Gerry Mugford

Prevalence of Depression among Households in Three Capital Cities of Pakistan: Need to Revise the Mental Health Policy

Background Pakistan, among the other developing countries, has a higher prevalence rate of depression because of the current social adversities. There is, thus, a great need for systematic studies on prevalence of depression. The current study aims at exploring the prevalence of depression among households in three capital cities of Pakistan. Methodology and Principal Findings A sample of N = 820 was randomly selected, and a cross sectional telephone-based study was conducted for a duration of six months. It was found that there was a regional variation in prevalence rates for depression among the three cities. Lahore had the highest number of depressives (53.4%), as compared to Quetta (43.9%) and Karachi (35.7%). Middle age, female gender and secondary school level of education were significantly associated with depression among the study group. Conclusions/Significance The different rates of prevalence among the three cities could be attributed to local cultural influence, geographical locations and social adversities. There is a need for revision of existing health policy by the government.

Physicians’ Attitudes and Practice Toward Treating Injection Drug Users Infected with Hepatitis C Virus: Results from a National Specialist Survey in Canada

BACKGRound: In Canada, more than 70% of new cases of hepatitis C virus (HCV) infection per year involve injection drug users (IDUs) and, currently, there is no consensus on how to offer them medical care. oBJeCtive: To examine the characteristics of Canadian specialist physicians and their likelihood to provide treatment to HCV patients who are IDUs. Methods: A nationwide, cross-sectional study was conducted in the specialty areas of hepatology, gastroenterology and infectious diseases to examine HCV services. The questionnaire requested information regarding basic demographics, referral pathways and opinions (yes/no), and examined how a physician’s treatment regimen is influenced by factors such as treatment eligibility, HCV care management and barriers to providing quality service. Results: Despite the fact that the majority of prevalent and incident cases of HCV are associated with injection drug use, very few specialist physicians actually provide the necessary therapy to this population. Only 19 (19.79%) comprehensive service providers were likely to provide treatment to a current IDU who uses a needle exchange on a regular basis. The majority of comprehensive service providers (n=86 [89.58%]) were likely to provide treatment to a former IDU who was stable on substitution therapy. On bivariate analysis, factors associated with the likelihood to provide treatment to current IDUs included physicians’ type, ie, infectious disease specialists compared with noninfectious specialists (OR 3.27 [95% CI 1.11 to 9.63]), and the size of the community where they practice (OR 4.16 [95% CI 1.36 to 12.71] [population 500,000 or greater versus less than 500,000]). Results of the multivariate logistic regression analysis were largely consistent with the results observed in the bivariate analyses. After controlling for other confounding variables, only community size was significantly associated with providing treatment to current IDUs (OR 3.89 [95% CI 1.06 to 14.26] [population 500,000 or greater versus less than 500,000]). ConClusion: The present study highlighted the reluctance of specialists to provide treatment to current IDUs infected with HCV. Providing treatment services for HCV-infected substance abusers is challenging and there are many treatment barriers. However, effective delivery of treatment to this population will help to limit the spread of HCV. The present study clearly identified a need for improved HCV treatment accessibility for IDUs. les attitudes et la pratique des medecins envers le traitement des consommateurs de drogues par injection infectes par le virus de l’hepatite C : les resultats d’un sondage national aupres de specialistes du Canada

The electronic Psoriasis and Arthritis Screening Questionnaire (ePASQ): a sensitive and specific tool to diagnose psoriatic arthritis patients.

Background: We report on an electronic version of the Psoriatic Arthritis Screening Questionnaire (ePASQ), a sensitive and specific tool for diagnosis of psoriatic arthritis (PsA) in patients with plaque psoriasis. Objective: To validate the ePASQ against the original paper version. Method: The ePASQ scores 15 points on 10 weighted questions and a 68-joint diagram. Data were collected from a prospective cohort of 42 patients with early PsA meeting the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria and from 12 plaque psoriasis patients without PsA. Results: The receiver operating characteristic curves for the ePASQ group yielded an optimal 97.62% sensitivity and 75.00% specificity, for a cutoff score of 7. A cutoff point of 8 yielded 88.10% sensitivity and 75.00% specificity. Concordance of the paper and electronic scores was very high. Conclusion: The ePASQ is a sensitive and specific tool to screen for PsA. The simple electronic administration and automatic scoring minimize clinician involvement and increase the potential for wider distribution.

The Self-Administered Psoriasis and Arthritis Screening Questionnaire (PASQ): A Sensitive and Specific Tool for the Diagnosis of Early and Established Psoriatic Arthritis

Background Psoriatic arthritis is a serious chronic inflammatory arthritis that can lead to significant joint damage and often is associated with comorbidities. Early detection and effective management of psoriatic arthritis may prevent the development of such complications. Most patients develop psoriatic arthritis years after onset of psoriasis, and most patients with psoriasis alone are managed by dermatologists or general practitioners. These clinicians are thus in an excellent position to screen for psoriatic arthritis early in the disease course. Objective The objective of this study was to evaluate the sensitivity and specificity of the Psoriasis and Arthritis Screening Questionnaire (PASQ) in detecting patients with psoriatic arthritis. Methods Two groups of patients were screened: patients with established disease and patients referred for evaluation of possible (i.e., early) psoriatic arthritis. Results In patients with established disease, analysis of the PASQ score yielded an optimal cutoff point of 9 with 86.27% sensitivity and 88.89% specificity. In patients with early disease, the PASQ indicated an optimal score of 7 with 92.86% sensitivity and 75% specificity. Conclusion The PASQ is an effective screening tool in psoriatic arthritis patients with a long history of disease as well as in those with short disease duration.

Poor access to timely pain reduction interventions for pediatric patients with supracondylar humerus fracture.

Objective The purpose of this study was to describe the use of analgesic interventions in children with acute supracondylar fractures presenting to a pediatric emergency department (ED) and to explore the relationship between timely interventions and severity of injury. Methods This was a retrospective cohort study. Structured chart reviews were conducted on all eligible cases of acute supracondylar humerus fracture presenting to a single pediatric ED over a 5-year period ending in December 2009. Two interventions were studied: administration of a systemic analgesic and placement of an immobilizing backslab. Criteria for timeliness were administration of an analgesic within 30 minutes from triage and placement of a backslab before radiography. Cases were dichotomized as nonsevere or severe based on whether the fracture was treated with casting alone or with another orthopedic intervention (closed reduction in the ED or any procedure in the operating room). Results Of 160 eligible cases, 116 were classified as nonsevere and 44 as severe. The proportions receiving a timely analgesic were 3% and 11%, respectively, in these groups (P = 0.04 for difference). For backslab application, 16% and 61% received timely treatment in the nonsevere and severe groups, respectively (P = 0.000 for difference). Conclusions Children presenting to a pediatric ED with a painful injury had low access to early systemic analgesics and backslab immobilization. Many factors may have played a role, including lack of mandated documentation of a formal pain score and lack of a medical directive allowing triage nurses to administer analgesics in the institution studied.

Optimizing Glycemic Control in Adults With Type 1 or Type 2 Diabetes Attending a Multidisciplinary Foot Clinic

OBJECTIVES To determine the impact of a diabetes nurse educator (DNE) on glycemic control in a multidisciplinary diabetes foot (MDF) clinic. METHODS A prospective cohort trial to measure the impact of a DNE on glycemic control was conducted in an MDF clinic. Change in glycated hemoglobin (A1C) levels over time was measured against the percentage of patient visits (PPVs) accompanied by a glucose meter and/or diary. RESULTS Increasing PPVs were significantly associated with decline in A1C levels in females. Every 10% increase in PPVs resulted in a 0.18% decrease in A1C levels (p<0.0001). To achieve a clinically important decrease of 1% in A1C levels, a 56% increase in PPVs was required. Increased A1C levels were significantly associated with higher baseline A1C levels (p<0.001) and increased hospital days for foot complications (p<0.0052). CONCLUSIONS Regular, face-to-face contact with a DNE in an MDF clinic has a positive impact on glycemic control in females.

Reported Experiences of Stalking Behavior from Patients towards Psychiatrists from the Atlantic Provinces of Canada

Aim: A study was conducted to assess the magnitude of stalking experienced by psychiatrists, itseffects and actions taken to ameliorate the problem. Methods: A cross sectional study to assess the magnitude of stalking the consequent effects on the psychological, s ocial and occupational life of psychiatrists; and any