Prevalence and Correlates of Mental Health Status Among Pre-Hospital Healthcare Staff.

INTRODUCTION: Mental stress amongst pre-hospital Emergency Medical Services (EMS) workers is an iceberg phenomenon; owing to unique occupational stressors faced by them. This study was aimed to examine the mental health status of pre-hospital EMS workers and its correlation with Post-Traumatic Stress Disorder (PTSD) and Work Environment Scale (WES). METHODS: This cross-sectional study incorporated 224 emergency EMS members from urban and road EMS bases in eastern Iran in 2018. General Health Questionnaire (GHQ-28), Post-Traumatic Stress Disorder Checklist-Civilian version (PTSD-C), and Work Environment Scale (WES) were used as research instruments. Data were analyzed via SPSS Statistics software (version 21); while p<0.05 was considered significant. RESULTS: The mean age of participants was 31.91±6.9 years; 36(16.1%) had PTSD ≥50, which increased with age (p-0.01), number of offspring (p-0.022) and time working at the EMS (p-0.002). Mean WES scores were 73.41±12.27; with a significant impact of marital status (p-0.007), the number of offspring (p-0.023), qualification (p-0.019) and less time working at the EMS (p-0.008). Mental distress was recorded in 89(39.7%) individuals. Multivariate logistic regression revealed that members at higher risk of mental distress were; those with associate's degree (adjusted OR 3.192; 95% CI, 1.456-6.998), individuals with 1 or 2 offspring (adjusted OR 2.03; 95% CI, 0.992-4.156; adjusted OR 3.380; 95% CI, 1.483-7.704, respectively), and those with PTSD equal or higher than 50 (adjusted OR 2.504; 95% CI, 1.063-5.903), with a reverse impact of WES (p>0.05). CONCLUSION: PTSD adversely affected mental health and clinical performance of the subjects; while work-place environment augmented working spirit as well as psychological resilience. Strategies aiming at stress-dilution and improvements in a professional environment cannot be over-emphasized.

Single versus double burr-hole drainage for chronic subdural hematoma: A study of relevant prognostic factors conducted in Pakistan.

OBJECTIVE: To compare the efficacy of single versus double burr-hole for drainage of chronic subdural hematoma, keeping in consideration pertinent demographic, pre and postoperative associations. METHODS: A prospective cohort study carried out in Combined Military Hospital, Multan, (December 2016-August 2018), on adults with diagnosed chronic subdural hematoma (CSDH); being segregated by randomized control trial, non-probability purposive sampling into Group-A and Group-B (who underwent single and double burr-holes for CSDH-drainage respectively). Utilizing SPSS-21, data expressed as frequencies/percentages and mean± standard deviation (SD) and cross-tabulated; p-value <0.05 was taken as significant. RESULTS: Age and GCS scores were 62±13.694 (range 38-94) and 11.00±3.350 (range 3-15) respectively, males being 40(66.7). Post-operative fatality was Nil, while 8(13.3%) and 14(23.3%) had post-operative seizures and recurrence of hematoma respectively. There was no significant association between type of burr-hole and hospital stay (p 0-884), seizures (p 0.448) or recurrence (p 0.542). Hospital stay (p<0.000) and seizures (p-0.005) were inversely proportional to GCS scores on presentation. Recurrence rates were not affected by age (p-0 .175) or gender (p-0 .281). CONCLUSION: There was no significant difference between outcomes of single and double burr-hole surgeries; the former must be preferred because of lesser iatrogenic trauma. GCS-score on presentation was validated as a negative association to anticipate post-operative outcomes.

Prevalence of myths concerning growth and health of children among females of local population of Pakistan.

OBJECTIVE: To analyse the prevalence of myths among women regarding growth and health-related issues of children, and to study the impact of basic demographic factors in this regard. METHODS: The educational, cross-sectional, descriptive study was carried out at the Combined Military Hospital, Peshawar, Pakistan, from January 2016 to January 2017. It comprised women reporting to paediatric outpatient clinics, and the subjects were selected using convenience sampling. A self-designed questionnaire was used which contained demographic details and 15 closed-ended questions encompassing common myths concerning child health-related issues. Total answers given by a client as YES (beliefs in myths) were grouped as >50% YES or <50% YES; and was cross-tabulated with independent variables. SPSS21was used for statistical analysis. RESULTS: Of the 422 subjects, 301(71.3%) believed in the existence of 'Garam' foods. Overall, 278(65.9%) subjects had <50% YES, and 144(34.1%) had >50% YES answers. Three most commonly believed myths were: a neonate must be tied for better growth 281(66.6%), 'Garam' food should not be given to children in summers 225(53.3%), and diseases like 'Kala Yarqaan' are transmitted through lactation 223(52.8%). There was a significant impact of education (p<0.001) and regional background (p=0.006) on predilection for harbouring myths. There was no significant impact of age (p=0.415), marital status (p=0.790) or socio-economic class (p=0.196) on the matter. CONCLUSIONS: Significant prevalence of myths pertinent to children's health-related issues among ladies was observed. The lacunae identified must be aptly addressed at clinical level as well as via lectures and seminars.

Reproductive health issues in Pakistan; do myths take precedence over medical evidence?

OBJECTIVE: To analyse the prevalence of myths pertinent to healthcare issues of females of reproductive age. METHODS: This cross-sectional, simple descriptive, knowledge, attitude and practices-education research was conducted at the Combined Military Hospital, Peshawar, Pakistan, from February to August 2016. A 30-item self-designed questionnaire was applied, collecting demographic details and answers to 21 close-ended questions encompassing the prevalence of myths pertinent to reproductive health issues of women in Pakistan.Every question had three options, Yes(myth), No(correct answer) and Don't Know(unsure). SPSS 21 was used for data analysis. RESULTS: There were 594 participants in the study. The overall mean age was 35.11±12.711 years and the mean duration of education was 9.41±6.353 years. Besides, >50% answers positive for myths and <50% answers positive for myths were given by 326(54.9%) and 268(45.1%) respondents, respectively. The prevalence of myths was directly proportional to age (p=0.004), and inversely proportional to education (p<0.001) and socio-economic class(p<0.001); impact of education was stronger than socio-economic class(Pearson's chi-square being 74.189 and 48.672, respectively). Khyber Pakhtunkhwa-based respondents harboured more myths (p=0.024). There was no significant impact of marital status (p=0.099). CONCLUSIONS: The participants held significant amount of myths regarding health issues in reproductive age.

Do doctors have hidden distress; a study conducted at tertiary care hospital at Lahore.

OBJECTIVE: Toanalyse the prevalence of distress in doctors serving in a tertiary care hospital and studying the factors having significant impact on the subject. METHODS: The cross-sectional study was conducted at the Combined Military Hospital, Lahore, from February to December 2014, and comprised doctors serving for at least six months who volunteered to fill out the standardised General Health Questionnaire-12Demographic features and level of job satisfaction were taken as independent variables. Outcome variable was the questionnaire score. SPSS 20 was used for data analysis. RESULTS: The mean questionnaire score of the 97 respondents in the study was 12.27±6.397. Of them, 19(19.6%) and 11(11.3%) had distress and severe distress respectively. Marital status (p=0.006), age (p=0.029), income per month (p=0.010) and levels of job satisfaction (p=0.001) had significant impact on the scores. Variables having insignificant impact were gender (p=0.529), number of children (p=0.220), education (p=0.816), service years (p=0.155), current employment (p=0.504), nature of job (p=0.531), working hours (p=0.632), additional duties (p=0.663), and socioeconomic class (p=0.935). CONCLUSIONS: Almost one-third of the doctors had distress under the significant impact of multiple factors.

Comparison of permeatal medial placement of graft without raising the tympano-meatal flaps to conventional methods of myringoplasty: An experience at tertiary care hospital in Pakistan.

OBJECTIVE: To compare the results of permeatal approach without raising the tympano-meatal flap to end-aural or post-aural approach in myringoplasty. METHODS: This Quasi-experimental study was carried out in CMH (Combined Military Hospital) Peshawar, from August 2006 to July 2013. Three hundred fifty patients of chronic suppurative otitis media (CSOM) with dry central; small, medium and large perforations were selected. They were divided into two groups depending upon the type of approach. In Group-A (n-200); permeatal approach without raising tympano-meatal flap was used; while in Group-B (n-150) end-aural or post-aural approach was used. Subjects were followed up for two years; graft take was checked regularly by examinations of ear under microscope. Data was collected on structured Performa and analysed by SPSS-17. RESULTS: Male and female were 74% and 26% respectively; Age ranged from 15 to 46 Years. There was no significant difference in the graft success at the end of two years in Group-A(80%) and Group-B(85%) (p-0.261). Type of approach had a significant impact on duration of surgery(p<0.001) and post-operative recovery time(p<0.001). CONCLUSION: The permeatal approach and end-aural/post-aural approach had almost equal graft success rates, but former is more useful as it causes lesser morbidity, decreased post-operative hospital stay and reduced operative time. It is under-utilized and should be employed more frequently.

Prevalence of anxiety and depression among doctors; the unscreened and undiagnosed clientele in Lahore, Pakistan.

OBJECTIVES: To analyze prevalence of anxiety and depression among doctors serving in a tertiary care hospital in Lahore, with a study of impact of relevant demographic features. METHODS: A cross sectional study was conducted at Combined Military Hospital, Lahore, from February 2014 to Jan 2015. Participants were doctors serving in subject hospital for at least six months duration. Standardized Hospital Anxiety Depression Score (HADS) inventory was selected as inventory. Formal approval from hospital ethical committee and written informed consent from participants were obtained. Demographic characteristics of participants were recorded as independent variables; anxiety and depression scores being outcome variables. Data analysis was done via descriptive statistics (SPSS-20), qualitative data expressed as frequencies, percentages; quantitative as mean ± standard deviation(SD). Cross tabulation was done via chi-square, p-value < 0.05 considered as significant. RESULTS: Out of 203 volunteers, 97(47.78%) responded. Score of anxiety was 7.04±4.470, maximum being 19, scores of depression was 4.94±3.605, maximum score being 15. Mild to moderate anxiety and depression were revealed in 33(34%) and 24(24.8%) respectively, while 7(7.2%) and 1(1.0%) had severe anxiety and depression respectively. There was strong positive relation between anxiety and depression (p<0.001). There was significant impact of service years on depression (p-0.011) and gender on anxiety (p-0.002), 9(17.31%) males and 24(53.33%) females had mild to moderate anxiety while 4(7.69%) males and 3(6.66%) females revealed severe anxiety and other variables did not reveal significant impact on HADS scores. CONCLUSION: Doctors showed high grades of anxiety and depression. They must be promptly screened and managed at all medical institutions.

Trends of contraception among ladies of local population in Pakistan; why, how, when and what?

OBJECTIVE: To analyze trends of use of methods of contraception along with study of impact of various demographic and social factors on contraception in Peshawar, Pakistan. METHODS: A cross-sectional descriptive study with random purposive sampling was conducted at Combined Military Hospital Peshawar, from Mar 2015-Nov 2015. Self-designed questionnaire with demographic details and questions pertinent to contraceptive practices was utilized as study instrument. Females reporting to concerned hospital for contraceptive advice and prescription were distributed with questionnaire and written informed consent form. Formal approval was taken from ethical committee of hospital. Data was analyzed via descriptive analysis (SPSS-21), qualitative data was expressed as frequencies and percentages; quantitative as mean±standard deviation (SD). Main outcome variable i-e contraceptive device used; was cross-tabulated with independent variables. RESULTS: Response rate was 53.2% (n-426). Usage of contraceptive device was as follows; 51.2% Nil, 9.4% barriers, 22.3% oral/injectable hormones, 13.4% IUCDs, 3.8% sterilization. There was a strong relationship between type of contraceptives used and age (p<0.001), client's education (p<0.001), husband's education (p<0.001), number of children (p<0.001), religion (p0.013), socioeconomic class (p<0.001), and religious beliefs about use of contraceptives (p<0.001). More Muslims considered contraception irreligious than non-Muslims (p 0.02). There was no significant impact of husbands' pressure to not to use contraceptives on type of contraception practised (p 0.114). CONCLUSION: Contraceptive devices are under-utilized in the study participants. Multidisciplinary approach should be applied to enhance client education, awareness and counseling to utilize these devices more appropriately and regularly.

Son Preference in Pakistan; A Myth or Reality.

OBJECTIVE: To analyze desire for sons/daughters among ladies of Peshawar, Pakistan, with a view to rule out son preference and to study impact of various demographic characteristics on the subject. METHODS: Cross-sectional descriptive study conducted at Combined Military Hospital, Peshawar, from August 2015 - January 2016; sampling technique was random/probability/non-purposive. Self-designed questionnaire was utilized; carrying questions pertinent to desire for sons/daughters during marital life, and demographic details. Data analyzed via descriptive analysis (SPSS-21), expressed as frequencies/percentages and mean ± standard deviation(minimum/maximum). Sons and daughters desired (dependent variables) were cross-tabulated with independent variables. RESULTS: Response rate was 63.25% (n-506). Data revealed following: Sons desired 3.05±2.061(1/12); Daughters desired 1.15±0.767(0/4); 6.1%(n-31) and 0.6%(n-3) desired infinite number of sons and daughters respectively, 18.2%(n-92) did not desire to have even one daughter, while 2.2%(n-11) considered it immaterial to have daughters or sons. There was a significant relation between sons desired and client's education (p<0.001), husband's education (p<0.001) and socioeconomic class (p<0.001). There was no significant impact of religion (p-0.142) on desire for sons. Impact of independent variables on daughters desired was similar but less pronounced. CONCLUSION: There was candid son preference among the respondents. Gender discrimination can be attenuated by adequately addressing son preference at all tiers.

Job satisfaction among doctors, a multi-faceted subject studied at a tertiary care hospital in Lahore.

OBJECTIVE: To study the level of job satisfaction among doctors serving in a tertiary care hospital in Lahore and ascertain its co-relation with multiple demographic variables which had a profound impact. METHODS: This cross sectional study with non-probability purposive sampling was conducted at Combined Military Hospital, Lahore, from February 2014 to November 2014. Subjects were doctors serving in that hospital for minimum six months duration. Pre-formed questionnaires were distributed to volunteers (average filling time was 3 ½ to 7 minutes). Multiple demographic features were independent variables. Outcome variable was job satisfaction. Statistical analysis was done via descriptive statistics (SPSS 20), data expressed as mean ± standard deviation (SD). RESULTS: Out of 263 doctors serving in hospital, 203 (77.91%) volunteered to participate; response rate by depositing the filled forms was 47.78% (97 doctors). Amongst the respondents, 10 (10.3%) doctors had below average job satisfaction, 32(33.0%), 21(21.6%), 21(21.6%) and 13(13.3%) had average, above average, well above average and outstanding job satisfaction respectively. There was significant relation between job satisfaction and age group of the doctors (p 0.025), education (p 0.015), service years (p 0.013) income per month (p<0.001). There was no significant impact of gender (p 0.540), marital status (p 0.087), number of children (p 0.153), current employment (p 0.71), nature of job (p 0.204), working hours (p 0.089), additional duties p 0.421) and socioeconomic class (p 0.104) on outcome variable. CONCLUSION: A significant number of doctors was found discontented with their job, which may consequently impact their yield/performance. The job satisfaction can be substantially improved if these contributory factors are aptly addressed at all tiers.

Why myringoplasties fail? Impact of relevant clinical factors on the surgical outcome; a study from pakistan.

BACKGROUND: Myringoplasty is the reconstruction of the tympanic membrane by grafting. Success varies from 50-100%. A study was conducted to unveil the vital causes for failed myringoplasty with an aim to attenuate graft rejections and augment better outcomes. METHODS: It was descriptive case series in which data was retrospectively collected at a tertiary care hospital (Rawalpindi, Pakistan) from January 2009 to December 2018. First 600 consecutive patients who qualified for inclusion/ exclusion criteria, underwent myringoplasties were followed-up for 6 months. Graft Take/Failure, the main outcome variable, was correlated with relevant independent variables. Data was collected on a structured pro forma, approved by hospital ethical committee. Data was analysed using IBM-SPSS- 21.0. RESULTS: Out of 600, 164 (27.3%) had graft rejection; failure being significantly enhanced by increasing age (p<0.001), larger perforation (p-0.025), co-morbidities (p<0.001), especially diabetics (p=0.040) and Eustachian tube (p-0.016) dysfunction amongst among systemic and ENT diseases respectively, and discharge-free ear (Dry Ear) for <4 weeks (p<0.001); while best graft take was achieved with end-aural surgical technique (p=0.048). Gender (p-0.897) did not caste a significant impact on graft outcome. CONCLUSIONS: The results of various surgical approaches of myringoplasty are equitable. Proper socio-demographic and clinical evaluation can improve graft outcome, and this surgery shall be discouraged in patients with diabetes mellitus and defective Eustachian Tube functions.

Respiratory Symptoms and Diminished Lung Functions Associated with Occupational Dust Exposure Among Iron Ore Mine Workers in Iran.

BACKGROUND: Dust exposure at quarry mines is inevitable and can result in poor air quality. This research aimed to assess pulmonary symptoms and lung functions of dust-exposed workers at an iron-ore mine in eastern Iran. METHODS: An environmental cross-sectional study sampled 174 dust-exposed mine workers and 93 unexposed administrative employees as the reference group. A standardized questionnaire on respiratory symptoms was completed in accordance with recommendations of the American Thoracic Society(ATS). Calibrated spirometer measured Pulmonary Function Tests (PFTs). Data were analyzed via SPSS-21, integrating independent samples t-test, Chi-square and linear or logistic-regression models. RESULTS: There was no significant variation between dust-exposed and reference groups in terms of age, weight, height, work experience and the number of smokers (P>0.05). Mean levels of exposure to inhalable and respirable mineral-dust were 15.09±2.34 and 3.45±2.57 mg/m3 respectively. Pulmonary capacities of dust-exposed group were considerably decreased as compared to others (Forced Vital Capacity [FVC] 86.55±13.77 vs. 105.05±21.5; Forced Expiratory Volume in 1 second [FEV1] 88.06±16.8 vs. 105.81±21.55; FEV1/FVC 103.03±18.17 vs. 93.3±12.49; and Peak Expiratory Flow [PEF] 89.82±22.58 vs. 98.09±20.60) (P<0.001); with a higher prevalence of cough (P=0.041), wheezing (P=0.032), and dyspnea (P=0.035) among formers. Age along with exposure to respirable-dust significantly reduced FVC, FEV1 and FEV1/FVC. Cigarette consumption attenuated FVC and FEV1 on an average of 5 to 9 units. CONCLUSION: Controlled occupational dust-exposure is a definitive pre-requisite to reduce respiratory problems among quarry workers, with an explicit consideration towards mineral- mine workers. Modifiable accomplices like smoking and non-compliance of PPEs usage should be amicably resolved.