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Inuit youth in Nunavut (NU) are resilient but face a protracted suicide crisis. The SPARX serious game and e-intervention, developed originally in New Zealand, teaches youth cognitive behavioural therapy (CBT) skills to ameliorate stress and depression. Inuit youth in NU reviewed and culturally adapted SPARX and an existing wellness outcome measure for Inuit. One hundred and twenty-one youth, aged 13 to 24, across NU then tested, played, and evaluated I(nuit)-SPARX, showing improvement in several areas of wellbeing post-play. Youth completed a CBT skills survey, engaged in sharing circles to assess CBT skill retention, and shared their thoughts about the usefulness and cultural fit of I-SPARX with Inuit Qaujimajatuqangit (IQ). Communication Skills, Listening Skills, and Problem Solving emerged as the most helpful learned CBT skills, and NU youth provided real-world examples of using I-SPARX skills to support their mental wellness. Several principles of IQ were exemplified and upheld in the content of the adapted SPARX tool and the process of the project as a whole. Empirically grounded, asynchronous e-tools, developed in collaboration with Inuit communities to ensure cultural specificity, may support psychological wellness in communities where mental health resources are scarce.

As an eco-friendly and technically feasible method for physical modification of materials, bead-milling has been extensively used in many industrial applications ranging from chemicals, nanomaterials, foods, and pharmaceuticals with impacts on particle size, surface morphology, stability, and overall products’ performance. Apparently, there have been limited studies conducted on sulfur curative dispersion using this technology, necessitating a thorough investigation of its performance. The objectives of the present study were to explore the influence of the bead-milling process parameters, particularly rotational speed and flow rate, on the sulfur curative dispersion characteristics and to analyze its behavior within the rubber elastomer matrix. Taguchi’s L9 orthogonal array experimental design was employed to identify the optimal rotational speed and flow rate of a 60-L bead-milling machine on the sulfur curative dispersion. The stability and morphology of the resulting sulfur curative dispersion were characterized, along with its mechanical properties in rubber elastomers. It was found that higher rotational speed (800 rpm) and lower flow rate (350 L/h) of the bead-milling process resulted in smaller sulfur particle sizes, leading to improved tensile strength of the rubber elastomer. This research may provide valuable insights to determine the ideal bead-milling process for sulfur curative, enhancing the mechanical properties and overall performance of elastomeric rubber composites as well as across various fields. ABSTRAK: Sebagai sebahagian kaedah mesra alam dan secara teknikal dapat mengubah suai bentuk fizikal bahan, mesin pengisaran manik telah digunakan secara meluas dalam kebanyakan aplikasi industri termasuk kimia, nanomaterial, makanan, dan farmaseutikal dengan kesan pada saiz zarah, morfologi permukaan, kestabilan, dan prestasi keseluruhan produk. Namun, terdapat kurang kajian terhadap taburan kuratif sulfur menggunakan teknologi ini, menyebabkan penyelidikan menyeluruh diperlukan bagi menilai prestasinya. Objektif kajian ini adalah bagi mengkaji pengaruh parameter proses pengisaran manik, terutamanya pada kelajuan putaran dan kadar aliran, iaitu terhadap ciri-ciri taburan kuratif sulfur dan mengkaji tindak balasnya pada matriks elastomer getah. Reka bentuk eksperimen Taguchi L9 bersusunan ortogonal telah digunakan bagi mengenal pasti kelajuan putaran dan kadar aliran optimal mesin pengisaran manik 60 liter terhadap taburan kuratif sulfur. Kestabilan dan morfologi taburan kuratif sulfur yang terhasil telah dicirikan, bersama sifat mekanikal dalam elastomer getah. Dapatan mendapati bahawa proses pengisaran manik pada kelajuan putaran lebih tinggi (800 rpm) dan kadar aliran lebih rendah (350 L/j) menyebabkan saiz zarah sulfur lebih kecil, membawa kepada peningkatan kekuatan regangan elastomer getah. Kajian ini mungkin memberikan pengetahuan penting bagi menentukan proses pengisaran manik yang ideal untuk kuratif sulfur, meningkatkan sifat mekanikal dan prestasi keseluruhan komposit getah elastomerik serta pelbagai bidang lain.

BackgroundStudents’ mental health crisis was recognized before the COVID-19 pandemic. Mindfulness virtual community (MVC), an 8-week web-based mindfulness and cognitive behavioral therapy program, has proven to be an effective web-based program to reduce symptoms of depression, anxiety, and stress. Predicting the success of MVC before a student enrolls in the program is essential to advise students accordingly. ObjectiveThe objectives of this study were to investigate (1) whether we can predict MVC’s effectiveness using sociodemographic and self-reported features and (2) whether exposure to mindfulness videos is highly predictive of the intervention’s success. MethodsMachine learning models were developed to predict MVC’s effectiveness, defined as success in reducing symptoms of depression, anxiety, and stress as measured using the Patient Health Questionnaire-9 (PHQ-9), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS), to at least the minimal clinically important difference. A data set representing a sample of undergraduate students (N=209) who took the MVC intervention between fall 2017 and fall 2018 was used for this secondary analysis. Random forest was used to measure the features’ importance. ResultsGradient boosting achieved the best performance both in terms of area under the curve (AUC) and accuracy for predicting PHQ-9 (AUC=0.85 and accuracy=0.83) and PSS (AUC=1 and accuracy=1), and random forest had the best performance for predicting BAI (AUC=0.93 and accuracy=0.93). Exposure to online mindfulness videos was the most important predictor for the intervention’s effectiveness for PHQ-9, BAI, and PSS, followed by the number of working hours per week. ConclusionsThe performance of the models to predict MVC intervention effectiveness for depression, anxiety, and stress is high. These models might be helpful for professionals to advise students early enough on taking the intervention or choosing other alternatives. The students’ exposure to online mindfulness videos is the most important predictor for the effectiveness of the MVC intervention. Trial RegistrationISRCTN Registry ISRCTN12249616; https://www.isrctn.com/ISRCTN12249616

Background: Continuing professional education (CPE) or continuous education (CE) is the means by which people maintain their knowledge and skills related to their profession. Mandatory continuing education is a major factor in relicensure that is being licensed to practice for a specific period with the license either getting renewed at the end of that period or forfeited. This study is designed to assess the awareness regarding importance of continuing professional education as a requirement for re-licensing among General Dental Practitioners and Specialists and to identify the role of governing bodies for endorsing re-licensure procedure on the basis of CME Methods: Cross sectional study was conducted among 450 dentists practicing in Karachi (July 2013 to Dec 2013), divided in to two groups ;General Dental Practitioners (n=350)and Consultant Specialists(n=100). Simple Random sampling technique was applied thorough lottery from available list of Dentists and Consultants. Data was collected through a self administered questionnaire. SPSS version 20 was used for analysis and Chi –square test to assess associations of categorical variables. P value less than 0.05 was considered as significant. Results: Majority participants n= 250 (55.6%) were aware about re -certification and re-licensing and n= 292 (64.9%)knew the difference between the two. Only n=153 (34%) were of the view that re -certification and re-licensing should be made mandatory in Pakistan. Conclusion: The awareness of CME & re-certification is high among our professionals Key Words: Re-certification, Re-licensing, Continuous Medical Education.

In Pakistan, tobacco consumption is at an all-time high with the tobacco industry witnessing a boom. According to the Pakistan Tobacco Company, production and sale has taken a sharp leap from Rs.1,000 million rupees to Rs.1,750 million in 2008. The youth remain particularly vulnerable as massive antismoking ad campaigns have failed to drill in the health hazards. The aim of this study is to assess the attitude, perception and practices of youth regarding cigarette smoking. Comparative cross-sectional study was conducted in Ziauddin University and Bahria University. Sample was taken from all years of teaching. Data was collected through self-administered structured questionnaire that was developed in English. It comprised of questions pertaining to their year of study, smoking history, and perception and practices regarding smoking. A total of 450 students were surveyed, medicine (n=260) and engineering (n=190). One-fourth of the survey sample admitted to have tried to smoke at least once in their lifetime (p=0.001), and at least 20% medical students (n=53) and 35% of engineering students (n=66) surveyed had smoked a cigarette (p=0.001). While students studying medicine were better aware of the risks associated with smoking and tobacco consumption, however compared to engineering students their overall knowledge of the health risks was unsatisfactory. A significant number of medical students were unable to list and hence effectively counsel about long and short term health benefits. Peer pressure and media played a large role in students picking up the habit. KEY WORDS: Pakistan/Epidemiology, Smoking, Karachi, Mechanism Medical Students.

Background: Thyroid gland volume (TGV) is highly variable as it is greatly influenced by age, gender, anthropometric measurements and geographical location. It has become essential for every population to determine reference range of their normal thyroid gland volume (TGV) in healthy individuals. This in turn will help the population in grading of goiter and will guide in large scale iodine monitoring programs. Objective: To determine TGV in a subset of Karachi population and to determine its association with age and gender. Methods: A cross-sectional study employing 421 volunteers aged 21 years and above went through the ultrasound (US) examination of their thyroid gland (TG) after being confirmed euthyroid by their serum thyroid stimulating hormones (TSH) evaluation. Results: TGV in the study was found to be 6.26 ± 2.89 ml. Males had significantly higher TGV 6.78 ± 2.88 ml as compared to females 5.7 ± 2.79 ml (P=0.00). Volume of right lobe was significantly greater than that of left lobe (P=0.00) in both the genders. TGV increased significantly with age till 60 years (P

Background: Osteporosis is increasingly observed as a major public health concern as it leads to poor quality of life, pain and often disability for those effected. Especially in the developing countries, its prevalence in alarming in the face of poor awareness and management. Objective: To assess the risk factors for osteoporosis in females coming to a tertiary care hospital of Karachi. Methods: This was hospital based case control study conducted in a private tertiary healthcare facility of Karachi. It was carried out in 2012. 57 cases and 60 controls were selected through WHO Sample size calculator. Matching among cases and controls was based on gender, socioeconomic status and age group. Data was collected through questionnaire based personal interviews. Data entry and analysis was done using Epi Info. Association between categorical variables was found using chi square. Odds ratio was calculated for finding association between different risk factors and osteoporosis. The study was cleared through the Ethical review board. Results: One hundred and seventeen cases and controls were taken in this study with the age range of 45+ years (mean age 56.8 ± 11.8). Statistically significant difference was found in under 50 age group where cases were only n=8 (14%) as compared to controls n=25(42%). Parsi ethnicity showed strong association with osteoporosis (OR 2.23). Strong association was observed between smoking and osteoporosis with an Odds Ratio of 4.0. Strong association was observed with Rheumatoid arthritis (OR 2.8, CI at 95% 1.2-6.3) and Calcium deficiency (OR 2.2, CI at 95% 1.1-4.7). Conclusion: The study revealed specific to Parsi ethnicity, family history, smoking, rheumatoid arthritis and Vitamin D deficiency were found to be potent risk factors. Therefore as reaffirmed from our study also, risk factors except from the non modifiable ones should be tackled well in advance through health education and interventions. Key Words: Osteoporosis, Rheumatoid Arthritis, Bone Density

Background: Motivation and job satisfaction ultimately effect work performance of an individual. There are various factors which influence the work motivation and knowledge of these factors can help in improving the work performance. Objective: To assess the different factors that are associated with work motivation among nurses working in private and public tertiary care hospitals of Karachi. Methods: This descriptive, cross-sectional study was carried out among nurses for duration of 3 months in 2013. Total 240 nurses from two tertiary care hospitals of Karachi were selected by convenience sampling. A pretested and self-administered questionnaire was used to assess factors associated with work motivation. Data was analyzed using SPSS version 20.0. Results: Of total 240 study participants, 48.8% (117) nurses were in favor of financial incentives that motivate them most. Salary structure and appraisal system both showed significant difference (p-value= 0.000) between nurses from public and private hospitals while the most content place to work was reported government hospitals by 43.4% (104) nurses. Work motivation mean score revealed significant difference (p-value =0.003) among nurses from different working areas of hospital. Factors associated with job satisfaction showed significant difference (p value = 0.000) among nurses from private and public sector hospitals. Conclusion: Financial incentives were found to be the most important motivating factor for nurses that improve their performance. It was also concluded that public sector hospitals along with so many factors of satisfaction are the most content place of working that motivate them most. Key Words: Motivation, Nurses motivation, Tertiary care hospital, factors of motivation.

Background: It is estimated that more than 6 million children die in the developing world at the hands of preventable conditions; primarily pneumonia and diarrhea. WHO in 1992 initiated the Integrated Management of Childhood Illness (IMCI) program as a strategy to provide an integrated approach for the management of major causes of childhood morbidity and mortality. Objective: To assess if IMNCI workshops that are held in hospitals that have post graduate training program in field of pediatrics are effective in enhancing knowledge; hence skills for improving health care delivery in limited resources. Methods: A KAP survey was conducted in 2013 among IMNCI trained doctors working in 5 tertiary care hospitals of Karachi. N=57 doctors were identified and administered a structured questionnaire based on recall questions and scenarios. Questionnaire was developed from a similar study conducted elsewhere. Data entry and analysis was done on SPSS version 20. Results: A total of n=57 doctors were included in the study, out of them resident medical officers (RMO) were n=10, postgraduate trainees (PG) n=38 and Medical Officers (MO) were n=9. Mean score of correct answers was 14 (3). No significant difference was observed when mean scores of PGs was compared with RMO and MO combined through application of Independent sample t test. Conclusion: The study revealed gaps in knowledge and practices of trained doctors regarding management according to IMNCI guidelines. Key Words: IMNCI, Vaccination, WHO, Training Programs.

Background: To find an association between presence of Chronic disease with Oral Health. Methods: It was a cross sectional study conducted in the Dental OPD of LCMD Karachi in 2014. Three hundred participants were enrolled in this study through consecutive sample technique. Data was collected using the self administered questionnaire along with the assessment of oral health examination, which was carried out by the Researcher and data was analyzed on SPSS version 20. Results: It was observed that 59% (n=176) suffered from chronic diseases and when oral examination was conducted, it was revealed that 39% (n=117) had mobile teeth (P value= 0.001), 39.3% (n=118) had missing teeth P value=(0.001) , 60.8% (n=115) had bleeding gums, 60.2% (n=112) had halitosis, 60.2% (n=71) had dry mouth, 61.3% (n=84) had oral ulcers,60.6% (n=117) had complain of food deposition and 60% (n=90) had tooth spacing due to periodontal diseases. Conclusion: It was concluded from this study that majority of participants with chronic diseases had poor oral health which needs immediate attention by the medical practitioners during the treatment of chronic diseases and as well as dentists should counsel the patients for maintenance of oral health. It still remains a chicken egg dilemma regarding the temporal sequence of events as many oral pathogens share a common factor with NCDs. Key Words: Association Non communicable Diseases, Oral Health

Background: To assess the satisfaction levels of employees in a health care organization at Karachi, Pakistan. Methods: A cross sectional survey was conducted on 598 employees working at University and tertiary care hospital for a period of 5 months. Purposive sampling technique was used for collection of data. All employees working for at least one year at any level of management were included in the study. Part time employees, visiting staff, those absent at the time of data collection and those who refused to consent were excluded from the study. Self administered questionnaires were utilized for the purpose of data collection. Entire analysis was performed using SPSS version 20. P value less than 0.05 was taken as significant. For descriptive statistics frequency and percentages were calculated for categorical variables while mean and standard deviation for numerical variables. Analysis of Variance was applied to see association between different groups. The study was approved by the ethical review board. Results: Majority 69.4% (n=415) employees were found to be satisfied. Upper management was seen to have slightly lower scores of satisfaction compared to middle and lower management levels. Between clinical & non-clinical side there was also no significant difference observed in the satisfaction level. Satisfaction levels were seen directly proportional to age and length of service. When overall benefits were seen non clinical side 61% (n=84) were found to be more dissatisfied than clinical side 40% (n=53). Conclusion: Study findings conclude that majority employees were satisfied. However most were dissatisfied with the overall benefit package and vacation policy. Key Words: Employee satisfaction, Management, Tertiary care hospital

Background: Chronic Hepatitis C (CHC) is highly prevalent in Pakistan. Current standard treatment is Interferon alpha/ Peginterferon with oral ribavirin. Interferon therapy is associated with development & worsening of depressive symptoms in CHC patients and to determine the frequency of depressive and anxiety symptoms among patients on treatment with interferon/ Pegasus. Methods: This cross sectional study was conducted at OPD of Liaquat University Hospital Hyderabad during a period of 4 months (from July2013 to October2013). A sample of 120 patients aged 18-60 years, either currently receiving interferon/ Pegasus treatment or had received that treatment during last 12 months was taken. Known cases of anxiety, depression and those suffering from other debilitating co morbid conditions like carcinoma & non-consenting were excluded. Ethical approval was taken from LUH ethical review committee. A Proforma was used to gather the data. The data collected were analyzed using SPSS version 20.0. Mean (±SD) were computed for quantitative variables. Categorical variables (such as gender and outcome variables i.e. anxiety and depressive symptoms) were measured in frequencies and percentages. Stratification was done with regard to age group & gender to see the impact of these on the outcome followed by application of chi-square test with P-value

Background: Injuries due to motorcycle accidents are frequent happenings in developing countries as people utilize it commonly as a mode of transport. In Pakistan 56% of Maxillofacial injuries can be associated to Road traffic accidents (RTA) majority of which are due to involvement of motorbikes. Methods: This cross sectional survey was carried out in public tertiary care setting in the year 2016. Three Hundred and Seventy participants were inducted in the study using Purposive sampling technique. Only those with maxillofacial injuries were included and diagnosed through conventional and panoramic radiographs and computed tomographic scans. Those who consented were included whereas, participants with language barrier or unable to answer were excluded. Data was collected by questionnaire with analysis being performed on SPSS version 21. Descriptive analysis was performed for quantitative variables with association between categorical variables tested through chi square. Bond of error was taken at 5% with 95% confidence interval. Permission was sought from ethical review board. Results: Majority, [267(84.5%)] were young patients with [ 282(89.2%)] patients involved in Motorcycle accidents. Of total participants male gender was [275(87%)] the driver inflicted in most situations [184(58.2%)]. Most patients [285(90.2%)] were without any safety device. Majority [220(69.6%)] had Mandibular fractures whereas, 111(35.1%) had Maxillary fractures. Soft tissue injuries were seen in 212(67.1%) patients. Conclusion: Motorcycle related accidents are common cause for maxillofacial injuries in road traffic accidents. Most patients suffered soft tissue injuries. Most commonly fractured bones were mandible and maxilla. Key Words: Maxillofacial injuries, Motorcycle, Accidents

Background: Body dysmorphic disorder (BDD), once known as dysmorphophobia, is a mental disorder in which the person afflicted is engrossed with an imagined imperfection in their appearance that is actually normal or is very minor. Methods: The cross-sectional study was conducted in Karachi at Ziauddin University targeting female students between the ages of 17– 25, using an adapted questionnaire which was used to diagnose BDD and determine the role of media in influencing their self-image. Results: Out of the 180 students included in this study, at least 9.4% were highly concerned about one or more than one physical attributes, while 2.8% showed extreme concern. 6.1% met the DSM-V criteria for BDD. The most frequent foci of concern were: Being too fat or too thin (35%), skin (24.4%), hair (15%), teeth (14%) and nose (14%). 24.4% of the students got sad/angry/depressed because of their appearance .The study also showed that 42% of the subjects spent 1-2 hours watching television every day, and 13.9% watching 3-7 hours of television per day. 46.7% also regularly visit entertainment/beauty websites or read entertainment magazines. 22.8% were extremely satisfied with their appearance, as opposed to 4.4% which were extremely dissatisfied. Conclusion: Our results show that BDD is widespread amongst female college students. The body features of concern were recognized and the influence that media, either through the use of beauty magazines or television/movies on self-image was estimated. Key Words: Body Dysmorphic disorder (BDD), Females, Frequency, Risk factors

The health of the common man, an oft-neglected issue in many developing countries, is marked by rampant corruption and gross neglect on the part of the very institutions delegated with this responsibility. It is rather unfortunate that Bioethics, despite being recognized as an important discipline and being around for more than 40 years, when there is a need to be reinforced in developing countries there is a blatant disregard for the ethical principles.

Background: The association between health and nutrition are eminent. Quality nutrition is acknowledged as one of the most important determinants of optimal development, good health, and wellbeing. Therefore, the study aimed to determine the knowledge, attitudes, and practices amongst adolescents regarding nutrition. Methods: It was a cross-sectional study conducted between 2016 to 2017 in Karachi. The sample size was 384; the purposive sampling technique was applied with a target population of adolescents between 14 and 19 years of age. Informed consent was taken before the questionnaire submission. Data were collected via self-administered questionnaires from students of various schools in Karachi. The Chi square test was applied for associations and a p-value of

ABSTRACT BACKGROUND: Treating patients with multi-morbidities have always been more difficult when compared to patients with no co-morbid conditions. Hence data from this study will empower us in exhibiting effective plans in the management of multi-morbidities with sepsis in our region. Objective: To determine the association of multi-morbidities with sepsis in adult patients admitted in a tertiary care hospital. Materials and Method: This is a case-control study conducted in the Medicine Wards and Intensive Care Unit of a tertiary care hospital in Karachi during the period of May 2018 to October 2018. Results: In this study, 52 patients were enrolled. The mean age of patients was 59.35 ± 6.17. Socioeconomic Status showed significant association (p-value 0.034). The Mean SOFA Score was 2.13 ± 1.86. The Odds of having cancer [OR: 3.10 (0.10 - 80.1), p-value 0.50] and other multimorbidities like rheumatoid arthritis [OR: 3.30 (0.30 - 33.6), p-value 0.32] in cases of sepsis respectively were more than in controls but the data was not statistically significant. The Mean Length of Hospital Stay was 4.71 ± 2.08. Conclusion: An association of multimorbidities in patients with sepsis could not be determined and requires to be researched further.

Background: Sex education is based on addressing the issues relating to human sexuality or other sexual activity includes reproductive health, emotional relations, reproductive rights and responsibilities, abstinence, consent and birth control. Youngsters, a vulnerable age group, experiment and engage in risky activities such as seeking information from adult themed content and pornography sources. Since, no study has addressed this subject thus; our study aims to see if there is an association between watching of pornography and lack of sex education among youngsters in Pakistan. Methods: The sample 151 at 95% confidence level consisted of both male and female participants (ages of 16-24 years). The data collection tool used in this study was an online questionnaire. Chi square was used to develop an association between lack of sex education and watching of adult themed content. All tests were significant when p

Background: Parental stress is the major factor that increases a risk of unwillingly placing children with disabilities. The aim of our study is to assess the frequency of depression amongst parents of children with intellectual disability. Methods: This was a cross sectional study conducted for 10 months in various hospitals and rehabilitation centers in Karachi, Pakistan. Participants were inducted using purposive sampling technique. Parents of intellectually challenged children up to 18 years of age were included and a self-administered questionnaire was utilized for data collection both in English and Urdu. PHQ 8 was used to assess the severity of depression amongst parents. For all purposes, p-value of

Food manufacturing generates a considerable amount of leftovers. Garbage disposal could cause environmental and ecological issues. Nevertheless, it is often possible to convert waste into high-value usable goods. Researchers have combed through natural wastes and discovered substances that could be re-utilised to address the issues. One of the materials discovered in marine waste is chitin, which could be transformed into chitosan. Chitosan is a natural biopolymer derived from chitin, which is non-toxic, biodegradable, and biocompatible. Therefore, chitosan has a wide range of possible applications. Moreover, chitosan has been widely acknowledged to be an effective biomaterial in a variety of ways. This review aims to examine more closely the primary sources of chitosan, extraction methods, and applications.

Despite significant advancements in the development of psychotropic medications, increasing adherence rates remain a challenge in the treatment and management of psychiatric disorders. The purpose of this study is to qualitatively explore the challenges underlying medication adherence and strategies to improve it among adolescents with psychiatric disorders in Malaysia. This qualitative research design presents results from 17 semi-structured interviews with adolescent psychiatric patients, aged 11 to 19 years old, from public hospitals across Peninsular Malaysia. The data collected from interviews were transcribed and processed through thematic analysis using the NVivo 11 software. A total of three main themes concerning medication adherence were identified: (1) challenges; (2) coping strategies and (3) protective factors. In this study, thirteen subthemes emerge as challenges underlying medication adherence experienced by adolescent psychiatric patients. The coping strategies identified in this study fall under three broad subthemes which are problem-focused strategies, emotion-focused strategies and maladaptive strategies. This study also highlights social support and positive medicinal effects as protective factors for non-adherence issues in adolescent psychiatric patients. In conclusion, this study supports the notion that adherence is a multi-factorial phenomenon. This study can inform future development of interventions and targeted health promotion programmes in enhancing adherence.

Depression and anxiety are prevalent mental health issues worldwide, especially among parental caregivers. By expanding the family stress model, this cross-sectional study investigated the relevant factors associated with depressive symptoms, anxiety symptoms, and satisfaction with life among Malaysian parental caregivers of adolescent psychiatric patients. Data were collected through questionnaires (N = 207) across five major public hospitals through convenience sampling. Participants answered questionnaires measuring financial strain, caregiver burden, relationship quality, belief in mental illness, perceived COVID-19 stress, satisfaction with health services, depressive symptoms, anxiety symptoms and life satisfaction. Findings revealed that relationship quality among spouses, COVID-19 stress and caregiver burden were significantly correlated with anxiety symptoms, depressive symptoms and satisfaction with life. The multiple regression model also suggested that depressive symptoms (β = .613, p < .001), anxiety symptoms (β= .657, p < .001) and relationship quality among spouses (β = .264, p < .001) were the most influential predictors of anxiety symptoms, depressive symptoms and satisfaction with life respectively. By addressing the mental health needs of parental caregivers, this study can contribute to improving the overall quality of care and support provided to adolescent patients and their caregivers in Malaysia and beyond.

A large amount of crude palm oil production in South East Asia (SEA) is causing the production of a vast amount of agricultural waste from the palm oil industry. Oil palm empty fruit bunch (OPEFB) is one of the agricultural wastes with high lignocellulose content. Lignin is the lignocellulose component that has the potential to be used as fuel for energy production and as a filler in composite materials. This review provides information on the solvent extraction methods used such as alkaline treatment, organosolv treatment, and deep eutectic solvent treatment to extract the lignin from lignocellulose OPEFB. The extracted lignin from different solvent extraction methods also gave different properties of lignin. In conjunction with that, catalyst and enzyme have been used to overcome the limitations of solvent extraction methods.

Abstract Banana peel is appreciated for higher dietary fiber, phenolics, flavonoid contents, and minerals (particularly iron, calcium, and potassium), despite being a waste product. After drying, it can be processed into powder/flour to be combined with wheat flour (WF) for development of value-added products. In this study, we substituted WF with banana peel powder (BPP) at supplementation rates of 5, 10, and 15%, and evaluated their suitability to develop salted noodles. The results showed that the composite flour with 15% BPP had significantly higher protein, ash, and crude fiber content as compared to control. Higher antioxidant capacity was observed in composite flour noodles: total phenolics content (TPC), total flavonoid content (TFC), ferric reducing power (FRAP) and DPPH reducing power were increased up to 278, 260, 143 and 13 percent respectively in the noodles containing 15% BPP as compared to control (100% WF). On the other hand, values for viscosity decreased up to 22% with addition of BPP in WF. Furthermore, water absorption capacity and cooking losses were increased up to 15 and 13 percent respectively with 15% BPP incorporation in WF. Results for sensory evaluation demonstrated that noodles with 10% BPP scored highest for sensory profile. Graphical abstract

BackgroundThe Recovery Knowledge Inventory (RKI) is a widely used self-report instrument that assesses recovery-oriented knowledge among mental health professionals. The purpose of this study is to translate the RKI into the Malay language (RKI-M) and to examine its psychometric properties among Malaysian health care workers.MethodsA cross-sectional study involving 143 participants was conducted at an urban teaching hospital, an urban government hospital, and a rural government hospital. Following the translation of the RKI, its internal reliability was determined using Cronbach’s alpha. Construct validity was also determined using confirmatory factor analysis.ResultsThe Malay-Version RKI (RKI-M) has good internal reliability with a Cronbach’s alpha of 0.83. However, the Malay-version RKI failed to replicate the original four-factor structure. The final model only achieved the best model fit after the removal of 9 items with two-factor loadings: (GFI = 0.92; AGFI = 0 0.87; CFI = 0.91; RMSEA = 0.074).ConclusionThe 20-item RKI-M is reliable but has poor construct validity. However, the modified 11-item Malay-version RKI is a more reliable measure as it has good construct validity, with room for future studies to examine the psychometric properties of the modified 11-item RKI among mental health care workers. More training on recovery knowledge should be done, and a simple worded questionnaire should be developed in keeping with local practitioners.

Background: The COVID-19 pandemic affected all socio-economic activities including the provision of routine vaccinations. Objective: This study determined the effect of the COVID-19 pandemic on routine vaccination rates among children aged 15-23 months. Methods: A cross-sectional study was conducted in Lahore, from April 2021 to November 2021. The study included 750 children aged 15 to 23 months from the District of Lahore. A structured questionnaire was used to collect data from the outpatient department of Services Hospital, Lahore after informed consent. The data was analyzed by using SPSS version 26. The p-value

Threats to the environment and the economy significantly worsened human health, greatly outweighing any gains associated with increasing food production. Numerous heavily fertilized crops are used as animal feed, contributing to global food inequalities and unbalanced diets, even in wealthy countries. Hazardous fertilizers have been linked to an excessive burden of communicable and non-communicable diseases, which significantly increase yields and poses considerable environmental and public health risks. The rate at which nitrogen fertilizers are applied is closely related to the buildup of toxins in the surrounding area, groundwater, and leafy and root crops. Consumption of diets including these ingredients has contributed to a significant risk to human health.

Background: Healthcare professionals experience stressful working conditions that can lead to burnout. This study investigates the association between psychosocial working conditions and burnout among healthcare professionals in a tertiary care hospital in Karachi, Pakistan. Methodology: This cross-sectional study was conducted at three different facilities of Dr. Ziauddin Hospital, Karachi, from July 2021 to December 2021. Two standardized surveys were used to assess the psychosocial working conditions and burnout. The selected participants were associated with the institutional healthcare facility and were working as house officers, residents, nurses, dentists, and allied health professionals. Results: out of 384 distributed questionnaires, only 172 participants completed and returned the questionnaire. The mean score of burnouts was 46.24 with an SD value of 16.1 when assessed with the different levels of burnout (i.e., no burnout, stressed out, mild burnout, burned out, server burnout), it was found that the majority of the participants' n=56 (32.6%) had mild burnout and n=55 (32%) had burnout while severe burnout was found in n=22 (12.8%). Conclusion: Our study results indicate that there is a significant increase in healthcare professionals' level of burnout in a tertiary care system.

Abstract Background A policy statement recommending that healthcare providers (HCPs) encourage cardiac patients to enroll in cardiac rehabilitation (CR) was recently endorsed by 23 medical societies. This study describes the development and evaluation of a guideline implementation tool. Methods A stepwise multiple-method study was conducted. Inpatient cardiac HCPs were recruited between September 2018–May 2019 from two academic hospitals in Toronto, Canada. First, HCPs were observed during discharge discussions with patients to determine needs. Results informed selection and development of the tool by the multidisciplinary planning committee, namely an online course. It was pilot-tested with target users through a think-aloud protocol with subsequent semi-structured interviews, until saturation was achieved. Results informed refinement before launching the course. Finally, to evaluate impact, HCPs were surveyed to test whether knowledge, attitudes, self-efficacy and practice changed from before watching the course, through to post-course and 1 month later. Results Seven nurses (71.4% female) were observed. Five (62.5%) initiated dialogue about CR, which lasted on average 12 s. Patients asked questions, which HCPs could not answer. The planning committee decided to develop an online course to reach inpatient cardiac HCPs, to educate them on how to encourage patients to participate in CR at the bedside. The course was pilot-tested with 5 HCPs (60.0% nurse-practitioners). Revisions included providing evidence of CR benefits and clarification regarding pre-CR stress test screening. HCPs did not remember the key points to convey, so a downloadable handout was embedded for the point-of-care. The course was launched, with the surveys. Twenty-four HCPs (83.3% nurses) completed the pre-course survey, 21 (87.5%) post, and 9 (37.5%) 1 month later. CR knowledge increased from pre (mean = 2.71 ± 0.95/5) to post-course (mean = 4.10 ± 0.62; p ≤ .001), as did self-efficacy in answering patient CR questions (mean = 2.29 ± 0.95/5 pre and 3.67 ± 0.58 post; p ≤ 0.001). CR attitudes were significantly more positive post-course (mean = 4.13 ± 0.95/5 pre and 4.62 ± 0.59 post; p ≤ 0.05). With regard to practice, 8 (33.3%) HCPs reported providing patients CR handouts pre-course at least sometimes or more, and 6 (66.7%) 1 month later. Conclusions Preliminary results support broader dissemination, and hence a genericized version has been created ( http://learnonthego.ca/Courses/promoting_patient_participation_in_CR_2020/promoting_patient_participation_in_CR_2020EN/story_html5.html ). Continuing education credits have been secured.

Abstract Purpose The purpose of the study was to pilot test the English and Urdu version of the Colon Cancer Screening Behaviours Survey among South Asians in Canada. The first objective was to evaluate feasibility of administration, data collection using computer assisted personal interviewing software on a tablet, and response burden. The second objective was to examine the prevalence of colorectal cancer screening among South Asians and evaluate the psychometric properties of sub-scales in the survey. Methods Purposive, network and snowball sampling were used to recruit participants for this cross-sectional study. Interviewer-led administration of the Colon Cancer Screening Behaviours Survey was conducted across two cities in Ontario, Canada. Qualitative data analysis assessed feasibility; and sub-scales were evaluated through principal component analysis, item-scale correlations, and construct validity using multiple linear and logistic regression. Results A total of 328 South Asians participated, 47% Urdu speaking, and 53% English speaking. There was a 23% refusal rate to participate. Feasibility identified: (1) successful recruitment despite reasons for refusal; (2) problematic items and response categories; and (3) computer/tablet limitations. Principal component analysis identified 14 components that explained 68.7% of total variance; 34 items were retained after factor analysis. Internal consistency of 4 scales ranged from 0.79–0.91. There were significant differences in perceived barriers scale scores (− 12.21; 95% CI, − 17.13 to - 7.28; p

Abstract Background Young adults starting college or university education encounter multiple stressors related to transitional life-stage and novel environments. Current studies reveal high rates of symptoms related to common mental health problems like depression, anxiety and stress. However, limited knowledge exists on the determinants on these problems among Canadian students. The primary aim of the study was to investigate the impact of contextual determinants, as perceived by students, on self-reported mental health, and how these impacts varied by depression, anxiety and stress. Methods A cross-sectional survey was conducted with students attending a large university in Toronto, Canada. Participants completed a self-administered online questionnaire as part of a larger project. The questions asked about contextual determinants related to personal, interpersonal, family, social, socio-economic and political factors along with levels of depression, anxiety and stress as measured by Patient Health Questionnaire-9, Beck Anxiety Inventory and Perceived Stress Scale. Results A total of 148 students completed the questionnaire (37 males and 111 females) with an age range of 19–54 years (median 22, IQR 21–24.8). English was reported as first language by 62.8% while 34.5% self-identified as white and 58.1% reported being born in Canada. Overall, 39.5% reported symptoms of moderate to severe depression, 23.8% reported moderate–severe anxiety and 80.3% reported moderate–severe levels of perceived stress, with no significant differences between males and females. In the final multivariate analysis, variables significantly associated with depression were grade-point-average (aOR 2.46, 95% CI 1.017–5.97), family factors (aOR 3.46, 95% CI 1.50–7.94), social factors (aOR 3.24, 1.30–8.1), self-rated health (aOR 0.34, 95% CI 0.14–0.82) and political factors (aOR 0.40, 95% CI 0.16–0.97). Anxiety was significantly associated with family factors (aOR 2.79, 1.09–7.18), socioeconomic factors (aOR 2.59, 95% CI 1.05–6.42) and age (aOR 0.33, 95% CI 0.11–0.98). The significant factors for stress were grade-point-average (aOR 2.41, 1.01–5.75) and social factors (aOR 3.87, 95% CI 1.59–9.43). Conclusion The study found strong to moderate impact of several determinants on depression, anxiety and stress. The results suggest a need to address a variety of factors affecting students’ mental health. Trial registration Parent trial: http://www.isrctn.com/ISRCTN92827275

Cereals like sorghum and millet are splendid sources of phenolics, dependent on their genetic makeup, and possess varied levels of flavonoids, flavanols, flavanones, anthocyanins, and condensed tannins. In this study, chemical composition and anthocyanin and tannin content of seven sorghum and two millet varieties were evaluated. American Association of Cereal Chemists (AACC) respective methods were used for chemical composition. Anthocyanins were determined through HPLC/UV-Vis, while condensed tannins were determined spectrophotometrically. Four anthocyanins determined included apigeninidin, kuromanin, pelargonidin, and cyanidin. Among sorghum varieties, JS-263 had the highest apigeninidin (16 µg/g). Other anthocyanins were not found in appreciable quantities. None of the anthocyanins were detected in millet varieties. Condensed tannins were highest in sorghum variety PC-1 (179.76 mg/100g) and millet variety S. Bajra-2011 (172.75 mg/100g). Two varieties, one each from sorghum and millet, were selected for extraction of bran as a separate fraction. Brans were modified by size reduction and enzymatic treatment (xylanase and cellulase). Enzymatic treatment favorably affected the extraction of phenolic compounds like anthocyanins. Sorghum and millet flour- and bran-supplemented breads were also developed and evaluated for sensory acceptability.

A maxillofacial patient's quality of life is distorted and social integration becomes difficult. An obturator is a maxillofacial prosthesis used to close a congenital or acquired tissue defect, primarily of the hard palate and/or contiguous alveolar/soft-tissue structures. Subsequently, it restores the esthetics, speech, and function. The present clinical report aimed for the prosthetic rehabilitation of a maxillectomy defect by the incorporation of a semi-precision attachment as PRECI-SAGIX – male part of 2.2 mm on fixed partial denture (#22 and #23 teeth) and matrix – plastic female part of size 2.2 mm and height 4.2 mm of yellow on cast partial in polymer base. It aids in the retention of a hollow lightweight obturator. The technique also described the method to make a bulbless obturator with a hollow self-cured acrylic resin occlusal shim. A patient is quite satisfied with bulb less, lightweight cast partial and hollow shim palatal obturator.

Abstract Objective The objective of this work was to develop a survey that considered cultural relevance and diversity of South Asian populations, with the aim of describing or predicting factors that influence colorectal cancer screening intention and adherence. The scientifically rigorous approach for survey development informed the final phase of an exploratory mixed method study. This initial survey was later cross-culturally translated and adapted into the Urdu language, and thereafter, items were cognitively tested for conceptual relevance among South Asian immigrants. Results The initial development of the Colon Cancer Screening Behaviours Survey for South Asian populations was completed using a number of steps. Development involved: the identification of key concepts and conceptual model; literature search for candidate measures and critical appraisal; and, expert consultation to select relevant measures. Five published surveys included measures that covered concepts relevant to South Asians and colorectal cancer screening behaviours. However, measures from these surveys missed content that emerged through parallel field work with South Asians, and additions were required along with item modifications. In the final stage, cross-cultural translation and adaptation into Urdu, and cognitive testing were completed. Future research will require an examination of proposed relationships, and psychometric testing of measures in the survey.

Abstract Background The purpose of this study was to cognitively test the Urdu and English language versions of a survey to assess colon cancer screening behaviours among South Asian immigrants in Canada. Methods The Colon Cancer Screening Behaviours Survey was cross-culturally translated and adapted into the Urdu language followed by cognitive interviews using an evidence-informed cross-cultural cognitive interview framework. The cognitive interviews were conducted in English and Urdu in three rounds; a preliminary round, round one, and round two. Two bilingual cognitive interviewers administered interviews in person with South Asian immigrants in Hamilton, Ontario. Scripted verbal and emergent probe techniques were used concurrently with survey item administration. Results A total of 30 South Asian immigrant participants, 12 English speaking and 18 Urdu speaking completed a cognitive interview. These groups were similar in age, gender, and years of residence in Canada. General design, culture, gender, and translation issues were identified. Revisions were made to improve the survey and the interview protocol was modified for future data collection. Conclusions The cross-cultural cognitive interview framework led to a systematic and rigorous process of pre-testing and revising the Colon Cancer Screening Behaviours Survey, which may be used to gain insights on beliefs, benefits, facilitators and barriers to colon cancer screening among South Asian immigrants. The study methods and experience may also inform the cross-cultural translation and adaptation and cognitive testing of other survey tools.

Background: A virtuous understanding of Electrocardiogram is an indispensable ability and essential skill required in doctors. This study assessed the understanding of the electrocardiogram and acute management of myocardial infarction among emergency doctors, general practitioners, medical officers, house officers and postgraduate students. Methods: A cross sectional survey was conducted for 7 months on n=312 doctors working in tertiary care public and private hospitals and as General practitioners in Karachi, Pakistan. Convenience sampling technique was used. Participants were asked to interpret a 12 lead electrocardiogram attached to questionnaire and write down their findings and diagnoses. They were then asked about its acute management. ANOVA and Chi square was applied for making inferences from the acquired data. p value of less than 0.05 was taken as significant. Approval was taken from the Ethical Review board. Results: Knowledge was assessed on basis of designation, 84.6% of the emergency doctors correctly interpreted the ECG while 75.4% of general physicians read it correctly. House officers and medical officers had the lowest scores in ECG interpretation. Years of experience demonstrated inverse results with >5 years experience at the lowest scores for interpretation of ECG and MI management. Interpretation scores of ECG were significantly high (p value 0.03) in participants who attended workshops compared to those who did not. Conclusion: Emergency doctors had better scores when it comes to ECG interpretation and management of MI. Frequent workshops and cardiology rotations should be mandatory for health care professionals to improve essential skill and knowledge of acute management of myocardial infarction.

Background: Most researches on Gastrointestinal (GI) disorders are conducted in secondary health care settings, yet majority patients present at a primary health care level. Functional dyspepsia (Idiopathic or non ulcer dyspepsia) constitutes a tremendous workload in primary care. This study aims to assess the knowledge of general practitioners regarding functional dyspepsia. Methods: Data was collected through a cross sectional study in 2016, targeting 18 towns of Karachi. Multistage sampling technique was employed. A total of n=250 general practitioners were inducted in the study. Data was collected through self administered questionnaire developed from the ROME III guidelines of functional dyspepsia. Descriptive analysis was carried out through SPSS 21. Results: From the total n=250 general practitioners only 17.5% were able to correctly identify the correct definition of functional dyspepsia. Less than 1% knew that ROME III guidelines are being followed for management of functional dyspepsia. The diagnostic criterion for functional dyspepsia was known to only 15% general practitioners. Only two alarm signs were identified by the participants of the study. Conclusion: The average number of patients seen by General Practitioners is high yet their knowledge is weak and practices are not according to the standard guidelines

Leukemia is a leukocyte cancer that is characterized by anarchic growth of immature immune cells in the bone marrow, blood and spleen. There are many forms of leukemia, and the best course of therapy and the chance of a patient’s survival depend on the type of leukemic disease. Different forms of drugs have been used to treat leukemia. Due to the adverse effects associated with such therapies and drug resistance, the search for safer and more effective drugs remains one of the most challenging areas of research. Thus, new therapeutic approaches are important to improving outcomes. Almost half of the drugs utilized nowadays in treating cancer are from natural products and their derivatives. Medicinal plants have proven to be an effective natural source of anti-leukemic drugs. The cytotoxicity and the mechanisms underlying the toxicity of these plants to leukemic cells and their isolated compounds were investigated. Effort has been made throughout this comprehensive review to highlight the recent developments and milestones achieved in leukemia therapies using plant-derived compounds and the crude extracts from various medicinal plants. Furthermore, the mechanisms of action of these plants are discussed.

Abstract Background Breast and cervical cancer screening rates remain low among immigrant women and those of low socioeconomic status. The Cancer Awareness: Ready for Education and Screening (CARES) project ran a peer-led multi-lingual educational program between 2012 and 2014 to reach under and never-screened women in Central Toronto, where breast and cervical cancer screening rates remain low. The objective of this qualitative study was to better understand how Chinese and South Asian immigrants – the largest and most under-screened immigrant groups according to national and provincial statistics - conceive of breast and cervical cancer screening. We explored their experiences with screening to date. We explicitly inquired about their perceptions of the health care system, their screening experiences with family physicians and strategies that would support screening in their communities. Methods We conducted 22 individual interviews and two focus groups in Bengali and Mandarin with participants who had attended CARES educational sessions. Transcripts were coded through an iterative constant comparative and interpretative approach. Results Themes fell into five major, overlapping domains: risk perception and concepts of preventative health and screening; health system engagement and the embedded experience with screening; fear of cancer and procedural pain; self-efficacy, obligation, and willingness to be screened; newcomer barriers and competing priorities. These domains all overlap, and contribute to screening behaviours. Immigrant women experienced a number of barriers to screening related to ‘navigating newness’, including transportation, language barriers, arrangements for time off work and childcare. Fear of screening and fear of cancer took many forms; painful or traumatic encounters with screening were described. Female gender of the provider was paramount for both groups. Newly screened South Asian women were reassured by their first encounter with screening. Some Chinese women preferred the anonymous screening options available in China. Women generally endorsed a willingness to be screened, and even offered to organize women in their community hubs to access screening. Conclusions The experience of South Asian and Chinese immigrant women suggests that under and never-screened newcomers may be effectively integrated into screening programs through existing primary care networks, cultural-group specific outreach, and expanding access to convenient community -based screening.

Objective: To assess the knowledge, attitude and practices of mothers regarding risk factors for diarrhea and its management in children under five years of age living in rural districts of Pakistan. Materials and Methods: A cross-sectional study was conducted in two union councils of Dadu and Badin Districts of Sindh in 2014. The sample size from each Union council was n=450. Cluster sampling technique was utilized for selection of households in both of the Union Councils. Personal interviews were conducted from mothers by trained data collectors on pretested questionnaire. Descriptive analysis was done on SPSS version 20. Results: 46% in Badin and 44% under 5 children in Dadu had suffered an attack of acute diarrhea in the last three months. Regarding the signs of dehydration, 36% mothers identified that absence of tears as a principal sign of dehydration in Badin, while 41% in Dadu identified lethargy as the chief sign. Contaminated water and stale food was identified as a cause of diarrhea by most participants in both districts. 48% in Badin and 41% in Dadu identified hand washing the most important method for prevention against diarrhea. When management of diarrhea was taken into account for majority 50% mothers it was through ORS. Conclusion: Knowledge on diarrhea and its treatment and prevention was found to be bleak in our survey among rural residents of Sindh. Results displayed poverty besides illiteracy, improper water and sanitation facilities and unhygienic practices serving as barricades dragging down health indicators similar to other rural parts of the country.

Objective: To study the phenomena of weight misperception and to assess the intentions of weight management in the adult population of Karachi, Pakistan. Factors which lead to weight loss efforts will also be identified. Methods: A cross-sectional study was conducted with a total of 450 male and female adults aged 20 to 60 years. Data was collected through purposive sampling technique. All participants had their weight and height measured and filled a questionnaire asking about perceived weight status. Data was analyzed using SPSS version 20. Chi square was used to form associations, with P value of less than 0.05 being taken as significant. Results: Based on body mass index (BMI), 13.3% of the participants were underweight, 54.9% were of normal weight, 25.3% were overweight and 6.4% were obese. Misperception was prevalent in 37.8% (40.3% in females versus 33.1% in males) of the subjects. 28% overestimated their weight and 9.3% underestimated their weight. About 46.7% of underweight, 17.6% of overweight and 31.7% of obese participants were not making any efforts about the discrepancy in their weight. 28% were trying to lose and 28.7% were trying to control their weight. The highest rated reason for this weight consciousness was ‘feeling better about myself’. Conclusion: There was more weight misperception in females than males with a tendency of overestimation in females and underestimation in males. More females were trying to lose weight and more males were trying to gain it. A significant number of participants were making efforts that were not in correspondence with their weight status. Satisfaction about self was rated to be more important than health concerns.

Objectives: To assess knowledge and attitude about malaria and dengue, its spread, symptoms and prevention among the population of Dadu and Badin district of Sindh province. Study Design and Methods: A cross sectional baseline survey was conducted in rural areas of Dadu and Badin districts of Sindh in 2014. Cluster sampling technique was utilized for selection of 900 households from two union councils. Personal interviews were conducted by trained data collectors on pretested questionnaire. Data was entered on SPSS version 20. Descriptive analysis was conducted. Results: Only 22.4% in Dadu and 34.4% of Badin residents heard about dengue fever. Merely13% from both districts knew about bleeding in dengue fever. Only 17.9% in Dadu and 25% in Badin opined that malaria occurred post rainfall. Only3.5% in Dadu and 2.9% in Badin had the perception that malaria incurred after floods. In Badin only 3% had ever sprayed inside their homes compared to 7% in Dadu in past one year. In Badin 84% were using mosquito nets as prevention while in Dadu 66%. Only 3.5% in Dadu and 6.2% were covering water buckets as a precautionary measure against mosquitoes. Conclusion: In the present survey, situation is alarming as there are gross deficiencies in knowledge and attitudes pertaining to malaria and dengue while preventive practices are negligible.

Objective: To assess the patterns seen in population visiting tertiary care facilities in Karachi Method: This cross-sectional study was conducted in 2013 an two tertiary care hospitals of Karachi. A totalof 398 participants were enrolled in the study through convenience sampling technique. Hypochondriasis wasassessed using Illness Attitude Scale (IAS) by Kellner. Data was analyzed using SPSS version 20. Differencein mean scores among different groups was taken out through Independent sample t test andANOVA, associations were taken out using chi-square test. P value less than 0.05 was taken as significant. Results: Out of the total participants, 53.8% were suffering from hypochondriasis. When categorized bygender, males were 45.8% and females 62.9% (p value 0.001). When categorized by marital status, it wasfound that 58.6% of married participants were hypochondriac whereas only 37.1% singles were hypochondriac(P value 0.001).Age group between 25-35 years had the maximum number of hypochondriacs (30%). Conclusion: The pattern of distribution of hypochondriasis was found out to be similar with that of otherstudies. Females are predominantly more hypochondriac as compared to males

Summary: The primary objective of this analysis was to evaluate group 2 carbapenem usage and to model the impact that a formalized de-escalation protocol to ertapenem could potentially have on group 2 carbapenem usage in the hope of alleviating the selective pressure on Acinetobacter and Pseudomonas. This analysis was conducted in three hospitals within the Detroit Medical Center in 2009. Patients were considered candidates for de-escalation of carbapenem therapy when a group 2 carbapenem was utilized to treat Enterobacteriaceae, such as extended spectrum β-lactamase (ESBL)-producing organisms, or if cultures were negative in non-intensive care unit (ICU) patients. In total, 179 patients (28%) and 1074 patient-days (29%) were deemed eligible for de-escalation according to our pre-defined criteria. We concluded that preferential utilization of ertapenem in appropriate patients warranting carbapenem therapy has the potential to significantly decrease group 2 carbapenem usage at our institution. Keywords: Ertapenem, De-escalation, Streamlining, Antimicrobial stewardship, Carbapenem

Objective: To assess and compare the attitude towards physical activity (PA) in midcareer doctors and midcareerphysical therapists (age 24-35 years old) and to assess their common barriers found against physical activity(PA). Methods: A cross-sectional survey of 376 midcareer doctors and midcareer physical therapists at different tertiary care hospitals was conducted. The participants were surveyed regarding their physical activity (PA)habits and barrier to physical activity (PA) through self-administered questionnaire. Fisher’s exact test was usedto find the association between doctors and physical therapist and their attitude towards physical activity andbarriers. Results: Walking was found to be most sought after physical activity among both doctors and physical therapists among barriers of lack of time and company was found to be most common barrier against planned structured physical activity (exercise). Conclusion: The results of the study concluded that midcareer doctors and physical therapist are not performing planned structured physical activity because of barriers like lack of time and lack of company yet they prefer walking as a form of leisure activity in comparison of other activities like gardening and swimming etc.

Objective: To assess the frequency of Spondylolisthesis among patients of Chronic Low Back Pain in Karachi Method: This cross-sectional study was conducted from April 2012 to December 2012. Patients were selectedfrom four Hospitals consisting of two private and two government tertiary care hospitals. A total of 313 patientsconfirmed through MRI as suffering from low back pain were selected through purposive sampling technique. Data was analyzed using SPSS version 20 and associations were assessed using chi-square test. Results: Out of the total 313 participants, 211 were diagnosed as suffering from Spondylolisthesis. Middle agegroup had significant association with spondylolisthesis. Housewives 57% (21) were found to be associatedwith Grade 3 Spondylolisthesis. Weight had a significant effect on the preponderance of spondylolisthesis as46.9% (99) obese had these findings on their MRI. Duration of pain greater than 1 year had significant associationwith spondylolisthesis, 85.3% (180) participants had these findings on their MRI (P value 0.000). Similarlyradiating pain was found to be more prevalent in spondylolisthesis as 80.6% (170) participants with spondylolisthesis as their finding complained of radiating pain Conclusion: In our survey majority of patients suffering from chronic low back pain had Spondylolisthesis(67.4%). Future studies should focus on measures that specify the risk factors of Spondylolisthesis and targettowards its intervention.

Objective: To assess the risk factors for falls in geriatric population of aged 60 and above Method: A cross-sectional study was conducted from September to December 2012 on geriatric population of age 60 and above. A total of 100 participants were selected through consecutive sampling technique. Personal interviews were conducted. Chi-square test was applied as the test of significance for finding association between falls and risk factors. P value less than 0.05 was taken as significant. Results: A total of 100 participants were included in the study, male and female ratio was 2:3. A large portion of participants had a history of fall as 45% said they had also fallen previously while the remaining 55% gave no history of fall. Fractures were the outcome of 51% of the falls that were included into this study. Majorityfractures observed were in the lower limb (59%), Majority of the participants, 51% gave slipping or tripping over some object as the reason of their fall only one third 33% were in the affirmative that physiotherapists can bring a change in their lifestyle. The time of fall as mentioned by the participants was for the majority in the morning as 56% falls occurred before noon. Conclusion: Approximately fifty percent of the falls had resulted in fractures especially of the lower limb. Lifestyle modifications that can help in minimizing the risk of falls should be incorporated in daily life to avert harmful consequences.

Growing interest in visual timeline methods signals a need for critical engagement. Drawing on critical emancipatory epistemologies in our study exploring resilience among marginalized groups, we investigate how the creation of visual timelines informs verbal semistructured interviewing. We consider both how experiences of drawing timelines and how the role of the timeline in interviews varied for South Asian immigrant women who experienced domestic violence, and street-involved youth who experienced prior or recent violent victimization. Here we focus on three overarching themes developed through analysis of timelines: (a) rapport building, (b) participants as navigators, and (c) therapeutic moments and positive closure. In the discussion, we engage with the potential of visual timelines to supplement and situate semistructured interviewing, and illustrate how the framing of research is central to whether that research maintains a critical emancipatory orientation.

Identifying follow-up (FU) visit patterns, and exploring which factors influence them are likely to be useful in determining which patients on antiretroviral therapy (ART) may become Lost to Follow-Up (LTFU). Using an operation and implementation research approach, we sought 1) to describe the timing of FU visits amongst patients who have been on ART for shorter and longer periods of time; and 2) to determine the median time to late visits, and 3) to identify specific factors that may be associated with these patterns in Zomba, Malawi.Using routinely collected programme monitoring data from Zomba District, we performed descriptive analyses on all ART visits among patients who initiated ART between Jan. 1, 2007-June 30, 2010. Based on an expected FU date, each FU visit was classified as early (≥4 day before an expected FU date), on time (3 days before an expected FU date/up to 6 days after an expected FU date), or late (≥7 days after an expected FU date). In total, 7,815 patients with 76417 FU visits were included. Ninety-two percent of patients had ≥2 FU visits. At the majority of visits, patients were either on time or late. The median time to a first late visit among those with 2 or more visits was 216 days (IQR: 128-359). Various patient- and visit-level factors differed significantly across Early, On Time, and Late visit groups including ART adherence and frequency of, and type of side effects.The majority of patients do not demonstrate consistent FU visit patterns. Individuals were generally on ART for at least 6 months before experiencing their first late visit. Our findings have implications for the development of effective interventions that meet patient needs when they present early and can reduce patient losses to follow-up when they are late. In particular, time-varying visit characteristics need further research.

Objective: To assess and compare the attitude towards physical activity (PA) in midcareer doctors and midcareer physical therapists (age 24-35 years old) and to assess their common barriers found against physical activity (PA). Methods: A cross sectional survey of 376 midcareer doctors and midcareer physical therapists at different tertiary care hospitals was conducted. The participants were surveyed regarding their physical activity (PA) habits and barrier to physical activity (PA) through self-administered questionnaire. Fisher’s exact test was used to find the association between doctors and physical therapist and their attitude towards physical activity and barriers. Results: Walking was found to be most sought after physical activity among both doctors and physical therapists Among barriers of lack of time and company was found to be most common barrier against planned structured physical activity (exercise). Conclusion: The results of the study concluded that midcareer doctors and physical therapist are not performing planned structured physical activity because of barriers like lack of time and lack of company yet they prefer walking as a form of leisure activity in comparison of other activities like gardening and swimming etc.