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BACKGROUND: Mentorship training programs demand a paradigm shift from theory-driven to hands-on practical approach with prioritization of preparation of mentors and mentees for their roles through self-awareness and targeted professional development planning. There is a lack of evidence generated from the health professions education institutions of global south regarding effectiveness of workshops in fostering mentorship culture. METHODS: This mixed method study with convergent parallel design was conducted through a collaborative mentoring workshop; "Faculty Mentoring-Building stronger by digging deeper" by Aga khan University Medical College, Karachi and University of Lahore, Punjab, Pakistan. Objective of the research was to emphasize the importance of faculty mentoring program, roles and responsibilities of mentors and mentees and perception of the participants regarding the associated role of institutions. It aimed to educate faculty members to develop personal development plans for becoming effective mentors and mentees. The demographic data was collected before the workshop, during the workshop data was collected from SWOT analysis, followed by goal settings and the action plans made by participants at the end. Post workshop online feedback was acquired by a questionnaire to comprehend participants' educational attainment. Association between quantitative findings was done through ANOVA, while the qualitative data was subjected to thematic analysis. RESULTS: Total of 37 faculty members participated in the hands-on workshop. All faculty equally perceived the workshop as satisfactory and reported that hands-on practice led to positive experience of setting clear goals and action plans in developing oneself both as mentor and mentee. Themes identified were; Faculty Mentorship Program, Personal development Plan of Mentors and Mentees and Building Positive Mentor-Mentee Relationships. Voluntary structured program, choice of more than one faculty mentor and portfolio development based on personal SWOT was recommended by participants for the success of formal mentoring programs. CONCLUSION: Medical Faculty of Pakistani Universities at all career levels is interested in development of formal mentoring programs in their universities. Formal training for the same is also recommended by the participants. Institutions should cultivate a culture of mentorship that supports the professional growth and success of academics for cultivating the minds that are in turn shaping our future generations.
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Docentes de Medicina , Tutoria , Mentores , Humanos , Paquistão , Feminino , Masculino , Desenvolvimento de Pessoal , Adulto , EducaçãoRESUMO
Oral cancer (OC) is the most common cancer in Pakistani males and the second most common in females. Major risk factors include peculiar chewing habits, human papillomavirus (HPV) infection and molecular pathways. However, less data is available for this avertible cancer regarding its association with high-risk HPV (HR-HPV) and chewing habits in this region. Therefore, this study was done to determine the prevalence of HR-HPV in oral squamous cell carcinoma (OSCC) and its correlation with p16 and chewing habits. Formalin-fixed paraffin-embedded (FFPE) biopsy specimens of 186 samples were tested for HR-HPV type 16/18 by PCR, followed by p16 immunostaining (IHC) in a subset of cases (n = 50). Appropriate statistical tests were applied to find the association between HR-HPV/p16 and peculiar chewing habits with significance criteria of p<0.05 with 95% CI. HR-HPV (type 16 &18) was present in seven out of 186 cases (3.8%). Of these seven cases, five were positive for HPV16, whereas two were positive for HPV16/18. The overall expression of p16 protein in 50 samples was 38% (n = 19), and among these 19-IHC positive samples, 26% were positive for HR-HPV DNA. No significant association was found between HR-HPV positivity and p16 and chewing habits (p>0.05). It was concluded that HR-HPV prevalence in OSCC was very low in our population, with no statistically significant correlation with p16 and chewing habits. These results suggest the role of HR-HPV as an independent risk factor in OSCC in the local setting.
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Carcinoma de Células Escamosas , Papillomavirus Humano 16 , Neoplasias Bucais , Infecções por Papillomavirus , Humanos , Neoplasias Bucais/virologia , Neoplasias Bucais/epidemiologia , Masculino , Feminino , Carcinoma de Células Escamosas/virologia , Carcinoma de Células Escamosas/epidemiologia , Pessoa de Meia-Idade , Prevalência , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Adulto , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/isolamento & purificação , Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Fatores de Risco , Idoso , Papillomavirus Humano 18/isolamento & purificação , Papillomavirus Humano 18/genética , Mastigação , Paquistão/epidemiologia , Papillomavirus HumanoRESUMO
Objectives: To assess the visual improvement and mean residual astigmatism in patients who underwent cataract surgery with toric intraocular lens. METHODS: The retrospective, observational study was conducted at the Department of Ophthalmology, Aga Khan University Hospital, Karachi, and comprised data from January 1, 2018, to December 31, 2020, related to adult patients who had regular astigmatism of at least 0.75D and underwent cataract surgery with toric intraocular lens implantation using a digital marker. The patients were followed up on post-operative days 1, 7, 30, 90 and 180. Along with age, the degree of astigmatism was noted. The visual acuity was calculated pre- and post-operatively. The mean residual astigmatism was then noted for all patients post-operatively. Data was analysed using SPSS 22. RESULTS: The sample comprised 240 eyes of 177 patients; 99(55.9%) males and 78(44.1%) females. The mean age of the sample was 62.5±10.6 years. The mean unaided visual acuity improved post-operatively from 0.57±0.38 to 0.07±0.22 at 90 days. At the 30-day follow-up, mean residual astigmatism had reduced from 1.52±0.84 to 0.01±0.09 (p<0.001). The mean intraocular lens rotation from the intended axis was 0.73°±0.92° on day 30. CONCLUSIONS: Toric intraocular lens implantation using a digital marker could effectively reduce the post-operative cylinder, and improve the unaided visual acuity following cataract surgery.
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Astigmatismo , Catarata , Lentes Intraoculares , Facoemulsificação , Masculino , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Implante de Lente Intraocular , Astigmatismo/cirurgia , Estudos Retrospectivos , Catarata/complicações , Catarata/terapia , Refração OcularRESUMO
Objective: To investigate the perceptions of mentors, mentees, administrators (including chairs, co-chairs, and coordinators of the mentoring program), and leadership regarding the Faculty Mentorship Program at AKU School of Nursing and Midwifery (AKU-SONAM). Additionally, the study aimed to explore the strengths and challenges faced by the program. Methods: A qualitative exploratory study on mentorship was carried out in AKU-SONAM from February till December 2021. In this study we conducted purposive criterion sampling. The study participants included mentors, mentees, administrators, and the dean of AKU-SONAM. An interview guide was developed, validated, and reviewed by experts. After piloting, two focused group discussions and three in-depth interviews were conducted. Results: Thematic analysis of the data revealed the following themes: "Nurturing growth and development in mentoring relationships," "Establishing a strong foundation for effective mentoring," and "Opportunities for growth and development through overcoming challenges." Conclusion: The participants expressed confidence in the existing support system, leadership, and mentorship program at the institution. They highlighted the significance of regular monitoring to recognize areas of improvement uphold high standards and ensure excellence.
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AIM: Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management. DESIGN: This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13-71 years). METHODS: Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist. RESULTS: Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake. CONCLUSION: CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities. IMPLICATIONS FOR PATIENT CARE: At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.
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Dor Crônica , Depressão , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Depressão/diagnóstico , Depressão/psicologia , Dor Crônica/diagnóstico , Dor Crônica/terapia , Estudos Transversais , Austrália , Ansiedade , AnalgésicosRESUMO
Background & Objective: Faculty members require mentoring in all stages of their professional development. Aga Khan University (AKU) has initiated mentorship programs for students and faculty at AKU Medical College (AKU- MC) and AKU School of Nursing and Midwifery (AKU-SONAM). This study aimed to explore perceptions of mentors, mentees, administrators (chairs, co-chairs, founder members and coordinators of the mentoring program) and leadership and further investigate the strengths and challenges faced by 'Faculty Mentorship Program' at AKU- MC. Methods: We conducted a qualitative exploratory study from February till December 2021 after approval from AKU using purposive criterion sampling. Mentors, mentees, administrators and dean of AKU- MC were included in the study. The interview guide was developed, validated and reviewed by experts. After piloting, four focused group discussions and 8 in-depth interviews were conducted in AKU- MC. Results: The findings described the transition from informal to formal mentorship, identified challenges faced by mentors and mentees and suggested the role of leadership / administrators. The themes identified were "Continuous improvement of mentoring practices", "Building strong foundations for mentoring relationships", and "Growth and development through challenging experiences". Conclusion: The faculty mentorship program at AKU-MC was in line with the goals and vision of the institution. All participants identified the need of additional resources, administrative support, rewards, incentives and recognition of mentors for sustainability of the program.
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Living with a chronic illness requires individuals to perform a critical role in self-managing their illness to improve their quality of life and prevent disease-related complications. To our knowledge, no studies have explored how individuals perceive managing their illness in daily living within the Asian context. This exploratory-descriptive qualitative study aimed to explore the individuals' perspectives regarding self-managing their life with a chronic illness within the Asian context. Individual interviews were conducted with 15 adults living with chronic illness, from three teaching hospitals in Pakistan. An iterative process was followed for data collection and analysis. The analysis identified self-management as complex and situation-driven with variable roles for individuals, namely follower, selective follower, self-permitting role, and active role. Three interrelated elements were found to be influencing these roles: the components of self-management; individuals' relationship with agencies (significant people and power); and their inner drives. Individuals keep moving between these four self-management roles to avoid disharmony and reciprocate the efforts of their significant others. The interdependent community structure, which is a reality in Asian society, was reflected in our data. With this in view, a great deal of authority was given to family relationships and healthcare professionals (HCPs). This study found a lack of collaborative partnership role between individuals and HCPs. The findings and a suggested conceptual figure can facilitate redefining the individuals' and professionals' roles in the healthcare system to promote collaborative partnership and improve individuals' experience of living with a chronic illness within the Asian context. Members of the research team have extensive experience in research around chronic illness management, and self-management (support) from the Western context. The researcher did not need the patient or public contribution in this preliminary exploratory study from the Asian context.
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Qualidade de Vida , Autogestão , Adulto , Humanos , Doença Crônica , Atenção à Saúde , Paquistão , Pesquisa QualitativaRESUMO
INTRODUCTION: The emergency department is the most affected by physical and verbal abuse and bullying in health care. Violence against health care workers not only affects their safety, but also their performance and motivation. This study aimed to determine the prevalence and associated determinants of violence against health care personnel. METHODS: A cross-sectional study design was used with 182 health care personnel at the emergency department tertiary care hospital of Karachi, Pakistan. Data were collected through a questionnaire comprised of 2 sections: (1) demographic questions and (2) statements to identify the prevalence of workplace violence and bullying among health care personnel. Nonprobability purposive sampling was used for recruitment. Binary logistic regression was used to identify the prevalence and determinants of violence and bullying. RESULTS: Most participants were younger than 40 years of age (n = 106, 58.2%). Participants were mainly nurses (n = 105, 57.7%) and physicians (n = 31, 17.0%). Participants reported experiencing sexual abuse (n = 5, 2.7%), physical violence (n = 30, 16.50%), verbal abuse (n = 107, 58.8%), and bullying (n = 49, 26.9%). The odds of experiencing physical violence were 3.7 times greater (confidence interval = 1.6-9.2) when there was not a procedure for reporting workplace violence compared to when there was a procedure. DISCUSSION: Attention is required to identify the prevalence of workplace violence. Creating effective policies and procedures for a reporting system would potentially lead to lowering violence rates and positively impacting health care workers' well-being.
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Bullying , Violência no Trabalho , Humanos , Estudos Transversais , Centros de Atenção Terciária , Paquistão/epidemiologia , Local de Trabalho , Pessoal de Saúde , Serviço Hospitalar de Emergência , Inquéritos e Questionários , Atenção à SaúdeRESUMO
BACKGROUND: The incidence of anal cancer, largely associated with anal human papillomavirus (HPV) infection, is increasing among men who have sex with men (MSM), and transgender women living with or without HIV. Screening for anal cancer to detect anal precancerous lesions in high-risk groups is an important opportunity for prevention but still lacking in many low-and-middle-income countries. The aim of this study was to explore the readiness of Pakistan's healthcare system to integrate anal cancer and HPV screening into a national HIV program, as perceived by policymakers, health managers, and healthcare providers. DESIGN: This qualitative study using key-informant interviews with participants influence in policy making, implementation and advocacy from public and private sector were conducted between March 2021 to August 2021 in Karachi Pakistan. METHODS: Key informants were purposely selected from different domains of the healthcare system responsible for the target group of interest, MSM and transgender-women in general and people living with HIV in particular. A total of 18 key informants, at different levels of seniority were recruited from governmental and non-governmental organizations, high-level infectious disease healthcare managers, and United Nations Program representatives. Qualitative content analysis was used to identify the manifest and latent themes, based on socioecological framework. RESULTS: The results were grouped into five major themes; (1) The policy context and priorities, (2) Health systems factors, (3) Community environment, (4) Healthcare setting & providers and (5) Individual-level obstacles. The policy actors expressed their concerns about their limited voice in country's health and health related priority setting. Informants reported a lack of political will and suggested that government should bring a change in the paradigm of healthcare service delivery from reactive to proactive approach. Although, participants unanimously favored integration of HPV preventive services into existing HIV program, they also identified several service delivery barriers including trained workforce shortage, limited capacity of information technology, lack of supplies needed for screening, lack of financing, and lack of services that could meet key-populations needs. Participants also predicted other implementation challenges such as stigma, social victimization, and systemic discrimination against at-risk groups at healthcare facilities. CONCLUSION: Although policy makers and health providers in Pakistan saw a clear need to scale-up and integrate anal cancer screening for key populations, the feasibility of this is dependent on political will, financing, anti-stigma and discrimination interventions and health system efficiency.
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Neoplasias do Ânus , Infecções por HIV , Infecções por Papillomavirus , Minorias Sexuais e de Gênero , Masculino , Humanos , Feminino , Homossexualidade Masculina , Papillomavirus Humano , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Infecções por HIV/epidemiologia , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Paquistão , Detecção Precoce de Câncer , Neoplasias do Ânus/diagnóstico , Neoplasias do Ânus/prevenção & controleRESUMO
OBJECTIVE: To explore the perceptions and experiences of healthcare professionals, including female health visitors, female health workers, community midwives, and heads of departments of healthcare facilities, regarding the importance of the Safe Motherhood Initiative (SMI), its pillars, and its foundational principles. DESIGN: Qualitative descriptive exploratory study. SETTING: This study was conducted in healthcare centres in 10 districts in Pakistan: six in Gilgit Baltistan, two in Chitral, and two in Sindh. PARTICIPANTS: Healthcare professionals were recruited using a purposive sampling technique. In total, 14 in-depth interviews were conducted. FINDINGS: The following themes emerged through thematic analysis: (1) health and well-being of mothers and newborns; (2) strengthening the SMI pillars; (3) equity of health services; and (4) effective strategies for behaviour modification. Each theme had two categories. KEY CONCLUSIONS: The health and well-being of mothers and newborns are key indicators; as such, interventions should be made to promote their quality of life. Capacity building and refresher training on antenatal care, childbirth, postnatal care, postabortion care, and family planning can be considered effective to enhance the competencies of healthcare professionals. IMPLICATIONS FOR PRACTICE: The findings of this study suggest that healthcare professionals should receive training to enhance their competencies and provide safe care.
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Cuidado Pré-Natal , Qualidade de Vida , Gravidez , Feminino , Humanos , Recém-Nascido , Paquistão , Parto , Mães , Pesquisa QualitativaRESUMO
Women experience perinatal mental health problems (PMHP), such as anxiety and depression antenatally and/or postnatally. Among Asian countries, Pakistan has the highest prevalence of postnatal depression ranging from 28% to 63%. This study aimed to explore midwives' perceptions, understanding, thoughts, and feelings regarding perinatal mental health (PMH), as well as experiences and roles in identifying and managing perinatal women cases suffering from PMHP. A qualitative, descriptive, exploratory design was used. The study was conducted at Koohi Goth Hospital. Purposive sampling was used to recruit practicing midwives holding diplomas in midwifery and public health, and with at least two years of experience. Ten participants were recruited. Data were collected by conducting in-depth interviews using a semi-structured interview guide, translated into Urdu. Interviews were audio recorded. Ethics approval was attained by the institutional Ethical Review Committee. Data analysis was done manually by using the content analysis steps described by Creswell. From the analysis, three themes emerged: 1) Dearth of PMH competencies; 2) Importance of PMH; and 3) Myths related to PMH. PMHP undermine mothers' and infants outcomes, thus, midwives should be competent in assessing and managing symptoms in perinatal women to reduce suffering.
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Tocologia , Lactente , Feminino , Gravidez , Humanos , Saúde Mental , Paquistão , Mães/psicologia , Pesquisa QualitativaRESUMO
School health remains an ignored domain in Pakistan. This article presents gaps in understanding hygiene promotion efforts in school settings in urban squatter settlements by exploring perspectives of the key stakeholders and undertaking a review of the education curriculum. Using qualitative methodology, 13 in-depth interviews were held with the key informants (teachers, health and education officers) and three focus group discussions were conducted with 36 mothers. The study setting includes three schools located in a semi-urban area in the province of Sindh, Pakistan. The semi-structured guide was utilized to obtain perspectives of key stakeholders on factors constraining hygiene promotion efforts in school settings. The primary education curriculum was reviewed using the content analysis approach to assess the integration of hygiene concepts into the curriculum. Analysis of qualitative interviews and curriculum review resulted in five categories under a theme that addressed multiple factors constraining hygiene promotion in the school settings. These include (i) Gaps in the school curriculum, (ii) Poor accountability of the local administration in the upkeep of schools, (iii) Parent's negligence toward children's hygiene, (iv) Inadequate training of school teachers on hygiene concepts, and (v) Lack of interdepartmental coordination between health and education sectors. Hygiene promotion at schools has been deterred by multiple factors at the selected primary schools in Pakistan. Recommended actions include integration of health and hygiene concepts into the education curriculum, capacity building of teachers, reviving water, sanitation and hygiene infrastructure, coordination among Education and Health Departments and ownership among the local government to ensure cleanliness at schools.
Schools are not only expected to provide education to children, their mandate also includes health and hygiene promotion. Keeping in view the dearth of evidence in understanding the role of schools in hygiene promotion in the local context, this research was conducted in three semi-urban school settings in Sindh province, Pakistan. We aimed to identify factors that constrain hygiene promotion efforts at the school level. As part of this research, we interviewed multiple stakeholders. This includes (teachers, mothers, education and health officers) at the primary school level. Our findings revealed serious gaps in hygiene promotion at schools. This includes inadequate attention to hygiene concepts in the curriculum books, inconducive school environment, teachers' and parents' negligence toward children's hygiene and communication gap among them, and absence of coordination between health and education sectors. To conclude, multiple actions are needed to emphasize hygiene promotion at the school level. This ranged from revision in the education curriculum and training of teachers in hygiene promotion to instituting accountability mechanisms at the local Education Department and building strong coordination between Education and Health departments.
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Currículo , Instituições Acadêmicas , Feminino , Criança , Humanos , Paquistão , Mães , Higiene , Pesquisa Qualitativa , Professores EscolaresRESUMO
BACKGROUND: Gender discrimination is any unequal treatment of a person based on their sex. Women and girls are most likely to experience the negative impact of gender discrimination. The aim of this study is to assess the factors that influence gender discrimination in Pakistan, and its impact on women's life. METHODS: A mixed method approach was used in the study in which a systematic review was done in phase one to explore the themes on gender discrimination, and qualitative interviews were conducted in phase two to explore the perception of people regarding gender discrimination. The qualitative interviews (in-depth interviews and focus group discussions) were conducted from married men and women, adolescent boys and girls, Healthcare Professionals (HCPs), Lady Health Visitors (LHVs) and Community Midwives (CMWs). The qualitative interviews were analyzed both manually and electronically through QSR NVivo 10. The triangulation of data from the systematic review and qualitative interviews were done to explore the gender discrimination related issues in Pakistan. RESULTS: The six major themes have emerged from the systematic review and qualitative interviews. It includes (1) Status of a woman in the society (2) Gender inequality in health (3) Gender inequality in education (4) Gender inequality in employment (5) Gender biased social norms and cultural practices and (6) Micro and macro level recommendations. In addition, a woman is often viewed as a sexual object and dependent being who lacks self identity unless being married. Furthermore, women are restricted to household and child rearing responsibilities and are often neglected and forced to suppress self-expression. Likewise, men are viewed as dominant figures in lives of women who usually makes all family decisions. They are considered as financial providers and source of protection. Moreover, women face gender discrimination in many aspects of life including education and access to health care. CONCLUSION: Gender discrimination is deeply rooted in the Pakistani society. To prevent gender discrimination, the entire society, especially women should be educated and gendered sensitized to improve the status of women in Pakistan.
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Sexismo , Comportamento Social , Masculino , Adolescente , Humanos , Feminino , Paquistão , Pesquisa Qualitativa , Grupos FocaisRESUMO
Objectives: To explore perception of mentors and mentees about 'Mentorship Program at Aga Khan University Medical College (AKU-MC) from a structured feedback form. Methods: A retrospective study was conducted for evaluation of mentorship program at AKU-MC during the period from Jan 2019 to March, 2021. Responses on validated "Pre-intervention Probe Forms", from forty-seven mentors and fourteen mentees inducted in the program were reviewed. Confidentiality and anonymity of data were deliberated. All replies to each question were entered in a separate worksheet to determine the frequency and percentage of answers. Responses conveying same message, but worded differently were then grouped. Results: All the mentees (n=14) responded positively to the question on the "understanding of the mentoring program. The mentees (n=12, 86%) recognized the potential of the program to transfer knowledge and skills, (n=11, 79%) supported its role for achievement of goals, (n=7, 50%), acknowledged its role in faculty relationships. The mentors expressed their enthusiasm to help the mentee's in their professional development. They (n=20, 43%) offered support to set career goals, (n=29, 62%) proposed transfer of knowledge, skills, and experiences to achieve goals, (n=15, 32%) decided to be "role models". Some (n=10, 21%) forecasted improved communication skills, (n=14, 30%) boosted leadership capabilities, (n=13, 28%) expected improved work performance, (n=15, 32%) opinioned that networking and leadership qualities will impact the growth of the mentee to meet the university's expectations. Conclusion: Both mentors and mentees recognized the importance of the faculty mentorship program at AKU-MC for professional guidance, development and improvement in work performance.
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Purpose: Esophageal cancer (EC) is the most common cancer among males in Afghanistan, thus we aimed to conduct a case-control study to determine the associated risk factors with EC in two tertiary care hospitals of Kabul, Afghanistan. Patients and Methods: We enrolled 132 EC cases and 132 controls and used conditional logistic regression to estimate the odds ratio (OR) with consideration of 95% confidence interval (CI). Results: The results of our study revealed that esophageal squamous cell carcinoma (ESCC) was the predominant type of EC constituting 75.8% of the cases. The results of the multivariate logistic analysis showed that males and older ages were at increased risk of developing EC (OR: 4.62, 95%CI, p-value=0.026) and (OR: 1.070, 95%CI, p-value <0.001), respectively. In addition, living in rural areas (OR: 46.64, 95%CI, p-value <0.001), being uneducated (OR: 13.94, 95%CI, p-value=0.042), using oral snuff (OR: 6.10, 95%CI, p-value=0.029), drinking hot tea (OR: 5.719, 95%CI, p-value=0.005), lack of physical exercise (OR: 32.548, 95%CI, p-value=0.001), less fresh fruit consumption (OR: 93.18, 95%CI, p-value<0.001) and family history of cancer (OR: 14.50, 95%CI, p-value=0.003) were significantly associated with the development of EC, while body mass index (BMI), smoking, alcohol drinking, consumption of spicy food and pickled vegetables did not have a significant association with EC. Moreover, the majority of the cases (83.3%) in our study were from to low-income families and the majority were unemployed (93.9%), of whom (50%) were farmers, who did not show statistically significant association. Conclusion: Our study concluded that EC risk was higher in older ages, males, rural residents, uneducated people, oral-snuff users, hot tea drinkers, fewer fresh fruit consumers, lack of physical exercise, and family history of cancer. Further detailed studies and screening policies of the affected groups are suggested to further elaborate on the subject.
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The prevalence of internet gaming disorders (IGD) is considerably high among youth, especially with the social isolation imposed by the ongoing COVID-19 pandemic. IGD adversely affects mental health, quality of life, and academic performance. The Internet Gaming Disorder Scale (IGDS9-SF) is designed to detect IGD according to DSM-IV diagnostic criteria. However, inconsistent results are reported on its capacity to diagnose IGD evenly across different cultures. To ensure the suitability of the IGDS9-SF as a global measure of IGD, this study examined the psychometric properties of the IGDS9-SF in a sample of Sri Lankan university students (N = 322, mean age = 17.2 ± 0.6, range = 16-18 years, 56.5% males) and evaluated its measurement invariance across samples from Sri Lanka, Turkey, Australia, and the USA. Among Sri Lankan students, a unidimensional structure expressed good fit, invariance across different groups (e.g., gender, ethnicity, and income), adequate criterion validity (strong correlation with motives of internet gaming, daily gaming duration, and sleep quality), and good reliability (alpha = 0.81). Males and online multiplayers expressed higher IGD levels, greater time spent gaming, and more endorsement of gaming motives (e.g., Social and Coping) than females and offline players. Across countries, the IGDS9-SF was invariant at the configural, metric, and scalar levels, although strict invariance was not maintained. The lowest and highest IGD levels were reported among Turkish and American respondents, respectively. In conclusion, the IGDS9-SF can be reliably used to measure IGD among Sri Lankan youth. Because the scale holds scalar invariance across countries, its scores can be used to compare IGD levels in the studied countries.
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OBJECTIVES: Men who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women's perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan. DESIGN: A qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan. METHODS: Participants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 transgender women took part in 6 FGDs. Discussions were recorded, translated, transcribed verbatim and analyzed using content analysis. RESULTS: Three themes were identified from the emerging analysis. These are, 1) Knowledge and risk perceptions about STIs and HPV, 2) Beliefs and attitudes towards HPV prevention, 3) Participant's recommendations for HPV vaccination and anal Pap screening. Participants described lack of knowledge of HPV and its health consequences as HIV is the only focus of attention of the government and the local CBOs. None of participants had heard about HPV prevention including vaccination and anal Pap screening for men but expressed a positive attitude towards prevention. Genital warts and anal cancer were perceived as severe potential consequences of a known risk behaviors. All participants stated they would be interested in taking an HPV vaccine but acknowledged that the provision of services for sexually transmitted infections (STI) are inadequate to meet the needs of key populations and are not prioritized by the government. The main perceived barriers to access HPV prevention included cost and challenges to access public health care services or openly discussing one's sexual orientation with health care providers. Participants generally preferred the CBO for more professional, unbiased staff attitudes that respect patients' integrity, confidentiality and privacy. Most participants thought that in case the government is non-cooperative, CBOs should work in the interest of HPV eradication and generate funds through international funding. CONCLUSIONS: The findings from this study can help public health policy and researchers to understand this minority's perspective on HPV prevention. Given the low level of knowledge about HPV infection and its negative health consequences there is a need of HPV education combined with STI education and awareness through HPV brochures to educate the target population effectively.
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Alphapapillomavirus , Neoplasias do Ânus , Condiloma Acuminado , Infecções por HIV , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Profissionais do Sexo , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis , Pessoas Transgênero , Neoplasias do Ânus/prevenção & controle , Condiloma Acuminado/prevenção & controle , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina , Humanos , Masculino , Paquistão/epidemiologia , Papillomaviridae , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Infecções Sexualmente Transmissíveis/prevenção & controleRESUMO
Concerns over the soaring number of COVID-19 cases has taken precedence within the healthcare community and overshadows the jarringly high rates of maternal mortality in developing countries. Pakistan is suffering from high maternal mortality, surges of COVID-19 cases, lack of integrated healthcare system, and rural poverty. Amidst fear and uncertainty, Community Midwives are stepping up as maternal healthcare leaders who are reaching out to neglected pregnant women in rural communities of Pakistan. They are responsible for rebuilding trust, delivering comprehensive and respectful maternal care and providing family planning counseling. To accomplish Sustainable Development Goal #3.1, Pakistan must support community midwives and diminish the barriers they face.
Assuntos
COVID-19 , Serviços de Saúde Materna , Tocologia , Feminino , Humanos , Paquistão/epidemiologia , Pandemias , Gravidez , SARS-CoV-2RESUMO
BACKGROUND: Anal squamous intraepithelial lesions (ASIL), strongly related to human papilloma virus (HPV) infection, is more prevalent among men who have sex with men (MSM). However, no such data are available for Pakistan yet, and neither HPV vaccination nor anal-cytology screening is implemented in Pakistan. The purpose of this first ever study was to assess the prevalence of HPV-related anal cytological abnormalities among MSM and transgender women living with and without HIV infection in Pakistan. METHODS: We conducted a cross-sectional study from March 2016 to November 2017 at sexual health centers run by the Perwaaz Trust and the National AIDS Control Program in Karachi. The study enrolled MSM and transgender women aged greater-than-and-equal-to-18-years who reported anal sex in the preceding 6 months. We collected two anal samples for liquid-based cytology and HPV type testing by PCR, and socio-demographic and behavioral data were collected through face-to face interviews. ASIL and its associations with biological and behavioral risk factors were analyzed through Cox regression for prevalence ratios (PR) and corresponding 95% confidence intervals (CIs). RESULTS: Out of 271 qualifying participants, 79% were MSM and 21% transgender women. The mean age was 28.8 (± 8) years. Almost 35% (93/271) of the study population had ASIL detected, ASIL was significantly more common among participants living with HIV than in HIV negative ((50/118) 42.4%; vs. (43/153) 28.1%) (p ≤ 0.001). Among ASIL, 66% (61/93) had low-grade squamous intraepithelial lesions (LSIL), and 3.6% (3/93) had high-grade squamous intraepithelial lesions (HSIL). The overall, HPV16 positivity was 35.5% (33/93) among all abnormal anal lesions and all 3 HSIL were HPV16 positive, however, HPV16 positivity could show its association with ASIL detection in univariate model only (PRcrude: 2.11(1.39-3.18)). Moreover, any HR-HPV type (PR 3.04; 95% CI 1.75-5.26), concurrent sexually transmitted infection (STI) (2.13; (1.28-3.55)) and HIV + /HPV + coinfection (1.75; (1.07-2.88)) remained independently associated with ASIL in the multivariate model. CONCLUSIONS: Abnormal anal cytology among MSM and transgender is prevalent enough to consider optimal screening regimens. Further studies are required to see if periodic anal cytology can be made part of HIV care and treatment programs among MSM in Pakistan.