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The study was designed to investigate the causes of dropout at primary level in Pakistan. Descriptive research method was adopted by using both quantitative and qualitative techniques for data collection. The study sought to get the opinion of education managers, teachers, parents and community members on various factors causing high dropout at primary level. Data was collected from 208 education managers and 291 primary school teachers. Twelve districts and 96 schools across the country were included in the sample. Moreover, focus group discussion was held with community members and parents in each sample school and district to solicit their opinion about causes of dropout. All the possible factors causing dropout were grouped into socio-economic factors, physical factors, geographical factors, teacher related factors, family related factors, teaching learning material related factors, administrative related factors, child related factors, and facilities in schools related factors.

Objectives: This study compares hearing outcomes of two prosthesis materials, bone and titanium, used in ossiculoplasty. Design: This retrospective nationwide registry‐based study uses data systematically collected by the Swedish Quality Registry for Ear Surgery (SwedEar). Setting: The data were obtained from clinics in Sweden that perform ossiculoplasty. Participants: Patients who underwent ossiculoplasty using either bone or titanium prostheses were registered in SwedEar between 2013 and 2019. Main Outcome Measures: Hearing outcome expressed as air–bone gap (ABG) gain. Results: The study found no differences between bone and titanium for ABG or air conduction (AC) for either partial ossicular replacement prostheses (PORP) or total ossicular replacement prostheses (TORP). In a comparison between PORP and TORP for ABG and AC outcomes, regardless of the material used, PORP showed a small advantage, with an additional improvement of 3.3 dB (95% CI [confidence interval], 0.1–4.4) in ABG and 2.2 dB (95% CI, 1.7–4.8) in AC. In secondary surgery using TORP, titanium produced slightly better results for high‐frequency pure tone average. The success rate, a postoperative ABG ≤20 dB, was achieved in 62% of the operations for the whole group. Conclusion: Both bone and titanium used to reconstruct the ossicular chain produce similar hearing outcomes for both PORP and TORP procedures. However, titanium may be a preferable option for secondary surgeries involving TORP. The success rate, a postoperative ABG ≤20 dB, is consistent with other studies, but there is room for improvement in patient selection criteria and surgical techniques. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to describe child health in relation to housing renovations in more than 800 rental units, consisting of repairs of dilapidated kitchens and bathrooms, in the disadvantaged neighbourhood of Herrgården in Rosengård, Malmö, Sweden. Methods: Data on housing conditions and self-reported health were collected during home visits to families living in Herrgården (building renovations area) and a comparison area (neighbouring Törnrosen, with generally better housing conditions). At baseline, 130 families with 359 children participated, while 51 families with 127 children participated at follow-up. All data were collected between 2010 and 2012. Additionally, regional register data on health-care usage/in- and outpatient contacts within the public health-care system between 2008 and 2013 were also collected for all 8715 children registered as living in the two areas. Results: Self-reported health seemed to somewhat improve in both areas, with 74% versus 86% and 78% versus 88% reporting good or very good health in Herrgården and in the comparison area at baseline and follow-up, respectively. In Herrgården, crowdedness increased, while it decreased in the comparison area. The number of health-care contacts remained stable over time in Herrgården, while it decreased in the comparison area. Conclusions: Partial housing renovations did not seem to result in clear health improvements as measured with the indicators used in the present study. This could possibly be due to persisting health effects due to increased crowdedness or persisting poor housing conditions, as only kitchens and bathrooms were renovated. [ABSTRACT FROM AUTHOR]

There is limited evidence regarding a possible association between exposure to ambient air pollutants and the risk of non‐Hodgkin lymphoma (NHL). Previous epidemiological studies have relied on crude estimations for air pollution exposure and/or small numbers of NHL cases. The objective of our study was to analyze this association based on air pollution modeled at the address level and NHL cases identified from the nationwide Danish Cancer Registry. We identified 20,874 incident NHL cases diagnosed between 1989 and 2014 and randomly selected 41,749 controls matched on age and gender among the entire Danish population. We used conditional logistic regression to estimate odds ratios (ORs) and adjusted for individual and neighborhood level sociodemographic variables. There was no association between exposure to PM2.5, BC, O3, SO2 or NO2 and overall risk of NHL but several air pollutants were associated with higher risk of follicular lymphoma, but statistically insignificant, for example, PM2.5 (OR = 1.15 per 5 μg/m3; 95% CI: 0.98–1.34) and lower risk for diffuse large B‐cell lymphoma (OR = 0.92 per 5 μg/m3; 95% CI: 0.82–1.03). In this population‐based study, we did not observe any convincing evidence of a higher overall risk for NHL with higher exposure to ambient air pollutants. What's new? Known risk factors of non‐Hodgkin lymphoma (NHL) appear to be involved in only a small percentage of NHL cases. However, while other factors are suspected of influencing NHL risk, including socioeconomic factors and outdoor air pollution, existing evidence is inconclusive. In this investigation of outdoor air pollution and NHL risk in NHL patients diagnosed between 1989 and 2014 in Denmark, no association was detected between long‐term air pollution exposure at an individual's residence and overall NHL risk. Air pollution was insignificantly associated with increased risk of follicular lymphoma and reduced risk of diffuse large B‐cell lymphoma, two common NHL subtypes. [ABSTRACT FROM AUTHOR]

Objective To determine particulate matter smaller than 2.5 mm (PM2.5) levels at various hospitality and entertainment venues of Karachi, Pakistan. Methods This was a descriptive cross-sectional study conducted at various locations in Karachi, during July 2009. Sampling was performed at 20 enclosed public places, including hospitality (restaurants and cafe's) and entertainment (snooker/billiard clubs and gaming zones) venues. PM2.5 levels were measured using an aerosol monitor. Results All entertainment venues had higher indoor PM2.5 levels as compared to the immediate outdoors. The indoor PM2.5 levels ranged from 25 to 390 µg/m³ and the outdoor PM2.5 levels ranged from 18 to 96 µg/m³. The overall mean indoor PM2.5 level was 138.8 µg/m³ (6112.8). Among the four types of venues, the highest mean indoor PM2.5 level was reported from snooker/billiard clubs: 264.7 µg/m³ (685.4) and the lowest from restaurants: 66.4 µg/m³ (657.6) while the indoor/outdoor ratio ranged from 0.97 to 10.2, highest being at the snooker/billiard clubs. The smoking density ranged from 0.21 to 0.57, highest being at gaming zones. The indoor PM2.5 concentration and smoking density were not significantly correlated (Spearman's correlation coefficient=0.113; p=0.636). Conclusions This study demonstrates unacceptably high levels of PM2.5 exposure associated with secondhand smoke (SHS) at various entertainment venues of Karachi even after 8 years since the promulgation of smoke-free ordinance (2002) in Pakistan; however, better compliance may be evident at hospitality venues. The results of this study call for effective implementation and enforcement of smoke-free environment at public places in the country. [ABSTRACT FROM AUTHOR]

Background: Leukemia is one of the most common forms of hematologic malignancy, which can affect people of all ages. We previously showed an association between exposure to ambient particulate matter 2.5 μg (PM 2.5 ) and risk for leukemia in adults. The aim of this study was to investigate which PM 2.5 constituents were responsible for our previous observation., Methods: This is a nationwide register-based case-control study. We identified 14,983 persons diagnosed with leukemia at age 20 or above, 1989-2014, in the Danish Cancer Registry. We selected up to four sex and age-matched controls per case at random from the entire Danish population (n = 51,613). We modelled concentrations of ambient PM 2.5 and its constituents at the addresses of cases and controls for the 10-year period before index date with a state-of-the-art multiscale air pollution modeling system. We used conditional logistic regression to estimate odds ratios (ORs) adjusted for individual and neighborhood level socio-demographic variables., Result: The results showed higher risk for overall leukemia in association with interquartile range exposure to PM 2.5 (OR = 1.09; 95% CI: 1.02, 1.17), black carbon (BC) (OR = 1.02; 95% CI: 1.00, 1.03), secondary inorganic aerosols (SIA) (OR = 1.15; 95% CI: 1.03, 1.29) and its components ammonium (NH 4 ) (OR = 1.08; 95% CI: 1.00, 1.17) and nitrate (NO 3 ) (OR = 1.08; 95% CI: 1.02, 1.14). In leukemia subtype analysis, statistically significant associations were found for AML with PM 2.5 (OR = 1.14; 95% CI: 1.00, 1.29), BC (OR = 1.03; 95% CI: 1.00, 1.07), SIA (OR = 1.23; 95% CI: 1.01, 1.51), NH 4 (OR = 1.16; 95% CI: 1.01, 1.34) and NO 3 (OR = 1.12; 95% CI: 1.01, 1.24). The association between PM 2.5 and leukemia persisted in two pollutants models including sum of primary emitted black and organic carbon (BC + OC), secondary organic aerosols (SOA), or sea-salt. The association between black carbon (BC) and leukemia persisted in two pollutants models including organic carbon (OC). The three pollutant model with sulfate (SO 4 ), NH 4 and NO 3 showed an association with NO 3 but not with SO 4 or NH 4 ., Conclusion: Ambient concentrations of the PM 2.5 components BC, NH 4 and NO 3 at the residence showed associations with risk of incident leukemia in adults., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Particulate matter (PM) air pollution is a complex mixture and the various PM constituents likely affect health differently. The literature on the relationships among specific PM constituents and the risk of cancer is sparse. In this study, we aimed to evaluate the association of PM 2.5 and its constituents with the incidence of non-Hodgkin lymphoma (NHL) and the two main NHL subtypes., Methods: We undertook a nationwide register-based case-control study including 20,847 cases registered in the Danish Cancer Registry with NHL between 1989 and 2014. Among the entire Danish population, we selected 41,749 age and sex-matched controls randomly from the Civil Registration System. We assessed modelled outdoor PM concentrations at addresses of cases and controls with a state-of-the-art multi scale air pollution modelling system and used conditional logistic regression to estimate odds ratios (ORs) adjusted for individual and neighborhood level socio-demographic variables., Results: The 10-year time-weighted average concentrations of PM 2.5 , primary carbonaceous particles (BC/OC), secondary inorganic aerosols (SIA), secondary organic aerosols (SOA) and sea salt were 17.4, 2.3, 7.8, 0.3, and 4.1 μg/m 3 , respectively among controls. The results showed higher risk for NHL in association with exposure to BC/OC (OR = 1.03; 95% CI: 1.00, 1.07, per interquartile range (IQR)) and SOA (OR = 1.54; 95% CI: 1.13, 2.09, per IQR). The results indicated a higher risk for follicular lymphoma in association with several PM components. Including PM 2.5 (OR = 1.16; 95% CI: 0.98-1.38), BC/OC (OR = 1.05; 95% CI: 0.97-1.14), SIA (OR = 1.44; 95% CI: 0.80-1.08), SOA (OR = 4.52; 95% CI: 0.86-23.83) per IQR., Conclusion: This is the first study on PM constituents and the risk of NHL. The results indicated an association with primary carbonaceous and secondary organic PM. The results need replication in other settings before any firm conclusion can be reached., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To estimate the frequency of needle stick injuries (NSI) among health care workers (nurses, student nurses and paramedical staff) in public hospitals of Karachi., Study Design: Cross sectional, observational., Place and Duration of Study: This study was conducted in three public tertiary care hospitals of Karachi, from November 2007 to January 2008., Methodology: Data was collected by structured interview-based questionnaires in Urdu and English language. Questionnaire was designed to obtain information regarding demography, work experience, hepatitis vaccination status, and occurrence of needle stick injuries with associated factors. Needle stick injury that occurred in the previous month was the defined outcome. Data was entered in Epi Data and analyzed in SPSS version 15., Results: A total of 417 health care workers participated in the study. Mean age of the participants was 24+/-11 years. Estimated proportion of participants with history of at least one time NSI was found in 66%. Around 13% (n=54) had one or more NSI in the previous one month at work and half of them were affected by non-sterile needle. None of them sought medical care. Almost 90% of them were not wearing gloves or taking any other protective measures at the time of injury., Conclusion: There can be serious consequences of needle stick injuries in public hospitals as large proportion of injuries involve non-sterile used needles and health care workers do not take appropriate measures of protection.

The objectives of this study were to determine the characteristics of medical students and graduates interested in choosing psychiatry as a career and the obstacles in choosing this field of medicine. Two private and two public medical institutes were surveyed from June 2007 to August 2007. A self-administered questionnaire was distributed to third, fourth and final year students and to medical graduates doing their internship in these four medical institutes. A total of 909 medical students and graduates participated in the study. Seventeen percent of participants responded positively regarding their interest in psychiatry as a career. Significantly higher proportion belonged to private medical institutes (14% vs. 24%, P-value =0.001). There was no significant difference in reporting interest for psychiatry in regard to age, sex, year in medical school and whether or not the participant had done a psychiatry ward rotation. However significantly higher proportion of participants (22%, n=43) were reporting their interest in the field of psychiatry who had done more than a month long psychiatry ward rotation as compared to those participants (14%, n=54) with less than a month or no psychiatry rotation (P-value=0.01). More students were reporting their interest in psychiatry with a family history of psychiatric illness as compared to without family history (24% vs 16%, P-value=0.03). In conclusion, students and graduates with more than a month long rotation in psychiatry, studying in private medical colleges and with a family history of psychiatric illness were more interested in choosing psychiatry as a career.

Objective: To determine frequency and pattern of non-fatal limb injuries in motorbike accidents victims., Study Design: Cross-sectional observational study., Place and Duration of Study: Study was conducted at Jinnah Postgraduate Medical Centre (JPMC), Karachi, from October 2006 to March 2007., Methodology: Trained data collectors prospectively collected data from the emergency department of JPMC, Karachi using structured pre-tested questionnaires. All motorbike accident victims presented to Emergency department with single or multiple bone injury in body extremities were included. Head injury patients who had first presented to neuro-surgery department were excluded. Motorbike accident victims with soft tissue injuries were also excluded from this study. Chisquare test was applied to find out statistical significance at 95% confidence level. P-value < 0.05 was considered as significant., Results: A total of 137 (39%) patients presented with tibial injury among the study sample of 348 patients, which was significantly higher than the bone injuries of the body part (p<0.001). Out of those, in 26% of patients, fibula was also involved along with tibia fracture. Other bone injuries included femur (16%), radius (9.2%), humerus (8.3%) and others. Radius was the commonest injured bone and in highest proportion among upper limb injuries (p<0.001). Overall, 66% of the injuries in motorbike involved lower limb fractures. The highest proportion of motorbike accidents were observed on Saturdays (31%). Majority of the accident victims were in the age group between 16 and 30 years (41% accident cases), 27% in age group 30 to 45 years, 15% in 45 to 60 years and 5% in >60 years. Those with less than 15 years accounted for 12% of cases., Conclusion: Tibial bone is at the greatest risk in motorbike accidents probably due to its superficiality and exposed position while riding motorbike. Protective measures need to be taken for the prevention of disability associated with lower limb involvement in motorbike accidents.