Breaking bad news: a descriptive study of physicians' perspective of Sindh, Pakistan.

OBJECTIVE: To assess the perception and attitude of physicians related to breaking bad news. METHODS: The cross-sectional study was conducted at three teaching hospitals in Karachi and Mirpurkhas, Pakistan, from April 2019 to February 2020, after approval from Hamdard University, Karachi, and comprised physicians of either gender having direct patient contact. Data was collected using a questionnaire based on literature. The questionnaire was pilot-tested before distribution among the subjects. The responses were categorised with respect to age, gender and professional experience. Data was analysed using SPSS 25. RESULTS: Of the 230 subjects, 119(51.7%) were females. The overall mean age was 34.5±8.8 years and mean professional experience was 9.1±8.2 years. Overall, 19(8.3%) subjects believed they had a very good ability to deliver bad news, while 26(11.3%) avoided telling the patient the truth about diagnosis, prognosis and treatment. Age had a significant association with correctly defining breaking bad news (p<0.05). CONCLUSIONS: The skill level related to breaking bad news was found to be deficient.

Health Related Quality of Life amongst Sewerage and Sanitary Workers of Karachi, Pakistan.

Objectives: To find out the impact of occupational and socio-demographic factors on the health related quality of life of sewerage and sanitary workers in Karachi. Methods: A cross-sectional study was conducted during 2019. Four hundred workers were chosen from five districts of Karachi using a non-probability convenient sampling technique. An Urdu version of WHO BRIEF quality of life questionnaire was used to collect the data about workers general health status and quality of life. Descriptive analysis was done and Chi-square test was used for the association of socio-demographic factors and quality of life. Multiple regression model was used to predict QOL of all domains. P-value<0.05 was considered as statistically significant. Results: Out of 400 sanitary workers, 228 (57.0%) were sweepers and the rest 172 (43.0) were sewerage workers. The majority of the workers 321 (80.3%) were male and 246 (61.5%) were illiterate. The vast majority of the workers 386 (96.5%) were not immunized against typhoid, / hepatitis and tetanus. Ninety-one percent (91%) were not using any kind of safety gadgets while at work. Male workers, married workers of both sexes and those with some education had a little better quality of life than their counterparts. Sanitary employees likewise had a higher quality of life score than sewage workers (P-value<0.05). Conclusion: The majority of workers, particularly sewage workers, have a very poor quality of life. Along with very bad working circumstances, their standard of living is significantly below par. They were not given any safety equipment. They were handling untreated sewage/waste with their bare hands, and they have never received a typhoid/hepatitis /tetanus vaccine.

Smartphone addiction and its associated behaviors among medical and dental students in Pakistan: A cross-sectional survey.

INTRODUCTION: Addiction refers to the irresistible urge to engage in certain actions or dependence on a particular substance despite knowing negative consequences. The current study evaluated the severity of Smartphone addiction and the factors associated with cell phone-like activity. MATERIALS AND METHODS: This cross-sectional study was conducted from July to August 2019 among medical and dental students in Karachi, Pakistan. A pretested self-administered questionnaire was used among 400 students. The mobile phone addiction was assessed using a 20-item, Mobile Phone Addiction Scale. A two-stage cluster analysis was used to assess mobile phone addiction-like behaviours. Chi-square test was used to find associations between categorical variables. Kolmogorov-Smirnov to test normality of data were also used. A P < 0.05 was considered to be statistically significant for all tests. RESULTS: Out of the total 400 students, the majority 316 (79%) comprise female students. The mean age was 20.54 ± 1.59 years. In 184 (48%) students, there was evidence of mobile phone addiction-like behavior. The prevalence was higher in female than male students and among older compared to adolescent students; the differences were statistically nonsignificant. A higher median score ≥ of 4 is found in questions related to components reflected intense desire, impaired control, and tolerance and harmful mobile use. CONCLUSION: This study highlights that a large number of students are addicted to their smartphones. Smartphone addiction continues to be the most problematic addiction aided by the presence of intense desire, impaired control tolerance, and harmful mobile use. The phenomenon must be fully understood to draw deeper and richer inferences about the origins of this addictive behavior, which is becoming more prevalent in our Pakistani society on a daily basis.

Prevalence and associated factors of restless leg syndrome (RLS) in Pakistani women during pregnancy.

There is a dearth of literature studying restless leg syndrome (RLS) among pregnant patients in Pakistan. The objective of this study was to determine the prevalence and associated factors of RLS among pregnant Pakistani patients. It was conducted in 2018 among 478 women attending ante-natal check-up in the outpatient department of five hospitals in Karachi, Pakistan. Individuals were interviewed for socio-demographic information, the key criteria for RLS and its associated factors. RLS was reported in 54 (11%) individuals based on International Restless Legs Syndrome Study Group (IRLSSG) criteria. The mean age was 33.44 ± 4.42 years. Association between pregnant women with RLS and those without reveals statistically significant differences with increasing age (p=.01), gravida (p<.01) and para (p<.001). RLS was significant among working women (p=.001), during third trimester (p=.001), with insomnia (p<.001), use of tobacco (p<.001) and among women with gestational diabetes (p<.001), hypertension (p<.001). The study showed a low prevalence of RLS among women during pregnancy. It further reported gestational diabetes, hypertension, insomnia and tobacco use to be independently linked to RLS. Impact StatementWhat is already known on this subject? Pregnancy has been demonstrated to be strongly associated with development of secondary restless leg syndrome (RLS). RLS in pregnancy has also been shown to portend poor maternal and neonatal outcomes such as postpartum depression and preterm birth. Various conditions and lifestyle factors in pregnancy have been shown to be associated with the development of RLS, but there are variations in these across different populations.What do the results of this study add? The prevalence of RLS was only reported twice in pregnant patients in Pakistan and our research helps to address this data shortage. In addition, the results of our study document a strong association of RLS with gestational hypertension and gestational diabetes and also show that smoking and exercise were correlated with RLS during pregnancy, both of which were previously unstudied in the pregnant Pakistani population.What are the implications of these findings for clinical practice and/or further research? Demonstrating the prevalence of RLS in pregnant Pakistani patients highlights the need to screen these patients, particularly those with associated conditions identified in our findings, for RLS during antenatal visits and to treat their condition to improve maternal and neonatal outcomes.

Beliefs and knowledge of osteoporosis amongst female graduate students in Karachi, Pakistan: A cross-sectional study.

OBJECTIVE: To assess the knowledge, belief and preventive measures taken regarding osteoporosis by students of different non-medical educational backgrounds. METHODS: The descriptive cross-sectional study was conducted from January to March, 2018, at one private-sector and two public-sector universities in Karachi, and comprised female participants aged >15 years from engineering, commerce, social and pure sciences background. Osteoporosis Knowledge Assessment Tool questionnaire was self-administered to collect data which was analysed using SPSS 23. RESULTS: There were 400 females with a mean age of 20.55±1.66 years. The overall mean score was 46.49±12.83 and 43(10.8) subjects had a good score, 204(51%) had an average score and 150(37%) had a poor score regarding knowledge about osteoporosis. Also, 186(47%) subjects identified previous studies as their source about osteoporosis, 103(26%) gained knowledge by health professionals and 62(16%) did it through electronic media. The knowledge on risk factors, protective factors and perceived susceptibility were significant (p<0.05) when compared by type of study and age. CONCLUSIONS: The knowledge of the disease was found to be insufficient, indicating need for generating awareness regarding osteoporosis.

Child physical abuse: awareness and practices of medical and dental doctors in Pakistan.

OBJECTIVE: To determine the awareness and practices of doctors and dentists in detecting and reporting suspected cases of child physical abuse. METHODS: The cross-sectional study was conducted from November 2017 to June 2018 at the Hamdard College of Medicine and Dentistry, Karachi, and comprised doctors and dentists practising in public and private hospitals across Pakistan. Data was collected using a predesigned questionnaire to assess knowledge of the social indicators of child physical abuse, response to child physical abuse, and actions taken by the professionals when they believed a child abuse case had been detected. Data was analysed using SPSS 22. RESULTS: Of the 575 healthcare professionals, 371(64.5%) were doctors and 204(35.5%) were dentists; 347(60.3%) were males; 446(77.6%) were working in private hospitals; 384(66.8%) had <10 years of experience; and 99(17.2%) had received formal training of child abuse. While 450(78.3%) subjects strongly agreed on the value of identifying and documenting child physical abuse, 336(58%) did not take any action in suspected cases. CONCLUSIONS: Although doctors and dentists had a positive attitude regarding child physical abuse, the majority preferred to remain silent in suspected cases.

Knowledge and perceptions about the health effects of environmental hazards among students from Hamdard University, Karachi: A cross sectional study.

Environmental hazards increase the health morbidity and mortality burden. This study compared the knowledge and perceptions about the health effects of environmental hazards among medical and engineering students of Hamdard University Karachi. A total of 263 (44.1%) engineering students, and 333 (55.9%) medical students participated in the study. Cumulatively, the three most commonly identified environmental hazards included tobacco smoking 561 (94.1%), global climate change 518 (86.9%), and solar ultraviolet radiation 511 (85.7%). The study results suggest the need for better quantifying the magnitude of understanding environmental hazards, and for health education and promotion programmes at the graduate level for medical and engineering students in Karachi.

Challenges in providing oral and dental health services in COVID-19 pandemic.

Coronavirus disease (COVID-19) pandemic has rendered the world completely unaware and off-balance. Most of the countries of the world are in a lockdown of varying severity to break the chain of transmission. Many non-essential healthcare practices have been shut down to impose social distancing against a population whose slogan has been freedom of movement. Several healthcare providers have also been caught off guard. Many are not well-versed in the use of transmission-based safeguards, and the dental community, is no different. In this article, we identify the challenges faced by the oral and dental care providers, whose procedures generate a significant amount of aerosol, which can be a significant source of disease transmission within the community. It further describes the dynamics of aerosol spread and various strategies to minimise aerosol generation. Guidelines for the delivery of emergency dental treatment are formulated based on different guidelines from various international dental associations and organisations.

Knowledge and awareness regarding spread and prevention of COVID-19 among the young adults of Karachi.

OBJECTIVE: To measure the awareness of COVID-19 infection among the general population following the outbreak in China. METHODS: This descriptive cross-sectional study was carried out during January and February 2020 amongst the general population of Karachi, Pakistan. A pre-tested, self-administered questionnaire was used among 399 young adult participants. The questionnaire was developed keeping in view of the already published study on severe acute respiratory syndrome (SARS) and the available literature on COVID-19. It included sociodemographic information, assessment of knowledge, beliefs regarding coronavirus and the perception of precautionary measures taken by an individual. Chi-square test was used for categorical variables and p<0.05 was used as statistically significant. RESULTS: There were more females 299 (75%) than male participants 100 (25%). The mean age was 20.9 ±2.30 years and 232 (58%) had graduate degrees. There is lack of knowledge and awareness about coronavirus as 226 (56.6%) participants claimed that coronavirus is actually the most dangerous virus in the world, and 171 (43%) did know that the common flu virus is potentially more lethal than coronavirus. Although a large majority of participants correctly identified sources of transmission, measures and precautions to be taken for coronavirus, their knowledge for symptom identification was deficient. The most pursued platform for information for coronavirus was found to be social media, followed by television and print media. CONCLUSIONS: The study highlighted the level of awareness of coronavirus among young adults in Karachi, Pakistan. The study further pointed out the public knowledge gaps for the authorities concerned to help them develop more effective and successful awareness campaigns using preferred channels.

Daughters witnessing domestic violence perpetrated by fathers on mothers: Case study from a private University of Karachi.

Violence against women is a human rights issue and a major public health problem. The objectives of this study were to determine the magnitude and type of emotional and physical domestic violence perpetrated by fathers on mothers of female students of a private university. A total of 564 questionnaires were duly filled and returned with a response rate of 94.0%. The most common form of violence was reported by 93 (16.5%) of the respondents who witnessed their fathers either saying or doing something to humiliate the respondents' mothers. While the most common physical violence witnessed was fathers slapping their mothers as reported by 39 (6.9%) of the respondents. Empowerment of women, and effective endeavours in education of both sexes are important steps towards addressing and preventing domestic violence.

Prevalence of obesity and its risk factors among school children in Karachi, Pakistan.

A cross-sectional questionnaire study was conducted during 2012 in private and public-sector schools of Karachi to determine the prevalence and factors influencing overweight and obesity among school children (aged 11-15 years). Sociodemographic characteristics and dietary habits were explored. The CDC Growth Chart was used to record height and weight. Of a total of 887 children, being overweight and frankly obese was found in 169 (19.1%) and 96 (10.8%), respectively. Of these, 176 (66.4%) were from private schools, and significant associations were found in 202 (76.2%) who were spending > 2 h/day watching television and 139 (52.5%) sleeping > 8 h/day.

Knowledge of scientific misconduct in publication among medical students.

BACKGROUND: Publication is a central element in research dissemination and scientific misconduct in publication is relatively ignored in biomedical research. This study is to assess the knowledge of scientific misconduct in publication among private and public sector medical students. METHODS: A questionnaire-based cross-sectional study was carried in four (two public and two private) medical colleges of Karachi in 2015. After ethical approval, data were collected through convenient sampling and analyzed in SPSS 16.0. Descriptive statistics was used to summarize the data and Chi-square test was used for cross tabulation with sex, type of medical colleges, and knowledge of scientific misconduct in publication. RESULTS: A total of 592 medical students participated with mean age of 22.2 ± 1.47 years. The majority (491, 79%) of medical students had heard about the word "publication ethics," higher among public sector students than from private sector (P < 0.001). Only 78 (13.2%) reported to had published original articles, and 64 (10.8%) and 53 (9%) medical students had heard of "ICMJE authorship criteria" and "COPE," respectively. Knowledge about fabrication of data and scientific misconduct in publication was found to be statistically significant (P < 0.05) among males than female students. Statistically significant differences were also observed between public and private medical students for knowledge regarding salami slicing, ghost author, fabrication, and photomanipulation (P < 0.001) and for plagiarism (P < 0.005). Participants from public sector colleges scored significantly better in all above variables than private medical colleges except knowledge about salami slicing in which participants from latter performed significantly better than public sector students. DISCUSSION: The study demonstrates deficiencies in knowledge regarding several aspects of publication ethics among medical students of both public and private medical colleges in Karachi. There is a need to increase the awareness of research and publication ethics among students during their academic years.

Frequency and determinants of malnutrition in children aged between 6 to 59 months in district Tharparkar, a rural area of Sindh.

OBJECTIVE: To assess the nutritional status of children living in Tharparkar. METHODS: This cross-sectional study was conducted in four villages of Tharparkar district of Sindh, Pakistan, in 2014, and comprised children aged between 6 and 59 months. Data was collected from mothers and anthropometry of children was done using standard techniques. Nutritional status was assessed by using age- and sex-specific World Health Organisation standard charts for underweight, stunting and wasting. Data was analysed using SPSS 16. RESULTS: Of the 304 children assessed, 117(38.5%) were stunted, 58(19.1 %) were wasted and 101(33.2 %) were underweight with no gender discrimination. Under-nutrition was particularly observed in the second year of life. Statistically significant factors associated with stunting were illiteracy of mother, family size of >5 members, pregnancy>4 times, child mortality in last 6 months, absence of breastfeeding and no history of child vaccination(p<0.05 each). Logistic regression revealed family size of <5 members, pregnancy ?4 times, breastfeeding and vaccination were protective factors for stunting (p<0.05 each). Mortality of a child in the last 6 months in the family was 3 times more likely to have a stunted child. CONCLUSIONS: Stunting was the most common type of under-nutrition with no sex discrimination.

Potential risk of cross-infection by tourniquets: a need for effective control practices in pakistan.

BACKGROUND: Tourniquets used repeatedly on patients for blood sampling are a potential source of nosocomial infections. They harbor numerous microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA). The aim of this study was to investigate tourniquets for the presence of microorganisms and to ascertain the infection control practices of health care workers. METHODS: A cross-sectional study was carried out in 2012 on 100 samples of tourniquets collected from public and private sector hospitals in Karachi, Pakistan. The samples were cultured, and pathogenic microorganisms were identified and tested for methicillin resistance. A questionnaire was administered simultaneously to 100 health care workers who had used the tourniquets. Descriptive data are represented as frequencies and percentages. Ethical considerations were taken into account. RESULTS: The total colonization rate was 51%, with no bacterial growth in 17/40 and 32/60 samples from public and private sector hospitals, respectively. S. aureus was isolated from 12 (42%) private sector hospital samples and 10 (43%) public sector hospital samples. Although MRSA was found in more samples from public than private sector hospitals, the difference was not statistically significant. Nevertheless, 90% of all elastic and 41% of all rubber tourniquets harbored microorganisms (P < 0.001). Although 96% of health care workers agreed that hospital staff and fomites can transmit infection, none identified tourniquets as a potential source. When asked whether tourniquets appeared clean before use, 66% agreed, and only 25% considered that tourniquets should be washed or cleaned before use. CONCLUSIONS: Tourniquets are a potential reservoir and vehicle for the spread of nosocomial infections, including MRSA. Health care workers have inadequate knowledge about infection control procedures and personal hygiene for disinfecting reusable items.

Parents' opinion of quality of life (QOL) in Pakistani thalassaemic children.

OBJECTIVE: To find out the physical, social, psychological life aspects and overall quality of life among thalassaemic children in Pakistan. METHODS: This cross-sectional study was done in ten Thalassaemia treatment centres in three major cities of Pakistan during the year 2007-08. The study population comprised of 221 thalassaemic children ranging from 4 to 12 years age brought for blood transfusion by their parents. All ethical considerations were taken into account during the study. Questions related to physical, social and psychological aspects that assess quality of life (QOL) of children with thalassaemia were asked and were further analyzed using SPSS version 12.0. RESULTS: Out of total 221 thalassaemic patients surveyed, the majority (61%) were boys with a mean age of 8.5 +/- 2.26 years for both sexes. An overwhelming majority of parents (86%) felt that the disease did not affect the child's family or social relationships. However, poorer quality of life (QOL) was found against psychological aspects (p < 0.05) and overall parent satisfaction for child's health (p < 0.001). Adverse impact of thalassaemia was also found for pain (73%), sleep (50%), eating habits (49%), leisure activities (54%) and task concentration (51%) among the participants. CONCLUSION: There was a substantial amount of concern raised by the parents for various aspects of QoL in their affected children. Hence, it is crucial to provide proper health education to parents for better understanding of the disease and rehabilitation of their thalassaemic children.

Medical students' perspectives on gender and smoking: a mixed methodology investigation in Karachi, Pakistan.

OBJECTIVE: To explore the gender dimensions on influences of tobacco uptake on medical students using both qualitative and quantitative methods. METHODS: A phased mixed-method study design was used with in-depth interviews followed by a survey questionnaire in a 'smoke-free' medical college campus in a private university of Karachi. Eight in-depth interviews were conducted to under-pin themes that were further used for developing the questionnaire. Tabulation and analysis of the quantitative data was done using SPSS software version 12. All the ethical issues for the research were taken into consideration. RESULTS: One hundred and sixty-five (72 male, 93 female) students participated in the study. Mean age was 21.57 +/- 1.66 years. The survey results reported perceived reasons for male smoking as stress relief (74%), image (62%), companionship (54%), leisurely independence (46%) and male power and masculinity (44%). Among reasons for women for not smoking by the majority was that it was frowned upon (87%) while the reasons for smoking clustered around concepts of images (65%), western culture (66%), stress relief (51%) and advertising (36%). A large proportion (55%) of students felt bad and bothered by male and female smoking. CONCLUSION: Despite being medical students, the anti-tobacco future role models, traditional concepts of gender were frequently involved that explains smoking and non-smoking gendered behaviours.