Screening for diseases in family practice

The active check-over for disease among apparently healthy people is a fundamental aspect of prevention. This is perceivable by screening, which is a search of unrecognized disease or condition by means of rapidly applied test, examination or other procedures in apparently healthy individuals. This is carried out in the hope that earlier diagnosis and subsequent management favorably alters the natural history of the disease in a significant proportion of those who are identified as \u27test-positive\u27. Family Practitioners have privilege to provide comprehensive and holistic health care services including preventive, curative and rehabilitative on continuous and long-term basis to all members of family irrespective of their age, sex and nature of disease and condition. Screening of disease being an important preventive strategy should be offered by Family Practitioners to their clients when ever recommended and appropriate. However, before screening is initiated, a decision must be made whether it is worthwhile, which requires scientific, financial and ethical justification. This review summarizes the basic concepts and criteria regarding the screening for diseases

Involvement of Community in Health Systems Management: An Experience from Sindh, Province of Pakistan

Summary The community is the ultimate barometer of success or failure of an intervention. Involvement of community members in health care programmes, decision?making, evaluation and implementation is a major means for achieving the necessary fit between the programme and its beneficiaries. The World Bank?funded Family Health Project was launched in Sindh Province of Pakistan, in 1992. It aims to strengthen the existing health system and improve the health status of the population. To achieve sustainable results, FHP focused on engaging community participation. Village Health Committees were formed at Basic Health Unit and Rural Health Centre levels under an Area Focus Approach. Village Health Committee members were trained to understand the basic concept of FHP, be able to identify factors which affect the health of the community, and suggest local methods for combating these problems. The Village Health Committee's main objective was to ensure community participation, improve utilisation of outreach health services, improve accountability of the service providers through community involvement, and decentralisation of power at the community level. This article reflects on the experience of the FHP in implementing these objectives

Cost effectiveness of screening of all newly recruited employees for diabetes at a tertiary care hospital

Diabetes Mellitus is a disease which remains asymptomatic for long duration of time and usually diagnosed either when gets complicated or by routine or opportunistic screening. The practice of universal screening is not recommended, particularly in constraint resources . However, we embarked with a study to assess the yield of recommended screening for Type 2 diabetes in all the newly recruited employees at a tertiary care hospital in Karachi. Methods: All the information required for this study was collected from medical records of all newly recruited employees of nursing services department of a tertiary care hospital of Karachi, Pakistan, over a period of 5 months (August 2004 to December 2004). Out of 360 subjects , 326, whose information was found to be complete, were included for final analysis. Results: Mean age of the study subjects was 25.3 ± 4.7 years and their mean casual plasma glucose level was 99.1 ± 16.3 mg/dl. 315 (96.6%) study subjects had casual plasma glucose level of 139 mg/dl or less. Only 10 (3.1%) study subjects had casual plasma glucose levels between 140 to 199 mg/dl. Just one employee, 41 years old, was found to have casual plasma glucose level of 213 mg/dl. Conclusion: In this study, screening of all individuals for diabetes had a very low yield. Recommendation of universal screening for diabetes does not represent a good use of resources and perhaps not costeffective. However, periodic screening of high risk individuals should be warranted

Family physicians understanding about Mantoux test: A survey from a high endemic TB country

<p>Abstract</p> <p>Background</p> <p>Tuberculosis is a global health emergency and is a big challenge to diagnose and manage it. Family physicians being first contact health persons should be well competent to diagnose and manage the patients with tuberculosis.</p> <p>Aims</p> <p>This study was aimed to assess the level of understanding about Mantoux Test amongst Family Physicians in Karachi, Pakistan and to determine the difference of level of understanding by gender and number of tuberculosis patients seen in a month.</p> <p>Methods</p> <p>A cross sectional survey was conducted among 200 Family Physicians working in Karachi; the largest city and economic hub of Pakistan. Family Physicians who attended Continuous Medical Education sessions were approached after taking consent. Pre-tested, self administered questionnaire was filled consisting of: basic demographic characteristics, questions regarding knowledge about Mantoux Test, its application and interpretation. Data of 159 questionnaires was analyzed for percentages, as rest were incomplete. Chi square test was used to calculate the difference of understanding levels between various groups.</p> <p>Results</p> <p>Almost two thirds of respondents were males and above 35 years of age. Majority of Family Physicians were private practitioners and seeing more than five tuberculosis patients per month. Overall, a big gap was identified about the knowledge of Mantoux Test among study participants. Only 18.8% of Family Physicians secured Excellent (≥ 80% correct responses). This poor level of understanding was almost equally distributed in all comparative groups (Male = 20.8% versus Female = 15.9%; p - 0.69) and (Seen < 5 tuberculosis patients per month = 18.6% versus seen ≥ 5 tuberculosis patients per month = 19.3%; p - 0.32). A huge majority of Family Physicians (92%) however, showed keen interest in obtaining further knowledge regarding Mantoux Test and amongst them 72% suggested Continued Medical Education sessions as preferable mode of updating themselves.</p> <p>Conclusion</p> <p>Our study revealed an overall major deficit in understanding and interpretation of Mantoux Test amongst Family Physicians which needs to be addressed. Continues Medical Education sessions for Family Physicians should be organized in regular basis for upgrading their knowledge in this regards.</p

Gender differences and clustering pattern of behavioural risk factors for chronic non-communicable diseases: community-based study from a developing country.

Objectives: This study estimates the burden of behavioural risk factors for chronic non-communicable diseases (CNDs) to evaluate the degree of clustering and the differential of these factors by gender in adults. Methods: In a community-based survey, information was obtained about behavioural risk factors for CNDs among 534 adults in Karachi, Pakistan. Chi-square test and odds ratio (OR) with 95% confidence interval (CI) were calculated to evaluate the differences of these factors by gender. Results: Overall, 22.5% of adults had anxiety/depression, 47.8% did not have adequate intake of fruits and vegetables, 60.1% were physically inactive while 49.8% were overweight/obese. More women had anxiety/ depression (OR = 2.1, 95% CI = 1.4-3.1), were physically inactive (OR=2.1, 95% CI = 1.5-3.1) and overweight/ obese (OR= 6.2, 95% CI = 4.3-9.1). On the contrary, greater number of men were found to have inadequate fruit and vegetable consumption (OR = 1.8, 95% CI = 1.3-2.5). Only 1.1% of study subjects had none of the studied risk factors, 16.9% had one while 82% had \u3e or =2 factors. The clustering of these risk factors was significantly higher in women (

Are Unhygienic Practices During the Menstrual, Partum and Postpartum Periods Risk Factors for Secondary Infertility?

This study was aimed at identifying practices during the menstrual, partum and postpartum periods posing possible risk factors contributing towards secondary infertility in women of a selected population in Karachi, Pakistan. A matched case-control study was conducted from April 2003 to March 2004. Four hundred cases were selected from five infertility clinics affiliated with tertiary-care hospitals, and 400 age-matched controls were recruited from the neighbourhood of each case. After taking written consents, trained interviewers conducted interviews using a pretested structured questionnaire. Factors found to be independently associated with secondary infertility were: previous delivery at an unclean place (adjusted odds ratio [AOR]=1.7, 95% confidence interval [CI] 1.1-2.6), delivery by a birth attendant without washing hands with soap (AOR=4.2, 95% CI 2.36-7.47), use of unclean material for absorption of lochia (AOR=3.1, 95% CI 1.5-6.5), non-washing of perineal area after urination/defaecation (AOR=7.1, 95% CI 1.4-35.7), and insertion of home-made vaginal medications (AOR=2.5, 95% CI 1.3-4.7). Since these factors are preventable/modifiable to a great extent, public-health interventions are, thus, recommended to address these risk factors at various levels

The accuracy of ultrasound in the diagnosis of congenital abnormalities

Objective: To determine the accuracy of ultrasound in the diagnosis of congenital abnormalities at the Aga Khan University Hospital, Karachi.Methods: The data of congenital abnormalities was obtained from the obstetrical database and medical records of all cases complicated by congenital abnormalities, delivering from January 2001 to December 2003 and was reviewed. Antenatal ultrasounds had been performed by operators with different level of experience. In addition this data was retrieved from the termination and Congenital anomaly register. A structured data collection form was used to collect information of different variables of interest.Results: Congenital abnormalities, complicated 2.8% (n=170), of all deliveries, including all cases of termination of pregnancy, stillbirth and live births. Out of the total, 11.6% occurred in women above the age of 35 years. Consanguinity was found in 18.2% cases. Prenatal diagnosis was made in just under half of the cases (48.8%). Central nervous system and renal abnormalities were commonly diagnosed. However, facial defects, heart defects or skeletal defects were more commonly missed.Conclusion: Antenatal ultrasound successfully diagnosed foetal abnormalities in 48.8% of cases, and more than 90% Central Nervous system defects and renal abnormalities. In contrast about a quarter of Cardiac defects and none of the facial defects were detected. Based on these findings we recommend that the Sonologist should incorporate four chamber view of the heart and also look at the face carefully

Acetaminophen induced Steven Johnson syndrome-toxic epidermal necrolysis overlap

Steven Johnson Syndrome and Toxic Epidermal Necrolysis are rare but severe form of hypersensitivity inflammatory reactions to multiple offending agents including drugs. Acetaminophen is extensively used due to its analgesic and anti-pyretic properties. It is rendered to be relatively safe, with hepatotoxicity considered to be the major adverse effect. However, very few cases of Steven Johnson Syndrome and Toxic Epidermal Necrolysis have been reported with acetaminophen usage in the past. We present the case of a 40 years old lady who developed an overlap of the two condition after taking several doses of acetaminophen for fever. She presented with widespread maculopapular rash, stinging in the eyes, oral mucosal ulcerations and high grade fever. She was successfully treated with corticosteroid therapy along with the supportive treatment. This case addresses the fact, that severe hypersensitivity reactions can occur with acetaminophen which can be potentially life threatening

Domestic violence among Pakistani women: an insight into literature

The objectives of this search were to estimate the burden of domestic violence, its contributing factors and strategies based on literature review for the prevention and control of domestic violence. Published literature about domestic violence in Pakistan during the years 1998 to 2008 was analyzed and scrutinized. This article is based on the searched result of 200 articles published in the English language from which finally 13 articles were selected. Search terms included “Violence”, “Domestic violence”, “Domestic violence in Pakistan” and “Strategies and Recommendations for Prevention of Domestic violence”. According to these studies, the intimate partners\u27 violence is reported as in the range of 30% to 79%. In Pakistan, there are some notable factors which make women prone to domestic violence like women\u27s low education, low empowerment, existing misconceptions about Islamic thoughts and traditional norms, misuse of women in the name of honor justifying honor killing, poverty and existence of unjust traditional dowry system in the society. The most common points made by researchers for prevention and control are 1) the need to recognize the domestic violence against women as an important issue 2) enhancement of educational and health facilities for the prevention and control of violence with combined awareness programs by governmental or nongovernmental organizations and 3) enactment and promulgation of comprehensive laws to combat this problem. Our work reveals that a significantly large proportion of women suffer with domestic violence and the factors identified are preventable and modifiable to a greater extent. Further research is also needed in this regar

Self-examination for breast and testicular cancers: a community-based intervention study.

The prevalence of cancers is growing rapidly in all parts of the word and Pakistan is no exception. Prevention is the best option to tackle this rising epidemic and screening, early detection and health awareness programs are cornerstones in this regard. A community-based interventional study was therefore her conducted to assess the effect of health education intervention about knowledge and practice of self-breast examination (SBE) among women and self-testicular examination (STE) among men. A total of 127 (70 females and 57 males) adults (\u3eor=18 years) from an urban community of Karachi, Pakistan were included after giving informed consent. Interventions were in the local language (Urdu) and included educational and awareness sessions by symposia, lectures and hand-on practice demonstrations about SBE and STE. Informative leaflets and brochure were also employed. Pre-intervention assessment revealed that 57% women had knowledge of SBE and 4% men knew about STE and this proportion increased significantly (