Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals

Background and Objective: Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients but physicians are also often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic

Methods: This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17

Results: Out of 300 patients included in study, 39% [n= 117] were males and 61% [n=183] were females. The mean age of the participants at presentation was 48.46+/-13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place [p-value 0.01]. The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant [p-value 0.001]particularly in subjects who have long duration of DM [>5 years]

Conclusion: Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe

Breast self examination - awareness and practices among lady health workers

To find out the awareness and practices regarding breast self examination [BSE] among the lady health workers of Tehsil Arifwala, district Pakpatan, Punjab. This cross sectional study was conducted in July 2011. 300 LHW's fulfilling the inclusion criteria were selected through consecutive sampling technique. Information was collected regarding awareness and practices of BSE through interviews on questionnaire covering all variables. The BSE practices of LHW's were determined on the basis of two criteria: 1. Number of BSE steps performed [categorized as 'average' for performing >2 steps and 'below average' for performing one or two steps]. 2. Interval of BSE [categorized as 'correct' for regular monthly interval and 'incorrect' for >1 month interval]. Data was entered and cleaned using Epi Data 3.1 and analyzed using Epi Info 3.5.1 Mean age of participants was 32.06 +/- 7.8 years. Majority were married [79%], rural dwellers [64.3%], had job experience up to 5 years [55.3%] and were educated above middle [53.7%]. Majority 280 [93.3%] were aware of breast self examination but only 80 [28.5%] were practicing it. Out of 80 who were performing BSE, 34 [12.1%] were practicing BSE at correct interval and only 46 [16.4%] were practicing average steps. Significant relationship was found between the age and awareness while higher levels of job experience had a significant relationship with BSE practice. The awareness level of LHW's regarding BSE was relatively high as compared to their practices of BSE. As a LHW has direct link with the community, there is a need to organize training courses for LHW's regarding correct BSE practices. Special emphasis should be paid to timeliness and steps of the procedure so that she can provide proper information to community for early detection of breast cancer.

Factors leading to the development of chronic obstructive pulmonary disease in adult Pakistani males

The study was conducted to determine the factors associated with development of COPD among adult Pakistani men of 40 to 70 years of age. This case control study was conducted with total sample of 88 males aged 40 to 70 years old, 44 cases and 44 matched controls with 1:1 ratio. Cases were selected from the patients admitted in the Pulmonology Department Jinnah Hospital Lahore and controls from the other departments of the same hospital, during one month period. The data was collected through questionnaire consisting of variables like age, locality, occupation and smoking status. The spirometric cut off points [FEV1<80% of predicted and FEV1/FVC ratio <70% of predicted] were used as diagnostic tool for COPD. Cross tabulation was performed with dependent variables as presence of COPD and independent variables such as smoking, age, occupational exposure, locality etc. Multivariate logistic regression model was used with backward elimination technique for the adjustment of age, locality, income status, occupation, previous history of disease and smoking status. Cigarette smoking and age of more than 55 yrs have shown significant relationship with the development of COPD [p value<0.05]. Adjusted odd's ratio was 9.1065 for smoking and 4.2315 for age. Urban residents have a risk of developing COPD 2.14 times more than that of rural residents. Cigarette smoking is most important risk factor for development of COPD, so efforts should be made to control it

Immunization status among children

To find out the immunization status against vaccine preventable diseases, timeliness of vaccination according to EPI schedule and availability of EPI card among children aged 0-23 months residing in Jallo village district Lahore. This descriptive cross-sectional study was conducted in village Jallo, District Lahore, having a population of 8061. 331 children aged 0-23 months of the area were included in the study. Data was collected by interviewing the mothers of selected children. Data was entered and analyzed using Epi Info. Frequency distribution with percentages were calculated. Out of total 331 children, 63.4% were fully immunized, 30.5% were partially immunized while 6.1% were not immunized. A child was considered as fully immunized if he/she was vaccinated as per EPI schedule according to his/her age. Only 6.2% were vaccinated according to the EPI schedule and vaccination card was available with 89%. Findings of this small scale study revealed that only 63.4% children were fully immunized which was much less than target of 80%. [EPI objective was to achieve 90% immunization coverage with at least 80% in every district by 2010]. Parents must be motivated to get their children completely vaccinated in a timely manner according to the recommended schedule