Promotion of sexual and reproductive health in Pakistan-The role of technology and online awareness

Digital health innovations such as online webinars,websites,blogs,and health apps have been associated with increased sexual and reproductive health(SRH)among the general population.Many studies have been conducted in developed countries in the West;however,little research has been conducted in low-income countries,especially in Pakistan.The socioeconomic instability and the government's lack of awareness and knowledge have resulted in no regulations being placed to incorporate telehealth in medicine.The healthcare departments must take into consideration the lifechanging impact of telehealth and the barriers that prevent it in becoming known,to reduce the incidence of unsafe abortions and sexual health practices that prove to be a stigma in society.

Effect of nutrition-related infodemics and social media on maternal experience: A nationwide survey in a low/middle income country

BACKGROUND Undernutrition is a crucial cause of morbidity and mortality among children in low-or middle-income countries(LMICs).A better understanding of maternal general healthy nutrition knowledge,as well as misbeliefs,is highly essential,especially in such settings.In the current era of infodemics,it is very strenuous for mothers to select not only the right source for maternal nutrition information but the correct information as well.AIM To assess maternal healthy nutritional knowledge and nutrition-related misbeliefs and misinformation in an LMIC,and to determine the sources of such information and their assessment methods.METHODS This cross-sectional analytical observational study enrolled 5148 randomly selected Egyptian mothers who had one or more children less than 15 years old.The data were collected through online questionnaire forms:One was for the general nutrition knowledge assessment,and the other was for the nutritional myth score.Sources of information and ways of evaluating internet sources using the Currency,Relevance,Authority,Accuracy,and Purpose test were additionally analyzed.RESULTS The mean general nutrition knowledge score was 29±9,with a percent score of 70.8%±12.1%(total score:41).The median myth score was 9(interquartile range:6,12;total score:18).The primary sources of nutrition knowledge for the enrolled mothers were social media platforms(55%).Half of the mothers managed information for currency and authority,except for considering the author's contact information.More than 60%regularly checked information for accuracy and purpose.The mothers with significant nutrition knowledge checked periodically for the author's contact information(P=0.012).The nutrition myth score was significantly lower among mothers who periodically checked the evidence of the information(P=0.016).Mothers dependent on their healthcare providers as the primary source of their general nutritional knowledge were less likely to hold myths by 13%(P=0.044).However,using social media increased the likelihood of having myths among mothers by approximately 1.2(P=0.001).CONCLUSION Social media platforms were found to be the primary source of maternal nutrition information in the current era of infodemics.However,healthcare providers were the only source for decreasing the incidence of maternal myths among the surveyed mothers.

Human Rights and Public Health in the International HIV Response： Issues of Contested Control, Treatment and Prevention： Human Rights and Public Health, Different,,,But the Same？

From its earliest formulation, the international HIV response has attempted to harness human rights as a central element of public health practice. Policy initiatives aimed at eliminating stigma and discrimination of affected people would enable them to access health and social services, practice safe behaviors and thereby protect public health. However, this response was characterized by tensions between differing perceptions of public health and human rights and, with the advent of effective treatments, between those who regarded behavioral and biomedical interventions as competing, if not mutually exclusive, approaches. A central theme in all of these elements has been control： control of the virus, control of the behaviors of people affected, control of policy and control of rights. HIV infection is both a cause and a consequence of human rights abuses, but for many people these two aspects are compounded into the same lived predicament; a predicament over which many feel they should have control. The test-and-treat debates at the 2010 IAS Conference demonstrated this as presenters and participants openly clashed over proposals to implement what many see as coercive measures in settings where viral transmission and the public health/human rights collaboration might both be regarded as now ＂out of control＂. This paper will explore issues of control in the international HIV response and how authority, in the forms of law and justice, is contested in that response.

Effectiveness of health coaching on diabetic patients: A systematic review and meta-analysis

、Background:Using health coaching to improve the quality of life and health outcomes of the patients with diabetes mellitus,has emerged as a possible intervention.However,the few published randomized controlled trials using health coaching for patients with diabetes mellitus have reported mixed results.The present meta-analysis aimed to determine the effectiveness of health coaching on modifying health status and quality of life among diabetic patients and to clarify the characteristics of coaching delivery that make it most effective.Methods:This study searched for articles on randomized controlled trials of health coaching interventions targeting type 2 diabetic patients that were published in the English language from January 2005 through December 2018 in the Cochrane,Medline,PubMed,Trip,and Embase databases.Patients in the control group received usual diabetes mellitus care,and those in the experimental group received health coaching based on usual diabetes mellitus care.The primary outcomes included Hemoglobin A1c(HbA1c)and cardiovascular disease risk factors,including systolic blood pressure,diastolic blood pressure,triglyceride,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol,total cholesterol,and body weight.The secondary outcomes included quality of life,self-efficacy,self-care skills,and psychological outcomes.Results:Health coaching intervention has a significant effect on HbA1c[mean difference(MD)=-0.35,confidence interval(CI)=-0.47,-0.22,I2=83%,P<0.001]and HDL-C(MD=-0.50,CI=-0.93,-0.07,I2=10%,P=0.02).The most effective strategy for health coaching delivery associated with improvement of HbA1c was decreasing the number of sessions and increasing the duration of each session.However,no significant difference was found for weight,SBP,diastolic blood pressure,triglyceride,low-density lipoprotein cholesterol,or total cholesterol.Mixed results were reported for the effect of health coaching on quality of life,self-efficacy,self-care skills,and depressive symptoms outcome.Conclusion:Health coaching intervention has a significant effect on HbA1c and HDL-C,and the most effective strategy is decreasing the number of sessions while increasing session duration.However,these results should be interpreted with caution as the evidence comes from studies at some risk of bias with considerable heterogeneity and imprecision.

Utilization, practice of herbal medicine in patients with type 2 diabetes mellitus in Kuwait and their perceptions

Background:Herbal medicine has become a popular treatment among patients with chronic diseases like diabetes mellitus worldwide.Many patients with diabetes mellitus use herbal medicine without consulting their health professionals.The aim of this study was to assess the prevalence,pattern of use,and perceptions in type 2 diabetes patients using herbal medicine.Methods:The study was conducted during the period of 1st January 2019 to the end of June 2019 in the diabetes clinic in Farwaniya hospital in Kuwait.It is cross sectional,quantitative study.Data were collected using a questionnaire in both Arabic and English designed by the investigators after a review of the literature on use of herbal medicine.The questionnaire was administered by working nurses.Results:The study denoted that the prevalence of using herbal medicine in the study sample(350 patients with type 2 diabetes)was 30.6%of all sample,females were greater than males in using herbal medicine about 56%of patients using herbs.Black Cumin(Habba Soda)i.e.Nigella Satival was the most frequent herbs used by the patients and a herbal mixture done by herbalist.The study revealed that 70%of herbal users has bad glycemic control HbA1C³7%and the diabetes complications were greater in herbal users than on conventional therapy.The study showed that irregular use of herbs that were used with diabetes conventional treatment and the majority of herbal users did not inform their treating doctors about herbal use(95.3%)herbal users.Conclusion:The study revealed that 30%of the sample were herbal users and they are in need for increase their awareness and education about risks and complications of herbal medicine.

Adherence in Patients with Type 2 Diabetes and Depression and the Role of Physician-Patient Relationship: A Cross-Sectional Study

Background: Diabetes mellitus (DM) challenges health and quality of life of patients, families, and communities. Patients with comorbid depression are more likely to develop macrovascular and microvascular complications. The aim was to assess glycemic control and adherence in diabetic patients with comorbid depression. Further, the study evaluated the relationship between adherence and the physician-patient relationship. Methods: The study was conducted at Al-Agouza Family Medicine Center (AFMC) between February 2018 and March 2020. The included patients were between 35 - 80 years of age;had type 2 diabetes with hemoglobin A1c (HbA1c) ≥ 6.5%, fasting plasma glucose ≥ 126 mg/dl, and scored between 11 - 30 on the Beck Depression Inventory (BDI). Logistic regression, chi-square, and analysis of variance (ANOVA) were used to assess the relationship between depression, adherence, physician-patient relationship, and other variables. Results: The study included 100 eligible patients with a median BDI score of 20 (10 - 30). The median diabetic panel for patients was FBS 188 (126 - 348) mg/dl, PPS 282.50 (162 - 448) mg/dl, and HbA1c 9.5 (6.6 - 14.0)%. Depression and regular follow-up visits were statistically associated with improvement of diabetes symptoms (p = 0.019). There was a significant relationship (p 0.001) between adherence, regular follow-up visits, and knowledge of DM. Further, there was a significant relationship between the physician-patient relationship and DM improvement (p = 0.047). Conclusion: Physician-patient relationship was paramount to improving adherence and positive diabetes care. Our findings suggest a shift to a physician-patient relationship model with mutual agreement on medical decisions is highly recommended.

Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer

Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy (D2) is the standard of care in Japan and South Korea since decades, while the majority of United States patients receive at most a limited lymphadenectomy (D1). United States and Northern Europe are considered the scientific leaders in medicine and evidence-based procedures are the cornerstone of their clinical practice. However, surgeons in Eastern Asia are more experienced, as there are more new cases of gastric cancer in Japan (107898 in 2012) than in the entire European Union (81592), or in South Korea (31269) than in the entire United States (21155). For quite a long time evidence-based medicine (EBM) did not solve the question whether D2 improves long-term prognosis with respect to D1. Indeed, eastern surgeons were reluctant to perform D1 even in the frame of a clinical trial, as their patients had a very good prognosis after D2. Evidence-based surgical indications provided by Western trials were questioned, as surgical procedures could not be properly standardized. In the present study we analyzed indications about the optimal extension of lymphadenectomy in gastric cancer according to current scientific literature (2008-2012) and surgical guidelines. We searched PubMed for papers using the key words “lymphadenectomy or D1 or D2” AND “gastric cancer” from 2008 to 2012. Moreover, we reviewed national guidelines for gastric cancer management. The support to D2 lymphadenectomy increased progressively from 2008 to 2012: since 2010 papers supporting D2 have achieved a higher overall impact factor than the other papers. Till 2011, D2 was the procedure of choice according to experts’ opinion, while three meta-analyses found no survival advantage after D2 with respect to D1. In 2012-2013, however, two meta-analyses reported that D2 improves prognosis with respect to D1. D2 lymphadenectomy was proposed as the standard of care for advanced gastric cancer by Japanese National Guidelines since 1981 and was adopted as the standard procedure by the Italian Research Group for Gastric Cancer since the Nineties. D2 is now indicated as the standard of surgical treatment with curative intent by the German, British and ESMO-ESSO-ESTRO guidelines. At variance American NCCN guidelines recommend a D1+ or a modified D2 lymph node dissection. In conclusion, D2 lymphadenectomy, originally developed by Eastern surgeons, is now becoming the procedure of choice also in the West. In gastric cancer surgery EBM is lagging behind national guidelines, rather than preceding and orienting them. To eliminate this lag, EBM should value to a larger extent Eastern Asian literature and should evaluate not only the quality of the study design but also the quality of surgical procedures.

Comparison of imaging-based and pathological dimensions in pancreatic neuroendocrine tumors

AIM To establish the ability of magnetic resonance(MR) and computer tomography(CT) to predict pathologic dimensions of pancreatic neuroendocrine tumors(Pan NET) in a caseload of a tertiary referral center.METHODS Patients submitted to surgery for Pan NET at the Surgical Unit of the Pancreas Institute with at least 1 preoperative imaging examination(MR or CT scan) from January 2005 to December 2015 were included and data retrospectively collected. Exclusion criteria were: multifocal lesions, genetic syndromes, microadenomas or mixed tumors, metastatic disease and neoadjuvant therapy. Bland-Altman(BA) and Mountain-Plot(MP) statistics were used to compare size measured by each modality with the pathology size. Passing-Bablok(PB) regression analysis was used to check the agreement between MR and CT.RESULTS Our study population consisted of 292 patients. Seventy-nine(27.1%) were functioning Pan NET. The mean biases were 0.17 ± 7.99 mm, 1 ± 8.51 mm and 0.23 ± 9 mm, 1.2 ± 9.8 mm for MR and CT, considering the overall population and the subgroup of non-functioning-Pan NET, respectively. Limits of agreement(LOA) included the vast majority of observations, indicating a good agreement between imaging and pathology. The MP further confirmed this finding and showed that the two methods are unbiased with respect to each other. Considering ≤ 2 cm non-functioning-Pan NET, no statistical significance was found in the size estimation rate of MR and CT(P = 0.433). PBR analysis did not reveal significant differences between MR, CT and pathology.CONCLUSION MR and CT scan are accurate and interchangeable imaging techniques in predicting pathologic dimensions of Pan NET.

Development of Health Literacy for Regular Hemodialysis Patients in Menoufia Governorate: A Cross-Sectional Study

Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian patients, a cross-sectional study from March to September 2020 was conducted at 4 hemodialysis (HD) units on 439 patients. A translated questionnaire including demographic characteristics and health literacy components was conducted. This study adapted Nutbeam’s model incorporating critical health literacy, interactive health literacy, and functional health literacy. Health literacy of hemodialysis patients was satisfactory among 35.5% of the studied patients. The average total score of health literacy questionnaire was (15.53 ± 4.32) distributed as (2.90 ± 1.26) for functional literacy, (3.10 ± 1.26) for basic health knowledge, (1.65 ± 1.21) for communicative literacy, (2.53 ± 0.70) for interactive literacy, (1.75 ± 1.30) for advanced health knowledge, (1.74 ± 0.48) for critical literacy, and (1.83 ± 0.93) for patient safety. It was found that poor health literacy was associated with low income (OR = 2.54, CI 95%: 1.66_3.89, p < 0.001), of increasing age (OR = 0.12 CI 95%: 0.07_0.19, p < 0.001), low education (OR = 1.08, CI 95%: 1.04_1.11, p < 0.001) and the patient did not undergo kidney transplant (OR = 4.19 CI 95%: 1.12_15.62, p = 0.033). There was a prevalent low health literacy among the studied regular hemodialysis patients which was affected by education, age and income and in turn it affected the adherence to treatment. Understanding the linkage between HL and self-care attitudes should enhance efforts to improve hemodialysis outcomes.

Correlates of first dose of measles vaccination delivery and uptake in Indonesia

Objective:To determine health systems-related,familial,and cultural factors which influence the delivery and uptake of measles vaccination in Indonesia.Methods:Logistic regression analysis of data collected during the 2007 Indonesian Demographic and Health Survey was undertaken by the authors to investigate these factors.The 2007 Indonesian Demographic and Health Survey dataset is a nationally representative,randomly sampled survey containing 15 065 children aged between 9 and 59 months.Results:72.8%of children had received the measles vaccine.Vaccination coverage was similar for males and females;however,coverage was higher amongst urban children,80.1%,compared to 68.5%in rural areas.The key findings of the regression analysis were congruent with the results of previous research targeting vaccination coverage.After controlling for all other factors,maternal age,maternal education,wealth, the use of a skilled birth attendant,and postnatal check-ups were positively and significantly (P【 0.01) correlated with measles vaccination.The number of children per household was negatively correlated(P【0.01).Conclusions:In order to enhance measles vaccination coverage in Indonesia,delivery to,and uptake by,rural and low socio-economic populations require substantial improvements.Mass health education and health systems improvements are also required.

Associations between walking parameters and subsequent sleep difficulty in older adults: A 2-year follow-up study

Purpose: This 2-year follow-up study aimed to examine the associations between total volume, frequency, duration, and speed of walking with subsequent sleep difficulty in older adults.Methods: A total of 800 older adults aged 65 years and over participated in the first survey in 2012 and 511 of them were followed 2 years later.The 5-item Athens Insomnia Scale(AIS-5) was used to measure sleep difficulty. Frequency, duration, and speed of outdoor walking were self-reported. Walking speed was assigned a metabolic equivalent value(MET) from 2.5 to 4.5. Total walking volume in MET-h/week was calculated as frequency × duration × speed. Negative binomial regressions were performed to examine the associations between volume and components of walking with subsequent sleep difficulty with covariates of age, sex, education, marital status, living arrangement, smoking, alcohol consumption, mental health, Charlson Index, exercise(excluding walking), and sleep difficulty at baseline.Results: Participants with low walking volume had a higher level of sleep difficulty 2 years later compared with those with high walking volume(incident rate ratios = 1.61, p = 0.004). When speed, frequency, and duration of walking were simultaneously entered into 1 model, only walking speed was significantly associated with subsequent sleep difficulty(after the model was adjusted for covariates and baseline sleep difficulty).Sensitivity analyses showed that walking duration emerged as a significant predictor among 3 walking parameters, with 2-year changes of sleep scores as dependent variable.Conclusion: Total amount of walking(especially faster walking and lasting for more than 20 min) is associated with less subsequent sleep difficulty after 2 years among older adults.

Patterns of hepatitis B virus exposure and associated predictors in Vietnam: A crosssectional study

Objective:To examine the magnitude of isolated anti-HBc and other HBV serological patterns and associated predictors among adults seeking general health check-up at a large health center in Vietnam.Methods:All 564 outpatients seeking general health checkup between January 2016 and December 2016 were asked to undertake HBV surface antigen,surface antibody,IgG and IgM core antibody(anti-HBc total),platelet counts,and liver function testing.An administered questionnaire was used to collect information regarding demography,in-house sources of infection,lifestyle,health condition and treatment,and HBV vaccination.Results:Male gender(P=0.043),age(P=0.000),living in urban areas(P=0.040),HBV vaccination status(P=0.033),and ALT(P=0.040) were associated with isolated anti-HBc.HBV infection was associated with HBV vaccination status(P=0.001),ALT levels(P=0.010),AST levels(P=0.020),and platelet counts(P=0.007).Past/resolved HBV infection was associated with AST levels(P=0.005),ALT levels(P=0.014),and age(P=0.000).Conclusions:Isolated anti-HBc is quite prevalent.Predictors of isolated anti-HBc include male gender,living in rural areas,and HBV non-vaccination.The prevalence of isolated anti-HBc also increases with age.To timely detect occult HBV infection and prevent transmission,anti-HBc testing should be included in the health check-up for high risk individuals and screening program where HBV nucleic acid test is not available.To prevent transmission,clinicians need to pay more attention on those who are at risk of having isolated anti-HBc and closely follow-up patients with isolated anti-HBc and educate them about the prevention of HBV infection.

Factors and Pattern of Injuries Associated with Road Traffic Accidents in Hilly District of Nepal

Introduction: In 21st century, road traffic accidents (RTA) are considered as increasing epidemic of non-communicable disease which is abandoned and needs special attention to prevent them. The aim of this study was to assess the factors and pattern of injuries associated with road traffic accidents. Methods: A cross sectional study was conducted among 112 RTA victims and 56 drivers in Palpa District of Nepal. The association of factors and pattern of injuries with exposure to accidents was assessed using Fisher’s exact test. Bivariate logistic regression examined the association between driving and socio-demographics factors and exposure to road accidents. Results: Of 112 RTA victims, 50% were in the age group of 21 to 40 years and 71.4% were male. Drivers who were in the age less than or equal to 30 years were more likely (OR: 3.6;95% CI: 1.0, 14.3) to expose to an accident than those who were above 30 years. Similarly, those having driving speed less than 40 km/hr were less likely to expose to an accident than those with speed 40 - 60 km/hr (OR: 6.0;95% CI: 0.8, 73.5) and those with speed more than 60 km/hr (OR 7.8;95% CI: 1.0, 100.1). Moreover, the driving experience was also found positively associated (OR: 5.6;95% CI: 1.1, 35.5) with the exposure to an accident. Conclusion: Being in younger age group, male gender, morning time, the driving speed, driving experiences, and driving hours on the road were positively associated with RTA. The efforts should be made to enforce laws in control of speed targeting experienced drivers and those with younger age groups.

Prevalence and Correlates of Overweight and Obesity among School Children in Sohag, Egypt

Background: Continually rising prevalence of obesity and overweight in children and adolescents is a major public health concern. This is due to its various and serious health hazards on one side and its preventable nature on the other side. This study aims at identification of prevalence of overweight and obesity and its risk factors among children between 6 - 14 years of age in Sohag, Egypt. Method: A cross sectional study was conducted on 711 school children between 6 - 14 years in four months’ period from February to May 2016. Weight and height of the studied children were measured to calculate BMI, which was compared with standard Egyptian growth charts for determining overweight and obesity. Then a questionnaire containing data about socio demographic, parental obesity, early life and dietary risk factors was completed by the children’s parents. Result: Out of 711 studied children, 117 (16.5%) were overweight and 104 (14.6%) were obese. Residing in urban area, having an obese parent or both of them, low level of maternal education, being on formula feeding during early life and lack of fresh vegetables and fruits in diets were significant risk factors for overweight and obesity in the studied children (P value < 0.05). Conclusion: Improperly educated mothers together with sedentary life style manifested in obesity among the parents and lack of sport practice among children constituted the majors risk factors for childhood obesity. This emphasizes the need for increased health awareness of the community about the importance of proper nutrition and physical activity.

Development, Dependency and HIV Risk in Kiribati

A study was undertaken in Kiribati, a small Pacific island nation, that has a low-level HIV epidemic but a high incidence of STIs among seafarers, their spouses (and children), and those involved in sex work. There are connections between development and dependency and HIV risk in Kiribati. Kiribati is a peripheral and dependent small island state underwritten by conditional aid and financial assistance and advice from donor countries, entwined in, and subject to, external globalising processes. We found two major factors related to Kiribati’s dependency engendered HIV risk. The first is Kiribati’s reliance on transnational seafaring. Long periods away from home, shipboard and port mateship cultures, and infrequent condom use in casual and paid sexual relations while in overseas ports, exacerbated by heavy alcohol use, have rendered i-Kiribati seafarers vulnerable to HIV. The second factor is related to the labour force participation of young women, which is extremely limited. In this context, some young i-Kiribati women choose to work on board, foreign fishing vessels selling sex. They stay with one client while on board a boat—for up to three months—and sex work is not only an economic transaction, but also emotional and affective labour. It is a pattern that makes consistent condom use problematic. Having multiple sequential seafarer partners may in fact generate considerable HIV vulnerability.

The Relationship between Human Papillomavirus and Oesophageal Squamous Cell Carcinoma in China—A Review of the Evidence

Background: China has one of the highest incidence rates of oesophageal cancer in the world. The role of human papillomavirus (HPV) has been extensively researched in oesophageal squamous cell carcinoma (OSCC) with indeterminate results. The majority of these studies have been conducted in the Chinese population. Evidence for a definitive HPV-OSCC association could potentially support prophylactic vaccination in target populations, highlighting the need for ongoing investigation. The aim of this review is to summarise the findings of HPV DNA in OSCC tissue in Chinese subjects, with a view to informing further research in this area. Methods: A systematic literature search of the Chinese National Knowledge Infrastructure (CNKI) database, Medline, Embase and PubMed was conducted for all studies in English and Chinese language, examining OSCC tissue for HPV DNA in China. Reference lists of retrieved articles were reviewed and hand searches of relevant, key journals were conducted, to source articles which were not electronically indexed. Sixty-four studies met our selection criteria. Data from case-control and cross-sectional studies were analysed separately for any HPV-OSCC association, using the Epi InfoTM 3.5.3 software program. Results: From all studies conducted in the Chinese population, 2166/5953 (36%) of all OSCC tissue and 478/1684 (28%) of healthy control tissue, tested positive for HPV. We found that 11/16 case-control and cross-sectional studies had a statistically significant crude odds ratio, which supported a potential HPV-OSCC association. The largest study, carried out in the high incidence County of Anyang in Henan Province, reported 207/265 (78%) OSCC tissues testing positive for HPV DNA against 203/357 (57%) controls and had an unadjusted odds ratio of 2.71 (p-value Conclusion: A rigorous meta-analysis would improve interpretation of the data and a well-designed large-scale case-control study is warranted. If a link is found between HPV and OSCC, prophylactic HPV vaccines could be of significant benefit in China.

Assessment of Standard Criteria Implementation in Heamodialysis Water Treatment Units in Sharkia Governorate

Introduction: Haemodialysis is the most well-established form of treatment for ESRD. Method: To evaluate the implementation of standard criteria in heamodialysis water treatment units in Sharkia governorate and to determine the weak points in application of standard criteria, and reach the optimal standards to improve pt. outcomes, across the sectional study was conducted at 30 heamodialysis units of Sharkia governorate, using a modified questionnaire was developed based on MOH protocol and international guidelines such as CARI guidelines, AAMI guidelines and others by the researchers. All data were collected, tabulated and statistically analyzed using SPSS 22.0 for windows (SPSS Inc., Chicago, IL, USA). Results: Of the 30 units, the majority more than 80% of the units achieved the infrastructure and schematic structure, contain water purification devices, good infection control policies, proper chemical disinfection, good monitoring and quality control, accepted maintenance technician evaluation and collected processed water samples results matched decree of 63 for 1996. Conclusion: Most of the studied units nearly fulfilled the standard specifications of both MOH and AAMI. Ensuring that water quality meets AAMI standards and recommendations will minimize patient exposure to potential contaminants such as chemical hazards and endotoxemia associated with the use of the treated water for HD.

Primary Healthcare System of Pakistan: Challenges to Self-Management of Type 2 Diabetes

This review article is aimed at describing the primary healthcare system of Pakistan and its challenges in the face of epidemic of type 2 diabetes, focusing particularly on the middle-aged population of rural area of Pakistan. The main concern in Pakistan is that its middle-aged population is facing the onslaught of obesity and overweight due to lack of physical activity. In addition unhealthy eating habits making it more difficult for this population to control their weight. All these factors are contributing to a high risk of type 2 diabetes for the population of Pakistan. This article provides insight into the primary health care system of Pakistan and highlights its deficiencies by identifying that its primary healthcare system has a poor utilization of health care services, the poor accessibility to health system and poor management of diabetes by the healthcare system, gender disparity and inequity in the health care system. The primary objective of this study is to provide an overview of self-management of diabetes among the middle-aged population of Pakistan and to identify the overall deficiencies in the primary healthcare system, its delivery and access to the system, barriers to self-management of diabetes and quality of life in that region.

Irritable Bowel Syndrome among Medical and Non-Medical Northern Border University Students, Kingdom of Saudi Arabia: Across Sectional Study

Background: Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder (FGID), characterized by abdominal pain or discomfort and alteration in bowel habits. Aim of the study: To determine the overall prevalence, prevalence of each type and risk factors of IBS among Northern Border University (NBU) students, Arar, Kingdom of Saudi Arabia. Material and methods: We use cross sectional, descriptive study with multistage cluster probability sample. Using Rome III criteria questionnaire of IBS;which is a self-administrated consists of ten questions assessing the current status of an apparently normal person. The questionnaire is administrated to Northern Border University students. Results: A total of 228 University students of them, 94 (41.2%) males and 134 (58.8%) females were included in the study. The overall prevalence of IBS according to Rome III criteria in northern border University was (32.5%). The disease prevalence was 33.6% in females and 30.9% in males. Among the study participants, the most common type of IBS was the mixed one 12.7%, followed by the constipation predominant type 10.5%, then the diarrhea pre-dominant type 5.7% while the least common was unsubtyped cases (3.5%). Statistically significant increase in prevalence of this disease was found among female students (60.8% vs. 39.2% in males) (p-value < 0.05), the students who experienced psychic stress and irritability (79.7%) (p-value < 0.05) and students who were obese (p-value < 0.001). Conclusion: The results of this study concluded the prevalence rate of 32.5% for IBS among the students studying in Northern Border University. Stress and high body mass index were significantly associated with IBS. In addition, this study concluded that IBS was not significantly associated with socio-demographic characteristics and smoking.