Stressors affecting nursing students in Pakistan.

AIM: To determine factors contributing to stress experienced by preregistration nursing students in Pakistan, using the Stressors in Nursing Students scale. The aim was to explore the psychometric properties of this instrument and to investigate the effect of a range of demographic variables on the perception of stressors in nursing students. BACKGROUND: Nursing is a stressful profession, and nursing students may experience more stress due to competing demands and challenges of nursing education, assessment, placements and worries about employment prospects. METHODS: In this cross-sectional survey, data from 726 nursing students from 11 schools of nursing in Karachi, Pakistan, were collected using a questionnaire. Data were analysed using descriptive as well inferential statistics. An exploratory factor analysis was also conducted. RESULTS: There was no apparent factor structure to the Stressors in Nursing Students scale, unlike in previous studies. The total score on the Stressors in Nursing Students scale was related to gender with males scoring higher. The score generally increased over 4 years of the programme, and students in private schools of nursing scored higher than those in public schools of nursing. CONCLUSION: Nursing students in Pakistan do not appear to differentiate between different stressors, and this may be due to cultural differences in the students and to the structure of the programme and the articulation between the academic and clinical aspects. Likewise, cultural reasons may account for differences between stress experienced by male and female students. IMPLICATIONS FOR NURSING AND POLICY: The fact that scores on the Stressors in Nursing Students scale increased over 4 years of the programme and males scored higher than females should alert nursing schools and policymakers related to nursing education and workforce to pay attention to prevent attrition from nursing programmes.

The efficacy of disease modifying anti-rheumatic drugs in rheumatoid arthritis in local patients of Karachi.

The primary objective of the study is to assess the efficacy of the 'Disease Modifying AntiRheumatic Drugs (DMARDs) on the disease activity in Rheumatoid Arthritis (RA) in the local patients of Karachi. The secondary objective is to evaluate whether the combination of two concurrent DMARDs (Combination Therapy) is superior to a single DMARD (Mono-therapy). This is an open labeled retrospective case series. One hundred and five consecutive patients fulfilling 1987 ACR criteria for the diagnosis of RA were initially selected from the case notes of out patients department. Sixty nine patients fulfilled the inclusion criteria and were finally recruited for analysis. Details of the Tender Joint Count (TJC), Swolen Joint Count (SJC), Patient Global Assessment (PGA) and ESR were obtained at six weeks, three months, six months and one year. Out of the 69 patients studied 48 were in the mono-therapy group and 21 in the combination therapy group. Methotrexate (MTX) was the most commonly used single DMARD (75%) as well as the most frequent component of the combination groups (85%). The TJC, SJC and PGA analyses of all patients show that DMARDs are effective agents for clinically controlling RA activity. The speed of their beneficial effect is slow and unlike analgesics and NSAIDS, may take up to six weeks to start working. The 6 week responses showed 32.49% improvement in TJC, 33.19% improvement in SJC and 59% better responses in PGA. This response continued to show further improvement and at six months when TJC improved by 63.41%, SJC by 53.21% and PGA with 81% better responses. After 6 months the response reached a plateau but nevertheless maintained until 1 year with improvements in TJC by 66.23%, SJC by 56.48% and PGA with 88.23% better responses. The changes in ESR did not go parallel with the other three outcome measures. The mean baseline ESR of 56 reduced to 44 at 6 weeks but rose again gradually to 54 at 1 year. The sub-group analysis did not show the overall superiority of combination therapy over mono-therapy. DMARDs are effective in controlling disease activity in RA. Their effect starts slowly over 6 week and may take up to 6 months to show full benefits. The beneficial effect was maintained for at least 1 year. Sub-group analysis did not show any advantage of combination therapy over mono-therapy in this series of patients. Methotrexote being the most frequently used DMARDs in both groups and being most cost effective agent seems to be the most useful drug in RA in the developing world.

Perinatal care in Pakistan: a situational analysis.

Pakistan, one of the most populous countries in the world, has an estimated perinatal mortality rate of 60 to 90 per thousand births, of which almost half are stillbirths. Although infant mortality rates have declined in recent years, nearly 60% of all deaths occur in the neonatal period and have shown comparatively little change over several decades. This is attributed mainly to inadequate attention to programs of maternal and newborn care. The recently implemented Social Action and Health Care Programs of the Government of Pakistan promises to provide domiciliary maternal and newborn care services through the use of trained birth attendants and community workers. The primary health care services network is also being revamped in an effort to improve timely recognition of high-risk pregnancies and to facilitate prompt referral. The importance of the newborn period is also being emphasized in pediatric undergraduate and postgraduate training programs, as well as through continuing medical education. However, the most important long-term solution would be improvement in the educational and social status of women, as well as a greater political support for diversion of limited resources to appropriate primary and secondary health care.

PIP: Pakistan has an estimated perinatal mortality rate of 60-90 per 1000 births, of which almost half are stillbirths. Infant mortality rates have declined in recent years, but the proportion of deaths occurring during the neonatal period has remained rather stable over several decades at almost 60% of all deaths. This latter mortality is largely the result of inadequate attention to programs of maternal and newborn care. The government of Pakistan's recently implemented social action and health care programs will deliver domiciliary maternal and newborn care services through trained birth attendants and community workers. Pakistan's primary health care services network is also being overhauled in an attempt to improve the timely recognition of high-risk pregnancies and to facilitate prompt referral. The importance of the newborn period is also being stressed in pediatric undergraduate and postgraduate training programs, as well as through continuing medical education. Health status and spending in Pakistan, the organization of health care services, maternal mortality, and the causes of infant and neonatal mortality are discussed.

Home health care: a comparative analysis of hospital-based and community-based agency patients.

This study analyzed the patient-type and service-mix of hospital-based and community-based home care agencies. The results of this analysis revealed that hospital-based agency patients were different than community-based agency patients, in terms of the above mentioned variables; and that these differences were statistically significant. Specifically, hospital-based agency patients were older, were more limited in their functional ability, received a higher intensity of care, and utilized a greater proportion of therapeutic services. Furthermore, a higher percentage of hospital-based agency patients were in an acute care facility prior to home care; had cancer and circulatory disorders as their primary diagnosis; and had Medicare as their primary source of payment. This study concludes with recommendations with respect to future planning and administration of home care services.