Apsara Ali Nathwani

Introduction: There is a lack of standardized, validated measures for assessing electronic cigarette use, which limits comparability across studies and hinders the development of consistent guidelines. We aimed to evaluate and compare the predictive validity of different e-cigarette use...

Introduction: E-cigarette use has raised concerns about health impacts beyond nicotine dependence, yet evidence on the relationship between vaping and sleep disturbance remains limited. This systematic review and meta-analysis examined the association between exclusive e-cigarette use and sleep...

Background: The aim was to obtain mental health profiles of caregivers of children with medical complexity (Co‐CMC) during periods of adjustment and adaptation through embedded case study during shared isolation in 2020. Methods: A sequential mixed‐methods embedded case study of mental health adjustment from an online community‐dwelling sample of Co‐CMC, Canada. The quantitative ‘unit of analysis’ was collected prospectively to classify study participants as having ‘well’ or ‘below‐average’ mental health, based on norm‐referenced self‐reported mental health trajectories using the PROMIS General Mental Health Scale. The qualitative ‘unit of analysis’ was conducted with a purposively selected subgroup of Co‐CMC caregivers, from each trajectory group, to provide an inductive framework of mental health adjustment. Distinguishing features between caregivers who demonstrated well, from below‐average mental health, were obtained through triangulating both units of analysis into ‘profiles’. Results: Over 70% of Co‐CMC (n = 35) reported below‐average (i.e., unwell) mental health, while caregivers with average or above average mental health (i.e., well) (n = 12) showed group declines after 6 months. Home care choices, positive orientations, familial support‐adaptations, and adapted employment qualitatively distinguished members of the ‘well’ group from the ‘unwell’, while financial concerns were unique descriptions to Co‐CMC in the ‘unwell’ group. Conclusion: This study was the first in‐depth profile of mental health of Co‐CMC, based on prospective longitudinal data and qualitative descriptions to enhance understanding of the trajectories. The distinguishing factors can be used to screen and potentially prevent caregiver mental health problems, as well as identify interventions to promote thriving families.

Objective: To determine the association between internet use and anxiety among people during the coronavirus disease-2019 pandemic. Method: The cross-sectional study was conducted across Pakistan from January 14 to February 21, 2021, which was the active phase of the coronavirus disease-2019 pandemic in Pakistan. The participants were aged at least 13 years having internet access regardless of gender or their location across Pakistan. The anonymous web-based survey was conducted using a questionnaire generated on Google Forms and disseminated through various social media platforms and WhatsApp groups. Anxiety symptoms were screened using the Depression, Anxiety and Stress Scale-21, while the Young Internet Addiction Test was used to evaluate symptoms of internet addiction. Data was analysed using STATA 16. Results: Of the 1,145 subjects, 686(60%) were females and 459(40%) were males. A total of 257(22.5%) participants were found to have extremely severe anxiety and internet usage pattern was significantly associated with the level of anxiety (p0.05), while family income and area of living were significantly different (pConclusion: A significant association of anxiety was found with internet addiction during the coronavirus disease-2019 pandemic. Key Words: Internet addiction, Anxiety, Pandemic, COVID-19, Low-income countries.

Objective: Mothers whose newborn experiences adversity may neglect their own health to care for their affected infant or following a perinatal death. Weight gain after pregnancy is one measure of maternal self‐care. We measured interpregnancy weight gain among women whose child had an adverse perinatal event.Methods: This population‐based observational study included 192 154 primigravid women with two consecutive singleton births in Ontario, Canada. Outcomes included net weight gain, and adjusted odds ratios (aOR) of moving to a higher body mass index (BMI) category between pregnancies, comparing women whose child did versus did not experience either a perinatal death, prematurity, severe neonatal morbidity, major congenital anomaly, or severe neurologic impairment.Results: Perinatal death was associated with a +3.5 kg (95% confidence interval [CI]: 2.1–4.9) net higher maternal weight gain in the subsequent pregnancy. Relative to term births, preterm birth <32 weeks (+3.2 kg, 95% CI: 1.9–4.6), 32–33 weeks (+1.8 kg, 95% CI: 0.7–2.8) and 34–36 weeks (+0.9 kg, 95% CI: 0.6–1.3) were associated with higher net weight gain. Having an infant with severe neonatal morbidity was associated with a +1.2 kg (95% CI: 0.3–2.1) weight gain. Likewise, the aOR of moving to a higher BMI category was 1.27 (95% CI, 1.14–1.42) following a perinatal death, 1.21 (95% CI: 1.04–1.41) after a preterm birth <32 weeks, and 1.11 (95% CI: 1.02–1.22) with severe neonatal morbidity.Conclusion: Greater interpregnancy weight gain, and movement to a higher BMI category, are each more likely in a woman whose first‐born was affected by certain major adverse perinatal events.

The onset of the COVID-19 pandemic and the public health measures instituted to mitigate its spread were associated with a dramatic reduction in circulating respiratory viruses such as respiratory syncytial virus and influenza.^1-3 Infections with respiratory viruses are common contributors to pediatric hospitalizations, either directly (eg, pneumonia) or indirectly (eg, asthma exacerbation).^4-6 Dramatic reductions in pediatric health care use were noted during the pandemic, due at least in part to the decrease in respiratory viral infections.^7-11 Children with medical complexity (CMC) are at risk of severe acute illness from respiratory infections (eg, children with cystic fibrosis,¹² congenital heart disease,¹³ or sickle cell disease¹⁴). In a Canadian evaluation, children who were admitted with SARS-CoV-2 infections during the early pandemic period often had existing comorbidities including obesity and neurologic impairment.¹⁵ Children with neurologic impairment (NI), which account for 28% of all Canadian CMC,¹⁶ are at particularly high risk due to a number of factors, including impaired cough and airway clearance, respiratory muscle weakness, bronchial hyperactivity, sleep disordered breathing, and risk of aspiration from oral secretions.¹⁷ This may result in CMC having an outsized benefit from this general decrease in burden of circulating viruses.¹⁸ Reports from multiple countries have suggested decreased emergency department visits^7,8 and admissions to hospital during the pandemic both for children with and without medical complexity,^9-11 but these findings were limited to those reporting solely on children’s hospitals, evaluations during the early pandemic period, and were not denominated on a defined at-risk population. The effect of pandemic-era suppressed respiratory viral transmission on hospitalization, intensive care unit (ICU) admission, and mortality among CMC and children without medical complexity (non-CMC) is unknown.

This study aims to determine the burden of COVID19-induced internet addiction and related psychosocial factors among the Pakistani sample. A web-based cross-sectional survey was conducted from January to March 2021. An analytical cross-sectional survey was broadcast on the internet via a Google form completed by 1145 Pakistanis. Individuals aged 13 years and above with competency to comprehend English or Urdu language, currently residing in any province of Pakistan, having access to the questionnaire, and willing to participate were eligible to participate. Overseas Pakistanis were excluded from the study. The outcome is COVID19-induced internet addiction was measured using the validated tool Young’s Internet Addiction Test (IAT). In addition, symptoms of depression, anxiety, stress, and other psychosocial factors were assessed using the validated tool Depression, Anxiety, and Stress Scale-21 (DASS-21). Adjusted odds ratios with a 95% confidence interval were reported using multinomial logistic regression. Most participants were females and youth (between 20 and 24 years). The prevalence of problematic internet users (PIU) and addictive internet users (AIU) was 27.3% and 11.3%, respectively. The odds of extremely severe anxiety among AIU were approximately three times (Adj OR: 2.6 (1.1-7.1), followed by the odds of having extremely severe stress being about five times higher among AIU (Adj OR: 5.4 (1.6-17.6)) as compared to normal internet users (NIU). Amid COVID-19, the burden of internet addiction has surged among the Pakistani populace. This study identified that gender, marital status, depression, stress, anxiety, work situation, and mood changes during the COVID-19 pandemic are significantly correlated with problematic and addictive internet use. Preventative measures against the addictive use of the internet are needed to avoid or mitigate any serious mental health problems.

Puerperal sepsis is an important cause of maternal morbidity and mortality in developing countries. Awareness of local terminology for its signs and symptoms may improve communication about this illness, what actions to take when symptoms appear, timely care seeking, and clinical outcomes. This formative research aimed to improve recognition and management of postpartum sepsis in Pakistan by eliciting local terms used for postpartum illnesses and symptoms. We conducted 32 in-depth interviews with recently delivered women, their relatives, traditional birth attendants, and health care providers to explore postpartum experiences. Terms for symptoms and illness are used interchangeably (i.e. bukhar, the Urdu word for fever), many variations exist for the same term, and gradations of severity for each term as not associated with different types of illnesses. The lack of a designated term for postpartum sepsis in Urdu delays care-seeking and proper diagnosis, particularly at the community level. Ideally, a common lexicon for symptoms and postpartum sepsis would be developed but this may not be feasible or appropriate given the nature of the Urdu language and local understandings of postpartum illness. These insights can inform how we approach educational campaigns, the development of clinical algorithms that focus on symptoms, and counselling protocols.