Humaira Maheen

Suicide by health professionals: a retrospective mortality study in Australia, 2001–2012

Objectives: To report age‐standardised rates and methods of suicide by health professionals, and to compare these with suicide rates for other occupations.

Perinatal outcome of twin pregnancies according to chorionicity: an observational study from tertiary care hospital

Abstract Objective: To assess the perinatal outcome in twin pregnancies according to chorionicity. Methods: This was a retrospective cohort study of twin pregnancies from January 2001 to December 2012. Maternal and perinatal outcomes of monochorionic (MC) and dichorionic (DC) twins were compared by using chi-square and t-test. Perinatal complications were compared by adjusted odds ratio using logistic regression at 5% level of significance. Results: Among 391 twin pregnancies, 116 (29.6%) were MC and 275 (72.95%) were DC. In MC twins, the rate of miscarriage was three fold higher than DC (12.6% versus 4.4%; p-value < 0.000). Mean birth weight in DC was 218.4 g higher than the MC (p value < 0.000). Similarly, MC twins were 1.92 times [CI (1.02–3.62), p value = 0.042] more likely to be delivered preterm. Likewise, neonatal intensive care admission for MC was 2.23 times [CI (1.08–4.06), p-value = 0.03], congenital anomalies were 4.75 times [CI (1.22–18.4), p value = 0.024]. Fetal growth restriction was 1.86 times more common in the MC twin pair [CI (1.07–3.21), p-value = 0.026]. Conclusions: MC twins were more at risk for adverse outcomes than DC twins. Determining chorionicity at early pregnancy will help the Obstetricians to plan the care of these patients. This will help not only in managing twin pregnancies but also help in counseling according to the local perinatal outcome.

Male suicide among construction workers in Australia: a qualitative analysis of the major stressors precipitating death

BackgroundSuicide rates among those employed in male-dominated professions such as construction are elevated compared to other occupational groups. Thus far, past research has been mainly quantitative and has been unable to identify the complex range of risk and protective factors that surround these suicides.MethodsWe used a national coronial database to qualitatively study work and non-work related influences on male suicide occurring in construction workers in Australia. We randomly selected 34 cases according to specific sampling framework. Thematic analysis was used to develop a coding structure on the basis of pre-existing theories in job stress research.ResultsThe following themes were established on the basis of mutual consensus: mental health issues prior to death, transient working experiences (i.e., the inability to obtain steady employment), workplace injury and chronic illness, work colleagues as a source of social support, financial and legal problems, relationship breakdown and child custody issues, and substance abuse.ConclusionWork and non-work factors were often interrelated pressures prior to death. Suicide prevention for construction workers needs to take a systematic approach, addressing work-level factors as well as helping those at-risk of suicide

Suicide among emergency and protective service workers: a retrospective mortality study in Australia, 2001 to 2012

BACKGROUND Emergency and protective services personnel (e.g., police, ambulance, fire-fighters, defence, prison and security officers) report elevated levels of job stress and health problems. While population-level research is lacking, there has been some research suggesting suicide rates may be elevated in emergency and protective services. OBJECTIVES This paper compares suicide rates between emergency and protective services occupational groups over a 12-year period (2001-2012) in Australia. METHOD Labour force data was obtained from the 2006 Australian Census. Suicide data was obtained from the National Coroners Information System (NCIS). Negative binomial regression was used to estimate the association between suicide and employment as an emergency or protective service worker (including prison and security officers) over the period 2001-2012, as compared to all other occupations. Information on suicide method was extracted from the NCIS. RESULTS The age-adjusted suicide rate across all emergency and protective service workers was 22.4 (95% CI 19.5 to 25.2) per 100,000 in males and 7.8 in females (95% CI 4.6 to 11.00), compared to 15.5 per 100,000 (95% CI 15.2 to 15.9) for males and 3.4 (95% CI 3.2 to 3.6) for females in other occupations. The highest risk by subgroup was observed among those employed in the defence force, prison officers, and ambulance personnel. The major method of death for all occupational groups was hanging. CONCLUSIONS Our results clearly highlight the need for suicide prevention among emergency and protective service occupations.

Rural Women’s Experience of Living and Giving Birth in Relief Camps in Pakistan

Background: Women are more vulnerable than men in the same natural disaster setting. Preexisting gender inequality, socio-cultural community dynamics and poverty puts women at significant risk of mortality. Pregnant women are particularly vulnerable because of their limited or no access to prenatal and obstetric care during any disaster or humanitarian emergency setting. Methods: In-depth interviews were conducted with 15 women who gave birth during the 2011 floods in Sindh Province, Pakistan. Thematic analysis explored women’s experiences of pregnancy and giving birth in natural disaster settings, the challenges they faced at this time and strategies they employed to cope with them. Results: Women were not afforded any control over decisions about their health and safety during the floods. Decisions about the family’s relocation prior to and during the floods were made by male kin and women made no contribution to that decision making process. There were no skilled birth attendants, ambulances, birthing or breastfeeding stations and postnatal care for women in the relief camps. Women sought the assistance of the traditional birth attendants when they gave birth in unhygienic conditions in the camps. Conclusion: The absence of skilled birth attendants and a clean physical space for childbirth put women and their newborn infants at risk of mortality. A clean physical space or birthing station with essential obstetric supplies managed by skilled birth attendants or community health workers can significantly reduce the risks of maternal morbidity and mortality in crisis situations.

Suicide prevention in Australia: Does the funding match the burden?

Estimates from the Global Burden of Disease indicate that suicide accounts for 18% of all deaths among persons aged 15–49 years in Australia (Institute for Health Metrics and Evaluation, 2016). The rate of hospitalisation for self-harm is approximately 118 per 100,000 persons per year (Australian Institute for Health and Welfare, 2017). There has been a recent reform of mental health and suicide prevention activities in Australia from being a government responsibility to one that is managed by Primary Health Networks (PHNs), following the review of their predecessors Medicare Locals (Horvath, 2014). There are currently 31 PHNs operating in Australia. Although what PHNs commission in terms of suicide prevention is critically important, it is not the focus of the current commentary. Rather, we are interested in extent to which the financial support PHNs have been allocated matches the burden of suicide and self-harm within the local area they support. The rationale for this investigation comes from an earlier paper in Australia, which found that suicide rates in younger men (aged 19–24 years) were already lower in areas that received locally targeted suicide prevention activity than in those that had no activities (Page et al., 2011). In this study, we explored whether the PHN funding is aligned with the burden of suicide and self-harm across Australia, for example, whether more funding has been allocated to areas with higher rates of suicide and self-harm.

Fetal outcome of cases with diaphragmatic hernia.

Abstract Objective: The aim of this study is to report the short-term morbidity of congenital diaphragmatic hernia at a tertiary referral center in Karachi, Pakistan. Methods: It is a retrospective cohort study of fetuses with congenital diaphragmatic hernia from January 2001 to December 2011. This includes all cases with prenatal diagnosis and those presenting in the postnatal period. This study analyses the survival of these cases and assesses the prognostic factors associated with the mortality of this condition. Results: During the 11 year study period, 65 cases of diaphragmatic hernia were identified. Among these, 41 cases were diagnosed in the antenatal period while the rest of the 24 presented in the postnatal period. Fifty-eight out of the 65 (89%) were born alive. Only 38% of these survived beyond 28 days of life. Factors like antenatal diagnosis and birthweight significantly influenced the outcome while mode of delivery, site of lesion and gestational age at delivery did not affect the prognosis. Conclusion: The overall mortality of congenital diaphragmatic hernia remains high. Survival rate of isolated hernia was substantially higher than those who had associated anomalies. The data from this study will provide the basis for counseling women in our setup.