Waris Qidwai

Depression in the elderly: Does family system play a role? A cross-sectional study

BackgroundThe most common geriatric psychiatric disorder is depression. The role of family systems in depression among the elderly has not been studied extensively. It has been suggested that urbanization promotes nucleation of family systems and a decrease in care and support for the elderly. We conducted this study in Karachi, a large urban city of Pakistan, to determine the relationship between the type of family system and depression. We also determined the prevalence of depression in the elderly, as well as correlation of depression with other important socio-demographic variables.MethodsA cross-sectional study was carried out in the premises of a tertiary care hospital in Karachi, Pakistan. Questionnaire based interviews were conducted among the elderly people visiting the hospital. Depression was assessed using the 15-item Geriatric Depression Scale.ResultsFour hundred subjects aged 65 and above were interviewed. The age of majority of the subjects ranged from 65 to 74 years. Seventy eight percent of the subjects were male. The prevalence of depression was found to be 19.8%. Multiple logistic regression analysis revealed that the following were significant (p < 0.05) independent predictors of depression: nuclear family system, female sex, being single or divorced/widowed, unemployment and having a low level of education. The elderly living in a nuclear family system were 4.3 times more likely to suffer from depression than those living in a joint family system (AOR = 4.3 [95% CI = 2.4–7.6]).ConclusionThe present study found that residing in a nuclear family system is a strong independent predictor of depression in the elderly. The prevalence of depression in the elderly population in our study was moderately high and a cause of concern. The transition in family systems towards nucleation may have a major deleterious effect on the physical and mental health of the elderly.

Effectiveness, Safety, and Tolerability of Powdered Nigella sativa (Kalonji) Seed in Capsules on Serum Lipid Levels, Blood Sugar, Blood Pressure, and Body Weight in Adults: Results of a Randomized, Double-Blind Controlled Trial

OBJECTIVE The seed extracts from Nigella sativa is used by Unani physicians of traditional medicine (Hakims or Tabibs) and Ayurvedic practitioners (Vaids) in the treatment of several medical disorders including dyslipidemia, obesity, and hypertension. It is, therefore, important to prove or disprove the effectiveness, safety, and tolerability of powdered N. sativa (Kalonji) seed in capsules on serum lipid levels, blood sugar, blood pressure, and body weight in adults. DESIGN The study design was a randomized, double-blind trial. SETTINGS/LOCATION Conducted at Aga Khan University Hospital, Karachi, from February 2006 to January 2007. SUBJECTS Half of the respondents received powdered N. sativa (Kalonji) seed in capsule and the rest received a placebo. INTERVENTION/OUTCOME Baseline and after-intervention variables recorded were the following: body-mass index, waist-hip ratio, blood pressure, fasting blood sugar, serum lipids, serum alanine aminotransferase, and serum creatinine. RESULTS One hundred and twenty-three (123) patients were recruited. Sixty-four (64) and 59 patients were randomized to the intervention and the control arms, respectively. Thirty-nine (39) patients in the intervention group and 34 in the control group completed the study. Favorable impact of powdered N. sativa (Kalonji) seed in capsule was noted on almost all variables, but results were not statistically significant because of small sample size. CONCLUSIONS Favorable impact of powdered N. sativa (Kalonji) seed in capsule was noted on almost all variables, but results were not statistically significant. A larger study with adequate sample size is recommended.

Prevalence and predictors of depression among an elderly population of Pakistan

Objective: To assess the magnitude and risk factors of the problem of depression in an elderly population of Pakistan. Method: A cross-sectional study was conducted using a sample of 402 people aged 65 and above visiting the Community Health Center of the Aga Khan University, Karachi. Questionnaire based interviews were conducted for data collection and the 15-Item Geriatric Depression Scale was used to screen for depression. Univariate and multivariate logistic regression analyses were performed to identify factors associated with depression. Results: Of the 402 participants; 69.7% (95% CI = ±4.5%) were men, 76.4% (95% CI = ±4.2%) were currently married, 36.8% (95% CI = ±5%) had received 11 or more years of education and 24.4% (95% CI = ±4.2%) were employed. The mean age was 70.57 years (SD = ±5.414 years). The prevalence of depression was found to be 22.9% (95% CI = ±4.1%) and multiple logistic regression analysis indicated that higher number of daily medications (p-value = 0.03), total number of health problems (p-value = 0.002), financial problems (p-value < 0.001), urinary incontinence (p-value = 0.08) and inadequately fulfilled spiritual needs (p-value = 0.067) were significantly associated with depressive symptoms. Conclusion: We have identified several risk factors for depression in the elderly which need to be taken into account by practicing family physicians and health care workers.

Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management

Fibromyalgia Syndrome (FMS) is a chronic condition causing pain, stiffness, and tenderness of the muscles, tendons, and joints. It is also characterized by restless sleep, tiredness, fatigue, anxiety, depression, and disturbances in bowel functions. The etiology of fibromyalgia remains unknown, but recent advances and discoveries have helped to unravel some of the mysteries of this disease. Research highlights some of the biochemical, metabolic, and immunoregulatory abnormalities associated with fibromyalgia. Management of FMS at the present time is very difficult as it has multiple etiological factors and psychological predispositions; however, a patient centered approach is essential to handle this problem.

Adolescent Lifestyle and Behaviour: A Survey from a Developing Country

Introduction Adolescents form two-thirds of our population. This is a unique group of people with special needs. Our survey aims to identify the lifestyle and behavioral patterns in this group of people and subsequently come up with issues that warrant special attention. Methods A survey was performed in various schools of Karachi. Data collection was done via a face-to-face interview based on a structured, pre-tested questionnaire. Participants included all willing persons between 12–19 years of age. Results Most adolescents with lifestyle issues fell in the age group of 16–18 years. Females were more depressed than males and had more sleep problems. Substance abuse and other addictions were documented more in males. Watching television or listening to music was stated as the most common late night activity (61.8%) and therefore was also referred to as the contributory factor for less than eight hours of sleep each day. (58.9%) of the respondents are getting less than eight hours of sleep daily. (41.5%) of the respondents who felt depressed sought treatment for it. Quite a few of them were also indulged in substance abuse and other addictions. Only (16.8%) of the respondents opined that physical activity is essential for health. Thirty-five adolescents out of all the respondents were smoking cigarettes currently, whereas 7% of the respondents chewed paan (areca nut). Peer pressure was the most common reason (37.1%) to start smoking. Conclusion Adolescents need to be treated as a distinct segment of our population and it is important to realize and address their health and lifestyle problems. Inadequate sleep, depression and smoking were the leading unhealthy behaviours among the respondents. Families can play an important role to help these adolescents live a healthier life. Further research studies should be carried out to highlight issues of concern and their possible solutions in this population.

Role of garlic usage in cardiovascular disease prevention: an evidence-based approach.

Introduction. Rapidly growing prevalence of cardiovascular disease is a major threat for the developed as well as developing world warranting urgent need of intervention. Complementary and alternative medicines are gaining popularity among general population because of their safety profile and easy administration. Garlic, in particular, is considered to be one of the best disease-preventive foods because of its potent and widespread effects. This study was done to find out the role of garlic usage in cardiovascular disease prevention. Methodology. Major databases including Google, PubMed, MEDLINE, and Cochrane library view were used for the literature search. Clinical trials conducted on humans assessing role of garlic usage in cardiovascular disease prevention and the possible mechanisms responsible for such therapeutic actions were assessed. Results. Various clinical trials and meta-analyses conducted have shown positive impact of garlic in cardiovascular-disease prevention especially its effects on lipid levels; however, some contradictory results are also reported. Similarly, its effects on hypertension control, and platelet are also mild with limited data availability. The possible reason for these inconsistent results is the difference in preparations with diverse composition, variations in sulphur content present in different garlic preparations used, and methodological variations in subject recruitment, duration of study, dietary control and so forth. Conclusion. Garlic can be used as an adjuvant with lipid-lowering drugs for control of lipids, however, its role as a main therapeutic agent cannot be recommended and it is suggested that more meta-analyses using standardized preparations with a close watch on methodological shortfalls should be conducted to prove its role.

Geriatric patients' expectations of their physicians: findings from a tertiary care hospital in Pakistan

BackgroundGeriatric health is a neglected and under-explored area internationally and in Pakistan. We aimed to ascertain the expectations of the geriatric patients from their physicians and the factors associated with patient satisfaction in this particular age bracket.MethodsA cross-sectional survey was carried out at a tertiary care teaching hospital in Karachi, Pakistan. Data collection was carried out via face-to-face interviews based on structured, pre-tested questionnaires. All consenting individuals aged 65 years or above were recruited into the study. Convenience sampling was used to draw the sample. The data was analyzed using SPSS version 16. Geriatric patients expectations from physicians were elicited using a set of 11 questions that were graded on a scale of 1-3 where 1 = not important, 2 = important, 3 = very important.ResultsThree hundred and eighty geriatric patients were interviewed. The response rate of this study was 89.8%. The mean age of the respondents was 73.4 ± 6.8 years. Two hundred and forty eight respondents (65.3%) were female. Diabetes mellitus (53.7%), hypertension (59.5%), arthritis (40.5%) and renal disease (32.1%) were common ailments among geriatric patients. More than 50% of the patients were visiting their physicians once every two to three months. Discussing treatment options and letting patients make the final decision (79.2%), prescribing minimum possible medications (84.5%), physicians holistic knowledge about the spectrum of care issues for geriatric patients (79.2%), being given a realistic but optimistic picture of future health by physicians (85.5%) were ranked as very important expectations by patients from their physicians. Cumulative household income (p = 0.005), most important health complaint (p = 0.01) and frequency of experiencing health complaint (p < 0.001) emerged as independent predictors of the satisfaction of geriatric patients from care provided by physicians.ConclusionWe have documented the expectations of the geriatric patients from their physicians in a developing country. Physicians belonging to all disciplines should keep these expectations in mind during clinical encounters with geriatric patients.

The present status and future role of family doctors: a perspective from the International Federation of Primary Care Research Networks

Background: Health care systems are changing around the world; family doctors need to adapt and prepare for future challenges. Aim: To consider the present status of family doctors, anticipated changes in health care systems, the challenges these will bring and possible solutions. Collection of information: Collaborative enquiry amongst members of the International Federation for Primary Care Research Networks (IFPCRN). Six strategic questions were addressed by 37 contributors from 23 countries. Responses were collated and contributors invited to further comment on the interim report. Findings: Present status: Despite wide variability, common problems relate to delivery systems, funding and policy, lack of evidence-based medical practice, education and research. Role of family doctors: There is wide variability in roles and often poor interaction with other caregivers. Anticipated changes: An expansion of the family physician model is anticipated, alongside shortages of family doctors in the face of increased health care needs, increased complexity of problems and the shift to ambulatory care. Advances in information technology may be useful. Anticipated challenges and proposed actions: Address quality issues. This requires audit and quality assurance, promoting adaptability, promoting group practices and teamwork, coordinating care, incorporating information technology and ensuring ethical relationships with industry. Improve education and continuing professional development: Improved education and continuing professional development are needed, as are measures to prevent burnout and retain the workforce. Develop a robust research enterprise: Research in primary care is needed to develop relevant guidelines. Improve support for family doctors: Providing excellent patient care is essential for improved status and support. Achieving this requires engagement with policy makers, academic institutions and the public. Conclusions: While there is great variability across different countries, common themes relate to present status, anticipated changes in health systems and the responses needed from family medicine.

Primary healthcare policy implementation in South Asia

Primary healthcare is considered an essential feature of health systems to secure population health and contain costs of healthcare while universal health coverage forms a key to secure access to care. This paper is based on a workshop at the 2016 World Organization of Family Doctors (WONCA) South Asia regional conference, where the health systems of Bangladesh, India, Nepal, Pakistan and Sri Lanka were presented in relation to their provision of primary healthcare. The five countries have in recent years improved the health of their populations, but currently face the challenges of non-communicable diseases and ageing populations. Primary healthcare should be a core component in restructuring health systems. However, there is a lack of understanding among policymakers of the unique contribution of primary healthcare to the health of populations. This results in insufficient investment in facilities and low priority of specialty training in the community setting. Regional collaboration could strengthen the advocacy for primary healthcare to policymakers and other stakeholders. Priorities were investment in community-based health facilities, and access to healthcare through professionals specialty-trained in the primary healthcare setting. This development fits the strategy of the WHO South East Asian Region to use community-based healthcare in achieving universal health coverage for the Asian populations.

Effect of dietary supplementation of black seed (N. Sativa L.) on lipid profile of patients suffering from diabetes.

Diabetes is a chronic metabolic problem closely related to cardiovascular disease leading to premature death. Dyslipidemia is an important risk factor responsible for cardiovascular disease in patients with diabetes. This paper is based on review of articles published to observe the effect of N. Sativa (black seed) on lipid levels in patients suffering from Diabetes Mellitus. A search of indexed papers and clinical trials was done using MEDLINE and PubMed and Cochrane search engine. All studies assessing the effect of N. Sativa ingestion on lipid levels among diabetics (animal or human) were included. A total of 12 trials (6 human studies and 6 animal studies) fulfilling the inclusion criteria were reviewed. Majority of human and animal trials done among humans and animals with diabetes or metabolic syndrome demonstrated reduction in weight and improvement in serum lipid levels including decrease total lipids, triglycerides, LDL levels. However, increase in HDL level showed questionable results. N. Sativa L and its different preparations can be used as an adjuvant with lipid lowering drugs for control of lipids however its role as a main therapeutic agent cannot be recommended and more metanalysis using standardized preparations with a close watch on methodological short falls is suggested to prove its role.