Risk Factors Of Idiopathic Pulmonary Fibrosis In Pakistani Population: A Matched Case-Control Studyy.

OBJECTIVE: To evaluate the factors associated with idiopathic pulmonary fibrosisrisk. Methods: The case-controlstudywas conductedfromJanuary 5, 2017,toSeptember 4, 2018, attheprivate-sectorAga Khan University Hospital and the public-sector Jinnah Postgraduate Medical Centre, two large tertiary care centres in Karachi, andcomprisedadultpatientsof eithergenderwithdiagnosedidiopathicpulmonary fibrosis, asdefinedby the IndianChest Registry. Subjects without idiopathic pulmonary fibrosis but registered with the department of pulmonology of the two hospitalswere enrolledas controls.Datawas collectedusinga structuredquestionnaire, andanthropometricmeasurements were noted for each subject. Gastroesophageal reflux disease was assessed using GerdQ. This wasfollowed by serological evaluations and spirometry. Data was analysed using SPSS 21. RESULTS: Of the 459 subjects, 154(33.6%)were cases and305(66.4%)were controls.Amongthe cases, 81(52.6%)were females and 73(47.4%) were males with mean age 66.1±10.9 years. Among the controls, 162(53.1%) were females and 143(46.9%) were males with mean age 64.6±11.1 years(p>0.05.)The most common ethnicity wasUrdu-speaking; 89(58%) among the cases and 150(49%) among the controls (p<0.05). Ethnicity, number of persons in the household per room, and type of house were significantly associated with the risk of developing idiopathic pulmonary fibrosis(p<0.05). CONCLUSIONS: Ethnicity,type of house and the number of personsin a household perroom were found to be the significant risk factorsfor idiopathic pulmonary fibrosisIPF.

Psychological Well-Being and Coping Strategies among Pakistani Heads of Households during COVID-19 Pandemic: An Online Survey.

Background: Coronavirus Disease (COVID-19) pandemic can affect mental health. Heads of the household are at higher risk of this effect because of their financial and social responsibilities. This study aimed to assess the psychological well-being and its associated factors during the COVID-19 pandemic among heads of households in Pakistan. Methods: We conducted an online survey in May 2020. A convenience sampling strategy was used to enroll the heads of the households from all regions of Pakistan. A validated English and Urdu version of the WHO-5 well-being scale was used to assess well-being. The prevalence of poor well-being and its associated factors among heads of the households was measured using logistic regression. Results: A total of 509 heads of households participated in the survey. About 35% of the participants were dependent on financial sources other than salary. The news was considered a source of fear as 70% assumed that avoiding such news may reduce the fear. The most common coping strategies used during lockdown were; spending quality time with family, eating healthy foods, adequate sleep and talking to friends on the phone. The prevalence of poor well-being was found to be 41% (95% CI: 36.62-45.51). Individuals with any chronic illness were at a higher risk of poor wellbeing adjusted odds ratio of 1.64 (95% CI: 1.04-2.59). Worriedness was also found to be associated with a higher risk of poor wellbeing adjusted OR 1.13 (95% CI: 1.06-1.19). Reading books showed a protective association with poor mental wellbeing adjusted OR 0.64 (95% CI: 0.42-0.98). Conclusion: There was a high prevalence of poor mental wellbeing among heads of households in Pakistan. Worriedness related to the pandemic and having chronic illness were significant predictors of poor psychological wellbeing. Actions are required in the form of targeted mass psychological support systems for the heads of the families to improve their mental health during the COVID-19 crises.

Factors associated with quality of life among joint and nuclear families: a population-based study.

BACKGROUND: Advantages and disadvantages associated with joint and nuclear family systems can affect quality of life (QOL). However, there is scarcity of literature about QOL among joint and nuclear family systems. This study aimed to assess the factors associated with QOL in joint and nuclear family systems. METHODS: We conducted a population based cross sectional study in all 52 Union Councils (UCs) of District Abbottabad, Khyber Pakhtunkhwa province, Pakistan from March 2015 to August 2015. Multistage cluster sampling technique was used to select participants from both nuclear and joint family houses. The validated Urdu version of World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF) was used to assess quality of life among participants. Univariate and multivariate analyses were performed to explore the associations of different socio demographic variables with QOL among both family systems. Also a multilevel linear regression using backward analysis to obtain final model for each domain was performed to find out the variables that are associated with QOL score in each of family systems. RESULTS: A total of 2063 participants were included in this study (51.0% joint family, 49.0% nuclear family) with the response rate of 97.4%. In multiple linear regression analysis of each domain for joint and nuclear family systems, rural residence compared to urban (p < 0.001), being female (p < 0.001), older age (p < 0.001), having comorbidity (p < 0.001) and lower socioeconomic status (p < 0.001) were found to be a strong predictor of poorer QOL. Furthermore, social capital (p < 0.001) had a positive effect on joint and nuclear family QOL scores. CONCLUSION: This study was the first of its kind which determined the factors of QOL in joint and nuclear families using the validated Urdu version of WHOQOL-BREF in Pakistan. Male gender, urban residence, younger age, higher socioeconomic status and social capital were positive predictors of QOL score while older age and presence of illness were associated with lower QOL scores among both family systems.

Financing mechanisms applied for successful Universal Health Coverage in Malaysia, Thailand and Singapore - Lessons for Pakistan.

Universal health coverage is a global agenda and, currently for Pakistan, achieving this goal is a challenge because of a number of constraints. The current narrative review was planned to describe an overview of the provision of health insurance in Malaysia, Thailand and Singapore that have achieved universal health coverage, and to propose a roadmap for Pakistan. Literature search was conducted on Google Scholar and PubMed databases as well as on the World Bank website to retrieve relevant articles. The three studied countries achieved universal health coverage by gradually increasing allocation for health and through various mechanisms, such as health insurance schemes which covered different segments of the population, and partnerships with private-sector care-providers. Pakistan needs to prioritise health in policy agenda because health insurance is negligible in Pakistan. Additionally, Pakistan also needs to efficiently utilise partnerships with the private sector to further increase healthcare coverage.

Situation analysis of antimicrobial resistance control, policy and regulation - a reflection of Pakistan.

Antimicrobial resistance (AMR) is a global threat that affects 700,000 lives every year and could lead to 10 million deaths every year by 2050. World Health Organization (WHO) has instituted a global action plan in 2015 to deal antimicrobial resistance in the 68th World Health Assembly. This paper aimed to review the situation analysis of current bottlenecks of the health system and provision of recommendations to improve the current regulatory mechanism for antimicrobial drugs in Pakistan. Antimicrobial Resistance (AMR) emerged as a threat practically in all nations of the world including Pakistan which is the world's sixth most populous country. This qualitative document analysis has been done by using Pakistan's National Policy on AMR. In 2004, total expenditure on pharmaceuticals was 1844 million US$ with a total pharmaceutical expenditure per capita of 11.3US$. Total number of pharmacists licensed was10,000 technician and assists were 20,000 and licensed pharmacies were 7000. There are only 0.9 pharmacists per 100000 populations are deployed. The health system and society are at risk of an emerging epidemic of AMR. This investigational analysis of AMR control, policy and regulation in Pakistan highlights some facts about misuse, availability of over the counter medicine, self-medications and low effect of existing approaches. Drug prescription monitoring law and policy investment is needed in the regulation of drugs to reduce unnecessary drug consumption and prescription, and strengthening quality parameters at several levels to control epidemic of AMR.

Epidemiology of asthma and associated factors in an urban Pakistani population: adult asthma study-Karachi.

BACKGROUND: This study was conducted in order to determine the prevalence of asthma and associated risk factors in the adult population of Karachi, Pakistan. METHODS: This multi-stage, cross-sectional survey was conducted from May 2014-August 2015; comprising 1629 adults in 75 randomly selected clusters in Karachi, Pakistan. Definitions included: 'self-reported asthma', 'reversibility in FEV1' and 'respiratory symptoms and reversibility in FEV1'. RESULTS: Prevalence of asthma was 1.8% (self-reported) (95% CI: 1.0-2.6), 11.3% (reversibility in FEV1) (95% CI: 9.4-13.3) and 6.6% (symptoms and reversibility in FEV1) (95% CI: 5.1-8.1). Asthmatics were more likely to belong to the age group ≥38 years according to 'reversibility in FEV1' and 'respiratory symptoms and reversibility in FEV1' (AOR: 1.9, 95% CI: 1.2-3.3) and (AOR: 2.1, 95% CI: 1.1-4.2), respectively. Asthmatics were more likely to report history of allergies (AOR: 1.9, 95% CI: 1.2-2.9) and (AOR: 2.8, 95% CI: 1.7-4.8); and were exposed to environmental tobacco smoke (AOR: 1.6, 95% CI: 1.1-2.5) and (AOR: 1.9, 95% CI: 1.1-3.3) according to 'reversibility in FEV1' and 'respiratory symptoms and reversibility in FEV1', respectively. Asthmatics were more likely to report pack years of smoking ≥5 (AOR: 2.3, 95% CI: 1.1-4.7) according to 'respiratory symptoms and reversibility in FEV1'. CONCLUSION: This study reports a high prevalence of asthma among Pakistani adults and calls for developing appropriate public health policies for prevention and control of asthma in the country. Further studies should be conducted to determine the national prevalence as well as follow-up studies to identify preventable causes for adult asthma.

Incidence, patterns and associated factors for occupational injuries among agricultural workers in a developing country.

Background: Injuries are common among agricultural workers, and a large section of the population is employed in agriculture worldwide. We aimed to determine the incidence, patterns and associated risk factors of occupational injuries among the agricultural workers in a developing country. Methods: A cross-sectional study in Hyderabad, Pakistan was conducted from December 2012 to February 2013. Information was collected about incidence, pattern and associated risk factors of occupational injuries from 472 agricultural workers. Injury incidence and patterns for place, severity, type, agent, parts of body affected and work activity were calculated. Analysis was performed using SPSS version 19.0. Multivariate logistic regression was performed to calculate the adjusted odds ratio (OR) with 95% confidence interval, to identify the putative risk factors for occupational injuries. Results: Incidence of occupational injuries was 35.0 per 100 per year (95% CI: 28.9 - 42.7). Cuts (70%) and hand tools (71%) were the most common type and agent for injury, respectively. Majority of injuries occurred during harvesting (55%). Increasing age [AOR 1.03 (95% CI: 1.01 - 1.05)], income <6000PKR/month [AOR 2.27 (95% CI: 1.08 - 4.76)] and driving tractor [AOR 2.58 (95% CI: 1.25 -5.33)] increase the risk for injuries. Conclusion: There was a high burden of injuries among the agricultural workers in Pakistan. Large-scale studies are required to further characterize the risk of injuries and develop preventive strategies to protect agricultural workers.

Risk assessment for arsenic-contaminated groundwater along River Indus in Pakistan.

The study determined the risk zone and estimated the population at risk of adverse health effects for arsenic exposure along the bank of River Indus in Pakistan. A cross-sectional survey was conducted in 216 randomly selected villages of one of the districts along River Indus. Wells of ten households from each village were selected to measure arsenic levels. The location of wells was identified using global positioning system device, and spatial variations of the groundwater contamination were assessed using geographical information system tools. Using layers of contaminated drinking water wells according to arsenic levels and population with major landmarks, a risk zone and estimated population at risk were determined, which were exposed to arsenic level ≥10 µg/L. Drinking wells with arsenic levels of ≥10 µg/L were concentrated within 18 km near the river bank. Based on these estimates, a total of 13 million people were exposed to ≥10 µg/L arsenic concentration along the course of River Indus traversing through 27 districts in Pakistan. This information would help the researchers in designing health effect studies on arsenic and policy makers in allocating resources for designing focused interventions for arsenic mitigation in Pakistan. The study methods have implication on similar populations which are affected along rivers due to arsenic contamination.

COMPARING LUNG FUNCTION OF TEXTILE WORKERS WITH THE HEALTHY PAKISTANI POPULATION.

BACKGROUND: The purpose of this study was to compare lung function of textile workers with healthy Pakistani population, compare predicted values based on the European Respiratory Society (ERS) equations with those based on the Pakistani equations, and to develop predictor equations for textile workers in Pakistan. METHODS: This was a secondary analysis of data from two previous surveys where lung function of textile workers was compared with healthy Pakistani men. Spirometry was performed according to the American Thoracic Society guidelines. Independent sample t-test was used to compare the lung function parameters and multivariate linear regression was used to develop predictor equations. RESULTS: There were significant differences in lung function of textile workers (FVC: 4.1 L, FEV1: 3.3 L and FEV1/FVC: 0.8) compared to healthy Pakistani men (FVC: 3.9 L, FEV1: 4.1 L and FEV1/FVC: 1.04). ERS reference equations tended to under-diagnose abnormal lung function, 16.9% versus 25.3% (p<0.01). Predictor equations for Pakistani textile workers were also developed. CONCLUSION: Lung function of textile workers was significantly reduced compared to healthy population. Use of ERS reference equations for Pakistani textile workers may not provide appropriate interpretation.

Problematic Use of Smartphones and Sleep Quality Among Healthcare Workers in Qassim, Saudi Arabia.

Background and objectives Problematic use of smartphones among healthcare workers can affect their performance, patient care, safety, care outcomes, and patient satisfaction. The aim of this study was to determine the prevalence of problematic use of smartphones and the relationship between the problematic use of smartphones and sleep quality among healthcare workers in Qassim, Saudi Arabia. Methods We enrolled 393 healthcare workers conveniently selected online for this cross-sectional survey. We assessed the problematic use of smartphones using the short version of the Smartphone Addiction Scale. For sleep quality, we used the Pittsburgh Sleep Quality Index (PSQI). Linear regression was used to assess the association of problematic use of smartphones with sleep quality. IBM SPSS Statistics, version 23.0 (IBM Corp., Armonk, NY) was used for analyses. Results The prevalence of smartphone addiction (SMA) was 59.0%, and 30.5% were at high risk for addiction. The mean PSQI score was 11.56 ± 2.1 out of 21. It was found that female gender was associated with poor sleep quality (adjusted B = 0.45, p-value = 0.049). On the other hand, SMA was also significantly associated with poor sleep quality (adjusted B = 0.90, p-value = 0.016). Conclusion There is a high prevalence of problematic use of smartphones among healthcare workers, which is associated with poor sleep quality. Given the significant occurrence of problematic smartphone use among healthcare professionals and its detrimental effects on sleep quality, it is crucial for public health initiatives to devise and execute suitable preventive measures, such as smartphone use policies at work and education of workers.

Patients' Perspectives on Type 2 Diabetes, Vitamin B12 Deficiency, and Supplementation in Buraidah, Saudi Arabia.

Objectives Long-term metformin is associated with vitamin B12 deficiency. There is a significant misunderstanding among both physicians and patients regarding vitamin B12 indications. This study aims to identify knowledge gaps and attitudes toward vitamin B12 among diabetic patients. Materials and methods A cross-sectional study was conducted among type 2 diabetic patients visiting four primary healthcare centers in Buraidah, Saudi Arabia. The data were collected using a structured self-administered questionnaire. Data were collected on diabetes and vitamin B12 knowledge and attitude toward vitamin B12 supplementation. Logistic regression analyses were used to assess the predictors of knowledge and attitude. Results Of the 388 participants, 192 (49.5%) were male. About 84.5% of the total diabetics were on metformin. Nearly three-fourths (72.7%) were taking vitamin B12. A large proportion, 160 (41.2%), believed that it is necessary to take vitamin B12 for every diabetic patient. Nearly half, 193 (49.7%), did not know the factors affecting vitamin B12 deficiency. Young (less than 39 years) diabetics were more likely to perceive that vitamin B12 is recommended for all diabetics, OR (95% CI) [6.26 (1.86-21.06)], as compared to participants aged more than 59. Similarly, younger patients were more likely to assume vitamin B12 necessary, OR (95% CI) [3.71 (1.26-10.89)]. Conclusion We found the knowledge and attitude of diabetic patients regarding vitamin B12 to be poor. It is, therefore, recommended that primary health care providers educate their patients about vitamin B12 supplementation to reduce the number of medications and financial burden. Further large-scale studies are also needed to generate stronger evidence of the problem.

Long COVID-19 and Coexistence of Fatigue and Depression: A Cross-sectional Study from Saudi Arabia.

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is associated with various manifestations even after infection resolution. This study aimed to assess the prevalence of post-COVID-19 fatigue and its predictors. METHODS: We conducted a nationwide cross-sectional study among Polymerase Chain Reaction test confirmed COVID-19 cases in Saudi Arabia from July 2021 to February 2022. We collected data through telephonic interviews covering socio-demographics, comorbidities, body mass index, smoking, illness severity, and COVID-19 vaccination status. We assessed fatigue using Fatigue Severity Scale while depression was assessed using Patient Health Questionnaire-2. Logistic regression was employed to analyze the relationship between post-COVID-19 fatigue and depression. RESULTS: The analysis included 361 participants with a mean age of 37 ± 10.5 years, among whom 43% were female. Approximately 10% had comorbidities, and 21% were current smokers. Nearly two-thirds (68%) of the participants reported mild illness. The prevalence of perceived fatigue was 22.7%, while fatigue measured by the Fatigue Severity Scale was 14.4%. The multivariable logistic regression model revealed that COVID-19 severity and depression were significant predictors of post-COVID-19 fatigue; adjusted odds ratio 1.87 (95% CI: 1.10 to 3.18) and 14.3 (95% CI: 4.55 to 45.0), respectively. CONCLUSION: Our findings suggest a higher prevalence of perceived fatigue compared to that measured by the Fatigue Severity Scale, underscoring the importance of using a valid assessment tool for fatigue among COVID-19 patients to ensure proper management. The significant association between post-COVID-19 fatigue and depression highlights the need for psychological assessment of COVID-19 patients to enhance their post-infection quality of life.

Insights into the Refusal of Free Screening Mammograms: Exploring Contributing Factors.

Background: Despite the availability of free screening mammograms (SMG) through the Breast Cancer Early Detection (BCED) Program in the Qassim region of Saudi Arabia, a notable gap exists between program implementation and the actual uptake of SMG. This study aims to assess the refusal rate, identify barriers to participation, and shed light on the factors influencing women's decisions regarding SMG. Methods: A cross-sectional study was conducted among consecutive women aged 40-69 participating anonymously in the BCED program in September 2023. The participants were administered a validated Arabic language survey encompassing breast cancer screening backgrounds and knowledge, reasons for refusal, and factors influencing SMG reconsideration. Logistic regression was employed to identify factors linked with SMG refusal using SPSS version 28. Results: Of the 2446 eligible women in the study, 576 (23.6%) declined to undergo SMG. The median age of participants was 49 years, primarily married (91.5%) and residing in central cities (60.3%). Previous mammogram history was reported by 21.4%, with only 12.9% performing regular SMGs every 1-2 years. Married women had a 31% lower refusal likelihood to SMG compared to widowed/divorced women (Adjusted Odds Ratio [aOR] = 0.69, p = 0.02). Women residing in peripheral areas showed approximately 1.45 times higher odds of refusal compared to those in central cities (aOR = 1.45, p < 0.001), and women without prior history of SMG had 2.13 times higher odds of refusal (aOR = 2.14, p < 0.001). Conclusion: The refusal rate for SMG in the Qassim region aligns closely with rates observed in developed countries. Despite this progress, significant barriers to SMG uptake persist, and tailored interventions targeting specific demographic groups and addressing these barriers are essential to improving screening participation, promoting a culture of proactive screening behavior, and ensuring equitable access to screening services for all eligible women.

Telehealth as a public health approach to mitigate the COVID-19 pandemic in Pakistan: A narrative review.

Technology is instrumental in delivering health services, especially telehealth during the COVID-19 pandemic. This article aimed to explore the role of telehealth as a public health approach to support responses to address the COVID-19 pandemic in Pakistan. We developed this article by mapping existing telehealth initiatives developed and implemented during the COVID-19 pandemic in Pakistan. The initiatives were identified searching online portals such as Google Scholar, PubMed, and websites of various governmental and non-governmental agencies. The services are categorized into teleconsultation and follow-ups, online vaccine registration, information dissemination, high-risk subset tracking, virtual Health Care Worker (HCW) and medical student training, and tele-psychological counseling. The teleconsultation category offers online registration and follow-ups. Information dissemination services include federal helpline, SMS alerts, and social media campaigns. The high-risk subset tracking services include app-based COVID-19 checks and online surveys. Virtual HCW and medical student training services include tele-ICU support, COVID-19 critical care courses, and COVID management courses. The tele-psychological counseling services offer helplines for emotional support, proactive counseling for COVID-19 patients, and mental health support and psychiatry services. Telehealth interventions provided novel solutions amid health and social crises such as the COVID-19 pandemic. Health care systems need to expand telehealth services and ensure that health care organizations deliver effective and safe medical care. However, future research should focus on assessing the impact of telehealth on population health.

Alleviation of Asthma Symptoms After Ketogenic Diet: A Case Report.

Asthma is a chronic disease that affects the quality of life of patients, and asthma exacerbations are often a reason for hospitalization and activity limitations. Obesity has been linked to asthma as a risk and exacerbating factor. Evidence suggests that weight reduction has a positive effect on asthma control. However, there is also debate on the role of the ketogenic diet in asthma control. Here we present a case of asthma who reported markedly improved asthma after starting a ketogenic diet in the absence of any other lifestyle change. Over the four months on the ketogenic diet, the patient reported losing 20 kg of weight, reduction in blood pressure (without antihypertensives), and complete alleviation of asthma symptoms. This case report is important as the control of asthma after a ketogenic diet is not studied well in humans and therefore needs to be studied extensively.

Awareness, attitude, and practice of evidence-based medicine among primary healthcare physicians in Buraidah, Saudi Arabia.

Context: Evidence-based medicine (EBM) is essential for safe and cost-effective care provision to the population. Aims: To assess the awareness, attitude and practices and barriers among primary care physicians about EBM in Buraidah, Qassim. Settings and Design: Cross-sectional study in Primary Health Care centers (PHCCs) of Buraidah, Qassim. Materials and Methods: The study was conducted among physicians working in PHCCs of Buraidah. Data were collected online through Google forms. Statistical Analysis Used: Descriptive analysis was carried out to measure the frequencies and proportions. Chi-square test was used to compare barriers based on gender, academic degree, and experience categories. Results: A total of 96 out of 144 physicians (66.7%) responded to the invitation. About 82.3% of the participants welcomed the promotion of EBM and 92% of the physicians knew about concept of EBM. About 94.8% of the physicians agreed that EBM will improve patient outcomes. The reported barriers were; patient load (87.5%), time availability (70.8%), computer availability (33.3%), internet availability (45.8%), and 56.3% stated updated clinical letters, journals, or guidelines are not available. Conclusions: This study found that there was high self-reported knowledge about the EBM concept; however, the knowledge about tools was poor. A number of barriers were found such as patient load, time, availability of clinical guidelines and journals and other resources such as internet and computers. Primary care physicians should be trained and facilitated for EBM.

COVID-19-Related Awareness and Behaviors of Non-Saudi Travelers and Their Satisfaction with Preventive Measures at Saudi Airports.

Airports could serve as hotspots for the spread of the COVID-19 infection. We aimed to assess the awareness, attitude, and behaviors of non-Saudi travelers about COVID-19 and their satisfaction with preventive measures at Saudi airports. A cross-sectional study was conducted among non-Saudi travelers arriving in Saudi Arabia at two international airports. Data were collected using a questionnaire in Arabic, Hindi, and Urdu languages. Awareness, attitude, behavior scores, and satisfaction levels were calculated. Linear regression analyses were done to assess the predictors of awareness, attitude, and behaviors. A total of 633 participants were included in the study. The mean awareness, attitude, and behavior scores were 16.3/22, 18.3/24, and 3.2/5, respectively. Nationality, education, and income were significant predictors of awareness. Nationality was the only significant predictor of attitude, while gender and nationality were predictors of behaviors. Overall satisfaction with preventive measures was: transportation (94%), lounges and corridors (96%), counters (98%), and airport staff (97%). There was overall good awareness and attitude among travelers. Behavior scores were relatively low, which needs to change as air travel poses a threat to the spread of infectious diseases. Airport authorities need to manage passengers properly to ensure adequate distancing to prevent the potential transmission of infections.

Online family medicine training amid the COVID-19 crisis in KSA: A mixed-method study.

Objective: Literature on the perceptions and experiences of postgraduate trainees and trainers regarding online methods of learning is scarce. We aimed to assess the perceptions and experiences of family medicine trainees and trainers regarding online learning during the novel coronavirus (COVID-19) pandemic in Qassim, KSA. Methods: This was a mixed-method study involving trainees and trainers at the Family Medicine Academy, Qassim. Quantitative data were collected using structured questionnaires from 36 trainees and 26 trainers. Qualitative data were collected through in-depth interviews with trainees (n = 4) and trainers (n = 3). Descriptive analysis was performed on the quantitative data, while thematic analysis was performed on the qualitative data. Results: Among the trainees, 39% perceived online learning to be less effective than traditional classroom learning. Moreover, 61% and 64% of the respondents were concerned about the motivation and quality of online learning, respectively. Lack of direct contact with other students was the most commonly perceived concern among 80% of trainees. Among the trainers, the majority were either dissatisfied or neutral about participation and interaction, speakers' and students' motivation, the quality of online learning, and the online teaching experience. Qualitative data showed that online methods provide the advantages of learning from other institutions and flexibility, as well as a viable alternative during crises. However, there were issues with interaction, participation, and trainers' online teaching skills. Conclusion: Online learning has provided an opportunity to continue training during the COVID-19 crisis. However, there are widespread concerns regarding its effectiveness among trainees and trainers. There is a need to train trainers in online teaching and adopt interactive methods to increase trainees' interaction, motivation, and participation.

Indoor Air Pollution and Respiratory Health in a Metropolitan City of Pakistan.

OBJECTIVE: We assessed the association of formaldehyde, carbon monoxide (CO), and particulate matter (PM 2.5 ) with respiratory symptoms, asthma, and post-bronchodilator reversibility. METHODS: We included 1629 adults in a community-based cross-sectional study in Karachi in 2015. Data were collected using the American Thoracic Society respiratory questionnaire and spirometry (available for 930 participants). YesAir eight-channel monitor was used for measuring concentrations of formaldehyde and CO, whereas PM 2.5 was measured using UCB PATS. RESULTS: Higher levels of formaldehyde and CO were associated with cough, phlegm, and wheeze, whereas those of PM 2.5 were associated with shortness of breath and presence of any of the respiratory symptoms (combined), as well as a "lower" risk of cough, phlegm, and bronchitis. CONCLUSION: Poorer household air quality was associated with poorer respiratory health in this population; however, further studies with a robust exposure assessment are required.

Verbal and Physical Abuse Against Nurses Working in Hospitals and Health Centers in Buraidah, Saudi Arabia.

Background Hospital staff, especially nurses, face violence of various forms in the workplace. This study aimed to assess the burden of verbal/physical abuse against nurses and their attitude towards such events in Buraidah, Saudi Arabia. Methods A cross-sectional study was conducted among nurses working in three public sectors and two private sector hospitals, and five primary healthcare facilities in Buraidah. Data was collected using a structured online questionnaire, disseminated among nurses through nursing departments of participating facilities. Data were analyzed using SPSS version 21.0. Results A total of 369 nurses participated in the survey, with a mean age of 34 (±6.9) years. About two-thirds, 68% (250) of respondents, had experienced at least one verbal/physical abuse incident during one year. The most common perpetrators were patients (44.4%). Sixteen percent of participants reported taking no action against the incident. Those working in private facilities were 80% less likely to experience abuse than those in public facilities, adjusted OR 0.20 (95% CI: 0.08-0.47). Conclusions There was a high burden of verbal/physical abuse against nurses, and they, therefore, suffer from disturbing memories. However, a little more than half do not officially report it to the managers, with only a small fraction seeing some action taken. Occupational health practitioners should take action to improve the policy and procedures related to workplace violence (WPV) in healthcare facilities. Further research is needed to characterize incidents to understand the patterns and develop interventions for the prevention of such events.