the complex relationships that rule our existence. This study focuses on Pakistan, an agricultural country, constantly influenced and pushed towards industrial agriculture. Industrial agriculture relies on high yielding variety seeds, synthetic fertilizers, and pesticides to boost food production. However, this approach has damaged the ability of farmers to depend on their local ecosystems for food. The research explores how traditional agroecological knowledge has been embraced as a form of social-ecological resurgence in Badin, Sindh, Pakistan. [...

Biofilm Forming Bacteria Isolated from Medical Implants

Background: Biofilm formation in indwelling medical devices poses serious risk of infection and increases the likelihood of  recurrence of infections. The study was carried out to identify the microbes which form biofilms on medical implants and are thus involved in nosocomial infections, to assess the potential of biofilm producing ability of these isolated microbes and to determine antibiotic resistance towards ampicillin, vancomycin ceftazidime, streptomycin and tetracycline.Methods: For this, 11 samples of 5 different implants were taken from Tertiary Care Hospital Multan, Pakistan. Bacteria were isolated and identified by culture plate method. Tryptone soy broth (TBS) media was used for biofilm development by microbes in plastic tubes. Developed biofilm in tubes was visualized with crystal violet staining method and then biofilm forming potential was estimated by measuring the optical density through spectrophotometer. Antibiotic susceptibility was done by Kirby Bauer disk diffusion method to determine the resistance and susceptibility pattern of biofilm producers.Results: Out of 11 different samples of indwelling medical devices, a total of 131 bacterial strains were isolated. The percentage of bacterial isolates which produced biofilms were Staphylococcus spp. (41%) followed by Escherichia coli (18%), Pseudomonas spp. (4%), Proteus spp. (7.2%), Klebsiella spp. (8.6%), Bacillus spp. (8.6%), Fusobacterium spp. (1.4%) Clostridium spp.(1.4%), Enterococcus spp. (7.2%) and Neisseria spp. (1.4%). Sixty-nine isolates were considered positive for biofilm formation while 58 were considered negative. The resistance was maximum against ampicillin (42%) followed by ceftazidime (17.1%), tetracycline (34%) and streptomycin (30%) while against vancomycin no resistance was observed.Conclusion: Biofilms produced on medical implants by different bacteria are considered to be the major cause of hospital acquired infections and are very difficult to eradicate. These biofilms associated implant infections are challenging to treat because of their resistance towards various antibiotic therapies. Therefore, some efficient methods of prevention of biofilm formation should be introduced.Keywords: Bacterial biofilms; Biofilm associated infections; Medical implants; Hospital acquired infections; Antibiotic resistance  

Diffusion-weighted magnetic resonance imaging may be useful in differentiating fungal abscess from malignant intracranial lesion: Case report

Background: Diffusion-weighted magnetic resonance has a well-defined role in differentiating between important intracranial lesions. Sometimes, the surgeon is faced with a dilemma of how to diagnose an infectious versus malignant lesion.Case Description: A 28-year-old male presented to the neurosurgery clinic with complaints of headache and left-sided weakness for 2 weeks. Neurological examination was intact. Magnetic resonance imaging (MRI) scan showed a large infiltrating heterogeneous mass involving the right parietal lobe. On further reviewing, there was homogenous diffusion restriction in the center of lesion. In addition, its aggressive behavior confirmed it to be a fungal abscess.Conclusions: Correctly identifying an infectious versus tumor etiology is important. Research has been carried out to employ diffusion-weighted imaging (DWI) in differentiating the variable radiological findings. The role of DWI in diagnosing bacterial abscess is more commonly seen in comparison to fungal abscess. DWI has a high diagnostic potential, but more works need to be done

A Qualitative Account of The Nature and Use of Self-Regulated Learning (SRL) Strategies Employed by University Students

Students\u27 conceptions of how they initiate, plan, implement and monitor self-regulated learning (SRL) strategies have practical implications for teaching and learning. This study explores the nature and use of SRL strategies employed by university students as it occurs in naturalistic settings, for example, studying in non-classroom environments. Framed within the social cognitive perspective, it focuses on a group of students from an under-researched population. Focus group interviews were used to elicit information about the nature of SRL strategies and contexts for their use. The findings reveal that students employ a range of SRL strategies, from shallow to cognitively rich and deep processing. Furthermore, the use of SRL strategies alters under different contextual influences such as personal goals, SRL phase specific conditions, semester and academic capabilities

Drought mitigation potential of Azospirillum inoculation in Canola (Brassica napus)

Azospirillum is considered to be a most effective Plant Growth Promoting Rhizobacteria (PGPR), which is responsible for various modifications in plants to cope with stress conditions. Therefore, the present research was planned to evaluate the effect of Azospirillum lipoferum (GQ 255949) inoculation on growth, biochemical, yield attributes of canola grown under drought conditions. Two different modes of inoculation were used; i.e., inoculation of seeds directly and exposure of planted seed in the rhizosphere. Drought stress was imposed at flowering stage. Azospirillum seed inoculation was helped mitigate stress effects by improving germination percentage up to 12.49%. Root area was increased up to 18.5% and 11.38% with seed and rhizosphere inoculation in drought stress respectively. Chlorophyll contents and water potential were increased 12.21%, and 11.0% in seeds inoculated under drought conditions. Superoxide dismutase activity was decrease up to 24.6% and 12.5% in seed and rhizosphere inoculated plants under well watered conditions. Seed inoculation was most effective, as number of seeds per pod and seed weight per plant was significantly increased up to 25%, and 14.28% as compared to the control. In conclusion, Azospirillum can mitigate deleterious effects of drought stress in canola under water deficiency conditions

Human papilloma virus infection: vaccine knowledge attitude, and informational behavior among undergraduate students

Background: The study aimed to know the Human Papilloma Virus infection, vaccine knowledge attitude, and informational behavior among university students. Methodology: The study was conducted on students of Government College University Faisalabad from January 2022 to March 2022. The study consisted of a questionnaire that verbalized the awareness and prevalence of HPV in particular age groups male and female students. The questionnaire was divided into four sections to assess the awareness, knowledge, and behavior of students toward the Human Papilloma Virus (HPV). Results: In the demographic representation about 85% (n=235 out of 275) of students belong to the age group of 18-22 while 14% (n=38 out of 275) students were from 23 to 24 years old. 23%(n=64) students were males while 76%(n=211) participants were females. Figures collected showed that 1%(n=3) participants were married while the remaining (about 98%) were single. According to the figures, about 70% of the partakers knew about the mode of transmission and the complications caused by the Human Papilloma Virus while 34% of all the students had no idea about HPV, its transmission, complications, or treatment. 65% had an idea that HPV causes genital warts and 75% were aware of the HPV vaccine. Moreover, 65% of students thought condoms as a source of prevention against HPV and 54% marked contact with body fluids as a mode of transmission of HPV. Conclusion: The knowledge and attitude towards HPV infection and HPV-related diseases and HPV vaccine among female students in the Government College University Faisalabad were significant. There is a need of well-defined education programs in the form of seminars, workshops and symposiums on the awareness of HPV infection are necessary to fill the knowledge gap among general population