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Impulse indicator saturation is a popular method for outlier detection in time series modeling, which outperforms the least trimmed squares (LTS), M-estimator, and MM-estimator. However, using the IIS method for outlier detection in cross-sectional analysis has remained unexplored. In this paper, we probe the feasibility of the IIS method for cross-sectional data. Meanwhile, we are interested in forecasting performance and covariate selection in the presence of outliers. IIS method uses Autometrics techniques to estimate the covariates and outlier as the number of covariates P > n observations. Besides Autometrics, regularization techniques are a well-known method for covariate selection and forecasting in high-dimensional analysis. However, the efficiency of regularization techniques for the IIS method has remained unexplored. For this purpose, we explore the efficiency of regularization techniques for out-of-sample forecast in the presence of outliers with 6 and 4 standard deviations (SD) and orthogonal covariates. The simulation results indicate that SCAD and MCP outperform in forecasting and covariate selection with 4 SD (20% and 5% outliers) compared to Autometrics. However, LASSO and AdaLASSO select more covariates than SCAD and MCP and possess higher RMSE. Overall, regularization techniques possess the least RMSE than Autometrics, as Autometrics possesses the least average gauge at the cost of the least average potency. We use COVID-19 cross-sectional data collected from 1 July 2021 to 30 September 2021 for real data analysis. The SCAD and MCP select CRP level, gender, and other comorbidities as an important predictor of hospital stay with the least out-of-sample RMSE of 7.45 and 7.50, respectively.

Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate technologies to reduce avoidable readmissions in hospitals require innovative interventions. mHealth and teach-back communication are robust interventions, utilized for the reduction in preventable hospital readmissions. This review was conducted to highlight the effectiveness of mHealth and teach-back communication in hospital readmission reduction with a view to provide the best available evidence on such interventions. Two authors independently searched for appropriate MeSH terms in three databases (PubMed, Wiley, and Google Scholar). After screening the titles and abstracts, shortlisted manuscripts were subjected to quality assessment and analysis. Two authors checked the manuscripts for quality assessment and assigned scores utilizing the QualSyst tool. The average of the scores assigned by the reviewers was calculated to assign a summary quality score (SQS) to each study. Higher scores showed methodological vigor and robustness. Search strategies retrieved a total of 1932 articles after the removal of duplicates. After screening titles and abstracts, 54 articles were shortlisted. The complete reading resulted in the selection of 17 papers published between 2002 and 2019. Most of the studies were interventional and all the studies focused on hospital readmission reduction as the primary or secondary outcome. mHealth and teach-back communication were the two most common interventions that catered for the hospital readmissions. Among mHealth studies (11 out of 17), seven studies showed a significant reduction in hospital readmissions while four did not exhibit any significant reduction. Among the teach-back communication group (6 out of 17), the majority of the studies (5 out of 6) showed a significant reduction in hospital readmissions while one publication did not elicit a significant hospital readmission reduction. mHealth and teach-back communication methods showed positive effects on hospital readmission reduction. These interventions can be utilized in resource-constrained settings, especially low- and middle-income countries, to reduce preventable readmissions.

Maternal depression is a global mental health and a public health priority. Despite the priority its active detection is still a challenge. We tested the accuracy of an adapted version of Community Informant Detection Tool for Maternal Depression (CIDT-MD) in rural settings of Pakistan. Using a single stage design, trained community informants (lady health workers and lay peers) identified women (pregnant and/or with children) with symptoms of probable depression using CIDT-MD. This was immediately followed by diagnostic interviews of all the women using the Structured Clinical Interview for the Diagnostic and Statistical Manual (SCID-V) for current major depressive episode by trained assessors, blinded to the outcome of CIDT-MD. Data were analyzed using Statistical Package for Social Sciences (Version 25.0, IBM Corp., Armonk, NY, USA) and FACTOR software (Version. 10.3.01, Virgili University, Tarragona, Spain). Descriptive statistics, factor analysis, validity, reliability and known group validity was conducted to evaluate the psychometric properties of the adapted CIDT-MD. In all, 425 women, with mean age of 28 years (SD = 4.7), participated. Nearly 10% were illiterate, while the rest (90%) had an education ranging from eight to 15 years of schooling. The majority (73.2%) of the participants had 1–3 children while only 17.4% had &gt, 3 children. The sensitivity and specificity of CIDT-MD in detecting depressive symptoms was 97.5% (95% CI: 94.2–99.1) and 82.4% (95% CI: 77.8–86.4) respectively. It’s positive predictive value (PPV), 77.3% (95% CI: 72.9–81.2) and the negative predictive value (NPV) was 98.17% (95% CI: 95.7–99.2). While factor analysis revealed high inter-item correlation for most items (0.62–0.77) with an adequately fair Kaiser-Meyer-Olkin (KMO) sampling adequacy (0.73), significant Bartlett’s test of sphericity (p &lt, 0.001). Uni-dimensionality for the CIDT-MD based on one-dimensional congruence (0.97), explained common variance (0.85), excellent internal consistency (0.90), good criterion validity (Area Under Curve = 81%), tester-test reliability (0.87–0.89) and statistically significant known group analysis (p &lt, 0.001). The adapted version of the Community Informant Detection Tool for Maternal Depression is a valid and a reliable tool for active case detection of maternal depression in rural settings of Pakistan.

Background Global burden of cardiovascular diseases is alarming which is intricately linked with health literacy. To what extent improvement in health literacy can lower down cardiovascular diseases occurrence has not yet properly documented. This study focused on assessing the knowledge and existing lifestyle behavior about cardiac diseases among university students. We further aimed to improve this awareness after imparting an educational intervention among undergraduate non-medical students to sensitize them about risk factors. Method A pre and post approaches with cross sectional study design was conducted in University of Gujrat during April–September 2017. Using structured questionnaire comprising of response items about hypertension, heart attack, stroke and preventive practices, data was randomly collected from students (n = 100). Survey respondents were also given a lecture regarding cardiovascular diseases awareness and a post test evaluation was also conducted on same group of students. Results With response rate of 86.95%, mean age of participating students was 21.2 (SD ± 1.34) years. Female students comprised of 53% out of which 57% were from rural background. Assessment of cardiovascular disease knowledge revealed maximum mean pre test score 30.53 (SD ± 7.61) and for post test 40.65 (SD ± 4.34) (p

Diabetes mellitus is a complex multisystem disease that requires high quality care. Clinical practice guidelines help physicians and patients make the best possible health care decisions and improve health care management of diabetic patients. These guidelines provide the norms for clinical management as well as monitoring of diabetes care. They are not simple algorithms but are based on structured evidence based diabetic management protocols developed from randomized controlled trials. Despite the widespread availability of this diabetic guideline, their use is suboptimal at best. There are several factors blamed for contributing to this missing link from available theoretical guideline recommendations to practical applications of these guidelines. We present a brief review based on available literature review for an ongoing interventional study being done by authors in two tertiary care hospital in Lahore Pakistan for improving adherence to diabetes guidelines. We will discuss guideline implementation cycle and also present a framework encompassing various factors involved in adherence to guidelines. Until recently the emphasis to improve the guideline adherence targeted the factors relating to individual health care professionals in reference to their knowledge, attitude practice of the guidelines. However, we will discuss that broader range of health care systems, organizational factors, and factors relating to patients which may also significantly impact the adherence to the guidelines. The framework emphasises that it is important to understand the factors that act as barriers and contribute to the missing link between theory and practice of diabetic guidelines. This will help plan appropriate strategies in the pre-implementation stage for effective and improved diabetes guidelines adherence and management.

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Background: The Patient Health Questionnaire (PHQ-9) possesses many characteristics of a good screening tool and has the capacity to be used for screening depression in patients with coronary artery disease (CAD). Aim: To examine the psychometric properties and criterion validity of the PHQ-9 to screen and detect depression in patients with CAD in Pakistan. Design: In this validation study, 150 patients with CAD completed the Urdu version of the PHQ-9. The major depressive episode module of the Mini International Neuropsychiatric Interview (MINI) was used as the gold standard. Results: The Urdu version of the PHQ-9 revealed a good internal consistency with Cronbach’s alpha of 0.83. Optimal sensitivity (76%) and specificity (76%) were achieved using the cut-off score of PHQ-9 ≥6, with area under the ROC curve of 0.86. Conclusion: The Urdu version of the PHQ-9 has acceptable psychometric properties to screen and detect major depression in patients with CAD.

To determine the prevalence of diabetes mellitus and its associated risk factors in urban population.The cross-sectional study was carried out at four union councils of Rawalpindi, Pakistan, from May to September 2014, and comprised members of the general public.A questionnaire was administered to obtain information about demographic characteristics and risk factors. Anthropometric and blood pressure measurements were obtained from the participants. Venous blood samples were taken for measuring glycated haemoglobin. SPSS 20 was used for data analysis.Of the 404 participants, 181(44.8%) were men and 223(55.2%) were women. The overall mean age was 42.3±13 years. Overall prevalence of diabetes was 133(32.9%) and that of pre-diabetes was 151(37.4%). The prevalence of diabetes was 203(50.3%) in 50-65 years age group and 143(35.4%) among obese subjects. Diabetes was significantly associated with increasing age (35-49 years (p0.05); 50-65 years (p0.01), positive parental (p0.05) and sibling (p0.05) history of diabetes, hypertension (p0.01) and central obesity (p0.05).The prevalence of diabetes and pre-diabetes was very high. Prevalence increased with increasing age and body mass index. Major independent risk factors were increasing age, central obesity, and family history of diabetes and hypertension.

Mainstream preventive interventions often fail to reach poor populations with a high risk of cardiovascular diseases (CVDs) in Pakistan. A community-based CVD primary prevention project aimed at developing approaches to reduce risk factors in such populations was established by Heartfile in collaboration with the National Rural Support Program in the district of Lodhran. The project implemented a range of activities integrated with existing social and health service mechanisms during a three year intervention period 2000/01-03/04. These were targeted in 4 key settings: community health education, mass media interventions, training of health professionals and health education through Lady Health Workers. The project received support from the Department for International Development, UK. At the community level, a pre-test-post-test quasi-experimental design was used for examining project outcomes related to the community component of the intervention. Pre and post-intervention (training) evaluations were conducted involving all health care providers in randomly selected workshops in order to determine baseline levels of knowledge and the impact of training on knowledge level. In order to assess practices of physician and non-physician health care providers patient interviews, with control comparisons were conducted at each health care facility. Significant positive changes were observed in knowledge levels at a community level in the district of intervention compared with baseline knowledge levels particularly in relation to a heart healthy diet, beneficial level of physical activity, the causes of high blood pressure and heart attack and the effects of high blood pressure and active and passive smoking on health. Significant changes in behaviors at a practice level were not shown in the district of intervention. However the project played a critical role in spurring national action for the prevention and control of non-communicable diseases and introducing sustainable public health interventions for poor communities in Pakistan.

Health of immigrants is challenge for any host country due to multiple reasons. Immigrants of Pakistani origin constitute a significant population in the USA and their population has doubled in last 10 years. This study was conducted to determine factors affecting health service utilization in the state of Maryland, USA.This was a descriptive study, utilizing mixed method research. A sample of 100 respondents from Pakistani immigrants in Maryland was selected through convenience sampling. A structured questionnaire was used for soliciting responses. Three focus group discussions were also conducted for qualitative assessment of health service utilization.Male gender, higher level of education, longer duration of stay, and higher income people had more utilization of health services. Those not having insurance had affordability issues as they had to pay out of pocket for treatment cost. A high proportion of uninsured were resorting to traditional home remedies for treatment. There was a concern on delays in appointment system and long waiting time for elective cases. Most respondents mentioned problem of language while interacting with doctors and need of English speaking family member in medical consultation. Many respondents reported difficulty in availing health services due to job commitments. They had to make arrangements for substitute at their workplaces, which affected their utilization of health services.Low-income immigrants in USA are less likely to have health insurance. Factors affecting service use are out of pocket costs, long waiting time, language problems and immigrants' job commitments. It is recommended to get a clear idea of health systems of USA before moving to US as immigrant.

The National Action Plan for Non-communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD) incorporates prevention of injuries into a comprehensive NCD prevention effort. This encompasses the prevention of road traffic crashes (RTC)s, occupational injuries, falls, burns and other injuries. In this programme, surveillance of injuries--as part of comprehensive population-based NCD surveillance system, supplemented by multiple data sources--has been stipulated as an entry point, to injury prevention and control efforts. Actions areas for preventing RTCs include interventions to improve road safety education, identification and implementation of safety measures for traffic black-spots, enforcement of seatbelt and helmet laws and the development and implementation of highway ordinances. Recommendations have also been made to establish a road safety committee and to facilitate inter-sectoral action. It has also been deemed essential to enact and enforce legislation on locally manufactured vehicles, regulate drivers' training and licensing and evaluation of Highway Police Force from a performance and fiscal perspective. To prevent worksite injuries, a national consensus has been achieved to develop a comprehensive policy and to enact and enforce legislation for occupational health and safety; to include preventive health in the mandate of organizations dealing with worksite safety and to study patterns of occupational injuries and their determinants with a view to defining precise targets for preventive interventions. In addition NAP-NCD makes a strong case for the establishment of a National Safety Commission, the development of product safety standards for household usage, enforcement of legislation on building safety, and efforts to improve trauma care to the extent that a credible, cost-effective analysis suggests. It also calls for the need to formally evaluate interventions to reduce all forms of violence in Pakistan. Building capacity in the health system for injury prevention and building partnerships for sustainable outcomes in injury prevention have also been defined as priority areas.