Insomnia and its correlates among elderly patients presenting to family medicine clinics at an academic center

@#Objective: The objective of this study is to determine the frequency and correlates of insomnia among elderly patients presenting to family medicine clinics at an academic center in Karachi, Pakistan. Study design: This is a cross-sectional study. Place and duration of study: The study was conducted at the Outpatient Family Medicine Clinics at Aga Khan University Hospital between February 2013 and June 2013. Methodology: Patients 60 years old and above were recruited (n=152) through non- probability consecutive sampling. Information was collected on a pretested structured questionnaire on demographics, insomnia symptoms, medical co-morbidities, lifestyle factors and sleep disorders. Data was analyzed on SPSS 19. Proportions and the Chi-Square test were used in the analyses, along with binary logistic regression. Results: The mean age of the participants was 65.68 years, and 38.80% of the participants were male and 61.20% were female. The prevalence of insomnia was 42.1%. It was more common in women than in men (64.10% vs. 35.9%). Increasing age [ORadj: 4.54; 95%CI: 1.85-11.17], being divorced/widowed [ORadj: 10.26; 95%CI: 2.79- 37.73] and having an average household income of over Rs.50, 000, were significantly related to insomnia. The other factors associated with insomnia were Gastro Esophageal Reflux Disease [ORadj: 4.30; 95% CI: 1.67-11.04], depression [ORadj: 2.88, 95% CI: 1.13-7.33], caffeine consumption [ORadj: 6.50; 95% CI: 2.27-18.57], and cigarette smoking close to bed time [ORadj: 4.78; 95% CI: 0.88-25.90]. Conclusion: The study showed that older adults with multiple diseases were at high risk of insomnia. Certain life style practices enhanced the risk; hence, physicians should incorporate sleep history and tailor treatment to target both insomnia and related factors to optimize quality of life.

Predictive Validity of Family Medicine Resident's Performance at Induction with Their Future Performance During Residency

Objective: To determine the predictive validity of induction assessment scores of family medicine residency program for performance in final year of residency. Study Design: Psychometric [predictive-validity] study

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 2008 to 2014

Methodology: All family medicine residents were evaluated

Family Medicine Residency induction assessment scores were used as independent predictor variables, whereas resident assessment scores during the final year residency program were used as dependent or outcome variables. Data was analyzed using SPSS version 19. Linear regression was used to determine predictive validity of induction scores as independent variables with outcome variables at 95% confidence level

Results: There were 33 residents. MBBS scores accounted for 30.1% of variance in final year Objective Structured Clinical Exam [OSCE] scores; whereas, induction written test accounted for 37.1% of variance in final year written test. Induction communication skill scores did not correlate with in-training communication skill scores or with the final year OSCE scores. Induction professionalism scores accounted for 13.7% of the variation in final year OSCE scores, but not with in-training continuous professionalism scores

Conclusion: Induction knowledge scores have acceptable predictive value for future knowledge and its application. Other valid and reliable assessment methods, such as multiple mini-interviews, should be explored for assessment of non-cognitive domains at induction

change in trainee physicians' knowledge and comfort levels with obstetric emergencies following ALSO training

The Advanced Life Support in Obstetrics [ALSO] is a course in emergency obstetrics to help physicians and other health care providers develop and maintain the knowledge and skills to effectively manage potential obstetric emergencies. This course was held for the first time in Pakistan at the Aga Khan University in September 2003. This study was conducted to evaluate the improvement in knowledge and comfort level of physicians-in-training [interns, family medicine, obstetric and emergency room residents] in dealing with emergency obstetrics after undergoing the course. After informed consent, study subjects were administered a written test and asked to complete a questionnaire 10 days before and immediately after taking the ALSO course. Level of comfort in handling obstetric emergencies was assessed using a three-point Likert scale. A total of 38 trainees participated in pretest, ALSO course and subsequent post-test. Eleven were males and 27 were females. The comparison of the pre-test and post test showed a significant increase in the knowledge. The mean difference between the scores was 24 and the paired t-test done showed there was a highly significant difference between the scores [t=18.8, p= <0.001]. There was also a significant improvement in the comfort level for handling emergency obstetrics. Following the ALSO course all participants said they would recommend the course to others. The ALSO course is a valuable teaching intervention that improves not only knowledge but also perceived comfort levels of emergency obstetrics among interns and residents in a developing country

Diagnosis and management of allergic rhinitis in adults

Allergic Rhinitis is a common condition seen in family practice, though prevalence data from Pakistan is lacking. Classification is based on severity of symptoms. Patient education and medications such as oral anti-histamine and intranasal corticosteroids are the mainstay of treatment. Medications like pseudoephdrine help with nasal congestion but have to be used with caution in people with heart disease

Distribution of lower urinary tract symptoms [LUTS] in adult women

To determine the distribution of lower urinary tract symptoms in adult women and the frequency with which the women consulted a health care provider for their symptoms. Design: Cross-sectional analytical study. Place and Duration of Study: Community Health Center of Aga Khan University Hospital from November 1st to 30th, 2002. Subjects and A trained interviewer administered a structured questionnaire to women patients or attendants aged 18 years and older coming to the center. Fifty-two% of the study subjects reported having at least one or more urinary complaints in the past. Stress incontinence was the highest reported complaint [38.4%] followed by burning [34.4%], frequency [26%], painful micturition [20.4%], urge incontinence [18.8%], incomplete emptying of bladder [14.4%], dribbling [12.4%] and poor stream [8.4%]. Forty-three% of the women with LUTS never consulted a health care provider for their problem. Although the distribution of LUTS among females was found to be high, the patients did not consider it important enough to consult a health care provider. There is a need to create awareness among females regarding LUTS and the need to consult a health care provider for their problems

Comparison of job satisfaction and stress among male and female doctors in teaching hospitals of Karachi

Background: Job dissatisfaction and stress among doctors affect the quality of health care. We assessed the levels of satisfaction for workplace characteristics and job stress among doctors of three teaching hospitals in Karachi

Methods: A postal-survey was conducted between May to June 2002. Satisfaction for workplace characteristics and stress were inquired and graded by Likert scale [1=very low to 5= very high]. Questions were also asked about its affect on their lives. In order to calculate the differences in means of job satisfaction and stress score by sex of doctors, chi-square and t-test with 95% confidence interval [CI] were used. Out of 270 doctors approached conveniently, 189 [70%] responded and 182 questionnaires were found complete for analysis

Results: Majority [68%] of the doctors was not satisfied with their jobs. Overall, the mean scores for satisfaction were low for workplace characteristics. Lowest scores were found for pay and benefits 2.12 [SE 0.8], safety and security 2.15 [SE 0.8] and workload 2.69 [SE 0.9]. Female doctors had significantly lower satisfaction about workload [mean job satisfaction score difference = 0.60; 95%CI, 0.24-0.97], relation with colleagues [mean job satisfaction score difference = 0.49; 95%CI, 0.11-0.87] and autonomy [mean job satisfaction score difference = 0.45; 95%CI, 0.07-0.82] as compared to their male counterparts. Overall, 48% of doctors graded job stress from high to very high levels

Conclusion: Majority of doctors working at these teaching hospitals of Karachi had poor satisfaction level for workplace characteristics and higher levels of job stress. This suggests that immediate steps should be taken for their control and management. This study invites further research to explore, implement and evaluate intervention strategies for prevention of stress and improvement in job satisfaction

Physical exercise as a key health determinant among patients

Physical exercise is among the key determinants of health. The role of physical exercise in health promotion was well known to the ancient Chinese. Even moderate activity such as daily brisk walking for 30 to 60 minutes, is associated with significant reductions in the incidence and mortality of cardiovascular disease. Benefits of increased physical activity have been shown among patients with hypertension, diabetes mellitus, and dyslipidemia. Therefore, a need was identified to study the perceptions and practice concerning physical exercise among patients in Karachi, Pakistan. A questionnaire based cross-sectional survey was conducted at the Family Practice Center, The Aga Khan University Hospital, Karachi, from March to July 2002. A total of 393 patients were surveyed. This is a short Communication