Search Results (29)

Background: The effectiveness of metformin in preventing Type-2 Diabetes Mellitus (T2DM) is examined. There are new available data. Currently, there are no available analyses classifying its effectiveness compared to placebo, standard care, or lifestyle interventions, and there is limited evidence on the combined action of metformin and lifestyle interventions in preventing T2DM. Objective: To calculate the updated overall effectiveness of metformin in preventing T2DM using all available and most recent data, and to explore the effectiveness of metformin and lifestyle interventions in preventing T2DM. Materials and Methods: A search was performed in PubMed and the Cochrane Library Central Register of Controlled Trials (CENTRAL) (from inception to 24 May 2025). A systematic review (SR) and meta-analysis (MA) of randomized controlled trials (RCTs) was carried out, including metformin-naïve adults with any identified diabetes risk factors. The overall effectiveness of metformin was estimated by combining studies that compare metformin against placebo, metformin and standard care against standard care, and metformin plus lifestyle interventions and the same lifestyle interventions. The combined action of metformin and lifestyle interventions was evaluated against standard care. We performed a GRADE assessment of the overall evidence. Results: Overall, metformin may reduce the incidence of T2DM by 23% in high-risk adults (OR 0.77, 95% CI 0.67, 0.88, p-value 0.0001) and 25% in patients with prediabetes (OR 0.75, 95%CI 0.66, 0.86, p-value < 0.0001). It is also effective in both obese and normal-weight patients, in Caucasians, in studies with female predominance, in studies with a mean age over 60 years, at 1700 mg daily, and after 18 months of administration. Effectiveness weakens after interruption of administration. Metformin is more effective compared to placebo and when combined with standard care than standard care alone, but not when combined with lifestyle interventions against lifestyle interventions alone. Metformin and lifestyle interventions reduce the incidence of diabetes in patients with prediabetes by 52% compared to standard care (OR 0.48, 95% CI 0.30, 0.77; p-value 0.002). There are effectiveness concerns in studies with more men than women, Asian Indians and Pakistanis, a mean age below 60 years, 500 mg of metformin daily, and after six months. The effect is reduced during post-intervention. Finally, metformin alone is more effective than standard care (OR 0.56, 95% CI 0.34, 0.90, p-value 0.02). The quality of evidence was moderate for the overall effectiveness of metformin and metformin combined with lifestyle interventions, and low for metformin against standard care. Conclusions: A 1700 mg dose of metformin daily is effective in preventing T2DM, especially in Caucasians, in women over 60 years, in prediabetes, and independent of obesity. Lifestyle interventions and 500 mg of metformin daily may prevent T2DM in patients with prediabetes, especially in men and Asian Indians or Pakistanis under 60 years. The effectiveness of complex interventions is more pronounced than that of metformin alone in patients with prediabetes. Further research is needed for post-intervention effectiveness, patients with any diabetes risk factors, patients from different regions, and women in complex interventions. Full article

Background/Objectives: Mental health conditions represent a growing global health concern, disproportionately impacting populations in low- and middle-income countries like Pakistan. Limited epidemiological data, coupled with recent socioeconomic and environmental disruptions, has intensified the need for current insights into psychological burden and coping capacities in the Pakistani population. Methods: A descriptive, cross-sectional survey was conducted from January to May 2023 among 400 community-dwelling adults attending outpatient departments in Islamabad and Rawalpindi. A structured 75-item questionnaire incorporating validated tools (PHQ-9, GAD-7, WHO-5, CSES, and SRQ-20) was used to assess depression, anxiety, well-being, coping self-efficacy, and mental distress. Descriptive statistics, χ² and Fisher’s exact tests, and Spearman’s rank correlation (r_s) analyses were performed using IBM SPSS 22.0. Results: Most respondents were male (73.0%), aged 25–34 (60.0%), and urban-dwelling (80.0%). Clinically relevant depression and anxiety were observed in 57.0% and 19.5% of participants, respectively; 38.0% reported mental distress. Conversely, 76.5% demonstrated fair-to-good coping efficacy and 51.0% had high well-being scores. Younger age (≤34 years), higher income, urban residence, and male gender were associated with significantly better mental health outcomes. Strong positive correlation was found between PHQ-9 and GAD-7 scores (r_s = 0.672), and moderate negative correlations were found between GAD-7 and WHO-5 (r_s = −0.496), and PHQ-9 and WHO-5 (r_s = −0.310). Conclusions: Our findings highlight the significant psychological burden among urban Pakistani adults, alongside promising levels of resilience and coping self-efficacy. These results emphasize the urgent need for early, culturally adapted mental health screening and intervention programs in outpatient settings. Integrating such strategies into primary care, particularly for vulnerable subgroups like women, older adults, and those with lower income could facilitate timely diagnosis, improve outcomes, and reduce stigma surrounding mental health. Full article

This paper analyses the socio-economic disadvantages of women from different ethnic minority heritages in the UK. Using data from the Labour Force Survey (2014–2023), which contains detailed information on parental class and respondents’ socio-economic conditions, we examine four domains of life chances which are crucial for ethnic integration: educational attainment at the degree level, risks of unemployment, access to professional-managerial (salariat) position and earning power. We proceeded with the gross differences and then examined the differences by ethno-gender status and parental class combinations, controlling for many confounding factors. We also examined the net ethno-gender differences over the life course and the trends of social fluidity over the period covered and across the ethno-gender groups. We found that women from all ethnic origins were doing well in education but faced multiple disadvantages in the labour market, especially in access to the salariat and in earning power. Women of Pakistani/Bangladeshi heritages faced pronounced unemployment risks, especially at the earlier life stages. There is a significant increase in fluidity over the period covered, but this is marked by considerable ethnic and class differences, with Black Caribbean, Black African, Pakistani and Bangladeshi women from more advantaged class origins being unable to secure advantaged class positions and those from working-class families unable to make long-range upward mobility as effectively as White men. Overall, Bangladeshi, Pakistani, Black African and Black Caribbean women are found to be considerably disadvantaged, but there are also signs of social progress. Full article

Gender equality is essential for economic and societal advancement, as outlined in the United Nations’ Sustainable Development Goal 5. This research examines the obstacles that hinder women’s progression from higher education to empowerment in Pakistan. Using a comprehensive descriptive survey questionnaire, we collected quantitative data to gain insights from a diverse sample of various provinces. The survey consisted of two sections: background information and 25 constructs of barriers from the existing literature. Data analysis involving 399 respondents included descriptive and inferential statistics, cross-tabulation, and significance testing using non-parametric tests. The findings highlighted significant sociocultural, familial, and professional barriers, with regional disparities underscoring the need for targeted interventions. Women respondents consistently perceived barriers more keenly than men, underscoring the gender-specific nature of these challenges. This study emphasizes the need for focused policies and educational initiatives to address barriers and promote gender equality in Pakistan’s higher education and professional spheres. Full article

While emerging research is highlighting the significant effects of culture on marital and family relationships, studies investigating relationship intimacy and abuse in non-Western cultures are non-existent. This investigation assessed relationship intimacy in Pakistani women experiencing trauma symptoms (PTSD) from domestic abuse (DA) who received a culturally informed trauma intervention in a context that differs greatly in values and assumptions about marital relationships relative to Western traditions. Forty women meeting inclusion criteria were assessed on domestic violence type and characteristics (both victim and perpetrator characteristics), PTSD symptomology, and three aspects of relationship intimacy: engagement, communication, and shared friendships. PTSD symptomology and relationship intimacy were reassessed post-intervention. Results indicated significant changes in engagement and communication intimacy following the intervention, with engagement decreasing and communication increasing. The third aspect of intimacy, namely, shared friendships, showed no change. Engagement and overall intimacy showed significant negative correlations with physical abuse, though not with sexual or psychological/emotional abuse. These findings are interpreted within a cultural context where women have few options for leaving an abusive relationship. As such, the results highlight the importance of culture when studying facets of intimate relationships and the need to use culturally informed assessments to better understand the experience of intimacy within abusive relationships. Full article

Introduction: Anemia remains a global public health problem, especially in developing countries. It affects primarily children under five (CU5), women of reproductive age (WRA), and pregnant women due to their higher need for iron. The most common form of anemia is iron-deficiency anemia (IDA). IDA is estimated to cause half of all anemia cases and one million deaths per year worldwide. However, there remains a lack of well-documented and biochemically assessed prevalence of IDA based on the representative population-based samples globally and regionally. In this study, we aimed to assess the National Nutrition Survey (NNS) 2018 to identify the prevalence and risk factors of IDA in Pakistani CU5 and WRA. Methods: Secondary analysis was conducted on the NNS 2018, a cross-sectional survey, which collected data on dietary practices, malnutrition, and food insecurity. Anemia was defined as hemoglobin levels < 11.0 g/dL in children and 12.0 g/dL in women. IDA was defined as low hemoglobin and low ferritin (<12 ng/mL) levels, adjusted for inflammation using AGP and CRP biomarkers in CU5 and WRA. Univariate and multivariable logistic regressions were conducted using Stata statistical software (version 16). We also compared the IDA rates of NNS 2018 and 2011. Results: A total of 17,814 CU5 and 22,114 WRA were included in the analysis. Of the CU5, 28.9% had IDA, while 18.4% of WRA reported to experience IDA. Among the CU5, IDA was most prevalent among male children aged 6–23 months living in rural areas and with the presence of diarrhea and fevers in the last 2 weeks. Children whose mothers had no education, were aged 20–34 years, and employed, had a higher prevalence of IDA. Married WRA, who are employed, living in rural areas, and with no education, had a higher prevalence of IDA. In the multivariable logistic regression, children aged 6–23 months (AOR = 1.19, 95% CI [1.08–1.33], p < 0.001) and with the presence of diarrhea in the last 2 weeks (AOR = 1.32, 95% CI [1.13–1.54], p < 0.001) or fever (AOR = 1.16, 95% CI [1.02–1.32], p = 0.02) had higher odds of IDA. At the household level, the odds of IDA among CU5 were higher in the poorest households (AOR = 1.27, 95% CI [1.08–1.50], p = 0.005), with ≥5 CU5 (AOR = 1.99, 95% CI [1.28–3.11], p = 0.002), and with no access to improved sanitation facilities (AOR = 1.17, 95% CI [1.02–1.34], p = 0.026). For WRA, the multivariable logistic regression found that the odds of IDA were higher among women with vitamin A deficiency (Severe: AOR = 1.26, 95% CI [1.05–1.52], p = 0.013; Mild: AOR = 1.36, 95% CI [1.23–1.51], p < 0.001), zinc deficiency (AOR = 1.42, 95% CI [1.28–1.57], p < 0.001), no education (AOR = 1.53, 95% CI [1.30–1.81], p < 0.001), and from severely food insecure households (AOR = 1.20, 95% CI [1.07–1.34], p = 0.001). The odds of IDA were lower among women whose body mass index was overweight (AOR = 0.77, 95% CI [0.69–0.86], p < 0.001) or obese (AOR = 0.71, 95% CI [0.62–0.81], p < 0.001). Conclusions: The child’s age, presence of diarrhea or fever, place of residence, household size, wealth status, and access to sanitation facilities were significantly associated with IDA among CU5 in Pakistan. For WRA, education, body mass index, vitamin A and zinc status, household food security status, wealth status, and access to sanitation facilities were significantly associated with IDA. Large, well-established, government-funded programmes focused on micronutrient supplementation, food fortification, the diversification of food supplies, and the treatment and prevention of infectious and parasitic diseases are needed to prevent IDA and all forms of anemia among children and women in Pakistan. Full article

Postpartum depression (PPD) can predispose to physical and mental health problems in Pakistani women. However, PPD is associated with health and perceived social support, yet their causal relationship is unclear. Therefore, this study intended to evaluate the association of PPD with insomnia, mental health, and physical health. The convenience sampling technique was used to collect data from 320 (52.8%) young and middle-aged postpartum women, at the outpatient departments of obstetrics and gynecology of the Government Maula Bakhsh Hospital, District Head Quarter in Sargodha, Pakistan. The Edinburgh Postnatal Depression Scale, Pittsburgh Sleep Quality Index, Warwick–Edinburgh Mental Well-being Scale, patient health questionnaire, and Multidimensional Scale of Perceived Social Support were used to measure study variables. The results revealed a significant positive relationship between PPD and physical health (r = 0.45, p = 0.001), negative relationships with insomnia (r = −0.24, p < 0.001), and perceived social support (r = −0.38, p = 0.001). Results further confirmed that perceived social support played a moderating role (β = 0.97, p = 0.01) in the relationship between PPD and mental health among Pakistani women. This study concluded that perceived social support has an important role in PPD and the health of Pakistani women. The study also concluded that poor health is a risk indicator for the identification of aid in the early stages of postpartum among Pakistani women. Full article

Despite government efforts, many rural Pakistani women forgo regular antenatal visits, are unprepared for birth, and deliver at home or in private facilities, because they are dissatisfied with public health services. This study examined pregnant women’s perceptions of public health hospital prenatal care to suggest areas for improvement. Using simple random sampling, 200 pregnant women visiting a secondary care public health facility in Sargodha District, Pakistan, were enrolled in a cross-sectional study. The quality of prenatal care was assessed using a structured and validated questionnaire. Descriptive analysis and multivariate linear regression stepwise models were used. Of participants, 52% consider the services to be of poor quality. Education, income, number of living children, and long waiting time influenced the perceived prenatal care quality in the study population. Stakeholders rated existing services as suboptimal, especially in terms of staff availability and time spent, which reduces service use. Facility managers and policymakers should work to improve the quality of services to satisfy patients, encourage them to use antenatal care, and improve the health of both mother and child, especially in rural areas. Full article

This study explored the baseline knowledge and symptoms associated with endometriosis, educated women about endometriosis, and documented the improvement in endometriosis knowledge. A brief intervention with an educational brochure on endometriosis was administered among 303 female participants. A paired-sample t-test and one-way ANOVA were run to compute endometriosis knowledge scores. In total, 49.5% of the participants had consistent access to annual healthcare, 25.1% were healthcare workers, and 45.2% had an undergraduate education. The entire sample had a pre-test endometriosis knowledge score of 4.2 (SD = 2.48), and the score was 6.3 (SD = 2.3) on the post-test. One-way ANOVA yielded no significant improvement in knowledge scores across the groups with consistent and inconsistent access to annual healthcare, despite a significant overall increase in scores (t = 16.63, df = 302, p < 0.001). We identified a significant improvement in the knowledge concerning endometriosis. Educational strategies among women who are menstruating are essential for addressing diagnostic delays and bridging the endometriosis knowledge gap. Full article

(1) Background: Pakistani women are among one of Catalonia’s most affected groups by obesity and cardiovascular disease. The design of health education strategies for them has become a compelling need. This paper aims to enlighten the elaboration and evaluation procedure of culturally and linguistically tailored nutrition education materials for Pakistani women participating in the PakCat Program, which aims to evaluate the efficacy of a nutrition education strategy allowing the participants to become ambassadors of healthy eating habits for their community. (2) Methods: In this Randomised Control Trial (RCT), 137 Pakistani women (70 from the intervention and 67 from the control group) took part. We conducted 10 sessions for the intervention group and 3 sessions for the control group in the form of small groups. The sessions were conducted in Urdu and Punjabi, and the material was translated into Urdu, Catalan, Spanish and English. For some sessions, we elaborated on new materials and for others, we adapted them from the existing nutrition material in aspects of language and culture. We evaluated the nutritional material from the observation carried out by the dietician who developed the sessions, participants’ feedback at the end of the sessions and a satisfaction questionnaire. (3) Results: We summarised the elaborated material in form of two multilingual nutritional guidelines about portion size and heart-healthy foods. We also registered several materials generated for the PakCat program such as an infographic about myths and beliefs related to food, a booklet to read and interpret the food labels, a recipe book for healthy snacks, and an infographic of 10 tips for healthy eating. We also organised a PhotoVoice exhibition of 70 healthy plates elaborated by the intervention group participants. The participants highly appreciated the material in terms of visualization, cultural and linguistic adequacy, and level of comprehension through all three evaluation methods. (4) Conclusions: The design of culturally and linguistically tailored nutrition education material for Pakistani women living in Catalonia is attainable and effective to meet their specific needs. The healthy dietary recommendation can be adapted to them preserving their traditional dietary pattern, and they acquire the confidence to start following a healthy diet. Full article

In the current digital environment, satisfying sexual needs via Internet pornography use has the potential to develop into a problem that affects one’s psychological health and daily functioning. The aim of this study was to examine potential cognitive and affective factors that could help explain the maintenance and exacerbation of self-defined problematic internet pornography use. Methods: 280 Pakistani men and women (mean age = 25.40; SD = 5.271, range 18–50) who were current pornography users were recruited through social networking sites (Facebook, Instagram, LinkedIn, WhatsApp groups) to participate in an online study about pathways to problematic pornography use (PPU). Structural equation modeling was used to estimate path analysis coefficients extending from predisposing variables (depression, anxiety, self-esteem, and loneliness) to PPU via the mediating variables of craving, dysfunctional sexual coping, and stimulus-specific inhibitory control. Results: Craving mediated the relationship between three predisposing variables (depression, anxiety, and self-esteem) and PPU, though not the fourth, namely loneliness. Indirect effects of depression, anxiety, and self-esteem were significantly linked to PPU through two serial mediation pathways: (a) craving and stimulus-specific inhibitory control, and (b) craving and dysfunctional sexual coping. Conclusion: These findings demonstrate that craving, stimulus-specific inhibitory control, and dysfunctional coping serve as important mediators in maintaining and exacerbating the cycle between negative predisposing variables and PPU. These results are interpreted within the general framework of therapeutic interventions that can help develop positive coping skills in individuals seeking to alter self-perceived bothersome or unwanted habits related to pornography use. Full article

Restrictions implemented by the UK Government during the COVID-19 pandemic have served to worsen mental health outcomes, particularly amongst younger adults, women, those living with chronic health conditions, and parents of young children. Studies looking at the impact for ethnic minorities have reported inconsistent findings. This paper describes the mental health experiences of mothers from a large and highly ethnically diverse population during the pandemic, using secondary analysis of existing data from three COVID-19 research studies completed in Bradford and London (Tower Hamlets and Newham). A total of 2807 mothers participated in this study with 44% White British, 23% Asian/Asian British Pakistani, 8% Other White and 7% Asian/Asian British Bangladeshi backgrounds. We found that 28% of mothers experienced clinically important depressive symptoms and 21% anxiety symptoms during the pandemic. In unadjusted analyses, mothers from White Other, and Asian/Asian British Bangladeshi backgrounds had higher odds of experiencing symptoms, whilst mothers from Asian/Asian British Indian backgrounds were the least likely to experience symptoms. Once loneliness, social support and financial insecurity were controlled for, there were no statistically significant differences in depression and anxiety by ethnicity. Mental health problems experienced during the pandemic may have longer term consequences for public health. Policy and decision makers must have an understanding of the high risk of financial insecurity, loneliness and a lack of social support on mother’s mental health, and also recognise that some ethnic groups are far more likely to experience these issues and are, therefore, more vulnerable to poor mental health as a consequence. Full article

Deviating from the predominantly women-focused investigations on Islamic clothing in anthropology, religion and consumer studies, this research places men’s Islamic clothing under the spotlight to understand how the notion of the extended self is evidenced in a religious context. Using a multi-sited ethnographic and in-depth interview approach to study the context of middle-class Pakistani male participants of the traditional revivalist movement the Tablighi Jamaat, this study finds that possessions such as clothing serve as a conduit to participants’ sense of extended self. In this case, the extended self is associated with the Muslim nation, its Prophet and his work. This investigation furthers the concept of the extended self by implicating the consumption of religiously identified clothing as an entity that becomes associated with the self. Moreover, this study concludes that possessions and the extended self are imbricated into one’s religious career path. Full article

This systematic review aimed to explore the challenges and strategies for maintaining a work–life balance (WLB) between individual workers and their organizations during COVID-19 in the Pakistani context. Using the inductive approach in thematic synthesis, we analyzed eight qualitative studies on WLB from December 2019–April 2022. The Quality Appraisal process for selecting studies, constant comparison method, and critical discussion was frequently used to enhance the validity and reliability of findings. Eight analytical themes provided insight related to the challenges of maintaining WLB, strategies for facilitating, and recommended strategies for a sustainable workforce. Workload during COVID-19, lack of resources, training in technology, and mental pressure appeared as significant barriers, while family support, counseling provided by the organization, and self-motivation emerged as facilitators for WLB. Further, the findings highlighted the need for organizational interventions, for instance, emergency preparedness and capacity building of employees. Findings provided insight about guidelines for policymakers and government to make informed decisions and policies about maintaining WLB for mental well-being and a sustainable workforce, particularly women. The synthesis implied that investment in the well-being and productivity of employees could contribute to retaining a more resilient and skilled workforce, ensuring women’s workforce sustainability, and enabling lasting recovery from the pandemic. Full article

(1) Introduction: Dietary and lifestyle changes along with the cultural and linguistic barriers convert the immigrant women of Pakistani origin into a risk population for developing metabolic syndrome (MetS) and cardiovascular diseases (CVD). The objective of this project is to evaluate the efficacy of a culturally and linguistically appropriate food education program based on the Transtheoretical model that will allow the participants to become ambassadors of healthy eating habits for their community. (2) Methods: In this community-based RCT, any Pakistani adult woman with residence in Badalona and Santa Coloma de Gramenet will be able to participate. We will use a mixed model approach. From the quantitative perspective, the participants will answer a survey accompanied by a multilingual nutritionist that will help us to determine the sociodemographic, clinical, anthropometric, dietary data, and quality of life. From the qualitative perspective, we will conduct 6 focus groups (3 in each municipality) to determine the cultural and religious beliefs with the aim of tailoring the intervention to the target population. Hereafter, the participants from one municipality will randomly become the control group and from the other, the intervention group. The intervention group will participate in 10 weekly food education sessions based on the Transtheoretical model while the control group will receive 3 general educational sessions on food and health. During the evaluation procedure, we will assess the impact of the intervention considering the outcomes of the study. (3) Discussion: This study will establish intercultural bridges between health professionals and the Pakistani community living in Catalonia. The project will open the door for future interventions, and it will be sustainable in time as the participating women will become health promotion agents for the rest of their community. Full article