Journal Club Presentation Public Health

1. Journal Club Presentation
Presented By:
Name: Nirdesh Baral
Roll No: 15
BPH, VIII Semester, SHAS, PU.
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2. Presented for the partial fulfillment of requirement
of
PHA 451 Journal Club/Health Seminar
of
Bachelor of Public Health, VIII Semester,
School of Health and Allied Sciences, Pokhara University
under the cardinal supervision of
Assistant Professor Dr. Hari Prasad Kaphle
By
Nirdesh Baral
17370192
2016-1-37-0116
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3. Selected Article for Presentation
“Anxiety and Depression among Patients with Thyroid Function
Disorders”
• DOI: https://doi.org/10.33314/jnhrc.v18i3.2499
• Volume : Vol. 18 No. 3 Issue 48 Jul-Sep 2020
• Published On : 2020-11-13
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4. Journal Information
• This Article Has been Published in Journal of Nepal Health Research
Council. Journal of Nepal Health Research Council (JNHRC) an
official, internationally peer reviewed, Pubmed Indxed, biomedical
journal of the Nepal Health Research Council (NHRC) since 2002.
• It is published three times a year and publishes articles on the
following category: Original Article, Review Article, Case Report,
Viewpoint and Letter to the Editor and others.
• Authors do not have to pay for submission, processing or publication
of articles at JNHRC.
Print ISSN: 1727-5482; Online ISSN: 1999-6217
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5. Editors
Editor-in-Chief
Prof Dr Ganesh Dangal
• Senior Consultant, Department of Obstetrics and Gynaecology, Kathmandu
Model Hospital; Professor of Obstetrics and Gynaecology, National
Academy of Medical Sciences (NAMS), Kathmandu, Nepal
• Member: Nepal Association of Medical Editors (NAME) | Committee on
Publication Ethics (COPE), UK | World Association of Medical Editors
(WAME)| Asia Pacific Association of Medical Journal Editors (APAME)
• Email: ganesh.dangal@gmail.com
List of Full Editors
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6. Critical Appraisal of Journal
• Journal is open access
• Journal is both peer reviewed with international and national reviewer.
• Rejection rate is 25% - 30%
• JNHRC uses double blinded peer review system
• Journal is indexed and associated with PubMed ,Cross-ref, Index
Copernicus ,Scopus, Embase, GoogleScholar, SJR and NepMed
• IF of Journal is not available.(1)
• Journal have limited publication from International Authors
• 1. Impact Factor of Medical Journals,Badri Man Shrestha
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7. Critical Appraisal of Journal
SJR analysis
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SJR Rank is 0.954 (2019) Total Cites of the Journal is 78 (2019)

8. Tittle of Article
“Anxiety and Depression among Patients with Thyroid Function
Disorders”
Recommended Citation: Gorkhali B, Sharma S, Amatya M, Acharya D, Sharma M.
Anxiety and Depression among Patients with Thyroid Function Disorders. J Nepal Health Res Counc
[Internet]. 2020Nov.13 [cited 2020Nov.21];18(3):373-8. Available from:
https://jnhrc.com.np/index.php/jnhrc/article/view/2499
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9. Critical Appraisal of Tittle
• Title is self explanatory
• Study population and gist of research is highlighted through title.
• Study area couldn’t be assessed from title
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10. Authors
• Binu Gorkhali
-Nepal Institute of Health Sciences, Jorpati, Kathmandu
• Sita Sharma
-Maharajgunj Nursing Campus, Institute of Medicine, Tribhuwan University, Maharajgunj, Kathmandu
• Mrigendra Amatya
-Department of Physiology, Nepal Medical College, Attarkhel, Gokarneswor-8, Kathmandu, Nepal
• Devaka Acharya
-Maharajgunj Nursing Campus, Institute of Medicine, Tribhuwan University, Maharajgunj, Kathmandu
• Muna Sharma
-Maharajgunj Nursing Campus, Institute of Medicine, Tribhuwan University, Maharajgunj, Kathmandu
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11. Critical Appraisal of Authors
• Authors are associated in variety of academic institutions with
different academic background.
• Credentials and details academic background is missing.
• Authors on an Average have a scientific publication of 4.
• Though multiple authors have contributed, author specializing in
psychology or any mental health science is missing.
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12. Abstract
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13. Critical Appraisal of Abstract
• Abstract is well structured as per Journal Guidelines.
• Expressive writing through use of easily understandable words
• Use of relevant Keywords
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14. Introduction
• Disturbances in thyroid function may significantly affect mental health
status including emotion and cognition.
• This study aimed to find the prevalence of anxiety and depression
among the patients of primary thyroid disorder, attending a tertiary
care hospital of Kathmandu.
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15. Critical Appraisal of Introduction
• Introduction defines technical definition of the Thyroid-dysfunction,
Prevalence and its’ association citing various articles.
• Since, this article emphasis on assessment of psycho-morbidities ,
definition and the causation with respect to thyroid dysfunction is
expected.
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16. Materials and methods
• The study is cross-sectional descriptive with the sample size of 129 thyroid
Patients attending Endocrinology Outpatient Clinic of the Tribhuvan
University Teaching Hospital, Maharajgunj, Kathmandu,
• For Assessment of the Depression and Anxiety, semi-structured
questionnaire and Beck Anxiety Inventory and Beck Depression Inventory
is used
• 20 years or above, primarily diagnosed of having thyroid function
disorder, were recruited for the study. Patients having comorbidity of
chronic medical illnesses (such as diabetes, heart diseases, obstructive lung
diseases, and renal diseases) and having depressive or anxiety disorders
before diagnosis of thyroid disorder were excluded. Patients taking
medicines other than to correct the thyroid hormone status (thyroxine,
carbimazole) were also excluded
• Group differences were compared (Chi square) or correlations were
determined (Pearson’s correlation coefficient).
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17. Use of Tools
1. Beck Anxiety Inventory (BAI)
• The BAI contains 21 questions, each answer being scored on a scale
value of 0 (not at all) to 3 (severely). Higher total scores indicate more
severe anxiety symptoms. The standardized cutoffs are:
Cutoff value
• 0–7: Minimal
• 8-15: Mild
• 16-25: Moderate
• 26-63: Severe.
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18. Use of Tools
• Beck Depression Inventory (BDI) is a tool created by Aaron T. Beck,
is a 21-question multiple-choice self-report inventory, one of the most
widely used psychometric tests for measuring the severity of
depression.
Cutoff Points
0–9: indicates minimal depression
10–18: indicates mild depression
19–29: indicates moderate depression
30–63: indicates severe depression.
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19. Critical Appraisal of Materials and Methods
• Selection criteria is strict and author have tried to address all the
confounding variable that might hamper results.
• Use of validated Nepalese translated BAI and BDI tools for the study.
• 0.05 p value is used throughout the research ,hence results of this study are
95% accurate.
• Sample Size is relatively small which makes the finding less reliable.
• Data is collected from single site.
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20. Critical Appraisal of Tools
BDI
• Use of Nepalese translated and validated tools.
• Can rapidly screen depression into 3 categories.
• The test also has high internal consistency (α=.91)
• This is a copyrighted content, Author has not disclosed about special
permission received.
• This tool is outdated. A new version of BDI-IA and BDI-II is available since
1978 and 1996 respectively
• This tool suffers a problem of self-reportness i.e individual result could be
exaggerated or minimized
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21. Critical Appraisal of Tools
BAI
• It is a fast paced screening tool comprising of 21 question
• BAI includes two factor approach i.e. cognitive and somatic approach
• BAI tends to have less reliable mean score.
• Much more emphasis is given on somatic as 15 out of 21 question are assess
somatic anxiety.
• This is a copyrighted content, Author has not disclosed about special
permission received.
• This tool suffers a problem of self-reportness i.e individual result could be
exaggerated or minimized
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22. Results
• The study aims to assess the anxiety and depression in the patients
with thyroid dysfunctions.
• Majority have hypothyroidism with the mean duration of 3 years.
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23. Results
By percentage distribution, majority
of the patients of both anxiety and depression
belonged to the hyperthyroid group, about
20% more than hypothyroid group .This
difference in prevalence was statistically
significant.
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24. Results
In further analysis, Both the psychiatric disorders were more common in
females and lower economic classes whereas age, marital status,
literacy status, occupation, religion, and family types did not have
significantly strong associations. The Brahmin/Chhetri people had
significantly less prevalence of depression compared to Janajati people
but ethnic difference observed for anxiety was not significant.
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25. Critical Appraisal of Results
• The results of the study aligns with the objective of the research.
• Research results are presented in tables, and graphs making it easily
interpretable
• Various Univariate analysis such as central tendency , count,
frequency and percentage is done to interpret analysis.
• Bivariate analysis such as chi-square test is adopted to associate
Anxiety and Depression with various socio-demographic variables.
• Variables with less counts such as age>60 years , muslim and other are
excluded to prevent confusion and misinterpretation.
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26. Critical Appraisal of Results
• Analysis is limited to univariate and bivariate only. Multivariate
analysis is expected where research paper involving many authors
with strong academic backgrounds.
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27. Discussion
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28. Critical Appraisal of Discussion
• Author have discussed their finding with comparison of 8 other
research paper findings.
• Writing is expressive yet there is use of simple words.
• Findings of this research align with the results of similar studies.
• Authors have given strong reasoning highlighting the cause incase if
research finding contradicts with other research.
• Authors have recognized their limitation and also have presented their
reliability and validity measures.
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29. Conclusion
• Author have concluded that there is a high prevalence of the
depressions and anxiety among patients with thyroid dysfunctions with
female sex, lower socioeconomic status , and hormonal disorder status
statistically significant .
• Recommendation section is missing while Author have recommended
following ; Management of thyroid disorders should incorporate
treatment of anxiety and depression; routine psychiatric screening of
the groups with higher prevalence is advisable.
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30. Critical Appraisal of Conclusion
• Conclusion & Recommendation is based on the research findings and
outcomes.
• Conclusion aligns with the research objective .
• Conclusion is short missing many important details about research
outcomes.
• Recommendation is too general and board.
• Authors fails to recommend any concrete solution and steps to manage
prevalence of psycho morbidities within patients with thyroid
dysfunctions
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31. References
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32. Critical Appraisal of References
• All the articles are open-accessed and full text are available .
• References are from diverse sources.
• References are relevant to the research.
• Link is available of references so that reader can directly visit
references instead of manual search.
• References are from reputed and trustworthy sites and journal.
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33. How will this help my research ?
• Explore various tools commonly used for psycho morbidity test in
Nepal.
• Helps to design questionnaire.
• Will aware me to modify research to prevent limitation of this study.
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34. Strengths
• Research is noble and interesting .
• It highlights the prevalence of psycho-morbidities in patients with
thyroid dysfunction.
• Research findings contributes to the scientific society as new evidence
are generated.
• It lights on the shadowed issues of the public health i.e. Mental health
and its association with thyroid dysfunction
• Writing is well structured with use of diverse yet simple and powerful
words.
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35. Weaknesses
• Sample size is relatively for the generalization of the research
findings.
• Study area is limited to one site.
• Use of relatively outdated-tools.
• Result even though statistically correct but might varies on large
population.
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36. Overall significance of the article
• Findings believable?
-Finding is statistically correct but doubts persists as sample size is low and
data is collected from one study site.
• Evidence generated
-Evidence is generated with univariate and bivariate analysis showing
various significant association between psycho morbidities and socio-
demographic variables.
• New finding
- New finding are achieved such as prevalence and significant associations
• Contribution to the scientific society
-It contributes to the scientific society as the research findings are published
in reputed journal of Nepal. The research findings are communicated and
various new evidences are generated.
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37. Overall Significance of the article
• Generalizability of article
-The article could not be generalize as sample size is relatively
low and data is collected from one study site.
• New research question generated
-The research generated various new questions such as;
As significant association is established, degree of association and
correlation is still unknown.
Prevalence of co-psycho morbidities is unknown.
Drug efficacy among patient with various level of
psychomorbidities could be assessed.
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38. Questions?
Queries?
Suggestions?
Feedbacks?
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39. Thank You!
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