Endothelial function/ dysfunction and oxidative stress during ischaemia reperfusion injury as a consequence of intermittent claudication. Is good endothelial function a prognostic indicator for poor cardiovascular outcome in intermittent claudication?

Peripheral Vascular Disease (PVD) has a major morbidity and mortality in the general population. The spectrum of PVD ranges from intermittent claudication to critical limb ischaemia. There is a high prevalence of intermittent claudication in the general population, however only five to ten percent will progress to more severe disease. The progression of disease is at present unpredictable. There is a growing awareness that patients with intermittent claudication may have differing propensities for developing cardiovascular morbidity and mortality. This study aims to investigate the relationship between the endothelial response to exercise in the macro and microcirculation and correlate this with plasma inflammatory cytokine levels, plasma oxidative state and a marker of acute kidney injury in patients with peripheral vascular disease and healthy controls. This information may lead to a new screening test for patients with an increased risk of disease progression who once identified could be better managed to reduce their risk. Furthermore potential new cytokine targets for halting disease progression and potential treatment will be investigated.Open Acces

Management of peripheral arterial disease in diabetes: a national survey of podiatry practice in the United Kingdom

Background We aimed to investigate podiatry practice in diagnosing peripheral arterial disease (PAD) in diabetes, decision making once PAD is suspected and limitations of referral pathways. Methods A survey, comprising 26 questions was distributed to podiatrists across the UK via mailing lists of collaborating organizations including the College of Podiatry (UK). Response rates were estimated based on NHS workforce data. Analysis of responses from the open-ended questions was performed using inductive content analysis. Results Data from 283 respondents were analyzed. Response rate for all NHS podiatrists across the UK was estimated to be 6%. For the detection of arterial disease only 18.8% (n = 49/260) of participants reported using a full combination of history, pulse palpation, Doppler and ABPI assessment. Self-reported confidence in detecting arterial disease was highest amongst podiatrists who felt they had received adequate training compared to podiatrists who felt they had not (median 85 (IQR 75–90) vs 67 (50–77), respectively; p  20 diabetic patients per week compared to those who see < 20 (median 80 (IQR 70–90) vs 72 (60–82.8), respectively; p < 0.001). Over one third of respondents (35.8%, n = 93/260) were aware of missed cases of PAD in the past year and 17.5% (n = 38/217) believed that this resulted in an amputation in some cases. The survey highlighted a lack of clarity amongst podiatrists regarding referral guidelines. Additionally, 69% (n = 169/242) reported that their patients had to wait longer than 2-weeks for specialist vascular assessment and 67.6% (n = 54/80) reported similar waits for a Duplex Ultrasound scan. There was a statistically significant variation in DUS waiting time across the UK (X2 (10, N = 80) = 21.59, p = 0.017). Inability to make a direct referral to vascular services and long delays were reported as major limitations of the referral pathway. Conclusion We have identified important targets for further investigation and quality improvement

Exploring morality among orphans: a study of akhlaq and social standards in Pusat Jagaan Hembusan Kasih Sayang

This study explores the Islamic perspective on the care and treatment of orphans, focusing on their moral development within an institutional setting. Islamic teachings emphasize the holistic welfare of orphans, advocating for their physical, emotional, and spiritual well-being. This notion is grounded in the Quran and Hadith, where caring for orphans is not only a moral obligation but a means to attain spiritual reward. The study employs a quantitative cross-sectional design, using self-report questionnaires distributed among 50 children at Pusat Jagaan Hembusan Kasih Sayang, Kuantan. The questionnaire assesses various aspects of morality ('akhlaq') in relation to God, guardians, peers, and daily life. Results show a strong adherence to Islamic practices among the children, such as prayer, Quran recitation, and fasting, reflecting their spiritual upbringing. Their interactions with guardians and peers demonstrate respect, assistance, and effective conflict resolution, aligning with Islamic values of empathy and social harmony. Daily habits like tidiness and honesty are indicative of the institution's success in instilling Islamic principles of cleanliness and integrity. The study highlights the significant role of institutions like Pusat Jagaan Hembusan Kasih Sayang in shaping the moral development of orphans. These institutions provide not only physical care but also moral and spiritual guidance, crucial for children lacking familial support. The findings suggest that integrating religious teachings into the upbringing of children fosters a strong moral compass, preparing them to be responsible and ethical members of society. Overall, this research underscores the potential of religious education in promoting moral and ethical values in young individuals and calls for its replication in other childcare and educational settings. Future research could explore the long-term societal impact of such upbringing and the challenges faced by caregivers and educators in reinforcing these values

The perceived psychological well-being of LGBTQ individuals in Malaysia

This study explores the psychological well-being of lesbian, gay, bisexual, and transgender (LGBTQ) individuals in Malaysia, focusing on their experiences of identity formation, societal understanding, and the impact of prevailing attitudes on their mental health. Through qualitative methods, including in-depth interviews with nine participants from the LGBTQ community in Kuantan, Pahang, this research delves into the personal narratives of two lesbians, two gay individuals, two bisexuals, and three transgender persons, to understand the complexities of living as an LGBTQ individual in a society marked by religious and legal considerations. .The findings reveal that participants recognized their LGBTQ identity during adolescence, often navigating societal expectations discreetly to avoid backlash. Despite challenges, participants demonstrated resilience and found support within familial and community networks. Notably, the study highlights a shift towards greater understanding of LGBTQ individuals in Malaysia, potentially reducing instances of psychological distress within the community. This research underscores the importance of supportive environments and the need for culturally competent mental health care for LGBTQ individuals. It also calls for further studies to include broader societal perspectives and professional insights to enrich the discourse on LGBTQ mental well-being. This study contributes valuable insights into the evolving landscape of LGBTQ perceptions and the factors influencing the psychological health of LGBTQ individuals in Malaysia

Medication adherence: understanding the challenges among the elderly

This study explores medication adherence challenges in the elderly population, focusing on the complexities and dynamics of managing polypharmacy in a geriatric care setting. The research was conducted in One Stop Home Care Centre, Sri Damai, Kuantan, Malaysia, involving 10 participants aged between 45 and 72. It employs a mixed-methods approach, utilizing structured questionnaires and in-depth interviews to assess medication adherence behaviours and the influencing factors. The findings indicate a significant discrepancy between self-reported medication adherence and actual practices. While 50% of participants reported managing a single medication, observational data revealed a more intricate medication regimen, with some managing up to four different medications. The study highlights the critical role of social support systems in promoting medication adherence, with all participants adhering to their prescribed schedules due to robust caregiver involvement. However, 30% reported occasional lapses due to the complexity of their medication regimens. Notably, side effects like headaches and sleepiness were identified as key factors affecting medication adherence, underscoring the need for tailored approaches to manage side effects. The study emphasizes the importance of understanding the unique characteristics and challenges of medication adherence in the elderly, especially in the context of polypharmacy. The research also points out the socio-economic impact of an aging population and the growing demand for age-appropriate healthcare services. It emphasises the need for strategic health policy and planning to cater to the unique needs of the elderly. The findings advocate for comprehensive patient education, shared responsibility between residents and caregivers, and the implementation of systems to monitor medication intake and side effects. The study therefore provides valuable insights into medication adherence among the elderly, highlighting the necessity for personalised interventions and strategies to enhance health outcomes in this demographic. The research also acknowledges limitations, including a one-time visit for data collection and the lack of long-term follow-up, suggesting areas for future research

Integrative healthcare approaches for children with special needs: a holistic study on challenges and solutions

This study delves into the intricate healthcare landscape for children with special needs, shedding light on the multifarious challenges these individuals face and evaluating the effectiveness of integrative healthcare models tailored to their unique requirements. Conducted at Sekolah Kebangsaan Pendidikan Khas Kuantan, this cross-sectional qualitative analysis involved detailed surveys with 20 teachers and engaging discussions with 24 students, aiming to unravel the complexities of providing holistic care to this vulnerable population. The investigation meticulously identifies pivotal concerns such as the prevalence of behavioral issues, particularly in autistic children, who often exhibit aggressive and self-injurious behaviors, and the struggles encountered by hearing-impaired students in communication and learning. It further explores the susceptibility of these children to frequent infections due to immune system dysfunction, exacerbated by dietary imbalances and physical inactivity. The research emphasizes the indispensable role of early detection and intervention in mitigating health risks and outlines the significance of specialized supplements, medications, and rigorous oral hygiene practices in maintaining the overall well-being of these children. Additionally, the study brings to the forefront the critical impact of socioeconomic factors on healthcare access, advocating for equitable healthcare solutions. It also highlights the transformative potential of technology, including telehealth and assistive devices, in overcoming barriers to healthcare and education. Through this analysis, the study advocates for a comprehensive, integrative care approach that encompasses medical, educational, social, and psychological services, underscoring the necessity of collaborative efforts among healthcare providers, educators, and families to significantly enhance the quality of life and well-being of children with special needs

The lifestyle of single mothers in the east coast of Malaysia: the impact on their health and wellbeing

This study focuses on the health challenges and support mechanisms for single mothers in Malaysia, a demographic that faces unique socio-economic issues. Employing a quantitative approach, the research uses a self-report questionnaire to gather data from 20 single mothers in Kuala Nerus, Terengganu. Analysis reveals that these mothers, predominantly Malay, Muslim, and widowed, face significant health risks including chronic diseases, cardiovascular issues, and psychological strain, exacerbated by factors like financial stress and societal stigma. Physical health challenges among single mothers include an increased prevalence of chronic diseases due to stress and lack of self-care. The study corroborates global trends of health deterioration in single parents, with a specific focus on conditions like back pain, chest infections, and cardiovascular issues. Psychological wellbeing is also a critical concern, affected by factors such as sleep disturbances, financial stress, and societal perceptions. Government initiatives like BKIT provide financial support, but often fall short of addressing the complex needs of this demographic. Community support, while advocated by Islamic teachings, shows a gap in practical implementation. The study highlights the need for more effective strategies to enhance community support. The research uncovers that the number of years without a spouse significantly impacts the financial and overall well-being of single mothers. The limited financial resources affect their access to healthcare and their ability to afford essential treatments. Social support systems in Malaysia are found to be lacking, with non-governmental organizations playing a crucial role in advocacy and support. The study concludes that single mothers in Malaysia face multifaceted challenges that require holistic approaches from government, researchers, and society. The paper proposes expanding research to include diverse demographic representations, longitudinal studies, and qualitative exploration of religiosity. The recommendations emphasize the need for a comprehensive understanding of the experiences and challenges of single mothers, advocating for more inclusive and supportive environments