Mapping exercise of mental health research and researchers in Pakistan

OBJECTIVE: To systematically identify mental health research and researchers in Pakistan. Subsidiary objectives were to identify methodologies of studies published in the indexed journals along with their country wide mean impact factor. METHODS: A systematic search strategy using key words related to neuropsychiatry was carried out to identify various studies published in Indexed and Non-indexed databases. RESULTS: We identified 108 studies from Indexed data bases (77.8% Medline; 22.2% PsychInfo). Beside these, 51 studies were also identified from non-indexed databases. Among the indexed articles, 97 (89.8%) were Journal articles while 10 were other type of documents--there were 3 clinical trials of which only one was a randomized controlled trial. The mean Impact Factor (IF) of these studies was 2.75 (Range; 2.21-3.29). The median IF was 2.90. The most preferred journal for publication was the Journal of Pakistan Medical Association (JPMA; N = 33) followed by British Journal of Psychiatry (B J Psych; N = 11) and Journal of College of Physicians and Surgeons, Pakistan (JCPSP; N = 9). From the indexed and non-indexed publications we identified 43 researchers. Among these 34 (80%) were psychiatrists. CONCLUSION: The key finding of this mental health research mapping exercise is that mental health research output from Pakistan is low both in numbers and quality, with very few studies making it to high impact international journals. There is an urgent need to strengthen research capacity in areas of mental health at individual, organizational and macro-system levels

Male gender preference, female gender disadvantage as risk factors for psychological morbidity in Pakistani women of childbearing age - a life course perspective

Background: In Pakistan, preference for boys over girls is deeply culturally embedded. From birth, many women experience gendered disadvantages, less access to scarce resources, poorer health care, higher child mortality, limited education, less employment outside of the home and circumscribed autonomy. The prevalence of psychological morbidity is exceptionally high among women. We hypothesise that, among women of childbearing age, gender disadvantage is an independent risk factor for psychological morbidity. Methods: A cross-sectional catchment area survey of 525 women aged 18 to 35 years living in Islamabad and Rawalpindi. The effect of gender disadvantage was assessed as a latent variable using structural equation modelling. Indicators were parental gender preference, low parental care, parental overprotection, limited education, early age at marriage, marital dissatisfaction and low autonomy. Psychological morbidity was assessed using the 20 item Self Reporting Questionnaire (SRQ). Results: Gender disadvantage was independently predictive of psychological morbidity. Among married women, socio-economic status did not predict psychological morbidity, and the effect of education was mediated through gender disadvantage rather than socioeconomic status (SES). The women\u27s own preference for a male child was strongly predicted by their perceptions of having been disadvantaged by their gender in their families of origin. Conclusions: The high prevalence of psychological morbidity among women in Pakistan is concerning given recently reported strong associations with low birth weight and infant stunting. Social action, public policies and legislation are indicated to reduce culturally embedded preferences. Neglect of these fundamentals will entrench consequent inequities including gender bias in access to education, a key millennium development goal

Diagnosis of pulmonary embolism with helical CT scan

Objective: To determine the role of helical C.T. scan in the diagnosis of pulmonary embolism.SETTING: Radiology department, Aga Khan University Hospital. One year prospective study May 2001 to May 2002.Methods: Sixty patients suspected of having pulmonary embolism were included in this study. Helical C.T. scan chest was performed from aortic arch to lung bases with intravenous contrast medium. Images were acquired in mediastinal and lung windows. Image interpretation was performed on the console and hard copies for main branch and segmental thrombus.Results: Fifteen patients were diagnosed of having pulmonary embolism on C.T. scan. Clinical correlation and follow up with pulmonary angiography and Doppler ultrasound of leg was carried out. Pulmonary angiography was performed in one patient with embolectomy done after confirmation of diagnosis. 8 patients had associated DVT confirmed on Doppler sonography. Sensitivity of helical C.T. is 93.75%, specificity 100% and positive predictive value 95.65%.CONCLUSION: Helical CT scan is a quick, easy and accurate imaging modality for diagnosing pulmonary embolism

Diagnosis of Faulty Sensors in Antenna Array using Hybrid Differential Evolution based Compressed Sensing Technique

In this work, differential evolution based compressive sensing technique for detection of faulty sensors in linear arrays has been presented. This algorithm starts from taking the linear measurements of the power pattern generated by the array under test. The difference between the collected compressive measurements and measured healthy array field pattern is minimized using a hybrid differential evolution (DE). In the proposed method, the slow convergence of DE based compressed sensing technique is accelerated with the help of parallel coordinate decent algorithm (PCD). The combination of DE with PCD makes the  minimization faster and precise. Simulation results validate the performance to detect faulty sensors from a small number of measurements

Integration of mental health into primary healthcare: Perceptions of stakeholders in Pakistan

Background: In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC).Objectives: This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan.Methods: A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out.Results: Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services.Conclusions: The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan

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