Does Lifestyle Behaviour Trigger Cardiovascular Risk Factors Among School-Going Adolescents In Pakistan?

OBJECTIVE: To explore the association of gender with risk factors for cardiovascular diseases among adolescents. Method: The cross-sectional study was conducted 2016-2019 in low-income schools in Karachi after approval from the ethics review board of Dow University of Health Sciences, and comprised adolescents of both genders aged 11-17 years. Anthropometric measurements and lifestyle behaviours were used to generate risk profile for cardiovascular diseases. Data was analysed using SPSS 16. RESULTS: Of the 1195 subjects, 468(39.2%) were boys and 727(60.8%) were girls. The mean age was 13.9±1.6 years. Mean family size was 5.9±3.64. Overall, 989(91.3%) participants consumed soft drinks, 44(4%) were smokers, 340(48.4%) consumed betel nut, 215(32.9%) Pan, 125(21.2%) Gutka and 9(1.7%) Bidi. Of the total, 867(83.3%) participants were physically less active than recommended, and daily screen time was >2 hours among 513(45.7%) participants. Body mass index and body fat percentage were significantly higher among girls (p<0.05). Higher rates of diastolic and systolic blood pressure and hand grip strength were observed in boys compared to girls (p<0.05). CONCLUSIONS: Interventional programmes in schools should emphasise the need for healthy lifestyle behaviours, increased physical activity, good eating habits and smoking cessation.

Exploring context specific anti-smoking warning labels on cigarette packs: A quasi-experiment.

OBJECTIVE: To evaluate the impact of introducing newly-designed warning labels in relation to the available conventional cigarette packs. METHODS: The quasi-experimental study was conducted at four co-educational academic institutions selected using cluster random sampling technique in Gulshan-e-Iqbal town of Karachi from September 2016 to October 2017. The respondents, aged 16-24 years, were exposed with an experimental condition using five graphic cards; each comprising of two separate labels; label 1 being a cigarette pack currently rotated, and label 2 being the newly designed graphic and text warning label. Each participant responded over efficacy measures for each label separately. The difference in the efficacy scores between the two labels was assessed using repeated measure ANOVA with Bonferroni correction in analysis. RESULTS: Of the 388 students, 256(66%) were males and 132(34%) were females. The overall mean age was 18±2.76 years. Also, 188(48.5%) subjects were studying in higher secondary, 179(46.1%) undergraduate and 21(5.4%) postgraduate level. Of them, 104(26.8%) were ever-smokers and 284(73.2%) reported to be never-smokers. A difference was observed in the efficacy of the newly designed label "poverty" compared with current cigarette pack on the measure of not to start smoking(p=0.006). Never-smoking males perceived newly-designed label element 'dead person' as fear-arousing (p=0.045), while never-smoking females considered 'look after family' as efficacious (p=0.024). CONCLUSIONS: There was some evidence of variation in efficacy scores after stratifying on gender and smoking status. A more holistic approach is needed in this regard.

Traumatic aortic transection repair with distal perfusion - single center experience.

Blunt aortic injury is associated with significant mortality. A large number of patients lose their lives before reaching the hospital, those who survive half die within a day. Isthmus is the commonest site of aortic injury. Aortic injury is usually associated with other injuries of the body hence a multidisciplinary approach is required. For aortic transection the treatment options have evolved from proximal and distal aortic cross clamping and repair with distal perfusion technique using shunt or partial heart bypass (extracorporeal circulation) to endovascular stenting depending upon the available facilities andexpertise. Distal perfusion technique helps in avoiding paraplegia. We present our institutional experience of polytrauma associated with blunt aortic injuries managed with open surgical repair with distal perfusion using cardiopulmonary bypass.

Inadequate checks on smokeless tobacco usage in Pakistan: cultural heritage or policy neglect?

The Asian-Eastern Mediterranean block has increased inhabitation of the smokeless tobacco users. Due to geopolitical reasons, Pakistan is one of the countries which is in danger of suffering from future smokeless tobaccorelated morbidity and mortality due to weak policy measures. This paper is an overview of smokeless tobacco control measures practised in Pakistan, in comparison to its neighbouring countries sharing similar socio-cultural parameters. Tobacco control reports confined only to smokeless tobacco control were extracted for the region of Southeast Asia and Eastern Mediterranean regions published under World Health Organisation. The selection of countries from each region was based upon the fulfilment of the criterion of sharing common borders with Pakistan and holding a signatory status under framework convention on tobacco control. There is a need to revise existing tobacco control strategy to include smokeless tobacco reforms over pricing, packaging and media communication in Pakistan.

Healthy lifestyle as a preventive measure against victimization among school-going adolescents.

BACKGROUND: Bullying and violence are problems of aggression in adolescents. Healthy lifestyle practices are common health promotion approaches in school settings; however, their association with aggressive behaviours in school-going adolescents is less explored. AIMS: This study examined the associations of healthy lifestyle behaviours including good hygiene, physical activity, recommended diet and refrainment from tobacco use with bully victimization and violence among adolescents. METHODS: Data were obtained from the Global School Health Survey conducted in Pakistan (2009). The study population consisted of school-going adolescents aged 13 to 15 years. We constructed our final dataset using information from 4102 participants. Association of healthy lifestyle behaviours with bully victimization and violence experience were assessed using multivariate logistic regression. RESULTS: Results indicate lower odds of being bullied (good hygiene: OR = 0.62, 95% CI 0.50-0.76, P <0.001; physical activity: OR=0.55, 95% CI 0.40-0.75, P <0.001; abstinence from tobacco: OR=0.43, 95% CI 0.30-0.63, P <0.001) and lower odds of violence (good hygiene: OR=0.68, 95% CI 0.55-0.84, P <0.001; physical activity: OR=0.55, 95% CI 0.43-0.71, P <0.001; abstinence from tobacco: OR=0.48, 95% CI 0.32-0.72, P <0.001), after controlling for socio-demographic and potential confounding factors. CONCLUSIONS: Our study supports the significance of healthy lifestyle as a preventive measure against victimization. Anti-bullying programmes focusing on social-emotional skill development may also consider promotion of healthy lifestyle behaviours among adolescents, aiming at reducing victimization and its related consequences.

Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan.

OBJECTIVES: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. METHODS: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. RESULTS: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p<0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p<0.001). CONCLUSIONS: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

Maternal depressive symptoms and child nutritional status: A cross-sectional study in socially disadvantaged Pakistani community.

Malnutrition is a primary cause of child morbidity and mortality. The effects of maternal depressive symptoms on children's health, especially their nutritional status, have received less attention in developing countries but needs to be evaluated to understand the public health implications of maternal depression. The aim of the current study was to investigate the association between maternal depressive symptoms and children's nutritional status using data from low socioeconomic community in Pakistan. Maternal depressive symptoms defined as Aga Khan University Anxiety and Depression Scale score of 20 or greater was assessed for mothers with children under two years of age. Logistic regression models estimated the association between maternal depressive symptoms and stunting and underweight. Of 325 mothers, 40% scored positive on the depressive scale. The prevalence of stunting and underweight in children under two years was 36.6% and 35.4%, respectively. Maternal depressive symptoms were significantly associated with children being stunted and underweight. Mothers with depressive symptoms were more than three times likely to have stunted (odds ratio (OR) 3.15, 95% confidence interval (CI) 1.91-5.18, p value < .001) and underweight (OR 3.26, 95% CI 1.99-5.34, p value < .001) children compared to non-depressed mothers. Maternal-related factors such as poor education, unemployment, and low household income were found to be significantly associated with higher odds of children's short stature and underweight.

Catamenial pneumothorax: A case report.

Catamenial pneumothorax (CP) is a rare and complex clinical condition caused by endometrial tissues, commonly found in reproductive women (age 15-49 years).Its diagnosis is often delayed or overlooked by clinicians, which may result in recurrent hospitalizations and other complications. A case of Catamenial pneumothorax is presented of a 38-year-old young married woman, admitted to hospital with signs and symptoms including chest pain and shortness of breath that started with her menstrual period. Right pneumothorax was observed in the Chest x-ray. Patient underwent Video-assisted thoracoscopic surgery (VATS). Patient was kept under observation, and was discharged when stable with no pain.Catamenial pneumothorax is still considered to be a mysterious disease and difficult to diagnose. Surgery is the best treatment.

Nutritional and lifestyle risk behaviors and their association with mental health and violence among Pakistani adolescents: results from the National Survey of 4583 individuals.

BACKGROUND: Unhealthy behaviors are associated with mental health problems and violence in adolescents, yet their combined association has been understudied. Using the Global School Health Survey, this study examined the association between combined unhealthy behaviors (including fast food, soft drink, smoking, other tobacco products and physical inactivity) and anxiety, suicidal ideation and involvement in physical fight among Pakistani adolescents. METHODS: Data were obtained from the Global School Health Survey conducted in Pakistan (2009). The study population consisted of school going adolescents aged 13 to 15 years. Association of combined unhealthy behaviors with anxiety, suicidal ideation and involvement in physical fight were studied through secondary analysis. We used univariate and multivariate logistic regression analysis by complex sample method, accounting for cluster sampling technique used for data collection. RESULTS: Of the total 4583 students, weighted percentage and unweighted count for one, two, three and four or more unhealthy behaviors was 39.4% (n = 1770), 22.1% (n = 963), 5.9% (n = 274) and 1.2% (n = 62) respectively. The weighted prevalence for anxiety, suicidal ideation and involvement in physical fight were 8.4%, 7.3% and 37.4% respectively. The results of multivariate logistic regression analysis after adjustment showed that students who had four or more unhealthy behaviors had higher odds of; being anxious (OR 2.45, 95%CI 1.31-4.59, p value 0.004), suicide ideation (OR 4.56, 95%CI 2.58-8.07, p value <0.001) and being involved in physical fight (OR 3.15, 95% CI 1.63-6.08, p value <0.001) as compared to those who had not adopted any unhealthy behaviors. CONCLUSIONS: This study suggests that the co-occurrence of unhealthy behaviors is associated with anxiety, suicidal ideation and physical fight among adolescents. These findings should be considered when developing interventions to combat detrimental outcomes of unhealthy behaviors during adolescence.