Thirty-year trends of triple burden of disease in the adult population of Pakistan.

BACKGROUND: The triple burden of disease, i.e. communicable diseases, non-communicable diseases and injuries, has significantly affected the healthcare system of Pakistan during the last three decades. Therefore, this study aims to determine and analyse the 30-year disease burden trends through prevalence, death rates and percentages. METHODS: The data for the last three decades, i.e. 1990 to 2019, was extracted from the Global Burden of Disease for Pakistan. Percentage change in prevalence and deaths over 30 years was calculated. Poisson regression analysis was performed to evaluate the triple disease burden trends and the incidence rate ratio. RESULTS: A relative decrease of 23.4% was noted in the prevalence rate of communicable diseases except for human immunodeficiency virus and dengue fever. A relative increase of 1.4% was noted in the prevalence rate of non-communicable diseases. A relative increase of 56.1% was recorded in the prevalence rate of injuries. The prevalence rate ratios of communicable diseases significantly decreased to 0.9796 [95% CI: 0.9887-0.9905], but the prevalence rate of injury increased to 1.0094 [95% CI: 1.0073-1.01145], respectively. CONCLUSION: Pakistan must take the next steps and develop strategies to decrease this burden and mortality rates in the population to create better outcomes and therefore help the healthcare system overall.

Generating 3D images of material microstructures from a single 2D image: a denoising diffusion approach.

Three-dimensional (3D) images provide a comprehensive view of material microstructures, enabling numerical simulations unachievable with two-dimensional (2D) imaging alone. However, obtaining these 3D images can be costly and constrained by resolution limitations. We introduce a novel method capable of generating large-scale 3D images of material microstructures, such as metal or rock, from a single 2D image. Our approach circumvents the need for 3D image data while offering a cost-effective, high-resolution alternative to existing imaging techniques. Our method combines a denoising diffusion probabilistic model with a generative adversarial network framework. To compensate for the lack of 3D training data, we implement chain sampling, a technique that utilizes the 3D intermediate outputs obtained by reversing the diffusion process. During the training phase, these intermediate outputs are guided by a 2D discriminator. This technique facilitates our method's ability to gradually generate 3D images that accurately capture the geometric properties and statistical characteristics of the original 2D input. This study features a comparative analysis of the 3D images generated by our method, SliceGAN (the current state-of-the-art method), and actual 3D micro-CT images, spanning a diverse set of rock and metal types. The results shown an improvement of up to three times in the Frechet inception distance score, a typical metric for evaluating the performance of image generative models, and enhanced accuracy in derived properties compared to SliceGAN. The potential of our method to produce high-resolution and statistically representative 3D images paves the way for new applications in material characterization and analysis domains.

How Green Mindfulness and Green Shared Vision Interact to Influence Green Creative Behavior.

Aim: The study is based on the self-determination theory and aims to investigate the mediating role of green intrinsic motivation and the moderating role of green shared vision in the association between frontline managers' green mindfulness and green creative behavior to leverage their capacity to think creatively and act sustainably. Methods: The study employs a time-lagged, multi-source research methodology to collect data from frontline managers of service businesses in the tourism and hospitality industry. Data are analyzed using SmartPLS Structural Equation Model to evaluate the structural and measurement models. The authors evaluated the measurement model by employing the criteria of internal consistency: reliability and Cronbach's alpha, validity: convergent and discriminant validity; and the structural model using the path coefficient, coefficient of determination, predictive relevance, and goodness-of-fit metrics. Results: Our findings indicate that green mindfulness significantly improves frontline managers' green creative behavior. Additionally, green intrinsic motivation mediates the connection between green mindfulness and green creative behavior. In addition, the direct effect of green mindfulness on green intrinsic motivation as well as the indirect effect of green mindfulness on green creative behavior through green intrinsic motivation, are both significantly moderated by green shared vision. Discussion: To the best of the authors' knowledge, this is one of the few efforts that outstretch the boundary conditions of green mindfulness and green creative behavior through the mediating role of green intrinsic motivation and the moderating role of green shared vision.

Discriminatory practices and poor job performance: A study of person-related hostility among nursing staff.

This study highlights the organisational-level factors that become the reason for propagating hostile behaviours among female nurses. Freire's theory of oppression has been used as an underpinning theory for developing the conceptual framework. This study empirically verifies the conceptual framework of the study that gender discrimination and lack of administrative support are the antecedents of person-related hostility, which is the reason for poor job performance in the healthcare sector. We applied a quantitative research approach, using questionnaires to collect data. Total of 707 survey forms were collected from female nurses working in public sector hospitals in four main cities of Pakistan. The software SPSS 20 and SmartPLS 3 were used for the final data analysis. All hypotheses regarding the direct and indirect relationship of variables were accepted. Gender discrimination and lack of administrative support were positively associated with person-related hostility. Moreover, person-related hostility also mediated the relationship between independent variables (gender discrimination, lack of administrative support) and dependent variable (poor job performance). Future research is directed to study person-related hostility among nursing staff of semi-urban areas and small towns with low literacy rates, considering other dependent variables like burnout, mental well-being, and mental health. HR strategies and policies for fair performance evaluation and timely promotions of nursing professionals are proposed in the study for building an overall healthy environment.

COVID-19 vaccine acceptance and hesitancy among the general population of Pakistan: a population-based survey.

OBJECTIVES: This study aims to determine the COVID-19 vaccination coverage and the factors associated with vaccine acceptance and hesitancy in the general population of Pakistan. SETTING: This population-based study covers all major areas of Pakistan, including Sindh, Punjab, Khyber Pakhtunkhwa and Baluchistan provinces and the capital Islamabad. PARTICIPANTS: A total of 541 male and female Pakistani adults above 18 years were interviewed to determine the COVID-19 vaccination coverage and understand the factors associated with vaccine acceptance and hesitancy. OUTCOME: The outcome was COVID-19 vaccination status (not vaccinated or vaccinated). RESULTS: Of 541 participants, 227 (41.96%) were non-vaccinated and 314 (58.04%) were vaccinated. Two-thirds of the participants from both the non-vaccinated and vaccinated groups (185 (81.50%) vs 236 (75.16%), p=0.008) reside in Sindh. Nearly one-third of participants from both groups were ever infected with COVID-19 (77 (33.92%) and 90 (28.66%)). The odds of COVID-19 vaccination among the age group 34-42 years were 1.75 times higher (95% CI 1.35 to 2.09, p=0.008) than the other age groups. The odds of COVID-19 vaccination among those with COVID-19 ever-infected family members were 1.87 times higher (95% CI 1.56 to 2.34, p=0.032) than those with uninfected family members. CONCLUSIONS: Targeted interventions for subsets of populations reluctant to vaccination can improve vaccine coverage. Moreover, advocacy and explaining the public health benefits of vaccination can enhance the coverage in Pakistan.

Strategic Attributes and Organizational Performance: Toward an Understanding of the Mechanism Applied to the Banking Sector.

The study examines and theorizes the importance of strategic attribute constructs (strategic orientation, organizational culture, and organizational internal market orientation) as applied to Pakistan's banking sector by identifying their roles in enhancing organizational performance and the mediating effect of organizational commitment. The current study adopted quantitative research designs and methods to determine structural relationships between the proposed constructs. A total of 10 hypotheses were tested underpinned by the Resource-Based View of the Firm and Social Exchange theories. The strategic attributes studied were significantly and positively related to, and enhance, organizational performance if the banks: (1) focus on strategic positioning, (2) fostering a strong organizational culture, (3) strategize internal marketing practices, and (4) boost organizational commitment. The findings supported the mediating role of organizational commitment between strategic attributes and organizational performance. This study contributes to existing literature and supports prior research while filling in gaps in the literature concerning developing countries.

Determinants of domestic violence among women of reproductive age (15-49 years) in Quetta, Balochistan-a mixed-method protocol.

BACKGROUND: Worldwide, domestic violence (DV) is a cause of death and disability among women aged 15-49 years. In Pakistan, DV appears in different forms, and only 3.2% of women report any DV. There are various factors associated with DV against women. The data are sparse for the Balochistan province due to the under-reporting and scattered population. This research study aims to determine the factors associated with DV and the types of violence among women of reproductive age. Also, to understand the perspective of community leaders and healthcare workers (HCWs) for developing interventions for DV prevention against women of reproductive age in Quetta Balochistan. METHODS AND ANALYSIS: A sequential explanatory mixed-method (quantitative study followed by qualitative) study design will be used to fulfil the study's objectives. Women of reproductive age (15-49 years), both married and unmarried, local residents, community leaders and community HCWs of Quetta Balochistan, will be made part of the study. A structured questionnaire will be used as the quantitative tool. Focus group discussions will be conducted using a semistructured guide for the qualitative data collection. The multivariable logistic regression analysis will be performed for the quantitative part. P value ≤0.05 will be considered significant. In the qualitative part, data will be transcribed, and recurrent themes/subthemes will be developed to understand the perspective and opinion regarding DV prevention. ETHICS AND DISSEMINATION: Ethical Approval was taken from Aga Khan University, Karachi, Pakistan. Informed written consent will be obtained from all participants. The article will be published after data collection and analysis in the journal to disseminate the results.

The Serological Confirmation and Outcome of the Pediatric Dengue Patients Presenting to Emergency Department: A Cross-Sectional Study.

Background: In the emergency department, it is very uncommon perform a differential diagnosis to serologically differentiate between dengue, dengue hemorrhagic fever, and dengue shock syndrome. Prompt differential diagnosis and treatment is essential with the presentation of dengue. This study aims to determine the serological confirmation and outcome of the dengue epidemic in the pediatric population presenting to the ED in a tertiary care hospital. Methods: A single-center cross-sectional study was conducted. All pediatric patients aged less than 18 years presented to ED with clinical features suggestive of DF, DFF, and DSS while also doing the serological confirmation for the dengue were enrolled in the study. Data was collected on demographics, clinical characteristics, diagnosis, and outcomes of 324 pediatric patients. Multivariable binary logistic regression was applied for the analysis. Results: Out of 324 patients, 191 (59.13%) underwent NS1 testing and 132 (40.87%) did the IgM test. Most participants were in the age range of 13 to 18 years in both groups. Fever was the most common complaint in both groups 191 (100%) and 132 (100%). In each group, around one-third of the participants complained about body aches 69 (36.13%) and 44 (33.33%). The patient having a history of traveling within the past 14 days created a 1.51 (95% CI: 1.27-2.25) times higher odds of contracting dengue fever as compared to no history of travel. Conclusion: The serologic confirmation of dengue in the ED helps in both the adequate and timely treatment as well as patient disposition and ultimately saves lives.

Effects of temperature on baseline susceptibility and stability of insecticide resistance against Plutella xylostella (Lepidoptera: Plutellidae) in the absence of selection pressure.

Plutella xylostella L. (Lepidoptera: Plutellidae) is an important pest causing significant losses to vegetables worldwide. Insecticides resistance in P. xylostella is a serious issue for scientists since last 30 years. However, deltamethrin and Bt Cry1Ac are commonly used insecticides against P. xylostella but studies involving development of resistance in P. xylostella against these two insecticides at different temperatures are lacking. The current study was aimed to find out the toxicity of deltamethrin and Bt Cry1Ac, and resistance development in P. xylostella. Results showed that the positive correlation between the temperature and toxicities of deltamethrin and Bt Cry1Ac. The results indicated -0.051, -0.049, -0.047, and -0.046 folds of deltamethrin resistance at 15 °C, 20 °C, 25 °C, and 30 °C temperatures, respectively from 1st to 12th generations. The toxicity of Bt Cry1Ac after 24 h was 2.2 and 4.8 folds on 1st generation at 20 °C and 25 °C temperatures, respectively compared to the toxicity recorded at 15 °C (non-overlapping of 95% confidence limits). Based on the results of this study, it is concluded that the temperature has a positive correlation with the toxicity of deltamethrin and Bt Cry1Ac against the larvae of P. xylostella. This study suggests that deltamethrin and Bt Cry1Ac can be included in the management program of P. xylostella on many vegetable crops. The baseline susceptibility data might be helpful to understand the resistance mechanisms in P. xylostella.

Effect of short-term cold temperature stress on development, survival and reproduction of Dysdercus koenigii (Hemiptera: Pyrrhocoridae).

Red cotton bug Dysdercus koenigii F. (Hemiptera: Pyrrhocoridae), is found destructive pest in various cotton growing areas. Under natural conditions insects are highly subjected to thermal stresses. In present work the developmental duration and survival rate of all immature stages, adult longevity and reproduction of D. koenigii by exposed to rapid changes in very low temperatures were studied. When 3 h short-stress of low temperatures (12-0 °C) was given to different stages of D. koenigii, the results revealed that survival rate of all stages were significantly reduced. Survival rate of female was significantly higher than male after exposed to cold temperature stress. Mating percentage, fecundity and hatching percentage were decreased significantly with the decrease of short-term cold temperature stress. Based on these results, we concluded that the developmental duration, survival rate and reproduction of D. koenigii significantly affected when they exposed to short term cold temperature stress.