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Raheem A, Soomar SM, Issani A, Rahim KA, Dhalla Z, Soomar SM, Mian AI, Khan NU. Thirty-year trends of triple burden of disease in the adult population of Pakistan. J Public Health (Oxf) 2024:fdae054. [PMID: 38654655 DOI: 10.1093/pubmed/fdae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/10/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024] Open
Abstract
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.
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Affiliation(s)
- Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | | | - Ali Issani
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | - Komal Abdul Rahim
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Zeyanna Dhalla
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
- University of Michigan, School of Public Health, Ann Arbor, Michigan 48109, USA
| | | | - Asad Iqbal Mian
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
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Padhani ZA, Rahim KA, Tessema GA, Avery JC, Damabi NM, Castleton P, Salam RA, Meherali S, Lassi ZS. Exploring preconception health in adolescents and young adults: Identifying risk factors and interventions to prevent adverse maternal, perinatal, and child health outcomes-A scoping review. PLoS One 2024; 19:e0300177. [PMID: 38630699 PMCID: PMC11023205 DOI: 10.1371/journal.pone.0300177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/16/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Preconception health provides an opportunity to examine a woman's health status and address modifiable risk factors that can impact both a woman's and her child's health once pregnant. In this review, we aimed to investigate the preconception risk factors and interventions of early pregnancy and its impact on adverse maternal, perinatal and child health outcomes. METHODS We conducted a scoping review following the PRISMA-ScR guidelines to include relevant literature identified from electronic databases. We included reviews that studied preconception risk factors and interventions among adolescents and young adults, and their impact on maternal, perinatal, and child health outcomes. All identified studies were screened for eligibility, followed by data extraction, and descriptive and thematic analysis. FINDINGS We identified a total of 10 reviews. The findings suggest an increase in odds of maternal anaemia and maternal deaths among young mothers (up to 17 years) and low birth weight (LBW), preterm birth, stillbirths, and neonatal and perinatal mortality among babies born to mothers up to 17 years compared to those aged 19-25 years in high-income countries. It also suggested an increase in the odds of congenital anomalies among children born to mothers aged 20-24 years. Furthermore, cancer treatment during childhood or young adulthood was associated with an increased risk of preterm birth, LBW, and stillbirths. Interventions such as youth-friendly family planning services showed a significant decrease in abortion rates. Micronutrient supplementation contributed to reducing anaemia among adolescent mothers; however, human papillomavirus (HPV) and herpes simplex virus (HSV) vaccination had little to no impact on stillbirths, ectopic pregnancies, and congenital anomalies. However, one review reported an increased risk of miscarriages among young adults associated with these vaccinations. CONCLUSION The scoping review identified a scarcity of evidence on preconception risk factors and interventions among adolescents and young adults. This underscores the crucial need for additional research on the subject.
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Affiliation(s)
- Zahra Ali Padhani
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Komal Abdul Rahim
- Centre of Excellence in Trauma and Emergencies (CETE), Aga Khan University Hospital, Karachi, Pakistan
- Dean’s Office, Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Gizachew A. Tessema
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Jodie C. Avery
- Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Negin Mirzaei Damabi
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Patience Castleton
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Rehana A. Salam
- Centre of Research Excellence, Melanoma Institute Australia, University of Sydney, Sydney, Australia
| | - Salima Meherali
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Zohra S. Lassi
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
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Abdul Rahim K, Shaikh NQ, Lakhdir MPA, Afzal N, Merchant AAH, Mahmood SBZ, Bakhshi SK, Ali M, Samad Z, Haider AH. No healthcare coverage, big problem: lack of insurance for older population associated with worse emergency general surgery outcomes. Trauma Surg Acute Care Open 2024; 9:e001165. [PMID: 38616789 PMCID: PMC11015297 DOI: 10.1136/tsaco-2023-001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 03/20/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Older populations, being a unique subset of patients, have poor outcomes for emergency general surgery (EGS). In regions lacking specialized medical coverage for older patients, disparities in healthcare provision lead to poor clinical outcomes. We aimed to identify factors predicting index admission inpatient mortality from EGS among sexagenarians, septuagenarians, and octogenarians. Methods Data of patients aged >60 years with EGS conditions defined by the American Association for the Surgery of Trauma at primary index admission from 2010 to 2019 operated and non-operated at a large South Asian tertiary care hospital were analyzed. The primary outcome was primary index admission inpatient 30-day mortality. Parametric survival regression using Weibull distribution was performed. Factors such as patients' insurance status and surgical intervention were assessed using adjusted HR and 95% CI with a p-value of <0.05 considered statistically significant. Results We included 9551 primary index admissions of patients diagnosed with the nine most common primary EGS conditions. The mean patient age was 69.55±7.59 years. Overall mortality and complication rates were 3.94% and 42.29%, respectively. Primary index admission inpatient mortality was associated with complications including cardiac arrest and septic shock. Multivariable survival analysis showed that insurance status was not associated with mortality (HR 1.13; 95% CI 0.79, 1.61) after adjusting for other variables. The odds of developing complications among self-paid individuals were higher (adjusted OR 1.17; 95% CI 1.02, 1.35). Conclusion Lack of healthcare coverage for older adults can result in delayed presentation, leading to increased morbidity. Close attention should be paid to such patients for timely provision of treatment. There is a need to expand primary care access and proper management of comorbidities for overall patient well-being. Government initiatives for expanding insurance coverage for older population can further enhance their healthcare access, mitigating the risk of essential treatments being withheld due to financial limitations. Level of evidence III.
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Affiliation(s)
| | | | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
| | - Noreen Afzal
- Medical College, The Aga Khan University, Karachi, Pakistan
| | | | | | - Saqib Kamran Bakhshi
- Section of Neurosurgery, Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
| | - Mushyada Ali
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Adil H Haider
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
- Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
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Lassi ZS, Rahim KA, Stavropoulos AM, Ryan LM, Tyagi J, Adewale B, Kurji J, Bhaumik S, Meherali S, Ali M. Use of contraceptives, empowerment and agency of adolescent girls and young women: a systematic review and meta-analysis. BMJ Sex Reprod Health 2024:bmjsrh-2023-202151. [PMID: 38479786 DOI: 10.1136/bmjsrh-2023-202151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/19/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The evidence on adolescent empowerment, which involves access to personal and material resources for reproductive autonomy and economic equity, is limited. This systematic review assesses the use of contraceptives in empowering and strengthening the agency and vice versa among adolescents and young women. METHODS We ran the searches in six electronic databases: Cochrane Database of Systematic Reviews (CDSR) and the Cochrane Central Register of Controlled Trials (CENTRAL), The Campbell Library, MEDLINE (PubMed), EMBASE, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Web of Science. The methodological quality of studies was assessed using ROBINS-I and ROB-II tools as appropriate. Meta-analysis was performed using Review Manager 5.4. RESULTS Forty studies that assessed the impact of empowerment on contraceptive use were included. Of these, 14 were non-randomised studies for intervention (NRSIs), and the remaining 26 were randomised controlled trials (RCTs). The results from RCTs show a significant effect of the sexual and reproductive health empowerment in increasing ever use of contraception (RR 1.22; 95% CI 1.02, 1.45; n=9; I²=77%; GRADE: Very Low), and insignificant effect on unprotected sex (RR 0.97; 95% CI 0.74, 1.26; n=5; I²=86%; GRADE: Very Low) and adolescent pregnancy (RR 1.07; 95% CI 0.61, 1.87; n=3; I²=36%; GRADE: Very Low). None of the studies assessed impact of contraceptive use on empowerment. CONCLUSIONS Empowerment of adolescents and young women certainly improves contraceptive use in the immediate or short-term period. However, more robust studies with low risk of bias, longer-term outcomes, and impact of contraceptive use on empowerment and agency-strengthening are required. To increase contraceptive use uptake, tailored policies and delivery platforms are necessary for youth in low- and middle-income countries.
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Affiliation(s)
- Zohra S Lassi
- School of public health, Faculty of health and medical sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Komal Abdul Rahim
- Dean's Office, Medical College, Aga Khan University, Karachi, Pakistan
- Center of Excellence in Trauma and Emergencies, Aga Khan University, Karachi, Pakistan
| | | | - Lareesa Marie Ryan
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jyoti Tyagi
- George Institute of Global Health, New Delhi, India
| | - Bisi Adewale
- University of Alberta, Edmonton, Alberta, Canada
| | - Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Soumyadeep Bhaumik
- Meta-Research and Evidence Synthesis Unit, Health Systems Science, George Institute of Global Health, New Delhi, India
- George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia
| | | | - Moazzam Ali
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
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Bakhshi SK, Afzal N, Merchant AAH, Abdul Rahim K, Shaikh NQ, Noorali AA, Lakhdir MPA, Tariq M, Haider AH. Undergraduate Medical Education Curriculum Reforms in Pakistan: A Mixed Methods Study of Academic Leadership Perspectives. Acad Med 2024:00001888-990000000-00783. [PMID: 38442198 DOI: 10.1097/acm.0000000000005683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
PURPOSE Periodic revision of undergraduate medical education (UGME) curricula is an essential part of evidence-based educational practices. Pakistan's national UGME curriculum, last updated in 2005, was reviewed, and recommended updates were made in 2022. The authors explore academic medical school leaders' perspectives about the proposed reforms, gaps within the existing curriculum, and how to ensure the reform implementation is effective, collaborative, and feedback-driven. METHOD Using a mixed methods approach, data were collected from April-July 2022. Academic leadership (principals, who could designate vice principals or medical educators) at all medical schools across Pakistan (n = 117) were invited. Agreement with each of 20 proposed reforms was measured via a survey employing a Likert scale. A semi-structured interview guide expanded on the survey questions with probes. RESULTS Eighty-eight survey responses, from private (59; 67.0%) and public (29; 33.0%) institutions, were obtained (75.2% response rate). Participants recommended most of the proposed reforms. The 3 reforms that received the highest agreement were teaching professionalism as an integral part of the curriculum (83; 94.3%), mandating bedside procedural skills training (80; 90.9%), and including patient safety in the UGME curriculum (79; 89.8%). Including multidisciplinary tumor boards and surgical oncology had the lowest agreement (26; 29.5%). Fifteen interviews were conducted, which revealed 3 major themes: perceptions about changes to the curricular content; limitation of human and financial resources as barriers to reform implementation; and recommendations for effective implementation of an updated curriculum. CONCLUSIONS The findings reflect an overall positive attitude of academic medical school leadership toward the 20 proposed UGME curriculum reforms, which could aid with on-the-ground implementation. However, major limitations, such as a lack of trained faculty and financial resources, must be addressed. The authors propose future research on the resources required for implementing UGME reforms and the reforms' impact after national implementation.
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Affiliation(s)
- Saqib Kamran Bakhshi
- S.K. Bakhshi is assistant professor, Department of Surgery, Aga Khan University, Karachi City, Sindh, Pakistan
| | - Noreen Afzal
- N. Afzal is instructor of research, Department of Surgery, Aga Khan University, Karachi City, Sindh, Pakistan
| | - Asma Altaf Hussain Merchant
- A.A.H. Merchant is clinical research fellow, Dean's Office, Aga Khan University, Karachi City, Sindh, Pakistan
| | - Komal Abdul Rahim
- K.A. Rahim is research associate, Dean's Office, Aga Khan University, Karachi City, Sindh, Pakistan
| | - Namra Qadeer Shaikh
- N.Q. Shaikh is a clinical research fellow, Dean's Office, Aga Khan University, Karachi City, Sindh, Pakistan
| | - Ali Aahil Noorali
- A.A. Noorali is research associate, Department of Medicine, Aga Khan University, Karachi City, Sindh, Pakistan
| | - Maryam Pyar Ali Lakhdir
- M.P.A. Lakhdir is senior instructor, Department of Community Health Sciences, Aga Khan University, Karachi City, Sindh, Pakistan
| | - Muhammad Tariq
- M. Tariq is professor of medicine and vice dean of the medical college, Aga Khan University, Karachi City, Sindh, Pakistan
| | - Adil H Haider
- A.H. Haider is professor, Departments of Surgery and Community Health Sciences, and dean of the medical college, Aga Khan University, Karachi City, Sindh, Pakistan
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Abdul Rahim K, Egglestone NJ, Tsagareli IG, Usmani W, Meherali S, Lassi ZS. Mental health outcomes beyond the post-partum period among adolescent mothers: a systematic review and meta-analysis. Health Psychol Behav Med 2024; 12:2305741. [PMID: 38313449 PMCID: PMC10836488 DOI: 10.1080/21642850.2024.2305741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Background Adolescence is the most crucial part of life. The vulnerability of adolescent mothers is even more pronounced and can affect various health aspects. While they suffer from social and emotional stresses shortly after giving birth, the long-term effect after the post-partum period of adolescent pregnancy on the mental outcomes holds prime importance. Thus, this systematic review aims to ascertain the association between adolescent pregnancy on mental health outcomes. Methods The search strategy was run in June 2023 on databases including PubMed, CINAHL, Scopus, Psych Info, and Embase . Quality assessment of the studies was done using the National Institute of Health (NIH)'s National Heart, Lung and Blood Institute (NHLBI) tool for observational studies. For studies that measured similar outcomes, a meta-analysis was conducted. Findings The search strategy yielded 21 results from all databases and cross-referencing. Of these, all except for one (case-control) were cross-sectional and cohort studies. The pooled analysis found a significant association between adolescent pregnancy and depression (RR 1.34; 95% CI 1.05, 1.72, 6 studies, heterogeneity: Chi2 P 0.01; I2 = 60%); however, no association was found in anxiety (RR 1.05; 95% CI 0.26, 4.14, 2 studies; heterogeneity: Chi² P = 0.0003; I2 = 93%) and suicidal ideation (RR 3.21; 95% CI 0.17, 59.33; 3 studies; heterogeneity: Chi2 P < 0.00001; I2 = 98%). Implication These findings suggest that the mental health needs of adolescent mothers must be addressed and innovative and effective interventions that support and address the mental health needs of adolescent mothers are needed to improve their mental health.
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Affiliation(s)
- Komal Abdul Rahim
- Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
- Dean’s Office, Medical College, Aga Khan University, Karachi, Pakistan
- Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | | | - Wania Usmani
- Public Health Information Development Unit, Torrens University Australia, Adelaide, Australia
| | | | - Zohra S. Lassi
- Adelaide Medical School, Robinsons Research Institute University of Adelaide, Adelaide, Australia
- Faculty of Health and Medical Sciences, School of Public Health, University of Adelaide, Adelaide, Australia
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Merchant AAH, Shaikh NQ, Afzal N, Noorali AA, Abdul Rahim K, Ahmad R, Ahmer A, Khan AA, Bakhshi SK, Mahmood SBZ, Lakhdir MPA, Khan MR, Tariq M, Haider AH. Disparities in patient-resident physician communication and counseling: A multi-perspective exploratory qualitative study. PLoS One 2023; 18:e0288549. [PMID: 37871016 PMCID: PMC10593213 DOI: 10.1371/journal.pone.0288549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/29/2023] [Indexed: 10/25/2023] Open
Abstract
Effective communication between physicians and patients plays an integral role in clinical care. Gaps in a physician's ability to ensure effective communication, especially with patients from diverse backgrounds, are known causes of medical errors. This study explores the potential biases and disparities in patient-resident communication, which may influence a patient's quality of care. This exploratory qualitative study was conducted at the largest academic medical center in Pakistan. Purposive sampling was used to approach participants from surgery, medicine, obstetrics and gynecology, pediatrics and family medicine. Faculty, fellows and residents working in these departments and medical students in their fourth and fifth years of undergraduate education with prior experience of at least one month in these specialties during their clinical rotations were included. Focus group discussions (FGDs) lasting 45-60 minutes were conducted with each cohort of healthcare professionals separately, using a semi-structured interview guide. Sixty participants (19 males and 41 females, mean age: 32.9, SD: 10.9) took part in the study. Thematic analysis revealed five major themes. Four themes focused on residents' biases and patient disparities hindering patient-resident communication: (1) patient-resident gender discordance (2) ethnicity and language barriers, (3) differing social class of the patient, and (4) challenging patient-resident interactions (patients resistant to treatment, exceedingly inquisitive and those with multiple attendants, etc.). The fifth theme identified the need for a communication skills curriculum in postgraduate medical education. Opposite gender and discordant socioeconomic/cultural backgrounds of patients pose a challenge to effective patient-physician communication. Self-identification and awareness of residents' biases when interacting with patients can ensure their active elimination and improve their communication skills. Integrating these components in a standardized curriculum within postgraduate programs can enable resident-physicians to provide the same level of care and communicate more efficiently with patients of all backgrounds.
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Affiliation(s)
| | | | - Noreen Afzal
- Dean’s Office, Aga Khan University, Karachi, Pakistan
| | | | - Komal Abdul Rahim
- Dean’s Office, Aga Khan University, Karachi, Pakistan
- Department of Medicine, Aga Khan University, Karachi, Pakistan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rida Ahmad
- Dean’s Office, Aga Khan University, Karachi, Pakistan
| | - Areesha Ahmer
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | | | | | | | | | - Muhammad Tariq
- Dean’s Office, Aga Khan University, Karachi, Pakistan
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Adil H. Haider
- Dean’s Office, Aga Khan University, Karachi, Pakistan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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Bakhshi SK, Abdul Rahim K, Merchant AAH, Afzal N, Qadeer Shaikh N, Noorali AA, Lakhdir MPA, Mahmood SBZ, Tariq M, Haider AH. Barriers to research productivity amongst postgraduate trainees: results from a survey of 333 medical and surgical residents. Postgrad Med J 2023; 99:1182-1188. [PMID: 37544657 DOI: 10.1093/postmj/qgad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE We aimed to determine the perceptions of, barriers to, and predictors of research engagement amongst residents at a national level in Pakistan. METHODS This cross-sectional study used REDCap for online survey dissemination to residents from 12 institutes accredited by the national accreditation body (College of Physicians and Surgeons Pakistan) for core medical and surgical specialties. Logistic regression was used to estimate associations between likelihood of publications and participant characteristics. RESULTS The response rate was 79% (333/423), with 171 (51%) medical and 162 (49%) surgical residents. The mean ± standard deviation age was 28.8 ± 2.7 years; 137 (41%) were males and 195 (59%) females. More than half the residents, 202 (61%), had received research training, but 189 (57%) scored <33% on basic research knowledge. While most residents agreed on the positive impact of research on their careers (P = .012) and realized that they should be involved in it (P = .33), they also strongly believed that it was difficult to engage in research during training (P < .01). Only 60 (18%) trainees had published a paper in local and 37 (11%) in international journals, respectively. The most significant barriers to conducting research included time limitation due to clinical work, lack of financial support, and unavailability of data (P < .01). CONCLUSION Residents have a positive attitude towards research. However, research engagement among residents is low. Improving research mentorship and creating systems that enable protected time and institutional access to data are needed to increase research output of postgraduate trainees. Key messages What is already known on this topic Postgraduate trainees benefit academically from research conducted during residency training. However, in low- and middle-income countries like Pakistan, research output among residents has remained low over the years. The nation has consistently produced very little research. What this study adds The current study helped shed light on the reasons for low research productivity amongst medical and surgical residents in Pakistan. How this study might affect research, practice, or policy The potential predictors for low research involvement highlighted in this study necessitate modification of the existing national residency curriculum to increase research engagement and productivity among residents. Not only can the potential factors be improved, but the study also helps in bringing stakeholders' attention to increasing research opportunities in Pakistan.
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Affiliation(s)
- Saqib K Bakhshi
- Section of Neurosurgery, Department of Surgery, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Komal Abdul Rahim
- Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Asma A H Merchant
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Noreen Afzal
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Namra Qadeer Shaikh
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Ali A Noorali
- Department of Community Health Sciences, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | | | - Saad B Z Mahmood
- Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Muhammad Tariq
- Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Adil H Haider
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan
- Department of Community Health Sciences, Medical College, Aga Khan University, Karachi, 74800, Pakistan
- Department of Surgery, Medical College, Aga Khan University, Karachi, 74800, Pakistan
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Bakhshi S, Ahmad R, Hussain Merchant AA, Noorali AA, Rahim KA, Qadeer N, Afzal N, Ali Lakhdil MP, Shamim SM, Haider AH. 368 Development, Outcome and Costs of a Simulation-Based Neurosurgery Bootcamp at the National Level. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Rahim KA, Lakhdir MPA, Afzal N, Merchant AAH, Shaikh NQ, Noorali AA, Tariq U, Ahmad R, Bakhshi SK, Mahmood SBZ, Khan MR, Tariq M, Haider AH. Leveraging the vantage point - exploring nurses' perception of residents' communication skills: a mixed-methods study. BMC Med Educ 2023; 23:148. [PMID: 36869344 PMCID: PMC9985286 DOI: 10.1186/s12909-023-04114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Effective communication is key to a successful patient-doctor interaction and improved healthcare outcomes. However, communication skills training in residency is often subpar, leading to inadequate patient-physician communication. There is a dearth of studies exploring the observations of nurses - key members of healthcare teams with a special vantage point to observe the impact of residents' communication with patients. Thus, we aimed to gauge the perceptions of nurses regarding residents' communication skills expertise. METHODS This study employed a sequential mixed-methods design, and was conducted at an academic medical center in South Asia. Quantitative data was collected via a REDCap survey using a structured validated questionnaire. Ordinal logistic regression was applied. For qualitative data, In-depth interviews were conducted with nurses using a semi-structured interview guide. RESULTS A total of 193 survey responses were obtained from nurses hailing from various specialties including Family Medicine (n = 16), Surgery (n = 27), Internal Medicine (n = 22), Pediatrics (n = 27), and Obstetrics/Gynecology (n = 93). Nurses rated long working hours, infrastructural deficits, and human failings as the main barriers to effective patient-resident communication. Residents working in in-patient settings were more likely to have inadequate communication skills (P-value = 0.160). Qualitative data analysis of nine in-depth interviews revealed two major themes: existing status-quo of residents' communication skills (including deficient verbal and non-verbal communication, bias in patient counselling and challenging patients) and recommendations for improving patient-resident communication. CONCLUSION The findings from this study highlight significant gaps in patient-resident communication from the perception of nurses and identify the need for creating a holistic curriculum for residents to improve patient-physician interaction.
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Affiliation(s)
- Komal Abdul Rahim
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
- Internal Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
| | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Noreen Afzal
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | | | - Namra Qadeer Shaikh
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Ali Aahil Noorali
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Umar Tariq
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Rida Ahmad
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Saqib Kamran Bakhshi
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Saad Bin Zafar Mahmood
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | | | | | - Adil H Haider
- Medical College, Aga Khan University, Karachi, Pakistan
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Bakhshi SK, Ahmad R, Merchant AAH, Noorali AA, Abdul Rahim K, Shaikh NQ, Afzal N, Lakhdir MPA, Shamim MS, Haider AH. Development, outcome and costs of a simulation-based neurosurgery bootcamp at the national level. BMC Med Educ 2022; 22:896. [PMID: 36578075 PMCID: PMC9795592 DOI: 10.1186/s12909-022-03965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION With a growing interest in simulation-based training to develop clinical proficiency, bootcamps have been utilized for imparting basic skills to medical trainees. While considerable research on the topic exists in high income countries, no such neurosurgical teaching standards have been employed in Low- and Middle-Income Countries. METHODS We conducted a cross-sectional study to explore the effectiveness of first low-cost, multi-center regional neurosurgery bootcamp in South Asia. Twenty-two participants attended the bootcamp and practiced 12 hands-on skills over the course of 2 days. Burr-holes and craniotomies were done on 3D printed skulls. Lumbar drain insertion was practiced on a purpose-built lumbar puncture mannequin. For laminectomy, we used an in-house designed simulation. The modified Objective Structured Assessment of Technical Skills tool was utilized for skills Assessment. Feedback from faculty and residents was collected via a standard 5-point Likert scale. RESULTS Only one participant (4.55%) had previously attended a neurosurgical skills workshop. Comparison of outcomes on 1st and 3rd attempts of cranial and spinal skills showed a significant improvement in all 14 domains assessed (p <0.05). Positive feedback was received ranging from 3.9 up to 4.8 on a 5-point Likert scale. Overall cost per participant culminated to $145, significantly lower than previously reported data. CONCLUSION Our findings report the effectiveness of sustainable, low-cost training models which can be easily reproduced elsewhere. These indigenously designed simulators can be modified for variable difficulty level and serve as an effective educational strategy in improving learners' skills, knowledge and confidence.
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Affiliation(s)
| | - Rida Ahmad
- Medical College, Aga Khan University, Karachi City, Sindh, Pakistan
| | | | | | - Komal Abdul Rahim
- Medical College, Aga Khan University, Karachi City, Sindh, Pakistan
- Community Health Sciences, Aga Khan University, Karachi City, Sindh, Pakistan
| | | | - Noreen Afzal
- Medical College, Aga Khan University, Karachi City, Sindh, Pakistan
| | - Maryam Pyar Ali Lakhdir
- Medical College, Aga Khan University, Karachi City, Sindh, Pakistan
- Community Health Sciences, Aga Khan University, Karachi City, Sindh, Pakistan
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Shahbaz H, Noorali AA, Inam M, Qadeer N, Merchant AAH, Khan AA, Afzal N, Abdul Rahim K, Munaf I, Ahmad R, Tariq M, Haider AH. Developing a communication-skills training curriculum for resident-physicians to enhance patient outcomes at an academic medical centre: an ongoing mixed-methods study protocol. BMJ Open 2022; 12:e056840. [PMID: 35981768 PMCID: PMC9394207 DOI: 10.1136/bmjopen-2021-056840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Effective physician-patient communication is directly linked to enhanced patient safety, improved healthcare quality and health outcomes. Numerous studies have been done to implement and reinforce communication skills as core competencies to be acquired during residency training for providing culturally competent care. Pakistan has an ethnically diverse culture with people from varying diasporas. Hence there is a need to develop a curriculum that teaches cultural competency to residents. Thus, the aim of this study is (1) the identification of existing problems of communication skills among residents across various specialties, and (2) to strategise a communication skills curriculum by organising a conference of experts based on the Delphi method/estimate-talk-estimate method. METHODS AND ANALYSIS This study is divided into two phases. The first phase will employ a mixed-methods approach whereby the perceptions of attendings, residents, fellows, nurses, medical students and patients about resident-patient communication will be assessed via validated surveys, focused group discussions and in-depth interviews. Quantitative and qualitative data will be analysed using Stata and NVivo, respectively. The second phase is the development of a communication skills curriculum for residents based on results from phase one and a Delphi consensus involving medical education experts. Both phases will be conducted at a tertiary care hospital in Karachi, Pakistan. ETHICS AND DISSEMINATION This study has received ethical approval from the Ethical Review Committee at the Aga Khan University (2021-6041-17126). All participants will be mandated to provide informed consent and their confidentiality will be maintained by using de-identifiers and limiting access of the data to the research team only. The findings from this study will be presented in the form of original research papers.
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Affiliation(s)
- Hamna Shahbaz
- Dean's Office, The Aga Khan University, Karachi, Pakistan
| | | | - Maha Inam
- The Aga Khan University Medical College, Karachi, Sindh, Pakistan
| | - Namra Qadeer
- Dean's Office, The Aga Khan University, Karachi, Pakistan
| | | | - Adnan Ali Khan
- The Aga Khan University Medical College, Karachi, Sindh, Pakistan
| | - Noreen Afzal
- Dean's Office, The Aga Khan University, Karachi, Pakistan
| | - Komal Abdul Rahim
- Dean's Office, The Aga Khan University, Karachi, Pakistan
- Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Rida Ahmad
- Dean's Office, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Tariq
- Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Adil H Haider
- Department of Surgery and Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
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Meherali S, Rahim KA, Campbell S, Lassi ZS. Does Digital Literacy Empower Adolescent Girls in Low- and Middle-Income Countries: A Systematic Review. Front Public Health 2022; 9:761394. [PMID: 34976923 PMCID: PMC8716589 DOI: 10.3389/fpubh.2021.761394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The vast majority (90%) of the world's adolescents aged 10–19 live in low- and middle-income countries (LMICs); and in those resource-limited settings, girls face distinct challenges across multiple health, social, and economic domains. Gender equality and girls' empowerment are key goals in their own right and are central to all other development goals. Digital literacy is a great enabler for the empowerment of young girls. This systematic review aims to assess the range and nature of digital literacy interventions implemented to empower adolescent girls in LMICs and identify evidence about adolescent girls' access and use of digital technologies in LMICs. Methods: We conducted a systematic review of studies following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards for systematic reviews. Two reviewers selected studies, conducted quality assessments, and extracted data by using standard forms. The collected data include the design of the study, type of digital literacy intervention, target audience, intervention received, intervention reach, data analysis, and study outcomes. The review is registered with PROSPERO (CRD42020216756). Results: Thirty-five studies met the eligibility for inclusion and of those, 11 were experimental studies (randomized controlled trial = 6; quasi-experimental = 2; before-after with no control = 3), 11 were cross-sectional/descriptive studies, seven studies used a mixed-method approach, and six were qualitative studies on digital literacy interventions to empower young girls in LMICs. The majority of digital literacy interventions were designed and implemented to improve sexual and reproductive health rights and decision-making of adolescent girls in LMICs (n = 33). Only three papers reported the use of digital media for health-related information and decision making, while only one reported on educational and social empowerment. Discussion: Our findings suggest that digital literacy interventions such as mobile phones, mobile health tools, media exposure, access to the internet, internet-based educational strategies, social media exposure are effective to empower adolescent girls to access health services and information and also enhance the access to educational resources. However, we found inconclusive evidence on the effectiveness of digital literacy to enhance girls' access to financial services and economic empowerment. More rigorous studies with long-term follow-ups to assess the effectiveness of such interventions to empower adolescent girls in LMICs are urgently needed.
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Affiliation(s)
- Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | | | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Zohra S Lassi
- Department of Medicine, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
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Meherali S, Punjani N, Louie-Poon S, Abdul Rahim K, Das JK, Salam RA, Lassi ZS. Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review. Int J Environ Res Public Health 2021; 18:ijerph18073432. [PMID: 33810225 PMCID: PMC8038056 DOI: 10.3390/ijerph18073432] [Citation(s) in RCA: 304] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022]
Abstract
Background: The COVID‑19 pandemic and associated public health measures have disrupted the lives of people around the world. It is already evident that the direct and indirect psychological and social effects of the COVID‑19 pandemic are insidious and affect the mental health of young children and adolescents now and will in the future. The aim and objectives of this knowledge-synthesis study were to identify the impact of the pandemic on children’s and adolescent’s mental health and to evaluate the effectiveness of different interventions employed during previous and the current pandemic to promote children’s and adolescents’ mental health. Methodology: We conducted the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included experimental randomized and nonrandomized controlled trials, observational studies, and qualitative studies. Results: Of the 5828 articles that we retrieved, 18 articles met the inclusion criteria. We thematically analyzed them and put the major findings under the thematic areas of impact of the pandemic on children’s and adolescents’ mental health. These studies reported that pandemics cause stress, worry, helplessness, and social and risky behavioral problems among children and adolescents (e.g., substance abuse, suicide, relationship problems, academic issues, and absenteeism from work). Interventions such as art-based programs, support services, and clinician-led mental health and psychosocial services effectively decrease mental health issues among children and adolescents. Conclusion: Children and adolescents are more likely to experience high rates of depression and anxiety during and after a pandemic. It is critical that future researchers explore effective mental health strategies that are tailored to the needs of children and adolescents. Explorations of effective channels regarding the development and delivery of evidenced-based, age-appropriate services are vital to lessen the effects and improve long-term capacities for mental health services for children and adolescents. Key Practitioner Message: The COVID-19 pandemic’s physical restrictions and social distancing measures have affected each and every domain of life. Although the number of children and adolescents affected by the disease is small, the disease and the containment measures such as social distancing, school closure, and isolation have negatively impacted the mental health and well-being of children and adolescents. The impact of COVID-19 on the mental health of children and adolescents is of great concern. Anxiety, depression, disturbances in sleep and appetite, as well as impairment in social interactions are the most common presentations. It has been indicated that compared to adults, this pandemic may continue to have increased long term adverse consequences on children’s and adolescents’ mental health. As the pandemic continues, it is important to monitor the impact on children’s and adolescents’ mental health status and how to help them to improve their mental health outcomes in the time of the current or future pandemics.
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Affiliation(s)
- Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada; (N.P.); (S.L.-P.)
- Correspondence:
| | - Neelam Punjani
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada; (N.P.); (S.L.-P.)
| | - Samantha Louie-Poon
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada; (N.P.); (S.L.-P.)
| | - Komal Abdul Rahim
- Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; (K.A.R.); (J.K.D.); (R.A.S.)
| | - Jai K. Das
- Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; (K.A.R.); (J.K.D.); (R.A.S.)
| | - Rehana A. Salam
- Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; (K.A.R.); (J.K.D.); (R.A.S.)
| | - Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia;
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15
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Meherali S, Punjani N, Louie-Poon S, Abdul Rahim K, Das JK, Salam RA, Lassi ZS. Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review. Int J Environ Res Public Health 2021; 18:ijerph18073432. [PMID: 33810225 DOI: 10.20944/preprints202103.0149.v1] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 05/24/2023]
Abstract
Background: The COVID‑19 pandemic and associated public health measures have disrupted the lives of people around the world. It is already evident that the direct and indirect psychological and social effects of the COVID‑19 pandemic are insidious and affect the mental health of young children and adolescents now and will in the future. The aim and objectives of this knowledge-synthesis study were to identify the impact of the pandemic on children's and adolescent's mental health and to evaluate the effectiveness of different interventions employed during previous and the current pandemic to promote children's and adolescents' mental health. Methodology: We conducted the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included experimental randomized and nonrandomized controlled trials, observational studies, and qualitative studies. Results: Of the 5828 articles that we retrieved, 18 articles met the inclusion criteria. We thematically analyzed them and put the major findings under the thematic areas of impact of the pandemic on children's and adolescents' mental health. These studies reported that pandemics cause stress, worry, helplessness, and social and risky behavioral problems among children and adolescents (e.g., substance abuse, suicide, relationship problems, academic issues, and absenteeism from work). Interventions such as art-based programs, support services, and clinician-led mental health and psychosocial services effectively decrease mental health issues among children and adolescents. Conclusion: Children and adolescents are more likely to experience high rates of depression and anxiety during and after a pandemic. It is critical that future researchers explore effective mental health strategies that are tailored to the needs of children and adolescents. Explorations of effective channels regarding the development and delivery of evidenced-based, age-appropriate services are vital to lessen the effects and improve long-term capacities for mental health services for children and adolescents. Key Practitioner Message: The COVID-19 pandemic's physical restrictions and social distancing measures have affected each and every domain of life. Although the number of children and adolescents affected by the disease is small, the disease and the containment measures such as social distancing, school closure, and isolation have negatively impacted the mental health and well-being of children and adolescents. The impact of COVID-19 on the mental health of children and adolescents is of great concern. Anxiety, depression, disturbances in sleep and appetite, as well as impairment in social interactions are the most common presentations. It has been indicated that compared to adults, this pandemic may continue to have increased long term adverse consequences on children's and adolescents' mental health. As the pandemic continues, it is important to monitor the impact on children's and adolescents' mental health status and how to help them to improve their mental health outcomes in the time of the current or future pandemics.
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Affiliation(s)
- Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Neelam Punjani
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | | | | | - Jai K Das
- Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan
| | - Rehana A Salam
- Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
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Rahim KA, Stambough JL. Radiographic evaluation of the degenerative cervical spine. Orthop Clin North Am 1992; 23:395-403. [PMID: 1620534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Despite some claims to the contrary, the use of plain film radiography can be an inexpensive initial means of evaluating the degenerative cervical spine if viewed in the context of the patient's clinical history and physical examination and may serve as a guide for further imaging techniques. This article presents a systematic approach for evaluating cervical spine radiographs for the spectrum of degenerative changes, followed by a brief discussion of differential diagnoses.
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Affiliation(s)
- K A Rahim
- Department of Radiology, University of Cincinnati School of Medicine, Ohio
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Abstract
beta-Galactosidase from psychotrophic Bacillus subtilis KL88 was specific to the beta-D-glycosidic linkage normally present in lactose. The enzyme was completely inhibited by transition metal ions (Cu2+, Fe3+, Fe2+, Zn2+) and partially inhibited by high concentrations of glucose and galactose as well as Ca2+. It was activated by most of the alkaline earth metal ions (NA+, K+, Li+). Oligosaccharides were formed at the different levels of lactose concentrations reaching more than 20% for high lactose concentration (20%). Three types of oligosaccharides were formed in significant concentrations detected by HPLC analysis.
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Affiliation(s)
- K A Rahim
- Department of Food Science and Agricultural Chemistry, McGill University Ste. Anne de Bellevue, PQ, Canada
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