The association between Betel Quid Chewing and Metabolic Syndrome among urban adults in Mandalay District of Myanmar / Journal of the ASEAN Federation of Endocrine Societies

Background@#As the prevalence of metabolic syndrome, obesity and diabetes increase worldwide, the need to identify modifiable lifestyle risk factors also increases, especially those that may be relatively unique to a specific population. To explore a possible association between betel quid chewing and metabolic syndrome, a community-based cross-sectional study was conducted.@*Methodology@#Three hundred ninety-one (391) adults were interviewed and the following parameters were measured: triglycerides, HDL-cholesterol, glucose, waist circumference, body mass index and blood pressure. Multiple logistic regression was used to determine the association between betel quid chewing and metabolic syndrome while controlling for confounders.@*Results@#The prevalence of metabolic syndrome was similar in chewers and non-chewers, 50% and 49%, respectively. After controlling for other factors, development of metabolic syndrome was positively associated with number of betel quid chewed per day, age greater than 40 years , and a positive family history of hypertension and diabetes. Regarding the duration of betel chewing, when analyzed by sex, the risk was doubled in men compared to non-chewers (OR 2.15; 95% CI = 1.21, 3.84]). As a result, a man chewing more than 10 pieces (OR 2.49; 95% CI = 1.36, 4.57]) of betel quids per day for more than 10 years had a two-fold increased chance of developing the metabolic syndrome.@*Conclusions@#Frequency and duration of betel quid chewing may represent a behavioral lifestyle target for approaches to reduce the incidence of metabolic syndrome.

Digital lectures for learning gross anatomy: a study of their efficacy / 한국의학교육

PURPOSE: The current study investigates the level of students' learning and attitudes towards the teaching and learning process when using digital lectures to teach gross anatomy to year 1 medical students. METHODS: The study sampled year 1 medical students of cohorts 2013 and 2014. The year 1 medical students in 2013 were taught gross anatomy of the heart by didactic classroom lectures while those in 2014 were taught with digital lectures using the same content. A review session was conducted for the 2014 cohort. A 19-item survey was distributed amongst students to investigate their attitudes and feedback. The data were analysed using SPSS software. RESULTS: The 2014 cohort had a mean score of 47.65 for short essay questions and 51.19 for multiple choice questions, while the 2013 cohort scored an average of 36.80 for short essay questions and 49.22 for multiple choice questions. The difference in scores for each type of question was found to be significant. Using a 5-point Likert scale, students gave an average of 4.11 when asked if they liked the teaching and learning process and would like it to be applied further. CONCLUSION: The results of the study provide strong evidence that the digital teaching and learning process was well received by students and could also lead to improved performance. Digital lectures can provide a satisfactory substitute for classroom lectures to teach gross anatomy, thus providing flexibility in learning and efficient learning, whilst also freeing lecture slots to promote mastery learning.

Gaps and challenges to integrating diabetes care in Myanmar.

In common with other low-income countries, diabetes is a growing challenge for Myanmar. Gaps and challenges exist in political commitment, policy development, the health system, treatment-seeking behaviour and the role of traditional medicine. National policies aimed at prevention – such as to promote healthy food, create a healthy environment conducive to increased physical activity, restrict marketing of unhealthy food, and initiate mass awareness-raising programmes – need to be strengthened. Moreover, existing initiatives for prevention of noncommunicabledisease (NCD) are channelled vertically rather than being horizontally integrated. Primary health care is traditionally orientated more towards prevention of infectious diseases and staff often lack training in prevention and control of NCDs. Capacitybuilding activities have been modest to date, and retaining trained health workers in diabetes-oriented activities is a challenge. The World Health Organization Package of Essential Noncommunicable (PEN) disease interventions for primary health care in low-resource settings has been piloted in Yangon Region and countrywide expansion awaits ministerial approval. Recently, the Myanmar Diabetes Care Model was proposed by the Myanmar Diabetes Association, with the aims of both bridging the gap in diabetes care between rural and urban areas and strengthening care at the secondary and tertiary levels. However, implementation will require policy development for essential drugs and equipment, capacity-strengthening of health-care workers, and an appropriate referral and health-information system.

Increased correlation coefficient between the written test score and tutors' performance test scores after training of tutors for assessment of medical students during problem-based learning course in Malaysia / 한국의학교육

This paper is aimed at finding if there was a change of correlation between the written test score and tutors' performance test scores in the assessment of medical students during a problem-based learning (PBL) course in Malaysia. This is a cross-sectional observational study, conducted among 264 medical students in two groups from November 2010 to November 2012. The first group's tutors did not receive tutor training; while the second group's tutors were trained in the PBL process. Each group was divided into high, middle and low achievers based on their end-of-semester exam scores. PBL scores were taken which included written test scores and tutors' performance test scores. Pearson correlation coefficient was calculated between the two kinds of scores in each group. The correlation coefficient between the written scores and tutors' scores in group 1 was 0.099 (p<0.001) and for group 2 was 0.305 (p<0.001). The higher correlation coefficient in the group where tutors received the PBL training reinforces the importance of tutor training before their participation in the PBL course.

Knowledge, attitude and practice on safety measures against occupational hazards among constructional workers at Bayint Naung Bridge construction site in Yangon Region.

A cross sectional analytic study was carried out to assess the knowledge, attitude and practice on safety measures against occupational hazards and their inter-relationships, among Bayint Naung New Bridge Construction workers during 2014. Altogether 184 workers were selected by simple random sampling. Face to face interview method was used to collect the necessary data. Among respondents, only 4.3% (95% CI = 2%, 8.1%) had good knowledge, but all respondents had favorable attitude and 77.7% (95% CI = 71.3%, 83.3%) had good practice. There were statistically significant associations between age (P = 0.040), educational status (P = 0.001), type of work (P = 0.013), type of worker (P = 0.016), attending skill training (P = 0.002) and knowledge. However, no statistically significant associations were found between knowledge and attitude, knowledge and practice, attitude and practice of respondents on safety measures against occupational hazards. Although attitude and practice among workers are satisfactory, knowledge of respondents needs to be improved. The information gained from this study may be helpful in prevention against occupational hazards.

Myanmar diabetes care model: Bridging the gap between urban and rural healthcare delivery / Journal of the ASEAN Federation of Endocrine Societies

@#There has been significant magnitude of problems of diabetes in Myanmar, according to the estimates of International Diabetes Federation (IDF) and the recent National Survey on the prevalence of diabetes. There has been a wide gap of equity between the urban and rural healthcare delivery for diabetes. Myanmar Diabetes Care Model (MMDCM) aims to deliver equitable diabetes care throughout the country, to stem the tide of rising burden of diabetes and also to facilitate to achieve the targets of the Global Action Plan for the Prevention and Control of NCDs (2013-2020). It is aimed to deliver standard of care for diabetes through the health system strengthening at all level. MMDCM was developed based on the available health system, resources and the country's need. Implementation for the model was also discussed.

The role of NS-1 antigen in early diagnosis of Dengue hemorrhagic fever in Yangon Children Hospital.

Detection of dengue virus NS1 antigen in patients’ sera serves as a supplementary assay for early diagnosis of dengue cases. This study evaluated the usefulness of NS-1 antigen for early diagnosis of dengue infection in children by use of a commercial immunochromato-graphic based SD Dengue Duo rapid test. The accuracy of SD Dengue Duo NS-1 antigen test was compared against a gold standard RT-PCR test in 117 children with suspected dengue infection attending YCH. All the children included in this study were tested for blood for complete picture and platelet count together with SD Dengue Duo rapid test. Among 117 samples, 65 serum samples were randomly selected and tested by RT-PCR. The sensitivity of SD Dengue Duo NS1 antigen assay was 40% (95% confidence interval) and specificity was 80% (95% confidence interval) as there were more secondary dengue cases in study population.The accuracy of NS1 antigen assay against RTPCR in patients with reduced platelet count showed that the sensitivity of NS1 antigen assay was 100% (95% confidence interval) and specificity was also 100% (95% confidence interval) when the platelet count was below 40,000.The result of this study demonstrated that the sensitivity and specificity of NS-1 antigen assay, at the time of low platelet count below 40,000, when specimens were collected within 5 days of fever, were relatively high compared to sensitivity and specificity of antibody detection. With the considerations for limitations such as NS1antigen assay being less sensitive in secondary dengue cases, in children, for diagnosis of dengue in early stage, with thorough clinical history and examination and also with platelet count, NS1 assay deserves inclusion in the diagnostic evaluation.

Summary of Myanmar clinical practice guidelines on the management of Dyslipidaemia in Type 2 Diabetes Mellitus / Journal of the ASEAN Federation of Endocrine Societies

@#Cardiovascular disease is a significant cause of morbidity and mortality in patients with diabetes mellitus (DM). According to the IDF Diabetes Atlas 2013, the prevalence of diabetes in Myanmar is 5.7%.(1) Diabetes is recognized as a risk equivalent for coronary heart disease. The lipid profile in patients with type 2 DM is characterized by elevated triglycerides, low high-density lipoprotein cholesterol and raised small dense low-density lipoprotein cholesterol (LDL-C) particles. This is believed to be a key factor in promoting atherosclerosis in these patients. There is ample evidence that aggressive statin therapy reduces cardiovascular end points in patients with DM in both primary and secondary prevention studies. In all persons with DM, current treatment guidelines recommend reduction of LDLC to less than 100 mg/dL, regardless of baseline lipid levels. In very high risk patients with DM and coronary heart disease lowering of LDL-C to less than 70 mg/dL may provide even greater benefits. Treatment for hypertriglyceridaemia is recommended only if TG levels is very high (>500 mg/dL).

A summary of the clinical practice guidelines for the management of patients with Peripheral Arterial Disease in Myanmar / Journal of the ASEAN Federation of Endocrine Societies

@#Peripheral artery disease (PAD) broadly encompasses vascular diseases caused primarily by atherosclerosis and thromboembolic pathophysiologic processes that alter the normal structure and function of the aorta, its visceral arterial branches, and the arteries of the lower extremity. The aims of the Myanmar clinical practice guidelines for the management of patients with PAD are to assist physicians in selecting the best management strategies for an individual patient with peripheral artery disease with main focus on lower extremity artery disease (LEAD) due to atherosclerosis, to help the physician to make decisions in their daily practice, and to aid in appropriate referrals to specialists. Early detection and treatment guidelines for the treatment of PAD are important to reduce the morbidity and mortality of patients with vascular problems in Myanmar.

Metabolic Syndrome in obese and normal weight Myanmar children / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#To estimate the frequency of Metabolic Syndrome (MS in Myanmar obese children and to determine the risk factors associated with MS in obese children comparing with normal weight children. @*Methodology@#A cross-sectional study was conducted to compare the risk factors for metabolic syndrome between normal and obese children by using the pediatric definition for metabolic syndrome [International Diabetes Federation (IDF), 2007]. Twenty-three obese children (BMI, ≥ 97th percentile) and 23 normal weight children (BMI, < 85th percentile) aged 5-12 years were included in the study. Blood pressure, body weight, height, waist circumference (WC), fasting triglycerides, HDL-cholesterol, total cholesterol and glucose concentrations were determined. @*Results@#Based on the IDF pediatric criteria, 9 obese children (39.1%) had metabolic syndrome while no normal weight child had metabolic syndrome. Ten (43.5%) normal weight children and 3 (13.0%) obese children had at least one risk factor for the metabolic syndrome. Central obesity (WC ³ 90th percentile for age and sex), the most common risk factor, was observed in 25 children (54.4% of the total population). @*Conclusion@#This study highlights the need for early recognition of risk factors for metabolic syndrome in all children to halt the progression of type 2 diabetes and cardiovascular diseases (CVD) in later life.

Summary of the clinical practice guidelines for diabetes mellitus in pregnancy in Myanmar / Journal of the ASEAN Federation of Endocrine Societies

@#The aims of the Myanmar CPG for Diabetes in Pregnancy were to provide a framework to assist healthcare professionals in the management of diabetes in pregnancy and to aid primary care physicians in referrals to specialists, when necessary, in an appropriate manner. This article summarizes clinical practice guidelines developed for assisting Myanmar healthcare providers (physicians, endocrinologists, obstetricians, general practitioners) to better diagnose and effectively manage diabetes in pregnancy. It recommends a multidisciplinary approach in the management of diabetes in pregnancy in Myanmar.

Sexual and reproductive health needs of vulnerable youth in Myanmar.

A cross-sectional survey of 56 youth, using participatory research methods, was conducted with the objective to identify the sexual and reproductive health needs among vulnerable youth in Pyin Oo Lwin town in terms of their livelihoods, perceptions about health and health risks, sex practices, perceived health information needs and preferred channels for health information, and visions for their future generation. The results indicated that a majority of young people of both sexes were deficient in knowledge of the locations and functions of reproductive organs. The majority of respondents of both sexes said that their main health concern was AIDS. Pre-marital sex among youth, 16-20 years of age, was identified in our study. Malaria and AIDS were mentioned as information needed by young people. TV and magazines/journals were prioritized as preferred channels of disseminating health messages. Almost all reported that education was the one thing that they wanted for their own children.

Household income, health and education in a rural area of Myanmar.

This study was to determine the relationship between a commonly used social stratification indicator, net equivalent income, and self-rated health, long-term disability, visual acuity status, death rate, birth rate, unsafe delivery and school enrollment in a rural area of Myanmar. Data were collected from 3,558 respondents in 805 households of all ages. Data analysis for various items was based on different age groups. The results from two income groups (highest and lowest) are as follows: the percent of those who self-rated their health as very good were 17.8% and 10.4% in the highest and lowest income groups, respectively (adjusted coefficient = 0.30, 95% Cl 0.11-0.50); those with an acute medical condition were found in 16.3% and 20.8% in the highest and lowest income groups, respectively (adjusted OR = 1.35, 95% Cl 1.08-1.68); those with long-term disability were found in 15.3% and 21.2% in the highest and lowest income groups, respectively (adjusted OR = 1.39, 95% Cl 1.05-1.84); and those with poor visual acuity at a distance of 13 feet were found in 8.1% and 13.5% in the highest and lowest income groups, respectively (adjusted OR = 1.64, 95% Cl 1.18-2.30). The birth rate ratio was 1.3, the death rate ratio was 1.2, and school enrollment was found in 92.8% and 83.2% in the highest and lowest income groups, respectively (adjusted OR = 0.34, 95% Cl 0.1-0.8). These results indicate that there is an urgent need to strengthen the health care infrastructure and educational system, targeting the poor in rural areas.

Quality of antenatal care at outpatient department of Mandalay General Hospital: time utilization and satisfaction among users

The study was a hospital-based cross-sectional survey using recording and interviewing techniques. Average waiting time (in minutes) before seeing registration clerk, nurses, laboratory staff and medical doctors, for all first visit and follow-up visit patients, were 10,5,8 and 31 respectively. Average time in contact (in minutes) with registration clerk, nurses, laboratory staff and medical doctors, for all patients, were 2,2,11 and 3 respectively. Among first visit patients, only 21 per cent were told of their body weights, 21 per cent were told of their blood pressures, 66 per cent were told of their urine examination results, and 64 per cent were told of their baby's clinical conditions. Similar figures for follow-up patients were, 29 per cent 26 per cent, 83 per cent and 80 per cent respectively at different service point. The types of service offered and the training and performance of the service providers can be concluded as from being adequate.