Marie Andrades

Reasons for migration among medical students from Karachi.

Context  The subject of economic migration among health care professionals has received intense attention. However, the aetiology of this migration has not been rigorously evaluated in Pakistan. Such knowledge can potentially influence health care and academic policies. Our current study proposes to quantify the relative contributions of various personal, professional and economic variables among final‐year medical students in Karachi.

Factors related to knowledge and perception of women about smoking: a cross sectional study from a developing country.

BackgroundSmoking rates among women are currently low, but they are the fastest growing segment of cigarette smoking population in developing countries. We aimed to assess the knowledge and perceptions towards smoking and to identify the factors related with level of knowledge and perceptions among adult women in urban slums.MethodsThis was a cross sectional study conducted on 250 adult (≥18 years of age) women attending primary care clinics in three slums of Karachi, Pakistan. A pre-tested and structured, interviewer administered questionnaire was used for data collection. Factors associated with level of understanding about smoking were analyzed with chi-square test.ResultsMost of the women knew that smoking has adverse effects on women and childrens health but the knowledge of specific health effects was limited. About one third of the women knew that active smoking can cause lung disease, but only a small percentage (7%) knew that it could lead to heart disease. None of the women were aware that smoking contributes to infertility and osteoporosis. A small proportion of women were aware that smoking can lead to low birth weight (7%), congenital anomalies (5%) and less than 1% of women knew that it contributes to pregnancy loss, still birth and preterm delivery. The understanding of passive smoking affecting childrens lung was low (20%) and a similar proportion voiced concern about the bad influence of maternal smoking on children. Educated women had better knowledge of health effects of smoking. Education was associated with having better knowledge about effects on women health in general (p = 0.02) and specific effects like lung (p = 0.03) and reproductive health effects (p < 0.001). Education was also associated with knowledge regarding effects on fetus (p < 0.001) and children (p < 0.005). Although most of the women disliked being around smokers, more than one third thought that smoking decreases boredom (39%), tension (38%) and also helps to relax (40%). A large proportion (48%) of women had the misconception that smoking helps to reduce weight.ConclusionsThis study reveals that women are aware of the general ill effects of smoking but fail to identify smoking to be associated with female maladies particularly those who were illiterate and had lower levels of education. Understanding and attitudes needs to be improved by increasing health awareness and education of women in these urban communities with special emphasis on the effects of smoking on womens health.

Effectiveness of a Formal Mentorship Program in Family Medicine Residency: The Residents’ Perspective

Introduction. Mentoring is a recognized form of teaching learning strategy in postgraduate medical education. This paper describes the effectiveness of a formal mentorship program from the residents’ perspective after a year of implementation. Methods. The Aga Khan University Family Medicine Residency Program is the first program in Pakistan to our knowledge to implement formal mentorship for all four years of residency. A mentorship program was developed, implemented, and evaluated a year later using a rating scale. The 10-point Likert scale consisted of questions on academics, clinical work, research, administrative issues, and personal/social issues. Results. The response rate was 95% (). Eighty percent () were women. Satisfaction level in seeking help was the highest for academics (75%). Residents scored mentorship as low in helping to tackle their personal problems (20%). Barriers reported in rapport building with mentor were time constraints and gender difference. The most useful attributes of the mentor which helped rapport building were accessibility, active listening, support for emotional needs, and trustworthiness. Conclusion. Mentoring has a role in trainees’ personal and professional growth especially when their needs are addressed. The effectiveness of the mentorship program in residency can improve if the residents are allowed to choose their own mentors.

Multiple Mini-Interviews (MMI) and Semistructured Interviews for the Selection of Family Medicine Residents: A Comparative Analysis

Background. Family Medicine Residency Program at the Aga Khan University has applicants for the residency position in excess of the positions offered resulting in formulation of certain selection criteria. The objective of this study was to compare MMI versus semistructured interviews for assessing noncognitive domains in the selection of residents. The secondary objectives were to determine perceptions of the interviewers and candidates for the acceptability and feasibility of MMI as a selection tool. Methods. The candidates underwent semistructured interviews along with MMI and identical attributes were tested in both. The attributes tested were safe doctor, communication skills, professionalism, problem solving, team approach, ethical issues, reasons for selecting family medicine, and commitment to the program. Descriptive statistics were calculated and comparison between ratings for MMI and interview was performed by Wilcoxon sign rank test. Results. Total number of candidates was 14. On comparison between interview and MMI, the scores were not statistically different for all attributes except ethics (mean interview scores: 3.04, mean MMI scores: 2.5, and P value 0.046). Conclusion. The study showed no difference between MMI and semistructured interviews. However, it needs to be replicated in order to determine the predictive validity and feasibility of MMI over time.

11 FACTORS ASSOCIATED WITH MISPERCEPTION OF ABDOMINAL OBESITY AT PRIMARY CARE CLINICS IN KARACHI, PAKISTAN

Objectives: To assess weight perceptions of individuals with abdominal obesity, identify misperceptions and factors associated with these misperceptions to provide appropriate counseling to such individuals. Methods: This was a cross sectional study conducted at primary care clinics from low, middle, and high socioeconomic neighbourhoods. A trained interviewer collected information on a structured questionnaire, after obtaining verbal informed consent, from 493 individuals. Proportion of individuals with misperceived waist circumference was calculated and used as the outcome variable. Univariate and multivariate logistic regression was used to identify factors associated with misperception. SPSS 16 was used for data analysis. Results: Half (n = 251) of the individuals had increased waist circumference. Out of which 77% were obese, 13% were overweight, and 11% were of normal weight. 15% of individuals with normal BMI had increased waist circumference, equally divided between males and females. One third of the individuals with increased waist circumference perceived their weight circumference to be normal. Individuals with increased waist circumference were more likely to misperceive if they were satisfied with their weight (AOR 10.8, 95% CI 6.4-18.2), had a co-morbid (AOR 2.95, 95% CI 1.7-5.0), had not been given weight advice by health professionals (AOR 1.8, 95% CI 1.1-3.0) and were unaware of their weight (AOR 1.9, 95%, CI 1.05-3.3). Conclusions: We found a high proportion of individuals with misperception of their waist circumference. Effective strategies are needed to increase awareness regarding abdominal obesity in this population especially focusing on the identified groups.