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Existe un debate considerable en la literatura sobre cómo el narcisismo predice diversos comportamientos asociados con la utilidad de los sitios de redes sociales, pero los investigadores han prestado menos atención a explorar los mediadores potenciales de esta relación. Con base en la literatura existente, anticipamos que el narcisismo predice comportamientos de autopromoción en los sitios de redes sociales. El estudio actual también investigó el papel mediador del perfeccionismo multidimensional entre el narcisismo y el comportamiento de autopromoción. Se recopiló un total de 605 cuestionarios completos de estudiantes de universidades de Rawalpindi e Islamabad, Pakistán, mediante un muestreo conveniente. El estudio utilizó el Inventario de Personalidad Narcisista (Ames et al., 2006), un cuestionario de desarrollo propio sobre comportamiento de autopromoción en sitios de redes sociales y la Escala de Perfeccionismo Multidimensional (Hewitt et al., 1991). Los hallazgos indicaron que las mujeres en comparación con los hombres y las solteras en comparación con las casadas obtuvieron puntuaciones más altas en narcisismo. Los niveles educativos más altos se asociaron con tasas más altas de narcisismo. Los resultados también sugieren que el narcisismo se correlaciona con el perfeccionismo orientado a uno mismo y, más significativamente, con el narcisismo orientado a los demás. El perfeccionismo orientado a uno mismo y a los demás medió significativamente la relación entre el narcisismo y el comportamiento de autopromoción en los sitios de redes sociales.(AU)
There is considerable debate in the literature about how narcis-sism predicts various behaviors associated with the utility of social net-working sites, but researchers have paid less attention to exploring the po-tential mediators of this relationship.Based on the existing literature, we anticipated that narcissism predicts self-promoting behaviors on social networking sites. The current study also investigated the mediating role of multidimensional perfectionismbetween narcissism and self-promoting behavior. A total of 605 complete questionnaires weregathered fromstu-dents from universities from Rawalpindi and Islamabad, Pakistan using convenient sampling. The study used Narcissistic Personality Inventory (Ames et al., 2006), self-developed Self-promoting Behavior on social net-working sites questionnaire, and the Multidimensional Perfectionism Scale (Hewitt et al., 1991). Findings indicated that females as compared to males and single as comparedto married individuals scored higher on narcissism. Higher educational levels were associated with higher rates of narcissism. The results also suggestthat narcissism correlated with self-oriented per-fectionism, and more significantlywith others-oriented narcissism. Self-oriented and others-oriented perfectionism significantly mediated the rela-tionship between narcissism and self-promoting behavior on social net-working sites.(AU)
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Humanos , Masculino , Femenino , Salud Mental , Perfeccionismo , Narcisismo , Conducta , Estudiantes/psicología , PakistánRESUMEN
Responsive caregiving is associated with secure attachment and positive child developmental outcomes. However, there is some debate on whether responsive caregiving is a universal construct. Few studies have researched responsive caregiving in diverse cultural settings, particularly in low- and middle-income countries. In this study, we explore if and how responsive caregiving is conceptualized among mothers of children under 3-years-old in rural, Sindh Pakistan. A phenomenological qualitative study was implemented in Naushahro Feroze through in-depth interviews with twenty mothers. Mothers were asked about their aspirations for their children and how they would respond in a variety of different scenarios. Data were analyzed using thematic content analysis with an inductive-deductive coding scheme. There was substantial variation in mothers' described responsive behaviors and beliefs. Almost all mothers described using some form of responsive parenting. Responding to children's demands while the mother was preoccupied, using verbal responses to console children, and if mothers believed that children should be praised, lacked consensus. Most mothers described using breastfeeding for consolation and highlighted the importance of immediately consoling their crying child. The results suggest that there is a need for a more nuanced approach to understand caregiver behaviors across contexts.
Una sensible prestación de cuidado se asocia con una afectividad segura y con resultados positivos en el desarrollo del niño. Sin embargo, se da un debate sobre si la sensible prestación de cuidado es una estructura universal. Pocos estudios han investigado la sensible prestación de cuidado en diversos escenarios culturales, particularmente en países de bajas y medias entradas económicas. En este estudio, exploramos si la sensible prestación de cuidado está conceptualizada entre las madres de niños menores de 3 años en el área rural de Sindh en Pakistán y cómo lo está. Un estudio fenomenológico cualitativo se implementó usando datos de Naushahro Feroze (ciudad en la provincia de Sindh), por medio de entrevistas profundas con veinte madres. A las madres se les preguntó acerca de sus aspiraciones con respecto a sus niños y cómo ellas responderían en una variedad de diferentes escenarios. Se analizaron los datos usando un análisis de contenido temático con un esquema de codificación inductivodeductivo. Hubo variación sustancial en las descripciones de las madres acerca de sus conductas y creencias sensibles. Casi todas las madres hicieron las descripciones usando alguna forma de crianza sensible. Faltó el consenso en el caso de responder a las peticiones de los niños mientras la madre estaba preocupada, en el uso de respuestas verbales para consolar a los niños, así como en el caso de si las madres creían que los niños debían ser elogiados. La mayoría de las madres hizo sus descripciones usando el amamantar como manera de consolar y subrayó la importancia de consolar inmediatamente al niño que llora. Los resultados sugieren que hay una necesidad de un acercamiento más matizado para comprender las conductas de prestación de cuidado a través de los contextos.
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Climate anxiety has a negative impact on the mental health and psychological wellbeing of the vulnerable population. The goal is to assess many factors that affect mental health and psychological wellbeing, as well as how climate change affects mental health in Pakistan's vulnerable population. This study provides evidence-based insights on the long- and medium-term impacts of extreme weather events on mental health. We conducted semi-structured interviews with a sample of 72 students aged 10-16 years, employing an exploratory qualitative design. The resulting process identified themes and questions for future research on climate change and its psychological effects on children's mental health. As a result, positive emotions embedded in children's climate strategic actions in parent and community contexts helped to mitigate children's perceptions of negative emotions (such as climate anxiety, phobias, fear, sleep disorders, depression, sadness, and substance abuse). Climate change's effects can have a significant impact on mental health. We will be discussing effective strategies to address the expected mental health issues among children caused by climate change. The discussion paper offers a set of recommendations for addressing the mental health impacts of climate change, including improving mental health support systems, integrating climate change education into services, and developing targeted interventions for vulnerable populations.
L'anxiété climatique a un impact négatif sur la santé mentale et le bien-être psychologique de la population vulnérable. L'objectif est d'évaluer de nombreux facteurs qui affectent la santé mentale et le bien-être psychologique, ainsi que la manière dont le changement climatique affecte la santé mentale de la population vulnérable du Pakistan. Cette étude fournit des informations fondées sur des données probantes sur les impacts à long et moyen terme des événements météorologiques extrêmes sur la santé mentale. Nous avons mené des entretiens semi-structurés avec un échantillon de 72 étudiants âgés de 10 à 16 ans, en utilisant une conception qualitative exploratoire. Le processus qui en a résulté a identifié des thèmes et des questions pour de futures recherches sur le changement climatique et ses effets psychologiques sur la santé mentale des enfants. En conséquence, les émotions positives intégrées dans les actions stratégiques climatiques des enfants dans les contextes parental et communautaire ont contribué à atténuer les perceptions des enfants concernant les émotions négatives (telles que l'anxiété climatique, les phobies, la peur, les troubles du sommeil, la dépression, la tristesse et la toxicomanie). Les effets du changement climatique peuvent avoir un impact significatif sur la santé mentale. Nous discuterons de stratégies efficaces pour résoudre les problèmes de santé mentale attendus chez les enfants causés par le changement climatique. Le document de travail propose un ensemble de recommandations pour faire face aux impacts du changement climatique sur la santé mentale, notamment en améliorant les systèmes de soutien en santé mentale, en intégrant l'éducation au changement climatique dans les services et en développant des interventions ciblées pour les populations vulnérables.
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Ansiedad , Cambio Climático , Salud Mental , Investigación Cualitativa , Poblaciones Vulnerables , Humanos , Femenino , Adolescente , Niño , Masculino , Poblaciones Vulnerables/psicología , Ansiedad/epidemiología , Ansiedad/psicología , Pakistán/epidemiología , Entrevistas como Asunto , Estudiantes/psicologíaRESUMEN
PURPOSE: Fascioliasis is a zoonotic parasitic disease spread by genus Fasciola that causes considerable health and economic losses to both humans and livestock. Pakistan is an endemic region for fascioliasis and only a few molecular studies have been conducted to describe the etiology of disease in the country. METHODS: Current study involved the molecular characterization of adult fluke specimens (n = 31) through ITS-1 region of rDNA collected from four host species (sheep, goats, cattle and buffaloes) of district Sargodha. Moreover, coprology based epidemiology (n = 28620) and association of different risk factors with disease prevalence was also determined. Additionally, an overview of prevalence of fascioliasis in Pakistan, including molecular studies in the four provinces and livestock species, was also carried out. RESULTS: The phylogenetic analysis revealed that Fasciola gigantica was the main etiological agent infecting the livestock species of this region. The coprological survey revealed an overall prevalence of 30.18% among the livestock species (sheep = 32.31%, goats = 30.67%, cattle = 31.01%, buffaloes = 25.23%). It was inferred that females were slightly more susceptible to infection (32.59%) and that the older age group had higher infection rate (34.01%) in all the host species. CONCLUSION: The current study suggests that fascioliasis is a disease of primary concern indicating its status as one of the prevalent diseases affecting livestock in this region. It was also concluded that both Fasciola gigantica and Fasciola hepatica existed among the infected animals in addition to presence of hybrid/intermediate form in Pakistan with F. gigantica as dominant species in Punjab province.
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Purpose: Burns are among the top five cause of unintentional injuries among youth. We aimed to determine the incidence and risk factors of burns in select youth from Pakistan and also explored their perceptions about burns. Methods: A sequential explanatory mixed methods study was conducted which comprised of two phases. Phase 1 consisted of a cross-sectional quantitative survey (QUAN) in which 550 vocational school youth (15 to 24 years-olds) filled out the WHO community survey tool for injuries and violence and provided data on burns in previous 12 months (2021-22). Phase 2 consisted of qualitative (QUAL), in-depth interviews (IDIs) with participants selected from Phase 1 based on the occurrence of burns. STATA™ version 15.1 was used for Phase 1 data analysis and Zero-Inflated Negative Binomial regression was used for determining the Incidence Rate Ratio (IRR) of burns. Thematic analysis was performed for in-depth interviews from Phase 2. Results: Out of 547 participants, 356 (65%) were males while 191 (35%) were females. Burns were reported by 85 participants (15%). A total of 137 counts of burns were reported showing multiple burns by some participants. The IRR for burns among young females was 2.89 (1.78-4.69) compared to males in the previous 12 months (2021-22). Age, sex, father's education, and combined family income were significant risk factors for burns in youth. Six IDIs were conducted with burn victims, two were males while six were females. Four cooking-related burns, and two occupational burns during vocational training were reported. Themes that emerged from IDIs were internal and external factors, personal carelessness and lack of knowledge and safety about burns. Two sub-themes that were significant for recovery from burns were family support and access to healthcare. Conclusion: Young females are at a higher risk of burn injuries in Pakistan. Various social, demographic, and behavioral risk factors are associated with burns. Pre-burn and post-burn interventions are needed for prevention from burns in youth.
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BACKGROUND: Quantifying quality of life (QoL) in extrapulmonary TB patients is crucial yet often overlooked. This study examines the impact of tuberculous lymphadenitis and pleuritis on patients' QoL, associated factors, and recurrence. METHODS: Data were collected prospectively from patients using a pre-designed questionnaire at baseline, post-treatment, and 2 years after treatment. Health domains are essential to overall health and well-being and can be assessed to understand health status. We included mobility for physical well-being, usual activities for self-care, pain/discomfort for disease manifestations, and anxiety/depression for emotional health. RESULTS: Of the 376 patients, 53% had TB lymphadenitis, and 47% had TB pleuritis, with a mean age of 25 years (SD ±12.95). The most commonly reported issues at baseline were pain/discomfort and restricted usual activities. After treatment, over 90% experienced improvement, but 8% re-developed symptoms after 2 years, and two patients required retreatment for recurrent EPTB. Predictors negatively impacting QoL included private income sources, residence outside the city, and marriage, with the first two primarily affecting emotional health. CONCLUSION: Tuberculous lymphadenitis and pleuritis significantly impact patients' physical and emotional health, necessitating healthcare providers to address non-medical factors affecting QoL to reduce morbidity and mortality and improve QoL.
CONTEXTE: La quantification de la qualité de vie (QoL) chez les patients atteints de TB extrapulmonaire (EPTB) est essentielle mais fréquemment ignorée. Cette recherche analyse l'influence de la lymphadénite et de la pleurésie tuberculeuse sur la QoL des patients, les facteurs associés et la récurrence. MÉTHODES: Les données ont été collectées de manière prospective auprès des patients à l'aide d'un questionnaire préétabli, initialement, post-traitement et deux ans après le traitement. Les aspects de la santé sont fondamentaux pour le bien-être général et peuvent être évalués afin de comprendre l'état de santé. La mobilité a été incluse pour le bien-être physique, les activités quotidiennes pour les soins personnels, la douleur/l'inconfort pour les symptômes de la maladie et l'anxiété/la dépression pour la santé émotionnelle. RÉSULTATS: Sur les 376 patients, 53% ont été diagnostiqués avec une lymphadénite tuberculeuse et 47% avec une pleurite tuberculeuse, avec un âge moyen de 25 ans (SD ±12,95). Les symptômes les plus couramment signalés initialement étaient la douleur/l'inconfort et la limitation des activités habituelles. Après le traitement, plus de 90% des patients ont constaté une amélioration de leur état, mais 8% d'entre eux ont présenté à nouveau des symptômes après deux ans, et deux patients ont nécessité un nouveau traitement pour une EPTB récurrente. Les facteurs prédictifs qui ont un effet négatif sur la QoL incluaient les sources de revenus privées, la résidence en dehors de la ville et le mariage, les deux premiers ayant principalement un impact sur la santé émotionnelle. CONCLUSION: La lymphadénite tuberculeuse et la pleurite ont un impact important sur la santé physique et émotionnelle des patients, ce qui nécessite que les professionnels de la santé abordent les facteurs non médicaux qui affectent la QoL afin de diminuer la morbidité et la mortalité, et d'améliorer la QoL.
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BACKGROUND: Esophageal cancer is a prevalent cancer, with a high incidence in low socioeconomic category countries. Minimally invasive esophagectomy is increasingly being used to treat this malignant condition. However, anastomotic stricture is a serious complication post esophagectomy. The study aims to enhance diagnostic consistency, improve treatment methods, guide patient management, stratify outcomes, and offer evidence-based preventive interventions. METHODS: A retrospective analysis of 550 patients who had minimally invasive esophagus surgery was carried out at Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore between 2015 and 2020. All patients were treated with radical resection. For tumors of the lower esophagus and gastroesophageal junction, transhiatal esophagectomy was used; for tumors of the middle and upper thoracic esophagus, right video-assisted thoracoscopic surgery (VATS) was used in a three-stage procedure. Patients were routinely followed up two weeks after discharge, then every three, six, and 12 months. RESULTS: The mean age and BMI were 46.7 years and 19.4 kg/m2, respectively. Anastomotic leaks were rare, with only 13 patients experiencing them. The grade of tumor differentiation was poor, moderate, and well-differentiated. The study found that older age, high Eastern Cooperative Oncology Group (ECOG) performance status, and malignancies located in the upper and middle one-third of the esophagus had significant associations with anastomotic stricture. However, some variables, like sex, did not show significant associations in either analysis. CONCLUSION: The study reveals that factors such as older patient age, high ECOG performance status, single comorbidity, and malignancies located in the upper and middle one-third of the esophagus significantly influence anastomotic stricture. The study suggests that measures against anastomotic stricture such as endoscopic procedures and minimally invasive esophagectomy should be implemented to minimize the complications.
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Cutaneous leishmaniasis (CL) stands out as a significant vector-borne endemic in Pakistan. Despite the rising incidence of CL, the genetic diversity of Leishmania species in the country's endemic regions remains insufficiently explored. This study aims to uncover the genetic diversity and molecular characteristics of Leishmania species in CL-endemic areas of Baluchistan, Khyber Pakhtunkhwa (KPK), and Punjab in Pakistan. Clinical samples from 300 CL patients were put to microscopic examination, real-time ITS-1 PCR, and sequencing. Predominantly affecting males between 16 to 30 years of age, with lesions primarily on hands and faces, the majority presented with nodular and plaque types. Microscopic analysis revealed a positivity rate of 67.8%, while real-time PCR identified 60.98% positive cases, mainly L. tropica, followed by L. infantum and L. major. Leishmania major (p = 0.009) showed substantially greater variation in nucleotide sequences than L. tropica (p = 0.07) and L. infantum (p = 0.03). Nucleotide diversity analysis indicated higher diversity in L. major and L. infantum compared to L. tropica. This study enhances our understanding of CL epidemiology in Pakistan, stressing the crucial role of molecular techniques in accurate species identification. The foundational data provided here emphasizes the necessity for future research to investigate deeper into genetic diversity and its implications for CL control at both individual and community levels.
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Variación Genética , Leishmaniasis Cutánea , Leishmaniasis Cutánea/epidemiología , Leishmaniasis Cutánea/parasitología , Pakistán/epidemiología , Humanos , Masculino , Adolescente , Adulto , Femenino , Adulto Joven , Niño , Persona de Mediana Edad , Leishmania/genética , Leishmania/clasificación , Leishmania/aislamiento & purificación , Preescolar , Análisis de Secuencia de ADN , Leishmania tropica/genética , Leishmania tropica/aislamiento & purificación , Leishmania tropica/clasificación , Leishmania major/genética , Leishmania major/clasificación , Leishmania major/aislamiento & purificación , ADN Protozoario/genética , Filogenia , Epidemiología Molecular , Anciano , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
BACKGROUND: Various tools had been used to measure the level of burnout, anxiety, and depression. The Copenhagen Burnout Inventory assesses personal, work or job, and patient related burnout. While DASS21 assesses stress, anxiety, and depression. OBJECTIVES: This study aimed to evaluate the validity, reliability of Copenhagen burnout tool and DASS-21 amongst the faculty members employed in Pakistan. METHODS: This cross-sectional research incorporated 384 medical, dental, and nursing faculty working full time at university. Data for research was collected from January to May 2023. Copenhagen and DASS21 survey were the survey tools used to identify the level of burnout and stress. Reliability of both tools was assessed using Cronbach alpha. Confirmatory factor analysis was performed to detect factorial structure of both tools. Pearson correlation was conducted to detect association between various domains. Multiple logistic regression was computed to detect relationship between the domains. RESULTS: From a total of 384 participants, there were 118 (30.7%) males, 266 (69.3%) females. There were 169 (44%) medical, 140 (36.5%) dental, and 75 (19.5%) nursing faculty. Reliability analysis revealed satisfactory results for both tools. Confirmatory factor analysis demonstrated a four-model fit for the CBI, whilst a three-factor model was observed for DASS21. Personal burnout demonstrated positive and significant correlation with work related burnout, and stress, while it showed significant but negative correlation with depression. CONCLUSION: Female faculty displaced higher academic burnout as compared to men. A statistically significant correlation between burnout, anxiety, and depression. Both tools displayed high reliability and validity for the current sample.
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Plasmodium vivax variant interspersed repeats (vir) refer to the key protein used for escaping the host immune system. Knowledge in the genetic variation of vir genes can be used for the development of vaccines or diagnostic methods. Therefore, we evaluated the genetic diversity of the vir genes of P. vivax populations of several Asian countries, including Pakistan, which is a malaria-endemic country experiencing a significant rise in malaria cases in recent years. We analyzed the genetic diversity and population structure of 4 vir genes (vir 4, vir 12, vir 21, and vir 27) in the Pakistan P. vivax population and compared these features to those of the corresponding vir genes in other Asian countries. In Pakistan, vir 4 (S=198, H=9, Hd=0.889, Tajima's D value=1.12321) was the most genetically heterogenous, while the features of vir 21 (S=8, H=7, Hd=0.664, Tajima's D value =-0.63763) and vir 27 (S =25, H =11, Hd =0.682, Tajima's D value=-2.10836) were relatively conserved. Additionally, vir 4 was the most genetically diverse among Asian P. vivax populations, although within population diversity was low. Meanwhile, vir 21 and vir 27 among all Asian populations were closely related genetically. Our findings on the genetic diversity of vir genes and its relationships between populations in diverse geographical locations contribute toward a better understanding of the genetic characteristics of vir. The high level of genetic diversity of vir 4 suggests that this gene can be a useful genetic marker for understanding the P. vivax population structure. Longitudinal genetic diversity studies of vir genes in P. vivax isolates obtained from more diverse geographical areas are needed to better understand the function of vir genes and their use for the development of malaria control measures, such as vaccines.
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Variación Genética , Malaria Vivax , Plasmodium vivax , Plasmodium vivax/genética , Pakistán/epidemiología , Variación Genética/genética , Humanos , Malaria Vivax/epidemiología , Malaria Vivax/parasitología , Malaria Vivax/genética , Genética de Población , Proteínas Protozoarias/genéticaRESUMEN
The present study focused on three leadership, autocratic, democratic, and Laissez-faire, to sustain high school academic performance. To accomplish this, we used quantitative survey method and employed convenient sampling technique to collect data from 358 high school teachers/educators in various regions of Multan, Punjab, Pakistan. Data collection consisted of administering a survey questionnaire that used a five-point Likert Scale. The questionnaire included four variables: one dependent variable, sustained academic Performance, and three independent variables: Autocratic Leadership, Democratic Leadership, and Laissez-faire Leadership. Following data collection, Cronbach's alpha was used to assess the questionnaire's reliability, while the Kolmogorov-Smirnov test was utilized to confirm the normality of the data. Formal statistical analysis included conducting a correlation study to ascertain the association between Autocratic Leadership, Democratic Leadership, and Laissez-faire Leadership with SAP and the impact of each independent variable on the dependent variable. CFA and SEM were conducted using Linear Structural Relations (LISREL) 8.80. These tests were used to identify relationships and differences among the study participants' opinions. The findings indicate that democratic leadership has a highly positive impact, and autocratic leadership has a moderate impact on sustaining academic performance. In contrast, the laissez-faire leadership style has the lowest impact on sustaining academic performance. Based on the study's findings, it is recommended that school teachers/educators should use a combination of democratic and authoritarian leadership styles in their classes to promote cooperation, student participation, ownership in the learning process and leading to their exceptional performance. Furthermore, the findings suggest that schools should actively promote teacher involvement in administrative tasks and decision-making. Ultimately, by integrating the advantages of both types, it is possible to cultivate a comprehensive educational experience that promotes scholarly achievement and equips students with the necessary skills to tackle future problems.
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Background: Reference intervals (RI) are a vital part of information provided with laboratory results. It is recommended that RI should be established by each laboratory following pre-laid guidelines. In this systemic review, we aim to comprehensively analyze and summarize all the published literature about establishment of RI for biochemical parameters in Pakistani population. Methodology: We conducted a comprehensive search using Medline (PubMed interface) and PakMediNet literature, adhering to PRISMA guidelines. The search spanned from January 1984 to February 2024. All studies done for establishment of RI of biochemical parameters were included, while were nonhuman studies, case studies, preprints, no full text and articles in languages other than English were excluded. Rigorous evaluation ensured the robustness of their study analysis. Results: Database search reveled 161 studies, 30 were analyzed as per inclusion criteria. The accumulated sample size of the studies comprised 108,563 individuals. Most of the studies were carried out on adults in Punjab and Sindh provinces. A wide variation was noted among the RIs established and units used in each study. Gaps were identified regarding description of healthy population, patient preparation sample handing and quality control. Conclusion: In this review, critical gaps in data, methodology and reporting were identified. To enhance future studies, researchers should clearly define healthy populations, incorporate rigorous sample handling and quality control, and collaborate across centers.
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OBJECTIVE: The study aims to explore the perceived outcomes of Medical Teaching Institution (MTI) reforms on autonomy and overall performance within tertiary healthcare institutions in Khyber Pakhtunkhwa (KP) province, Pakistan. METHODOLOGY: A cross-sectional study was carried out from September 2023 to March 2024, involving interviews with frontline staff, administrative personnel, and senior management within MTI-affiliated institutions. The methodology employed, using both qualitative and quantitative data analysis techniques. RESULTS: The study showed that institutional staff members' knowledge and understanding of the MTI changes differed. Some observed very minor adjustments, while others saw advances in hospital operations and service delivery. Administrative complexity, political meddling, and resource allocation problems were noted as challenges. Positive results were also observed, though, and they included improved infrastructure, possibilities for staff training, and decision-making procedures. CONCLUSION: Despite significant improved, there are still challenges, such as inconsistent staff comprehension, mixed impacts on service delivery, resource allocation issues, and political meddling. Addressing these issues necessitates improved communication, continuous evaluation, and coordinated efforts to improve administrative systems and obtain consistent funding.
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Atención Terciaria de Salud , Pakistán , Humanos , Estudios Transversales , Reforma de la Atención de Salud , Docentes Médicos , Investigación Cualitativa , Centros de Atención Terciaria/organización & administración , Entrevistas como AsuntoRESUMEN
Hearing loss affects around 5% of the global population. Two preliminary studies have described genetic variants in sporadic individuals with hearing loss from Pakistan. Here we extend these studies to determine the spectrum of variants in a cohort of individuals with no previous history of hearing loss. Individuals with hearing loss born to consanguineous couples were identified from special schools. Audiograms were assessed. DNA from participants negative for GJB2 pathogenic variants was subjected to exome sequencing. Data were filtered to include variants with frequencies < 0.01 in the public databases. The effects of the missense variants on respective amino acids were analyzed by using PyMol software. Among the 44 participants, hearing loss was moderate for two individuals; 14 exhibited moderately-severe hearing loss while 25 had a severe degree of hearing loss. Hearing loss was reported to have been progressive in four participants and was currently profound in three participants. Variants were unambiguously identified in 17 genes, of which the majority affected SLC26A4. CDH23, MYO15A and OTOF were other significant contributors. Deleterious variants detected in two genes suggest new associations for hearing loss. Molecular characterization of hearing loss in our cohort revealed high genetic heterogeneity with a 75% diagnostic rate.
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Secuenciación del Exoma , Pérdida Auditiva , Transportadores de Sulfato , Humanos , Masculino , Niño , Femenino , Pérdida Auditiva/genética , Transportadores de Sulfato/genética , Adolescente , Proteínas Relacionadas con las Cadherinas , Cadherinas/genética , Proteínas de la Membrana/genética , Conexina 26/genética , Predisposición Genética a la Enfermedad , Pakistán , Consanguinidad , Conexinas/genética , Mutación Missense , MiosinasRESUMEN
Objective: To explore impact of flood on breastfeeding practices and identify barriers in continuation of breastfeeding among mothers residing in flood relief camps. Methods: This exploratory observational study was conducted during visit of medical team of The University of Child Health Sciences, Children's Hospital at flood relief camps of Sindh (7th September to 12th September, 2022) and south-west of Punjab province (18th November to 20th November, 2022). The data was collected on structured questionnaire from 40 lactating mothers residing in flood relief camps. Purposive sampling technique was used in this regard. Results: The mean age of breastfed children was 16.1±7.811 months. There was negative impact on breastfeeding practices (n=21, 52.5%) as frequency decreased in 18(45%) mothers and 3(7.5%) totally stopped breastfeeding. There was significant relation between pre-flood breastfeeding status and impact of flood on breastfeeding practices (p=0.001). The major barriers to appropriate breastfeeding were mother's perception of insufficient breast milk due to inadequate diet (n=6, 15%) or depression and anxiety (n=4, 10%), mother's illness (n=3, 7.5%), constant displacement (n=2, 5%) and provision of breast milk substitutes (n=2, 5%). Conclusion: There has been significant negative impact of flood on breastfeeding practices among lactating mothers residing in flood relief camps. Perception of decreased milk production due to inadequate diet and stress are major barriers in continuation of breastfeeding. Breastfeeding supportive services need to be integral component of flood crisis management.
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Background & Objectives: Ataxia is usually caused by cerebellar pathology or a decrease in vestibular or proprioceptive afferent input to the cerebellum. It is characterized by uncoordinated walking, truncal instability, body or head tremors, uncontrolled coordination of the hands, dysarthria, and aberrant eye movements. The objective of the current investigation was to identify the underlying genetic cause of the hereditary ataxia that affects the Pakistani population. Methods: We studied numerous consanguineous Pakistani families whose members had ataxia-related clinical symptoms to varying degrees. The families were chosen from the Punjab province, and the neurophysician conducted a clinical examination. Peripheral blood samples from both sick and healthy members of the family were taken after obtaining informed consent. Genomic DNA was used to find potential variations in probands using whole exome sequencing. The study was carried out at the University Hospital of Tübingen, Germany, and Government College University in Faisalabad, Pakistan, during 2018-2023. Results: The molecular analysis of these families identified different variants including SGCB: c.902C>T, c.668G>A, ATM: c.6196_6197insGAA, SPG11: c.5769del, SETX c.5525_5533del, and ATM: c.7969A>T. A noteworthy mutation in ATM and SETX was observed among them, and its symptoms were shown to cause ataxia in these families. Conclusion: The current study broadens the mutation spectrum of several hereditary ataxia types and suggests the next generation sequencing in conjunction with clinical research for a more accurate diagnosis of overlapping phenotypes of this disorder in the Pakistani population.
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The objective of the study is to determine the electricity use, and tourism industry environmental impacts, and increase in CO2 emissions in Pakistan. What are the linkages of foreign direct investment, intercountryal trade, gross domestict product, and CO2 emissions. The study has applied the Autoregressive distributed lag (ARDL) method to analysis the data set from 1985 to 2023. The robustness test is applied using Dynamic Ordinary Least Square (DOLS), and Fully modified ordinary least squares (FMOLS). The results reveal that the increase in the electricity use, and tourism industry has significant negative impacts on CO2 emissions in both short- and long-run. The increase in intercountry trade effects the Domestic Product growth (GDP) growth and causes to increase in use of fossil fuels, which are the major source of CO2 emissions. The increase in foreign direct investment (FDI) increase the GDP growth, and FDI also increase the CO2 emissions in Pakistan. The results suggests that the incresae in the renewal energy consumption for the electricity production and transportation can help to decrease the CO2 emissions in Pakistan.
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INTRODUCTION: Mycobacterium tuberculosis is the main cause of tuberculosis in humans, accounting for numerous illnesses and thousands of fatalities globally. Data regarding the association of various risk factors and TB in livestock farmers in Pakistan is scarce. METHODOLOGY: A retrospective matched case-control study of TB cases was performed in Lahore, Pakistan to investigate the potential risk factors that lead to the development of TB in Pakistani livestock farmers. A total of 170 participants were included in the study. The case was matched with control based on neighborhood and the case-control ratio was kept 1:1. Data were statistically analyzed using R version 4.2.1. Conditional logistic regression was conducted to identify biologically and statistically plausible risk factors associated with the TB outcome among livestock farmers. RESULTS: In univariable analysis, 10 risk factors were identified (p < 0.05). Gender, age, being married, family type, living in a big family, BCG vaccination status, history of smoking, working at a cattle farm, co-housing with cattle at night, , consumption of raw milk. The multivariable model identified four risk factors i.e., consumption of raw milk (Odds Ratio [OR]: 7.7; 95% Confidence Interval [CI]: 1.95-30.68), living in big family (OR: 6.2; 95% CI: 1.25-30.82) and working at cattle farm (OR: 4.2; 95% CI: 1.08-16.56), while gender was found to be a protective factor with OR < 1 (OR: 0.06; 95% CI: 0.01-0.26). CONCLUSIONS: This study demonstrated that sociodemographic risk factors and exposure to infected cattle can influence the development of TB in farmers.
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Agricultores , Ganado , Tuberculosis , Pakistán/epidemiología , Humanos , Estudios Retrospectivos , Masculino , Femenino , Factores de Riesgo , Adulto , Animales , Estudios de Casos y Controles , Agricultores/estadística & datos numéricos , Persona de Mediana Edad , Tuberculosis/epidemiología , Ganado/microbiología , Bovinos , Adulto Joven , Anciano , Modelos LogísticosRESUMEN
BACKGROUND: Health systems responsiveness (HSR) is the ability of systems to respond to legitimate non-health expectations of the population. The concept of HSR by the World Health Organization (WHO) includes respect for dignity, individual autonomy, confidentiality, prompt attention to care, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. The WHO tool is applied globally to assess HSR in low, middle, and high-income countries. OBJECTIVE: We have revised the conceptual framework of HSR following a rigorous systematic review and made it specific for low- and middle-income countries (L&MICs). This study is designed to (1) run the Delphi technique to validate the upgraded conceptual framework of HSR, (2) modify and upgrade the WHO measurement tool for assessing HSR in the context of L&MICs, and (3) determine the validity of the upgraded HSR measurement tool by pilot testing it in Pakistan. METHODS: The Delphi technique will be run by inviting global public health experts to provide suggestions on the domains and subdomains of HSR specific to L&MICs. Cronbach É will be calculated to determine internal consistency among the participants. The upgraded HSR conceptual framework will serve as a beacon to modify the measurement tool by the research team, which will be reviewed by subject experts for refinement. The modified tool will be pilot-tested by administering it to 1128 participants from primary, secondary, and tertiary care hospitals in Rawalpindi district, Pakistan. Additionally, an "observation checklist" of HSR domains and subdomains will be completed to objectively measure the state of HSR across health care facilities. HSR assessment will be further strengthened by incorporating the perspective of hospital managers, service providers, and policy makers (ie, the supply side) as well as community leaders and representatives (ie, the demand side) through qualitative interviews. RESULTS: The study was started in January 2024 and will continue until February 2025. A multidimensional approach will yield significant quantifiable information on HSR from the demand and supply sides of L&MICs. CONCLUSIONS: This study will provide a conceptual understanding of HSR and a corresponding measurement tool specific to L&MICs. It will contribute to global public health literature and provide a snapshot of HSR in Rawalpindi district, Pakistan, with concrete action points for policy makers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/59836.