Objective To evaluate the safety and integrity of scar at repeat cesarean section, in patients with previous one cesarean section performed at different settings. Study design A reterospective study in a tertiary care obstetric unit over a period of one year (2006). Material and methods All patients with previous one cesarean section, undergoing emergency and elective cesarean sections were enrolled at our institution. The variables noted were age, parity, residential area, location of previous cesarean section and associated complaints, e.g uterine contractions, vaginal leaking/ bleeding and comorbid medical disorders. Outcome measures Operative findings in terms of thinning of scar, dehiscence or rupture were recorded. The effects of skill level of surgeon and set-up of previous cesarean section were analyzed. Results Two hundred and seventy cesarean sections were performed for different indications in patients with previous one cesarean section over a period of one year. Out of all patients, extreme thinning of scar was noted in 36 (13.3%) patients. Seven patients(2.6%) had scar dehiscence. Only 3 (42.8%) patients with scar dehiscence had associated complaint of scar tenderness, while 22 (61%)of 36 cases of scar thinning were having scar tenderness. All 7 cases of scar dehiscence had their previous cesarean sections at teaching hospitals. No patient underwent hysterectomy and all patients with scar dehiscence had successful repair. Conclusion The study concludes relatively inadequate scar thickness rate but at the same time relatively acceptable scar dehiscence rate. Thus it will still be safe to subject the patients to trial of labor after meticulous scrutinization and individualization. At the same time adequate surgical training of doctors (trainees and community doctors) through different formats is recommended.

Background: Health literacy refers to the ability to access, understand and use health related information to promote good health. It is required to achieve good health of an individual. Good health literacy has been shown to improve health outcomes of a person and is now the focus of many researches internationally. The objective of the study was to assess health literacy levels and its determinants in patients visiting tertiary care hospital in Rawalpindi Methods: This cross-sectional survey was conducted in three public sector tertiary care hospitals in duration of four months. 450 adults of either gender with age > 18 years capable of providing informed consent and able to communicate in any of the local languages were selected from outpatient and emergency departments. The data entry and statistical analysis were done using SPSS version 23. Results: 26.2% of people had poor health literacy, 56.4% had satisfactory health literacy whereas only 17.3% had good health literacy. Health literacy was poorest in domain of disease prevention (lowest mean score of 2.3+.86). Mean health literacy was significantly positively associated with higher income, and higher frequency of watching health-related television programs. Conclusion: Health literacy levels were found to be low in our study population. Gaps in health literacy should be addressed by more research and interventions. The health educators (health care professionals) can play a major role in helping to enhance the health literacy and act as an advocate for health education.

Background: The objective of this study was to assess the willingness of medical doctors to work in rural areas. The study also aimed to elucidate the factors influencing the decision of doctors to work in rural versus urban location of clinical practice. Methods: It is a cross-sectional study that was conducted from 8th January 2016 to 18th January, 2016 including randomly selected House officers (Hos), Postgraduate Trainees (PGTs) and Medical Officers (MOs) working in various departments of Holy Family Hospital, Rawalpindi using a self-administered semi-structured questionnaire. The questions related to demographic details, future plans and willingness of doctors. Factors facilitating or preventing them from accepting a rural position were also enquired about. Results: Thirty (30%) of the respondents were found willing to work inrural areas while 45% were neutral and 25% had a negative attitude towards practice in rural areas. Factors significantly related to rural choice of practice included rural place of birth (p value=.001), previous experience of having lived in rural settings (p value= .001)payment of fees by parents rather than by family or loans (p value=.001) and with the doctors' expectations of whether they are likely to work in rural/urban/foreign locations (p value=.001). Conclusion: The study shows that most of the doctors who have a rural birthplace/ experience of living are more willing to work in rural areas. Therefore, if the government wants to fill the vacant posts in rural locales, scholarship schemes for students from rural areas should be increased.

Background: Research culture includes the way we support and reward research. An important element in developing it is the organization’s approach towards prioritizing research and providing an environment for enabling and facilitating researchers. Methods: This study is based on the findings of a pilot project initiated for developing research culture at Heavy Industries Taxila Education City Institute of Medical Sciences (HITEC IMS). A multidisciplinary team was assembled consisting of focal persons from all departments for collaboration with research cell. This team was trained and given goals for leading research projects in their departments. At the end of first quarter, the idea of this program was projected in form of a model for developing and evaluating research culture. Results A model was derived on the basis of experience and refined by the use of theories of change process, that was helpful in identifying input and process elements of the program. This was named as HITECh (Heading towards Innovation and Translating Evidence into Care of health) research model. Outcomes of the program were encouraging in terms of an increase in motivation, research thinking and number of research projects running in the college. The program was perceived by faculty as a great initiative and the whole research team supported it. Conclusion: The program was helpful in strengthening research culture at HITEC IMS, and a model developed during the process of formative evaluation can help in guiding other institutes for planning, implementing and evaluating similar programs.