Medicinal Plants with Anti-Leukemic Effects: A Review.

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.

Depression-level symptoms among Syrian refugees: findings from a Canadian longitudinal study.

BACKGROUND: Canada launched the Syrian Refugee Resettlement Initiative in 2015 and resettled over 40,000 refugees. AIM: To evaluate the prevalence of depression-level symptoms at baseline and one year post-resettlement and analyze its predictors. METHODS: Data come from the Syrian Refugee Integration and Long-term Health Outcomes in Canada study (SyRIA.lth) involving 1924 Syrian refugees recruited through a variety of community-based strategies. Data were collected using structured interviews in 2017 and 2018. Depression symptoms were measured using Patient Health Questionnaire 9 (PHQ-9). Analysis for associated factors was executed using multinomial logistic regression. RESULTS: Mean age was 38.5 years (SD 13.8). Sample included 49% males and 51% females settled in Ontario (48%), Quebec (36%) and British Columbia (16%). Over 74% always needed an interpreter, and only 23% were in employment. Prevalence of depression-level symptoms was 15% at baseline and 18% in year-2 (p < 0.001). Significant predictors of depression-level symptoms at year-2 were baseline depression, sponsorship program, province, poor language skills, lack of satisfaction with housing conditions and with health services, lower perceived control, lower perceived social support and longer stay in Canada. CONCLUSION: Increase in depression-level symptoms deserves attention through focusing on identified predictors particularly baseline depression scores, social support, perceived control and language ability.

Association amid the comorbidity of Diabetes Mellitus in patients of Active Tuberculosis in Pakistan: A matched case control study.

OBJECTIVES: This study aims to test the association between diabetes and tuberculosis. METHODS: It is a matched case control study conducted in tertiary care hospitals in 2019-2020. Cases and controls were 144 each, selected on the basis of an odds ratio of 2 at 95% confidence interval with a significance level of 5%. Cases of pulmonary tuberculosis were selected through consecutive sampling technique, either visiting OPD or admitted in hospital. Controls were taken from the general population and frequency matching was done based on age, gender and socioeconomic status. Data was collected through structured questionnaire after taking written consent. Data was analyzed on SPSS version 23. Binary Logistic regression model was applied for finding association between the risk factors and the disease. P value <0.05 was considered statistically significant. RESULTS: Out of all cases and controls, 45% and 20% were diabetics respectively. The association between the risk factors and tuberculosis was estimated by univariate analysis, positive association was found between diabetes and tuberculosis (OR= 3.32), a high frequency of diabetes in cases as compared to controls were observed with a highly significant p- value (<.001). CONCLUSIONS: This study provides evidence for a strong positive association between tuberculosis and diabetes.

Implementing recommendations for inpatient healthcare provider encouragement of cardiac rehabilitation participation: development and evaluation of an online course.

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.

Posttraumatic Stress Disorder, Social Support and Coping Among Afghan Refugees in Canada.

Posttraumatic-stress-disorder (PTSD) is one of the common mental health conditions among Afghan refugees resettled in developed countries. The current study explores how social support, coping and other factors correlate with PTSD in this population. A survey was conducted with 49 adult Afghan refugees (males 41%, female 59%) who completed Harvard Trauma Questionnaire during their visit to a Community Health Centre in Toronto. Bivariate analysis and structural-equation-modeling (SEM) were used to examine associations and pathways between PTSD and other variables. Mean PTSD score was 2.53 (SD 0.92) with 53% showing symptoms of PTSD which was significantly associated with age, unemployment, social support and self-rated health. SEM showed that higher social support scores were significantly associated with lower PTSD scores, and the effect of coping and English language were mediated through social support. The high prevalence of PTSD, its association with social support and self-rated health are important issues to be considered for refugee resettlement programs.

A study with Bangladeshi women: Seeking care for breast health.

In many low- and middle-income countries, breast cancer survival is low. Reasons for this are multifactorial, but delayed presentation for care is a common theme. In this survey study with 100 urban Bangladeshi women, we examined the role of socioeconomic and sociocultural factors on their likelihood to seek breast care from a family physician. In our multivariate model, a woman's age and education significantly predicted her likelihood to see a physician. Sociocultural aspects (e.g., concerns about time commitment of family members, personal household obligations) were significant at bivariate level. Findings are discussed in relation to practice, policy, and research.

"I want to save my life": Conceptions of cervical and breast cancer screening among urban immigrant women of South Asian and Chinese origin.

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.

Computer-assisted client assessment survey for mental health: patient and health provider perspectives.

BACKGROUND: The worldwide rise in common mental disorders (CMDs) is posing challenges in the provision of and access to care, particularly for immigrant, refugee and racialized groups from low-income backgrounds. eHealth tools, such as the Interactive Computer-Assisted Client Assessment Survey (iCCAS) may reduce some barriers to access. iCCAS is a tablet-based, touch-screen self-assessment completed by clients while waiting to see their family physician (FP) or nurse practitioner (NP). In an academic-community initiative, iCCAS was made available in English and Spanish at a Community Health Centre in Toronto through a mixed-method trial. METHODS: This paper reports the perspectives of clients in the iCCAS group (n = 74) collected through an exit survey, and the perspectives of 9 providers (four FP and five NP) gathered through qualitative interviews. Client acceptance of the tool was assessed for cognitive and technical dimensions of their experience. They rated twelve items for perceived Benefits and Barriers and four questions for the technical quality. RESULTS: Most clients reported that the iCCAS completion time was acceptable (94.5 %), the touch-screen was easy to use (97.3 %), and the instructions (93.2 %) and questions (94.6 %) were clear. Clients endorsed the tool's Benefits, but were unsure about Barriers to information privacy and provider interaction (mean 4.1, 2.6 and 2.8, respectively on a five-point scale). Qualitative analysis of the provider interviews identified five themes: challenges in Assessing Mental Health Services, such as case complexity, time, language and stigma; the Tool's Benefits, including non-intrusive prompting of clients to discuss mental health, and facilitation of providers' assessment and care plans; the Tool's Integration into everyday practice; Challenges for Use (e.g. time); and Promoting Integration Effectively, centered on the timing of screening, setting readiness, language diversity, and technological advances. CONCLUSIONS: Participant clients and providers perceived iCCAS as an easy and useful tool for mental health assessments at the Community Health Centre and similar settings. The findings are anticipated to inform further work in this area. TRIAL REGISTRATION: ClinicalTrials.gov; NCT02023957 ; Registered retrospectively 12 Dec. 2013.

Burden of common mental disorders in a community health centre sample.

OBJECTIVE: To examine the rates of common mental disorders (CMDs) such as depression, anxiety, posttraumatic stress disorder (PTSD), and alcohol use in an urban community health care centre (CHC) serving vulnerable immigrant and ethnoracial communities in order to improve knowledge on the rates of CMDs specific to these groups accessing primary care settings. DESIGN: English or Spanish, self-administered, tablet-based survey known as the Interactive Computer-Assisted Client Assessment Survey (iCCAS). SETTING: Access Alliance Multicultural Health and Community Services CHC in Toronto, Ont. PARTICIPANTS: Adult patients waiting to see a clinician. MAIN OUTCOME MEASURES: The iCCAS screened for depression (using the PHQ-9 [Patient Health Questionnaire]), anxiety (using the GAD-7 [Generalized Anxiety Disorder 7-item scale]), PTSD (using the PC-PTSD [Primary Care PTSD Screen]), and alcohol dependency (using the CAGE questionnaire); those with an existing diagnosis and active treatment for one of these conditions were not asked to complete that condition-specific screening scale. An exit survey measured demographic characteristics and relevant indicators. RESULTS: A response rate of 78.6% was achieved. The iCCAS survey was completed by 75 patients (26 men and 49 women) with a mean age of 36.5 years. Almost all were first-generation immigrants: 32.0% originated from Latin America, 28.0% from South Asia, and 17.3% from Africa or the Middle East. Major depression was found among 44.0% of participants (11 with diagnosis and treatment, 22 with a score of 10 or greater on the PHQ-9). Generalized anxiety disorder was present in 26.7% of participants (7 with diagnosis and treatment, 13 with a score of 10 or greater on the GAD-7 scale). Posttraumatic stress disorder was detected in 37.3% of participants (7 with diagnosis and treatment, 21 with a score of 3 or greater on the PC-PTSD tool). Alcohol dependency was found among 10.7% of participants (1 with diagnosis and treatment, 7 with a score of 2 or greater on the CAGE questionnaire). CONCLUSION: The high rates of probable depression, generalized anxiety, and PTSD that were found in the studied population suggest a need for systematic assessment of CMDs in CHCs, as well as training and resources to increase readiness to handle identified cases.

Factors contributing to early menarche in school girls.

OBJECTIVE: To assess the average age of menarche in Pakistani girls from different socioeconomic backgrounds. METHODOLOGY: This was a cross sectional study design carried out on female students studying in different schools of Karachi in 2014. Girls aged 10-14 years age were included. Schools from all three socio economic strata were selected through random sampling technique from a list of schools having health care services. Data was collected through a self-administered questionnaire translated in Urdu where required. Height and Weight was measured through calibrated instruments. Sample size was n=385 based on maximum proportion of 50%. Analysis was done on SPSS version 20. Chi-square and ANOVA was applied after checking data for normality. RESULTS: The total sample size was 275 after excluding poorly filled questionnaires. The mean age of menarche in our sample population was 11.73±1.2 years. Out of the total participants 127 (46%) students had reached the age of menarche. It was found that mean age of menarche was highest in participants of Kashmiri origin 14.5±0.1 years and lowest mean age was observed in those of Gujrati origin at 11.0±0.1 years (p 0.036). When mean age of menarche was compared with socioeconomic class highest mean age was observed in lower class 12.13 ±0.1 (p 0.268). CONCLUSIONS: Our study reveals a decline in the mean age of menarche of at least 2 years in girls aged 10-14 years.

Post-dialysis effects in patients on haemodialysis.

OBJECTIVE: To assess the post-dialysis effects in normal and diabetic patients on haemodialysis. METHODS: This cross-sectional study was conducted from January to December 2013 at two hospitals in Karachi, and comprised patients receiving dialysis. Participants were selected through purposive sampling technique. SPSS 20 was used for data analysis. RESULTS: Of the 150 subjects, 148(98.8%) were diabetics. Overall, 93(62%) were men and 57(38%) women. Besides, 22(14.7%) participants were having dialysis as a complication of hypertension and 128(85.3%) as a complication of diabetes. Diabetes was a comorbid condition for 148(98.7%) patients, hypertension for 139(92.7%) and cardiac diseases for 40(26.7%). Of the total, 114(76%) subjects were having dialysis thrice a week, 31(20.7%) twice and 5(3.3%) once. Post-dialysis, dizziness was present every time in 25(16.6%) patients, nausea and vomiting in 14(10%), cramps in 22(14.7%), headache in 21(14%), anxiety and depression in 16(10.7%), hunger in 43(28.7%) and itching in 30(20%). CONCLUSIONS: Post-dialysis complications were common in normal and diabetic patients. Nutritional status was found to be poor among long-term dialysis-dependent diabetics.

Tuberculosis knowledge and health seeking behaviour: A tale of two districts of Sindh, Pakistan.

OBJECTIVE: To assess the knowledge about tuberculosis and health-seeking behaviour of people living in rural areas of Sindh. METHODS: This cross-sectional survey was conducted by the Pakistan Red Crescent Society in Dadu and Badin districts of Sindh, Pakistan, from January to August 2014. Cluster sampling technique was used for the selection of 900 households from two union councils. Those staying for less than 6 months and who refused to participate were excluded. Personal interviews were conducted by trained data collectors on pretested questionnaire. Data was analysed using SPSS 20. RESULTS: Of the 900 households, there were 450(50%) in each districts. In Dadu, 298(66.6%) participants were illiterate compared to 236(52.4%) in Badin. Half of the respondents n= 225 (50%) in Dadu were farmers compared to 136(30.2%) in Badin. Besides, 341(75.7%) in Dadu and 311(69%) in Badin were earning less than Rs10,000 per month. In addition, 318(70.6%) respondents in Dadu and 235(52.2%) in Badin had heard about tuberculosis. In Dadu, 237(52.6 %) thought it was curable compared to 263(58.4%) in Badin, whereas 32(7%) in Dadu and 45(10%) in Badin thought there was no remedy for it. Besides, 216(48%) villagers in both the districts were of the opinion that fever was the chief symptom, followed by cough and weight loss. Only 109(24.2%) respondents in Badin district confirmed the presence of a lady health worker in their village compared to 75(16.6%) in Dadu. CONCLUSIONS: Pakistanis living in rural areas had insufficient knowledge about most aspects of tuberculosis, and held misconceptions about the disease.

Who are the under- and never-screened for cancer in Ontario: a qualitative investigation.

BACKGROUND: Observed breast, cervical and colon cancer screening rates are below provincial targets for the province of Ontario, Canada. The populations who are under- or never-screened for these cancers have not been described at the Ontario provincial level. Our objective was to use qualitative methods of inquiry to explore who are the never- or under-screened populations of Ontario. METHODS: Qualitative data were collected from two rounds of focus group discussions conducted in four communities selected using maps of screening rates by dissemination area. The communities selected were archetypical of the Ontario context: urban, suburban, small city and rural. The first phase of focus groups was with health service providers. The second phase of focus groups was with community members from the under- and never-screened population. Guided by a grounded theory methodology, data were collected and analyzed simultaneously to enable the core and related concepts about the under- and never-screened to emerge. RESULTS: The core concept that emerged from the data is that the under- and never-screened populations of Ontario are characterized by diversity. Group level characteristics of the under- and never-screened included: 1) the uninsured (e.g., Old Order Mennonites and illegal immigrants); 2) sexual abuse survivors; 3) people in crisis; 4) immigrants; 5) men; and 6) individuals accessing traditional, alternative and complementary medicine for health and wellness. Under- and never-screened could have one or multiple group characteristics. CONCLUSION: The under- and never-screened in Ontario comprise a diversity of groups. Heterogeneity within and intersectionality among under- and never-screened groups adds complexity to cancer screening participation and program planning.

Single item measures of self-rated mental health: a scoping review.

BACKGROUND: A single-item measure of self-rated mental health (SRMH) is being used increasingly in health research and population health surveys. The item asks respondents to rate their mental health on a five-point scale from excellent to poor. This scoping study presents the first known review of the SRMH literature. METHODS: Electronic databases of Medline, CINAHL, PsycINFO, EMBASE and Cochrane Reviews were searched using keywords. The databases were also searched using the titles of surveys known to include the SRMH single item. The search was supplemented by manually searching the bibliographic sections of the included studies. Two independent reviewers coded articles for inclusion or exclusion based on whether articles included SRMH. Each study was coded by theme and data were extracted about study design, sample, variables, and results. RESULTS: Fifty-seven studies included SRMH. SRMH correlated moderately with the following mental health scales: Kessler Psychological Distress Scale, Patient Health Questionnaire, mental health subscales of the Short-Form Health Status Survey, Behaviour and Symptom Identification Scale, and World Mental Health Clinical Diagnostic Interview Schedule. However, responses to this item may differ across racial and ethnic groups. Poor SRMH was associated with poor self-rated health, physical health problems, increased health service utilization and less likelihood of being satisfied with mental health services. Poor or fair SRMH was also associated with social determinants of health, such as low socioeconomic position, weak social connections and neighbourhood stressors. Synthesis of this literature provides important information about the relationships SRMH has with other variables. CONCLUSIONS: SRMH is associated with multi-item measures of mental health, self-rated health, health problems, service utilization, and service satisfaction. Given these relationships and its use in epidemiologic surveys, SRMH should continue to be assessed as a population health measure. More studies need to examine relationships between SRMH and clinical mental illnesses. Longitudinal analyses should look at whether SRMH is predictive of future mental health problems.

What factors determine academic achievement in high achieving undergraduate medical students? A qualitative study.

BACKGROUND: Medical students' academic achievement is affected by many factors such as motivational beliefs and emotions. Although students with high intellectual capacity are selected to study medicine, their academic performance varies widely. OBJECTIVES: The aim of this study is to explore the high achieving students' perceptions of factors contributing to academic achievement. MATERIALS AND METHODS: Focus group discussions (FGD) were carried out with 10 male and 9 female high achieving (scores more than 85% in all tests) students, from the second, third, fourth and fifth academic years. During the FGDs, the students were encouraged to reflect on their learning strategies and activities. The discussion was audio-recorded, transcribed and analysed qualitatively. RESULTS: Factors influencing high academic achievement include: attendance to lectures, early revision, prioritization of learning needs, deep learning, learning in small groups, mind mapping, learning in skills lab, learning with patients, learning from mistakes, time management, and family support. Internal motivation and expected examination results are important drivers of high academic performance. Management of non-academic issues like sleep deprivation, homesickness, language barriers, and stress is also important for academic success. CONCLUSION: Addressing these factors, which might be unique for a given student community, in a systematic manner would be helpful to improve students' performance.

Evaluation of the awareness and perception of professional students in medicine, business and law schools of Karachi, regarding the use of (recreational) cannabis.

OBJECTIVE: To assess the awareness and perception of students attending professional medicine, law and business schools regarding recreational use of cannabis. METHODS: The cross-sectional study was conducted between June 2010 and November 2010. Using convenience sampling, 150 students from medical, business and law schools from both private and public sectors were enrolled. Government institutions included, Sindh Medical College, Institute of Business Administration and S.M. Law College, private schools were Ziauddin Medical College, SZABIST and Lecole for advanced studies. Data was collected through self-administered questionnaire. SPSS 17 was used for statistical analysis. RESULTS: A total of 250 students were approached out of which 150(60%) filled the questionnaire. Of them 91(60.7%) were males and the overall mean age of the respondents was 22 ± 2 years. A total of 68 (45.3%) students were from the medical field, 53 (35.3%) from business and 29 (19.3%) from law. The private and public sectors were equally represented at 75 (50%) each. Overall, 93 (62%) agreed that hashish is a serious problem concerning student population. When asked to identify factors encouraging abstinence, 67 (44.7%) respondents each cited religion and health risks. CONCLUSION: Our youth is not only concerned about the menace of hashish and but want proper awareness to be provided.

Awareness regarding research skills among clinical and academic post graduate doctors in teaching hospitals of Karachi.

OBJECTIVE: To assess the awareness regarding research skills among clinical and academic post-graduate doctors in teaching hospitals of Karachi. METHODS: The cross-sectional study was carried out from August to October 2012 in two teaching hospitals of Karachi. Total 92 doctors who were enrolled in academic and clinical post-graduation programmes were included in the study through convenience sampling. Data was collected through a self-administered questionnaire and analysed by SPSS version 20. RESULTS: The mean age of the 92 doctors was 30.4 + 3.4 years; 49 (53.3%) were clinical; and 43 (46.7%) were academic post-graduate trainee doctors. Besides, 74 (80.4%) post-graduate doctors had attended research methodology course during their academic or professional careers. Low level of competence was found regarding various research skills, such as 56 (60.8%) in statistics, 47 (51.09%) in paper preparation, 40 (43.5%) in study design, 39 (42.4%) both in result interpretation and paper presentation, 37 (40.2%) in protocol writing and 35 (38.04%) in sampling technique. Moreover, 68 (73.91%) doctors reported lack of research curriculum (p < 0.001) as reason for low research output in Pakistan. CONCLUSION: Post-graduate medical doctors showed positive attitude towards research, but they lacked research skills. They needed training in all aspects of research skills.

Frequency of thyroid incidentalomas in Karachi population.

OBJECTIVES: The aim of this study was to determine frequency of thyroid incidentalomas (TI) through ultrasound (US) and its association with age, gender and ethnicities. METHODS: It was a cross-sectional study. Total 269 adults who were asymptomatic for thyroid disease aged 21 years and above underwent ultrasound examination of their thyroid. RESULTS: Frequency of TI found was 21%. TI was detected in 25% of females and 16% males (P= 0.078). 61% had thyroid nodules (TNs) in one lobe (right, left or isthmus) and 39% had TNs in more than one location. About 55% had single TN and 45% had multiple TNs. 38% had TNs greater than 1cm while 57% had TNs smaller than 1 cm. 5% had TNs greater and smaller than 1 cm. TI was equally common in individuals of different ethinicities (P= 0.758). CONCLUSION: Frequency of thyroid incidentalomas found in our study was higher than most of the other iodine sufficient states. Unlike other studies, incidentalomas were equally common in both the genders of our study. This may be due to the previous iodine deficient status of Pakistan which was prevalent. However further studies on the same topic will help us in identifying the correct status of thyroid incidentalomas if Pakistan retains it's status as an iodine sufficient state.

A Comprehensive, Multi-modal Evaluation of the Assessment System of an Undergraduate Research Methodology Course: Translating Theory into Practice.

OBJECTIVE: To evaluate assessment system of the 'Research Methodology Course' using utility criteria (i.e. validity, reliability, acceptability, educational impact, and cost-effectiveness). This study demonstrates comprehensive evaluation of assessment system and suggests a framework for similar courses. METHODS: Qualitative and quantitative methods used for evaluation of the course assessment components (50 MCQ, 3 Short Answer Questions (SAQ) and research project) using the utility criteria. RESULTS of multiple evaluation methods for all the assessment components were collected and interpreted together to arrive at holistic judgments, rather than judgments based on individual methods or individual assessment. RESULTS: Face validity, evaluated using a self-administered questionnaire (response rate-88.7%) disclosed that the students perceived that there was an imbalance in the contents covered by the assessment. This was confirmed by the assessment blueprint. Construct validity was affected by the low correlation between MCQ and SAQ scores (r=0.326). There was a higher correlation between the project and MCQ (r=0.466)/SAQ (r=0.463) scores. Construct validity was also affected by the presence of recall type of MCQs (70%; 35/50), item construction flaws and non-functioning distractors. High discriminating indices (>0.35) were found in MCQs with moderate difficulty indices (0.3-0.7). Reliability of the MCQs was 0.75 which could be improved up to 0.8 by increasing the number of MCQs to at least 70. A positive educational impact was found in the form of the research project assessment driving students to present/publish their work in conferences/peer reviewed journals. Cost per student to complete the course was US$164.50. CONCLUSIONS: The multi-modal evaluation of an assessment system is feasible and provides thorough and diagnostic information. Utility of the assessment system could be further improved by modifying the psychometrically inappropriate assessment items.

Autism, Stigma, and South Asian Immigrant Families in Canada.

Considerable empirical evidence suggests early recognition of autism and access to support result in long-term positive outcomes for children and youth on the spectrum and their families. However, children of racialized families are often diagnosed at later ages, are more likely to be misdiagnosed, and experience many barriers to service access. There is also a paucity of research exploring the experiences of parents from specific immigrant groups caring for their children on the spectrum in Canada, many of whom identify as members of racialized communities. As such, the main aim of the study was to examine how South Asian immigrant parents in Canada are experiencing available care programs and support. Another aim was to examine their perceptions of social stigma associated with autism. We conducted an inductive thematic analysis of qualitative data from nine interviews with South Asian parents living in Ontario, Canada. Findings confirmed barriers to an autism diagnosis and to service access. Additionally, parents reported pronounced autism stigma, which enacted impediments to timely diagnosis, service access, and health-promoting behaviors. Findings also revealed that parents experience considerable caregiver stress and psychological distress. The generated evidence is anticipated to inform equitable policy, programming, and practices that better support the needs of children on the spectrum and their immigrant families.