Cardiovascular Disease and Diabetes: Two Sides of the Same Coin!

Cardiovascular disease (CVD) and type 2 diabetes (T2DM) are rapidly rising around the globe. Empirical researches demonstrated rapid increase in mortality and morbidity related to CVD and T2DM. Much of the diabetes-associated morbidity and mortality predominantly reflects its deleterious effect on macrovascular and microvascular diseases. The microvascular complications of T2DM include retinopathy, neuropathy and nephropathy and the macrovascular complications include ischemic heart disease, cerebrovascular disease and peripheral vascular diseases. Research indicates that coronary heart disease (CHD) is the major cause of mortality in people with T2DM. Herein, this chapter reviews relationship between CVD and T2DM, associated complications and effectiveness of relevant treatment modalities to treat/prevent diabetic macrovasculopthy. Macrovascular disease occur due to underlying obstructive atherosclerotic changes of major arteries which cause functional and structural abnormalities of blood vessels. The long-term complications can be controlled and prevented by controlling glycemia, maintaining normal lipid profiles, adopting a healthy lifestyle and using pharmacological interventions. Clinical trials have shown that lifestyle interventions help in prevention and reduction of CVD risk, but evidence for long-term CVD outcomes is lacking. A multidisciplinary approach involving patients, health professionals and researchers and governments should be undertaken to reduce the incidence and prevalence of diabetes-related cardiovascular complications

Perception of tomorrow’s Health-Care connoisseur and front-runners of their educational environment utilizing DREEM inventory in Bahasa Melayu version, the native language of Malaysia

Background There have been a lot of reports throughout the world that medical students were abused during their undergraduate education and clerkship training. Thereafter, calls for intensifying the evaluation of medical and health schools’ curricula based on students’ perceptions of their educational environment. Several studies, methods, and instruments were developed including the Dundee Ready Education Environment Measure (DREEM) inventory, to evaluate the medical educational environment in last five decades. The DREEM inventory has been translated into minimum eight different native tongues namely Arabic, Chinese, Japanese, Persian, Portuguese, Spanish, Swedish, and Turkish. Aims The objective of this study was to assess the educational environment of the UniSZA undergraduate medical program from the students’ perspective utilizing the DREEM inventory translated in Bahasa Melayu. Methods This was a descriptive cross-sectional survey conducted among the medical students of session 2015-2016 to assess educational environment of the Faculty of Medicine, UniSZA. The study was conducted from December 2015 to January 2016. Universal sampling technique was adopted. Results A total of 277 (95.5 per cent) out of 290 students responded to the questionnaire; among them 27.4 per cent were male and 72.6 per cent were female respondents. The overall mean DREEM scores for both preclinical and clinical students were 67.41±24.06. The scores for pre-clinical and clinical were 64.02±25.10 and 69.65±23.15 respectively; however, no statistically significant (p=0.57) differences was observed between two phases. A significant difference was observed between gender of the respondents in students’ perceptions of teachers (p=0.005) and students’ social self-perceptions (p=0.046)

Perceptions of medical students regarding community-based teaching experiences: an observation from Bangladesh

Introduction: Community orientation in medical education, which prepares medical students to become more effective practitioners, is now a global movement. Many medical schools around the world have adopted the concept as the main curricular framework in order to align learning programs with the needs of the community and the learner. Despite many changes over the past few decades, many improvements are still needed in medical education in Bangladesh. This study investigated medical students’ perceptions of the community-based learning experiences incorporated into the Bachelor of Medicine, Bachelor of Surgery (MBBS) degree at Uttara Adhunik Medical College, Dhaka (UAMC), Bangladesh. Methods: A total of 135 students from three undergraduate year levels of the MBBS degree at UAMC, Dhaka, Bangladesh, undertook study tours (community-based teaching, CBT) as a part of a community medicine course and visited a medical college, two rural health centres and a meteorology centre in the Cox’s Bazar district, 400 km from Dhaka city. A questionnaire was used to assess the perceptions of students regarding the administration, organisation and learning experiences of the study tours. Students were required to write reports, present their findings and answer questions in their examinations related to the study tours and CBT. Results: The majority of the students agreed or strongly agreed that the tour was a worthwhile (93%) and enjoyable (95%) learning experience that helped them to understand rural health issues (91%). More than half of the students reported that the study tours increased their awareness about common rural health problems (54%) and provided a wider exposure to medicine (61%). Only 41% of students reported that the study tour increased their interest in undertake training in a rural area. A substantial number of students also expressed their concerns about the planning, length, resources, finance and organisation of the study tours. Conclusions: Overall, the study tours had a positive effect, enhancing students’ awareness and understanding of common rural health problems. As study tours failed to increase the motivation of the students (approximately 60%) to work in rural areas, CBT in the medical curriculum should be reviewed and implemented using effective and evidence-based models to promote interest among medical students to work in rural and underserved or unserved areas

Evaluation of out-patient care educational environment of National Defence University, Malaysia utilizing the ACLEEM Inventory

Purpose: A friendly educational environment is required for optimal learning, and students should be asked to provide feedback on their experiences to improve curriculum. Moreover, students’ academic progress, mental growth, and physical well-being are influenced by the educational and clinical environment of the institute. Essential constituents of the educational climate include atmosphere, number of proper teaching-learning sessions and available amenities. Primary health care and ambulatory settings allow students ample opportunities to interact with patients and observe health promotional activities more often practiced at the community levels. The study aims to evaluate the outpatient care educational environment of National Defense University of Malaysia by seeking feedback from medical students using Ambulatory Care Educational Environment Measure (ACLEEM) instrument. Methods: This was a cross-sectional study. The study participants were medical students of the earlier mentioned university. The universal sampling method was adopted. The ACLEEM validated instrument was utilized for the data collection. The instrument was developed on the basis of 5-point Likert Scale (Minimum: 0, and Maximum: 4). Results: The response rate 100%. Most respondents were male, Malay and Muslim. The total mean score was 1.0±0.4. The domain mean scores for clinical teaching, clinical training, and support were 0.8±0.4, 1.1±0.4, and 1.1±0.5, respectively. Conclusions: The ACLEEM questionnaire was found to be valid and reliable for local UPNM, Malaysian context. However, the overall ACLEEM scores reported for the present study is low, and some areas that could be improved. The UPNM authority should take appropriate measures to improve the educational environment to enhance the academic experiences of the medical students

Self-medication of antibiotics: investigating practice among university students at the Malaysian National Defence University

Background: Self-medication of drugs to alleviate symptoms is a common global behavior, helping relieve burdens on health services, but many drugs eg, antibiotics are prescription-only. Self-medication of antibiotics (SMA) is an irrational use of drugs, contributing to microbial resistance increasing health care costs and higher mortality and morbidity. This study aimed to assess SMA among university students. Methods: This was a cross-sectional study conducted among medical and non-medical students of the National Defence University of Malaysia. A validated instrument was used to gather data. Ethics approval was obtained. Random and universal sampling was adopted, and SPSS 21 was used for data analysis. Results: A total of 649 students participated in the study: 48.5% male and 51.5% female, 39.3% reported self-medicating with antibiotics. Penicillin, doxycycline, clarithromycin were the antibiotics most used with the majority reporting no adverse drug reactions. Cost savings and convenience were the principal reasons for SMA which were mainly obtained from local retail pharmacies. Despite medical students (particularly the more senior) having better knowledge of antibiotic use than non-medical students, 89% of all research participants responded that practicing SMA was a good/acceptable practice. Conclusion: SMA is common amongst Malaysian students and, despite understanding why SMA is unwise, even medical students self-medicate

Assessment of academic/non‑academic factors and extracurricular activities influencing performance of medical students of Faculty of Medicine, Universiti Sultan Zainal Abidin, Malaysia

Background: Physical and mental comfort is known to have a crucial influence on health and performance amongst medical students. Very often, medical students suffer from poor quality of life (QOL) related to the work‑life balance due to the lack of sleep, nutritional and dietary disorders and low physical activity, resulting in a negative impact on their academic performance. This study aims to determine the potential academic/non‑academic factors and extra‑curricular activities influencing the performance of medical students in Universiti Sultan Zainal Abidin (UniSZA). Materials and Methods: This was a cross‑sectional study conducted on medical students at the Faculty of Medicine, UniSZA, Terengganu, Malaysia. A sample size of 300 respondents were recruited from Year I to V medical students. The questionnaire was adopted, modified and validated from a similar study in Saudi Arabia. Results: Majority of the students enjoy medical education are self‑motivated, have a good command of English, non‑smokers and have a sufficient sleep. Conclusion: University medical students possess good QOL within the optimum educational environment

Personal protective equipment (PPE) related adverse skin reactions among healthcare workers at the main COVID-19 isolation center in Barbados

Background: The use of personal protective equipment (PPE) reduces the risk of transmission of infectious agents significantly among healthcare workers (HCWs). The study aimed to investigate the prevalence and characteristics of PPE-related adverse skin reactions among HCWs working at the main COVID-19 isolation center in Barbados. Methods: A cross-sectional web-based online survey was conducted during April to June 2021 which recorded demographic information, details of PPE use and adverse skin reactions including severity and duration of onset of symptoms. Results: Most of the respondents used PPE for consecutive days (77.9%), 1–6 h/day (59.2%), and more than a year (62.5%). Fewer than half of the participants (45.6%) experienced adverse skin reactions from the use of PPE. The reactions were mostly observed in the cheeks (40.4%) and nose bridges (35.6%). Females had more reactions than their male counterparts (p = 0.003). The use of N95 masks and a combination of surgical and N95 masks produced adverse effects predominantly in the ears (60%) and cheeks (56.4%). Binary logistic regression showed that female HCWs (OR = 5.720 95% CI: 1.631, 20.063), doctors (OR = 5.215 95% CI: 0.877, 31.002), and longer duration of PPE use (>1 year) (OR = 2.902 95% CI: 0.958, 8.787) caused a significantly higher prevalence of adverse skin reactions. Conclusion: The PPE-related skin reactions were common among HCWs which mainly occurred due to prolonged use. Preventive measures inclusive of appropriate training of HCWs on the use of PPE are recommended to minimize these adverse event

Domestic violence and decision-making power of married women in Myanmar: analysis of a nationally representative sample

BACKGROUND: Women in Myanmar are not considered decision makers in the community and the physical and psychological effect of violence makes them more vulnerable. There is a strong negative reaction, usually violent, to any economic activity generated by women among poorer and middle-class families in Myanmar because a woman's income is not considered necessary for basic survival. OBJECTIVE: Explore the relationship between domestic violence on the decision-making power of married women in Myanmar. DESIGN: Cross-sectional. SETTING: National, both urban and rural areas of Myanmar. PATIENTS AND METHODS: Data from the Myanmar Demographic and Health Survey 2015-16 were used in this analysis. In that survey, married women aged between 15 to 49 years were selected for interview using a multistage cluster sampling technique. The dependent variables were domestic violence and the decision-making power of women. Independent variables were age of the respondents, educational level, place of residence, employment status, number of children younger than 5 years of age and wealth index. MAIN OUTCOME MEASURES: Domestic violence and decision-making power of women. SAMPLE SIZE: 7870 currently married women. RESULTS: About 50% respondents were 35 to 49 years of age and the mean (SD) age was 35 (8.4) years. Women's place of residence and employment status had a significant impact on decision-making power whereas age group and decision-making power of women had a relationship with domestic violence. CONCLUSION: Giving women decision making power will be indispensable for the achievement of sustainable development goals. Government and other stakeholders should emphasize this to eliminate violence against women. LIMITATIONS: Use of secondary data analysis of cross-sectional study design and cross-sectional studies are not suitable design to assess this causality. Secondly the self-reported data on violence may be subject to recall bias. CONFLICT OF INTEREST: None

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

STUDENTS' PERCEPTIONS OF 'TECHNOLOGY-BASED' LECTURE HANDOUTS

Lecture handouts are widely used instructional tools. Handouts supplement rather than substitute students' regular reading. It is now a common practice to supply PowerPoint handouts and publish lecture handouts on the web for students' access. A study was conducted among the first year medical students (n=142) of School of Medical Sciences (SMS), Universiti Sains Malaysia (USM) in order to determine their perceptions and expectations with regards to lecture handouts provided to them. The majority of the students reported that they read the lecture handouts as a reference and found them useful as a guide for future learning. More than half (68%) of the students expressed dissatisfaction with the overall presentation format of the handouts which is mainly technology-related i.e. PowerPoint and photocopying. This study indicated that students' expectations and experiences were positive towards the use of handouts. They used handouts as a means of supplementing rather than substituting their learning. Much care is needed when educators supply computer-based handouts, as this study shows a number of limitations when students use them. Medical schools should consider publishing web-based handouts with online and other facilities to make it interesting and effective