Lectures in medical educaton: what students think?

BACKGROUND: The volume of medical knowledge has increased exponentially and so has the need to improve the efficiency of current teaching practices.With increasing emphasis on interactive and problem based learning, the place of lectures in modern medical education has become a questionable issue. Objectives were to assess the perspective of undergraduate medical students regarding the role and effectiveness of lectures as a mode of instruction as well as the ways and means that can be employed to enhance the effectiveness of lectures. METHODS: A cross sectional study was carried out among 2nd to final year medical students from five medical colleges including both private and public sector institutions. A total of 347 students participated by completing a structured questionnaire. Data was analyzed using SPSS-17. RESULTS: Sixty seven percent students considered lectures as a useful mode of instruction (47% males and 77% females), whereas 83% of the students reported that clinical sessions were superior to lectures because of small number of students in clinical sessions, active student participation, enhanced clinical orientation, and interaction with patients. About 64% responded that lectures should be replaced by clinical sessions. Majority of the students (92%) reported not being able to concentrate during a lecture beyond 30 minutes, whereas 70% skipped lectures as they were boring. A significantly greater proportion of male respondents, students from clinical years, and those who skipped lectures, considered lectures to be boring, a poor utilization of time and resources, and could not concentrate for the full duration of a lecture compared to females, students from preclinical years, and those who do not skip lectures, respectively. CONCLUSION: Lecturing techniques need to be improvised. The traditional passive mode of instruction has to be replaced with active learning and inquiry based approach to adequately utilize the time and resources spent on lectures.

Knowledge and barriers to screening for colorectal cancer among individuals aged 40 years or older visiting primary healthcare clinics in Al-Khobar, Eastern Province.

BACKGROUND: Colorectal cancer (CRC) ranks third as the most common cancer in the world and the 4th most common cause of deaths from cancer. In Saudi Arabia, CRC is the most common cancer in males and the third most common in females. Early screening reduces the risk of CRC and death. However, there is a lack of awareness of CRC screening in Saudi Arabia. The objective of this study was to determine the knowledge, practices, and barriers to CRC screening using the Health Belief Model (HBM). MATERIALS AND METHODS: This study enrolled Saudis aged 40 years or older visiting PHCCs in Al-Khobar. Data were collected using a self-administered questionnaire or a direct interview of the selected participants. Information sought included sociodemographics, past CRC screening, CRC knowledge, and HBM items. Data analysis was done using SPSS; the Chi-squared test and ANOVA were used to determine statistical significance. RESULTS: A total of 206 of the individuals approached completed the questionnaire. The average age was 51.1 years, and 51% were males. Only 10% reported that a physician had provided information on CRC prevention or discussed/recommended screening for CRC, and 10% had undergone screening for CRC. Seventy-five percent of respondents had heard of CRC, and 74% said that CRC was preventable. Regarding the HBM, no significant difference in the mean scores for perceived susceptibility, perceived severity, self-efficacy, and benefits of CRC screening was found by age groups. The mean score for perceived severity was higher for females than males. About 60% of participants were extremely likely to have a screening test for CRC done on the day if recommended by the doctor. CONCLUSION: The knowledge and awareness of CRC screening of the targeted sample is inadequate. Individuals with higher perceived susceptibility, severity of CRC, and perceived benefit of the screening tests were more willing to undergo the test. The highest perceived barrier was having no symptoms, and the lowest was "getting a stool test is too much of a hassle." These findings underline the importance of having a national screening program and campaigns to deal with the concerns of people and raise awareness of CRC.

Frequency of impaired glucose tolerance and its correlates in females of reproductive age in urban slums of Lahore, 2019.

BACKGROUND: The prevalence of diabetes mellitus has almost reached global epidemic proportions. Fortunately, the progress of the disease can be stemmed at the prediabetic level. The objective of the present study was to determine the frequency of impaired glucose tolerance (IGT) and its predictors in females of reproductive age in the urban slums of Lahore. MATERIALS AND METHODS: A cross-sectional study was conducted among females of reproductive age in the slums of metropolitan Lahore. The calculated sample size was 384. Data were collected using a structured questionnaire covering demographic variables, lifestyle, medical, and dietary history. The oral GT test was carried out on the study participants after a 10 hour overnight fasting. Data were entered and analyzed using Statistical Package for the Social Sciences (SPSS version 23). Frequency distributions and percentages were calculated for categorical variables, and the mean and standard deviation were calculated for continuous variables. The Chi-square test or Fisher's exact test, as appropriate, was used to determine the association between IGT and various categorical variables. Logistic regression analysis was performed to determine the correlates of IGT after adjusting for confounders. RESULTS: The final sample size was 394 women; 17% of whom had IGT, and 8.6% had newly diagnosed diabetics. Results of logistic regression showed increased waist/hip ratio, lower literacy of father or husband, age, and low intake of pulses as significant predictors of IGT (P < 0.05). CONCLUSION: The frequency of IGT is high in females of reproductive age living in the urban slums of Lahore. There is a need for targeted health promotion and educational activities to improve the health and social conditions of slum dwellers.

Internet gaming disorder: Its prevalence and associated gaming behavior, anxiety, and depression among high school male students, Dammam, Saudi Arabia.

BACKGROUND: Video games have become popular in the last few decades, resulting in an increase in reported negative consequences. This study aimed to assess the prevalence of internet gaming disorder (IGD), its association with gaming behavior, depression, and anxiety in male high school students. MATERIALS AND METHODS: This cross-sectional study involved male high school students in Dammam. Schools were selected using stratified random sampling, and data were collected using a self-administered questionnaire. Data analyzed using SPSS v23.0; the initial analysis included descriptive statistics. Continuous and ordinal variables were compared using t-test or Mann-Whitney U test, and ANOVA or Kruskal-Wallis test, as appropriate; Chi-square test was used for categorical variables. Spearman correlation coefficient was calculated to determine the correlation between IGD score and depression and anxiety scores. RESULTS: A total of 726 high school gamers were involved, 87% of whom were Saudi, with a mean age of 16.92 years and 45% were from public schools. The mean IGD score was 18.12, and the prevalence of IGD was 21.85%. Students who spent ≥4 h/day on weekdays or ≥6 h/day at weekends on videogames and gamers who spent ≥200 Saudi Riyals per month on gaming had significantly higher mean IGD scores (P < 0.001). Gamers who used PC/laptop for gaming had significantly higher IGD scores compared to those who used other devices (P = 0.002). Action, fight, open-world games, and games with violence were associated with significantly higher IGD scores. Among students with IGD, 21.7% had moderately severe/severe depression and 11.4% had severe anxiety. CONCLUSION: IGD is a concerning psychiatric disorder in male high school students. It is associated with certain gaming behavior and other mental problems. We recommend future larger-scale research that includes females as well.

Water and sanitation risk exposure in children under-five in Pakistan.

BACKGROUND: Children under-five constitute 11.9% (n = 20,447,628) of the total population of Pakistan. Poor water and sanitation in Pakistan cause 97,900 deaths annually, 54,000 of whom are children under-five. MATERIALS AND METHODS: This study calculates an index for water and sanitation risk for children under-5 in Pakistan to give a detailed understanding and insight into the prevalent risks. Data from Pakistan Integrated Household Survey 2011-12 are used. Stata 15.0 was used for data analysis. A risk index was created by integrating hazard and vulnerability factors including toilet facilities, water source, mother's education, and the number of children in the household. Children were ranked according to their risk score in three categories: low risk, medium risk, and high risk. For each level of risk, profiles of children are created at the national, regional (urban, rural), and provincial levels. RESULTS: Out of 20.5 million children under-five in Pakistan, 71.6% live in rural areas. About 24.9% of children benefit from pipe-borne drinking water; 15.5% of children have toilets connected to the public sewerage system; 62.6% of the children have mothers who had no education; and 50.5% of children live in households with three or more children. It appeared that 57.5% of children are at high risk of poor water and sanitation as compared to merely 1.3% of children at low risk. Around 69.9% of children living in rural areas are at high risk compared to 24.6% of children in urban areas. In Balochistan, 77.9% of children are at high risk, the highest of all provinces. CONCLUSION: The majority of children under-five in Pakistan are at high risk owing to poor water and sanitation. A comprehensive public health program is needed to address the key indicators related to child health risk identified in this research such as safe drinking water, improved sanitation, education and mothers' awareness, and population growth.

Pulmonary function parameters among marble industry workers in Lahore, Pakistan.

Background: Occupational contact with dust particles is a well-known phenomenon, particularly in developing countries of the world. Crystalline silica present in marble dust is the main etiology of a rising prevalence of obstructive lung diseases in marble stone workers, who are in direct contact with marble dust in the surrounding environment during their regular work.  The purpose of this study was to compare the pulmonary function parameters of workers in marble workshops and age matched healthy individuals in the Lahore District of Pakistan. Methods: The study included 164 male individuals, 82 individuals working in marble workshops and 82 healthy individuals from the same community. Data were collected through in-person interviews using a structured questionnaire after obtaining written consent. A Spiro Lab spirometry for pulmonary function tests was used to identify any change in the lung function parameters. FVC% (forced vital capacity), FEV 1 (forced expiratory volume in first second) and FEV1 / FVC ratio were evaluated. Results: Mean age in the exposed group (marble workers) and non-exposed group (healthy individuals) were 29.92 ± 6.19 and 30.58 ± 6.37 years, respectively. The mean years of work experience of the exposed group was 11.92 ± 5.67 years. A statistically insignificant difference was observed between marble exposed workers & healthy individuals from the demographic variables. Lung function parameters in marble workers exhibited a highly significant (P < 0.001) decrease in FVC%, FEV 1 & FEV 1 / FVC ratio when compared to healthy individuals. Seventy-one percent of marble workers had abnormal pulmonary parameters whereas 34% of workers had restrictive pulmonary impairment. Marble workers who had worked for more than 15 years had a highly significant risk of developing abnormal pulmonary function (P < 0.001). Conclusion: Continuous exposure to marble dust deteriorates the lung function of marble workers.

Journal of Family and Community Medicine: A scientometric analysis 1994-2020.

The Journal of Family and Community Medicine (JFCM) is a peer-reviewed open access journal published by the Saudi Society of Family and Community Medicine. This review is aimed to analyze the scientometric attributes of manuscripts published over 27 years from 1994 to 2020 using scientometric technique. The bibliographic records of manuscripts published from 1994 to 2020 were retrieved from the Web of Science and Medline-PubMed databases. The data were analyzed by using VOSviewer, CiteSpace, and Biblioshiny software. A total of 648 manuscripts were included; these were written by 1442 authors, with an average of 2.22 authors per manuscript and 24 manuscripts per year. All manuscripts gained 2,693 citations with a mean ratio of 4.15 citations per manuscript. All the top-20 contributing authors belonged to Saudi Arabia, and 48% of the manuscripts were in the single-author pattern; the multiauthored manuscripts received a higher ratio of citations. The review highlighted the most contributing institutions and countries.Bibliographic coupling of countries, institutions, keywords co-occurrence, and co-citation of journals were also presented. The JFCM is an important journal of Saudi Arabia that has provided a platform to family medicine researchers to share their scholarly and scientific communication for the past 27 years. Over the years, the frequency and number of publications in the journal have improved. Although the journal has received manuscripts from all over the world, most contributions were from Saudi Arabia.

Determinants of nonimmunization of children under 5 years of age in Pakistan.

BACKGROUND: Child vaccination is perhaps the first line of defense to ensure a healthy society. Unfortunately, the coverage of child vaccination in Pakistan is poor resulting in unnecessary yet preventable deaths. This study investigated the determinants and reasons for not vaccinating children in Pakistan. MATERIALS AND METHODS: The study used the Pakistan Integrated Household Survey/Household Integrated Economic Survey 2001-2002 data. Demographic, distance to health facility, poverty status, literacy and education, and location of residence were used as determinants of nonimmunization of children. Descriptive statistics including frequency distribution, proportions for categorical variables and mean for continuous variables, and logistic regression analysis were done using the Stata 11.0. RESULTS: Almost 7.73% children in Pakistan were never immunized. More than 87.4% of these lived in the rural areas. Prevalence of nonimmunization was highest in Balochistan compared to other provinces. Large households appeared to have increased risk of a child not being vaccinated. Moreover, low literacy and education of the head of the household and the spouse was also associated with low vaccination coverage. Distance from the health facility was found to be another factor related to nonimmunization of children. Increase in per capita income significantly decreased the risk of missing vaccinations. CONCLUSIONS: Prevention and immunization programs should focus more on high-risk regions such as Balochistan and rural areas. Literacy, education, and economic status were among the other significant factors associated with low vaccination rates, which need a special focus in the public policy to achieve the target of a healthy society.

An audit of acute pain service in Central, Saudi Arabia.

OBJECTIVE: A retrospective analysis of acute pain service (APS) was performed to look at the epidural and patient-controlled analgesia (PCA) with respect to their indications, duration and quality of pain control, dosage regimen and common side effects. METHODS: This study was conducted in the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. All APS monitoring forms, from the year 1994 to 2003 were collected. Every tenth PCA and epidural form was then randomly taken out and reviewed. From each sample form information concerning operation, analgesic modality (epidural or PCA), its duration, side effects and non-steroidal anti-inflammatory drug (NSAID) use was collected. Postoperative pain and sedation were monitored as 0=none, 1=mild, 2=moderate and 3=severe. For the first 24 hour of APS period, information was also gathered concerning duration of each pain score, highest pain score, sedation score and lowest respiratory rate. Informations of PCA (incremental dose, lock-out interval, back ground infusion, number of hours PCA not activated and total morphine consumed) and epidural infusion (concentration of mixture of local anesthetic with opioid and its volume consumed during first 24 hours) were also collected. RESULTS: A total of 10002 patients aged 16-74 years received APS; one third of them receiving epidural and two thirds receiving PCA. Eighty-five percent of patients received APS after cesarean section and 7.8% received APS after abdominal hysterectomy. Acute pain service served 77% of total APS patients for 24-48 hours. The average duration of APS was 44.2 hours. For the first 24 hours, PCA and epidural was compared for severity and duration of pain. A pain score of zero was found for a longer period (average 19.6 hours) with epidural whilst; a pain score of 1 and 2 was observed for a longer period (average 11.4 and 4.0) with PCA. The mean highest pain score was 0.7 for epidural and 1.7 for PCA. Patients having no postoperative pain included 35.7% of the epidural analgesia group and 0.5% of the PCA group. The highest sedation score of one was found more often in the epidural group and a score of 2 was found more often in the PCA group. No case was documented where the respiratory rate was <12/minute. Most (51%) PCA patients were prescribed an incremental dose of 1.5 mg of morphine with a lock-out interval of 10 minutes. Basal morphine infusion was used in 96% of PCA patients. Patient-controlled analgesia was not activated for the mean period of 13.2 hours in the first 24 hours postoperative period. Average total amount of morphine consumed by patients was 76.8 mg during the average total duration of 42.9 hours of PCA. Amongst patients who received epidural analgesia, 93.6% received the mixture of fentanyl (4 microgram/ml) and Bupivacaine (0.03%). On average, 194 mls of epidural infusion was used in the first 24 postoperative hours. Overall, 35% of patients received NSAIDs along with APS and 12.6% of patients developed complications during APS. Complications were recorded in 25.6% of epidural patients and 4.4% of PCA patients. The most common complication was pruritus. CONCLUSION: In the past decade, APS has provided a safe and efficient service to over 10 thousand postoperative obstetric and gynecology patients. Epidural analgesia as compared to PCA provided superior analgesia but caused more frequent minor side effects. More resources are required to provide good quality APS to all eligible postoperative patients for the desirable period.

Child health inequalities and its dimensions in Pakistan.

BACKGROUND AND OBJECTIVE: Poverty and inequality in health is pervasive in Pakistan. The provisions and conditions of health are very dismal. A significant proportion of the population (16.34%) of Pakistan is under 5 years, but Pakistan is in the bottom 5% of countries in the world in terms of spending on health and education. It is ranked the lowest in the world with sub-Sahara Africa in terms of child health equality. The objective of this study was to examine child health inequalities in Pakistan. MATERIALS AND METHODS: We analyzed data from Pakistan Integrated Household Survey/Household Integrated Economic Survey 2001-2002, collected by the Pakistan Bureau of Statistics, Government of Pakistan. Coverage of diarrhea and immunization were used as indicators of child health. Stata 11.0 was used for data analysis. Descriptive statistics including frequency distribution and proportions for categorical variables and mean for continuous variables were computed. RESULTS: Children under 5 years of age account for about 16.34% of the total population, 11.76% (2.5 million) of whom suffered from diarrhea in 1-month. The average duration of a diarrheal episode was 7 days. About 72% of the children who had diarrhea lived in a house without pipe-borne water supply. Around 22% children who had diarrhea had no advice or treatment. More than one-third of the households had no toilet in the house, and only 29% of the households were connected with pipe-borne drinking water. About 7.73% (1.6 million) children had never been immunized. The main reason for nonimmunization was parents' lack of knowledge and of immunization. CONCLUSION: Child health inequalities in Pakistan are linked with several factors such as severe poverty, illiteracy, lack of knowledge, and awareness of child healthcare, singularly inadequate provision of health services, and poor infrastructure.

Serogroup W-135 meningococcal disease during the Hajj, 2000.

An outbreak of serogroup W-135 meningococcal disease occurred during the 2000 Hajj in Saudi Arabia. Disease was reported worldwide in Hajj pilgrims and their close contacts; however, most cases were identified in Saudi Arabia. Trends in Saudi meningococcal disease were evaluated and the epidemiology of Saudi cases from this outbreak described. Saudi national meningococcal disease incidence data for 1990 to 2000 were reviewed; cases from January 24 to June 5, 2000, were retrospectively reviewed. The 2000 Hajj outbreak consisted of distinct serogroup A and serogroup W-135 outbreaks. Of 253 identified cases in Saudi Arabia, 161 (64%) had serogroup identification; serogroups W-135 and A caused 93 (37%) and 60 (24%) cases with attack rates of 9 and 6 cases per 100,000 population, respectively. The 2000 Hajj outbreak was the first large serogroup W-135 meningococcal disease outbreak identified worldwide. Enhanced surveillance for serogroup W-135, especially in Africa, is essential to control this emerging epidemic disease.