Psychiatric disorders are highly prevalent in Pakistan and burdens the scarce number of psychiatrists present in the country. The establishment of evidence-based clinical practice guidelines (EBCPGs) ...and primary-care referral pathways within the local context is imperative to make the process efficient. In this Health Policy, we aimed to develop EBCPGs and primary-care referral pathways that are specific to Pakistan's primary-care setting, with the aim of facilitating the management of psychiatric conditions. Ten EBCPGs were created through the GRADE-ADOLOPMENT process; two recommendations were adopted with minor changes, 43 were excluded, and all others were adopted without any changes. Ten primary-care referral pathways for managing ten psychiatric disorders were created and 23 recommendations were added which will help to bridge the gap in care provision. These psychiatric referral pathways and EBCPGs will bring Pakistan's healthcare system a step closer to achieving optimal health outcomes for patients.
Considering the disproportionate burden of delayed traumatic brain injury (TBI) management in low- and middle-income countries (LMICs), there is pressing demand for investigations. Therefore, our ...study aims to evaluate factors delaying the continuum of care for the management of TBIs in LMICs.
A systematic review was conducted with PubMed, Scopus, Google Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Observational studies with TBI patients in LMIC were included. The factors affecting management of TBI were extracted and analyzed descriptively.
A total of 55 articles were included consisting of 60,603 TBI cases from 18 LMICs. Road traffic accidents (58.7%) were the most common cause of injury. Among included studies, factors contributing to prehospital delays included a poor referral system and lack of an organized system of referral (14%), long travel distances (11%), inadequacy of emergency medical services (16.6%), and self-treatment practices (2.38%). For in-hospital delays, factors such as lack of trained physicians (10%), improper triage systems (20%), and absence of imaging protocols (10%), lack of in-house computed tomography scanners (35%), malfunctioning computed tomography scanners (10%), and a lack of invasive monitoring of intracranial pressure (5%), limited theater space (28%), lack of in-house neurosurgical facilities (28%), absence of in-house neurosurgeons (28%), and financial constraints (14%) were identified.
Several factors, both before and during hospitalization contribute to delays in the management of TBIs in LMICs. Strategically addressing these factors can help overcome delays and improve TBI management in LMICs.
A meta-analysis was conducted to compare: 1) time from traumatic brain injury (TBI) to the hospital, and 2) time within the hospital to intervention or surgery, by country-level income, World Health ...Organization region, and healthcare payment system.
A comprehensive literature search was conducted and followed by a meta-analysis comparing duration of delays (prehospital and intrahospital) in TBI management. Means and standard deviations were pooled using a random effects model and subgroup analysis was performed using R software.
Our analysis comprised 95,554 TBI patients from 45 countries.
From 23 low- and middle-income countries, a longer mean time from injury to surgery (862.53 minutes, confidence interval CI: 107.42–1617.63), prehospital (217.46 minutes, CI: −27.34–462.25), and intrahospital (166.36 minutes, 95% CI: 96.12–236.60) durations were found compared to 22 high-income countries.
African Region had the greatest total (1062.3 minutes, CI: −1072.23–3196.62), prehospital (256.57 minutes CI: −202.36–715.51), and intrahospital durations (593.22 minutes, CI: −3546.45–4732.89).
Multiple-Payer Health Systems had a greater prehospital duration (132.62 minutes, CI: 54.55–210.68) but greater intrahospital delays were found in Single-Payer Health Systems (309.37 minutes, CI: −21.95–640.69).
Our study concludes that TBI patients in low- and middle-income countries within African Region countries face prolonged delays in both prehospital and intrahospital management compared to high-income countries. Additionally, patients within Single-Payer Health System experienced prolonged intrahospital delays. An urgent need to address global disparities in neurotrauma care has been highlighted.
We examined associations of central family (i.e., children, parents, in-laws) social network size with healthy lifestyle factors (i.e., favorable body mass index, physical activity, diet, alcohol ...use, smoking). Using data on 15,511 Hispanics/Latinos 18–74 years old from the Hispanic Community Health Study/Study of Latinos, multivariable adjusted survey logistic regression was used to compute associations of social network size with healthy lifestyle factors. A one-unit higher total of central family size was associated with lower odds of healthy body mass index (OR 0.90; 95% CI 0.86–0.93) and having all five healthy lifestyle factors (OR 0.90; 95% CI 0.85–0.96). Findings suggest familial structural social support may contribute to healthy lifestyle factors and differ based on the type of relationship among Hispanics/Latinos.
Abstract only Background: Social ties within social networks have been shown to influence healthy lifestyles. However, little is known about the association among size of familial social networks, ...social network dynamics (such as frequency of contact and perceived connectedness), and healthy lifestyle factors in Hispanic/Latino adults. We examined cross-sectional associations of central family social network size, as well as frequency of contact with central family members (children, parents, in-laws) and perceived connectedness to extended family members (uncles, aunts, and other relatives), with individual healthy lifestyle factors. Methods: Data were analyzed from 15,511 self-identified Hispanic/Latino adults ages 18-74 years from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Size of central family, frequency of contact with central family members in past 2 weeks, and perceived connectedness to extended family, were categorized into approximate tertiles based on the distribution of the data. Healthy lifestyle factors included alcohol use (men <30g/day; women <15g/day), not currently smoking, body mass index BMI 18.5 to <25.0 kg/m 2 , physical activity in the highest sex-specific 40%, and healthy diet in the highest sex-specific 40%. Survey logistic regression was used to compute odds ratios OR and 95% confidence intervals CI, with models adjusted for age, sex, education, income, Hispanic/Latino background, employment status, religion, church attendance, marital status, acculturation, and language preference. Results: Compared to participants with a central family social network of 0-3 individuals, those with a family social network of 4-5 members were significantly less likely to have a healthy diet (OR: 0.86; 95% CI: 0.74, 0.99) or a healthy BMI (OR: 0.74; 95% CI: 0.65, 0.85). Also, those with 6-11 members were also significantly less likely to have a healthy BMI (OR: 0.58; 95% CI: 0.49, 0.69). Individuals reporting frequent contact with 3-4 and 5-11 family members were less likely to have a healthy BMI (OR: 0.76; 95% CI: 0.66, 0.87; OR: 0.60; 95% CI: 0.51, 0.72; respectively) versus those reporting frequent contact with only 0-2 family members. However, individuals who reported feeling connected to 3-5 extended family members were more likely to have a healthy diet (OR: 1.16; 95% CI: 1.00, 1.36) and healthy BMI (OR: 1.15; 95% CI: 1.00, 1.33), and those who felt connected to 6-7 extended family members were more likely to be non-smokers and to have a healthy BMI (OR: 1.16; 95% CI: 1.00, 1.34; OR: 1.20, 95% CI: 1.20; 95% CI: 1.04, 1.38; respectively) versus those who reported feeling connected to 0-2 extended family members. Conclusions: These findings suggest that social network size and dynamics may play an important role in influencing healthy lifestyle factors among Hispanic/Latino adults. Further, specific influences may differ based on the type of relationship.
Objective: To assess the community structure, seasonal dynamics of dinoflagellates population with environmental conditions in the nutrient-rich and polluted coastal waters off, Karachi. Methods: ...Sampling sites were located from Karachi harbour (Station A) and Mouth of Manora Channel (Station B). Total 180 replicate samples were collected at 1-m depth through Niskin bottle sampler (1.7 L) and fixed with 2% lugol's preservative then examined under light inverted microscopy, scanning electron and epiflourescence microscope. Results: The environmental conditions, such as temperature (20-27) degreesC, salinity (35-40) psu, chlorophyll a (1-103) mug/L, pH (6.03-8.13) and dissolve oxygen (0.7-5.5) mg/L were recorded from both stations. A total of 96 species were identified into potential harmful toxic/ non-toxic bloom forming species and cysts producer. Total dinoflagellate cells between two coastal sites were much concentrated at the adjacent area of mouth of Manora Channel compare to harbor site. The dinoflagellate cell concentration ranging from 20 to ~55000 cells/L and the maximum values observed in two season, (~55000 cells/L) in autumn and (~ 3000 cells/L) in winter season. Gyrodinium sp. was the predominant taxa with the maximum abundance (48166 cells/L) observed in autumn season following by Scrippsiella trochoidea(1200 cells/L), Alexandrium ostenfeldii(3000 cells/L) in winter season, and Ceratium furca(640 cells/L), Protoperidinium steinii(780 cells/L), Ceratium fusus(906 cells/L), Pyrophacus steinii(840 cells/L), Gonyaulax spinifera(666 cells/L), Alexandrium tamarense(520 cells/L) and Dinophysis caudata(393 cells/L) in summer and spring season. Statistically, abundance of dinoflagellates correlated significant to chlorophyll a with chlorophyll a and temperature but inverse relation to salinity and pH observed from both sites. Conclusions: The present study reports on the prevalence and significance of harmful algae bloom forming taxa in the area which would be available for the coastal zone managers and fishery industry to inform them of possible threat and damage that can be caused by any blooms to, for example, fishery industry, and environmental and human health.
The in situ growth rates of dinoflagellates along the Karachi coast off Pakistan was studied by the size fractionated method during winter (February 2006) and summer (May 2007). The growth rate per ...day ranged from -2.87 to 2.3 d
(20 species) in winter and from 1.20 to 1.95 d
(13 species) in summer. Growth rates (μ
d
) of the dominant species were as follows: Prorocentrum gracile, Prorocentrum minimum, Prorocentrum arcuatum (1.0-1.10), Protoperidinium steinii (0.92), Gonyaulax spinifera (0.69), Dinophysis acuminata (2.3), Dinophysis caudata (0.92), Ceratium lineatum, Prorocentrum micans (1.95), Gyrodinium sp. (1.88), Ceratium furca (1.70), and Alexandrium ostenfeldii (1.34). The declining growth rates were observed for Pyrophacus stein (-1.10), Scrippsiella trochoidea (-1.61 to -0.82), Prorocentrum donghaiense (-1.94) and Karenia mikimotoi (-2.48). Our results suggest that a higher temperature induce an increase in dinoflagellate growth rates.
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