Association between residential green spaces and pregnancy outcomes: a systematic review and meta-analysis.

Residential exposure to greenness has shown positive influences on pregnancy outcomes like birth weight, preterm births, and small to gestational age (SGA) deliveries. We aimed to comprehensively review and investigate these associations by conducting a systematic review with meta-analysis. Relevant studies were retrieved from PubMed, EMBASE, ScienceDirect, and Google Scholar databases before June 2023. Summary effect estimates included birth weight, low birth weight (LBW), preterm births, and SGA which were calculated for 0.1 unit increase in residential greenness exposure. Overall quality of the evidence was examined through Joanna Briggs Institute (JBI) critical appraisal tool. The review included 31 articles and found a statistically significant increase in birth weight measured at 250 m buffer distance (ß = 8.95, 95% CI = 1.63-16.27). Green spaces were also associated with lower odds of LBW (OR = 0.97, 95% CI = 0.96-0.98). Residential greenness had positive impacts on pregnancy outcomes that calls for emphasis on urban planning, especially in developing countries.

Screen Time And Its Relationship With Attention Deficit Hyperactivity Disorder Among Children Attending A Tertiary Care Hospital.

Objective: To estimate the frequency of attention deficit hyperactivity disorder and its relationship with screen time and sociodemographic characteristics among children. METHODS: The cross-sectionalstudy was conducted at the National Institute of Child Health, Karachi, in June-July 2022, and comprised children of either gender aged 5-10 years visiting the paediatric outpatient department. Screen time was measured using a pretested questionnaire, while attention deficit hyperactivity disorder was measured using ADHD rating scale IV. The relationship of sociodemographic characteristics and screen time with the disorder was explored through multiple linear regression analysis. Data was analysed using SPSS 20. RESULTS: Of the 247 participants, 126(51%) were boys and 121(49%) were girls. The overall mean age was 7.84±1.87 years. There were 149(60.3%) children at the primary level of education, while 76(30.8%) had no formal education. There were 139(56.3%) children having screen time >2 hours/day with a mean of 3.36±3.14 hours. There were 15(6.1%) children with attention deficit hyperactivity disorderscore >26 with a mean of 11.58±9.27. Boys were more frequently affected by attention deficit hyperactivity disorder compared to girls (p=0.026), and there was a significant positive correlation between screen time and attention deficit hyperactivity disorder (p<0.001). Conclusion: The majority of children were found to be spending more than the recommended time on screen. Male gender and screen time were associated with attention deficit hyperactivity disorder.

Prevalence of anxiety and depression in high school students of Karachi, Pakistan.

Objectives: Anxiety and depression are commonly occurring mental disorders in school-going students and if not considered can result in a worse outcome. The objective of our study was to determine the prevalence, risk factors and relationship of anxiety and depression with different variables among high school students of Karachi. Methods: This cross-sectional study was conducted in October - November 2020 in government and private high schools of four districts of Karachi. Two stage cluster sampling was used to select study sites with 400 students inducted. Data was collected by using Aga Khan University Scale of anxiety and depression. Relationship of outcome with predictor variables was examined by applying univariate and multivariate logistic regression analysis. Results: Overall 53.2% participants reported anxiety and depression out of which 78.8% were females. Participants who were studying in private schools (OR 0.39, CI 0.21-0.69 at 95%, p=0.002) and had mothers who were housewives (OR 0.28, CI 0.09-0.83 at 95%, p=0.022) were less likely to develop anxiety and depression. Participants whose fathers and mothers had a history of anxiety and depression were three times more likely to develop anxiety and depression (OR 3.12, CI 1.52-6.41 at 95%, p=0.002) and (OR 3.02, CI 1.39-6.59 at 95%, p=0.005) respectively. Conclusion: The study found a high prevalence of anxiety and depression among high school students. Female students of public sector school and those who had a family history of anxiety and depression were more likely to develop it. Early detection and management of anxiety and depression by screening are necessary to overcome this burden.

Enhancing satisfaction and respect for health care personnel: a mixed-methods case study of a community-based intervention.

Health care personnel (HCP) face violence as a result of lack of satisfaction and respect among community members. It is imperative for HCP to engage in social work by involving communities for enhancing satisfaction and respect for them. This study attempted to provide insight on this phenomenon by using a mixed-methods concurrent embedded approach. Communities were selected based on modified Solomon four-group design from Karachi in southern province and from three cities of northern province, Khyber Pakhtunkhwa of Pakistan. Focus group discussions and in-depth interviews took place for formulating the quantitative tool. Six hundred pretests were done prior to introducing low-cost community-based interventions followed by 601 posttests. We found increased levels of satisfaction in both provinces, whereas level of respect increased significantly in Karachi in the southern province only. Qualitative interviews revealed the important role played by media and religious leaders. These findings suggest that satisfaction and respect for HCP can be enhanced through community support, involvement of religious leaders, and effective media campaigns.

How frequent is burnout among informal caregivers of disabled children? Findings from a cross-sectional study in Karachi, Pakistan.

BACKGROUND: Informal caregivers are those who care for children without getting paid. They are often more prone to stress due to their extra daily tasks which leads to burnout. This study aimed to determine the frequency and associated risk factors of burnout among informal caregivers of children with disabilities in Karachi. METHODOLOGY: A cross-sectional study was done in 10 rehabilitation institutes of Karachi with 310 mothers of children with disabilities from infancy till 18 years of age in 2019. Pretested questionnaire was administered to collect data in which 31 mothers were interviewed through convenience sampling from each rehabilitation institute. To assess burnout, the Maslach Burnout Inventory (MBI) was used. Association of different variables of study participants with the scores of its three subdimensions, Emotional Exhaustion (EE), Depersonalization (DP) and Personal Accomplishment (PA), were analysed using linear regression modelling. RESULTS: Mean EE score was high in 6.5% of the mothers while PA scores were low in 58.7% of the mothers. High EE with low PA (defined by our team as 'burnout') was found in 4.2% of the mothers, with none of them reporting high levels of DP. Linear regression analysis significantly predicted higher EE scores of mothers with more than one disabled child while lower EE scores were significantly predicted in highly educated mothers and mothers who spent more time in caregiving. Higher PA scores were also significantly predicted for highly educated mothers. DP scores were significantly predicted to be higher in mothers who had highly educated husband/guardian, employed mothers and those living in joint families whereas they were significantly predicted to be lower in highly educated mothers. CONCLUSION: We have identified that mothers who are less educated, have more than one child with disability and who live in joint families will need extra support and input to prevent burnout.

Caregiver strain and its predictors among parents of autistic children: a cross-sectional study.

Objective: This study estimates the frequency and predictors of caregiver strain (CGS) among parents of autistic children.Methods: Demographic details and CGS were collected through a validated tool from 403 parents of autistic children in Karachi, Pakistan. Regression modelling was performed to report associations between social, behavioural, and communication problems and socioeconomic predictors of CGS. Results were reported using adjusted beta-coefficients with 95% confidence intervals.Results: In total, 88.3% of the parents reported moderate to severe CGS. A high family income (ß = -4.31, 95% CI -7.55, -0.11), and caregiver's higher level of education (ß = -4.73, 95% CI -8.84, -0.61), along with care-recipient age group (ß = -9.35, 95% CI -15.17, -3.52) significantly predicted lower CGS. Diagnosis of more than 5 years (ß = 7.57, 95% CI 2.36, 12.79), tendency to self-harm (ß = 10.75, 95% CI 6.62, 14.88), and social withdrawal in the care-recipient (ß = 4.56, 95% CI 1.68, 7.44) were significantly associated with higher CGS.Conclusion: Parents of children on the autistic spectrum suffer from high CGS. There is a need to introduce tailored parenting interventions at the individual and community levels to help parents reduce the CGS, ultimately benefiting their child.

Effect of health education on awareness and practices of breast self examination among females attending a charitable hospital at North Karachi.

OBJECTIVE: To assess the effectiveness of health education as an intervention to promote breast self-examination in a low-resource setting. METHODS: The quasi-experimental study was conducted from January to August 2018 in Karachi after approval by the Jinnah Sindh Medical University, and comprised women from a low resource locality and dividing them into intervention group A and control group B. Demographic data was collected using a pretested questionnaire filled through interviews. Subsequently, group A received health education regarding carcinoma of breast, importance of breast self-examination and monthly motivation through cell phone to perform self-examination. The questionnaire was again filled after 6 months of intervention. Data was analysed using SPSS 20. Group B was given the same health education sessions after the completion of the study. RESULTS: Of the 172 subjects, there were 86(50%) in each of the two groups. In terms of demographic data, the groups were similar (p>0.05). After the intervention, group A showed significant (p<0.001) improvement in knowledge and practice of breast self-examination. There was no change in group B (p>0.05). Being in the intervention group (p=0.001) and level of education (p=0.018) showed positive and negative associations with selfexamination practice. Upon adjusting for age, marital status, family history and education, group A (p=0.001) remained significant, while the level of education (p=0.116) became non-significant. CONCLUSIONS: Designed health promotion programmes with monthly reminders through cell phone improved knowledge and practice of breast self-examination.

Spiritual Health Among Pakistani Religious and Non-Religious Professional: A Comparative Cross-Sectional Study Highlighting the Role of Regional Beliefs and Practices.

BACKGROUND: Spiritual health forms the core of health and is associated with better physical and mental health. Spiritual health and wellbeing has been shown to be significantly associated with better mental outcomes, yet there's lack of understanding of the determinants of spiritual health. Religious practices have been shown to improve health and have been assumed to be associated with spirituality, yet there remains a gap between religious practices and spiritual health. It is therefore, crucial to understand the role of religious beliefs and practices in improving spiritual health. PURPOSE: To assess spiritual wellbeing between religious and non-religious professionals and assess how regional religious beliefs and practices are associated with spiritual wellbeing. METHODS: We examined spiritual health among religious and non-religious professionals. A comparative cross sectional study was done with a sample size of 210. Differences of spiritual health and spiritual experiences, perceived spiritual traits and psychological parameters were observed. RESULTS: Religious professionals were found to be more spiritually healthy than non-religious professionals (P < .05). Spiritual experiences weakly contribute to spiritual health (r = 0.39, P < .05). Perceived spiritual traits including frequency of prayer (ß = 5.25, CI = 1.80-8.70, P < .01) and belief in the presence of Supreme Being (ß = 1.001, CI = 0.120-1.883, P < .05) influenced spiritual wellbeing and spiritual wellbeing showed a negative association with psychological parameters including anger (OR = 0.95, CI = 0.929-0.987, P < .05). CONCLUSION AND IMPLICATIONS: The findings from this study show that religious professionals tend to be more spiritually healthy than non-religious professionals highlighting the importance of incorporating religious practices to ensure spiritual wellbeing. Improving spiritual wellbeing can provide an important tool for promoting holistic healing.

Does watching violent electronic and social media content lead to increased levels of aggression? A survey among adolescents in an urban slum of metropolitan Karachi.

OBJECTIVES: Increased levels of aggression and desensitization of adolescents has been witnessed as a result of exposure to violent social/electronic media content. It is imperative for policymakers to study such behavioral outcomes in order to make sound policies regarding media literacy. The objective of the study therefore was to assess relationship between violent electronic/social media exposure and level of aggression. METHODS: A cross sectional study was conducted among adolescents aged 9-19 years in peri-urban slum of Karachi. Content-based Media Exposure scale and Buss and Perry questionnaire, internationally validated tools were used to collect data. Level of aggression was the main outcome variable which was analyzed. RESULTS: Four hundred and twenty-two adolescents participated in the survey. Usage of television was significantly higher in the younger age group whereas the effect of watching violent content among the adolescents varied. It was observed that 153 (36.3%) respondents felt stressed and 24 (5.7%) felt aggressive after watching violent content on electronic and social media. The contents showing people who fight (39.6 ± 5.6, p-value<0.05), who steal (39.5 ± 7.5, p-value=<0.05) and destroyed someone else's belongings (40.6 ± 7.6, p-value=<0.05) had a significant effect on the level of aggression. Regression analysis predicted a strong positive association of exposure of violent content with level of aggression (ß=0.43). CONCLUSIONS: The usage of violent content on social and electronic media was popular among adolescents, and produced negative effects on the behavior of adolescents. Measures should be taken to introduce media literacy of the children in Pakistan, especially in the peri-urban slums.

Internet addiction among social networking sites users: Emerging mental health concern among medical undergraduates of Karachi.

OBJECTIVE: To determine the frequency and intensity of Internet Addiction (IA) among medical undergraduates, using Social Networking Sites (SNS), in Karachi. METHODS: A cross-sectional survey was conducted in March-June '16 in a private and government medical college of Karachi. Self-administered, Young's Internet Addiction Test was implemented by 340 medical students to assess the frequency and intensity of IA among SNS profile users for past three years. The structured questionnaire further enquired regarding the social and behaviour patterns relevant to IA and SNS use. Data was analyzed using SPSS 16. RESULTS: Internet Addiction (IA) was found in 85% (n=289) of all study participants. Among them, 65.6% (n=223) were 'minimally addicted', 18.5% (n=63) were 'moderately addicted', whereas 0.9% (n=3) were found to be 'severely addicted'. Burden of IA was relatively higher among female medical students as compared to male medical students (p=0.02). There was no significant difference between type of medical college attended and IA (p=0.45). However, statistically significant differences were observed in certain behavioural patterns among addicted and non-addicted medical students. CONCLUSION: Internet Addiction (IA) is an emerging mental health concern affecting social behaviour patterns of medical undergraduates. However, the burden of IA is relatively higher among female medical students.