Association between socioeconomic factors and soft drink consumption among adults in Cambodia: a cross-sectional study

Background: Soft drinks are an attractive and popular drink, consumed by many people to fulfill their energy. However, soft drink consumption is an important risk factor for non-communicable diseases. This study aimed to investigate the association between socioeconomic factors and soft drink consumption among adults in Cambodia. Methods: A cross-sectional analytical study with multi-stage random sampling was used to select 749 respondents from 12 communes across 5 districts in Phnom Penh, the capital city of Cambodia. A structured questionnaire was used to assess socioeconomic factors and soft drink consumption. Data were analyzed using bivariate and multivariable logistic regression. Crude odds ratios and adjusted odds ratios (AORs) with 95% confident intervals (CI) were calculated to show the strength of associations.Results: The overall prevalence of soft drink consumption was 44.73% (95%CI: 41.16-48.30%) across the sample population. The final model of multiple logistic regression showed only four factors to be significantly associated with soft drink consumption: gender, age, family size and income. Respondents most likely to consume soft drinks were men (AOR: 1.49, 95%CI: 1.10-2.00; p=0.009), those aged 31-59 years (AOR: 1.93, 95%CI: 1.98-4.62;

Cortical cross-modal plasticity following deafness measured using functional near-infrared spectroscopy

Evidence from functional neuroimaging studies suggests that the auditory cortex can become more responsive to visual and somatosensory stimulation following deafness, and that this occurs predominately in the right hemisphere. Extensive cross-modal plasticity in prospective cochlear implant recipients is correlated with poor speech outcomes following implantation, highlighting the potential impact of central auditory plasticity on subsequent aural rehabilitation. Conversely, the effects of hearing restoration with a cochlear implant on cortical plasticity are less well understood, since the use of most neuroimaging techniques in CI recipients is either unsafe or problematic due to the electromagnetic artefacts generated by CI stimulation. Additionally, techniques such as functional magnetic resonance imaging (fMRI) are confounded by acoustic noise produced by the scanner that will be perceived more by hearing than by deaf individuals. Subsequently it is conceivable that auditory responses to acoustic noise produced by the MR scanner may mask auditory cortical responses to non-auditory stimulation, and render inter-group comparisons less significant. Uniquely, functional near-infrared spectroscopy (fNIRS) is a silent neuroimaging technique that is non-invasive and completely unaffected by the presence of a CI. Here, we used fNIRS to study temporal-lobe responses to auditory, visual and somatosensory stimuli in thirty profoundly-deaf participants and thirty normally-hearing controls. Compared with silence, acoustic noise stimuli elicited a significant group fNIRS response in the temporal region of normally-hearing individuals, which was not seen in profoundly-deaf participants. Visual motion elicited a larger group response within the right temporal lobe of profoundly-deaf participants, compared with normally-hearing controls. However, bilateral temporal lobe fNIRS activation to somatosensory stimulation was comparable in both groups. Using fNIRS these results confirm that auditory deprivation is associated with cross-modal plasticity of visual inputs to auditory cortex. Although we found no evidence for plasticity of somatosensory inputs, it is possible that our recordings may have included activation of somatosensory cortex that masked any group differences in auditory cortical responses due to the limited spatial resolution associated with fNIRS

Randomised controlled trial of fish oil supplement to treat cancer cachexia

Patients with advanced cancer often suffer from cachexia, a debilitating and complex extreme weight loss syndrome which is also associated with shorter survival times. A pragmatic randomised controlled trial was conducted to determine whether an oral nutritional supplement containing the omega-3 fatty acid eicosapentaenoic acid (EPA) was able to improve quality of life and survival times of patients with advanced solid tumour cancer in a mixed tumour cancer type population

Physiological MRI for neuropharmacological and advanced cerebral haemodynamic studies

This thesis investigates the application of physiological measures made using magnetic resonance imaging (MRI) to study cerebral haemodynamics and the pharmacological modulation of brain activity. Blood Oxygen Level Dependent (BOLD) functional MRI (fMRI), together with Arterial Spin Labelling (ASL), were used to study of the effect of beta-blockers on the brain’s response to emotional visual stimuli at 3 T. The study aimed to test the James-Lange theory, which states that emotions result from the perception of bodily arousal. Autonomic nervous system responses to emotional stimuli can be predicted by the level of activity in the limbic system (including amygdala, brainstem and salience network). This thesis assesses the action of the peripherally acting beta-blocker, nadolol, on the fMRI response to neutral, pleasant and unpleasant visual stimuli, and during rest. 80 mg nadolol and placebo tablets were administered to twenty healthy human subjects in a double blinded, randomised, placebo controlled crossover design. Drug induced reduction in anterior insula response to emotional stimuli supports results from previously published studies, and the James-Lange theory. The preliminary finding of drug induced increase in amygdala response is contradictory. Territorial ASL (TASL) and multi-phase ASL were used in combination for advanced investigation of the vascular territories, and quantitative perfusion and blood transit times. These measures were used for the assessment of the location and haemodynamic properties of the cerebral watershed regions. Watershed region masks formed from TASL and multi-phase ASL data exhibited reduced perfusion and lengthened transit times compared to other cortical regions. The accuracy of watershed delineation was shown to be enhanced by the use of both techniques in combination. Furthermore, TASL is developed and implemented at 7 T. Alternative labelling schemes were compared and parameters optimised for control condition efficiency, and TASL assessment was performed in three healthy volunteers

Physiological MRI for neuropharmacological and advanced cerebral haemodynamic studies

This thesis investigates the application of physiological measures made using magnetic resonance imaging (MRI) to study cerebral haemodynamics and the pharmacological modulation of brain activity. Blood Oxygen Level Dependent (BOLD) functional MRI (fMRI), together with Arterial Spin Labelling (ASL), were used to study of the effect of beta-blockers on the brain’s response to emotional visual stimuli at 3 T. The study aimed to test the James-Lange theory, which states that emotions result from the perception of bodily arousal. Autonomic nervous system responses to emotional stimuli can be predicted by the level of activity in the limbic system (including amygdala, brainstem and salience network). This thesis assesses the action of the peripherally acting beta-blocker, nadolol, on the fMRI response to neutral, pleasant and unpleasant visual stimuli, and during rest. 80 mg nadolol and placebo tablets were administered to twenty healthy human subjects in a double blinded, randomised, placebo controlled crossover design. Drug induced reduction in anterior insula response to emotional stimuli supports results from previously published studies, and the James-Lange theory. The preliminary finding of drug induced increase in amygdala response is contradictory. Territorial ASL (TASL) and multi-phase ASL were used in combination for advanced investigation of the vascular territories, and quantitative perfusion and blood transit times. These measures were used for the assessment of the location and haemodynamic properties of the cerebral watershed regions. Watershed region masks formed from TASL and multi-phase ASL data exhibited reduced perfusion and lengthened transit times compared to other cortical regions. The accuracy of watershed delineation was shown to be enhanced by the use of both techniques in combination. Furthermore, TASL is developed and implemented at 7 T. Alternative labelling schemes were compared and parameters optimised for control condition efficiency, and TASL assessment was performed in three healthy volunteers

The flipped classroom approach in a pediatric anesthesiology fellowship curriculum

Background The flipped classroom approach is well documented to enhance medical education outcomes. Additionally, both the need for online learning materials and the increased demand for medical professionals during the COVID-19 pandemic has made this approach more relevant. The pediatric anesthesiology fellowship curriculum at one institution transitioned from a traditional classroom model to a flipped classroom approach to optimize the educational experience and support learner well-being. Approach Utilizing the American Board of Anesthesiology (ABA) and Accreditation Council for Graduate Medical Education (ACGME) content outlines, a novel, comprehensive curriculum was developed focusing on core clinical material and board review with the goal of providing structured learning while alleviating the burden of completing board review independently to improve work-life balance and reduce the potential for burnout. Evaluation Graduates of the program from 2017 to 2021 evaluated the flipped classroom structure and its perceived impact on their educational outcomes, wellness, and career development via a one-time, voluntary survey. Results indicated improved participation rates and educational benefits with the flipped classroom structure compared to the traditional structure. Fellows preferred the flipped classroom approach to the traditional lecture approach (72.2% vs. 27%), and they preferred custom-made prework material to traditional textbooks and articles. Fellows benefited from having more time for personal activities and other scholarly work, as evidenced by open-ended responses. Implications The flipped classroom structure was perceived as beneficial by pediatric anesthesiology fellows because of increased educational engagement, alleviation of academic burden, and improved wellness due to more time for non-academic activities. Further study is needed to optimize and correlate the new curriculum with objective educational outcomes

Socio-demographic and lifestyle factors associated with understanding fast food consumption among adults in Cambodia

Background: Over the past decades, fast food has been rapidly gaining popularity and availability worldwide. Its consequential impact on human health is among the highest in terms of non-communicable diseases. Therefore, this study aimed to investigate the level of understanding of fast food consumption among adults in Phnom Penh, the capital city of Cambodia.Methods: A cross-sectional analytical study aimed to investigate the level of understanding of factors associated with fast food consumption, among adults in Phnom Penh. Multi-stage random sampling was used to select 749 respondents from 12 communes of five districts in Phnom Penh. A structured questionnaire was used to assess the level of understanding of fast food consumption, and associated factors. Data were analyzed using descriptive statistics, together with bivariate and multivariable logistic regression. Crude odds ratios (CORs) and adjusted odds ratios (AORs) with 95% confident intervals (CI) were calculated to show the strength of associations.Results: The understanding of factors associated with fast food consumption was poor in 52.07% (95% CI: 48.48-55.66), fair in 22.70% (95% CI: 19.69-25.70) and good in 25.23% (95% CI: 22.12-28.35) of those surveyed. After adjusting for other covariates, unsatisfactory levels of knowledge around fast food consumption were found to be significantly associated with not taking regular exercise (AOR = 1.53; 95% CI: 1.15-2.25;

The Role of “Special Clinics” in Imparting Clinical Skills: Medical Education for Competence and Sophistication

Purpose: Advanced methodical learning and optimised learning leads to better-trained doctors. Such teaching typically comprises the illustration of features and access to facilities. This article explores the role of “Special clinics” in medical education. The role of sophisticated “Special clinics” is to provide vigour and vibrancy in treating and teaching as well as advancing the art and science of medicine. All this contributes towards the current evidence indicating benefits of reducing hospitalization.Methods: This article comprises an analysis of the guidance produced by leading medical education institutions. Findings are presented in the perspective of a relevant theoretical framework around “Special clinics”, in light of the available evidence and personal experience.Results: The implementation and potential impacts of “Special clinics” are presented within the context of the “ 4SAs”, a favoured teaching mnemonic: 1) Scientific Approach: medical education rules and regulations reflecting scientific reasoning in support of “Special clinics”, 2) Setting Advantages: the mechanisms by which “Special clinics” are conducive to and contribute towards increasing the capacity to comprehensively treat complex disorders in the outpatient setting, avoiding hospitalization and its associated risks, as well as expenditure, 3) Sophistication Advantages: tools and techniques to ensure advanced clinical skills teaching including novel outpatient technologies, understanding the need for focussed study and practice, and exploiting the advantages of internationalization of medical education, and 4) Successes and Advancements: opportunities to observe experts providing specialist care of the highest standard. The use of a focussed approach aims to explore and advance frontiers of medical education.Conclusion: “Special clinics” will soon form a major component of the hospital workload and play a crucial role in medical education. They provide the advantage of condition-specific patient-centered care, the motivation for excellence. Clinical skills learnt by medical students in “Special clinics” will undoubtedly contribute to long-term improvements in the medical care

Pandemic preparedness of community pharmacies for COVID-19

© 2020 Elsevier Inc. Background: Community pharmacies provide an important healthcare service, which is broadly established, and constitutes the preferred and initial contact for members of the community. The significant value of community pharmacies was further highlighted during the COVID-19 pandemic crisis. Objective: The assessment of community pharmacies preparedness for the COVID-19 pandemic. Methods: A cross-sectional interview survey of 1018 community pharmacies working in four regions of Egypt (South, East, Centre, and North). Data collection was conducted from 8–19 April 2020. Results: Availability of personal protective equipment (PPE) and medication was better than alcohol (70% conc.). Home delivery services were available in 49.1% of pharmacies. Infection control measures covering interactions between staff were in place in up to 99.5% of pharmacies. Conversely, there was less frequent availability of contactless payment (29.1%), hand sanitizers (62.1%) or masks (86.5%) for customer use, or a separate area for patients with suspected COVID-19 (64%). Verbal customer education (90.4%) was used preferably to written (81.3%). Despite high clinical knowledge and awareness (97.6%–99.2%), only 8.8% of pharmacists had reported suspected COVID-19 cases, however this varied significantly with pharmacist demographics (geographic region P < 0.001; pandemic training p < 0.001; position p = 0.019; age p = 0.046). Conclusions: Government and policymakers strive to mitigate the shortage of PPE and medication. More attention should be given to infection control measures around interactions between staff and customers to ensure community pharmacists are fit and able to provide continuity in their important role. Educating customers using regularly-updated posters, banners or signs will contribute to decreasing contact with patients, and reducing the number and duration of visits to the pharmacy. Pandemic preparedness of community pharmacists must also extend to reporting procedures. By avoiding under-reporting or over-reporting, community pharmacists will contribute to accurate monitoring of the national spread of infection