Outcome of dietary intervention on weight and Anthropometric indices of overweight and obese females: a randomized controlled trial

Objective: To study impact of dietary intervention and counseling on weight and anthropometric indices of obese females

Study Design: Prospective randomized controlled trial

Place and Duration of Study: This study was conducted at Pakistan Navy Ship [PNS] Shifa, from Feb 2014 to Sep 2014. Patients and Methods: Study subjects were 320 obese females from Karachi, Pakistan, aged 20 to 40 years. Before randomization all baseline anthropometric measurements were recorded. After that females were randomly placed into intervention and control groups. Anthropometry and 24-hour dietary recall were used for nutritional assessment. Intervention strategy was individualized diet plan by registered dietitian according to base line body weight and anthropometric indices of study subject. Primary outcome was the change in body weight and body mass index

Results: The final analysis was run on 280 participants [intervention=127, control=153]. Both intervention and control group were comparable with respect to anthropometric variables at start except intervention group had more body mass index [BMI] [28.024 +/- 3.561]. A significant change was observed in body weight [p=0.001], BMI [p=0.001], waist circumference [p=0.001], hip circumference [p=0.01], waist hip ratio [p=0.04] in an intervention group while control group only showed significant reduction in waist circumference [p=0.041]. Intervention group showed significant improvement in dietary behavior which was depicted by increased intake of fruit and fiber consumption [p=0.001], reduction in consumption of simple carbohydrates [p=0.001], animal protein [p=0.001] and fatty food [p=0.001]. Control group showed decrease in waist circumference in response to reduction in dietary fat intake and increase intake of fruits [p=0.001] and vegetables [p=0.042]

Conclusion: The results of our study have positively demonstrated that nutritional intervention among obese females was successful in reducing weight and BMI. Reduction inwaist and hip circumference and change in diet behavior were also observed as secondary outcome variable

Assessment of functional health literacy among adolescents of model schools of Islamabad

Objectives: To assess the functional health literacy among adolescents of Model schools of Islamabad. To determine association between health literacy and health seeking behaviour of adolescents. Study Design: Cross sectional descriptive study

Material and Methods: Multi stage systematic sampling was done and a sample size of 350 using WHO sample size calculator. After taking informed consent from the students data were collected using the newest vital sign [NVS] for assessment of functional health literacy. Data were analyzed using SPSS version 22. Place and duration of study: The study was conducted in Model schools of Islamabad, from Jan to Dec 2016

Results: The mean age of the respondents was 15 [SD +/- 0.6] years. There were 181 [52%] females and 169 [48%] males in the study. Out of 350 respondents 73 [20.9%] had very limited health literacy, while 187 [53.4%] had limited while 90 [25.7%] had adequate health literacy. In health seeking 30 students [8.6%] scored 1-2 on the health seeking behaviour score of 1-6 and therefore were categorized as having poor health seeking behaviour. While 164 students [46.9%] scored 3-4 and were categorized as having satisfactory health seeking. One hundred and fifty six students [44.6%] scored 4-5 and had good health seeking behavior

Conclusion: The health literacy among the adolescents was limited and had no association with health seeking behaviour

Awareness of antimicrobial resistance from one health perspective and its relation to social determinants in residents of Wah

Objective: To assess the awareness about antimicrobial resistance [AMR] and the various aspects of AMR from a one health concept in relation to social determinants in residents of Wah. Study Design: Cross sectional-analytical study. Place and Duration of Study: One year from Jan to Dec 2017 in Wah, Pakistan

Material and Methods: A total of 400 participants completed the questionnaire, aged 16 years and older. A probability sampling technique was used and Chi-square test of significance was applied to determine the relationship between social variables with dependent variables, p-value <0.05 was taken as significant

Results: The phrase 'antibiotic resistance' was known to 52.5%, and 19.8% heard 'antimicrobial resistance'. The term least heard was 'superbugs' [9.5%]. The most cited source of information was 'doctor' followed by 'media.' Results showed that 67.3% believed that health of people is connected to the health of animals and environment, 62% agreed that collaborative efforts could achieve the best health of people and environment

Conclusion: The awareness related to the causes and spread of antimicrobial resistance came out to be quite low, and the outcomes were found to be associated with gender, age, education, occupation and socioeconomic status. Participants had many misconceptions about various aspects of antimicrobial resistance. Public awareness of AMR was low in all occupational groups, and the results show that high education level, high socioeconomic status, and healthcare-related occupation marked a higher level of knowledge about AMR awareness

Non-communicable diseases in Pakistan; a health system perspective

Global shifting of disease burden from communicable to non-communicable diseases [NCDs] has led to large proportion of deaths in developed and developing countries. Gravity of the situation is further intensified in low and middle-income countries due to major health system inadequacies in responding to the emerging challenge. Similar situation is being faced by Pakistan where despite availability of comprehensive National Action Plan, no significant improvement is seen at policy level. Prior to development of any intervention, there is need to assess the issue of NCDs through health system perspective. This will help us to understand interplay of various factors crucial for health system's response to NCDs. World Health Organization [WHO] framework of six building blocks will help us in identification of bottlenecks in our system and areas that are not performing well. Gaps and inadequacies in the system can be tackled through appropriate measures like development of knowledge, skills, system thinking and leadership to enable our system to respond to NCD challenges effectively and efficiently. Political commitment, good financing, collaborative working, comprehensive integrated NCD plan, team-based services to patients through care pathways, incorporation and incentivization of general physicians, efficient logistics support, integrated health information system with development of population based surveillance system and use of multi-sectorial and holistic approach can lead to efficient control of NCDs in the country

Does playing video games effect cognitive abilities in pakistani children?

Objective: To find out the effect of playing video games on cognitive abilities among teenagers

Methods: A comparative cross sectional study was conducted at two schools in Rawalpindi from August 2014 till February 2015. A sample size of 171 was calculated by using WHO sample size calculator using non-probability convenient sampling technique. A mixed questionnaire was used as a data collection tool and two groups were defined as video gamers and non-video gamers. Video gamers were those students who were using video games for two hours or more. Cognitive ability of the students were assess by standardized questionnaire named Wonderlic Cognitive Ability Test Questionnaire. Data were entered and analyzed in SPSS version 20

Results: There were 93 [54.4%] gamers whereas 78[45.4%] were non-gamers. Mean age of the participants was 18.86 +/- 1.46 years. Gamers with correct answers to knowledge, analogy, processing speed, deductive reasoning, mathematical intelligence were 57[61.3%], 67[72%], 68 [73%], 58 [62.4%] and 73[78.5%] respectively. Significant association was found between gamer status and gender [p=0.023], analogy [p=0.049], processing speed [p<0.001], deductive reasoning [p=0.003] and mathematical intelligence [p<0.001]. There was no significant association of gamer status with knowledge [p=0.188]

Conclusion: Gamers exhibit better range of cognitive abilities specifically involving analogy, processing speed, deductive reasoning and mathematical intelligence. In this study, those who play video games on long term basis, showed improvement in cognitive abilities, in comparison to those who do not indulge in gaming activities

Usability of hospital management system in clinical work physician's perspective

Objective: To assess effectiveness of hospital management system in clinical work in military hospitals: physicians' perspective

Study Design: Descriptive cross sectional study

Place and Duration of Study: Military hospitals of Rawalpindi, from Apr 2013 to Jun 2014

Material and Methods: Sample selected through convenient non probability sampling. Sixty-one [61] physicians in clinical work: 23 [38%] specialists and 38 [62%], Health Care Administrators [HCAs] were included in the study. Tools used were questionnaire, interviews, think aloud protocol, log book analysis and chart reviews

Results: More than 50% of respondents agreed that hospital management system in clinical setting lacks appropriate attributes. System is not customized to the needs of each specialty and doesn't support the continuity of care. It does not support evidence based decision making since it lacks clinical decision support system. Majority of physicians expect their clinical HMS to provide better support for collecting statistics for research. Most respondents agreed that HMS often diverts attention away from the patients and physicians [worked around] the system due to number of cofounders like lack of time, increased number of patients. Chart review revealed majority did not add alerts

Conclusion: This study has highlighted a significant number of usability issues which are on one hand lessening the effectiveness and efficiency of this system; while at the other hand leading to user frustration. These findings call for usability evaluations at all levels and the subsequent redesign of HMS application leading to a usercentered design which is effective in providing physicians with key functionalities which support physician's tasks and improve patient care

Birth preparedness and complication readiness: a cross sectional survey from expectant mothers visiting a rural health center

Objective: To assess level of awareness of expectant mothers about their birth preparedness and complication readiness [BPACR]

Study Design: Descriptive cross sectional study

Place and Duration of Study: It was a descriptive cross sectional study conducted at a Rural Health Center, Mandra over period of six months, from Sep 2016 to Feb 2017

Material and Methods: Three hundred and twenty pregnant women of rural area of residence in their third trimester [29-40 wks] were approached using non probability convenient sampling. They were interviewed by using a structured questionnaire after taking informed consent. SPSS version 20 was used for data entry and analysis. A p-value <0.05 was considered statistically significant

Results: The mean age of the participants was 29.02 +/- 6.403 years. All the 320 participants were from rural area of residence. The knowledge of elements of BPACR was highest [7 out of 8] in only 26 [8.1%] women followed by 6 elements in 47 [14.7%], 5 elements in 78 [24.4%], 4 elements in 83 [25.9%]. There was significant number of females who had poor knowledge of only 3 elements 69 [21.6%]. Overall 45% of pregnant women knew 5 or more elements were well prepared while 55% were less prepared regarding birth and related complications. Participants' education and husbands' monthly income was found to be significantly associated with birth preparedness and complication readiness knowledge [p-value<0.05]

Conclusion: The majority of expectant mothers were well prepared for the birth and were also aware of the danger signs of pregnancy. Antenatal visits were taken by majority of the participants. However arrangements for transportation, financial support and blood donor identification were not satisfactory