Intimate-partner violence and its association with symptoms of depression, perceived health, and quality of life in the Himalayan Mountain Villages of Gilgit Baltistan.

STUDY OBJECTIVES: We aimed to estimate the prevalence of intimate partner violence (IPV) and associated risk factors in married women in rural villages of Gilgit Baltistan in Pakistan. METHODS: A cross-sectional design to assess the magnitude and factors associated with IPV in a random sample of 789 married women aged 18-49 years. A World Health Organization screening instrument was used to assess the presence of IPV in the previous 12 months. A locally validated instrument was adopted to identify self-reported symptoms of major depression according to the DSM IV. Trained nurses obtained socio-demographic and reproductive history through structured interviews. Bivariate and multivariable logistic regression analyses were used to estimate prevalence and identify significant predictors of IPV. RESULTS: The mean age of the participants was 38.3 years (SD: ±12.8). The prevalence of IPV in women was 22.8% (95% Confidence Interval: 20.0-25.9), 18.5% in pregnant women (95% CI: 11.7-27.9) and significantly associated with depression in 55.1% of IPV cases. Husband education level (college/higher) (Adjusted Odds Ratio: 0.40; 95%CI: 0.22-0.70) and high household income (AOR: 0.44; 95% CI: 0.29-0.68) were protective against IPV. Increase in age (AOR;1.02; 95% CI: 1.01-1.02) and poor relationship with mother-in-law increased the risk of IPV (AOR = 2.85; 95% CI: 1.90-4.28). IPV was positively associated with symptoms of depression (AOR = 1.97; 95% CI:1.39-2.77), poor perceived quality of life (AOR = 3.54; 95% CI: 1.90-6.58) and poor health (AOR = 2.74; 95% CI: 1.92-3.92). CONCLUSION: IPV is substantial public health burden significantly associated with depressive symptoms, poor perceived health and the quality of life.

Child maltreatment and neglect in the United Arab Emirates and relationship with low self-esteem and symptoms of depression.

OBJECTIVES: To our knowledge, this study is the first in the United Arab Emirates (UAE) to investigate the prevalence of child maltreatment in relation to depressive symptoms and self-esteem. STUDY DESIGN: Exposure to physical maltreatment, emotional abuse and neglect was evaluated in 518 adolescents (86% response rate) randomly selected from schools in Al Ain in the Emirate of Abu Dhabi. The Rosenberg self-esteem scale and the Beck Depression Inventory were used to measure self-esteem and depressive symptoms by using multivariate logistic regression analyses. RESULTS: The mean age of study participants was 14.3 years. Emotional abuse was the most frequent form of maltreatment (33.9%), physical abuse (12.6%) and neglect (12.1%) followed. Male sex was a positive predictor of physical abuse (OR = 2.12; 95% CI 1.18-3.77), whilst higher maternal level of education was protective (OR = 0.40; 95% CI 0.19-0.86). Daily screen time (OR = 2.77; 95% CI 1.17-6.56) and tobacco smoking (OR = 1.86; 95% CI 1.09-3.18) positively predicted emotional abuse. Emotionally maltreated and neglected participants were less likely to report high level of self-esteem and more likely to report symptoms of depression. CONCLUSIONS: Child maltreatment in the UAE is of a similar magnitude to what reported in other countries around the world and significantly associated with low self-esteem and depressive symptoms.

Leaving Against Medical Advice From In-patients Departments Rate, Reasons and Predicting Risk Factors for Re-visiting Hospital Retrospective Cohort From a Tertiary Care Hospital.

BACKGROUND: Approximately 1% to 2% of hospitalized patients get discharged or leave from the hospital against medical advice and up to 26% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital. METHODS: Retrospective cohort study on patients admitted in all departments at our institute over a 1-year period. All patients who were admitted to an in-patient ward at the hospital and who left against medical advice by submitting a duly filled LAMA form were included. Univariate and multivariate logistic regression models with forward selection methods were employed. Revisit to hospital within 30 days; to clinic or emergency department was outcome variable for regression. RESULTS: From June 2015 to May 2016 there were 429 LAMA patients, accounting for 0.7% of total admissions. Females were 223 (52%) compared to males 206 (48%). Finances were quoted as the most common reason for LAMA by 174 (41%) patients followed by domestic problems 78 (18%). Internal medicine was the service with the highest number of LAMA patients ie, 153 (36%) followed by Pediatric medicine with 73 (17%). Of the 429 patients, 147 (34%) patients revisited the hospital within 30 days. Sixty-one percent of these 'bounced-back' LAMA patients had worsening or persistence of same problem, or new problem/s had developed. In unadjusted bivariate logistic model, patients who were advised for follow-up during discharge against medical advice were four times more likely to revisit the hospital. Patients who were married had an increased odd of revisiting the hospital. CONCLUSION: Financial reasons are the most common stated reasons to LAMA. Patients who LAMA are at a high risk of clinical worsening and 'bouncing back.' This is the first study from our region on in-patient LAMA rates, to our knowledge. The results can be used for planning measures to reduce LAMA rates and its consequences.

Incidence rate, clinical correlates, and outcomes of AKI in patients admitted to a comprehensive cancer center.

BACKGROUND AND OBJECTIVES: Incidence of AKI in hospitalized patients with cancer is increasing, but reports are scant. The objective of this study was to determine incidence rate, clinical correlates, and outcomes of AKI in patients admitted to a cancer center. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Cross-sectional analysis of prospectively collected data on 3558 patients admitted to the University of Texas M.D. Anderson Cancer Center over 3 months in 2006. RESULTS: Using modified RIFLE (Risk, Injury, Failure, Loss, ESRD) criteria, 12% of patients admitted to the hospital had AKI, with severity in the Risk, Injury, and Failure categories of 68%, 21%, and 11%, respectively. AKI occurred in 45% of patients during the first 2 days and in 55% thereafter. Dialysis was required in 4% of patients and nephrology consultation in 10%. In the multivariate model, the odds ratio (OR) for developing AKI was significantly higher for diabetes (OR, 1.89; 95% confidence interval [CI], 1.51-2.36), chemotherapy (OR, 1.61; 95% CI, 1.26-2.05), intravenous contrast (OR, 4.55; 95% CI, 3.51-5.89), hyponatremia (OR, 1.97; 95% CI, 1.57-2.47), and antibiotics (OR, 1.52; 95% CI, 1.15-2.02). In patients with AKI, length of stay (100%), cost (106%), and odds for mortality (4.7-fold) were significantly greater. CONCLUSION: The rate of AKI in patients admitted to a comprehensive cancer center was higher than the rate in most noncancer settings; was correlated significantly with diabetes, hyponatremia, intravenous contrast, chemotherapy, and antibiotics; and was associated with poorer clinical outcomes. AKI developed in many patients after admission. Studies are warranted to determine whether proactive measures may limit AKI and improve outcomes.

Prevalence of antenatal depression: comparison between Pakistani and Canadian women.

OBJECTIVE: To study the prevalence and correlates of depression in pregnant women of different cultures. METHODS: We used a score of 13 or greater on the Edinburgh Postnatal Depression Scale (EPDS) to indicate depression status and logistic regression to determine its correlates in pregnant women from Northern Pakistan (n=128), Caucasian (n=128) and Aboriginal (n=128) women from Saskatchewan, Canada. RESULTS: A higher proportion of Pakistani women (48.4%) had depression compared to their Aboriginal (31.2%) and Caucasian (8.6%) counterparts. Depression was associated with poor physical health in all women; however, there were unique correlates of antenatal depression in each group: physical abuse in Pakistani women (AOR=4.40:95% CI, 1.15-16.85), sexual abuse in Aboriginal women (AOR=3.02:95% CI, 1.09-8.40), and low income in Caucasian women (AOR=5.74:95% CI, 1.04-31.78). CONCLUSION: Depression is a substantial public health problem among pregnant women, with women in Pakistan having a much higher burden of antenatal depression than their Canadian counterparts.

Assessing obesity and overweight in a high mountain Pakistani population.

OBJECTIVES: To estimate the prevalence of obesity and overweight among adults in a high mountain rural population of Pakistan, and to determine the correlates of excess body weight. Design Cross-sectional study. METHODS: A random sample of 4203 adults (aged 18 years and over) was selected by stratified random sampling from 16 villages in north Pakistan. Trained medical students measured height, weight and blood pressure. Trained interviewers obtained information from participants on sociodemographic variables, use of snuff, daily cigarette consumption, hypertension and family history of hypertension. Body mass index (BMI) calculated as kg/m(2) was used to define overweight (BMI > or = 25 kg/m(2)) and obesity (BMI > or = 30 kg/m(2)). RESULTS: Using weight and height data available for 1391 men and 2754 women, mean BMI was 22.4 (95% CI 21.9, 22.9) for men and 22.6 (95% CI 21.9, 23.2) for women. The age-adjusted prevalence of BMI > or = 25 (overweight/obesity) was 13.5% for men and 14.1% for women. Overweight/obesity increased with age and the increase per year was identical for both men and women [adjusted odds ratio (AOR) = 1.01, 95% CI 1.01, 1.03]. Overweight/obese men and women were more likely to be hypertensive (men, AOR = 3.32, 95% CI 2.16, 5.09; women, AOR = 1.70, 95% CI 1.21, 2.39). Overweight/obese women were more likely to work in business or as skilled workers (AOR = 6.24, 95% CI 1.18, 32.83) while overweight/obese men were more likely to work as government employees (AOR = 2.59, 95% CI 1.66, 4.03). Family history of hypertension was a significant correlate of overweight/obesity in men (P value 0.004) and women (P value 0.000). Overweight/obese men and women were less likely to use smokeless tobacco (men, AOR = 0.65, 95% CI 0.43, 0.97; women, AOR = 0.54, 95% CI 0.35, 0.85). CONCLUSION: The prevalence of risk factors for non-communicable diseases (NCDs) in Pakistan is expected to increase as further epidemiologic, nutritional and demographic changes occur. The assessment of excess body weight, and patterns and determinants of other risk factors for NCDs is important to provide useful guidelines in the planning of interventions to counter a growing problem.

Prevalence and correlates of diarrhea.

OBJECTIVE: The present study aimed to estimate the prevalence of acute diarrhea and its correlates in remote rural villages of south Pakistan. METHODS: The authors selected 1878 children less than 3 years of age through stratified random sampling from 64 villages having the number of children enrolled proportionate to the size of each village, in rural Sindh, Pakistan. Trained field workers completed child physical measurements and maternal interviews. RESULTS: Among the children examined, 961 (51%) had diarrhea in the preceding 14 days prior to the date of survey. The prevalence of diarrhea was marginally higher among girls than boys (53% versus 49%, odds ratio 1.18, 95% CI 0.98, 1.41). The factors related with higher prevalence of diarrhea were lack of education of mother, lack of exclusive breast feeding, breast feeding for less than one year, roundworm infestation, low weight-for height, night blindness, female sex and number of older siblings more than 2 in the family. CONCLUSION: This study demonstrated that the acute diarrhea is major problem among children in rural Pakistan. Appropriate intervention programmes should be formulated focused on identified risk factors.