This study is the first robust evidence regarding asthma among children in Pakistan, reporting a high burden in this group. Family history, male gender, Sindhi ethnicity and ill-ventilated kitchen were identified as important predictors of asthma. Targeted preventive measures and intervention studies are required to better understand and reduce the burden of asthma among children in Pakistan.

At our medical college many students have lower ratings in their clinical performance once they start their clinical years (third year). This is contrary to their results in other written exams. Some students demonstrate better clinical performance. We used the six-step Positive Deviance (PD) Conceptual Framework to identify and disseminate the strategies employed by the successful students to improve group clinical performance. Fifty 3rd year students (of a 5-year MBBS program) rotating through internal medicine were assessed mid-rotation with mini-CEX and 360° evaluations. Twenty students (40%) who performed well were invited for in depth interviews in order to identify positive deviant behavior in their clinical skills learning practices. The seven students (14%) who reported novel behaviors were asked to develop strategies for dissemination of their learning behavior in their peers. They decided to work in small groups with their peers, using the identified PD behaviors to encourage learning of history taking and examining skills in their peers. Group performance was assessed at the end of rotation, using mini-CEX and 360° evaluation in comparison to a subsequent group of students in the same year that did not work in PD peer learning groups. For the 360° evaluation the EP(2) (generalizability coefficient) was 0.92 and for the mini-CEX the EP(2) was 0.95, taking into account the variances between participants, groups, time and the interactions effects; thus indicating good reliability of both the assessment methods. A statistically significant difference (p < 0.05) was seen for improvement in medical interviewing skills and clinical judgment on the mini-CEX exam and 360 evaluation (p < 0.0001) in the PD group. Positive Deviance approach can help highlight behaviors among medical students, which contribute to success but may go unnoticed. Learning strategies based on the PD framework can improve student's group performance.

Objectives: To assess the nutritional status of adolescent college girls by assessing the dietary intake in terms of carbohydrates, proteins, Estimating the hemoglobin levels in the study group and studying the clinical signs of malnutrition with special emphasis to vitamin A, iron and iodine deficiency. Design of Study:A cross-sectional study.Settings: Two Post-Graduate women colleges of Rawalpindi. Materials and Methods:Nutritional status of 508 adolescent girls was assessed with a questionnaire, clinical examination and biochemical estimation (hemoglobin). The data thus collected was analyzed in July 2006 on computer with the help of Statistical Package for Social Sciences (SPSS) and Excel.Results: Results revealed that 20%of girls were having BMI <18.5, 77% above 18.5% and 3% were obese. 57.09% of the girls had goiter out of which 52.96% had palpable goiter and 4.13% had visible goiter. Pallor conjunctiva was seen in 1% girls. No clinical signs of Vitamin A deficiency were seen. Biochemical results indicated that 32.87% of the girls was suffering from Iron deficiency anemia.Conclusions: Large longitudinal and cross-sectional studies, regarding nutrient consumption, dietary habits and nutritional intervention are required in the adolescent girls. These studies can be thought provoking for the policy maker at the government level. Nutritional education and health promotion can be used as tool to improve the health status of the nation.

A cross sectional survey was conducted among textile workers of six textile factories of different industrial areas of Karachi to determine the frequency of hearing loss. A total of 264 workers were assessed for frequency of hearing loss with audiometric and otoscopic examination conducted by audiologist. About 79% workers had hearing impairment on audiometric assessment having hearing loss ≥25 dB. Of these, 19% of the workers had conductive deafness while 71% had mixed hearing loss. Otoscopic examination revealed that 38% had wax, 41.8 % had ear discharge and 1.6 % had perforation. The multiple logistic regression model shows sound level more than 25 dB aOR: 1.15; 95%CI: 1.10, 1.30 and ear discharge aOR: 2.23; 95%CI: 1.27, 3.92, was found as a strong risk factor of hearing loss (p<0.05). Hearing impairment affects a large proportion of the workers in Pakistan. There is a need for screening of workers exposed to occupational noise. Efforts should be made by the health care system to prevent the problem from an early stage and require effective management of ear-related diseases.