Interpersonal risk communication matters more than media risk communication in its impact on individuals' trust and preventive behaviors during COVID-19.

A cross-sectional survey study from 1496 respondents was conducted to investigate how interpersonal risk communication and media risk communication foster individuals' interpersonal trust and trust in scientists during the ongoing COVID-19 pandemic. Findings reveal that interpersonal risk communication is significantly related to interpersonal trust and trust in scientists, but have no direct association with preventive behaviors. Media risk communication is significantly associated with preventive behaviors and increases individuals' trust in scientists while having no effect on interpersonal trust. Preventive behaviors are significantly influenced by both interpersonal trust and trust in scientists. In addition, trust mediated the association between risk communication and preventive behaviors.

Source Credibility and the Information Quality Matter in Public Engagement on Social Networking Sites During the COVID-19 Crisis.

During the coronavirus disease 2019 (COVID-19) pandemic, people use social networking sites (SNSs) to seek social support, ease the move toward the social distance, and communicate and engage with one another. However, there is growing evidence that trustworthiness and quality of information can affect individuals' online engagement behaviors. This study proposes a theoretical model to test people's online engagement during the COVID-19 pandemic by applying the elaboration likelihood model (ELM). Through a questionnaire survey of 630 SNS users, the study examines whether and how source credibility and information quality affect people's online engagement during the COVID-19 pandemic. The model was tested using structural equation modeling. The findings show that source credibility and information quality have a significantly positive relationship with perceived benefit, while negative and significantly associated with perceived risk. Furthermore, perceived benefit is a stronger predictor of online public engagement than the perceived risk. To improve online public engagement as a crisis response strategy, careful source selection and careful generation of online crisis information should not be overlooked.

The oracle study - fibromyalgia, prevalence and severity in the hospital setting in the Pakistani population.

OBJECTIVE: To assess the prevalence and severity of fibromyalgia in hospital-visiting patients. METHODS: The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from July, 2018, to January, 2019, and comprised patients aged 18-75 years of either gender. Demographic information, comorbidities and previous medications were recorded for each patient. The modified American College of Rheumatology preliminary diagnostic criteria 2010-11 for fibromyalgia diagnosis. If diagnosed, the fibromyalgia impact questionnaire was administered to assess its severity. Data was analysed using SPSS 25. RESULTS: Of the 750 hospital-visiting patients, fibromyalgia was diagnosed in 250(33.3%); 190(76%) of them being females (p<0.0001). Comorbidities, age and increased elevated body mass index were significantly associated with fibromyalgia. Severity was not influenced by comorbidities, marital status, education or economic status (p>0.05). Menarche at a later age and menstrual irregularity were associated with fibromyalgia severity (p<0.05). CONCLUSIONS: The hospital-based prevalence of fibromyalgia was found to be high, especially among females.

Attention or Distraction? The Impact of Mobile Phone on Users' Psychological Well-Being.

Cumulative evidence has demonstrated that mobile phone distraction, in particular among emerging adults, is a growing problem. Considerable efforts have been made to contribute to the literature by proposing cognitive emotion pre-occupation which acts as an underlying mechanism through which mobile phone distraction results in a reduction in psychological well-being. The proposed model is supported by distraction-conflict theory which reveals that users, with high attention control, are better at coping with the negative consequences of mobile phone distraction. The data, consisting of 914 University students in China, was analyzed using statistical tools. The results support that mobile phone distraction has a significant positive relationship with cognitive emotional pre-occupation which negatively affects users' psychological well-being. Our findings also reveal that attention control moderated the mediation effect of cognitive emotional pre-occupation in association with mobile phone distraction and psychological well-being. The theoretical and practical implications are also discussed along with limitations and future research.

The Use of Social Networking Sites and Pro-Environmental Behaviors: A Mediation and Moderation Model.

Climate change poses a huge threat. Social networking sites (SNSs) have become sources of human-environment interactions and shaped the societal perception of climate change and its effect on society. This study, based on the extended parallel process model, aims to examine the effect of exposure to climate change-related information on SNSs on the pro-environmental behaviors of individuals. The study examines the mediation effect of fear of victimization from climate change between the exposure to climate change-related information on SNSs and pro-environmental behaviors, including the moderation effect of attention deficit and decision-making self-efficacy with the help of appropriate instruments. A total sample of 406 reliable questionnaires were collected from students using SNSs in China, and data were analyzed through SPSS and AMOS. Results indicate that the exposure to climate change-related information on SNSs has a direct positive effect on users' pro-environmental behaviors (ß = 0.299, p < 0.01). Fear of victimization from climate change also mediates the relationship between exposure to climate change-related information on SNSs and pro-environmental behaviors (ß = 0.149, SE = 0.029, p < 0.01). In addition, attention deficit moderates the relationship of exposure to climate change-related information on SNSs with fear of victimization from climate change (ß = -0.090, p ≤ 0.01) and pro-environmental behaviors (ß = -0.090, p ≤ 0.05). Similarly, the relationship between fear of victimization from climate change and pro-environmental behaviors is moderated by decision-making self-efficacy (ß = 0.267, p ≤ 0.01). The findings offer implications for media organizations and government policy makers, who should post or spread environmental information through the most trustworthy media, with trustworthy sources, in an effective manner, and without exaggerated adverse impacts.

Fibrodysplasia ossificans progressiva (stone man syndrome): a case report.

BACKGROUND: Fibrodysplasia ossificans progressiva is an ultrarare autosomal dominant disorder and disabling syndrome characterized by postnatal progressive heterotopic ossification of the connective tissue and congenital malformation of the big toes. Fibrodysplasia ossificans progressiva has worldwide prevalence of about 1 in 2 million births. Nearly 90% of patients with fibrodysplasia ossificans progressiva are misdiagnosed and mismanaged and thus undergo unnecessarily interventions. So far, the number of reported existing cases worldwide is about 700. Clinical examination, radiological evaluation, and genetic analysis for mutation of the ACVR1 gene are considered confirmatory tools for early diagnosis of the disease. Association of fibrodysplasia ossificans progressiva with heterotopic ossification is well documented; however, postsurgical exaggerated response has never been reported previously, to the best of our knowledge. CASE PRESENTATION: We report a case of a 10-year-old Pakistani boy brought by his parents to our institution. He had clinical and radiological features of fibrodysplasia ossificans progressive and presented with multiple painful lumps on his back due to hard masses and stiffness of his shoulders, neck, and left hip. He underwent surgical excision of left hip ossification followed by an exaggerated response in ossification with early disability. Radiological examination revealed widespread heterotopic ossification. All of his laboratory blood test results were normal. CONCLUSION: Fibrodysplasia ossificans progressiva is a very rare and disabling disorder that, if misdiagnosed, can lead to unnecessary surgical intervention and disastrous results of early disability. We need to spread knowledge to physicians and patients' family members about the disease, as well as its features for early diagnosis and how to prevent flare-up of the disease to promote better quality of life in these patients.

Primary Sjogren's Syndrome Presenting as Acute Interstitial Pneumonitis/Hamman-Rich Syndrome.

A previously well, 45-year-old Pakistani lady was admitted to the medical unit on-call of Khyber Teaching Hospital (KTH) Peshawar with a 5-day history of fever, productive cough with copious mucoid sputum, dyspnea, and pleuritic chest pain. She also complained of dry eyes, mouth, and vagina. Her chest X-ray showed diffuse alveolar shadowing and arterial gas analysis confirmed type 1 respiratory failure. Over the next few days, she deteriorated rapidly making an urgent transfer to the medical intensive care unit (MICU) necessary, where she was mechanically ventilated. An HRCT followed by bronchoscopic biopsies made a diagnosis of acute interstitial pneumonitis (AIP), formerly known as Hamman-Rich syndrome. She also turned out to be positive for both anti-SS-A/Ro and anti-SS-B/La antibodies along with a positive Schirmer's test and lower lip biopsy. She received intravenous steroids and supportive care. The patient had a complete recovery after approximately three weeks' stay in the hospital with lung function returning back to normal. This is most probably the first ever case of primary Sjogren syndrome (pSjS) presenting as AIP, recovering completely in less than a month time.

Coexisting giant splenic artery and portal vein aneurysms leading to non-cirrhotic portal hypertension: a case report.

BACKGROUND: Splenic artery aneurysms are the commonest visceral and third most common abdominal artery aneurysms, having a strong association with both pregnancy and multiparity. Here we report possibly the first case of a giant splenic artery aneurysm in association with a smaller portal vein aneurysm, in a woman who had never conceived, leading to non-cirrhotic portal hypertension. CASE PRESENTATION: A 40-year-old Pakistani Asian woman who had no evidence of liver cirrhosis presented in April 2016 for a diagnostic workup of ascites, massive splenomegaly, and pancytopenia. An abdominal ultrasound followed by computed tomography angiography showed a giant aneurysm in her splenic artery and another smaller one in her portal vein. She underwent splenectomy and excision of the splenic artery aneurysm. Surgical findings included a giant splenic artery aneurysm pressing on her portal vein and causing its aneurysmal dilatation. On her first review in July 2016, she was generally in good health, ascites had subsided, and her full blood count was normal. Her portal vein aneurysmal dilatation, which was presumed to be secondary to the pressure effect from the splenic artery aneurysm, had shrunken remarkably in size. CONCLUSION: A giant splenic artery aneurysm can cause non-cirrhotic portal hypertension and should be treated with splenectomy and aneurysmectomy.

Induced abortions and unintended pregnancies in pakistan.

During the past decade, unmet need for family planning has remained high in Pakistan and gains in contraceptive prevalence have been small. Drawing upon data from a 2012 national study on postabortion-care complications and a methodology developed by the Guttmacher Institute for estimating abortion incidence, we estimate that there were 2.2 million abortions in Pakistan in 2012, an annual abortion rate of 50 per 1,000 women. A previous study estimated an abortion rate of 27 per 1,000 women in 2002. After taking into consideration the earlier study's underestimation of abortion incidence, we conclude that the abortion rate has likely increased substantially between 2002 and 2012. Varying contraceptive-use patterns and abortion rates are found among the provinces, with higher abortion rates in Baluchistan and Sindh than in Khyber Pakhtunkhwa and Punjab. This suggests that strategies for coping with the other wise uniformly high unintended pregnancy rates will differ among provinces. The need for an accelerated and fortified family planning program is greater than ever, as is the need to implement strategies to improve the quality and coverage of postabortion services.

Postabortion care in Pakistan.

The current law in Pakistan permits abortion only under narrow circumstances. As a result, women resort to clandestine and unsafe abortion procedures, which often lead to complications. This report summarizes findings from a study that examined the conditions under which women obtain abortion in Pakistan; the incidence, coverage and quality of facility-based postabortion care (PAC); and the extent to which recommended standards for PAC have been implemented in health facilities.

The importance of public sector health facility-level data for monitoring changes in maternal mortality risks among communities: the case of pakistan.

This paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.