Tobacco control efforts in the Gulf Cooperation Council countries: achievements and challenges

This paper reports a review into the current state of tobacco use, governance and national commitment for control, and current intervention frameworks in place to reduce the use of tobacco among the populations of the Gulf Cooperation Council [GCC] member states and Yemen. It further reviews structured policy-oriented interventions [in line with the MPOWER package of 6 evidence-based tobacco control measures] that represent government actions to strengthen, implement and manage tobacco control programmes and to address the growing epidemic of tobacco use. Our findings show that tobacco control in the GCC countries has witnessed real progress over the past decades. These are still early days but they indicate steps in the right direction. Future investment in implementation and enforcement of the Framework Convention on Tobacco Control, production of robust tobacco control legislation and the establishment of universally available tobacco cessation services are essential to sustain and strengthen tobacco control in the GCC region.

Characteristics of smokers and their knowledge about smoking at a theaching hospital in Karachi

To study the characteristics of smokers and their knowledge about smoking, among Family Practice patients, at a teaching hospital in Karachi, Pakistan. Design: A questionnaire based survey Settings: Family Practice Center, Aga Khan University Hospital, Karachi, Pakistan. Main outcome measures: Age at starting smoking, duration and number of cigarettes smoked, started smoking under influence of friends, colleagues, family members or self motivation, number of friends and colleagues who smoked, whether smoking is unhealthy, and actual chance of harm to an individual due to smoking is very rare or not. One hundred patients who visited Family Practice Center were interviewed. Sixty one% were young married men, well educated and either student, in private service, self employed or unemployed. Eighty four [84%] smokers started smoking between 16-25 years of age, and smoked 6-20 cigarettes daily for two to twenty five years. Sixty nine [69%] of them started smoking under the influence of friends and had 3-5 friends and colleagues who smoked. 91% of smokers believed that smoking is unhealthy and were aware that it causes lung cancer and heart disease. Majority of them [69%] believed that the actual harm of smoking to an individual is not very rare. We have documented the characteristics of smokers and their knowledge about smoking among Family Practice patients. Majority of the respondents started smoking at a young age under the influence of friends though they were aware of its harmful effects. Though the sample size is small but it does give an indication about the responsible factors to plan interventional preventive strategies

Awareness of the process of informed consent among family practice patients in Karachi

To study the awareness of 'Informed Consent', among patients presenting to Family Physicians. A cross-sectional study was carried out at the Community Health Centre, Aga Khan University Hospital, Karachi in July 2002. Written Consent was taken and confidentially was assured. Out of the 100 patients interviewed, 80 agreed to participate in the study, forty-four men and thirty-six women. Approximately half the participants [45%] were graduates and 40% had less than five years of school education. The awareness of the process of 'informed consent' was observed in only 20% of the respondents, all in the educational category of graduates. A lack of awareness of informed consent was observed in patients attending the Community Health Centre, Aga Khan University, despite stringent institutional policies, which are adequately followed. To improve awareness, 'Health Education Programs' for the population are required with media support. Readability of written consent forms should be of class V level or less to give advantage to the less educated classes in the society. Local languages should be utilized for written and verbal consent. Public health programs should also be aimed at educating physicians, nurses and paramedics. Provisions should be made to legalise the process of taking consent

Implications for the practice of a patient expectation and satisfaction survey, at a teaching hospital in Karachi, Pakistan

To study the expectations and satisfaction of patients visiting Family Practice Clinics, at the Aga Khan University Hospital, in Karachi, Pakistan. A cross sectional survey of 316 patients was carried out. A questionnaire, based on the study objectives was developed and administered. The participating patient signed a consent form, after assurance of confidentiality was provided. Data on the demographic profile of the patients was collected. The mean age was 33.81 years, with 105 [33.2%] women, and 211 [66.8%] men. The majority were married, with education above intermediate level and were in private or government service or were housewives. The median for the patient waiting time was 30 minutes, against an expectation of 12.69 minutes. Reading newspaper, watching television, reading magazine, reading Quran and listening to music were quoted as ways to lessen the burden of waiting to see a physician. The average consultation time with the physician was 13.89 minutes, against an expectation of 16.37 minutes. Patient expectation in terms of listening by the doctor with patience, explanation of the diagnosis and treatment, prescription of medicines, ordering of investigations and specialist referral has been documented. Objections to the presence of medical student, nursing student, resident doctor, nurse and an observer, in the consultation room have also been documented. Reasons quoted for the objection include issues of privacy/confidentiality, lack of justification, discomfort, and interference with the consultation process. The expected average cost for doctor's consultation was Pakistani Rs. 124, while 196 [61.8%] of the respondents were satisfied with the consultation based on Rs. 70. We have collected important information to improve the services offered at our Family Practice clinics

Physician assisted suicide perceptions among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan

OBJECTIVE: To study the perceptions on physician assisted suicide, among patients presenting to family physicians, at a teaching hospital in Karachi, Pakistan. METHOD: The study was carried out at the Community Health Center of The Aga Khan University Hospital, Karachi, between December 1999 and May 2000. The principal and co-investigators filled a pre-coded and pretested questionnaire consisting of important demographic characteristics and bio-medical ethics issues. A system of convenience sampling was used and a written consent was taken from respondents over the age of 16 years, who agreed to participate. The data were managed by using the Epi Info [version 6.0] program. Four hundred twenty respondents were interviewed against an estimated sample size of 385. Majority [88%] were males between 25 and 34 years of age, and were self employed or in private service. Overall 9% respondents were advocated of physician assisted suicide, advocates was 9%. Those who advocated the Physician assisted suicide were more likely to be female, elderly, married and educated amongst the total respondents. Those who support Physician assisted suicide were less likely to attach divine qualities to physicians and were more bold, courageous and tolerant towards broader biomedical ethics issues. We have found a substantial acceptability to the idea of Physician assisted suicide in a Muslim society and have identified characteristics of those who support it