Diabetes Score questionnaire for lifestyle change in patients with type 2 diabetes

Background. Designed for use in clinical settings, the Diabetes Score is a 10-item, one-page questionnaire for discussing lifestyle change. We aimed to evaluate the Diabetes Score questionnaire for its validity and acceptability among individuals with type 2 diabetes.Methods. An observational study was conducted using interviewer-administered questionnaires to adult patients with type 2 diabetes at three ambulatory clinics. We used the Diabetes Score questionnaire for measuring adherence to diet, exercise and other lifestyle recommendations. The questionnaire yields an intuitive score ranging from 0 to 100, by addition of each of the 10 items which are rated as 0, 5 or 10 by the patient. A score of more than 60 was consideredsatisfactory.Results. A total of 311 patients, 56% females, with a median age of 55 years (range: 23 to 87) participated in the study. Diabetes Score correlated with glycemic control, HbA1c (r = –0.20) and blood glucose (r = –0.25; P < 0.001), indicating validity. Reliability was demonstrated by internal consistency (alpha .577) and discriminant factor analysis. Based on multivariate modeling, an improvement of 30 points on the Diabetes Score corresponded to a drop in HbA1c by 1.0%-unit (11 mmol/mol).Conclusion. Diabetes Score is a valid and reliable tool for empowering lifestyle and behavior modification among patients with diabetes mellitus. This brief and free-to-use questionnaire has the potential to be used in diabetes clinics to discuss behavior change. It can serve as the first-line intervention in diabetes patients while reducing the cost of diabetes care

Faculty perceptions regarding an individually tailored, flexible length, outcomes-based curriculum for undergraduate medical students

Purpose The perception of faculty members about an individually tailored, flexible-length, outcomes-based curriculum for undergraduate medical students was studied. Their opinion about the advantages, disadvantages, and challenges was also noted. This study was done to help educational institutions identify academic and social support and resources required to ensure that graduate competencies are not compromised by a flexible education pathway. Methods The study was done at the International Medical University, Malaysia, and the University of Lahore, Pakistan. Semi-structured interviews were conducted from 1st August 2021 to 17th March 2022. Demographic information was noted. Themes were identified, and a summary of the information under each theme was created. Results A total of 24 (14 from Malaysia and 10 from Pakistan) faculty participated. Most agreed that undergraduate medical students can progress (at a differential rate) if they attain the required competencies. Among the major advantages mentioned were that students may graduate faster, learn at a pace comfortable to them, and develop an individualized learning pathway. Several logistical challenges must be overcome. Providing assessments on demand will be difficult. Significant regulatory hurdles were anticipated. Artificial intelligence (AI) can play an important role in creating an individualized learning pathway and supporting time-independent progression. The course may be (slightly) cheaper than a traditional one. Conclusion This study provides a foundation to further develop and strengthen flexible-length competency-based medical education modules. Further studies are required among educators at other medical schools and in other countries. Online learning and AI will play an important role

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Resilience and academic performance: exploring the link in dental students

This study aims to assess the correlation between the resilience level of dental students (preclinical and clinical years) and its effects on their academic performance. It is a correlational research study that was carried out on second, third, and final-year dental students at Lahore Medical & Dental College, Lahore. Academic resilience was judged by using the academic resilience scale (ARS-30). The correlation between resilience and academic performance was established by applying the bivariate Pearson correlation. The mean age of the students was 21.49±1.39 years. Among 196 dental students from different years, 132(67.35%) were females and 64(32.65%) were males. A strong positive correlation was observed between the academic performance and resilience of dental students, i.e. r=0.774. From the results, it can be concluded that there is a positive correlation between academic resilience and academic performance among dental students. Keywords: Resilience, Dental students, Academic performance

Covid-19 pandemic: How stressed the students and faculty are?

Objective: To assess the perceived stress levels amongst faculty and students of medicine, dentistry and allied health sciences during COVID-19 pandemic. Material and Method: This multi-institutional descriptive study was conducted from April to June 2020. All the students and faculty from three institutes namely University College of Medicine, University College of Dentistry and the Institute of Allied Health Sciences were invited to participate. Data was collected using a pre-validated Perceived Stress Scale (PSS-10). descriptive and inferential statistics were calculated using SPSS v.21. Results: 1199 responses were obtained. Students from the University College of Medicine reported higher scores on the Perceived Stress Scale (23.02+11.85) than those from the University College of Dentistry (21.87+10.86) and the Institute of Allied Health Sciences (21.95+11.32). The students and the faculty experienced stress ‘sometimes to fairly often’ during this pandemic. Females experienced more stress than males and there was no significant difference among students and faculty of various age groups. Conclusion: During the COVID-19 pandemic, the students and the faculty from medicine, dentistry and allied health sciences institutes were moderately stressed. The medical students were more affected than the allied health and dental students. A higher stress level was reported among dental faculty as compared to the other two institutes. Institutions should hence promote resilience and mental well-being and provide for more flexible work schedules

Kwestionariusz Diabetes Score stosowany w celu zmiany stylu życia u chorych na cukrzycę typu 2

Wstęp. Diabetes score to 10-punktowy, jednostronicowy kwestionariusz do omawiania zmiany stylu życia, zaprojektowany do użytku w praktyce klinicznej. celem autorów była ocena kwestionariusza Diabetes Score pod kątem jego trafności i akceptowalności wśród osób  z cukrzycą typu 2. Materiał i metody. Badanie obserwacyjne przeprowadzono z wykorzystaniem kwestionariuszy ankie-towanych u dorosłych pacjentów z cukrzycą typu 2 w trzech poradniach ambulatoryjnych. Wykorzystano kwestionariusz Diabetes Score do pomiaru przestrzegania zaleceń dotyczących diety, ćwiczeń i innych aspektów stylu życia. kwestionariusz daje intuicyjny wynik  w zakresie od 0 do 100 punktów po dodaniu wszystkich 10 pozycji, które zostały ocenione przez pacjenta na 0, 5 lub 10 punktów. Wynik powyżej 60 punktów uznano za zadowalający. Wyniki. W badaniu wzięło udział łącznie 311 pacjentów, 56% kobiet, o medianie wieku 55 lat (zakres: 23 do 87). Ocena w skali Diabetes Score korelowała z kontrolą glikemii, HbA1c (r = –0,20) i stężeniem glukozy we krwi (r = –0,25; p < 0,001), co wskazuje na trafność kwestionariusza. Rzetelność wykazano na podstawie wewnętrznej spójności (alfa 0,577) i dyskryminacyjnej analizy czynnikowej. Jak pokazało modelowanie wieloczynnikowe, zwiększenie liczby punktów o 30 odpowiadało zmniejszeniu HbA1c o 1,0% (11 mmol/mol). Wnioski. kwestionariusz Diabetes Score to rzetelne i trafne narzędzie umożliwiające modyfikację stylu życia oraz zachowań chorych na cukrzycę. Ten krótki i darmowy kwestionariusz może być używany w poradniach diabetologicznych w celu omówienia zmiany stylu życia. Może służyć jako interwencja pierwszej linii u nowo zdiagnozowanych pacjentów z cukrzycą, po-zwalając na obniżenie kosztów opieki diabetologicznej

New challenges in the use of nanomedicine in cancer therapy

Nanomedicines are applied as alternative treatments for anticancer agents. For the treatment of cancer, due to the small size in nanometers (nm), specific site targeting can be achieved with the use of nanomedicines, increasing their bioavailability and conferring fewer toxic side effects. Additionally, the use of minute amounts of drugs can lead to cost savings. In addition, nanotechnology is effectively applied in the preparation of such drugs as they are in nm sizes, considered one of the earliest cutoff values for the production of products utilized in nanotechnology. Early concepts described gold nanoshells as one of the successful therapies for cancer and associated diseases where the benefits of nanomedicine include effective active or passive targeting. Common medicines are degraded at a higher rate, whereas the degradation of macromolecules is time-consuming. All of the discussed properties are responsible for executing the physiological behaviors occurring at the following scale, depending on the geometry. Finally, large nanomaterials based on organic, lipid, inorganic, protein, and synthetic polymers have also been utilized to develop novel cancer cures