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Background Although the role of airborne plant pollen in causing allergic rhinitis has been established, the association of concentrations of paper mulberry (Broussenetia papyrifera) pollens in the air and incidence of asthma exacerbations has not, despite an observed increase in the number of asthma patients attending physician clinics and hospital Accident and Emergency (A&E) Departments during the paper mulberry pollen season. We aimed to assess the association between paper mulberry pollen concentrations (typically peaking in March each year) and asthma exacerbations in the city of Islamabad. Methods We used three approaches to investigate the correlation of paper mulberry pollen concentration with asthma exacerbations: A retrospective analysis of historical records (2000-2019) of asthma exacerbations of patients from the Allergy and Asthma Institute, Pakistan (n = 284), an analysis of daily nebulisations in patients attending the A&E Department of the Pakistan Institute of Medical Sciences (March 2020 to July 2021), a prospective peak expiratory flow rate (PEFR) diary from participants (n = 40) with or without asthma and with or without paper mulberry sensitisation. We examined associations between pollen data and asthma exacerbations using Pearson correlation. Results We found a strong positive correlation between mean paper mulberry pollen counts and clinical records of asthma exacerbations in patients sensitised to paper mulberry (Pearson correlation coefficient (r) = 0.86; P < 0.001), but not in non-sensitised patients (r = 0.32; P = 0.3). There was a moderate positive correlation between monthly nebulisation counts and pollen counts (r = 0.56; P = 0.03), and a strong negative correlation between percent predicted PEFR and pollen counts in sensitised asthma patients (r = -0.72, P < 0.001). However, these correlations were of low magnitude in the non-sensitised asthma (r = -0.16; P < 0.001) and sensitised non-asthma (r = -0.28; P < 0.001) groups. Conclusions Our three approaches to analysis all showed an association between high paper mulberry pollen concentration in Islamabad and asthma exacerbations. Predicting pollen peaks could enable alerts and mobilise strategies to proactively manage these peaks of asthma exacerbations. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is a widespread acceptance and shift towards sustainable, inclusive and smart mobility solutions around the world. However, in Karachi, poorly coordinated urban planning, lack of effective governance structure and investment in transport, has allowed the growth of an almost unregulated and ungovernable informal transport sector. Women are more severely affected by the poor service since men not only have more space allocated to them on public transport but also have the freedom to use alternative and cheaper private vehicles such as motorbikes and cycles. Poor representation of women in the transport sector further aggravates the situation. OBJECTIVE: The paper aims to highlight the gender-disaggregated effects of poor transport design, provision and lack of personal agency on mobility, for emphasising the social and cultural attitudes faced by female employees. It argues that not integrating the gender-based disadvantages faced by women into planning, reinforces their disadvantaged position and force them to take complex trips. METHODS: Scenario-based questions were designed for focus group discussion which covered not only the everyday mobility challenges but also their reactions to the potential solutions. For a gender-based comparative analysis, two separate focus group discussions were organised. RESULTS: Adopting a sector-based mapping approach of the issues discussed in the groups helped understand the complexity of female user experience at various levels, starting from planning or discussing the trips with families, to making modal choices. It also helped to tease out the impact of these issues on their employment opportunities as early-career women. CONCLUSION: The model proposed in this paper can help illustrate where changes can be made in the system considering the social aspects of transport. [ABSTRACT FROM AUTHOR]

Introduction: Mild cognitive impairment (MCI) is a stage between health and dementia, with various symptoms including memory, language, and visuospatial impairment. Chiropractic, a manual therapy that seeks to improve the function of the body and spine, has been shown to affect sensorimotor processing, multimodal sensory processing, and mental processing tasks. Methods: In this paper, the effect of chiropractic intervention on Electroencephalogram (EEG) signals in patients with mild cognitive impairment was investigated. EEG signals from two groups of patients with mild cognitive impairment (n = 13 people in each group) were recorded pre- and post-control and chiropractic intervention. A comparison of relative power was done with the support vector machine (SVM) method and non-parametric cluster-based permutation test showing the two groups could be separately identified with high accuracy. Results: The highest accuracy was obtained in beta2 (25–35 Hz) and theta (4–8 Hz) bands. A comparison of different brain areas with the SVM method showed that the intervention had a greater effect on frontal areas. Also, interhemispheric coherence in all regions increased significantly after the intervention. The results of the Wilcoxon test showed that intrahemispheric coherence changes in frontal-occipital, frontal-temporal and right temporal-occipital regions were significantly different in two groups. Discussion: Comparison of the results obtained from chiropractic intervention and previous studies shows that chiropractic intervention can have a positive effect on MCI disease and using this method may slow down the progression of mild cognitive impairment to Alzheimer’s disease. [ABSTRACT FROM AUTHOR]

Evidence has shown that parenting intervention programmes improve parental knowledge, attitudes, and practices, which helps in promoting child development. This study aims to examine the effectiveness of parenting intervention in improving child behaviours. This is a secondary analysis of data from a cluster-randomised controlled trial with depressed mothers aged 18–44 years with a child aged 0 to 36 months. This paper reports findings from the dataset of participants with a child aged between 24 and 36 months. Villages (n = 120) were randomised into either of two arms: learning through play plus (LTP Plus) or treatment as usual (TAU). LTP Plus is a 10-session, group parenting intervention integrated with cognitive behaviour therapy, delivered over 3 months. This secondary analysis reports findings on the Eyberg Child Behaviour Inventory (ECBI) and the Home Observation for Measurement of the Environment (HOME). Findings show a significant improvement in child behaviour (ECBI) scores (p < 0.011) and HOME scores (p < 0.001) in the intervention group compared to TAU at 3-month follow-up. In a low-resource setting, low-cost group parenting intervention delivered by community health workers has the potential to improve child behaviours and quality of the home environment. Parenting interventions aimed at improving child behavioural problems can have significant implications for the child, family, and broader societal outcomes. Addressing behavioural problems in early years, parenting interventions can potentially reduce long-term consequences and costs associated with untreated child behavioural issues. [ABSTRACT FROM AUTHOR]

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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]

Negative perceptions within parent–child relationship has become a focus of research in recent psychological literature. Keeping this in view, the current paper aims to study how parental psychological maltreatment and negative cognitive style connect with psychological distress among Pakistani adolescents? Three hundred and seventy adolescents including 200 boys and 170 girls took part in the study. The mean age was 16.11 (SD = 1.54). Participants from different educational institutes filled in Psychological Maltreatment Experience Scale, Adolescent Cognitive Style Questionnaire – Short Form (Adapted version) and Depression, Anxiety and Stress Scale. Findings of the study indicated that both parental psychological maltreatment and negative cognitive styles have strong association with psychological distress. The results emphasize the role of negative cognition in parent–child relationship and importance of reducing the hostile effects of parental maltreatment on youth's mental health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Modern medical education has flourished with an emergent interest in a variety of assessment approaches that entails direct observation of performance and provision of feedback. Workplace-based assessment (WPBA) has been embraced into specialty training in the United Kingdom (UK) within National Health Service (NHS). In Pakistan, this educational framework is incorporated to gauge the clinical proficiency of trainees at the postgraduate and undergraduate levels. The present study was done to identify how WPBA is perceived by dental field postgraduate trainees in Pakistan. OBJECTIVE: The study explored and ascertained trainees' perceptions, attitudes, and preferences considering their experiences with the systematic organization and execution of WPBA in dental educational settings. METHODS: This cross-sectional study design involved the clinical trainees of various cadres in a tertiary care hospital in Multan. A structured and validated questionnaire previously used for another analysis was administered among 90 trainees at the institute. The results were analyzed and tabulated using SPSS-21. Influential statistics (Pearson's Chi-Square Test) was performed and the confidence interval was set at 95% (P≤0.05). RESULTS: The response rate was 88%. Opinions were more positive compared to the former surveys. The majority of the respondents (65.8%) have shown a positive attitude towards WPBA and preferred it to be a valuable assessment system as it fosters reflective practices in educational settings. In addition, it was shown that WPBA has the potential to improve clinical training (72.2%) and aid in the effective implementation of clinical practice (68.4%). As the system of digital education has been introduced ever since the pandemic, the highest percentage of participants (56%) preferred a combination of on-paper and online assessment systems. CONCLUSION: The study reported that WPBA proposes the opportunity to associate teaching, learning, and assessment. The faculty training program is a significant input to upholding the quality of WPBA. Empirical research on WPBA is essential to be carried out to overcome the inadequacies thus endorsing its application universally. [ABSTRACT FROM AUTHOR]

Context: Cannabidiol (CBD), used in conjunction with other antiepileptics, is gaining interest in managing drug-resistant epilepsy (DRE), which accounts for 10-20% of all childhood epilepsies worldwide. Aims: We highlight a first experience of using CBD amongst children with refractory epilepsy in a tertiary care hospital in Pakistan and its possible effect on seizure frequency and associated adverse outcomes. Settings and Design: A retrospective review, conducted at a pediatric neurology outpatient clinic at the AKUH, a tertiary care hospital in Karachi, Pakistan. Materials and Methods: We assessed children with DRE who were prescribed escalating doses of CBD from June 2019 to October 2020 at Aga Khan University, Pakistan. A descriptive analysis was performed, and improvement in seizure frequency and adverse effects (as reported by caregivers) were measured. Statistical Analysis Used: Statistical analyses were performed using IBM Statistical Package for the Social Sciences 21.0. Results: CBD was prescribed to 17 patients with DRE with a mean age of 5.52 ± 0.96 years, and 15 of them were boys. The mean baseline seizure frequency was 27.65 ± 3.59 episodes per day. All patients were stabilized on antiepileptics before administration of CBD and were started at an initial dose of 10 mg/kg/day, which was subsequently escalated, where needed. Our results showed that 70.6% of children reported an improvement in seizure frequency. The mean percentage reduction in seizure frequency at 12 weeks was 68.33% ± 7.55 from baseline; seven patients reported more than 75% improvement, and two patients became completely seizure-free. Nine patients reported minimal side effects. Conclusion: In this initial experience, we saw an improvement in overall seizure frequency in DRE patients, with tolerable adverse outcomes. The paper highlights an initial potential of using CBD in children with DRE in an LMIC, without drawing any firm conclusions. It highlights the potential for making a bigger change for which adequately designed and powered studies would be needed in such contexts to ascertain the actual impact. [ABSTRACT FROM AUTHOR]

Purpose: Gaslighting a form of abusive manipulation both emotional and psychological is a growing phenomenon in recent times. However, as of yet, there is a scarcity of a valid and reliable instrument which can measure the severity of gaslighting in victims of interpersonal relationships abuse. The purpose of this study is the development of an instrument which can effectively measure gaslighting in victims and is psychometrically reliable and valid. Design/methodology/approach: Since the aim of the study was the development of a scale first a sample of eight women who were victims of domestic abuse was taken for the focus group. Afterwards using purposive sampling a sample of 20 women for the pilot study and a sample of 150 women for the main study was taken with age range 18–40 (M = 23.38, S.D = 4.03). For the development of scale theoretical basis along with a focus group was conducted to establish an item pool. Afterwards, subject matter experts helped in establishing contend validity followed by Velicer's minimum average partial (MAP) method and maximum likelihood factor analysis (FA) was performed for the establishment of the factorial structure of the instrument. Findings: Velicer's MAP method and Maximum Likelihood FA suggested two factor structures including peer disagreement and loss of self-trust. Instrument displayed high alpha reliability of α = 0.934, with α = 0.927 and α = 0.854, for the subscale, respectively. Research limitations/implications: Though all necessary steps were taken to minimize the limitations of the present study, however, some limitations do exist which needs to be addressed. The foremost limitation of the present scale is that it is being developed with only a female sample, however, the inclusion of a male sample in future studies can help in identifying whether men also are victims of gaslighting from peers and other family members or not. The second limitation is of validity though necessary validities have been established future studies should study on establishing further validities to further refine the instrument. Additionally, the scale has only been validated and tested on female samples future studies should be conducted on other specific groups or samples to develop norms. Moreover, testing the scale on other cultures could also help in establishing cross cultural validation of the instrument. Finally, though the scale assumes a higher level of scores suggests a higher level of victimization, a proper cutoff score can help in further identifying proper victims from the normal level of gaslighting. Practical implications: The present instrument has its applicability in several domains the most important being in the criminal justice system as gaslighting comes under gaslighting and even in the UK is considered as a criminal offense. This instrument can help in determining the severity of gaslighting in victims. Likewise, it can be used in clinical settings for psychologists to identify possible cases of gaslighting victims which can enable them to provide specific help and treatment for them. Moreover, researchers can also benefit from the instrument as it can enable them to explore gaslighting with other possible variables which can help them explore the concept of gaslighting even further. Originality/value: This paper is a novel study and has been completed with the purpose of evaluating the effects of gaslighting in victims of interpersonal relationships abuse as the earlier measures are either not psychometrically valid or cannot be generalized to a wider population. The present established scale is an effort to construct an instrument that can be used worldwide. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study analyzes the impact of active smoking and secondhand smoke on the ischemic stroke burden of Pakistan, 1990-2019. METHODS We used data from the Global Burden of Disease (GBD) database to conduct a comprehensive evaluation of ischemic stroke-related indicators in Pakistan, including the number of deaths, mortality rates, disability-adjusted life years (DALYs), DALY rates, and the estimated annual percentage change (EAPC). Joinpoint analysis was applied to assess sex-specific temporal trends in the burden of active smoking and secondhand smoke in Pakistan and regions of Pakistan. These assessments incorporated the Socio-Demographic Index (SDI) and we have made comparative analyses of epidemiological differences between active smoking and secondhand smoke exposure. RESULTS The burden of ischemic stroke related to tobacco use is presented in terms of the age-standardized mortality rate (ASMR) and the age-standardized disabilityadjusted life year rate (ASDR) per 100000 population. The results (ASMR/ ASDR) for Pakistan were 6.04/130.81, in the middle SDI region 7.69/176.54, and low-middle SDI region 5.64/124.22. Pakistan's ASMR is higher than the global average of 5.85, while ASDR is lower than the global average of 140.23. From 1990 to 2019, a downward trend in both ASMR and ASDR was observed, indicating progress in controlling tobacco-related stroke burdens. Individuals aged ≥70 years experienced the highest rates of stroke (ASMR: 66.31; ASDR: 1091.20). Gender disparities were evident: men were more affected by active smoking (ASMR: 3.08; ASDR: 78.47) than women (ASMR: 0.79; ASDR: 20.76), while women faced a higher burden from secondhand smoke (ASMR: 0.66; ASDR: 16.33) compared to men (ASMR: 0.79; ASDR: 9.93). Regional differences within Pakistan show fluctuating death and DALY rates. Notably, an increasing trend in female ASDR due to secondhand smoke in the Khyber Pakhtunkhwa Region (annual percentage change, APC=0.17 from 2010 to 2019) calls for focused health interventions. CONCLUSIONS The study finds ASMR for tobacco-related ischemic stroke in Pakistan exceeds global averages, with significant gender and age disparities in exposure to smoke, highlighting the need for targeted health interventions. [ABSTRACT FROM AUTHOR]

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]

Objective: To determine prevalence of professionalism lapses related to academic integrity by students Pakistani medical colleges. Subjects: 520 students. Study design: Cross sectional. Data collection: A validated and customized version of Dundee Polyprofessional Inventory - 1 for use in Pakistani medical schools was used. The students' perceptions on 47 behaviors were explored. Result: The response rate of students was 92%. Ninety percent or more than 90% of student agreed that 30 of the 47 listed behaviors were wrong. Different percentages of the students admitted doing 44(94%), out of 47 behaviors. Students thought that fellow students were doing dishonest behaviors far more frequently than they themselves were. The commonest dishonest behaviors admitted were proxy attendance (308, 64%), receiving information about the paper from a student who has already sat in the exam, or themselves providing information about a paper who have yet to sit in it (297, 62%), completing work for another student 291(61%). Conclusion: There are significant issues related to academic integrity in Pakistani medical schools that require remedy. The Dundee Polyprofessional Inventory - 1 as customized for use in Pakistan is a useful tool to measure professionalism lapses related to academic integrity. [ABSTRACT FROM AUTHOR]

Background and aim: A Society's view of disability may influence the perception and use of Assistive Technology (AT) products. Semantic cues or cultural coding provide the viewer with a series of visual stimuli to be given or ascribed meaning. Previous research has shown cognitive approaches to visual perception and assignment of meaning vary between diverse cultures. This study reviews the influence of contextual settings on perception, to provide the basis for a debate on the societal perception of communicative content (semantic/meaning) of an AT product; and, the relevance of different cultural cognitive styles. The paper explores, from a cultural viewpoint, the overall understanding of disability internationally. Method: A Semantic Differential (SD) scale was used to obtain views on the image of an attendant wheelchair from nine hundred and ninety-one (991) young adults from the United Kingdom (UK) and Pakistan (PAK), reflecting the individualist and collectivist societies, respectively. This survey follows a previous paper-based study using the same image and protocol. Comparing the two surveys, a consensus of views from the two groups was achieved. Results and conclusion: The responses from the UK group were skewed towards a negative view of disability compared to the Pakistan group. This inferred greater social stigma associated with this AT product in the UK. The combined findings from both surveys provide insights into societal perception of AT products and disability. Areas for future research are suggested, including what visual components of an AT product (graphemes) appear to be associated with positive or negative responses for collectivist and individual societal groups. Assistive Technology (AT) product designers, academics, professionals and stakeholders need to be aware of challenges which are originated from one's socio-cultural environment. AT products convey certain meanings, semantics, which are interpreted by the society and are subjective to a specific cultural setting. •For the effective communication of meanings and values an AT product relies on the visual clues and design features embedded within the design. However, there have been a limited number of studies reviewing this aspect of product semantics. •The survey and associated testing has highlighted the differences in cultural perception towards AT products and demonstrated the importance of effectively designing the semantic attributes of an AT product as well as its function. •The demonstration of the efficacy of methods within the study for exploring the interpretation of semantic attributes of AT products will help designers and developers better understand the perceptions of individual cultures and societal groups. •A better understanding of different cultures and societies will enable designers and clinicians who specify AT products to reduce AT product abandonment; and, the associated stigma around disability. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to inspect the potential mediation pathways among emotional empathy, personality traits and coping strategies in orphan and non-orphan students. Additionally, it designed to investigate the association of coping strategies with emotional empathy and personality traits.Design/methodology/approach Purposive sampling technique and cross-sectional design were employed in current study. The data of 130 adolescents (institutionalized orphans, n= 62; school students, n=68) were included from different high schools and orphanages of Rawalpindi and Islamabad, Pakistan, in 2017. Three instruments, emotional empathy scale (Mehrabian and Epstein, 1972; Shazia, 2004), coping of problem experience (Carver, 1989; Akhtar, 2005), and Eysenck personality questionnaire (Naqvi and Kamal, 2010; Eysenck, 1964; Eysenck and Eysenck, 1994), were employed to measure personality traits, emotional empathy and coping strategies in orphan and non-orphan students.Findings Mediation analyses illustrated that personality traits relegated active avoidance coping strategy through emotional empathy in orphan students. On contrary, the study findings demonstrated that neurotic personality promoted positive coping strategy through emotional empathy in non-orphan students.Research limitations/implications The methodological limitations of this study are that the sample is of 130 participants that limits the generalizability of its results; furthermore, it was done on only the male orphans students of only one institute. Further research can be done on different orphanages to enhance the generalizability of results. This study included orphan and non-orphan students from the two cities of Pakistan; consequently, its findings may not be generalizable to the whole population. In the future, cross-sectional and experimental researches working with more assorted data could help elucidate the mechanisms by which interpersonal factors affect and stimulate coping strategies in orphans and high school students.Practical implications This paper exposes a number of ways for upcoming future studies. This study findings can be employed to enhance knowledge and offer assistance for orphans, on how to identify and get help from coping resources to tackle various problems and how to build new psychological preventions and interventions strategies in the Pakistani society. There still exists a need to find out the effect of emotion, empathy on personality types in relation to different environmental conditions. The findings have implications for pedagogical intervention as such improvements can be initiated in the pedagogical context.Social implications This study comprised only orphan and non-orphan students from two twin cities of Pakistan; consequently, its findings may not be applicable to the whole population. In future, cross-sectional and experimental researches with more assorted data will assist clarify the mechanism that interpersonal factors affect and stimulate coping strategies in high school students.Originality/value Study findings proposed that coping strategies can be promoted by interpersonal factors such as personality traits and empathy to tackle different orphan's psychological problem in various negative situation. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to examine the moderating role of the demographic variables in emotional intelligence, homesickness and the development of mood swings in university students. Additionally, the paper investigates the relationship among emotional intelligence, homesickness and mood swings in university students. Design/methodology/approach - Purposive sampling technique was employed based on a cross-sectional design. The sample comprised 304 university students (male students, n=210, female students, n=94). Three scales were used to measure the homesickness, emotional intelligence and positive and negative mood swings in university students. Findings - The results revealed that homesickness was positively and significantly correlated with mood swings (r=0.34, p<0.001) and negative mood swings (r=0.49, p<0.001). The result also displayed that emotional intelligence was correlated with homesickness (r=-0.15, po0.05), positive mood swings (r=0.33, po0.05) and negative mood swings (r=-0.24, p<0.05). The results of the analysis revealed that demographic variables such as age and gender were the moderator between homesickness and development of mood swings. The results also revealed that demographic variable such as gender was the moderator between emotional intelligence and mood swings. This study recommended that those younger students who had experienced homesickness were more likely to develop negative mood swings as compared to older students. Social implications - The study also recommended that those young students who had emotional intelligence were less likely to develop negative mood swings as compared to older students. Originality/value - The study further recommended that those female students who had experienced homesickness were more likely to develop positive mood swings as compared to male students. Recommendations of the currents study are that university students can benefit equally but female students can benefit more from an intervention addressing homesickness. This study would be helpful in pedagogical and clinical settings to raise the awareness to effectively deal with their children. [ABSTRACT FROM AUTHOR]

Aim(s): This paper investigated the impact of organisational dehumanization on nurses' deviant behaviours in the Pakistani health sector directly and indirectly through job stress. The study also examined the moderation role of occupational self‐efficacy on the relationship between organisational dehumanization and job stress. Background: While the attitudinal outcomes of organisational dehumanization have been a focus of research, its behavioural outcomes are a relatively ignored research area. Method: Data were collected from 295 nurses working in hospitals across Pakistan via self‐administered questionnaires with two measurement points to test the direct and indirect effects of organisational dehumanization. Results: The hypothesized relationships were tested with SPSS 25 and the Process Macro Model 7. The results showed that organisational dehumanization increased deviant behaviours among nurses directly and indirectly via job stress. Moreover, occupational self‐efficacy plays moderation role and weakens the relationship between organisational dehumanization and job stress. Conclusion: This study contributes to the existing literature by concentrating on predictors that trigger deviant behaviour among nurses. It also assessed the mediating impact of job stress, an essential endeavour for researchers and practitioners. Implications for Nursing Management: The study outcomes can help the health sector improve their strategies to address organisational dehumanization and deviant behaviour among nurses. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to examine the moderating role of marital status between infidelity and development of stress, anxiety and depression. Additionally, to investigate the relationship among infidelity, stress, anxiety and depression among married couples and divorced individual. Design/methodology/approach - A purposive sampling technique was used based on cross-sectional design. In total, 200 participants (married couples, n=100; divorced individuals, n=100) were incorporated from different NGO's and welfare organizations of Rawalpindi, and Islamabad, Pakistan. Age ranged from 20 to 60 years. Two scales were used to measure the infidelity, stress, anxiety and depression in married couples and divorced couples. Findings - The result revealed that emotional infidelity was positively significant correlated with stress (r=0.39, p=0.001), anxiety (r=0.40, p=0.001) and depression (r=0.35, p=0.001) for married couples. The result also displayed that sexual infidelity was positively significant correlated with stress (r=0.39, p=0.001), anxiety (r=0.39, p=0.001) and depression (r=0.34, p=0.001) for married couples. The result further elaborated that emotional infidelity and sexual infidelities were positively non-significant correlated with stress, anxiety and depression for divorced individuals. The analysis results revealed that marital status was moderator between infidelity and development of stress, anxiety and depression. Research limitations/implications - This paper consisted of sample from three basic cities of Pakistan; thus, this paper finding may not be applied on whole population. Consequently, explanatory, exploratory and descriptive studies would be useful to enlighten the infidelity's mechanism in prolongation of psychological distress across married couples and divorced individual in detail. Local tools to measure gender-related issues would be helpful in prospect while it combine cultural aspects as well. Social implications - This study would be helpful in clinical settings to raise the awareness to effectively deal with their children. Originality/value - The study recommended that those divorced individuals who had experienced either sexual infidelity or emotional infidelity were more likely to develop psychological problems as compared to married couples. This study would be helpful in clinical settings to raise the awareness to effectively deal with their children. [ABSTRACT FROM AUTHOR]

azhar s., hassali m.a., mohamed ibrahim m.i., saleem f. & siow yen l. (2012) A survey evaluating nurses' perception and expectations towards the role of pharmacist in Pakistan's healthcare system. Journal of Advanced Nursing 68(1), 199-205. Abstract Aim. This paper is a report of a study of nurses' perception towards the role of pharmacist in Pakistan healthcare setup. Background. Collaborative care by the healthcare professionals has the potential to improve patient care, enhance patient safety and to reduce workload issues that cause burn out among healthcare professionals. Design. A quantitative (cross-sectional) study design was adopted. Method. A sample of 458 nurses was selected from government hospitals of three cities of Punjab, Pakistan. The study took place from 10 January 2009 to 15 March 2009. Results. Two hundred and sixty-six questionnaires were returned, giving the response rate of (58·07%). Three-fifths of the nurses reported that they had once a day interaction with the pharmacist. Seven-tenths of the nurses expected the pharmacist to take personal responsibility for resolving any drug-related problems. Moreover they appear to have high expectations of the pharmacist, almost nine-tenths regarded pharmacists as knowledgeable drug therapy experts, and almost two-thirds of the nurses emphasized on counselling of patient by the pharmacist. Conclusion. Nurses in Pakistan showed negative perception towards the role of pharmacist in healthcare setting. Although nurses considered pharmacist as a drug information expert but their expectation did not match their experience. A possible factor for this behaviour could be due to nurses' belief that incorporating the role of pharmacist in patient care, may decrease their worth and can result in intrusion into their duties. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine the incidence of prescribing errors in a main public hospital in Pakistan and to assess the impact of introducing electronic prescribing system on the reduction of their incidence. Background. Medication errors are persistent in today's healthcare system. The impact of electronic prescribing on reducing errors has not been tested in developing world. Design. Prospective review of medication and discharge medication charts before and after the introduction of an electronic inpatient record and prescribing system. Methods. Inpatient records ( n = 3300) and 1100 discharge medication sheets were reviewed for prescribing errors before and after the installation of electronic prescribing system in 11 wards. Results. Medications (13,328 and 14,064) were prescribed for inpatients, among which 3008 and 1147 prescribing errors were identified, giving an overall error rate of 22·6% and 8·2% throughout paper-based and electronic prescribing, respectively. Medications (2480 and 2790) were prescribed for discharge patients, among which 418 and 123 errors were detected, giving an overall error rate of 16·9% and 4·4% during paper-based and electronic prescribing, respectively. Conclusion. Electronic prescribing has a significant effect on the reduction of prescribing errors. Relevance to clinical practice. Prescribing errors are commonplace in Pakistan public hospitals. The study evaluated the impact of introducing electronic inpatient records and electronic prescribing in the reduction of prescribing errors in a public hospital in Pakistan. [ABSTRACT FROM AUTHOR]

Assistive Technology (AT) product use occurs within a socio-cultural setting. The growth internationally in the AT product market suggests that designers need to be aware of the influences that diverse cultures may have on the societal perception of an AT product through its semantic attributes. The study aimed to evaluate the visual interaction with an AT product by young adults from Pakistan, a collectivist society, and the United Kingdom (UK), an individualist society. A paper-based questionnaire survey was carried out with 281 first-year undergraduate students from the UK and Pakistan to evaluate their perception towards the visual representation of a generic conventional wheelchair image. A semantics differential (SD) scale method was used involving a seven-point bipolar SD scale incorporating sixteen pairs of adjectives defining functional, meaning, and usability attributes of the product. The mean (M) and standard deviation (sd) values were obtained for each pair of adjectives and compared between both groups by employing appropriate parametric tests. The results show that having a diverse cultural background did not appear to have overtly influenced the meanings ascribed to the generic manual wheelchair, which was unexpected. The University 'Internationalist' environment may have influenced the results. Some minor but critical differences were found for some pairs of adjectives (bulky-compact, heavy-light), having p-value less than.05 (p <.05) that related to previous experience of wheelchairs and/or their use. Further studies are planned to investigate and validate outcomes with other student and non-student groups. The semantic attributes of assistive technologies highlight a number of aspects that have implications for those involved in Assistive Technology (AT) product development, manufacturing and marketing. • For online sales, the AT products rely on the web page image to communicate the purpose and attributes of the product. There are limited explorations related to the semantic/communicative attributes of AT product presented in images, as perceived by individuals from diverse cultural backgrounds. • The knowledge towards semantic meaning ascribed to the AT product is important to investigate to provide a perspective that goes beyond practical functions of the AT product towards the communicative function. • Information of comprehending semantics and significance of the AT product from a social (non-users) viewpoint may benefits manufacturers in the development of AT products that best meet the societal needs, preferences and expectations. • A model of best practice, with a focus on semantic manipulation will offer Industrial Designers (ID) internationally with the suitable process and tools to reframe perceptions of disability and enhance acceptance of AT products not only for users, but also for the society around them. [ABSTRACT FROM AUTHOR]

This paper examines the issue of quality assurance (QA) in library and information science (LIS) education in Pakistan. It identifies the practices of quality assessment prevalent in Pakistani LIS schools and examines the perceptions of faculty members concerning the accreditation of LIS programs. A questionnaire sent to heads of departments and semi-structured interviews with faculty were employed to collect data. The findings of the study identify human, physical, procedural, and behavioral hindrances to imparting quality education. The study revealed a need for developing and implementing robust internal and external quality assurance mechanisms. The findings may lead to the development of policy guidelines for quality assurance in Pakistan and other countries with a similar context. [ABSTRACT FROM AUTHOR]

This study investigated the topic of the academic integrity among medical students and postgraduate trainees in the teaching hospitals of South Punjab, Pakistan. A cross‐sectional survey was conducted involving 318 medical students and postgraduate trainees of teaching hospitals. The results found that medical students of pre‐clinical years engaged in unethical behaviour, that is, exam cheating and plagiarism to cope with internal and external evaluation and the range of subjects needed to be studied. For postgraduate trainees, results showed trainees unintentionally engaged in the practice of plagiarism due to lack of understanding about what constitutes plagiarism, coupled with externally perceived pressures associated with expectations of research publication, promotions and tenured positions. To address these concerns, it is recommended that information literacy sessions for undergraduate and postgraduate medical students on plagiarism prevention and ethical practice be designed and facilitated by medical librarians in collaboration of faculty members. [ABSTRACT FROM AUTHOR]

This paper quantifies the factors explaining long ‐ term improvements in child height for age z ‐ scores in Bangladesh (1996/1997–2011), India (1992/1993–2005/2006), Nepal (1997–2011) and Pakistan (1991–2013). We apply the same statistical techniques to data from a common data source from which we have extracted a set of common explanatory variables that capture ‘nutrition ‐ sensitive’ factors. Three are particularly important in explaining height for age z ‐ score changes over these timeframes: improvements in material well ‐ being; increases in female education; and improvements in sanitation. These factors have comparable associations across all four countries. [ABSTRACT FROM AUTHOR]

Background: Plantar fasciitis, a common musculoskeletal disorder, is characterized by inflammation of the plantar fascia, a thick band of tissue that connects the heel bone to the toes. The plantar fascia plays a crucial role in supporting the arch of the foot and absorbing shock during movement. Factors such as excessive physical activity, improper footwear, and biomechanical abnormalities are recognized contributors to the development of plantar fasciitis. However, the prevalence and underlying causes may vary across different demographic groups, necessitating targeted investigations. Objective: This study aims to investigate the prevalence, causes and treatment of plantar fasciitis in young female students (18–30) of a medical college in Pakistan and explore potential associations with high-heel footwear. Methodology: In this study, a cross-sectional survey was carried out, engaging 100 young females from a medical college. Employing a structured questionnaire, we assessed a spectrum of parameters, including heel pain symptoms, footwear habits, and available treatment options. The diagnostic precision of the Windlass test, specific to plantar fasciitis, was incorporated. Rigorous data analysis, utilizing SPSS, centered on discerning associations between the nuances of high-heel wear (considering types and duration) and the reported symptoms. This methodological framework ensures a comprehensive and precise exploration of the prevalence, causes, and treatment of plantar fasciitis in our targeted demographic. Results: All the participants were female, and the total number was 100, of which 66% felt pain in the heel when they wore high heels. Out of this 66%, only 6% are diagnosed with plantar fasciitis. The rest of the 60% have pain in the heel due to different causes such as heel spurs, stress fractures, etc. 2% of people receive treatment with steroid injections, and 12% are treated with ice. Conclusion: We conclude that the prevalence of plantar fasciitis is high in females wearing high heels. This study reveals that an increase in the total duration of wearing high heels with hard soles increases the symptoms of plantar fasciitis. Plantar fasciitis can be prevented by education and applying ergonomics and could be treated by steroids and the ice method, according to medical practitioners. [ABSTRACT FROM AUTHOR]

Objective: To identify the frequency and types of prescription errors, assess adherence to WHO prescribing indicators, and highlight the gaps in current prescribing practices of Junior dental practitioners in a tertiary care hospital in Karachi, Pakistan. Methods: This cross-sectional study was conducted from January 2021 to March 2021. The study included the prescriptions by house surgeons and junior postgraduate medical trainees for walk-in patients visiting the dental outpatient department. A total of 466 prescriptions were evaluated for WHO core drug prescribing indicators. The prescription error parameters were prepared by studying the WHO practical manual on guide to good prescribing and previous studies. Prescription errors, including errors of omission related to the physician and the patients, along with errors of omission related to the drug, were also noted. The statistical analysis was performed with SPSS version 25. Descriptive analysis was performed for qualitative variables in the study. Results: The average number of drugs per encounter was found to be 3.378 drugs per prescription. The percentage of encounters with antibiotics was 96.99%. Strikingly, only 16.95% of the drugs were prescribed by generic names and 23.55% of drugs belonged to the essential drug list. The majority lacked valuable information related to the prescriber, patient, and drugs. Such as contact details 419 (89.9%), date 261 (56%), medical license number 466 (100%), diagnosis 409 (87.8%), age and address of patient 453 (97.2%), form and route of drug 14 (3%), missing drug strength 69 (14.8%), missing frequency 126 (27%) and duration of treatment 72 (15.4%). Moreover, the wrong drug dosage was prescribed by 89 (19%) prescribers followed by the wrong drug in 52 (11.1%), wrong strength in 43 (9.2%) and wrong form in 9 (1.9%). Out of 1575 medicines prescribed in 466 prescriptions, 426 (27.04%) drug interactions were found and 299 (64%) had illegible handwriting. Conclusion: The study revealed that the prescription writing practices among junior dental practitioners are below optimum standards. The average number of drugs per encounter was high, with a significant percentage of encounters involving antibiotics. However, a low percentage of drugs were prescribed by generic name and from the essential drug list. Numerous prescription errors, both omissions and commissions, were identified, highlighting the need for improved training and adherence to WHO guidelines on good prescribing practices. Implementing targeted educational programs and stricter regulatory measures could enhance the quality of prescriptions and overall patient safety. [ABSTRACT FROM AUTHOR]

Background: This study was exclusively focused on the documentation and cross-cultural evaluation of ethnomedicinal knowledge (EMK) within the diverse linguistic groups of Kohistan situated between the Himalayan and Hindukush Mountain ranges in the north Pakistan. Methods: Data were gathered during the field survey (May 2022 to July 2023) through group conversations, semi-structured interviews, and on-site observation. Venn diagrams were employed to illustrate the comparative assessment of EMK, and different ethnobotanical indices were utilized to examine the data. Results: A total of 96 wild medicinal plant species (MPs) belonging to 74 genera and 52 botanical families were documented. The most reported MPs belong to the family Polygonaceae (11 species), followed by Asteraceae (9 species) and Lamiaceae (8 species). The ethnomedicinal uses of Leontopodium himalayanum, Pedicularis oederi, Plocama brevifolia, Polypodium sibiricum, Pteridium esculentum, Sambucus wightiana, Solanum cinereum, Teucrium royleanum, Rhodiola integrifolia, Aconitum chasmanthum were reported for the first time in this region. Among the reported taxa herbaceous species were dominated (72%), followed by trees and shrubs (17% and 10%, respectively). Digestive problems (40 taxa and 114 use reports) and skin disorders (19 taxa and 549 use reports) were the most cited disease categories, whereas M. communis, M. longifolia, Ajuga integrifolia, Ziziphus jujuba, and Clematis grata exhibited the highest percentage fidelity levels. Out of 109 documented medicinal uses, a mere 12 were shared across all linguistic groups, and Bateri emerges as a notable outlier with the highest number of medicinal uses. In addition, a significant homogeneity was noted in the reported botanical taxa (61 species) among different linguistic groups. However, since the last decade biocultural heritage of Kohistan is facing multifaceted risks that need urgent attention. Conclusion: Our findings could be valuable addition to the existing stock of ethnomedicinal knowledge and may provide ethnopharmacological basis to novel drug discovery for preexisting and emerging diseases prioritizing detailed phytochemical profiling and the evaluation of bioactive potential. [ABSTRACT FROM AUTHOR]

Purpose: Poor mental health in men and women is attributable to disparities in physical traits, social roles, power and health-seeking behaviours. This study aims to examine the gender differences in mental health among Pakistan and German university students and focuses on their right to seek mental health care. Design/methodology/approach: Data on depression, anxiety and stress symptoms, as well as positive mental health (PMH), resilience, social support and life satisfaction, were gathered from Pakistani and German students. Findings: In contrast to the Pakistani group, where no such gender differences were seen, women in Germany reported higher degrees of stress, anxiety and depression, as well as a lower level of overall good mental health. In comparison to German men and women, Pakistani women scored equally high on resilience. While gender had no bearing on life happiness in either Pakistan or Germany, women in both countries perceived more social support than men did. Research limitations/implications: The study's strengths include its large sample size and battery of mental health measures. The results of partial weak measurement Invariance (MI) on the stress subscale underlined the importance of using MI in cross-cultural studies. The validity of a direct comparisons on sum score between different language versions or country samples shall be cautious. Still, there are limitations. Firstly, the authors did not differentiate gender and biological sex, and there was no group of non-binary gender. Pakistani (N = 1,840) and German (N = 7,890) students were in unequal numbers. Again, only university students were sampled, so the results cannot be generalised to older (probably less educated) populations. Self-reported data that mainly obtained via online survey were the third limitation. This design is cost-effective and easy to administer for cross-cultural survey research. However, social desirability and memory bias are common in self-report inventories. Fourthly, although English is an official language in Pakistan and the medium of instruction in education, the authors recommend future study to use questionnaires that have been translated and validated into Urdu (Pakistan's national language) and investigate gender differences in a general population. Fifthly, this is a cross-sectional survey; the authors were not able to explore the causality or risk factors that contribute to the poor mental well-being in Pakistan students in general or the relatively worse mental health in German women. Future studies may investigate the mechanism behind the phenomena observed in this study with longitudinal or experimental design. Last but not least, Germany and Pakistan differ in so many different aspects from culture, religions and history to social structure and economic status, which make it hard to claim whether the observed differences were due to national differences, cultural differences, economic differences, gender inequality differences or other effects. It would be helpful for future studies to include more country samples with clear definitions of different "culture" aspects for a better understanding of gender differences in other countries and in different mental well-being constructs. Practical implications: The current study is the first attempt to compare the gender difference patterns in positive and negative mental health between European and South Asian counties and focuses on gender-specific approaches. Although Pakistani university students reported in general worse mental well-being, the differences between the two genders in mental health (e.g. depression, anxiety, general PMH) were not as pronounced as in the German student sample. Gender comparisons in these mental health constructs would help to improve protective factors against mental illness and to develop appropriate management programmes based on cultural differences. The results suggest that the gender differences found in western countries cannot always be directly translated into the South Asian cultural framework. Our results also highlight the importance of improving the general situation of Pakistan (students) instead of focusing on one gender. At the same time, in Germany, prevention and intervention plans are more warranted for women. It could be that once the general situation in Pakistan is improved, the gender-related differences in mental health will be clearly observed. Originality/value: These findings imply the significance of cultural context when inferring gender variations in mental health. Moreover, it supports the advancement of comprehensive policies to reduce gender-related mental health inequalities and focuses on the equal rights of men and women to get mental health care. [ABSTRACT FROM AUTHOR]

Background: There is an abundance of studies explaining the separate impact of female employment and household wealth status in reducing malnutrition. However, our study has unraveled the combined impact of maternal employment and household wealth on undernutrition among children under three in Pakistan. Methods: Using a sample of 1093 children under three years of age from the Pakistan Demographic and Health Survey 2017–2018, a binary logistic model was employed to gauge factors influencing the children's undernutrition. Results: Our results indicated that children up to a certain age (three years old) with residence in certain regions (Pakistan) and recent episodes of diarrhea had an increased risk of undernutrition. Conversely, secondary and higher maternal education, access to improved water sources, and sanitation facilities lowered the chances of undernutrition in children under three in Pakistan. The interaction between maternal employment and household wealth showed that maternal employment significantly lowered the risk of stunting, being underweight, and wasting among the average, rich, and richest households; however, it did not contribute to child nutrition among the poorer and poor households. Notably, regardless of whether the mother was employed, the wealth status of being rich and richest reduced the risk of stunting, being underweight, and wasting. Conclusions: In overcoming undernutrition, maternal employment significantly contributed to middle-income households. However, in the richer and richest households, the wealth status played a more crucial role compared to the maternal employment. This indicates that while employment plays a supportive role in household resources, the wealth status is overall more influential in reducing undernutrition. [ABSTRACT FROM AUTHOR]

Background: Because of diverse topographical habitats, the Chenab River wetland harbors a wealth of medicinal and food plant species. This paper presents first quantitative assessment on the ethnobotanical use of plants by the local peoples residing in the Chenab riverine area. Methods: The ethnobotanical data were collected from six parts of the Chenab River wetland: Mandi Bahuddin, Gujranwala, Gujrat, Sargodha, and Sialkot during 2014 to 2015, using semi-structured interviews. Quantitative indices including informant consensus factor (FCI), relative frequency of citation (RFC), relative importance level (RIL), use value (UV), fidelity level (FL), and corrected fidelity level (CFL) were used to analyze the data. Results: On the whole, 129 medicinal plant species belonging to 112 genera of 59 families were reported, with herbs as dominant life forms (51%). Poaceae was the leading family with 13 species, and leaves were the most frequently utilized plant parts (28%). Herbal medicines were mostly used in the form of powder or decoction, and were mainly taken orally. Withania somnifera, Solanum surattense, Solanum nigrum, Azadirachta indica, Ficus benghalensis, Morus nigra, Morus alba, Polygonum plebeium, and Tribulus terrestris were among the highly utilized plant species, with highest UV, RFC, RIL, FL, and CFL values. The reported ailments were grouped into 11 categories based on FCI values, whereas highest FIC was recorded for gastrointestinal diseases and glandular diseases (0.41 and 0.34, respectively). The use report (UR) and frequency of citation (FC) depicted strong positive correlation (r = 0.973; p = 0.01). The value of determination (r2 = 0.95) indicating 95% variation in UR can be explained in terms of the FC. Conclusion: The significant traditional knowledge possessed by local communities depicts their strong relation with phytodiversity. Reported data could be helpful in sustainable use and protection of plant species in the Chenab wetland, with special emphasis on medicinal plants. Furthermore, screening of plant-borne active ingredients and in vivo/in vitro pharmacological activities could be of interest for novel drug synthesis. [ABSTRACT FROM AUTHOR]

Background: Although Pakistan was one of the first countries in Asia to launch national family planning programs, current modern contraceptive use stands at only 26% with a method mix skewed toward short-acting and permanent methods. As part of a multiyear operational research study, a baseline survey was conducted to understand the predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan. This paper presents the baseline survey results; the outcomes of the intervention will be presented in a separate paper after the study has been completed. Method: A cross-sectional baseline household survey was conducted with randomly selected 3,998 married women of reproductive age (MWRA) in the Chakwal, Mianwali, and Bhakkar districts of Punjab. The data were analyzed on SPSS 17.0 using simple descriptive and logistic regression. Results: Most of the women had low socio-economic status and were younger than 30 years of age. Four-fifths of the women consulted private sector health facilities for reproductive health services; proximity, availability of services, and good reputation of the provider were the main predicators for choosing the facilities. Husbands were reported as the key decision maker regarding health-seeking and family planning uptake. Overall, the current contraceptive use ranged from 17% to 21% across the districts: condoms and female sterilization were widely used methods. Woman's age, husband's education, wealth quintiles, spousal communication, location of last delivery, and favorable attitude toward contraception have an association with current contraceptive use. Unmet need for contraception was 40.6%, 36.6%, and 31.9% in Chakwal, Mianwali, and Bhakkar, respectively. Notably, more than one fifth of the women across the districts expressed willingness to use quality, affordable long-term family planning services in the future. Conclusion: The baseline results highlight the need for quality, affordable long-term family planning services close to women's homes. Furthermore, targeted community mobilization and behavior change efforts can lead to increased awareness, acceptability, and use of family planning and birth spacing services. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to examine the mediating role of work engagement (vigor and dedication) between personal resources (self-efficacy and Big Five model) and job performance (task and contextual) rated by supervisor. Design/methodology/approach - A sample of 364 nurses and their supervisors was used. Structural equation modeling with Amos-17 was used to obtain model fit with path significance of work engagement as mediator between personal resources and job performance. Findings - The results found support for the proposed conceptual claim and confirm that work engagement with the two-factor model (vigor and dedication) mediates the relationship between personal resources (self-efficacy and Big five model) and with multidimensional construct of job performance (task and contextual performance) rated by the supervisor. Originality/value - Past researches have never tested the two-factor model of work engagement (vigor and dedication) as mediating variable between personal resources (self-efficacy and big five model) and job performance rated by the supervisor. [ABSTRACT FROM AUTHOR]

Appropriate feeding practices are crucial for survival, growth, and development in childhood. This paper analyzes Pakistan's Demographic and Health Survey 2012-2013 to fill the knowledge gap in risk factors of poor complementary feeding practices in Pakistani children. Multilevel models were applied to fit the multistage cluster sample of 2,827 children aged 6-23 months from 489 communities. Introduction of solid, semi-solid, or soft foods (intro) was achieved in 67% infants aged 6-8 months. Among children aged 6-23 months, the proportion of children meeting minimum meal frequency, dietary diversity (MDD), and acceptable diet criteria were 63%, 22% and 15%, respectively. Consumption of legumes and nuts, flesh foods, and vitamin A-rich fruits and vegetables was low in all children (6-19%), even among children who met the MDD criteria (15-55%). Younger child age, especially between 6 and 11 months and delayed maternal postnatal checkup were significant individual-level risk factors that consistently increased the odds of not meeting all four criteria examined. Fewer antenatal care visits predicted the odds of achieving intro and minimum meal frequency while younger maternal age and household poverty predicted the odds of achieving MDD and minimum acceptable diet. Community-level factors included geographic region and general access to maternal and child health care services. The overall poor quality of children's complementary diets in Pakistani calls for stronger policy and program action to promote the consumption of key nutrient-dense foods while prioritizing interventions for the most vulnerable children and populations. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to explore the role of diet in determining insulin-associated weight gain (IAWG) in Pakistani people. Materials and Methods: This observational study was conducted in the Diet and Education Department of Baqai Institute of Diabetology and Endocrinology. The data are obtained from Electronic Health Records from the Health Management System, and it included demographical, anthropometric, clinical, biochemical, and dietary information of the subjects. A total of 917 cases were included in this study, on the basis of inclusion criteria, which were subjects to be of age 18 years and above, diagnosis of type 2 diabetes, and availability of clinical, medical, and dietary data for at least two visits, for subsequent years. Dietary data include energy and macronutrient intake, which is calculated by the system on the basis of food intake data collected and entered by registered dietitians at each visit. Ethical approval for the study was taken from BIDE Institutional Review Board. Results: Differences in the rate of weight gain between insulin-treated and oral antihyperglycemic agents-only-treated groups could not be attributed to differences in dietary changes. Higher intake of insulin in relation to carbohydrate intake was found to be associated with higher weight gain among insulin-treated groups. The rate of weight gain with HbA1c (glycated hemoglobin) increase was lowest among those who had a "decreased" energy intake, with moderate insulin doses, whereas it was highest among those who had high insulin doses with "increased" energy intake. Conclusion: Weight gain was observed following deviation in the macronutrient composition among the insulin users in this study. Dietary intake in relation to body needs for healthy weight and economical doses of insulin appears to have a good potential for inducing normoglycemia without promoting IAWG. [ABSTRACT FROM AUTHOR]

Objectives. Current research aims to identify factors that affect the occupational safety climate in university laboratories despite their perception as low-risk areas compared to industrial environments. Methods. A safety climate survey was conducted in science laboratories across various engineering universities in Pakistan. The survey questionnaire was administered to 406 personnel, and a quantitative method for analysis was selected to examine the socio-demographic variables. A 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) was used to perceive responses from participants. Additionally, a scale reliability test was conducted, and multivariate analysis of variance was performed to determine the relationship between selected dependent and independent variables. Results. The study found an overall safety climate score of 3.16 ± 0.55, indicating a moderate to high perception of safety on a scale of 1–5. Parameters such as role in the laboratory, departments/disciplines, accident experience and safety training significantly affected the safety climate score, while gender, age group, duration in university and accident witnessing did not. Conclusion. Upper management involvement, safety communication and direct supervision are crucial for improving the safety climate of university laboratories. The study recommends the consideration of the identified significant safety climate dimensions in laboratory safety policy-making at academic institutes. [ABSTRACT FROM AUTHOR]

Objectives: This study assesses the frequency of depression, anxiety, and stress in formal and informal caregivers of autistic children in Karachi City, Pakistan. Methods: This cross-sectional study was conducted among caregivers of autistic children in specified centers in Karachi City, Pakistan. There were 255 participants out of which 111 were formal caregivers and 144 were informal caregivers. Depression, anxiety, and stress scale (DASS) was used to collect the data. The chi-square test was used to determine the relationship between the frequency of depression anxiety and stress among the two groups. Results: A total of 76.3% of informal caregivers were suffering from mild depression, 59.3% were moderately depressed, and 76.5% were severely depressed (P<0.01). Similarly, 72.4% had mild anxiety, 68.2% were moderately anxious, and 50.5% were severely anxious (P<0.01). In addition, 75.0% demonstrated mild, 71.1% moderate, 85.7% severe, and 95.0% extremely severe stress (P<0.01). However, there were no significant levels of depression, anxiety, and stress found among formal caregivers. Discussion: Depression, anxiety and stress were more commonly present in parents of autistic children (informal caregivers) as compared to formal caregivers. [ABSTRACT FROM AUTHOR]

Background: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a major worldwide public health issue, with a focus on developing nations. Despite having a very low HIV prevalence, South Asia faces serious issues with stigma and false information because of a lack of awareness. This stigma highlights significant gaps in popular awareness while also sustaining unfavorable attitudes towards those living with HIV/AIDS. Pakistan is ranked second in South Asia for the rapidly increasing AIDS epidemic. Thorough information and optimistic outlooks are essential for successful HIV/AIDS prevention, control, and treatment. But false beliefs about how HIV/AIDS spreads lead to negative perceptions, which highlights the need to look into how women's knowledge and attitudes about HIV/AIDS in Pakistan are influenced by sociodemographic traits and autonomy. Methods: The purpose of this study is to evaluate Pakistani women's discriminatory attitudes and level of awareness on HIV/AIDS. This study used data (the women in reproductive age 15-49 years' dataset) from the Pakistan Multiple Indicator Cluster Survey to conduct an analytical cross-sectional analysis. To represent the respondents' attitudes and knowledge towards people living with HIV (PLHIV), two composite variables were developed and composite scored. Binary logistics regression was used to identify predictor variables and chi-square was used for bivariate analysis. Results: The findings reveal that almost 90% of Pakistani women have poor knowledge and attitude with HIV/AIDS. In Punjab, 72.8% of rural residents have low knowledge, whereas only 20.6% of young individuals (15-< 25 years old) show the least amount of ignorance. Education is shown to be crucial, and "Higher "education is associated with superior knowledge. Urban dwellers in Khyber Pakhtunkhwa typically have more expertise. Knowledge of HIV is positively correlated with education; those with higher education levels know a lot more (odds ratio [ OR ] = 5.419). Similarly, quintiles with greater incomes show a higher likelihood of knowing about HIV (OR = 6.745). The study identifies age, wealth index, place of residence, educational attainment, and exposure to contemporary media as significant predictors influencing HIV knowledge and attitudes among women in these provinces. Conclusion: The majority of respondents had negative opinions regarding the virus, and the majority of women in the study knew very little about HIV. Individuals who live in metropolitan areas, have higher incomes, are better educated, are exposed to contemporary media, and are generally more aware of HIV and have more positive attitudes towards HIV/AIDS, or PLHIV. The study found that, in comparison to those living in urban environments, those from rural areas with low socioeconomic level have a negative attitude and inadequate understanding. [ABSTRACT FROM AUTHOR]

This study explores how information and communication technologies (ICTs) influence transforming attitudes toward intimate partner violence (IPV) and women's empowerment in Pakistan and Nepal. By analyzing data from married women using recent Demographic and Health Surveys, the research reveals that owning multiple ICTs is associated with decreased experiences of physical IPV and reduced acceptance of wife-beating. Notably, increased ownership of ICTs corresponds to heightened participation in household decisions. Furthermore, regular internet use further diminishes the likelihood of experiencing physical IPV and justifying wife-beating. These findings underscore ICTs' potential to empower women, reshape gender norms, and enhance decision-making autonomy. The study advocates for gender-inclusive policy interventions that leverage the transformative influence of ICTs in fostering positive sociocultural changes. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular joint disorders (TMDs) are a variety of conditions that affect different parts of the temporomandibular joints (TMJ) and can cause orofacial pain and functional impairment. This study aims to investigate dental practitioners' knowledge and management of Temporomandibular Joint Disorders (TMDs), particularly their knowledge of the role physical therapy plays in TMD treatment. Methods: A mixed-methods approach was adopted to provide a comprehensive view of current knowledge, management practices, and attitudes toward collaboration among dental practitioners in treating TMD. Data were collected from a convenience sample of 335 dentists in Karachi using a detailed questionnaire to assess their knowledge of the role of physical therapy in the treatment of TMD. Twenty dentists were chosen for face-to-face, in-depth interviews to explore their experiences and challenges in managing TMDs based on their responses to the administered questionnaire. Results: The cumulative quantitative and qualitative findings of the study revealed a landscape marked by individualized approaches to referral practices and significant gaps in interdisciplinary collaboration. Most practitioners holding a bachelor's degree predominantly used medication (65.2%) and cause-specific treatment (65.3%) for TMD treatment. Thematic analysis of clinical efficacy and practitioner challenges in managing TMD revealed significant issues faced by dental professionals. Conclusions: The study successfully validated a questionnaire to understand dental practitioners' knowledge regarding physical therapy in TMD treatment. The study identified significant gaps in knowledge and a lack of collaboration between dentists and physiotherapists. The limited referral practices highlighted in the study, along with insights from dentist interviews, emphasize the need for improved interdisciplinary approaches to managing TMDs within dental practice. [ABSTRACT FROM AUTHOR]

Undernutrition is a major public health problem in developing countries. Around 40·2 % of children are stunted in Pakistan. This longitudinal study aimed to assess the effectiveness of locally produced ready-to-use supplementary foods in the prevention of stunting by detecting change in of children in intervention v. control arm against the 2006 WHO growth reference. A community-based non-randomised cluster-controlled trial was conducted from January 2018 to December 2020 in the district of Kurram, Khyber Pakhtunkhwa, Pakistan. A total of 80 clusters (each cluster comprising ≈ 250–300 households) were defined in the catchment population of twelve health facilities. Children aged 6–18 months were recruited n 1680. The intervention included a daily ration of 50 g – locally produced ready-to-use-supplementary food (Wawa-Mum). The main outcome of this study was a change in length for age z-score (LAZ) v. WHO growth standards. Comparison between the interventions was by t test and ANOVA. Cox proportional hazard models were used to assess the association between stunting occurrence and the utilisation of locally produced supplement. Out of the total 1680, fifty-one out of the total 1680, 51·1 out of the total 1680 and 51·1 % (n 859) were male. Mean age 13·9 months (sd + 859) were male. Mean age 13·9 months (sd + –4·4). At baseline, 36·9 % (n 618) were stunted. In the intervention group, mean LAZ score significantly increased from −1·13(2·2 sd) at baseline to −0·93(1·8 sd) at 6-month follow-up (P value 0·01) compared with the control group. The incidence rate of stunting in the intervention arm was 1·3 v. 3·4 per person year in the control arm. The control group had a significantly increased likelihood of stunting (Hazard Ratio (HR) 1·7, 95 % CI 1·46, 2·05, P value < 0·001) v. the intervention group. Locally produced ready-to-use supplementary food is an effective intervention for reducing stunting in children below 2 years of age. This can be provided as part of a malnutrition prevention package to overcome the alarming rates of stunting in Pakistan. [ABSTRACT FROM AUTHOR]

Introduction. According to the Global Climate Risk Index, Pakistan is ranked as the fifth-most vulnerable country to climate change. Most recently, during June-August 2022, heavy torrential rains coupled with riverine, urban, and flash flooding led to an unprecedented disaster in Pakistan. Around thirty-three million people were affected by the floods. More than 2 million houses were damaged, leaving approximately 8 million displaced and approximately 600,000 people in relief camps. Among those, 8.2 million women and 16 million children are the worst affected, with many requiring urgent medical and reproductive healthcare. To plan an efficient healthcare program and a climate-resilient health system, it is crucial to understand the issues that the affected people face during floods. Methodology. This rapid assessment included the population in the most severely affected districts across the four provinces of Pakistan. A mixed methods approach using qualitative and quantitative techniques was utilized. A total of 52 qualitative, in-depth interviews were conducted with community-level healthcare providers, national and provincial government departments, and development partners involved in relief activities. Using a structured questionnaire, the quantitative cross-sectional survey was conducted with a final sample of 422 women, married and unmarried (15-49 years old), residing in the relief camps in the flood-affected areas. The outcome variable of the survey was the access to sexual and reproductive health services faced by the women in the flood-affected districts. Data collection took place four months postfloods during Nov-Dec 2022, while the data analysis was conducted between Dec 2022 and Jan 2023. The quantitative data was analyzed using SPSS (Statistical Package for the Social Sciences) version 20, and qualitative data was analyzed using NVivo 12. Ethical consent was sought from all the participants. Ethical approval was also sought from the ethics committee of the Health Services Academy, Government of Pakistan. Results. The findings indicated that, overall, all the provinces were unprepared for a calamity of such a large magnitude. Access to services and health data reporting from the flood-affected areas was challenging mainly due to a shortage of trained health workforce because of the displacement of a large volume of the health workforce. Overall, equipment, medicines, supplies, and food were scarce. Women residing in the camps were markedly affected, and 84% (375) were not satisfied with the flood relief services provided to them. The floods impacted their monthly income as 30% (132) of respondents started depending on charity postfloods. Almost 77% (344) reported limited access to sexual and reproductive health services and had yet to receive sanitary, hygiene, and delivery kits, while 69% (107 out of 154) of girls stopped schooling postfloods. Almost 77% (112) of the married women reported having a child less than one year of age. Yet, only 30% (44 out of 144 currently married women) were using any form of family planning method—damage to the health facilities affected access to overall maternal care services. Conclusion. The findings concluded that there was no planning for sexual and reproductive health services in the flood-affected areas. Several barriers were identified. The government and development partners needed to prepare to cater to women's needs during the floods. The findings highlight the need for collaborative efforts between the government, civil society, and development partners to address the challenges faced in disaster management and strengthen disaster management capacity. [ABSTRACT FROM AUTHOR]

Purpose:Very little is known about how older people from black and minority ethnic (BME) groups caring for someone after a stroke access and engage with social care services. This paper explores both the experiences of carers whose relative was receiving social care services in their own home and the value of a theory of humanising care to understand and explain these experiences. Method:Semi-structured interviews were undertaken with 50 carers from five different ethnic groups: Asian Indian, Asian Pakistani, Black African, Black Caribbean and White British. Data were thematically analysed within a phenomenological framework. Results:Five interacting themes emerged: communication and bureaucracy; time and timing; communication and rapport building; trust and safety; humanity and the human dimensions of care. Many of the experiences could be interpreted within a conceptual framework of humanising care underpinned by eight interacting dimensions of what it means to be treated as an individual and a human. Conclusions:Carers from BME and White British groups share many experiences of homecare although language and cultural difference may exacerbate common pressures and stresses. The framework for humanising care is a useful tool to evaluate aspects of homecare that are responsive to dignity and diversity.Implications for RehabilitationExplicitly identifying, describing and valuing the human dimensions of care may support services in responding appropriately to homecare users from black minority ethnic communities as well as those from white majority groups.Unresponsive services and poor communication may lead to loss of trust with care agencies and undermine BME carers’ sense of entitlement and competence in engaging with homecare services.Care worker continuity investing time in building relationships and care worker familiarity is important to many families who access social care services. [ABSTRACT FROM AUTHOR]

Background: Optimum oral health is impossible to achieve without managing dental caries. The first step to manage dental caries at a community level is to know its prevalence and trend. Unfortunately, the prevalence of dental caries at the national/regional level is not known in many developing countries. Pakistan is no exception. The present meta-analysis was planned to document the prevalence of dental caries at the national, as well as regional level. This paper will serve as a baseline for making future health policies, and health promotion activities in the country. Methods: Literature was searched through various databases, such as PubMed, SCOPUS, and Web of science using: "Prevalence", "Dental Caries", "Dental Decay" and "Severity" as keywords. Any study that reported the prevalence of dental caries, and was conducted in the Pakistani population was included. Thirty studies fulfilled the inclusion criteria. Quality assessment of all the included studies was performed using Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence studies. MedCalc software was used to analyze the data. Results: In total 27,878 subjects were included in a meta-analysis from 30 studies. The prevalence estimate of dental caries at the national level was 56.62% (95% CI: 49.54 to 63.57). The I2 value was 99.07% (95% CI: 98.94 to 99.18), (I2 > 75%) indicating heterogeneity, hence pooled proportion was reported using a random-effect model. The prevalence estimate of dental caries in Sindh was 58.946% (95% CI: 43.796 to 73.274), and in Punjab, it was 55.445% (95% CI: 44.174 to 66.44), whilst in Baluchistan and KPK combined was 51.168% (95% CI: 22.930 to 79.004). Conclusion: Based on the existing data nearly 60% of the Pakistani population have dental caries. The proportion is almost the same in all provinces. Most of the included studies were found to be of high risk. [ABSTRACT FROM AUTHOR]

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Aim. This research study aims to examine the professional quality of life (ProQOL) among healthcare workers (HCWs) in Pakistan during the fourth wave of COVID-19. Background. Under intense pressure to fight the coronavirus disease 2019 (COVID-19) pandemic, HCWs are more likely to experience psychological problems. Numerous investigations carried out in the past at various points during the pandemic have shown that COVID-19 has had important detrimental effects on HCWs. However, there are many unknowns with regard to ProQOL for HCWs. Methods. This is a cross-sectional study conducted with Pakistani HCWs who performed their duties during the fourth wave of COVID-19. Data were collected between January 1 and March 31, 2022. A total of 258 HCWs took part in the study evaluating ProQOL. The significance level was <0.05. Results. Most respondents were males (79.1%), and 20.9% were females. The scores of secondary traumatic stress (STS), burnout (BO), and compassion satisfaction (CS) were 24.03 ± 3.79, 19.18 ± 2.92, and 35.29 ± 4.37, respectively. Compared with higher-income groups, HCWs with lower incomes were significantly (P < 0.001) more likely to experience psychological issues. Males had lower BO and STS than female HCWs (P < 0.001). Similarly, doctors had a lower STS than nurses (P < 0.05). HCWs who worked hours per day longer had a heavier STS (P < 0.001). Conclusion. This study shows low BO levels, moderate CS levels, and STS levels among HCWs. HCWs with lower salary were at a higher risk of mental distress due to the pandemic. HCWs who worked for long hours and had less income had more STS and BO. HCWs who were dissatisfied with their works had poor CS. Implications for Nursing Management. It is supposed that these results may help HCW managers to improve job satisfaction and rewards while reducing working hours and workload to improve the ProQOL of HCWs fighting COVID-19. The government should focus on the mental health of HCWs, enhancing their satisfaction and allocating sufficient resources. [ABSTRACT FROM AUTHOR]

This research examines individual and area level factors associated with maternal health care utilization in Pakistan. The 2012-2013 Pakistan Demographic and Health Surveys data was used to model five outcomes: prenatal care within the first trimester, four plus prenatal visits, birth attendance by a skilled attendant, birth in a medical facility, and receipt of postnatal care. Less than half of births were to mothers receiving prenatal care in the first trimester, and approximately 57 % had trained personnel at delivery. Over half were born to mothers who received postnatal care. Evidence was found to support the positive effect of individual level variables, education and wealth, on the utilization of maternal health care across all five measures. Although, this study did not find unilateral differences between women residing in rural and urban settings, rural women were found to have lower odds of utilizing prenatal services as compared to mothers in urban environments. Additionally, women who cited distance as a barrier, had lower odds of receiving postnatal health care, but still engaged in prenatal services and often had a skilled attendant present at delivery. The odds of utilizing prenatal care increased when women resided in an area where prenatal utilization was high, and this variability was found across measures across provinces. The results found in this paper highlight the uneven progress made around improving prenatal, delivery, and postnatal care in Pakistan; disparities persist which may be attributed to factors both at the individual and community level, but may be addressed through a consorted effort to change national policy around women's health which should include the promotion of evidence based interventions such as incentivizing health care workers, promoting girls' education, and improving transportation options for pregnant women and recent mothers with the intent of ultimately lowering the Maternal Mortality Rate as recommended in the U.N.'s Millennium Development Goal 5. [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]

BACKGROUND: The realization of the China-Pakistan Economic Corridor (CPEC) has opened up new horizons for economic development along with threats to climate change in Pakistan. It has intended to change the social and corporate landscape, which necessitates investigation regarding corporate green HRM practices and employee behaviors of the firms involved. OBJECTIVE: This study developed a theoretical framework and investigated the mediating impact of pro-environmental psychological climate (PEPC) between green human resource management (GHRM) and pro-environmental behavior (PEB) of the employees working under CPEC in Pakistan. Therefore, the core intent lies in recognizing those aspects of manipulating the pro-environmental behavior of the employees of the firms involved. METHODS: Based on the simple random sampling technique, data was collected from 388 employees using a quantitative approach. SmartPLS was used to analyze the data. RESULTS: The findings suggest that GHRM practices have an impact on organizations' pro-environmental psychological climate and employees' pro-environmental behavior. Furthermore, the pro-environmental psychological climate encourages employees to engage in environmentally friendly behaviors within Pakistani organizations working under CPEC. CONCLUSION: GHRM has proved to be a vital instrument for attaining organizational sustainability and pro-environmental behavior. The original study results are particularly valuable for employees of the firms working under CPEC as they motivate them to engage in more sustainability solutions. The study findings add to the body of GHRM practices and strategic management, and thus policymakers can better postulate, align, and exercise GHRM practices. [ABSTRACT FROM AUTHOR]

Objectives: Reflective practice is a thinking method about experiences, learning from mistakes, identifying skills and strengths, and developing options and actions for change and future success. This practice empowers individuals to explore diverse methods of introspection, thereby enhancing their proficiency in applying reflective techniques within both personal and professional domains and ultimately fostering their learning skills and self-development. Objectives: This study aims to compare the reflective practice and self-assessment methods of novice practitioners who graduated from the governmental and private sectors. Methods: A comparative cross-sectional study was conducted on 138 practitioners who graduated from the governmental and private sectors (69 from the governmental sector and 69 from the private sector). A random sampling method was used to collect data. Data were analyzed using SPSS software, version 20. Mean±SD was calculated for five main variables. Independent t-test was applied to calculate the reflective practice of novice practitioners. P=0.05 was considered statically significant. Results: The study focused on investigating various factors related to the reflective practice of novice practitioners. All five main variables, namely reflection on events, reflection methods, others' points of view, questioning of assumptions, and ability to reflect, were examined for potential differences between the graduates of private and governmental sectors. The results indicated no significant differences between these sectors, as evidenced by the P<0.05. Discussion: This study concluded that no significant difference is observed between reflective practice and self-assessment methods of novice practitioners who graduated from government or private institutes because reflective practice is the ability of a person to think and learn from experience in a way. [ABSTRACT FROM AUTHOR]