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Research is the most unwanted, and orphaned part of every discipline in Pakistan. Pakistan Medical & Dental Commission, Higher Education Commission (HEC) or numerous medical universities in the country have been responsible for promoting research, but their responsibilities are finished after counting the number of published papers by any candidate for promotion. HEC has developed a software - called HJRS, but you visit this site and find a jumbled-up data which is four years old. Out of 58 listed Pakistani medical journals only 4 are in 'W' category. Many of the journals have been derecognized, but listed. Research related software like plagiarism check, reference actuality check, reference accuracy check, language etc. are hard to find by the average researcher. 'Anaesthesia, Pain & Intensive Care' was started in 1997, with the objective to foster the culture of research in the members of the neglected specialty of anesthesia, and the journal engaged renowned research fellows to write on the research related topics and published. This invited editorial sheds some light on the barriers to research and the suggested measures to promote research in Pakistan. [ABSTRACT FROM AUTHOR]

Background: Infertility is a major reproductive health problem in Pakistan. It has the potential to cause serious negative impact on a couple's marital life and psychological health. Aim: This study aimed to assess the factors associated with maladjustment among infertile couples. Method: An analytical cross‐sectional design was employed. Validated scales were used to assess marital adjustment, depression, resilience and quality of life among infertile couples. Purposive sampling was employed to enrol 334 infertile couples from a private infertility medical centre, of Karachi, Pakistan. Results: Among couples, marital adjustment scores were comparable, but resilience and quality of life were significantly low among wives whereas depression was significantly high among wives compared with husbands. Wives' marital adjustment was positively correlated with husband's resilience and quality of life and negatively related with his depression. After employing adjusted actor–partner interdependence modelling, wives' own depression and resilience had significant effect on their marital adjustment and their partner's resilience, depression and quality of life did not have any impact on their outcome. On the contrary, wives' resilience had a significant effect in increasing the marital adjustment of their husband. Conclusion: This study highlights the need to promote psychological support (resilience building skills) or couples' therapy to all those couples undergoing infertility treatment. Summary statement: What is already known about this topic? Infertility has an unequal impact on women and men. Women tend to have marital distress and more negative psychological impact than men.Infertility is ignominy for families of the infertile couple. Constant pressure from families to conceive increases psychological distress in the infertile couple.Infertility is a public health issue that impacts both couples therefore, a dyadic solution must be considered. What this paper adds? This is the first study to look at infertile couples' marital maladjustment, depression, resilience and quality of life, as well as their impact on other partners.According to the findings, depression was found to be significantly higher in wives than in their husbands, while resilience and quality of life were significantly lower in wives compared with their husbands. Depression and resilience had a significant actor effect on the wife's marital adjustment, whereas the husband's depression, quality of life and resilience had no discernible effect. Wives' resilience, on the other hand, has a significant impact on husbands' marital adjustment. The implications of this paper: Every infertile couple should be assessed for the risk of mental illnesses along with positive psychological contrast like resilience; mental health support should be available for couples.Couples should be given training module on resilience building skills in order to improve their mental health and positive healthy coping.Basic couple counselling should be introduced and implemented in all medical and nursing institutes, and medical and nursing students should be trained to provide infertile couples with basic counselling sessions. [ABSTRACT FROM AUTHOR]

Objective To describe a systematic process of transforming paper registers into a digital system optimized to enhance service provision and fulfil reporting requirements. Methods We designed a formative study around primary health workers providing reproductive, maternal, newborn and child health services in three countries in Bangladesh, Indonesia and Pakistan. The study ran from November 2014 to June 2018. We developed a prototype digital application after conducting a needs assessment of health workers' responsibilities, workflows, routine data requirements and service delivery needs. Methods included desk reviews, focus group discussions, in-depth interviews; data mapping of paper registers; observations of health workers; co-design workshops with health workers; and usability testing. Finally, we conducted an observational feasibility assessment to monitor uptake of the application. Findings Researchers reviewed a total of 17 paper registers across the sites, which we transformed into seven modules within a digital application running on mobile devices. Modules corresponded to the services provided, including household enumeration, antenatal care, family planning, immunization, nutrition and child health. A total of 65 health workers used the modules during the feasibility assessment, and average weekly form submissions ranged from 8 to 234, depending on the health worker and their responsibilities. We also observed variability in the use of modules, requiring consistent monitoring support for health workers. Conclusion Lessons learnt from this study shaped key global initiatives and resulted in a software global good. The deployment of digital systems requires well-designed applications, change management and strengthening human resources to realize and sustain health system gains. [ABSTRACT FROM AUTHOR]

The article discusses the process of scientific paper writing among physicians in Pakistan. It mentions the importance of patience, practice, and time in writing scientific papers. It offers some tips on how to write scientific papers. It outlines the advantages, and disadvantages of writing scientific papers.

Introduction: British South Asians have a higher prevalence of overweight and obesity than the wider population. Bradford (UK), with its high Pakistani presence and levels of economic deprivation, has exceptionally high instances, especially in deprived areas where many Pakistanis reside. British Pakistani women in Bradford are more likely to be overweight and obese. There is uncertainty on how these women can be aided to manage their weight. Therefore, the objective of this study was to explore the obesity concerns of Pakistani women living in deprived inner‐city areas of Bradford. Methods: Three focus groups interviews were carried out with 23 Pakistani women living in deprived areas of Bradford. Data were analysed thematically. Results: This exploratory study identified a wide range of concerns that women had around managing their weight. Participants disclosed distrust in information given around medication, conflicting dietary information and reported low levels of trust in women‐only organized physical activities. Cultural barriers were identified, which included the gender role of the woman, the lack of culturally appropriate dietary advice, cultural misunderstandings of what constitutes a healthy diet and healthy weight, the lack of culturally suitable exercise facilities and conforming to family and community expectations. Other concerns were language barriers around a lack of understanding, the inability to read Urdu and reliance on others to translate information. Conclusion: These findings have implications for researchers, local authorities, policy makers and others with an interest in reducing the rates of obesity in this population. Recommendations include training health practitioners to be culturally aware of the diet and eating practices of this community, exploring different ways to support socially isolated women to be more physically active at home, addressing physical activity and diet misconceptions and designing obesity management information materials appropriate for a range of literacy levels. Patient or Public Contribution: Public contributors were involved in the development of the interview guide and design of the research. A pilot focus group with participants not included in the present paper was used to help test and refine the focus group questions. Interview transcripts were member checked by participants, and participants assisted with data analysis. [ABSTRACT FROM AUTHOR]

The prime purpose of this study is to find out the research productivity of three regions Nigeria, Pakistan, and India. The bibliometric quantification was used to analyze the data. The present research identifies the importance of this online journal. The study discloses frequency of publication growth, author's collaborations, papers length, and most cited papers, most productive authors, and total references used. Design/methodology/approach The survey method was used to find out the full-text research articles on the online database of LPP. The Google scholar was used to retrieve the citations. All the collected data has been analyzed using MS excel and other electronic devices. Findings The results of this study indicate that in the year 2008 to 2013. The contribution of Nigerian authors is more than the other two nations that are 226 while Indian comes 2nd with 193 research papers and Pakistan comes 3rd with 67 research articles from the studied period in the wellknown journal of Library and information science field that is LPP. The present study revealed the majority of the research articles were single authors from Nigeria 114, Pakistan 18, and India 80. The study results show that the majority of the paper length in the range of 6-10 Nigerian 116, Pakistan 34, and India 70 respectively. The study showed the total references were calculated 4140 from Nigeria, 1506 Pakistan, and 3243 from Indian. The most cited paper was retrieved by a Nigerian paper that is 197 citations. The analyzed data shows the most productive authors were Rubina Bhatti from Pakistan with 18 research papers. This study contributes to the existing literature of three-nation contributions to the Library Philosophy and practice throughout the year. This is the first study of three-nation research productivity in the well-known online journal library philosophy and practice. Limitations of the study The present study was limited to the well-known LIS Journal and research articles specifically published at online journal library philosophy and practice. This study is purely limited to the research productivity of Nigerian, Pakistani, and Indian authors to the Library Philosophy and Practice from 2008 to 2013. Practical implications Despite its limitations, the findings of the study will help the LIS professionals of three nations and as well as other parts of the LIS professionals to provide more information about their research productivity of a particular journal. [ABSTRACT FROM AUTHOR]

This research study aims to find out the research productivity of Nigerian authors and Pakistani authors to the library philosophy and practice from 2008 to 2013. The present research finds the 226 research articles have been contributed by Nigerian authors and 67 papers have been contributed by Pakistani authors. The highest number of papers has been written by Nigerian authors was 76 in 2010 and from Pakistan 18 papers were contributed in 2013. This present study identifies those 114 single authors from Nigeria and 18 from Pakistan. 116 papers form Nigerian author those range 6-10 pages while 18 from Pakistan. The total numbers of references were used by Nigerian authors those were 4140 while Pakistan was used 1506 references from 2008 to 2013. The most productive authors Rubina Bhatti from Pakistan who wrote 18 papers and Dike Agah from Nigeria has contributed only 5 papers. The most cited papers were retrieved from Nigerian author with 197 citations while 91 citations were received from Pakistan were top-cited research papers. [ABSTRACT FROM AUTHOR]

Introduction: Smokeless tobacco (ST) is a significant South Asian public health problem. This paper reports a qualitative study of a sample of South Asian ST users.Methods: Interviews, using a piloted topic guide, with 33 consenting, urban dwelling adult ST users explored their ST initiation, continued use, and cessation attempts. Framework data analysis was used to analyze country specific data before a thematic cross-country synthesis was completed.Results: Participants reported long-term ST use and high dependency. All reported strong cessation motivation and multiple failed attempts because of ease of purchasing ST, tobacco dependency, and lack of institutional support.Conclusions: Interventions to support cessation attempts among consumers of South Asian ST products should address the multiple challenges of developing an integrated ST policy, including cessation services.Implications: This study provides detailed understanding of the barriers and drivers to ST initiation, use, and cessation for users in Bangladesh, India, and Pakistan. It is the first study to directly compare these three countries. The insight was then used to adapt an existing behavioral support intervention for ST cessation for testing in these countries. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus infection is the most commonly reported bloodborne infection in Pakistan. Frequent blood transfusions in β-thalassemia patients expose them to a high risk of HCV infection. The purpose of this paper is to summarise the current data on the prevalence of HCV infection in β-thalassemia patients in Pakistan by using a systematic review and meta-analysis.Methods: PubMed, EMBASE, Web of Sciences, the Cochrane Library, Directory of Open Access Journal and local databases were systematically searched for studies published between January 1st, 1995 and May 31st, 2019. Meta-analysis was performed using the DerSimonian and Laird random-effects models with inverse variance weighting. The presence of publication bias was tested by Egger test, and the methodological quality of each included article was evaluated by the STROBE.Results: We identified a total of 229 potential studies, of which 27 studies were finally considered in the meta-analysis. The pooled prevalence of HCV in β-thalassemia patients in Pakistan was 36.21% (95% CI: 28.98-43.75%) based on 5789 β-thalassemia patients, but there was considerable heterogeneity. Meta-analysis estimated the HCV prevalence among the β-thalassemia patients at 45.98% (95% CI: 38.15-53.90%) in Punjab, 31.81% (95% CI: 20.27-44.59%) in Sindh, and 28.04% (95% CI: 13.58-45.26%) in Khyber Pakhtunkhwa. Meta-regression analysis showed that geographical location was a key source of heterogeneity.Conclusions: The pooled prevalence of HCV in β-thalassemia patients in Pakistan was more than one in three, and higher than in neighbouring countries. It varies regionally within the country. With the use of standard prevention procedures during blood transfusion, the risk of HCV transmission in β-thalassemia patients could be controlled and the prevalence of HCV in β-thalassemia patients reduced. [ABSTRACT FROM AUTHOR]

Introduction: Despite the growing attention to the relationship between menstruation and girls schooling, there remain many challenges to addressing the issue. Current interventions, which mostly focus on developing WASH infrastructure and sanitary hygiene management products, while necessary, may not be sufficient. This paper aimed to identify the root causes of poorly maintained WASH infrastructure, and understand the deeply embedded socio-cultural values around menstrual hygiene management that need to be addressed in order to provide truly supportive school environments for menstruating girls.Methods: Qualitative data were collected in rural and urban sites in three provinces in Pakistan using participatory activities with 312 girls aged 16-19 years, observations of 7 School WASH facilities, 42 key informant interviews and a document review.Results: Three key themes emerged from our data: (1) a poorly maintained, girls-unfriendly School WASH infrastructure was a result of gender-insensitive design, a cultural devaluation of toilet cleaners and inadequate governing practices; (2) the design of WASH facilities did not align with traditionally-determined modes of disposal of rag-pads, the most common used absorbents; (3) traditional menstrual management practices situate girls in an 'alternate space' characterised by withdrawal from many daily routines. These three socio-culturally determined practices interacted in a complex manner, often leading to interrupted class engagement and attendance.Conclusions: To be truly effective, current menstrual hygiene management strategies need to address the root causes of poor WASH infrastructure and ensure facility design is sensitive to the gendered and deeply embedded local socio-cultural values and beliefs around menstrual hygiene management. [ABSTRACT FROM AUTHOR]

Books are considered as one of the chief sources of human development. It civilizes society, inculcates intellectual openness, mediates morality, and supports grounded learning; at the same time communicates information and holds up our ideas. According to Suarez-Orozco and Qin- Hilliard, with the discourse of cumulative transitions, globalization has bridged the dissemination of knowledge.1 Research at higher education level has now become a diffused principle criterion for success with greater emphasis on digital resources.2 In this regard, digital libraries are contributing to its best. The present study was undertaken to find the involvement of digital libraries in reconciling global knowledge and their stand to promote research culture in Pakistan with special reference to the existing opportunities and challenges. The overall strategy for this study is based on mix-method research. The population for the study consists of all the faculty members of public and private universities in Sindh having access to digital library. Total sample of 40 faculty members were chosen through random sampling. Questionnaire was filled by all the participants. Focused group interview was additionally conducted with 20 respondents. Findings divulged that the concept of digital libraries is enhancing the research capacity across the globe, particularly in Pakistan. Majority of the respondents are familiarized with the concept of digital library and believe that it has promoted the culture of research. Majority have accessed digital resources for research. The most common digital resource use by respondents is research paper. With regard to quality researches, the major challenges which emerge include lack of access to digital resources, plagiarism, lack of technical expertise and digital preservation. Suggestions are incorporated at the end of the paper. [ABSTRACT FROM AUTHOR]

Pakistan is the sixth most populous country in the world, with a population of over 180 million people. It is reported in the 1998 census the sex ratio (male per 100 female) is 108.5 and the literacy ratio (education of above 10 years) is 43.92%. Population under 15 years is 43.4% and between 15 and 65 years is 53.09%. Keeping in view the current reforms and vision of 'one nation - one vision' there is growing interest in developing programs to make Pakistan listed in top 25 economies by 2025. The social barriers faced by female scientists in their professional career are discussed in this paper. The opportunities for an exciting career in physics in particular for women are discussed. A degree in engineering physics as proposed in the paper could make the subject more attractive and may help in improving the position of Pakistan in the Global Innovation Index. This paper also presents the current status of women in physics and is aimed to attract women taking physics as a profession to bring innovation and thus promoting entrepreneurship in Pakistan to achieve the vision by 2025. [ABSTRACT FROM AUTHOR]

It is well recognised that unsafe abortions have significant implications for women's physical health; however, women's perceptions and experiences with abortion-related stigma and disclosure about abortion are not well understood. This paper examines the presence and intensity of abortion stigma in five countries, and seeks to understand how stigma is perceived and experienced by women who terminate an unintended pregnancy and influences her subsequent disclosure behaviours. The paper is based upon focus groups and semi-structured in-depth interviews conducted with women and men in Mexico, Nigeria, Pakistan, Peru and the United States (USA) in 2006. The stigma of abortion was perceived similarly in both legally liberal and restrictive settings although it was more evident in countries where abortion is highly restricted. Personal accounts of experienced stigma were limited, although participants cited numerous social consequences of having an abortion. Abortion-related stigma played an important role in disclosure of individual abortion behaviour. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To analyze the output and quality of neurosurgical research published from Pakistan in indexed peer reviewed journals. Methods: Indexed peer reviewed publications from 2003 to 2008 were searched for neurosurgical contributions from Pakistan. The retrieved articles were evaluated to analyze the trends of publication and quality of evidence. Results: Sixty-two neurosurgical research papers (10.3 per year, range 8–13) were published from Pakistan during the study period. Twenty-four (38.7%) publications were the contribution of just four primary authors; 25 (45.3%) of the publications were original research articles and 30 (48.4%) were either case reports or case series; and 38 (61.3%) of all the publications were from just three institutions in the country. Majority of publications were pertaining to neurooncology (n =23, 37.1%) and neurosurgical trauma (n =16, 25.8%). Overall, 48 (77.4%) papers were published in local indexed journals and only 14 (22.6%) in international journals. There were no basic science studies, and no papers offering level 1 or 2 evidence were published during the study period. Conclusion: Neurosurgical research in Pakistan over the past six years has been unsatisfactory, both in terms of number and quality of publications. Analysis of six year publications also did not show any significant improvement in research trends. [ABSTRACT FROM AUTHOR]

Research supervision is crucial and the literature very well emphasizes the fundamental role that research supervisors play in the entire process of research work. We are novice researchers and student-teachers, who have tried to manifest the strong link between the theory and practice of research supervision by reflecting on their concerted efforts of research under the supervision of a senior faculty, an Assistant Professor at the Aga Khan University-Institute for Educational Development (AKU-IED) Karachi, Pakistan. We narrate how, initially, our supervisor gauged our conceptual and intellectual level of understanding of the areas to be researched, our emerging professional needs, helped us to examine or explore that particular topic or area, and how she created a working environment in which the consensus between the research supervisor and the supervisees developed. The paper illustrates how the constructive feedback from the supervisor helped to bring clarity and focus when writing and presenting the research proposals, and how the supervisor's critical questioning brought rigor in the data analysis and took us as researchers to a desirable level of producing the research text. This paper also highlights how the research supervisor, as a mentor, contributed to the development of our research skills as supervisees and enabled us to carry out research following the requirements of quality and ethics in qualitative educational research. Although the paper reflects the learning experiences of us as two student-teachers, from the broader perspective of research supervision it also provides some useful groundwork for both novice researchers and research supervisors. [ABSTRACT FROM AUTHOR]

This paper examines the transcultural relations between researchers and research subjects in a postcolonial research setting. I draw from my experience doing dissertation research in northern Pakistan to discuss how my research subjects’ effectively constructed me as a sahib, or what I saw as a colonial subject position. I examine the ways that my research subjects and I co-constructed, although unequally, my position and location as a researcher. The asymmetries of power relations in research are exacerbated by postcolonial relations in this contact zone. The contribution of those I researched is significant towards understanding our locations as postcolonial subjects in this research setting, and the location from which I produced the research. While it was difficult to do research as anyone other than a sahib during my research, the stories I tell and metaphors I employ in this paper attempt to destabilize my location as a colonial sahib, an authority. The scatological references that run throughout this paper are an attempt to write against the inherently colonial epistemologies that underpin geographic research more generally. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to describe and discuss the recruitment strategies used in a research study of cervical cancer screening among South Asian women, the challenges encountered and the lessons learnt from the experience. Background Ethnic minority populations face different barriers to participating in research studies. Strategies have been developed to recruit this population to health-related research in Western countries, but there is little information about such research in the Asian region. Design Discussion paper. Data sources The discussion is based on our previous experience. The source of this experience is the recruitment strategies used, their results and the challenges encountered during the process. Implications for nursing Culturally, relevant strategies and maintaining good relationships with stakeholders improved participant recruitment. Familiarity with South Asians' traditional calendar - when cultural and religious festivals are held every year - would aid the setting up of appropriate schedules for participant recruitment, either before or after the periods when they cannot be reached, such as Ramadan. South Asian women are often busy with childcare and housework. This is their major responsibility in the family and any failure to fulfil such duties is a source of stress and may foster feelings of guilt. A better understanding of their daily routines is therefore important. Such information enables the establishment of daily meeting schedules to increase the success rate of recruitment. Conclusion Recruitment is a tedious process, but appropriate planning and taking account of cultural and religious practices and daily schedules will help to improve its rate of success. [ABSTRACT FROM AUTHOR]

Considering the high burden of injuries, the Health Authority - Abu Dhabi developed a draft electronic and paper-based injury and poisoning notification system (IPNS) to generate better data on the nature and severity of injuries. The pilot testing and evaluation of IPNS was conducted with the specific objectives to (1) identify the characteristics of injury cases, (2) explore potential risk factors, (3) illustrate the nature and type of data, and (4) the working mechanism of data collection. Data were collected from selected hospitals on patient demographics, injury information and clinical assessment. Descriptive, bivariate and multivariate analyses were conducted. Of 4226 injury cases, nearly three-fourths were male, majority were non-UAE nationals, and the mean age was 21.9. Multivariate findings suggested that compared to UAE nationals, non-UAE nationals were 27% more likely to experience fatal, severe or moderate injuries (p= 0.01). Individuals with health insurance were 31% less likely to suffer a fatal, severe or moderate injury compared to those having no health insurance (p< 0.001). This is the first systematically standardised collection of injury data across three facilities in Abu Dhabi, and provides initial information on characteristics and injury risk factors that will help identify the need for evidence-based intervention for injury prevention and control. [ABSTRACT FROM PUBLISHER]

Background: There is an absence of formal error tracking systems in public sector hospitals of Pakistan and also a lack of literature concerning error reporting culture in the health care sector. Nurse practitioners have front-line knowledge and rich exposure about both the organizational culture and error sharing in hospital settings. The aim of this paper was to investigate the association between organizational culture and the culture of error reporting, as perceived by nurses.Methods: The authors used the "Practice Environment Scale-Nurse Work Index Revised" to measure the six dimensions of organizational culture. Seven questions were used from the "Survey to Solicit Information about the Culture of Reporting" to measure error reporting culture in the region. Overall, 309 nurses participated in the survey, including female nurses from all designations such as supervisors, instructors, ward-heads, staff nurses and student nurses. We used SPSS 17.0 to perform a factor analysis. Furthermore, descriptive statistics, mean scores and multivariable logistic regression were used for the analysis.Results: Three areas were ranked unfavorably by nurse respondents, including: (i) the error reporting culture, (ii) staffing and resource adequacy, and (iii) nurse foundations for quality of care. Multivariable regression results revealed that all six categories of organizational culture, including: (1) nurse manager ability, leadership and support, (2) nurse participation in hospital affairs, (3) nurse participation in governance, (4) nurse foundations of quality care, (5) nurse-coworkers relations, and (6) nurse staffing and resource adequacy, were positively associated with higher odds of error reporting culture. In addition, it was found that married nurses and nurses on permanent contract were more likely to report errors at the workplace.Conclusion: Public healthcare services of Pakistan can be improved through the promotion of an error reporting culture, reducing staffing and resource shortages and the development of nursing care plans. [ABSTRACT FROM AUTHOR]

Attempt in this paper to evaluate the User Education Programs (UEPs) carried out for library users by university libraries of Islamabad. Aims of the study were to know, the allotted time limit, methods are being used, the frequency of performing UEPs and library users' perceptions about UEPs. Extensive relevant literature was reviewed and developed a structured questionnaire as a data collection tool. The 361 students in total responded, nominated as sample size using convenient sampling technique from 10 selected universities of Islamabad. The study revealed UEPs are being conducted with 1 hour time length allocated for a class. To instruct UEP lecture, workshop and library tours were the methods used. Mostly UEPs are being arranged 1 time in each term, annual and on a monthly basis. The data indicated UEPs increased the participants' searching skills, trained in use of library resources and services effectively. The UEPs' instructors are friendly, attendees praised UEPs are not losing up time and guarantee for friends. UEPs are being arranged in few organizations with the collaboration of university administration and faculty, but it is more better way, if it integrates with course curriculum. There is need to develop a policy at national level to initiate such type of training programs at formal basis [ABSTRACT FROM AUTHOR]

Background: Rates of perinatal depression (antenatal and postnatal depression) in South Asia are among the highest in the world. The delivery of effective psychological treatments for perinatal depression through existing health systems is a challenge due to a lack of human resources. This paper reports on a trial protocol that aims to evaluate the effectiveness and cost-effectiveness of the Thinking Healthy Programme delivered by peers (Thinking Healthy Programme Peer-delivered; THPP), for women with moderate to severe perinatal depression in rural and urban settings in Pakistan and India.Methods/design: THPP is evaluated with two randomised controlled trials: a cluster trial in Rawalpindi, Pakistan, and an individually randomised trial in Goa, India. Trial participants are pregnant women who are registered with the lady health workers in the study area in Pakistan and pregnant women attending outpatient antenatal clinics in India. They will be screened using the patient health questionnaire-9 (PHQ-9) for depression symptoms and will be eligible if their PHQ-9 is equal to or greater than 10 (PHQ-9 ≥ 10). The sample size will be 560 and 280 women in Pakistan and India, respectively. Women in the intervention arm (THPP) will be offered ten individual and four group sessions (Pakistan) or 6-14 individual sessions (India) delivered by a peer (defined as a mother from the same community who is trained and supervised in delivering the intervention). Women in the control arm (enhanced usual care) will receive health care as usual, enhanced by providing the gynaecologist or primary-health facilities with adapted WHO mhGAP guidelines for depression treatment, and providing the woman with her diagnosis and information on how to seek help for herself. The primary outcomes are remission and severity of depression symptoms at the 6-month postnatal follow-up. Secondary outcomes include remission and severity of depression symptoms at the 3-month postnatal follow-up, functional disability, perceived social support, breastfeeding rates, infant height and weight, and costs of health care at the 3- and 6-month postnatal follow-ups. The primary analysis will be intention-to-treat.Discussion: The trials have the potential to strengthen the evidence on the effectiveness and cost-effectiveness of an evidence-based psychological treatment recommended by the World Health Organisation and delivered by peers for perinatal depression. The trials have the unique opportunity to overcome the shortage of human resources in global mental health and may advance our understanding about the use of peers who work in partnership with the existing health systems in low-resource settings.Trial Registration: Pakistan Trial: ClinicalTrials.gov Identifier: NCT02111915 (9 April 2014) India Trial: ClinicalTrials.gov Identifier: NCT02104232 (1 April 2014). [ABSTRACT FROM AUTHOR]

Research training at higher education level for clinical and teaching staff is important and there are methods to introduce research culture in employees at clinical and teaching departmental level. Objectives: To recognize and quantify the research productivity status of teaching and clinical faculty of (DUHS) Dow University of Health Sciences Karachi before and after its establishment in 2003. Design: Non experimental cross sectional study. Period: 1st October 2012 to 1st February 2013. Setting: Medical college Karachi. Subjects and method: Students of third semester were applied to sort out the ten years record from 1998 to 2008 of all researches conducted by faculty of Dow University of Health Sciences, published in international and national journals by using different online search engines. Research Output was measured in terms of the increase in the number of publications and quality of publications before and after the launch of Dow University. Data was entered in Microsoft office excel version 2007 and analyzed it in statistical package for social sciences (SPSS) version 17; Pearson chisquare was applied to test the statistical significance at 95% confidence interval. Results: Data of total 594 researches was found out between the years 1998 to 2008, 175(29.5%) researches were published before the foundation of Dow university of Health sciences Karachi (2003) while 419(70.5) researches were produced after 173(45.6%) research papers were published in indexed journals before, "whereas" 206(54.4%) were published in indexed journal after 2003. Original research articles were 152 (31%) before 2003, which rose to 339 (69%). Publications of article types such as case reports, case series, and short communication, editorials and review articles also increased to 80 from 23 after establishment of Dow University. Conclusions: From a total of 594 faculty researches o published in indexed and non indexed journals between the years 1998 and 2008; there was a significant increase in production after establishment of Dow university of Health Sciences Hence it is confidently reported that due to establishment of research committees after the founding, there is a promotion and facilitation of research activities among faculty members. [ABSTRACT FROM AUTHOR]

Background: Pakistan observes a very high i.e. 37 percent modern contraceptive method related discontinuation rates within 12 months of their initiation. And almost 10 percent of these episodes of discontinuation happened due to the side effects or health concerns experienced by the women. Most importantly, it was noted that more than 12,000 first-level care facilities are located in the rural areas, including rural health centers, basic health units, and family welfare centers, but more than 30% of these facilities are nonfunctional. This paper presents a study protocol and participants' profiling of a prospective cohort follow-up to compare the effectiveness of household based and telephonic approaches in sustaining the use of Long Acting Reversible Contraceptives (LARC) whilst to facilitate lowering method related discontinuation and increasing switching amongst the contraceptive users. Methods: A 12-month multi-centre, non-inferiority prospective user follow-up is employed using three different study categories: a) household based follow-up; b) telephonic follow-up; and c) passive or need-based follow-up along with the hypothetical assumption that the telephonic client follow-up is not inferior to the household based follow-up by continuation rate of LARC and the telephonic follow-up is less-costly than the household based client follow-up. This follow-up will be conducted in 22 health facilities - (16 rural and 6 urban based facilities) in district Chakwal. The first two study categories will receive scheduled but different follow-up from the field workers at 1, 3, 6, 9, and 12 month while the third one i.e. the ‘passive or need-based follow-up' will serve as a control group. Using sampling software PASS 11, it was estimated to have 414 clients in each study category and around 1366 clients will be recruited to account for 10% attrition rate. Discussion: The study will help us to examine a more convenient method of effective follow-up for managing side effects, decreasing method discontinuation and increasing switching amongst users. The study information will also facilitate to develop a robust, effective and efficient mechanism for client follow-up to promote the continuation rates of LARC methods. The follow-up results and lessons learnt will be widely shared with stakeholders for their implementation and streamlining in health system. [ABSTRACT FROM AUTHOR]

Aim To explore the experiences of women from three population groups of immediate skin-to-skin contact ( SSC) with their newborn babies. Method A mixed methods approach was adopted in a phenomenological study to elicit the experiences of English, Pakistani and Bangladeshi women. Audiotaped diaries, semi-structured interviews, photographs and video recordings were employed. Concept mapping was central to data analysis. Results This paper reports novel findings that women contextualized and accepted secretions and bodily fluids from birth. This contradicts the beliefs of midwives that Asian women find bodily secretions abhorrent and culturally unacceptable. All participants reported positive experiences of SSC despite varying degrees of soiling from birth fluids. Limitations The study was conducted in a single setting, and participants may not have been representative of others in their cultural groups. Third-party translation may have added an unsought layer of interpretation. The imposition of cultural expectations by peers in the recruitment process excluded some potential participants. Conclusion Stereotypical assumptions about cultural background often characterize professional responses. When this stereotyping was put aside, women of all three cultures, whether breastfeeding or bottle-feeding, were able to enjoy SSC with their babies. Implications for Nursing and Health Policy The findings suggest that changes will be needed in professional practice to be more open to women's expressed preferences, in local policy to ensure that choices are made clear and are available, and in national strategic direction to ensure widespread adoption of positive practices for opportunities to increase breastfeeding, promote parent-child bonding and support patient choice to be realized. [ABSTRACT FROM AUTHOR]

Education is a key element in progress and change. This paper discusses the education practices and librarianship development in Pakistan in historical, present and future perspectives. Pakistan has been struggling to develop an all-encompassing identity since the founding of the state in 1947. The literature shows that education in Pakistan at all levels is characterised by low quality since independence; the contributing factors are limitation of financial resources, poor appreciation of the education priorities; inadequate delivery system and population pressure have never allowed a full expression of the desired change. The other causes include poorly equipped educational institutions, lack of organised library services and lack of devotion on the part of teachers and library professionals etc. Policy makers have not yet studied seriously the actual demands from educational institutions, while some institutions carry on supplying mere degree holders with no destination ahead. There is little correlation between supply and demand. The study suggests a need to create a literate, innovative and creatively self-reliant generation whose productivity and skills after formal education would form an asset in the well being of society and country. All this calls for the reconsideration of the precedence within the education and librarianship system. Higher Education Commission has played a considerable role for the up-gradation of education and research in the country keeping in consideration of the demands of modem era. Pakistan needs to bring its educational policies and programmes well matched to demands of the intellect of people and contemporary trends all over the globe having considered its history and culture. [ABSTRACT FROM AUTHOR]

It is generally recognized that in many developing countries, for a variety of reasons, research output in most disciplines lags behind that in the developed nations. Among the reasons is a range of factors that may hinder good-quality research outputs. This paper focuses on the matter of research quality in library and information science (LIS) in Pakistan as a case study. To test the types of barriers that the researcher believes hinder the production of quality research in Pakistan, a web-based survey was conducted using a questionnaire consisting of structured and open-ended questions. The questionnaire was based on a set of barriers to quality research production, which were identified from the literature. The respondents were asked to indicate their views on the impact of these barriers on the production of quality research. The data was analysed using SPSS. The findings reveal that the lack of critical thinking, a poor research culture, lack of encouragement of research, and inadequate imparting of research skills in LIS education are the most significant barriers. The study suggests that determining the order in which to tackle these barriers will facilitate the production of high-quality research in countries like Pakistan. [ABSTRACT FROM AUTHOR]

This paper investigates the impact of corporate governance variables on the financial performance of the banking sector in Pakistan. The data of financial performance and corporate governance variables of thirty banks are used for the period of 2001-2009. The panel regression analysis is applied to determine the impact, firstly for the whole banking sector, and secondly for different types of banks. The results show that there is a significant impact of corporate governance variables on the performance of the overall banking sector in Pakistan. But there is no significant impact of corporate governance practices on the performance of foreign banks. [ABSTRACT FROM AUTHOR]

This paper provides some comparison and reflections based on the author's involvement in two children related research studies in Pakistan, one of which was conducted in quantitative while the other in the qualitative-interpretive research tradition. The former might be useful in mapping and quantifying the demographics of certain groups of children and the extent of their problems; it is done from the adult perspective. The latter provided children greater 'voice' and 'control' over the research process by giving them the power to fix the terms of the researcher-participant interaction, which, let them express and maintain their individuality, autonomy and privacy in the Pakistani cultural context characterized by rigid hierarchies of age, gender and class among others. Such research ensures children's rights to form opinions and express them in their preferred form and protect them against exploitation through research processes. [ABSTRACT FROM AUTHOR]

This paper contrasts the results of conventional poverty status regressions with an alternative approach, the analysis of poverty transitions, using a five-year longitudinal household survey from rural Pakistan. The results show that while the incidence of income poverty in the sample villages was high, turnover among the poor was rapid. Almost 60 percent of households experienced poverty during the five years of the panel but only 35 percent stayed in poverty for two or more years. Only 3 percent of households were poor in all five years of the panel. Furthermore, the correlates of entries and exits from poverty are found to differ in important but unexpected ways from those of poverty status. The policy implications of these findings, if confirmed elsewhere, indicate that targeting anti-poverty policies using the characteristics of the currently poor is highly problematic. [ABSTRACT FROM AUTHOR]

This paper examines urban-rural differences in the fertility of Pakistani women, as shown by the 1975 Pakistan Fertility Survey, part of the World Fertility Survey. The urban fertility rates were slightly higher than the rural rates. Urban marital fertility exceeded rural marital fertility at the younger reproductive ages, mainly on account of shorter duration of breast-feeding, which reduces birth intervals, but fell below it at the older reproductive ages. The beginnings of parity-specific birth control are discernible at the older reproductive ages in urban areas. [ABSTRACT FROM PUBLISHER]

Introduction: In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan.Methods: The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional injuries and compares patient demographics, nature of injury, and discharge outcome for two categories of intentional injuries: assault and self-inflicted injuries.Results: Intentional injuries presenting to the emergency departments (EDs) accounted for 8.2% (2551/30,937) amongst all other causes for under 18 years. The boy to girl ratio was 1:0.35. Intentional injuries included assault (n = 1679, 65.8%) and self-inflicted injuries (n = 872, 34.2%). Soft tissue injuries were most commonly seen in assault injuries in boys and girls but fractures were more common in self-inflicted injuries in both genders.Conclusion: Intentional injury is one of the reasons for seeking emergency treatment amongst children and a contributor to morbidity in EDs of Pakistan. Moreover, such injuries may be underestimated due to lack of reporting and investigative resources. Early identification may be the first step leading to prevention. [ABSTRACT FROM AUTHOR]

Background: Long-acting reversible contraceptives, such as the intrauterine device (IUD), remain underutilised in Pakistan with high discontinuation rates. Based on a 24-month prospective client follow-up (nested within a larger quasi-experimental study), this paper presents the comparison of two intervention models, one using private mid-level providers branded as "Suraj" and the other using community midwives (CMWs) of Maternal Newborn and Child Health Programme, for method continuation among IUD users. Moreover, determinants of IUD continuation and the reasons for discontinuation, and switching behaviour were studied within each arm.Methods: A total of 1,163 IUD users, 824 from Suraj and 339 from the CMW model, were enrolled in this 24-month prospective client follow-up. Participants were followed-up by female community mobilisers physically every second month to ascertain continued IUD usage and to collect information on associated factors, switching behaviour, reasons for discontinuation, and pregnancy occurrence. The probabilities of IUD continuation and the risk factors for discontinuation were estimated by life table analysis and Cox proportional-hazard techniques, respectively.Results: The cumulative probabilities of IUD continuation at 24 months in Suraj and CMW models were 82% and 80%, respectively. The difference between the two intervention areas was not significant. The probability distributions of IUD continuation were also similar in both interventions (Log rank test: χ(2) = 0.06, df = 1, P = 0.81; Breslow test: χ(2) = 0.6, df = 1, P = 0.44). Health concerns (Suraj = 57.1%, CMW = 38.7%) and pregnancy desire (Suraj = 29.3%, CMW = 40.3%) were reported as the most prominent reasons for IUD discontinuation in both intervention arms. IUD discontinuation was significantly associated with place of residence in Suraj and with age (15-25 years) in the CMW model.Conclusion: CMWs and private providers are equally capable of providing quality IUD services and ensuring higher method continuation. Pakistan's National Maternal Newborn and Child Health programme should consider training CMWs and providing IUDs through them. Moreover, private sector mid-level providers could be engaged in promoting the use of IUDs. [ABSTRACT FROM AUTHOR]

Background: Burn injury is an important yet under-researched area in Pakistan. The objective of this study was to determine the characteristics and associated outcomes of burn injury patients presenting to major emergency departments in Pakistan.Methods: Pakistan National Emergency Department Surveillance (Pak-NEDS) was a pilot active surveillance conducted between November 2010 and March 2011. Information related to patient demographics, mode of arrival, cause of burn injury, and outcomes was analyzed for this paper. Data were entered using Epi Info and analyzed using SPSS v.20. Ethical approval was obtained from all participating sites.Results: There were 403 burn injury patients in Pak-NEDS, with a male to female ratio 2:1. About 48.9% of the burn injury patients (n = 199) were between 10 - 29 years of age. There was no statistically significant difference between unintentional and intentional burn injury patients except for body part injured (p-value 0.004) and ED disposition (p-value 0.025). Among 21 patients who died, most were between 40 - 49 years of age (61.9%) and suffered from fire burns (81%).Conclusion: Burn injuries are a burden on emergency rooms in Pakistan. We were able to demonstrate the significant burden of burn injuries that is not addressed by specialized burn centers. [ABSTRACT FROM AUTHOR]

Background: Evidence-based decision making is essential for appropriate prioritization and service provision by healthcare systems. Despite higher demands, data needs for this practice are not met in many cases in low- and middle-income countries because of underdeveloped sources, among other reasons. Emergency departments (EDs) provide an important channel for such information because of their strategic position within healthcare systems. This paper describes the design and pilot test of a national ED based surveillance system suitable for the Pakistani context.Methods: The Pakistan National Emergency Department Surveillance Study (Pak-NEDS) was pilot tested in the emergency departments of seven major tertiary healthcare centres across the country. The Aga Khan University, Karachi, served as the coordinating centre. Key stakeholders and experts from all study institutes were involved in outlining data needs, development of the study questionnaire, and identification of appropriate surveillance mechanisms such as methods for data collection, monitoring, and quality assurance procedures. The surveillance system was operational between November 2010 and March 2011. Active surveillance was done 24 hours a day by data collectors hired and trained specifically for the study. All patients presenting to the study EDs were eligible participants. Over 270,000 cases were registered in the surveillance system over a period of four months. Coverage levels in the final month ranged from 91-100% and were highest in centres with the least volume of patients. Overall the coverage for the four months was 79% and crude operational costs were less than $0.20 per patient.Conclusions: Pak-NEDS is the first multi-centre ED based surveillance system successfully piloted in a sample of major EDs having some of the highest patient volumes in Pakistan. Despite the challenges identified, our pilot shows that the system is flexible and scalable, and could potentially be adapted for many other low- and middle-income settings. [ABSTRACT FROM AUTHOR]