Nutrition and dietetics curriculum for BS study program - assessment and evaluation

The main objective of this study was to evaluate the curriculum for BS degree program in Human Nutrition and Dietetics in Pakistan. For this purpose, a working group comprising of experts in the field from NEAT [a Pakistan based registered organization: www.neat.org.pk ] was assigned the responsibility to evaluate the curriculum. As suggested by the working group, a modified Delphi technique was used and a group of expert panelists [n=46] was identified. Three main 'areas of enquiry' '[AE]' were proposed, where the responses from the panels were requested: AE[1] evaluated the curriculum against a set of 15 characteristics reported in the literature; AE[2] evaluated the curriculum against 32-item 'knowledge areas' based on findings of a recent investigation. AE[3]: scored the course contents of individual courses against a 'perceived standards' in light of a 14-item Battery. For AE[1] and [2] and [3], the panelists responded, respectively, on scoring scale [0 - 4] and ticked any one from 1 -3. The data were analyzed for mean and median scores for each individual item. Findings of AE[1] suggest that majority of the panelists agreed that the curriculum 'adequately'/'excellently' highlighted the fifteen criteria set-forth. Findings of AE[2] suggest 8 out of 32 'knowledge areas' being 'poorly' reflected in the curriculum. Findings of AE[3] suggest majority [28/43: 65%] of courses fulfill the perceived standards except 2 courses ["Nutrition through Life Cycle"; and "Research Methods in Nutrition"] fulfilling <50% of the required standards. In all, the findings are of suggestive that the curriculum is 'good' except certain shortfalls. It was recommended that the deficiencies may be addressed in the coming revision

Chemical stress as a consequence of prolong drug use: a study on chronic health condition

Background: Chemical stress is an indication of increase or a lesser amount of chemicals that body has exposed both internal or external environment provided to singe cell such as pollution, smoking, ingested food additives, pesticides, excessive consumption of sugar and alcohol, too many cups of coffee and even passive smoking cause chemical stress. This prolong exposure to any affluence can cause chemical stress that interferes with body's natural balance

Methodology: A cross sectional survey based study was conducted at a local hospital including 3 groups of patients, Group I was using only anti diabetic drugs, Group II was chronic user of cardiac medications while Group III was using both. Demographic data, medical history and drug use duration and dosage were investigated as well as intensity of Chemical stress was calculated by Sadaf stress scale. The patients with severe and psychological and mental illness or any other chronic illness or patients who were failed to provide reliable information were excluded from study

Results: The result showed that there is a stressful built-up of chemicals as a result of altered metabolism due to excess drugs use in these patients. However moderate stress is majorly reported in Group III that indicates increased number of prescribed medications and their correlation with intensity of chemical stress. However, none of the patient scored severe stress which is again an indication that there is a progressive psychophysiological deteriorating state rather than fully damaged that can be improved

Obesity as a noticeable cause of physical stress; a study on relationship of physical exertion and cardiovascular parameters

Introduction Physical tension is a response to environmental pressures, needs or demands or any vigorous bodily activity leading in altering physiological responses, is counted as physical stress such as aerobics, work outs, injury or aches. It may also count on physical traumas as cuts, burns, sprains, broken bones, surgery etc. in other words physical stress is bodily response to substantial pressures such as exertion, noise, illness or exercises

Methodology The purpose of this study is to observe the seventy of physical stress in individuals with respect to their BMI, subjects were assessed pre and post for blood pressure and pulse while Physical stress scores were calculated through Sadaf stress scale [SSS], the data was then analyzed using SPSS 19.0

Results showed that physical stress increases with increased BMI while it also shows significant difference in obese individuals presystolic and pre diastolic with post systolic and post diastolic pressures

Conclusion From this study we conclude that BMI is directly proportional to physical stress. So maintenance of normal body weight is the utmost requirement for healthier life

Prevalence and characteristics of stress among bereaved parents after the death of their under-five children in the urban slums of Karachi, Pakistan

Introduction to understand the prevalence of stress and identifying the prevalence of different differentials of stress among bereaved parents of died under-five children is of utmost importance. This paper is based on the data from Karachi VASA under-five mortality study. The cases of this study are bereaved parents of deceased under-five children belonging to randomly selected 12 slums of Karachi city

Methodology a total of 321 parents excluded out form enrolment in VASA study were undergone stress assessment using Sadaf Stress Scale [SSS]. It was found that 100% of them were truly stressed in one form or the other and the distribution is equally affecting all the slums [with slight variations]. Females were found highly stressed [72%] than males [28%]. The most prevalent types of stress identified were emotional [67%], traumatic [17.2%] and mental stress [7%]. Out of all the stressed parents, a high proportion belongs to highest severity. The highest prevalence of the severity of traumatic stress shows that the large proportion of stressed parents has gone to Post-Traumatic Stress Disorder [PTSD], especially among mothers

Conclusion the results are quiet disturbing. The data shows that there is a high prevalence of traumatic, physical and emotional stress among bereaved parents [especially mothers] of deceased children. The prevalence of traumatic stress and its severity shows that a high proportion of stressed parents have gone to PTSD, which again have a huge impact on the overall mental health of the affected and the close family members

Nutritional stress as an adverse effect of anti-diabetic medications

Objective to estimate the intensity of nutritional stress among the diabetic patients

Background non-Communicable diseases [NCDs] are the leading cause of morbidity and mortality in Pakistan. The WHO report evaluated diabetes at the fourth position among the four types of NCD's, this accounts for 1.5 million deaths annually

Introduction nutritional stress depends on what we give to our body, whether it is toxin loaded, chemically constituted platefuls of food and expect it to cope without a grumble. As, diabetes is metabolic syndrome so there is an altered carbohydrate and fat metabolism in these patients that will lead to the development of nutritional stress in these patients

Methodology a cross sectional survey based study was conducted at a local hospital including diabetic patients on anti-diabetic medicines. Demographic data, medical history and drug use duration and dosage were investigated as well as intensity of nutritional stress was calculated by Sadaf stress scale [SSS]. The patients with severe and psychological and mental illness or any other chronic illness or patients who were failed to provide reliable information were excluded from study

Result the total of 42 patients have participated in the study out of that 50% have reported mild nutritional stress and 36% have reported moderate nutritional stress. The most common reported symptom of nutritional stress includes sleep problem, abdominal bloating, incomplete emptying and sugars and carb craving

Conclusion the patients have reported the nutritional stress due to the altered carbohydrate and fat metabolism and the use of anti-diabetic medicine further increases the intensity of nutritional stress. The symptoms that are reported in diabetic patients are not associated with diabetes instead occur as a result of anti-diabetic medication use. Such as, sleep problem usually associated with increased stress, increased blood pressure, impaired control of blood glucose, and increased inflammation

verbal/social autopsy [VASA] child mortality inquiry to investigate under-five mortality determinants in slums of Karachi, Pakistan: a mix methods interventional study

Background Pakistan stands along top ten countries responsible for two-third of global child mortality burden. To improve Child Mortality [CM] estimates in Pakistan, there is an exigent need to understand the in-depth reasoning behind mortalities. In Pakistan, the data on cause-of-death [CoD] for a large number of child mortalities in Pakistan is either not available or not suitable for use. Pakistan uses an alternative technique called Verbal autopsy [VA]. Since VA only determines the biological cause of death [BCoD], and does not capture multitude of other modifiable social, cultural and health system determinants, it has a limited importance. Such non-biological determinants are captured by another technique i.e. Social Autopsy [SA]

Objective by integrating VA with SA, extended set of mortality related determinants will be explored, in addition to strengthening death notification coverage and assigning CoD in such missed out mortalities

Method under the working group of Health Advocacy Council for Women and Children [HACWC] in collaboration with Child Registry of Pakistan [CROP], mixed method [QUAN-QUAL] interventional study will be carried out in urban-slums of Karachi city using VASA-integrated under-five mortality investigative technique. Parents of dead children will be interviewed. Second stage of study will be followed by qualitative interviews with different cadres of stakeholders

Expected Outcomes by focusing the specific determinants related to case-management and care-seeking process [identified by The Pathway to Survival Framework-TPtoSF] an in-depth understanding of related determinants can be achieved, which will help in crafting potential interventions required to limit the barriers that increase the chances of CM in developing nations

Relationship of physical stress and hypertension among cardiovascular disease patients

Objective the aim of the study is to find out amount of physical stress among cardiovascular disease [CVD] patients and its relation with hypertension

Background physical stress is defined as a pressure - force and strain a state of physical mental tension. Stress is among the mental factors that has for some time been recorded among the potential. Furthermore, essential hazard variables of hypertension and coronary illness

Methodology a cross-sectional study was conducted in the patients of department of Cardiology at tertiary hospitals, Karachi, from January 2014 to December 2014. Sadaf stress scale [SSS] 2.0 was used to find out the physical stress

Results it showed physical stress among CVD patients about n=39 [43.3%] have moderate physical stress. which was decreased over time after 5 year of illness as compared to the patient who have disease for less than 5 years. While systolic blood pressure among subjects with severe physical stress showed an average systolic B.P. of 147mmhg, moderate have 146mmhg and patients with mild physical stress have 135mmhg

Conclusion this report concluded moderate physical stress among CVD patients which was decrease over time due different coping mechanism and blood pressures are directly related to severity of physical stress mainly systolic which lead to hypertension

Generalized review of the successes and challenges of medicine; An insight of the past, present and future prospects

Evidence from recent millennia demonstrates the progressive efforts of humans to prevent diagnose and cure diseases. Understanding diseases and developing cures has always been a challenge for various reasons, but the successes surpass the setbacks in terms of discoveries. Overcoming infectious diseases has shown the most successes as well as challenges, and still the case may be so. New technologies are bringing many opportunities for the future. While cures for cancer, heart disease, diabetes, AIDS, etc. still remain to be included in the successes, on the other hand regenerative medicine, nanotechnologies and point of care are very promising developments. In this review we have tried to cover the past, present and future expectation and challenges associated with medicine and surgery

Atrocious dietary habits leading females of Karachi towards polycystic ovary syndrome

Polycystic ovary syndrome [PCOS] is the most common chronic endocrine disorder that is responsible for imbalance of hormones affecting women of reproductive age leading to difficulties in period cycle and getting pregnant. The aim of study was to evaluate the routine eating habit of the patients. The study was conducted in Gynecology ward of Tertiary care hospital. This analytical study was performed after taking consent including those patients, who came to the clinic to report their problem of infertility [married women] and irregular periods problems [unmarried girls], targeted age group was between 25 to 35. Interview based study was conducted which include all the questions related to their eating habits like; food typically eaten in breakfast, lunch, dinner and amount of snacks taken per meal. High intake of carbohydrate and fats also investigated per meal. There BMI and FBS was also calculated. Total 300 patients were studied out of which 50 patients were included in the study and the results showed that in PCOS patients the frequency of obesity and overweight is [92%], followed by [66%] of patients had excess carbohydrate/sugar craving while 34% patients had normal eating patterns. High rates of these complications were seen in the series. From the results it is suggested that obese women with PCOS requires more attention toward the appropriate management of their dietary habits, as their high BMI and high fasting blood sugar is correlating with abnormal clinical and biochemical features. Calorie intake should be restricted. Diet control along with exercise was suggested to the patients

"Ratio of gender dependency", a comparative study between Karachi and Hyderabad's populace

Karachi and Hyderabad both are metropolitan cities of Pakistan but Karachi is more developed and mobilized city than Hyderabad. This difference may possibly bring change in the gender dependency ratio. Gender is the socially and culturally shaped characteristics for males and females [sexes] of any society; both genders have to perform the roles which are expected from them. Gender dependency is the result of the cultural practices in any society while the culture in developing societies is masculine by its nature and men are the one who lead, secure and are responsible for bread earning for their families. To confirm this fact, data from 500 respondents was collected from Karachi and Hyderabad, age between 25 to 40 years, Questions about respondent's experience, hesitation, insecurity, independency in decision making were also the part of detail questionnaire. This study shows that the ratio of educated population was high in Hyderabad. In both cities females were more dependent than males, Females of Karachi were more confident and independent in their lives and the level of insecurity was high in females of Hyderabad. Findings proposed the importance of education, development and mobility on the road to independent life

Early marriages leads to low self-esteem of young girls

The focus of this study is to be acquainted with the level of trust and reliance regarding reproductive health concerns among early married females. Many females around the globe are subjected to early marriage with immature minds and bodies, and they are forced to shoulder heavy duties, early pregnancies, harsh family behaviors, family disputes, behavioral problems and understanding problems. Early pregnancies and other health problems have a great impact on their self-esteem, confidence level and their trust on elders to share their problems. When females are married at early age, they are not only deprived of their education but they are also not aware of the health consequences and their solutions. A cross-sectional observational study was conducted in Karachi and data was collected through detailed interview among 100 subjects [married and unmarried females]. 41.98% of the unmarried girls relied on lady doctors for their reproductive health problems whereas 37.50% of married girls approached mothers and few talked to lady doctors while most of them were not sharing theirs obstacles with anyone. It is concluded that females in their teens before marriage had normal self-esteem and courage to share their problems, on the other hand early marriages were found to cause a decline in their levels of self-esteem due to domestic pressures, less social buck up, fears of in-laws and husbands

Association of chemical stress with type I and II diabetes

Background: Diabetes mellitus is characterized by absolute or relative deficiencies in insulin secretion or insulin action correlated with chronic hyperglycemia and other disturbances in carbohydrate, lipid and protein metabolism results in weakening immunity. In addition, various biochemical disorders associated with diabetic vascular complications, such as hyperlipidemia and oxidative stress frequently co-exist with diabetes mellitus. Previous studies have also suggested that these and additional factors might involve with increasing chemical stress in diabetic patients

Material and methods: The questionnaire based survey was conducted including both close and open ended questions along with the assessment of chemical stress using Sadaf Stress Scale [SSS] version 2 among diabetic patients. This study was conducted in tertiary care hospitals of Karachi from October 1st till November 10th, 2014. Data was analyzed and plotted using SPSS version 20.0

Results: This study showed that 28% of diabetic patients were in severe chemical stress. However, the various symptoms of severity included body temperature alterations [50%], feeling of dehydration [56%] and shortness of breath [63%] were obtained

Conclusion: It is concluded that the diabetes patient with type 2 diabetes are at higher risk of developing chemical stress that may indicate multiple metabolic and as indicated by prominent symptoms that can be a oxidative alterations on sequence of increase use of medications and altered glucose metabolism

Exercise leads to physical stress, a cross sectional study of Karachi - Pakistan

Exercise has many health benefits but also exercise is a stress situation for which the body must find a new dynamic equilibrium. If workout is performed beyond the limitations than it may disturb normal body homeostasis and results in stress. The basic objective behind this study was to evaluate the relation between Physical activities andPhysical Stress. A cross sectional study was conducted to evaluate physical stress during exertion. All the subjects were randomly selected from Arts, Science, Commerce, Engineering andPharmacy faculty of Karachi University. Serum cortisol, a potential biomarker evaluating stressed condition and finding a correlation with stress scores noted by using sadaf stress scale showed high intensity of stress while other results showed that around 41 percent participants were severely affected with physical stress during performance

Fitness consequences of dietary patterns and consumption in young girls

The investigation of usual dietary patterns are of physiological significance including carbohydrate rich diet, caffeine consumption, protein intake specifically red and white meat along with intake of dietary supplements, milk and juices utilization as they have known to effect BMI and body fat distribution of those with increasing body weight, underweight and normal weight. The study was carried out on 435 university girls aged between 18 to 25 Years, we used the multiple logistic to investigate the relationship of dietary habits, family history, BMI, waist-hip ratio and body fat distribution. The result showed that there is no direct relation of body mass with dietary habits as the Girls with BMI <18 found to take the diet characterized by decrease consumption of good diet [milk, juices, egg, mineral supplements] and increase consumption of bad diet [junk food, fried and oil rich food], while girls with > 23 considered as overweight found diet conscious and were taking healthy diet. The association of these dietary patterns with raised body fat distribution, BMI and hip to waist ratio may specify the risk of developing health maladies but we conclude that in our population the lean girls are taking more junk food and are prone to various diseases more than the obese. We recommend that these unhealthy dietary patterns should be avoided as they may be a silent cause of many health issues

Medical education as a necessitate for field force

Caregivers are important escort in the healing journey of any patient. Our country in last decades excel so much in terms of offering training programes for nurses and midwives to bridge the gap between the therapeutic interventions and knowledge of these working individuals. We have done a survey on 182 nurses both male and female working in specifically small towns and trust hospitals. They were interviewed about their skills and the duties allocated to them. With reference to the patient care and conditions they were inquired about the medical background and awareness of the sufferer's ailment. We have found nearly disappointing results as almost 71% of these workers were ignorant of the fact that they lack basic knowledge of related medical conditions of concerned patients. Rest of the data also gave the evidence for a huge breach among the awareness, education and realistic approach in this selected workforce. We suggest that caregivers must be aware of indications and have strong medical foundation of the concerned departments where they are serving. We propose the medical education and clinical workshops for this set of serving individuals at ground levels along with the technical fine tuning with the help of case studies and practice. We recommend to improve this field force especially who are serving the majorities and in rural areas

Physical stress during menstrual cycle; a study on pain, discomfort and exhaustion

Premenstrual syndrome [PMS] is a set of physical, emotional and behavioral symptoms that start during the week preceding menstruation and are alleviated when the menstrual flow begins. The purpose of this study was to evaluate symptoms of PMS in relation to intensity of pain and physical stress by using Sadaf Stress Scale [SSS]. PMS affects menstruating women globally and causes extensive personal and public health problems with high degree of absenteeism. It is the most common gynecological problem that has been reported to affect the ability of women to carry out daily activities. Data was collected from women aged 17-35 years having premenstrual pain. The prevalence was determined by questionnaire include issues about exercise, intensity of pain, severity and flow of blood during reproductive cycle. Results shows 15% mild, 14% moderate and 5% sever symptoms of physical stress with only 4% females are interested in doing exercise. Premenstrual pain was one of the most common complain among these females of reproductive age with sever to moderate discomforts during menstruation along with the concerns of heavy or moderate bleeding. It is recommended that inquiries about pelvic pain and menstrual discomforts should be made compulsory in health care centers, so that this major problem could be overcome causing hindrances in routine life with women

Pathophysiology and management of ischemic and neuropathic pain

Both nociceptive and neuropathic types of pain utilize the same nervous pathway for conduction with considerable physiologic disparities exist in the mechanism through which the body processes and resolves these painful stimuli. Nociceptive pain that results from a known or obvious source [e.g. trauma, cancer metastasis, ischemia, arthritis] is often simple to recognize. Neuropathic pain, however, may occur with the nonappearance of any particular precipitating cause. Anticonvulsants, topical anesthetic agents, antidepressants, antiarrhythmic, anti-inflammatory agents, opioid analgesics, NMDA receptor antagonists, combined analgesic therapy, physiotherapeutic modalities and other ways are used as treatment. Other interventions such as motor cortex stimulation, transcutaneous electrical nerve [TENS] stimulation units, and other peripheral stimulation have been shown to be supportive. A frequent sequella of both types of diabetes is the development of peripheral neuropathy in either motor or sensory nerves, or both. High-frequency TENS can suppress abnormal, spontaneous activity in a damaged peripheral nerve and can block nociceptive transmission in the dorsal horn, the use of this practice seems a practical approach for relief of neuropathic pain. Indeed, TENS applied to the lower extremities of neuropathic pain sufferers reduces the intensity of pain. However what actual molecular mechanism is followed is still a mystery and these studies emphasize for carrying out further work to correlate the neuropathic and ischemic aspects of disorders in these patients

Mental stress decreases with older age in Karachi, Pakistan

Mental Stress is a Kind of mental revival or strain that can be aroused by a number of mental tasks-e.g., mental arithmetic, maze solving or a mentally troubled condition is called the mental stress. Major life events as changes in work, financial problems, studies load, children and family problems are few of these. Mental stress is seen to affect parts of the brain where thoughts, approach, speculation and decision making are processed through and stored along with basic motor activities. Constant exposure to mental stress hormones, whether it occurs during the upbringing, teenage years, old age, has an impact on brain structures involved in cognition and mental fitness. The WHO suggests that there can be "no health without mental health". People in many countries are exposed to harmful stress that leads to an augment in mental stress. The purpose of this study is to evaluate the cause of mental stress in Karachi population through Sadaf stress scale [SSS]; various stressors may contribute to these mental stresses. The data was collected from different areas of Karachi .Sadaf stress scale [SSS] was used as an instrument for evaluation of mental stress. Results demonstrates that in age 20 and less shows 16.0% mild level of stress, in age 20 to 30 shows 24.0% mild level of stress, in age 30 to 40 shows 5.0% mild level of stress however 40 and greater age shows no stress levels. The hypothesis that mental stress responses are associated with age and gender was investigated

Emotional stress estimation in general population

Despite great deal of popular research interest in existence and altered body responses of emotional stress there are still strong arguments regarding its positive and negative impact on psychophysiological health. Stress is a state of mental or emotional strain or suspense and also a number of normal reactions of the body [mental, emotional, and physiological] and designed for self-preservation. The potentially lethal consequences of emotional stress are deeply rooted in folk wisdom, as reflected by phrases such as scared to death and a broken heart. In the past decade, cardiac contractile abnormalities and heart failure have been reported after acute emotional stress. a cross sectional study, data was collected by means of structured questionnaire from 370 subjects [age ranges between 20-50 years]. Stress was accessed by using Sadaf Stress Scale [SSS] which comprises of 114 items divided into seven subscales data was analyzed by using SPSS 20.0. The main findings of this study are that emotional stress has a direct relation with age. People ranging below 30 years showed emotional stress and women being remarkably more susceptible to it

Postraumatic stress disorder in Karachites due to random events of violence

Karachi is one of the biggest City in Asia and since past 20 years terrorism in Karachi is increasing frequently, due to these terrorist activities people living here have developed several phobias and anxiety disorders. To contrast the occurrence of traumatic events and its relationship with symptoms of post-traumatic stress disorder in Karachites. Survey of residents of Karachi was conducted between January 12, 2011 and March 4, 2012. Symptoms of PTSD were assessed using questionnaire related to psycho social factors that prone to PTSD .Out of total 164 both male and females, 62% of respondents reported appetite changes due to these terrifying activities, 58% of respondents reported hostile personalities, depression and mood fluctuations, while remaining 30% reported insomnia. 76.82% reported depression According to their economical condition 71% Middle class was highly affected as compare to upper class and lower class. There was also a significant difference observed among the populations who are engaged both in education and also doing jobs for survivals. 88% of them were found frustrated and protesting against the situation of the city. The results of the current study suggest that the trauma incident by the resident population is significant. Stresses tend to be numerous and chronic. The trauma experienced correlated strongly with psycho social, somatic, PTSD symptoms and depression