Video based educational intervention in waiting area to improve awareness about health screening among patients visiting family medicine clinics.

BACKGROUND: Multiple educational modalities have been utilized including leaflet, face-to-face counseling and watching videos in waiting areas for engaging patients. Considering the two challenges of waiting time frustration and lack of health screening awareness, Family Physicians' waiting area are an ideal place to bridge this gap. The objective of this study is to evaluate the effectiveness of video-based health education intervention in improving knowledge about health screening among patients and their families sitting in waiting area of Family Medicine clinics. METHODS: It was a pre and post quasi-experimental study that was conducted in family medicine clinics located at main campus and Outreach centers of a tertiary care hospital. A total of 300 participants were approached during the six month period. The intervention consisted of an educational video on health screening. The content of the video was taken from the recommended preventive care guidelines from CDC and USPSTF. The pre-and post-intervention knowledge of the participants was assessed through a semi-structured coded questionnaire by an interviewer who was trained in data collection. Data was analyzed using SPSS version 26. Pre and post intervention knowledge adequacy was determined using MacNemar's Chi-square test. RESULTS: Total 300 participants voluntarily participated into the study. Median age of the participants was 28 (IQR = 23.25-36.75) years. Majority of participants were males (56%). Following the intervention, there was significant increase in the proportion of participants (51.3% versus 68%) who had understanding of health screening check-up (p < 0.001). Following the study intervention, there was significant increase in proportion of participants who had adequate knowledge related to diabetes (p = 0.045), hypertension (p < 0.001), cholesterol (p < 0.001), cervical cancer (p < 0.001), colon cancer (p < 0.001) and hepatitis B & C (p < 0.001). No significant improvement in breast cancer related knowledge was observed (p = 0.074). Highest post-intervention increase in knowledge from baseline was observed for hypertension (13.3% versus 63.3%) followed by colon cancer (24.3% versus 59.3%), cholesterol (67 versus 96.7%), hepatitis b & C (56.7% versus 77.3%), diabetes (29.7% versus 48%), cervical cancer (1.7% versus 19%), and breast cancer (7.7% versus 18.3%). CONCLUSION: This study highlighted a pivotal role of an educational video intervention in clinic waiting area to improve awareness regarding health screening among patients and their families. Further interventional community based or multicenter studies are warranted to assess the long-term impact of these educational videos on knowledge and utilization of health screening among adult population.

Comparison of fatty liver index with fibroscan in non-alcoholic fatty liver disease.

Context: Non-alcoholic fatty liver disease (NAFLD) is an escalating global health issue. Early detection and precise diagnosis are imperative for effective management. Aim: To evaluate the sociodemographic and clinical attributes of study participants concerning their ultrasound grading with FibroScan and FLI values. Settings and Design: A cross-sectional study was carried out among patients visiting gastroenterology clinics at a tertiary care hospital situated in Karachi, Pakistan. Methods and Material: We included participants after written informed consent underwent an extensive array of laboratory assessments, encompassing liver function tests, lipid profile, fasting blood sugar analysis, hepatitis B and C screening, and abdominal ultrasound, while those with positive hepatitis B or C markers, documented alcohol use, or those who declined to offer informed consent were excluded from the study. Statistical Analysis: Data were analyzed using SPSS version 26. Results: Around 225 patients were studied with a median age of 42 years (IQR = 34-50 years). Metabolic syndrome (MetS) was present in 61.8%. Steatosis was not found among 4.9% of patients, whereas severe steatosis was seen among 51.1% of patients. Significant variations in BMI, WC, GGT, and TG levels were identified when comparing FLI scores. The same was observed for the frequency of MetS as FLI scores increased. The agreement between FLI and ultrasound observations was found to be slight (k = 0.077, P = 0.027). On the multivariable regression model, having diabetes, elevated serum glutamate pyruvate transaminase levels and mild disease on ultrasound were associated with increased odds of severe steatosis. Conclusion: FLI is a good predictor of frequency of MetS and NAFLD and correlates well with increasing steatosis score (CAP) on FibroScan which can be utilized for early detection of NAFLD in primary care.

Nutritional status and its associated factors among the geriatric population in outpatient clinics of a tertiary care hospital in Karachi, Pakistan.

Context: Elderly malnourishment remains a largely unexplored area, despite having a significant effect on the level of mortality and morbidity. This study aims to explore the level of malnourishment and identify those at risk of malnourishment among the elderly population presenting to a teaching hospital in Karachi. Aims: To assess nutritional status and its associated factors among the elderly population. Settings and Design: This study was conducted in outpatient clinics of family medicine at a teaching hospital and its outreach primary care centres from December 2020 to December 2021. The study design was cross-sectional. Materials and Methods: The prevalence of malnourishment and at risk of malnourishment with its associated factors were assessed using the Mini-Nutritional Assessment (MNA) scale as a screening tool among the elderly population (65 years and above) presenting to the family medicine OPDs of a teaching hospital. Statistical Analysis: Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 21. Results: A total of 191 patients were recruited into the study, and the majority of them were males (66.5%). Median age and body mass index (BMI) of participants were 70 (IQR = 74-65) years and 24 (IQR = 27-21) kg/m2, respectively. The median MNA scores were 23.5 (IQR = 20.5-26). A total of 92 (48.2%) participants were found to have a normal nutritional status, 81 (42.4%) were found to be at a risk of malnourishment, and 18 (9.4%) were malnourished. On the multivariable regression model, BMI and ability to manage finances were significantly associated with malnourishment. Conclusion: This study shows an alarmingly high rate of the elderly population at risk of developing malnourishment, and financial independence and increasing BMI were associated with a decreased risk of malnourishment.

Frequency and predictors of depression among the elderly population of Karachi.

Context: Depression among the elderly is falsely considered as a normal part of aging and hence remains un-diagnosed in the majority. Elderly people are at a high risk of depression, which may produce a negative impact on their quality of life. Depression is a potentially treatable condition; hence, it is worthwhile to explore its burden in order to ensure its timely evaluation and management. Aims: To determine the frequency and predictors of depression among the elderly population of Karachi. Settings and Design: The current study was a cross-sectional study, conducted in out-patient clinics of a tertiary care hospital and its out-reach centers located in different areas of Karachi. Methods and Material: Patients aged 60 years and above were enrolled in the study. Demographic profiles and physical health conditions were investigated. Depression was assessed using Geriatric Depression Scale-15. Statistical Analysis: Data were entered in SPSS version 21 for statistical analysis. Results: A total of 232 participants were enrolled into the study with a median age of 65.8 [inter-quartile range = 61-69] years. Out of 232 participants, 186 (80.2%) were found to be depressed. In the multi-variable model, employment status, financial issues, and peer groups were left as independent predictors of depression. Conclusion: The current study found a significant burden of depression among elderly people in Karachi. Employment status, financial problems, and relationship with peers have been identified as risk factors of depression. There might be over-reporting of depression as the data collection was conducted during the coronavirus disease 2019 first wave. Hence, further community-based research is warranted to confirm the findings.

Prevalence of erectile dysfunction and associated factors among males visiting family medicine clinics in a Tertiary Care Hospital in Karachi, Pakistan.

BACKGROUND: The burden of erectile dysfunction (ED) among the developed countries is found to be quite high. However, there is a paucity of data among developing countries to know its actual burden and factors associated with it. METHODS: The current study is cross-sectional and was conducted in Family Medicine clinics of Liaquat National Hospital during May 2017-January 2018. A total of 450 males participated in this study with the age range of 24-77 years. More than half of the participants were graduates or above. RESULTS: On multivariable analysis, age (aOR = 5.47, 95% CI: 2.74-10.89), alcohol use (aOR = 5.23, 95% CI: 1.45-18.84), diabetes (aOR = 6.61, 95% CI: 3.27-13.36), and current smoking (OR = 2.41, 95% CI: 1.35-4.31) were significantly associated with ED. ED risk was significantly lower in those who either attended secondary school (aOR = 0.33, 95% CI: 0.13-0.88) or were at least graduates (aOR = 0.40, 95% CI: 0.17-0.96) than illiterate when model was adjusted for other covariates. CONCLUSION: Erectile dysfunction in a Pakistani male population highlights the need for routine screening at the primary care level. There is a possibility that the actual burden is underreported due to cultural stigmatization; hence, further research is warranted to validate the findings.

COVID-19 Pandemic Prevalence and Risk Factors for Depression Among Health Care Workers in South Asia.

Health care workers (HCW) are especially vulnerable to developing mental health problems in pandemic situations. The impact may be much devastating in developing countries due to fragmented health care system. Our study aims to explore the underlying burden of depression and its related factors among health care workers in South Asian countries. Data was collected through an online survey. A total of 476 health care workers including doctors, nurses, and paramedical staff participated from Pakistan, India, and Sri Lanka. A validated WHO Self Reporting Questionnaire (SRQ-20) was used to screen for Depression. A 25.7% prevalence of depression was reported among health care workers. Almost 70% of them were either not satisfied or partially satisfied with the provided personal protective equipment. On multivariable analysis, females gender (aOR=1.80, 95% CI: 1.11 - 2.90), fear of unprotection (aOR=1.80, 95% CI: 1.11 - 2.90), confirmed COVID-19 case in workplace (aOR=1.98, 95% CI= 1.18 - 3.33) and family (aOR=2.98, 95% CI: 1.02 - 8.70) were found to be independent predictors of depression among healthcare workers. Depression among HCW in South-Asian countries is quite alarming. This may jeopardize attention to other non-COVID health problems which are still on a priority in developing countries.

COVID-19 pandemic- knowledge, perception, anxiety and depression among frontline doctors of Pakistan.

BACKGROUND: COVID-19 is a global pandemic and has become a major public health burden worldwide. With already fragile healthcare systems it can have long lasting effects in developing countries. Outbreaks especially a pandemic situation evokes fear related behaviors among healthcare professionals and there is always an increased risk of mental health disorders. Therefore, this study aims to determine knowledge and perception about this pandemic, prevalence and factors associated with anxiety/depression among frontline physicians of Pakistan. METHODS: Data were collected through an online survey released in the last week of March-2020. 389 frontline physicians from all four provinces and 65 cities of Pakistan participated. Survey questionnaire consisted of 4 parts including informed consent section, demographic section, knowledge and perception about COVID-19 pandemic and assessment of depression through World Health Organization Self-reporting questionnaire (SRQ-20). A score of 8 or above on SRQ-20 was used as cut-off to label the participant as depressed. Data was analyzed using SPSS version22. RESULTS: A 43% prevalence of anxiety/depression among frontline physicians of Pakistan was reported. Almost all the doctors had moderate to high knowledge score. Majority of participants marked N-95 mask as "essential" during aerosol generating procedures, assessing patients with respiratory symptoms, in COVID patient-care area, ER triage and direct care of COVID-19 patient. Only 12% of the doctors were fully satisfied with the provision of PPEs and almost 94% felt unprotected. In multivariable model, assessing more than five COVID suspects/day (aOR = 2.73, 95% CI: 1.65-4.52), working 20 h/week or less (aOR = 2.11, 1.27-3.49), having children among household members (aOR = 1.58, 95% CI: 1.00-2.50) and moderate to low knowledge of the infection (aOR = 2.69, 95% CI: 1.68-4.31) were found to be independent predictors of anxiety/depression among physicians. CONCLUSION: Anxiety/depression among more than a third of frontline doctors of Pakistan warrants the need to address mental health of doctors caring for patients during this pandemic; control modifiable factors associated with it and explore the effectiveness of interventions to promote psychological well-being of physicians.