Exploring health seeking behaviour among incidentally diagnosed HIV cases in Rawalpindi, Pakistan: A qualitative perspective.

Objective: To identify the determinants of health-seeking behaviour among incidentally diagnosed cases of HIV and to explore the patterns of care seeking behaviour among these HIV infected persons. METHODS: The qualitative study based on the grounded theory was conducted from February to September 2019 at the Armed Forces Institute of Transfusion, Rawalpindi, Pakistan, and comprised incidentally diagnosed new cases of human immunodeficiency virus. Data was collected using in-depth interviews to understand how local environments and settings impact healthcare-seeking behaviour. Data was analysed using the constant comparison method. RESULTS: Of the 12 patients, 10(83.3%) were male, 1(8.3%) female and 1(8.3%) transgender. The mean age of the sample was 31±5 years. Of the total, 10(83.3%) patients were receiving free antiretroviral treatment from government hospitals in Rawalpindi/Islamabad, while 2 (16.7%) opted for some alternative form of healthcare. Ten (80%) were married and were carrying the diagnosis for >6 months. Processing of human immunodeficiency virus status, value placed in one's own health, experiences with healthcare provider and medication-related factors were the main themes that emerged from the data. Better counselling services, free-of-cost medication, positive patient-provider relationship and social support were the key players, while non-disclosure due to fear of stigma and beliefs about the disease were the main stumbling blocks. CONCLUSIONS: Value placed in one's own healthcare and thus the need for healthcare services, regardless of social norms, cultural reservations and personal beliefs, was the most important factor affecting the healthcare-seeking behaviour of human immunodeficiency virus patients.

Evaluation of empathy and fatigue among physicians and surgeons in tertiary care hospitals of Rawalpindi.

BACKGROUND AND OBJECTIVES: Clinicians need to build an astute doctor-patient relationship. The term clinical empathy is the ability of doctor to cognitively appreciate a patient's perspective, experiences, and deliver such an understanding back to patient. Studies associate high physician empathy with improved patient trust and clinical outcomes. In Pakistan, there is paucity of research data on this relationship. This study assessed the empathy and its relation to fatigue levels among physicians and surgeons. METHODS: This was a cross-sectional analytical study involving 262 Physicians and Surgeons (1:1) chosen by convenience sampling method. Physicians and Surgeons were included from three hospitals in Rawalpindi from September 2017 to February 2018 and RAO soft sample calculator was used. The Jefferson Scale for Physician empathy (JSPE) (score range 20-140) and Multidimensional Fatigue Inventory (MFI-20) (score range 20-100) were used as data collection tools. The data was analyzed using SPSS version 23. Statistical tests including T-test and Pearson Correlation were used. RESULTS: Overall, mean score of empathy was found to be 98.8±21.9 (range; 46-138). The empathy in Physicians (106.8±18.3) was found to be greater than Surgeons (89.4±22.1) and the difference was statistically significant (p value <0.01). Mean score of fatigue was 50.6±16.0. The fatigue level in Surgeons was greater than Physicians and the difference was found to be statistically significant (p value < 0.01). Strong negative correlation was observed between empathy and fatigue (r= -0.5, p=<0.01) using Pearson correlation. CONCLUSION: Overall, physicians had better empathy than surgeons, while fatigue scores were higher among surgeons. Fatigue is associated with empathy decay. This research provides an understanding of empathy deterioration and other factors responsible for it.

ASSOCIATION OF MATERNAL PERIODONTITIS WITH LOW BIRTH WEIGHT IN NEWBORNS IN A TERTIARY CARE HOSPITAL.

BACKGROUND: Low birth weight is a major public health problem in Pakistan. So there is a need for identification of its modifiable risk factors like periodontitis which will reduce its burden on the society. The objectives of the study were to find out the association between maternal periodontitis and low birth weight in new-borns of all gestational ages delivered in a tertiary care hospital of Abbottabad as well as to see the frequency of periodontitis severity in these subjects. METHODS: A hospital-based matched case-control study was conducted among 160 postpartum mothers in Gynaecology/Obstetrics- B ward Ayub Teaching Hospital, Abbottabad. The 80 cases were mothers of low birth weight babies (< 2,500 g), the 80 controls were mothers of normal weight babies (> 2,500 g) matched with maternal age and gestational age. Data was collected through the hospital records, interview and a periodontal examination. RESULTS: Periodontitis was more in the cases than in the controls (OR: 4.167, 95% CI: 2.142-8.109, p = 0.000). On multivariate logistic regression, periodontitis was found to be a significant independent risk factor for low birth weight (aOR: 3.173, 95% CI: 1.429-7.047, p = 0.005). Other significant risk factors were educational level (aOR: 3.408, 95% CI: 1.452-7.996, p = 0.005), socioeconomic status (aOR: 3.173, 95% CI: 1.366-7.368, p = 0.007), maternal nutrition (aOR: 3.071, 95% CI: 1.392-6.778, p = 0.005) and moderate/severe anaemia (aOR: 3.035, 95% CI: 1.052-8.756, p = 0.040). CONCLUSIONS: Periodontitis is found to be a strong, independent, and clinically significant risk factor for low birth weight. So periodontal therapy should form a part of the antenatal care of the pregnant women in Abbottabad.