Objective: To examine the differences in the demographic and clinical characteristics of patients... more Objective: To examine the differences in the demographic and clinical characteristics of patients admitted through emergency versus non-emergency routes and see if these two groups of patients were significantly different from each other with respect to criteria mentioned in the title. Methods: Retrospective data was analysed in all 2576 patient records were reviewed and these patients were divided in two groups with respect to their mode of admission (emergency vs non emergency). These groups were then compared with respect to sex, age, length of stay, discharge status and diagnostic categories. Statistical package for social sciences version 8.0 (SPSS 8.0) was used to analyze the data. Setting: The study was conducted at the Aga Khan University Hospital, is a private tertiary care hospital with a 13 bed psychiatric facility. Results: When these two groups were compared, significant differences were found, with ER patients having a shorter length of stay and youngest mean age, proportion of females admitted via ER was greater than those in non-ER group. There were significantly more women in each group who were married. The percentage of patients who left against medical advice was greater in the ER group. In both the groups mood disorders including Bipolar disorder and major depressive disorders was the most prevalent category with psychotic disorders to follow. The percentage of patients in both these categories was greater in the non-ER group where as percentage of patients with conversion disorder was higher in the ER group. Conclusion: Significant differences were found in the patient characteristics admitted via ER versus Non ER. Shorter length of stay in ER group might indicate an acute episode resolving quickly. Studies need to be done prospectively to determine the difference in the two groups thus ascertaining the level of care needed for each group. Lastly, the high proportion of patients coming through the ER also indicates that there exists a need for primary care involvement in mental health care thus reducing the need for emergency room usage. Clinical and Demographic Characteristics of inpatients admitted via emergency and non-emergency routes at a university hospital in Pakistan.
Journal of Psychopathology and Behavioral Assessment, Aug 10, 2014
Mothers rated the frequency of suicide ideation and attempts in 925 children and adolescents with... more Mothers rated the frequency of suicide ideation and attempts in 925 children and adolescents with ADHD (3-16 years). Ideation and attempts were more than twice as common in ADHD-Combined type than in ADHD-Inattentive type. Ideation occurred in 19 % with ADHD-C and in 7 % with ADHD-I. Percentages for attempts were 7 % and 3 %. For children and adolescents with co-occurring sadness and oppositional defiant disorder (ODD), 46 % had ideation and 21 % had attempts (vs. 6 and 2 % for ADHD alone). For those with ideation, 78 % had ODD or sadness. For those with attempts, 84 % had ODD or sadness. Maternal ratings of aggressive, explosive, sad, and moody were significant independent predictors of suicide behavior for ADHD-C, and sad and moody were predictors for ADHD-I. All children and adolescents with ADHD should be screened for suicide ideation and attempts, and co-occurring ODD and sadness should be treated to prevent suicide behavior.
Background/Objective: Recent literature has identified links between vitamin B12 deficiency and d... more Background/Objective: Recent literature has identified links between vitamin B12 deficiency and depression.We compared the clinical response of SSRI-monotherapy with that of B12-augmentation in a sample of depressed patients with low normal B12 levels who responded inadequately to the first trial with the SSRIs. Methods: Patients with depression and low normal B12 levels were randomized to a control arm (antidepressant only) or treatment arm (antidepressants and injectable vitamin B12 supplementation). Results: A total of 199 depressed patients were screened. Out of 73 patients with low normal B12 levels 34 (47%) were randomized to the treatment group while 39 (53%) were randomized to the control arm. At three months follow up 100% of the treatment group showed at least a 20% reduction in HAM-D score, while only 69% in the control arm showed at least a 20% reduction in HAM-D score (p<0.001). The findings remained significant after adjusting for baseline HAM-D score (p=0.001). Conclusion: Vitamin B12 supplementation with antidepressants significantly improved depressive symptoms in our cohort.
Introduction: Attention deficit hyperactivity disorder (ADHD) and learning disorder (LD) remain p... more Introduction: Attention deficit hyperactivity disorder (ADHD) and learning disorder (LD) remain prevalent globally and are also speculated to have a high occurrence in Pakistan. An early diagnosis and intervention in these disabilities is imperative for achieving good clinical and functional outcomes. This can be ensured by an effective screening at the level of primary paediatric care in the developing countries. We aimed to explore the ability of general practitioners (GPs) and paediatricians in Pakistan to screen for ADHD and LD based on their awareness regarding the risk factors and symptomatology of ADHD and LD. Methods: A total of 96 paediatricians and 98 GPs practising in Karachi, Pakistan were included in the study. Data was collected employing a self-administered questionnaire. Results: Only 13.7 percent of the GPs and 21.6 percent of the paediatricians were shown to have knowledge sufficient to effectively screen for/diagnose ADHD. Alarmingly, not a single GP was adequately familiar with the established risk factors and clinical symptoms of LD. The level of knowledge was not influenced by age, gender, and clinical practice attributes of the physicians. Doctors who regularly read medical journals and attend medical education seminars showed slightly better trends. Conclusion: We hypothesise that this demonstrated lack of knowledge at the level of primary care in Pakistan prevents an early screening of ADHD and LD. A multipronged strategy targeted at the provision of objective screening tools for primary paediatric care providers, regular continuing medical education seminars and an emphasis on paediatric mental health in undergraduate and postgraduate curricula may ensure an early detection of ADHD and LD in Pakistan.
Objectives: ADHD affects 3% to 5% of school-age children. Clinical and community based epidemiolo... more Objectives: ADHD affects 3% to 5% of school-age children. Clinical and community based epidemiological studies in Pakistan have shown a high prevalence of ADHD among school going children. A thorough review of literature shows that no studies of teachers’ training programs regarding ADHD have been published in Pakistani research literature. The aim of the present study is the development and evaluation of an ADHD training program for teachers. Methods: A teachers’ training program for ADHD was designed and a pilot run in 3 schools of Karachi, Pakistan. Teachers knowledge regarding signs and symptoms of ADHD was tested before and after the workshop and then again after 6 months using an ADHD knowledge questionnaire. Results: Forty-nine teachers, all of them women, completed the questionnaires before and after the training program, and 35 of them filled it out at the 6-month interval. Mean scores of these tests were compared using a paired t test. The authors found the difference of mean score of 1.48 ± 2.95, and this was statistically significant ( p &lt; .005). Conclusion: The authors conclude that the workshop improved the knowledge of the school teachers regarding ADHD symptomatology, and it remained significant even after 6 months of training (J. of Att. Dis. 2010; 13(4) 420-423).
... For example, in Pakistan the ratio is one psychiatrist to 0.51 million population, compared ... more ... For example, in Pakistan the ratio is one psychiatrist to 0.51 million population, compared with one psychiatrist to approximately 25,000 of the population in the United Kingdom (Karim, Saeed, Rana, Mubbashar, & Jenkins, 2004). ...
Objective. While a number of studies in the western countries as well as developing countries hav... more Objective. While a number of studies in the western countries as well as developing countries have provided estimates of prevalence of emotional and behavioral problems among school children relatively little is known about the prevalence of child psychiatric problems and associated risk factors in Pakistan. A cross sectional survey of 5-11 years old children attending main stream private and community schools in Karachi was conducted in order to determine some baseline prevalence data. Methods. A cross sectional survey of school children of certain towns within Karachi metropolitan area, aged 5 to 11 years during 1 st half of 2006. SDQ was filled out by parents and school teachers for the same children. Demographic data of parents, teachers and children were also collected using a separate performa. Results. 7 private and 8 community schools agreed to participate. 1488 consent forms were sent to 700 parents of private school and 788 parents of community school children. A total of 675 parents agreed to participate in the study. The response rate was 45.3%. Assessment of children's mental health was conducted using Strength and Difficulties Questionnaire (SDQ). Parents rated 34.4% of children as falling under the "abnormal category on SDQ, slightly higher estimates 35.8% were reported by the teacher. The findings suggest a striking difference between the informants' ratings as well as gender wise difference in prevalence of common child mental health problems. Conclusion. In the present study prevalence of child mental health problems was higher than reported in studies from other countries. There was also a gender difference in prevalence; boys had higher estimates of behavior/externalizing problems, whereas emotional problems were more common amongst females. There is a need for developing programs to train, sensitise and mobilize teachers and parents regarding child's psychological, emotional and behavioral problems.
Social Psychiatry and Psychiatric Epidemiology, Apr 21, 2007
While a number of studies in the western countries have provided estimates of prevalence for chil... more While a number of studies in the western countries have provided estimates of prevalence for child psychiatric morbidity and associated risk factors, relatively little is known about child psychiatric problems and risk factors in developing countries like Pakistan. A cross sectional survey of 5-11-year-old children attending main stream private and community schools in Karachi was conducted. Seven private and eight community schools agreed to participate. About 1488 consent forms were sent to 700 parents of private school and 788 parents of community school children. A total of 675 parents agreed to participate in the study. The response rate was 45.4%. Assessment of children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s mental health was conducted using Strength and difficulties questionnaire (SDQ) by parents based on cut-off provided by Goodman. About 47% children were rated as normal, 19% as borderline and 34% as abnormal by the parents. Ordinal regression was used to identify factors associated with parent&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s rating. The odds of female children of being normal was 1.5 times relative to male children, adjusting for school type and mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s education (ORadj = 1.5, 95% CI: 1.1-2.0). Children attending private schools were more likely to be normal as compared to community school children, adjusting for child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s gender and mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s education (ORadj = 2.3, 95% CI: 1.3-4.0). In the present study, prevalence of child mental health problems was higher than reported in studies from other countries. Prevalence was higher amongst children attending community schools. Consistent with most studies, male children were at a higher risk than females. There is a need for developing programs to train, sensitise and mobilize teachers and parents regarding child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s psychological, emotional and behavioural problems with special attention to community schools. Since the male child is at a greater risk we should be cognizant of this while evaluating children for psychopathology.
Objective: To determine whether caring for a child with mental health issues could lead to mental... more Objective: To determine whether caring for a child with mental health issues could lead to mental distress among mothers. Design: Cross-sectional study. Place and duration: Outpatient Clinics of The Aga Khan University Hospital and PNS Shifa Hospital, Karachi, from January to June 2005. Patients and methods: A total of 238 consecutive mothers bringing their children to child psychiatric and pediatric clinics were recruited over a 6-month period. As per inclusion criteria, 106 mothers of child psychiatric patients were compared to 132 mothers taken from pediatric clinics. They were asked to fill out a psychiatric screening instrument (WHO SRQ-20). Mothers' mental distress (score>or=10 on SRQ-20) and other potential risk or protective factors were measured. Results: Mental distress among mothers determined by WHO SRQ-20 was associated with their child attending a psychiatric clinic (odds ratio 2.51, 95% confidence interval 1.38-4.51). This association remained significant for age of mother being less than 30 years. No significant association was found with the number of children and duration of marriage. Conclusion: Mental distress among mothers is associated with the child having psychiatric problems. These mothers may represent a group who are at higher risk of depression. Early recognition and treatment of mental health problems in mothers may help reduce psychiatric morbidity in children.
Background: To assess the associations of depression with glycemic control and compliance to self... more Background: To assess the associations of depression with glycemic control and compliance to self-care activities in adult patients with Type 2 Diabetes Mellitus Methods: This cross-sectional study was conducted at a tertiary-care hospital in Karachi (Aga Khan University Hospital). Equal numbers of depressed and non-depressed patients were consecutively recruited from the diabetic clinic. Information on demographic and clinical characteristics was collected in face-to-face interviews and from medical records. Hospital Anxiety Depression Scale (HADS) was used to measure depression. Associations of depressed status (HADS ≥ 8) with poor glycemic control (Hemoglobin A1c level ≥ 7%) and compliance to self-care activities were assessed by logistic regression analyses. Results: A total of 286 patients were included in this study with a male-female ratio of 1.2:1. Mean age was 52 years and in 64.7% of them, the duration of diabetes was more than 3 years. Depressed patients were more likely to be female (adjusted odds ratio [OR] = 1.88; 95% confidence interval [95%CI] = 1.07-3.31), had a family history of diabetes (OR = 2.64; 95%CI = 1.26-5.55), and poor glycemic control (OR = 5.57; 95%CI = 2.88-10.76) compared with non-depressed patients. Depression was also associated with low compliance to self-care activities such as taking dose as advised (OR = 0.32; 95%CI = 0.14-0.73), dietary restrictions (OR = 0.45; 95%CI = 0.26-0.79) and foot care (OR = 0.38; 95%CI = 0.18-0.83). Conclusions: Adult patients with Type 2 Diabetes who have depression were more likely to have poor glycemic control and lower compliance to self-care activities, and they might need particular attention during follow-up visits.
Purpose: This study examined the association between non-suicidal self-injury (NSSI) and suicide ... more Purpose: This study examined the association between non-suicidal self-injury (NSSI) and suicide attempts among Chinese adolescents and college students. Methods: A total sample of 2013 Chinese students were randomly selected from five schools in Wuhan, China, including 1101 boys and 912 girls with the age ranging between 10 and 24 years. NSSI, suicidal ideation, suicide attempts and depressive symptoms were measured by self-rated questionnaires. Self-reported suicide attempts were regressed on suicidal ideation and NSSI, controlling for participants' depressive symptoms, and demographic characteristics. Results: The self-reported prevalence rates of NSSI, suicidal ideation, suicide attempts were 15.5%, 8.8%, and 3.5%, respectively. Logistic regression analyses indicated that NSSI was significantly associated with self-reported suicide attempts. Analyses examining the conditional association of NSSI and suicidal ideation with self-reported suicide attempts revealed that NSSI was significantly associated with greater risk of suicide attempts in those not reporting suicidal ideation than those reporting suicidal ideation in the past year. Conclusions: These findings highlight the importance of NSSI as a potentially independent risk factor for suicide attempts among Chinese/Han adolescents and college students.
Objectives: This study aims to compare two widely used instruments in child mental health researc... more Objectives: This study aims to compare two widely used instruments in child mental health research, the Strength and Difficulties Questionnaire (SDQ) is a brief behavioral screening questionnaire that can be completed in about 5 minutes by the parents and teachers of 4-16 year olds. Design: Cross sectional and correlation study Place and duration of study: This study was conducted in schools of Karachi between January to June 2006. Subjects and Method: The Urdu version of SDQ has been translated and was downloaded from the website (www.sdqinfro.com), the SDQ has been validated in Pakistan. The CBCL was translated by a team of expert through a rigorous seven step process of translation. Both the SDQ and CBCL were completed by 556 parents of school children aged 5-11 attending schools in various towns of Karachi. Results: Given the non normal nature of some of the distributions , correlations were calculated using Spearman's rho co efficient. Scores from the SDQ and CBCL were moderately corelated and equally able to screen out children with emotional and behavioral problems. SDQ had a certain advantage over CBCL as it is much shorter and can be completed in much lesser time than the longer CBCL. Conclusion: The study shows that like the original English version and other similar studies , the SDQ-Urdu and the Urdu CBCL are equally valuable tools for the most clinical and research purpose.
Background: To assess the associations of depression with glycemic control and compliance to self... more Background: To assess the associations of depression with glycemic control and compliance to self-care activities in adult patients with Type 2 Diabetes Mellitus Methods: This cross-sectional study was conducted at a tertiary-care hospital in Karachi (Aga Khan University Hospital). Equal numbers of depressed and non-depressed patients were consecutively recruited from the diabetic clinic. Information on demographic and clinical characteristics was collected in face-to-face interviews and from medical records. Hospital Anxiety Depression Scale (HADS) was used to measure depression. Associations of depressed status (HADS ≥ 8) with poor glycemic control (Hemoglobin A1c level ≥ 7%) and compliance to self-care activities were assessed by logistic regression analyses. Results: A total of 286 patients were included in this study with a male-female ratio of 1.2:1. Mean age was 52 years and in 64.7 % of them, the duration of diabetes was more than 3 years. Depressed patients were more likely...
2011 IEEE/NIH Life Science Systems and Applications Workshop (LiSSA), 2011
Break junctions have emerged as an important tool to interrogate electrical transport properties ... more Break junctions have emerged as an important tool to interrogate electrical transport properties of molecules. A number of approaches have been reported for the fabrication of break junctions, including optical/e-beam lithography, electromigration, and electrochemical deposition of conductive materials. All of these are either time consuming (due to slow e-beam writing) or give low yield. We report a novel method to fabricate a nanogap between two gold electrodes. A scratch made by focused ion beam (FIB) milling followed by electromigration provides rapid and high throughput break junctions. These nanogap break junctions are used to selectively capture and electrically detect cancer biomarker protein.
Background: The aim of study was to assess differences in reporting of violence and deliberate se... more Background: The aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan. Methods/Principal Findings: Study setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital's ED, or both in Rawalpindi city from July 1, 2007 to June 30, 2008 were included. In Rawalpindi city, 1 016 intentional injury victims reported to police whereas 3 012 reported to ED. Comparing violence related fatality estimates (N = 56, 95% CI: 46-64), police reported 75.0% and ED reported 42.8% of them. Comparing violence related injury estimates (N = 7 990, 95% CI: 7 322-8 565), police reported 12.1% and ED reported 33.2% of them. Comparing DSH related fatality estimates (N = 17, 95% CI: 4-30), police reported 17.7% and ED reported 47.1% of them. Comparing DSH related injury estimates (N = 809, 95% CI: 101-1 516), police reported 0.5% and ED reported 39.9% of them. Conclusion: In Rawalpindi city, police records were more likely to be complete for violence related deaths as compared to injuries due to same mechanism. As compared to ED, police reported DSH related injuries and deaths far less than those due to other types of violence.
Background: Several studies from other countries have shown that bullying, harassment, abuse or b... more Background: Several studies from other countries have shown that bullying, harassment, abuse or belittlement are a regular phenomenon faced not only by medical students, but also junior doctors, doctors undertaking research and other healthcare professionals. While research has been carried out on bullying experienced by psychiatrists and psychiatry trainees in Pakistan no such research has been conducted on medical students in this country. Methodology/Principal Findings: We conducted a cross-sectional questionnaire survey on final year medical students in six medical colleges of Pakistan. The response rate was 63%. Fifty-two percent of respondents reported that they had faced bullying or harassment during their medical education, about 28% of them experiencing it once a month or even more frequently. The overwhelming form of bullying had been verbal abuse (57%), while consultants were the most frequent (46%) perpetrators. Students who were slightly older, males, those who reported that their medical college did not have a policy on bullying or harassment, and those who felt that adequate support was not in place at their medical college for bullied individuals, were significantly more likely to have experienced bullying. Conclusion: Bullying or harassment is faced by quite a large proportion of medical students in Pakistan. The most frequent perpetrators of this bullying are consultants. Adoption of a policy against bullying and harassment by medical colleges, and providing avenues of support for students who have been bullied may help reduce this phenomenon, as the presence of these two was associated with decreased likelihood of students reporting having being bullied.
Objective: To examine the differences in the demographic and clinical characteristics of patients... more Objective: To examine the differences in the demographic and clinical characteristics of patients admitted through emergency versus non-emergency routes and see if these two groups of patients were significantly different from each other with respect to criteria mentioned in the title. Methods: Retrospective data was analysed in all 2576 patient records were reviewed and these patients were divided in two groups with respect to their mode of admission (emergency vs non emergency). These groups were then compared with respect to sex, age, length of stay, discharge status and diagnostic categories. Statistical package for social sciences version 8.0 (SPSS 8.0) was used to analyze the data. Setting: The study was conducted at the Aga Khan University Hospital, is a private tertiary care hospital with a 13 bed psychiatric facility. Results: When these two groups were compared, significant differences were found, with ER patients having a shorter length of stay and youngest mean age, proportion of females admitted via ER was greater than those in non-ER group. There were significantly more women in each group who were married. The percentage of patients who left against medical advice was greater in the ER group. In both the groups mood disorders including Bipolar disorder and major depressive disorders was the most prevalent category with psychotic disorders to follow. The percentage of patients in both these categories was greater in the non-ER group where as percentage of patients with conversion disorder was higher in the ER group. Conclusion: Significant differences were found in the patient characteristics admitted via ER versus Non ER. Shorter length of stay in ER group might indicate an acute episode resolving quickly. Studies need to be done prospectively to determine the difference in the two groups thus ascertaining the level of care needed for each group. Lastly, the high proportion of patients coming through the ER also indicates that there exists a need for primary care involvement in mental health care thus reducing the need for emergency room usage. Clinical and Demographic Characteristics of inpatients admitted via emergency and non-emergency routes at a university hospital in Pakistan.
Journal of Psychopathology and Behavioral Assessment, Aug 10, 2014
Mothers rated the frequency of suicide ideation and attempts in 925 children and adolescents with... more Mothers rated the frequency of suicide ideation and attempts in 925 children and adolescents with ADHD (3-16 years). Ideation and attempts were more than twice as common in ADHD-Combined type than in ADHD-Inattentive type. Ideation occurred in 19 % with ADHD-C and in 7 % with ADHD-I. Percentages for attempts were 7 % and 3 %. For children and adolescents with co-occurring sadness and oppositional defiant disorder (ODD), 46 % had ideation and 21 % had attempts (vs. 6 and 2 % for ADHD alone). For those with ideation, 78 % had ODD or sadness. For those with attempts, 84 % had ODD or sadness. Maternal ratings of aggressive, explosive, sad, and moody were significant independent predictors of suicide behavior for ADHD-C, and sad and moody were predictors for ADHD-I. All children and adolescents with ADHD should be screened for suicide ideation and attempts, and co-occurring ODD and sadness should be treated to prevent suicide behavior.
Background/Objective: Recent literature has identified links between vitamin B12 deficiency and d... more Background/Objective: Recent literature has identified links between vitamin B12 deficiency and depression.We compared the clinical response of SSRI-monotherapy with that of B12-augmentation in a sample of depressed patients with low normal B12 levels who responded inadequately to the first trial with the SSRIs. Methods: Patients with depression and low normal B12 levels were randomized to a control arm (antidepressant only) or treatment arm (antidepressants and injectable vitamin B12 supplementation). Results: A total of 199 depressed patients were screened. Out of 73 patients with low normal B12 levels 34 (47%) were randomized to the treatment group while 39 (53%) were randomized to the control arm. At three months follow up 100% of the treatment group showed at least a 20% reduction in HAM-D score, while only 69% in the control arm showed at least a 20% reduction in HAM-D score (p<0.001). The findings remained significant after adjusting for baseline HAM-D score (p=0.001). Conclusion: Vitamin B12 supplementation with antidepressants significantly improved depressive symptoms in our cohort.
Introduction: Attention deficit hyperactivity disorder (ADHD) and learning disorder (LD) remain p... more Introduction: Attention deficit hyperactivity disorder (ADHD) and learning disorder (LD) remain prevalent globally and are also speculated to have a high occurrence in Pakistan. An early diagnosis and intervention in these disabilities is imperative for achieving good clinical and functional outcomes. This can be ensured by an effective screening at the level of primary paediatric care in the developing countries. We aimed to explore the ability of general practitioners (GPs) and paediatricians in Pakistan to screen for ADHD and LD based on their awareness regarding the risk factors and symptomatology of ADHD and LD. Methods: A total of 96 paediatricians and 98 GPs practising in Karachi, Pakistan were included in the study. Data was collected employing a self-administered questionnaire. Results: Only 13.7 percent of the GPs and 21.6 percent of the paediatricians were shown to have knowledge sufficient to effectively screen for/diagnose ADHD. Alarmingly, not a single GP was adequately familiar with the established risk factors and clinical symptoms of LD. The level of knowledge was not influenced by age, gender, and clinical practice attributes of the physicians. Doctors who regularly read medical journals and attend medical education seminars showed slightly better trends. Conclusion: We hypothesise that this demonstrated lack of knowledge at the level of primary care in Pakistan prevents an early screening of ADHD and LD. A multipronged strategy targeted at the provision of objective screening tools for primary paediatric care providers, regular continuing medical education seminars and an emphasis on paediatric mental health in undergraduate and postgraduate curricula may ensure an early detection of ADHD and LD in Pakistan.
Objectives: ADHD affects 3% to 5% of school-age children. Clinical and community based epidemiolo... more Objectives: ADHD affects 3% to 5% of school-age children. Clinical and community based epidemiological studies in Pakistan have shown a high prevalence of ADHD among school going children. A thorough review of literature shows that no studies of teachers’ training programs regarding ADHD have been published in Pakistani research literature. The aim of the present study is the development and evaluation of an ADHD training program for teachers. Methods: A teachers’ training program for ADHD was designed and a pilot run in 3 schools of Karachi, Pakistan. Teachers knowledge regarding signs and symptoms of ADHD was tested before and after the workshop and then again after 6 months using an ADHD knowledge questionnaire. Results: Forty-nine teachers, all of them women, completed the questionnaires before and after the training program, and 35 of them filled it out at the 6-month interval. Mean scores of these tests were compared using a paired t test. The authors found the difference of mean score of 1.48 ± 2.95, and this was statistically significant ( p &lt; .005). Conclusion: The authors conclude that the workshop improved the knowledge of the school teachers regarding ADHD symptomatology, and it remained significant even after 6 months of training (J. of Att. Dis. 2010; 13(4) 420-423).
... For example, in Pakistan the ratio is one psychiatrist to 0.51 million population, compared ... more ... For example, in Pakistan the ratio is one psychiatrist to 0.51 million population, compared with one psychiatrist to approximately 25,000 of the population in the United Kingdom (Karim, Saeed, Rana, Mubbashar, & Jenkins, 2004). ...
Objective. While a number of studies in the western countries as well as developing countries hav... more Objective. While a number of studies in the western countries as well as developing countries have provided estimates of prevalence of emotional and behavioral problems among school children relatively little is known about the prevalence of child psychiatric problems and associated risk factors in Pakistan. A cross sectional survey of 5-11 years old children attending main stream private and community schools in Karachi was conducted in order to determine some baseline prevalence data. Methods. A cross sectional survey of school children of certain towns within Karachi metropolitan area, aged 5 to 11 years during 1 st half of 2006. SDQ was filled out by parents and school teachers for the same children. Demographic data of parents, teachers and children were also collected using a separate performa. Results. 7 private and 8 community schools agreed to participate. 1488 consent forms were sent to 700 parents of private school and 788 parents of community school children. A total of 675 parents agreed to participate in the study. The response rate was 45.3%. Assessment of children's mental health was conducted using Strength and Difficulties Questionnaire (SDQ). Parents rated 34.4% of children as falling under the "abnormal category on SDQ, slightly higher estimates 35.8% were reported by the teacher. The findings suggest a striking difference between the informants' ratings as well as gender wise difference in prevalence of common child mental health problems. Conclusion. In the present study prevalence of child mental health problems was higher than reported in studies from other countries. There was also a gender difference in prevalence; boys had higher estimates of behavior/externalizing problems, whereas emotional problems were more common amongst females. There is a need for developing programs to train, sensitise and mobilize teachers and parents regarding child's psychological, emotional and behavioral problems.
Social Psychiatry and Psychiatric Epidemiology, Apr 21, 2007
While a number of studies in the western countries have provided estimates of prevalence for chil... more While a number of studies in the western countries have provided estimates of prevalence for child psychiatric morbidity and associated risk factors, relatively little is known about child psychiatric problems and risk factors in developing countries like Pakistan. A cross sectional survey of 5-11-year-old children attending main stream private and community schools in Karachi was conducted. Seven private and eight community schools agreed to participate. About 1488 consent forms were sent to 700 parents of private school and 788 parents of community school children. A total of 675 parents agreed to participate in the study. The response rate was 45.4%. Assessment of children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s mental health was conducted using Strength and difficulties questionnaire (SDQ) by parents based on cut-off provided by Goodman. About 47% children were rated as normal, 19% as borderline and 34% as abnormal by the parents. Ordinal regression was used to identify factors associated with parent&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s rating. The odds of female children of being normal was 1.5 times relative to male children, adjusting for school type and mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s education (ORadj = 1.5, 95% CI: 1.1-2.0). Children attending private schools were more likely to be normal as compared to community school children, adjusting for child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s gender and mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s education (ORadj = 2.3, 95% CI: 1.3-4.0). In the present study, prevalence of child mental health problems was higher than reported in studies from other countries. Prevalence was higher amongst children attending community schools. Consistent with most studies, male children were at a higher risk than females. There is a need for developing programs to train, sensitise and mobilize teachers and parents regarding child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s psychological, emotional and behavioural problems with special attention to community schools. Since the male child is at a greater risk we should be cognizant of this while evaluating children for psychopathology.
Objective: To determine whether caring for a child with mental health issues could lead to mental... more Objective: To determine whether caring for a child with mental health issues could lead to mental distress among mothers. Design: Cross-sectional study. Place and duration: Outpatient Clinics of The Aga Khan University Hospital and PNS Shifa Hospital, Karachi, from January to June 2005. Patients and methods: A total of 238 consecutive mothers bringing their children to child psychiatric and pediatric clinics were recruited over a 6-month period. As per inclusion criteria, 106 mothers of child psychiatric patients were compared to 132 mothers taken from pediatric clinics. They were asked to fill out a psychiatric screening instrument (WHO SRQ-20). Mothers' mental distress (score>or=10 on SRQ-20) and other potential risk or protective factors were measured. Results: Mental distress among mothers determined by WHO SRQ-20 was associated with their child attending a psychiatric clinic (odds ratio 2.51, 95% confidence interval 1.38-4.51). This association remained significant for age of mother being less than 30 years. No significant association was found with the number of children and duration of marriage. Conclusion: Mental distress among mothers is associated with the child having psychiatric problems. These mothers may represent a group who are at higher risk of depression. Early recognition and treatment of mental health problems in mothers may help reduce psychiatric morbidity in children.
Background: To assess the associations of depression with glycemic control and compliance to self... more Background: To assess the associations of depression with glycemic control and compliance to self-care activities in adult patients with Type 2 Diabetes Mellitus Methods: This cross-sectional study was conducted at a tertiary-care hospital in Karachi (Aga Khan University Hospital). Equal numbers of depressed and non-depressed patients were consecutively recruited from the diabetic clinic. Information on demographic and clinical characteristics was collected in face-to-face interviews and from medical records. Hospital Anxiety Depression Scale (HADS) was used to measure depression. Associations of depressed status (HADS ≥ 8) with poor glycemic control (Hemoglobin A1c level ≥ 7%) and compliance to self-care activities were assessed by logistic regression analyses. Results: A total of 286 patients were included in this study with a male-female ratio of 1.2:1. Mean age was 52 years and in 64.7% of them, the duration of diabetes was more than 3 years. Depressed patients were more likely to be female (adjusted odds ratio [OR] = 1.88; 95% confidence interval [95%CI] = 1.07-3.31), had a family history of diabetes (OR = 2.64; 95%CI = 1.26-5.55), and poor glycemic control (OR = 5.57; 95%CI = 2.88-10.76) compared with non-depressed patients. Depression was also associated with low compliance to self-care activities such as taking dose as advised (OR = 0.32; 95%CI = 0.14-0.73), dietary restrictions (OR = 0.45; 95%CI = 0.26-0.79) and foot care (OR = 0.38; 95%CI = 0.18-0.83). Conclusions: Adult patients with Type 2 Diabetes who have depression were more likely to have poor glycemic control and lower compliance to self-care activities, and they might need particular attention during follow-up visits.
Purpose: This study examined the association between non-suicidal self-injury (NSSI) and suicide ... more Purpose: This study examined the association between non-suicidal self-injury (NSSI) and suicide attempts among Chinese adolescents and college students. Methods: A total sample of 2013 Chinese students were randomly selected from five schools in Wuhan, China, including 1101 boys and 912 girls with the age ranging between 10 and 24 years. NSSI, suicidal ideation, suicide attempts and depressive symptoms were measured by self-rated questionnaires. Self-reported suicide attempts were regressed on suicidal ideation and NSSI, controlling for participants' depressive symptoms, and demographic characteristics. Results: The self-reported prevalence rates of NSSI, suicidal ideation, suicide attempts were 15.5%, 8.8%, and 3.5%, respectively. Logistic regression analyses indicated that NSSI was significantly associated with self-reported suicide attempts. Analyses examining the conditional association of NSSI and suicidal ideation with self-reported suicide attempts revealed that NSSI was significantly associated with greater risk of suicide attempts in those not reporting suicidal ideation than those reporting suicidal ideation in the past year. Conclusions: These findings highlight the importance of NSSI as a potentially independent risk factor for suicide attempts among Chinese/Han adolescents and college students.
Objectives: This study aims to compare two widely used instruments in child mental health researc... more Objectives: This study aims to compare two widely used instruments in child mental health research, the Strength and Difficulties Questionnaire (SDQ) is a brief behavioral screening questionnaire that can be completed in about 5 minutes by the parents and teachers of 4-16 year olds. Design: Cross sectional and correlation study Place and duration of study: This study was conducted in schools of Karachi between January to June 2006. Subjects and Method: The Urdu version of SDQ has been translated and was downloaded from the website (www.sdqinfro.com), the SDQ has been validated in Pakistan. The CBCL was translated by a team of expert through a rigorous seven step process of translation. Both the SDQ and CBCL were completed by 556 parents of school children aged 5-11 attending schools in various towns of Karachi. Results: Given the non normal nature of some of the distributions , correlations were calculated using Spearman's rho co efficient. Scores from the SDQ and CBCL were moderately corelated and equally able to screen out children with emotional and behavioral problems. SDQ had a certain advantage over CBCL as it is much shorter and can be completed in much lesser time than the longer CBCL. Conclusion: The study shows that like the original English version and other similar studies , the SDQ-Urdu and the Urdu CBCL are equally valuable tools for the most clinical and research purpose.
Background: To assess the associations of depression with glycemic control and compliance to self... more Background: To assess the associations of depression with glycemic control and compliance to self-care activities in adult patients with Type 2 Diabetes Mellitus Methods: This cross-sectional study was conducted at a tertiary-care hospital in Karachi (Aga Khan University Hospital). Equal numbers of depressed and non-depressed patients were consecutively recruited from the diabetic clinic. Information on demographic and clinical characteristics was collected in face-to-face interviews and from medical records. Hospital Anxiety Depression Scale (HADS) was used to measure depression. Associations of depressed status (HADS ≥ 8) with poor glycemic control (Hemoglobin A1c level ≥ 7%) and compliance to self-care activities were assessed by logistic regression analyses. Results: A total of 286 patients were included in this study with a male-female ratio of 1.2:1. Mean age was 52 years and in 64.7 % of them, the duration of diabetes was more than 3 years. Depressed patients were more likely...
2011 IEEE/NIH Life Science Systems and Applications Workshop (LiSSA), 2011
Break junctions have emerged as an important tool to interrogate electrical transport properties ... more Break junctions have emerged as an important tool to interrogate electrical transport properties of molecules. A number of approaches have been reported for the fabrication of break junctions, including optical/e-beam lithography, electromigration, and electrochemical deposition of conductive materials. All of these are either time consuming (due to slow e-beam writing) or give low yield. We report a novel method to fabricate a nanogap between two gold electrodes. A scratch made by focused ion beam (FIB) milling followed by electromigration provides rapid and high throughput break junctions. These nanogap break junctions are used to selectively capture and electrically detect cancer biomarker protein.
Background: The aim of study was to assess differences in reporting of violence and deliberate se... more Background: The aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan. Methods/Principal Findings: Study setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital's ED, or both in Rawalpindi city from July 1, 2007 to June 30, 2008 were included. In Rawalpindi city, 1 016 intentional injury victims reported to police whereas 3 012 reported to ED. Comparing violence related fatality estimates (N = 56, 95% CI: 46-64), police reported 75.0% and ED reported 42.8% of them. Comparing violence related injury estimates (N = 7 990, 95% CI: 7 322-8 565), police reported 12.1% and ED reported 33.2% of them. Comparing DSH related fatality estimates (N = 17, 95% CI: 4-30), police reported 17.7% and ED reported 47.1% of them. Comparing DSH related injury estimates (N = 809, 95% CI: 101-1 516), police reported 0.5% and ED reported 39.9% of them. Conclusion: In Rawalpindi city, police records were more likely to be complete for violence related deaths as compared to injuries due to same mechanism. As compared to ED, police reported DSH related injuries and deaths far less than those due to other types of violence.
Background: Several studies from other countries have shown that bullying, harassment, abuse or b... more Background: Several studies from other countries have shown that bullying, harassment, abuse or belittlement are a regular phenomenon faced not only by medical students, but also junior doctors, doctors undertaking research and other healthcare professionals. While research has been carried out on bullying experienced by psychiatrists and psychiatry trainees in Pakistan no such research has been conducted on medical students in this country. Methodology/Principal Findings: We conducted a cross-sectional questionnaire survey on final year medical students in six medical colleges of Pakistan. The response rate was 63%. Fifty-two percent of respondents reported that they had faced bullying or harassment during their medical education, about 28% of them experiencing it once a month or even more frequently. The overwhelming form of bullying had been verbal abuse (57%), while consultants were the most frequent (46%) perpetrators. Students who were slightly older, males, those who reported that their medical college did not have a policy on bullying or harassment, and those who felt that adequate support was not in place at their medical college for bullied individuals, were significantly more likely to have experienced bullying. Conclusion: Bullying or harassment is faced by quite a large proportion of medical students in Pakistan. The most frequent perpetrators of this bullying are consultants. Adoption of a policy against bullying and harassment by medical colleges, and providing avenues of support for students who have been bullied may help reduce this phenomenon, as the presence of these two was associated with decreased likelihood of students reporting having being bullied.
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