Disorders In Pakistan Research Articles

Cyberbullying and Internet Gaming Disorders in Pakistan: Strategies for Mitigation

Dear Editor,Cyberbullying and internet gaming disorders (IGDs) have emerged as significant concerns in Pakistan, particularly among adolescents. This editorial explores the prevalence, impacts, and potential interventions for these issues, drawing on recentresearch and literature. The need for a multifaceted approach involving parents, educators, communities, and government is emphasized to protect vulnerable populations and promote a healthier digital environment. The advent of widespread internet access in Pakistan has brought numerous benefits, yet it has also introduced challenges such as cyberbullying andinternet gaming disorders (IGDs). These phenomena have serious implications for the mental health and well-being of adolescents. Given the relative novelty of these issues in the local context and the paucity of research, it is crucial to develop a comprehensive understanding and effective strategies for mitigation. According to a met analysis of earlier research, Asianyouth have a high IGD prevalence 1 Defining Cyberbullying and IGDs Cyberbullying lacks a universally accepted definitiondue to its complexity. Alipan and Skues provide a useful framework, describing it as behavior that intentionally harms victims using information and communication technology, perceived as harmful by victims, and witnessed by bystanders as negative2 . IGDs are recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition warranting further study. Vulnerability of Adolescents Adolescents are particularly susceptible to cyberbullying and IGDs due to the developmental changes they experience. The American Academy of Pediatrics recommends against providing personal mobile phones to children under 13 years old, highlighting their vulnerability to risky behaviors3. The prefrontal cortex, responsible for decision making and impulse control, is not fully developed in adolescents, making them prone to impulsive and risky behaviors, including cyberbullying and excessive gaming.

Adaptation of unified protocol treatment for transdiagnostic disorders in Pakistan: A heuristic framework.

The access to evidence-based treatments for mental health problems is limited in low-resource settings. Transdiagnostic approaches, such as the Unified Protocol (UP), are a potential solution for these settings because they are multi-problem focused, modular, flexible, and have low complexity. This study aimed to adapt UP to the mental health context of an urban speciality clinic in Pakistan using a four-step process of heuristic framework. The study employed an iterative and stakeholder-based approach to align the protocol with local values, language, and needs. Primarily, the proposed modifications focus on language use, matching literacy level, graphical illustrations, and relevance of examples. A multi-method approach including expert review, cognitive interviewing, and adaptation testing ensured cultural equivalence. Participants diagnosed with depression and anxiety were provided culturally adapted treatment (N = 15) at the testing phase. Findings indicated that the participants not only experienced significant reductions in symptoms of depression and anxiety but also found the culturally adapted UP to be easy to understand, culturally relevant, and engaging. This study provides evidence that the UP can be culturally adapted and used in the mental health context of Pakistan. The findings suggest that the UP is a promising intervention for individuals with depression and anxiety in low-resource settings.

A review on impediments related to the legislation and implementation regarding iodine deficiency disorders in pakistan; a lesson for other nations

A review on impediments related to the legislation and implementation regarding iodine deficiency disorders in pakistan; a lesson for other nations

A feasibility randomized controlled trial of culturally adapted Getting Better Bite-by-Bite (Ca-GBBB) intervention for individuals with eating disorders in Pakistan

BackgroundEating disorders (EDs) are serious mental health conditions that affect a person physically and psychologically. In the past, EDs were only recognized as a cultural phenomenon/societal by-product of the West. However, research evidence marks its presence in non-western countries also, including South Asia. This study aims to evaluate the feasibility and acceptability of a manualized psychological intervention called Getting Better Bite by Bite (GBBB) in individuals who screened positive on measures of EDs in Pakistan.MethodsThe proposed study is a feasibility randomized controlled trial (fRCT). The study will be conducted at five sites across Pakistan: Karachi, Hyderabad, Lahore, Rawalpindi, and Multan to recruit a total of 80 participants. Eligible participants will be randomized to either (1) the intervention group; in which they will receive one-to-one sessions of GBBB along with routine care or (2) the routine care group; in which they will only have access to the routine care. We have received ethics approval by the National Bioethics Committee. The study is registered at clinicaltrials.gov (NCT05724394). The study team has received permission from recruitment centers: hospitals (i.e. the psychiatry department of public and private hospitals based in these cities), fitness centers (i.e., gyms), educational institutes (i.e., colleges and universities), and community settings (i.e. community health clinics). Self-referrals from General Practitioners and community settings will be accepted. The intervention manual has been translated into Urdu and a multidisciplinary team including service users has culturally adapted the content of intervention for local context.DiscussionThis study will provide evidence on feasibility and acceptability of a culturally adapted intervention for individuals who screen positive on measures of EDs. The findings of this study will inform a fully powered Randomized Controlled Trial of the proposed intervention.Trial Registration. The study is registered on clinicaltrials.gov (NCT05724394). Protocol version (1.0. 1st June 2022).

Sleep Medicine Clinics: A Solution for Obstructive Sleep Apnea and Sleep Disorders in Pakistan

Sleep Medicine Clinics: A Solution for Obstructive Sleep Apnea and Sleep Disorders in Pakistan

Systematic Review on Oral Health Knowledge, Practice and Attitude In Pakistan

Background: The term "oral health" describes the state of the mouth's defence against ailments that affect the oral cavity, such as tooth decay, periodontal disease, cancer of the mouth and throat, facial discomfort, and ulcers. Oral cleanliness, tobacco usage, alcohol consumption, and general diet are the main contributors to oral health issues and illnesses. The most significant advantage of maintaining proper dental hygiene is the prevention of diseases. In Pakistan, dental health is not given much priority. The aim of this systematic review is to thoroughly examine and summaries the body of research on Pakistani people's attitudes, practices, and knowledge on oral health. The study aims to identify knowledge gaps, offer a thorough review of the existing situation regarding oral health awareness, habits, and attitudes, and indicate possible areas for development. Methods: This thorough systematic review, which adheres closely to PRISMA principles, examines all cross-sectional studies examining the gaps in oral health knowledge, practice, and attitude in Pakistan. Several databases such as Medline, ProQuest Central, Web of Science, and Scopus were used and past and current reviews on the same subject were looked in the Cochrane Database of Systematic Reviews. Selected papers were meta-synthesized to produce results that were both statistically sound and strong. Results: The findings reveal that there are differences in the population's knowledge about oral health, certain groups with low socio-economic status showing less understanding of preventive and good oral hygiene habits. Conclusion: This review highlights the need for all-encompassing strategies that account for differences in geography, culture, and socioeconomic disparities by placing the findings in a broader literary context. To improve oral health outcomes across the country, specific public health campaigns, educational programmes, and policy measures are crucial given the knowledge gaps and practice discrepancies that have been discovered. By addressing these problems, we can improve people's general health and lessen the prevalence of oral disorders in Pakistan.

Examining the relationship between Exposure to Avengers Action Figures and Men’s Body Dissatisfaction and Eating Disorders in Pakistan

This study investigates the relationship between social comparison, body dissatisfaction, and eating disorders among males in five major cities of Pakistan. The sample comprised 400 male participants drawn from diverse socioeconomic backgrounds. The Social Comparison Theory serves as the theoretical framework for examining how individuals' perceptions of their bodies are influenced by comparisons with others. Results revealed significant correlations between eating disorder symptoms and body dissatisfaction as well as social comparison tendencies. More specifically, there was a larger tendency toward disordered eating practices and higher degrees of body dissatisfaction among those who participated in upward social comparison. The results emphasis the importance of considering social comparison processes in understanding body image concerns and eating disorders among males in Pakistan. Implications for intervention and prevention efforts aimed at promoting positive body image and healthy eating behaviors are discussed. The implications of these findings extend to intervention and prevention strategies geared towards fostering positive body image and cultivating healthy eating behaviors among this demographic.

Treatment Approaches to Speech Sound Disorders: A Scoping Review

Objective: The objective was to highlight and review different therapeutic approaches to cater to speech sound disorders in Pakistan. Methodology: To find the different therapeutic approaches, a literature search for related articles/ publications was conducted using the Keywords “speech sound disorders, phonological disorders, articulation disorder and a combination of words using search engines like Google & and databases like PubMed and other websites. Around 130 publications, reports, and articles were downloaded, of which 25 were used for literature review. Results: There are many treatments used to cater for speech sound disorders including contextual utilisation, phonological contrast, complexity, core vocabulary, cycles phonological pattern, distinctive feature therapy, metaphor therapy, naturalist speech intelligibility, non-speech oral-motor therapy, speech sound perception training and bilingual or cross-lingual approach. However, novel trends like the use of hybrid treatment, speech motor learning- phonetic placement approach, blocked practice versus serial practice schedule & interventions using biofeedback need to be utilized. Conclusion: Treatment approaches in use include contextual utilisation, phonological contrast, complexity, core vocabulary, cycles phonological pattern, distinctive feature therapy, metaphor therapy, naturalist speech intelligibility, non-speech oral-motor therapy, speech sound perception training and bilingual or cross-lingual approach, however, novel treatments need to be utilised. Keywords: Articulation disorders, Phonological disorders, Phonological Representations

Anti MOG antibody associated disorders in Pakistan: A retrospective audit

Anti MOG antibody associated disorders in Pakistan: A retrospective audit

Burden of mental disorders by gender in Pakistan: analysis of Global Burden of Disease Study data for 1990-2019.

We aimed to examine the burden of mental disorders in Pakistan over the past three decades. We used the crude data of disability-adjusted life-years (DALYs) obtained from the Global Burden of Disease Study database (1990-2019) to represent burden. Data were retrieved on 26 January 2021. Data for adults of reproductive age (aged 15-49 years) were analysed to discuss and interpret the disease burden. An analysis was conducted on total DALYs separately for the genders for ten mental disorders reported in Pakistan. DALYs increased drastically with the onset of reproductive age. Depressive disorder was the most reported mental disorder, contributing 3.13% (95% CI 2.25-4.24) of total DALYs, and varied significantly between genders: females 3.89% (95% CI 2.73-5.29) versus males 2.37% (95% CI 1.62-3.25). A nationwide high-quality epidemiological surveillance system should be implemented to monitor mental disorders and offer culturally appropriate preventive services.

National guidelines for the treatment of common headache disorders in Pakistan

National guidelines for the treatment of common headache disorders in Pakistan

Development and Validation of Caregiver Social Isolation Scale

Objective: To develop an indigenous Caregiver Social Isolation Scale (CSIS) in Urdu for caregivers of mental and physical disorders in Pakistan.
 Study Design: Mixed method study.
 Place and Duration of Study: Department of Psychology, University of Gujrat, Pakistan, from Jan to Jun 2021.
 Methodology: An item pool of 48 was generated based on a thematic analysis of structured interviews with six experts and nine caregivers. The content validity was evaluated by three PhDs in Psychology and two Physicians. The reliability calculated on thirty participants for a tryout was 0.95. Item total correlation of item tool was in the acceptable range. A pilot study was done on three hundred individuals. The value of the KMO was 0.952, which showed the adequacy of the data, with the value of Bartlett’s test significant. No item was deducted. The reliability of 48 items on 300 individuals was 0.976, with two factors. First, for the validity of CSIS, data was collected from 120 individuals with standardized Ryff’s psychological well-being scale, Scale of Social Support and Delong Loneliness Scale. Second, confirmatory factor analysis was conducted on 200 caregivers of children with cleft lip and palate.
 Results: Exploratory factor analysis yielded two factors, mental agony and lack of social cohesion, with 48 items. Model fit indices of CFA on caregivers......
 Conclusion: CSIS is a reliable and valid scale for assessing the social isolation experiences of caregivers of either mental or physical diseases in Urdu.Keywords: Cleft lip, Cleft palate, Caregiver social isolation scale, Exploratory factor analysis.

Mindfulness-based intervention: A potential regimen for mental health disorders in Pakistan.

Mindfulness-based intervention: A potential regimen for mental health disorders in Pakistan.

Therapeutic Role of Clinical Inertia among Patients with Degenerative Arthritis

Aim: In underdeveloped countries, clinicians face obstacles in achieving goals of management in conditions such as diabetes, hypertension, stroke, arthritis, sciatica, and lower back pain. In practice, clinical inertia plays a notable role as a factor that leads to inadequate management of chronic diseases. Clinical inertia has on no occasion been elaborated in musculoskeletal disorders in Pakistan. Consequently, the purpose of this study was to check the occurrence of clinical inertia among patients with degenerative arthritis and to know the medical errors associated with it. Methods: This cross-sectional study was conducted from April 2022 to December 2022 and included 150 study participants suffering from degenerative osteoarthritis by non-probability convenient sampling. Data were collected by retrospective chart reviews from private physical therapy clinics in Lahore. Friedman ANOVA was used for comparison between NPRS at the time of the first visit; at week 1 and week 2. Results: The findings of this study suggest that there is a significant difference (P ≤ 0.000) between the pain of study participants at the time of the first visit, after one week, and after the second week. The study also showed that the charts of the research participants receiving treatment did not mention the range of motion associated with degenerative osteoarthritis which is considered one of the crucial goals in patients suffering from degenerative osteoarthritis. Practical Implication: There is a dire need to have an in-depth knowledge of clinical inertia and its factors which will ultimately help to develop specific strategies to minimize reflexive errors that play a causative role in clinical idleness. Conclusions: There is a difference in pain intensity of patients in the first week and during the second week but there is a high risk of clinical inertia in physical therapy practice related to lack of knowledge. Keywords: Degenerative Arthritis, Inertia, Joint Diseases, Musculoskeletal Diseases, Osteoarthritis, Physiotherapy, and Physical Therapy.

Initiating newborn screening for metabolic disorders in Pakistan: A qualitative study of the early challenges and opportunities

In multiple countries, newborn screening (NBS) initiatives have provided prevalence insights for inborn errors of metabolism (IEM), but Pakistan lacks such data. Few reports exist on IEM in Pakistan, and none offer comprehensive population-based prevalence information. In response to this deficiency, our study surveyed specialized schools and care centers in Punjab (Faisalabad, Lahore), Pakistan, focused on children with intellectual disabilities (ID). Information from 409 ID children (n = 212 from Faisalabad and n = 197 from Lahore) suspected of IEM was collected. Our objective was to uncover biochemical and molecular underpinnings, ultimately revealing prevalence rates for Punjab, Pakistan. This report details our challenges engaging with affected children, parents, and school staff, emphasizing the potential of such efforts, despite resource limitations, to establish an IEM newborn screening program in Pakistan. By developing NBS program in Pakistan, it will help to minimize the burden of such IEM from the society.

Trends in the burden of eating disorders in Pakistan over the past three decades: A joinpoint regression analysis

Trends in the burden of eating disorders in Pakistan over the past three decades: A joinpoint regression analysis

Hematological Parameters and Demographic Distribution of Hemoglobinopathies and Various Hemoglobin Variants.

Background The study was conducted to find the prevalence of hemoglobinopathies along with their geographical/ethnic distribution to highlight the region of high prevalence that can be used to guide screening. Method Results of blood samples received for hemoglobin variants determination by high-performance liquid chromatography (HPLC) were retrospectively analyzed at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore. Blood samples were assayed for CBC (complete blood count), red blood cell morphology, and hemoglobin analysis by HPLC. CBC was performed on Sysmex XN 9000 analyzer (Sysmex, Kobe Japan), peripheral smears to review RBC morphology were stained with Wright-Giemsa stain, and HPLC was performed on BIO-RAD variant II (Bio-Rad Laboratories, Hercules, USA). Results Hemoglobinopathies were identified in 9.7% (n=997) out of 10,297 samples. Beta thalassemia trait was the most common hemoglobinopathy recognized with a prevalence of 5% (n=516), with the maximum number of cases in the Lahore district of Punjab province. The next most common hemoglobinopathy identified was sickle cell disease with a frequency of 1.43% (n=148) and the maximum cases from the Dera Ismail Khan district of the Khyber Pakhtunkhwa province. The additional important hemoglobinopathies found were sickle cell trait, hemoglobin-D Punjab trait, and compound heterozygote for sickle and beta thalassemia. Conclusion Hemoglobinopathies are the most common inherited disorders in Pakistan and worldwide. Screening for hemoglobinopathies is recommended in high-prevalence districts of Pakistan. Sickle cell screening is also recommended in newborns in the high prevalence area of Pakistan, such as the northwest regions.

Functional Gastrointestinal Diseases and Dietary Practices among Pakistani Children-A Schools Based Cross-Sectional Study.

Functional gastrointestinal diseases (FGIDs) are an important yet highly under explored area among public health issues. FGIDs' complex etiology makes them of interest along with their prevalence in children steadily increasing, especially in the developing world. We aimed to determine the burden FGIDs pose on school-going children, and to determine its association with the dietary intake patterns in Pakistani children. The study included 385 school-children from public and private schools in Pakistan through multistage random sampling, from March to August 2022. We used the Food Frequency Questionnaire (FFQ) and Rome IV Criteria for a comprehensive exploration of the issue. Associations between the FGIDs and dietary factors were analyzed using chi-square and Fischer's exact tests in SPSS version 26.0. Females constituted 77.4% (n = 298) of all respondents, while 44.9% (n = 173) of the total reported a family history of gastrointestinal diseases. FFQ analysis showed varying consumption frequencies for different food groups. Functional abdominal pain and irritable bowel syndrome (IBS) were the highest reported FGIDs with a prevalence of 38.7% (n = 149) and 24.9% (n = 96), respectively. Statistical associations were found between different FGIDs and gender, age, household income, family members, and dietary variables such as fruit, vegetable, beverage and pulse consumption. FGIDs were found to be associated with a number of socio-demographic and dietary factors which calls for small scale and large scale attention to the issue. Results from the current study and further studies may help develop guidelines to manage these disorders in Pakistan.

Technology-assisted task-sharing to bridge the treatment gap for childhood developmental disorders in rural Pakistan: an implementation science case study

BackgroundAs in many low-income countries, the treatment gap for developmental disorders in Pakistan is nearly 100%. The World Health Organization (WHO) has developed the mental Health Gap Intervention guide (mhGAP-IG) to train non-specialists in the delivery of evidence-based mental health interventions in low-resource settings. However, a key challenge to scale-up of non-specialist-delivered interventions is designing training programs that promote fidelity at scale in low-resource settings. In this case study, we report the experience of using a tablet device-based application to train non-specialist, female family volunteers in leading a group parent skills training program, culturally adapted from the mhGAP-IG, with fidelity at scale in rural community settings of Pakistan.MethodsThe implementation evaluation was conducted as a part of the mhGAP-IG implementation in the pilot sub-district of Gujar Khan. Family volunteers used a technology-assisted approach to deliver the parent skills training in 15 rural Union Councils (UCs). We used the Proctor and RE-AIM frameworks in a mixed-methods design to evaluate the volunteers’ competency and fidelity to the intervention. The outcome was measured with the ENhancing Assessment of Common Therapeutic factors (ENACT), during training and program implementation. Data on other implementation outcomes including intervention dosage, acceptability, feasibility, appropriateness, and reach was collected from program trainers, family volunteers, and caregivers of children 6 months post-program implementation. Qualitative and quantitative data were analyzed using the framework and descriptive analysis, respectively.ResultsWe trained 36 volunteers in delivering the program using technology. All volunteers were female with a mean age of 39 (± 4.38) years. The volunteers delivered the program to 270 caregivers in group sessions with good fidelity (scored 2.5 out of 4 on each domain of the fidelity measure). More than 85% of the caregivers attended 6 or more of 9 sessions. Quantitative analysis showed high levels of acceptability, feasibility, appropriateness, and reach of the program. Qualitative results indicated that the use of tablet device-based applications, and the cultural appropriateness of the adapted intervention content, contributed to the successful implementation of the program. However, barriers faced by family volunteers like community norms and family commitments potentially limited their mobility to deliver the program and impacted the program’ reach.ConclusionsTechnology can be used to train non-specialist family volunteers in delivering evidence-based intervention at scale with fidelity in low-resource settings of Pakistan. However, cultural and gender norms should be considered while involving females as volunteer lay health workers for the implementation of mental health programs in low-resource settings.

Cost of Mental Illness and Depression in Developing Countries: A Case Study of Pakistan

Depression causes a substantial burden to persons, their beloved ones, and the nations as a whole. Major depression results in disability, high morbidity, high mortality, suicides, physical and mental impairment, and deteriorates the quality of life in a society. Depression is common in developing countries like Pakistan. This study analyzes the economic burden of depression and depressive disorders in Pakistan. The study was conducted in Pakistan’s third largest city, Faisalabad. Respondents were selected using a multistage sampling technique. As a first step, hospitals were selected from both the public and private sectors. In step two, respondents were selected and interviewed using a well-structured and pre-tested questionnaire. Review of literature reveals that the largest share of the burden of depression and depressive disorders is in the form of indirect cost. Direct healthcare cost is mostly in the form of outpatient care, doctor fee, and medicine bills, etc. This study, therefore, estimated both types of costs using cost of illness (COI) analysis. In order to find out the level of depression in patients, the center of epidemiologic studies depression (CES-D) scale was used. Then the direct and indirect cost of depression was estimated. Additionally, multiple regression analysis was used to examine the determinants of health cost, including the level of depression. The direct and indirect costs of depression were 11,108 Pakistani Rupees (PKR) and 4,869 PKR per month, respectively. Results of regression analysis revealed that besides the level of depression, monthly income, age, education, and the number of visits to a doctor’s clinic determine health cost, positively and statistically significant. Additionally, the occurrence of depression and anxiety was evident in adults more than other age groups. Females were suffering from this disorder comparatively more than male respondents. The economic burden related to depression is considerable, especially for those who belong to low-income group. Government should provide facilities for treatment for depression in public hospitals by keeping a special focus on less privileged groups of the population.