Journal of Family and Community Medicine最新文献

Background: The evolution of Medical learning shows the incorporation of modern technology in teaching, learning, assessment, and medical practice. Clickers are easy to use, and provide instantaneous feedback on the student's comprehension of the information given. The aim of the study was to assess the effectiveness of clickers in undergraduate medical students' learning by comparing clickers' scores with group discussion scores.

Materials and methods: A cross-sectional comparative study with cross-over design was conducted for 6 months on 80 students of Phase III Part I MBBS. After an interactive lecture on diarrhea with a community medicine perspective, the students were divided into two groups, A and B, each consisting of 40 students. Group B students were further divided into five subgroups of eight students each. Group A students were assessed with clickers, Group B with group discussion and the cross-over done after 2 weeks. A questionnaire was used to assess the perceptions of the students on the use of clickers. Academic performance scores of the students were compared within the groups at different times (i.e. immediately after the interactive lecture and after 1^st week and 2^nd weeks) and between the two main groups. Data analysis was performed using SPSS. Mean and standard deviations were calculated for quantitative variables, whereas categorical data was presented as frequencies and proportions. Qualitative data was analyzed using content analysis technique.

Results: The mean age of students was 20.4 (SD=0.6) years. The mean scores for the students using clickers were significantly higher than the mean scores for the students using group discussion. Most of the students (78.8%) either agreed or strongly agreed that the "clickers were easy to use."

Conclusion: The study concluded that the academic performance of medical undergraduate students using clickers was better than the performance of the students using group discussions.

Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in a huge burden on healthcare systems and necessitated a risk assessment of patients and an update of the treatment protocol to include home isolation for low-risk patients. The primary objective was to describe the outcome of home isolation and the characteristics of patients at higher risk of admission. The secondary objectives were to determine the proportion of patients with pneumonia and hypoxemia and the correlation between cycle of the threshold (CT) value and severity of the disease.

Materials and methods: For this study, 394 patients were randomly selected from a total of 8000 home-isolated COVID-19 patients during July to October 2020, and were followed by Bahrain International Hospital (BIH). All data were obtained from a live Excel sheet completed by physicians covering BIH during the study period. Data analysis included Chi-square test to determine significant association between categorical variable, Pearson correlation, and logistic regression analysis.

Results: Of the 394 home-isolated patients followed, 18 patients with missing data were excluded. The overall admission rate was 50% for ≥50 age group compared to 13.3% for 18-49 age group, while only 2.8% in <18 age group. Moreover, Intensive Care Unit (ICU) admissions were significantly higher in the older age group: 15.2% for ≥50 age group (P < 0.001). About 14% of the patients with comorbidities needed ICU admission, compared with 1.8% of those without comorbidities (P < 0.001). Of the home-isolated patients, 6.3% were diagnosed with pneumonia and 9.9% of those presenting had low oxygen saturation. The CT value was significantly correlated with the severity of symptoms and the need for admission.

Conclusion: Home isolation of low-risk patients with monitoring and follow-up was a safe and necessary step in dealing with the COVID-19 pandemic.

Background: The implementation of Sharia Model Childbirth (SMC) is in accordance with Fatwa Majelis Ulama Indonesia (MUI) no l07/DSN-MUI/X/2016 on the practice of sharia principles in health services. Sharia services in hospitals are general. This SMC innovation is specific and comprehensive, covering prenatal, delivery and postnatal. This model was implemented in 2017 but has never been qualitatively evaluated. The purpose of this study was to evaluate the application of SMC in the maternity services from the perspective of midwives and staff of the Islamic service unit.

Materials and methods: Applied qualitative research was conducted from 5 December 2021 to 31 January 2022. In-person in-depth interviews were conducted using semi-structured interview guidelines. Informants were taken from the midwives of the maternity room and the Islamic service installation until a fair saturation of data was achieved. Observational and documentation were conducted for the validity of the data. The data were analyzed thematically and presented in themes and sub-themes.

Results: The results of the study were on the work procedures implemented, and the obstacles and shortcomings found. Most of the procedures and accompanying regulations had been implemented. Participants revealed obstacles and shortcomings in this innovative program. The major obstacle found was that the patient's right to choose a female medical officer was not fulfilled because of the type of teaching hospital it was and the lack of female medical staff. The shortcomings were in the reading of prayers and remembrances, the understanding of the contents of the manual, and the design of the delivery room, which did not maintain privacy.

Conclusion: Overall, SMC is being implemented, but there are obstacles and shortcomings in the implementation. Solutions and regulations in sharia services should urgently be found and enforced. The deficiencies in this innovative program must be corrected immediately.

Background: The prevalence of morbidity and mortality for type 2 diabetes mellitus (DM) is still increasing because of changing lifestyles. There needs to be a means of controlling the rise in the incidence of the disease. Many researchers have utilized technological advances such as machine learning for disease prevention and control, especially in noncommunicable conditions. Researchers are, therefore, interested in creating an early detection system for risk factors of type 2 diabetes.

Materials and methods: The study was conducted in February 2022, utilizing secondary surveillance data from Puskesmas Johar Baru, Jakarta, in 2019, 2020, and 2021. Data was analyzed utilizing various bivariate and multivariate statistical methods at 5% significance level and machine learning methods (random forest algorithm) with an accuracy rate of >80%. The data for the three years was cleaned, normalized, and merged.

Results: The final population was 65,533 visits out of the initial data of 196,949, and the final number of DM 2 population was 2766 out of the initial data of 9903. Age, gender, family history of DM, family history of hypertension, hypertension, high blood sugar levels, obesity, and central obesity were significantly associated with type 2 DM. Family history was the strongest risk factor of all independent variables, odds ratio of 15.101. The classification results of feature importance, with an accuracy rate of 84%, obtained in order were age, blood sugar level, and body mass index.

Conclusion: Blood sugar level is the most influential factor in the incidence of DM in Puskesmas Johar Baru. In other words, a person with a family history of type 2 diabetes, at unproductive age, of female gender, and of excessive weight can avoid type 2 diabetes if they can regularly maintain their blood sugar levels.

Background: The cognitive process of critical thinking (CT) involves the examination of the existing reasons and an analysis of the information to draw conclusions and make decisions. The goal of the study was to determine how concept mapping (CM) technique affects family medicine residents' capacity for critical thought.

Materials and methods: We conducted a randomized controlled trial among family medicine residents aged between 26 and 28 years. A total of 100 residents were involved; over the course of 3 months, 50 residents were exposed to the conventional teaching model and 50 residents to the CM model. Data was collected using California CT skills test (CCTST) modified Arabic version and a self-administered questionnaire. The primary intervention was teaching method, experimental group received CM lessons while control group had conventional lessons. First session was carried out at baseline and second session one week after baseline, whereas 3^rd, 4^th, and 5^th sessions conducted at end of 1^st, 2^nd, 3rd months, respectively. Both groups were assessed at baseline and at end of 3rd month. Both groups were reassessed at end of three months. Quantitative data was presented as mean and SD, whereas frequencies and percentages used for qualitative data. Pre- and post-intervention CT scores for study groups were compared using t-test or Mann-Whitney U test, as appropriate. Groups were compared on pre- and post-intervention CT grades using Chi-square test.

Results: Vast majority (98%) of participants were females, nearly half were 27 year old, and belonged primarily to urban areas (76%). There was no difference in the CT scores between the groups at baseline. The post-intervention CT scores for study group were statistically significantly higher (18.36±2.68) compared to control group (15.94±1.94) (P = 0.001).

Conclusion: The CM approach was superior to the conventional teaching approach in terms of improving CT.

Background: Periodic Health Examinations (PHEs) typically occur annually and provide an important opportunity for providers to screen their patients for undiagnosed health conditions and monitor existing conditions, such as diabetes and hypertension. Unfortunately, PHEs are reported to be low in Saudi Arabia. This study's aim was to assess the regular uptake of PHEs by adults residing in Al-Jouf region, Saudi Arabia.

Materials and methods: A cross-sectional survey was conducted among adults (aged ≥ 20 years) residing in five communities in the Al-Jouf Region on sociodemographic characteristics, self-reported chronic conditions, knowledge of PHEs, and their regular uptake. Chi-square tests and multivariate logistic regression analysis were performed to determine the factors associated with regular uptake of PHEs.

Results: A total of 624 participants completed the survey questionnaire. Of the participants, 27.7% reported a regular uptake of PHEs. The odds of regular uptake of PHEs were higher among older respondents (odds ratio [OR] =1.98; P = 0.002), those who reported that they had diabetes (OR = 3.25; P < 0.001), hypertension (OR = 4.11; P = 0.001), hyperlipidemia (OR = 2.66; P = 0.003), and those with a higher PHEs knowledge score (OR = 1.35; P < 0.001). However, the odds regular uptake of PHEs among respondents residing in the three governorates and Skaka city were significantly lower (OR = 0.27; P = 0.001 and OR = 0.30; P = 0.002, respectively) than their counterparts.

Conclusion: Low rates of PHEs uptake were observed among the survey participants in the Al-Jouf Region of Saudi Arabia. The characteristics of individuals associated with low uptake of PHEs were identified. Tailored interventions, such as the use of community health workers and clinic communications, could target these individuals to increase the uptake of PHEs.

Background: The use of telemedicine has increased considerably in healthcare delivery, especially during this time of the coronavirus disease 2019 (COVID-19) pandemic. It has, therefore, become necessary to train medical students to better equip them for this new means of healthcare delivery. The aim of the present study was to assess the perception of undergraduate medical students on telemedicine training.

Materials and methods: A cross-sectional study was conducted on a total of 521 undergraduate medical students studying in the Eastern Region of Saudi Arabia. Data were collected via a self-administered pretested questionnaire comprising two main sections: demographics and knowledge and opinions regarding telemedicine training.

Results: About 73% students think that the use of telemedicine for patient care will increase in the future, and 59.3% think that the medical students should be trained in telemedicine. Majority of the students (78%) opined that telemedicine training should be optional and 58% said it should be taught during the clinical phase of the undergraduate curriculum. The best telemedicine training course learning objectives medical students opined to be included were: telemedicine practical skills (70.2%), legal aspects of telemedicine practice (68.3%), and potential positive and/or negative use of telemedicine tools and methods (67.6%). Telemedicine skills students would like to learn how to effectively engage patients, knowledge about telemedicine regulations and the consequences of breaching them.

Conclusion: Medical students are aware of the importance of incorporating telemedicine training into the medical curriculum. Training these students is vital to ensure their competence as physicians in their future clinical careers, that is make them a digitally health-literate future workforce.

Background: Coronavirus disease 2019 (COVID-19) has proven to be detrimental to the psychological well-being of healthcare providers (HCP). This study was a psychological intervention during the COVID-19 pandemic to check extent to which brief mindfulness-based interventions (MBIs) and progressive muscle relaxation (PMR) affect psychological well-being, resilience, and anxiety of HCPs.

Materials and methods: A randomized trial study conducted from July to August 2020. One hundred and forty-seven COVID-19 frontline HCPs were randomized to a 2-week virtual intervention with a brief MBI or a PMR. Pre- and postintervention assessments were done using the State-Trait Anxiety-20-Item Scale, the Connor-Davidson Resilience Scale-10, and WHO-5 Well-Being Index.

Results: The final sample included 125 HCPs (64 in BMI group and 61 in PMR group) who completed pre- and post-intervention assessment. The results showed a significant improvement in the psychological well-being and reduction of the state anxiety of the two groups, but not in the trait anxiety or resiliency. Improvement was more in the group's brief MBI (81.3%) than in the group's PMR (51.8%) (P = 0.0001), concerning psychological well-being.

Conclusion: Both the brief MBI and PMR improved the psychological well-being and reduced the anxiety of frontline healthcare providers during the COVID-19 pandemic with a slightly better improvement in the brief MBI.

Background: Depression is a major mental problem in the elderly, particularly those with disability. This study's aim was to identify variables that predict depression in the elderly with disabilities.

Materials and methods: This cross-sectional study was conducted in Gunungkidul Regency and Yogyakarta City from April to June 2021. The study participants were community-dwelling elderly aged 60 years and above with disabilities, who could communicate verbally without any apparent cognitive impairment. Data was collected by interviewing participants using structured questionnaire on following sections: Demographic characteristics, Mini-Mental State Examination (MMSE), Washington Group Short Set (WG-SS), Barthel Index of activities of daily living (ADL), Lawton Instrumental ADL (IADL) Scale, and Geriatric Depression Scale-30 (GDS-30). Multivariate linear regression analysis applied to identify variables significantly correlated with depression. Multinomial logistic regression analysis performed to obtain the odds ratio (OR).

Results: Study included 115 elderly persons with disabilities. Most of them had mobility impairment. Higher independence in ADL and being married were related with lower risk of depression, whereas increased age at disability increased the risk of depression (P = 0.001). The elderly who had greater independence with daily activities were less likely to have depression (OR = 0.639 for mild depression and OR = 0.589 for severe depression). Those who were not married were more likely to have mild depression (OR = 3.203) and severe depression (OR = 29.119). compared to the married elderly. Age at acquiring disability was associated with higher risk for mild depression (OR = 1.025) and severe depression (OR = 1.053). Higher independence in ADL and being married were related with lower risk of depression, whereas increased age at disability increased the risk of depression (P = 0.001).

Conclusion: Independence in the ADL, being married, and being disabled as a young adult are negative predictors of depression in the elderly with disability.

Despite the numerous reports of cutaneous manifestations associated with vaccines for coronavirus disease 2019 (COVID-19), the relationship between COVID-19 vaccines and cutaneous side effects remains unevaluated. In this review, we examine these manifestations and their management. Reported dermatoses included injection-site reaction (early and delayed), type I allergic reaction, morbilliform eruption, pityriasis rosea, Sweet syndrome, lichen planus, psoriasis, herpes zoster reactivation, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis (TEN). The most common COVID-19 vaccination-related cutaneous manifestations are delayed local reactions, approximately 66% of which are associated with the Moderna vaccine, and 33% with the Pfizer vaccine. Aside from mild injection-site reactions, severe reactions include anaphylaxis and TEN. Most reactions, except for Stevens-Johnson syndrome and anaphylaxis, though unpredictable and unpreventable are mild and can be treated symptomatically. Findings from this review should allow primary care physicians and dermatologists to reach faster diagnosis and initiate prompt intervention.