Effectiveness of media awareness campaigns on the proportion of vehicles that give space to ambulances on roads: An observational study

Background and Objective: The findings of the Health Care in Danger project in Karachi suggests that there is presence of behavioral negligence among vehicle operators on roads in regards to giving way to ambulances. A mass media campaign was conducted to raise people's awareness on the importance of giving way to ambulances. The main objective of this study was to determine the effectiveness of the campaign on increasing the proportion of vehicles that give way to ambulances

Methods: This was a quasi-experimental study that was based on before and after design. Three observation surveys were carried out in different areas of the city in Karachi, Pakistan before, during and after the campaign by trained observers who recorded their findings on a checklist. Each observation was carried out at three different times of the day for at least two days on each road. The relationship of the media campaign with regards to a vehicle giving space to an ambulance was calculated by means of odds ratios and 95% confidence intervals using multivariate logistic regression

Results: Overall, 245 observations were included in the analysis. Traffic congestion and negligence/resistance, by vehicles operators who were in front of the ambulance, were the two main reasons why ambulances were not given way. Other reasons include: sudden stops by minibuses and in the process causing obstruction, ambulances not rushing through to alert vehicle operators to give way and traffic interruption by VIP movement. After adjustment for site, time of day, type of ambulance and number of cars in front of the ambulance, vehicles during [OR=2.13, 95% CI=1.22-3.71, p=0.007] and after the campaign [OR=1.73, 95% CI=1.02-2.95, p=0.042] were significantly more likely give space to ambulances

Conclusion: Mass media campaigns can play a significant role in changing the negligent behavior of people, especially when the campaign conveys a humanitarian message such as: giving way to ambulances can save lives

Effect of leadership styles on job satisfaction among critical care nurses in Aseer, Saudi Arabia

Objective: To evaluate the effect of transformational and transactional leadership styles of head nurses on the job satisfaction of staff nurses in critical care units [CCU] of a tertiary care hospital

Study Design: Cross-sectional study

Place and Duration of Study: Critical care units at Aseer Central Hospital [ACH], Abha, Saudi Arabia, from July to December 2012

Methodology: The multifactor leadership questionnaire [MLQ-5X] and job satisfaction survey with demographics were used. Staff nurses [N=89] reporting to 8 nurse leaders responded as per the requirements of MLQ-5X and also filled the job satisfaction survey. ANOVA, correlation coefficient [Pearson r] and multiple linear regression were used for analyses

Results: All nurse leaders demonstrated a combination of transactional [TA] and transformational [TF] style of leadership. Nurses working under leaders with a TF style demonstrated significantly [p < 0.05] higher job satisfaction. The operating conditions were related negatively to the style of leadership. Pay, fringe benefits and nature of work were not related to the style of leadership. The nurses were moderately satisfied with their work and 23% of the variation in nurses' job satisfaction could be explained by the head nurses 6 leadership facets with positive effect of professional support, intellectual motivation, management by correction and their laissez faire style

Conclusion: The study emphasized the importance of TF style of head nurses for increasing staff nurses' job satisfaction. It is suggested that nurse leaders should be trained in TF style of leadership and provided more support and training for effective management of CCU

Problem-based learning in medical education: theory, rational, process and implications for Pakistan

Historically, lectures were the medium to transfer cognitive information to the learners in medical education. Apprenticeship training, labs, bedside teaching, tutorials etc. were used to impart psychomotor and affective skills. It was assumed that the learner will assimilate all this knowledge and will be competent to apply this learning in practical life. Problem-based learning [PBL] emerged due to problems in building the appropriate competencies in the medical graduates and is a relatively newer mode of transfer of knowledge. This paper will deal with problem-based learning which took the world with storm in the So's and most institutions in the world started using different variants of PBL. This paper attempts to define and explore the theoretical basis and historical background of PBL. The paper will systematically review literature and argue about the advantages and disadvantages of PBL and the implications of its implementation in Pakistan

Anxiety and depression in pre-operative catractectomy patients: a pilot study

The objective of this study is to use the hospital anxiety and depression scale which is a valid scale to rule out whether these patients are undergoing anxiety or depression prior to surgery. A random surveillance [prospective]. The department of psychiatry conducted a random survey of all the patients reporting for cataract elective surgery in the Department of Ophthalmology during the months of August and September 2004. In total 52 patients were interviewed, after informed consent out of which fourteen had clinical levels of anxiety where as fourteen had depression. All these patients were rated on a standardized urdu version of hospital anxiety and depression scale. Those suffering from anxiety there were ten females and three males whereas depressed were six males and nine females. In all there was a morbidity of twenty-seven cases out of fifty-two which had either anxiety or depression. Local studies as well as international studies carried out have indicated the importance of recognizing and intervening before surgery. This is to enhance recovery and achieve level of satisfaction in surgery patients. The limitation of this study was the small number of cases selected to conduct the study. Anxiety and depression is very common in patients undergoing surgery. Reassurance and counseling is necessary before surgery

Hospital waste management in the teaching hospitals of Karachi

To evaluate the current practices of segregation approaches, storage arrangements, collection and disposal systems in the teaching hospitals of Karachi. A cross-sectional survey was conducted in eight teaching hospitals of Karachi, using convenient sampling technique. The instrument of research was a self administered questionnaire, with four sections, relating to the general information of the institution, administrative information, information regarding Health Waste Management personnel and a check-list of Hospital Waste Management activities. Out of eight hospitals visited 2 [25%] were segregating sharps, pathological waste, chemical, infectious, pharmaceutical and pressurized containers at source. For handling potentially dangerous waste, two [25%] hospitals provided essential protective gears to its waste handlers. Only one [12.5%] hospital arranged training sessions for its waste handling staff regularly. Five [62.5%] hospitals had storage areas but mostly it was not protected from access of scavengers. Five [62.5%] hospitals disposed off their hazardous waste by burning in incinerators, two [25%] disposed off by municipal landfills and one [12.5%] was burning waste in open air without any specific treatment. No record of waste was generally maintained. Only two [25%] hospitals had well documented guidelines for waste management and a proper waste management team. There should be proper training and management regarding awareness and practices of waste disposal. Research must be undertaken to seal existing gaps in the knowledge about hospital waste management. The hospital waste management guidelines enacted on 7th June 2004 should be followed and regulated by law enforcement agencies rigorously [JPMA 55:192;2005].

Association of anemia with parasitic in pregnant Nepalese women: results from a Hospital - based study done in eastern Nepal

Anemia is a major contributor to maternal deaths in developing countries. Association of anaemia with helminthic infestations has been seen in the world and by eliminating it, anemia may be reduced with positive effects on maternal outcome. Methodology: A comparative cross-sectional study was done to assess the association of anemia with parasitic infestation, and other significant risk factors in eastern Nepal. One hundred and twelve pregnant women with and without anemia were enrolled in the study at the antenatal clinic at Dhankuta District Hospital, Nepal from May 2001 to July 2001. The data on social and demographic variables was collected through a structured questionnaire. Hemoglobin estimation and stool examination for parasitic infestation was done for all these women. Anemia was found in 66 [58.9%] women and 52 [46.5%] had helminthic infestation. Anemia was significantly related to hookworm infestation. There was a highly significant relationship between education and the knowledge of women regarding effect of helminthic infestations [P<0.000], transmission and spread of infestations [P<0.000]. The knowledge of women regarding effect of helminthic infestation was significantly [P<0.001] related to the occurrence of parasitic infestations but its association with anaemia was not significant. Hookworm infestation in pregnancy was significantly related with anaemia. Hence all women coming to antenatal clinics should be screened for hookworm infestation. The antenatal care should include de-worming with correction and prevention of anaemia

Health and safety measures available for young labourers in the cottage industries industries industries of Karachi

To determine the health problems faced by labourers, 18 years and under, working in the cottage industries of Karachi and know the safety measures available and utilized at these places. Cross-sectional study using two-stage cluster sampling. From February 2002 to March 2003, 95 cottage industries from 10 different locations of five districts of Karachi were included. All workers, 18 years and below, present were interviewed. The environmental and safety gadgets present at the industry were inspected by the surveyors and the manager was interviewed for presence of health and safety benefits for the workers. A total of 280 workers were interviewed, 26 [9.3%] children were between 9-12 years, 82 [29.3%] were between 13-15 and 172 [61.4%] were between 16-18 years of age. Health benefit was given to only one 13-year-old worker in silk industry; appropriate gadgets were absent in 93 [97.8%] industries, present only in 2 industries [one silk and one loom]. First Aid box was present in only one loom industry. Two hundred and forty workers [85.7%] were unaware of the materials they were using. One hundred and ninety-three [69%] children were working in improper light, 199[71%] workers experienced high level of noise, 232[83%] were working in high temperature and 155[55.3%] were working with improper ventilation. Health problems faced included joint pains [n=64, 22.85%], backache [n=85, 30.35%], vertigo [n=48, 17.14%], numbness of fingers [n=77, 27.5%] and fatigue experienced by 143 [51.07%] children. The children and adolescents employed in cottage industry are suffering from health problems due to lack of knowledge on their part, and improper ergonomics, environmental and safety conditions at the workplace. The cottage industry should be regulated and brought under labour law. The health sector non-governmental organizations should make concerted efforts for the rehabilitation of this workforce by creating awareness and providing opportunities for education and development of skills

Comparison of an integrated problem-based learning curriculum with the traditional discipline-based curriculum in KSA

To compare the integrated problem-based learning [PBL] curriculum of the third year medical students of KSU at the Al-Qaseem campus with the traditional discipline-based teaching curriculum of students of Riyadh campus. A comparative cross-sectional study. Al-Qaseem and campuses of King Saud University [KSU]. A structured questionnaire was used for comparing the students of third year at both campuses of KSU. The student's learning behaviours and their liking for teaching methodologies was evaluated from March to June 2003. There were 138 3rd year students of Riyadh campus [59 females and 79 males] and 65, of Al- Qaseem campus [17 females and 48 males] [N=203]. Fifty-eight percent of students' at Al-Qaseem campus went to the library two or more times compared to 3.4% of the Riyadh campus [P =0.000], 18.5% of Al-Qaseem campus used Journals [P =0.000], and 86% did self-learning [P =0.000], which was much higher than the students' at Riyadh campus. Almost 75% students at Al-Qaseem campus were satisfied with their system of education compared to 20% at Riyadh campus [P =0.000]. Sixty-nine percent students at Al-Qaseem campus answered problem-solving questions correctly versus 7.25% of the students at Riyadh campus. The students of both campuses liked group teaching almost equally and thought it makes them remember better. The Al-Qaseem campus students liked PBL, clinical skills lab, tutorials, and also lectures delivered at the college. PBL improved the students' usage of learning resources, problem-solving abilities and they were satisfied with their learning and the curriculum

Introducing problem - based learing in a medical school with traditional / conventional curriculum

Globally, over the last two decades, medical education and its learning strategies are being made more prone to problem-solving in order to produce better clinicians. The medical curriculum has not changed in Pakistan since its inception and that is reflected in the form of inadequacies in health delivery system. There is a dire need of creating relevance between medical education / training and medical practice in order to introduce an effective health care system. This study is particularly aimed at evaluating the effect of problem-based learning [PBL] in a group of students accustomed to conventional teaching and to assess any change in students' attitudes/learning abilities after repeated PBL interventions. Design: An interventional study. Subjects and Response of 32 students of fourth year MBBS of Karachi Medical and Dental College was recorded against two PBL exercises in September 2002. A significant change in the study trend and analytical ability [p < 003] was shown in the two PBL sessions. The students who liked PBL were 33% more prone to practice group-study [OR = 1.33 and 95% CI=1.28, 1.39] than those who preferred other modalities of teaching. The final professional grades of these students were significantly higher than those in the previous years [p < 0.000]. A strong association between liking for PBL and group study was found and the analytical performance and thought process of students were significantly improved after the second PBL session

Health problems of the cotage industry workers

The purpose of this study was to observe the general environmental conditions of the cottage industry and the health problems faced by the workers. Design: Cross-sectional study using convenience sampling Place and Duration of study: Cottage industries located in the residential area of Korangi were visited. Six industries were visited and all the available 24 workers were interviewed through a structured questionnaire with both open- and close-ended questions. The level of noise was above 95 decibels particularly in the injection plastic industry and temperature in all the industries was above 380 C; more so in the injection plastic and toys industry. The majority of the workers were females and children aged 10-18 years. The work ergonomics varied significantly in all the industries [p<0.003] and ranged from standing to bending for long hours The major symptoms of the workers included Lack of concentration [33.3%], headache [37.5%], fatigability [39.2%], reduced appetite [25%], Backache [29.2%], numbness [33.3%], joint pains [33.3%], vertigo [29.2%], and cough [16.7%]. All these complaints were not related to the type of industry and majority [91.7%] of the workers in all industries had no knowledge of the adverse effects of the material that they were using. Conclusions: The study suggests that this neglected industry needs to be covered under the labour laws and the workers particularly females and children should be protected from adverse effects of the chemicals used

Is the admission test at institute of business administration a good predictor of final professional test grades?

To assess the predictor validity of the IBA admission test for academic performance of MBBS and BDS students at KM and DC. Setting: Karachi Medical and Dental College results of admission test and final professional exams were used for analysis. Methodology: Data based study using the results of first three batches of KM and DC which graduated in 1997, 1998 and 1999. Data was entered on SPSS-8 and correlation and regression analysis was done on the same. The average IBA score was 68.52 and final professional score was 1730.78 for 116 MBBS students. The correlation co-efficient R was.057 meaning weak or no relationship and when IBA score was used as a predictor, it was not significant [P=0.544]. The results of 30 BDS students was that their average IBA score was 66.97 and final professional score was 509.7. The results were correlated and R was -.172 meaning negative weak or no relationship, and when IBA score was used as a predictor, the B came out to be -.971 that was not significant [P=0.364]. Conclusions and suggestion: These results show that there is no significant positive relationship between the IBA scores and the academic achievement of MBBS students. For the BDS students, there is a negative relationship between the IBA scores and the academic achievement. Hence, we need to revisit the admission test and look at the instrument itself to see which sections of the test are good predictors and how can they be improved

Does training affect quality of diarrhoea case management

Improvement in diarrhoea case management through training of health care providers in the government and the private sector was the key element of diarrhoea policy in Pakistan in 1989. Numerous training sessions were organized by the Child Survival project. The aim of this project was to look at the effect of training on quality of diarrhoea case management at the oral rehydration therapy [ORT] corners and diarrhoea treatment units [DTUs] of Sindh. A systematic random sample of 62 ORT corners and DTUs in Sindh was assessed using the WHO drafted Health Facility Survey manual. It was observed that the trained health providers were better in taking history for blood in stools [P < 0.004] and other illnesses [p < 0.000]. For assessment of dehydration, no significant difference [p < 0.933], was found between trained and untrained health providers. Trained were better than untrained [p < 0.035] only in treatment 'Plan A' and correct rehydration [p < 0.004] of child at facility. Training did not influence advising mothers for home case management. Thus diagnosis was good and training did improve the quality of assessment of child but treatment [inclusive of advice giving] was not significantly affected by training, except for a child with no dehydration. It is recommended that on the job training should emphasize on skills for management of diarrhoea. Further studies are needed to identify why inspite of training. Health providers do not offer better treatment than the untrained ones

Supervision for diarrhoea case management at the oral rehydration therapy corners anddiarrhoea training units in Sindh

The role of supervisors in diarrhoea case management at the Oral Rehydration Therapy [ORT] corners of Sindh was assessed by a random sample of 62 ORT corners in rural and urban areas of Sindh. The supervisors at each facility included, Medical Superintendents, District Health Officers, Senior Medical Officers, Civil Surgeons and Medical Officers. In 65% cases the supervisors were working at the same facility and in 35% the supervisors were based elsewhere. In 33.7% cases, there had been no meeting with the supervisor in the past 3 months which incidently was the diarrhoea season. In 6.5% cases there had been only 1 meeting, in 8.5% there had been 2-3 meetings and in the remaining 41.3% cases there had been more than 3 meetings with the supervisor. In majority of the cases the supervisors did not do anything related to improvement of diarrhoea case management. Supervisors had given some importance to case management in the urban areas and the Diarrhoea Training Units [DTU]. The supervision at ORT facilities was found to be at a rudimentary level and it is suspected that this might be adversely affecting the quality of diarrhoea case management