Physicians’ perspective regarding direct to consumer marketing of nutraceuticals products

Objectives: Recently pharmaceutical marketers have expanded their audience by directly to the consumers advertising [DTCA] which is almost always limited to non-prescription drugs. DTCA has substantial effects on patient behavior and physician prescription. The aim of this study was to assess the perspectives of physicians regarding the rapidly proliferating trend of direct to consumer marketing of nutraceutical drugs [ND]

Methods: It was a cross-sectional study from June 2016 to December 2016 which included 325 physicians from various cities of Pakistan who completed a structured questionnaire after providing informed consent. Questions were asked to assess physicians' perception of the increasing trend of Direct to Consumer advertisement of nutraceuticals and its influence on their practice. The data was analyzed using SPSS [SPSS Inc., Chicago, Illinois, USA]

Results: There were 182 [56%] male and 143 [44%] female physicians in the study. Most of them were general practitioners [48%], spent an average weekly time of 1-2 hours gaining medical knowledge [56%], and most of them [52%] utilized internet as their source. Most physicians [88%, n=286] experienced knowledgeable patients who inquired about their diseases and treatment plans. Most of the physicians believed that e-detailing [72%, n=234] and DTCA [68%, n=221] of nutraceuticals helps practitioners in shaping a more effective treatment plan. Almost [62%, n=201] physicians prescribed medications their patients requested them to

Conclusion: Physician perception of DTCA and e-detailing of nutraceuticals seems to be promising. However, physicians must be more prepared to deal with knowledgeable patients and put in maximum efforts to counsel them in such a manner that the prescription doesn't contain "request specific" drugs but only the ones that are most beneficial for the patients

Comparison of cognitive professionalism in residents of public and private hospitals of Karachi

Objective: To evaluate and compare the cognitive professionalism in resident medical officers [RMOs] of public and private hospitals of Karachi

Study Design: A cross-sectional survey

Place and Duration of Study: Civil Hospital and Ziauddin Medical University Clifton Campus, Karachi, from August to December 2014

Methodology: This survey was conducted in one public and one private medical college. All residents from Gynecology and Obstetrics, Medicine and Surgery departments were included with non-probability purposive sampling. A validated tool [Barry Challenges to Professionalism questionnaire] was used to assess professionalism, containing six challenges to professionalism [acceptance of gifts, conflict of interest, confidentiality, physician impairment, sexual harassment, and honesty] with multiple-choice responses. Data was analyzed with SPSS version 17 and chi-square test was used for determining significant difference between public and private institutes

Results: Forty-three residents from both the places responded. The frequency of acceptable answers to the six scenarios ranged from 0% to 55.8%. Acceptable responses were more from private-sector institute residents than public-sector residents, but no statistical significant difference was seen

Conclusion: Most residents did not provide appropriate responses to professional challenges. The postgraduate training programs are very stringent on medical knowledge and skills. However, it is needed to address formally professional attitudes and behaviors and include them as a competency in the training program

Physicians' migration: perceptions of Pakistani medical students

Objective: to study the perceptions of medical students about factors responsible for physicians' migration

Study Design: cross-sectional survey

Place and Duration of Study: Dow Medical College and Civil Hospital, Karachi, from April to May 2015

Methodology: a self-administered structured questionnaire was used including demographic details, attitudes about push and pull factors of migration, and reasons for migrating or not migrating abroad. Final year students and interns were included. Likert scale from 1 to 4 [1=strongly disagree to 4=strongly agree] was used to assess attitudes. Data was analyzed by SPSS version 16

Results: a total of 240 medical students, mostly females [n=181, 75%] [60% final year and 40% interns], participated in the study. Majority wished to go abroad [n=127; 54%] with United States being the favorite destination [n=80; 66.1%] and internal medicine fields being the preferred choice for specialization [n=126; 54%]. The major pull factors were better quality of postgraduate education abroad [n=110; 48.2%] and economic prospects [80; 35.2%]; while the push factors were a weak healthcare system [n=219; 94.3%], inadequate salary structure [n=205; 88.3%], insecurity [n=219; 93.9%] and increasing religious intolerance in Pakistan [n=183; 78.5%]

Conclusion: this survey highlights the continuing trend of physician migration from Pakistan owing to interplay of various push and pull factors. Majority of our medical students wish to migrate, mainly due to low salaries, poor job structure, and insecurity. Urgent interventions are required to reverse this trend of medical brain-drain

Psychosocial determinants of nutritional neglect in a developing country

To determine the demographic features and psycho-social and economic determinants of nutritional neglect in order to suggest interventional strategies. Cross-sectional, observational study. Department of Paediatrics, Dow University of Health Sciences [DUHS] and Civil Hospital Karachi [CHK], from January 2009 to December 2010. All children suffering from nutritional neglect suggested by weight and height less than the third centile for age, and their mothers were recruited in the study through non-probability consecutive sampling. A team comprising of paediatrician, psychologist, medical social worker and social motivator interviewed the mothers and children suffering from nutritional neglect. Information about demographic, social, economic and psychological factors was obtained. The results were analyzed and described as frequency distribution and percentage. A total of 658 children suffering from nutritional neglect were inducted. Around 75% of children were below 5 years of age, 51% were females. Other determinants of nutritional neglect were, large family size [family of > 5 members [84%] young mother [60%], uneducated parents [67% father and 77% mothers being illiterate], low income [77% earning less than Rs. 7000/month], addiction [23%], tobacco smoking [50%] and non-nutritive substance use [51%]. Psychological indicators identified in mothers were depression [70%], anxiety [73%], helplessness [70%], displaced aggression [50%] and insecurity [36%]. Psychological factors identified in children as a secondary outcome were aggression [80%], rebellious behaviour [75%], lack of confidence [70%], lack of social interaction [70%] and paranoid tendencies [60%]. Psycho-social and economic factors are important determinants of neglect. A holistic approach and intervention at multiple levels is required to address these issues

Maternal and perinatal outcome of hypertensive disorders of pregnancy at a tertiary care hospital

To study the frequency of various hypertensive disorders of pregnancy and to determine their maternal and perinatal outcome. Retrospective descriptive study. Department of Obstetrics and Gynecology Unit III, Civil Hospital Karachi, from January 2002 to December 2007. A total of 626 cases were reviewed for age, parity, gestational age, diagnosis, antenatal and intra partum complications, mode of delivery and neonatal outcome. Data was analyzed using SPSS software [version 16]. Total number of deliveries during the study period was 11,718 and there were 626 cases of hypertensive disorders of pregnancy giving a frequency of 5.34%. Pre-eclampsia was seen in 308 [49%], severe pre-eclampsia in 85 [13%], eclampsia in 121 [19.2%], chronic hypertension in 41[6%] and postpartum eclampsia in 21 [3.3%] patients. There were 39 maternal deaths [case fatality rate: 6.23%]. The mean ages for pre-eclampsia, severe pre-eclampsia, eclampsia and chronic hypertension were 28, 27, 24 and 29 [27 years] years respectively. The commonest maternal complication of hypertensive disorders was postpartum hemorrhage in 24 women [4.2%]. This was followed by placental abruption in 9 women [1.6%] and pulmonary edema in 8 women [1.4]. The prevalence of prematurity in pre-eclampsia, severe pre-eclampsia and eclampsia in study population was 14%, 5% and 8.6% respectively. Cesarean section was required for pre-eclampsia, severe pre-eclampsia and eclampsia in 46%, 51% and 61% of patients respectively. The main fetal complications were found to be still birth [14% in pre-eclampsia, 18% in severe pre-eclampsia and 15% in eclampsia] and low birth weight [31% in pre-eclampsia, 49% in severe pre-eclampsia and 52% in eclampsia]. Hypertensive disorders in pregnancy are an important cause of maternal and perinatal mortality and morbidity

Socio-demographic characteristics and the three delays of maternal mortality

To describe the socio-demographic characteristics and the three delays of maternal mortality in a tertiary teaching hospital. Retrospective, observational study. Department of Obstetrics and Gynaecology, Unit III, Civil Hospital, Karachi, from April 2005 to May 2008. One hundred and four consecutive maternal deaths were reviewed. Data regarding age, parity, sociodemographic characteristics, booking status, referral source, cause of death and the three delays was collected on structured proformas, analyzed by the statistical software, SPSS version 13, and presented in the form of frequencies and percentages. The projected maternal mortality ratio was 1650/100,000 live births. The mean age was 28 +/- 6.2 years and median parity was two. Seventy-one women [68%] were uneducated, 65 [62.5%] belonged to lower socioeconomic class and 60 [58%] had received no antenatal care. Ninety-eight women [94%] had one or more delays, with 70 [71%] having the first delay, 73 [74%] having the second delay and 47 [48%] the third delay. The most frequent reasons for first, second and third delays were lack of awareness in 88.5% women, long distance in 39.7% women and difficulty in getting blood in 49% women respectively. The very high maternal mortality ratio suggests lack of access of women to quality healthcare facilities. A majority of these women suffered first and second delays in their management, which could be due to their poor sociodemographic factors

Ectopic pregnancy: presentation and risk factors

To describe the clinical features and risk factors in ectopic pregnancy. A descriptive study. The study was conducted in Unit III of the Department of Obstetrics and Gynaecology, Civil Hospital, Karachi from January 2002 to December 2003. A total of 38 women diagnosed with ectopic pregnancy were included in the study. Data was retrieved from the charts of all the patients diagnosed with ectopic pregnancy through a structured proforma. The variables studied included age, parity, symptoms and signs, risk factors, treatment and associated maternal morbidity. Among the clinical features, the most common presenting symptom was abdominal pain in 37 [97.3%] patients whereas history of amenorrhea and vaginal bleeding were found in 28 [73.6%] and 22 [57.8%] patients respectively. The most common physical sign was tenderness: abdominal tenderness in 28 [73.6%] and pelvic tenderness in 23 [60.5%] patients. Cervical excitation was only present in 19 [50%] patients. Risk factors were present in 23 patients [60.5%], the most frequent being infertility in 9 patients [23.6%]. Other risk factors were tuberculosis in 6 patients [15.7%], previous ectopic pregnancy in 3 [7.8%] and previous tubal surgery in 1 [2.6%] patient. History of IUCD was present in 1 [2.6%], injection Depo-provera in 4 [10.5%] and OCP in 3 [7.8%] patients. History of D and C and C-section were present in 7 [18.4%] and 4 [10.5%] patients respectively. Abdominal pain was the single most consistent feature of ectopic pregnancy. Risk factors may not always be present. Therefore, ectopic pregnancy should be suspected in every woman of reproductive age who presents with unexplained abdominal pain, irrespective of amenorrhea and vaginal bleeding and whether risk factors were present in the past history or not