Innovations in Medical Education During the COVID-19 Era and Beyond: Medical Students' Perspectives on the Transformation of Real Public Health Visits Into Virtual Format.

Background: At the College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Bahrain, the Public Health Program comprises two core components, namely, lectures and field visits (consumer products safety, communicable diseases control, and food safety). Digital transformation has innovated the medical educational activities during the COVID-19 pandemic where the real public health field visits were transformed into a virtual format. This study is aimed to examine the potential effect of converting the real public health field visit programs into a virtual format during the COVID-19 pandemic. Methods: All medical students who have submitted online feedback evaluation forms upon completing the Public Health Program in the academic years 2019-2020 (180 students; before the COVID-19 pandemic) and 2020-2021 (167 students; during the COVID-19 pandemic) were included in the study, a total sample size of 347 responses. Independent samples t-test was employed to compare students' feedback on Public Health Program before and during the COVID-19 pandemic while the Pearson chi-square test was used for categorical data. A p-value of <0.05 was considered statistically significant. Results: The mean score of students' satisfaction from the virtual program during the COVID-19 pandemic toward the consumer products safety and food safety field visits was significantly higher than that for students before the COVID-19 pandemic (the real field visits). However, there was no observed statistically significant difference for the Communicable Diseases Control visit. In addition, no significant differences were detected between the mean responses of male and female students toward all field visits, whether the feedback was provided before or during the COVID-19 pandemic. Conclusion: Transformation of real public health field visits into virtual format is acceptable and applicable during the COVID-19 era and maybe beyond.

Knowledge of health professional students on waterpipe tobacco smoking: curricula implications.

BACKGROUND: Tobacco prevention research traditionally focuses upon cigarette smoking, but there is also a need to implement and evaluate the usefulness of waterpipe tobacco smoking (WTS) interventions since it is considered less harmful than cigarettes. This study aimed to assess the impact of an educational intervention on WTS knowledge of health professional students in three academic health institutions in Bahrain. METHODS: A quasi-experimental design was used to include medical students from the Arabian Gulf University, medical and nursing students from the Royal College of Surgeons in Ireland-Bahrain and nursing students from the University of Bahrain. Two hundred fifty students participated in the three phases of the study during October 2015-June 2016 from an original sample of 335. The participants answered knowledge questions on WTS before and after an intervention, which included a lecture by an expert and a video on the awareness about the health hazards of WTS. RESULTS: The mean age of starting cigarette and WTS was 16.8 ± 2.8 and 17.5 ± 1.7 years, respectively. The prevalence of ever smoking any type of tobacco among students was 22.4% (medical 25.8% and nursing 37.5%) and that of WTS, 17.7% (medical 20.0%, nursing 13.6%). The prevalence of current cigarette smoking was 9.6% among medical and nursing students combined with 10.3 and 8.5% for medical and nursing students, respectively. WTS was prevalent at a proportion of 6.8% among medical and nursing students combined with 6.5% in medical and 14.8% in nursing students. The university curriculum as the main source of knowledge on WTS increased from 14.2 to 33.3% after the intervention (p < 0.005). Knowledge about the hazards of WTS increased in 16 of the 20 statements. The difference in overall knowledge score was significant (p < 0.05) for nursing (77. 5 ± 1.5 vs 85.8 ± 2.2) compared to medical students (85.3 ± 1.0 vs 87.3 ± 0.9) after the intervention. CONCLUSIONS: Our educational intervention with health professional students improved their knowledge about the health effects of WTS. Medical and nursing institutions may consider using various methods such as informative videos and expert lectures to include in their teaching curricula as part of WTS prevention strategies.

Anticonvulsant therapy for status epilepticus.

BACKGROUND: Status epilepticus is a medical emergency associated with significant mortality and morbidity that requires immediate and effective treatment. OBJECTIVES: (1) To determine whether a particular anticonvulsant is more effective or safer to use in status epilepticus compared to another and compared to placebo.(2) To delineate reasons for disagreement in the literature regarding recommended treatment regimens and to highlight areas for future research. SEARCH METHODS: For the latest update of this review, the following electronic databases were searched on 15/08/2013: the Cochrane Epilepsy Group's Specialized Register, CENTRAL The Cochrane Library July 2013, Issue 7, and MEDLINE (Ovid) 1946 to 15/08/2013. SELECTION CRITERIA: Randomised controlled trials of participants with premonitory, early, established or refractory status epilepticus using a truly random or quasi-random allocation of treatments were included. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. MAIN RESULTS: Eighteen studies with 2755 participants were included. Few studies used the same interventions. Intravenous diazepam was better than placebo in reducing the risk of non-cessation of seizures (risk ratio (RR) 0.73, 95% confidence interval (CI) 0.57 to 0.92), requirement for ventilatory support (RR 0.39, 95% CI 0.16 to 0.94), or continuation of status epilepticus requiring use of a different drug or general anaesthesia (RR 0.73, 95% CI 0.57 to 0.92). Intravenous lorazepam was better than placebo for risk of non-cessation of seizures (RR 0.52, 95% CI 0.38 to 0.71) and for risk of continuation of status epilepticus requiring a different drug or general anaesthesia (RR 0.52, 95% CI 0.38 to 0.71). Intravenous lorazepam was better than intravenous diazepam for reducing the risk of non-cessation of seizures (RR 0.64, 95% CI 0.45 to 0.90) and had a lower risk for continuation of status epilepticus requiring a different drug or general anaesthesia (RR 0.63, 95% CI 0.45 to 0.88). Intravenous lorazepam was better than intravenous phenytoin for risk of non-cessation of seizures (RR 0.62, 95% CI 0.45 to 0.86). Diazepam gel was better than placebo gel in reducing the risk of non-cessation of seizures (RR 0.43 95% CI 0.30 to 0.62)For pre-hospital treatment, intramuscular midazolam is at least as effective as (probably more effective than) intravenous lorazepam in control of seizures (RR1.16, 95% CI 1.06 to 1.27) and frequency of hospitalisation (RR 0.88, 95% CI 0.79 to 0.97) or intensive care admissions (RR 0.79, 95% CI 0.65 to 0.96). It was uncertain whether Intravenous valproate was better than intravenous phenytoin in reducing risk of non-cessation of seizures (RR 0.75, 95% CI 0.28 to 2.00). Both levetiracetam and lorazepam were equally effective in aborting seizures (RR 0.97, 95% CI 0.44 to 2.13). Results for other comparisons of anticonvulsant therapies were uncertain due to single studies with few participants.The body of randomised evidence to guide clinical decisions is small. It was uncertain whether any anticonvulsant therapy was better than another in terms of adverse effects, due to few studies and participants identified. The quality of the evidence from the included studies is not strong but appears acceptable. We were unable to make judgements for risk of bias domains incomplete outcome reporting (attrition bias) and selective outcome reporting (selection bias) due to unclear reporting by the study authors. AUTHORS' CONCLUSIONS: Intravenous lorazepam is better than intravenous diazepam or intravenous phenytoin alone for cessation of seizures. Intravenous lorazepam also carries a lower risk of continuation of status epilepticus requiring a different drug or general anaesthesia compared with intravenous diazepam. Both intravenous lorazepam and diazepam are better than placebo for the same outcomes. For pre hospital management, midazolam IM seemed more effective than lorazepam IV for cessation of seizures, frequency of hospitalisation and ICU admissions however,it was unclear whether the risk of recurrence of seizures differed between treatments. The results of other comparisons of anticonvulsant therapies versus each other were also uncertain. Universally accepted definitions of premonitory, early, established and refractory status epilepticus are required. Diazepam gel was better than placebo gel in reducing the risk of non-cessation of seizures. Results for other comparisons of anticonvulsant therapies were uncertain due to single studies with few participants.

Social, dietary and lifestyle factors associated with obesity among Bahraini adolescents.

The main purpose of this study was to explore some of the social, dietary and lifestyle factors that could be related to the risk of obesity among adolescents in Bahrain. A multistage stratified method was used to select secondary school students (15-18years old) from governmental schools in Bahrain. The total sample selected was 735 (339 males and 396 females). A pre-validated self-report questionnaire was used to obtain information on socio-demographics, food and the lifestyle habits of adolescents. Weight and height were taken and percentiles of Body Mass Index for age and gender were used to classify the adolescents as non-obese and obese (overweight and obese), using NHANES-1 growth standard. In general, the prevalence of overweight and obesity was 29.5% and 36.8% among males and females, respectively. The risk of obesity was not consistent among male and female adolescents. Mothers' education was found to be a risk factor for obesity among both males and females (p=0.0167 and p=0.007, respectively). Bringing food from home to school (odds ratio (OR)=0.54, confidence interval (CI) 0.35-0.81) was protective factor for obesity among females but not among males. Fathers' education (p=0.0167), rank among siblings (p=0.009), place where breakfast is eaten (p=0.0398), eating between lunch and dinner (p=0.0152), fruit intake (p=0.042), sweet intake (p=0.0192), size of burger (p=0.002) and hours of watching television per day (p=0.004) were significantly associated with the risk of obesity among males, but not among females. Various social, dietary and lifestyle factors were found to contribute to obesity among adolescents in Bahrain. These factors should be considered in school health policy in the country.

Perception of aging and ageism among women in Qatar.

The objective of this study was to find out the perceptions of age and aging among women in Qatar. Respondents consisted of 250 women aged between 20 and 70 years, selected from those attending the health centers in Doha city, the capital of Qatar. They were interviewed using a pretested validated questionnaire, and data were collected through direct face-to-face interviews using the incidental sampling method. It was found that physical appearance and mental alertness were the most important criteria for defining aging in men and women. A statistically significant association was found between age of respondents and physical criteria for aging such as hair color (p < .000) in women and body image in men (p < .0298). As for aging characteristics, decreasing hearing ability (p < .000), performance as before (p < .004), more irritability (p < .0227), ability to travel alone (p < .0429), needs check up (p < .001), and needs a geriatric home (p < .001) were statistically associated with age of women studied. Both positive (socializing factors, independence, housework, retirement, and geriatric care) and negative stereotyping (care for self, learning capabilities, irritability, and worries) with regard to aging were evident among the Qatari women. In general, Qatari women had several positive attitudes toward aging. Such attitudes could be utilized in any health promotion for elderly people.

Dietary and lifestyle habits amongst adolescents in Bahrain.

BACKGROUND: Changes in dietary habits and lifestyle are considered the main factors associated with several diet-related diseases in the Arab Gulf countries. The aim of this study was, therefore, to describe the dietary and lifestyle habits amongst adolescents in Bahrain. DESIGN: A cross-sectional study was carried out amongst male and female secondary school students selected using the multi-stage stratified random sampling technique. A sample size of 735 subjects (339 males and 396 females), aged 15-18 years, was selected from government schools from all the governorates of Bahrain. RESULTS: Skipping breakfast was significantly greater in females (62.8%) compared to males (37.2%), (P<0.01). About 88% of adolescents snacked during school break, 70.7% procuring food from the school canteen. Fruit was not consumed by about 27.7% of respondents (33.5% males, 66.5% females) and the gender difference was statistically significant (P<0.01). Fish and lentils were less preferred, while chicken was more popular. There was no significant difference between gender and frequency of eating fast food. About 8.4% of respondents reported not eating burgers, with 68.8% preferring regular size burgers. Furthermore, 24.4% preferred large portions of potato chips (53.1% male, 46.9% female). About 29.8% watched TV for more than 5 hours a day (51.2% females, 48.8% males). About 69% of males practiced sports everyday as against 30.8% of females (P<0.01) and 81.6% of those who participated in sport activity outside school were males compared to 18.4% of females. CONCLUSION: It seems that the adolescents in Bahrain are moving toward unhealthy dietary habits and lifestyles, which in turn will affect their health status in the future. Promoting healthy lifestyle and eating habits should be given a priority in school health programs.

Determinants of family size in a Gulf Arab state: a comparison between two areas.

AIMS: The rapid economic transition in the Gulf Arab countries has resulted in marked changes in fertility and marriage patterns and a decrease in the number of children per family. Yet little is known about the determinants of family size in urban and less urban areas. METHODS: A cross-sectional study was carried out on 450 Kuwaiti women aged 20-60 years who attended health care centres in Al Asima and Al Jahra governorates. A semi-structured questionnaire was administered through face-to-face interview which included variables on socio-demographic characteristics, family size, actual and ideal spacing, marriage related variables, health conditions and utilization of health services. Both univariate and multivariate analyses were performed to identify the factors that affect family size. RESULTS: The socio-economic indicators were significantly better in Al Asima, the capital, than in Al Jahra, a less urbanized area. On average, family size for the total sample was 5.97 +/- 0.114 with a larger size (6.27 +/- 0.242) in Al Jahra than in Al Asima (5.80 +/- 0.118) but without a significant difference. Al Jahra women reported a larger number of deliveries and past pregnancies but a lower usage of contraceptive measures. The total fertility rate was 3.65 in Al Asima, 3.84 in Al Jahra and 3.71 births per woman in the total population. Family size was inversely related to the educational level of women and their husbands. Currently employed women had a smaller family size (5.22 +/- 0.119) than the unemployed (6.81 +/- 0.187); p < 0.0005. Health problems in the interviewee or her husband played a minor role in the decision to have more children. Families where the husband was the decision-maker on the number of children had a significantly larger family size (6.91 +/- 0.451) than families where the couple both participated in the decision (5.83 +/- 0.129; p = 0.032). The duration of marriage, ideal number of children, age of women at last delivery, number of rooms and the crowding index had significant positive effects on family size, whereas age at first delivery, duration between two consecutive pregnancies and history of past abortions were inversely related to family size in the stepwise multiple regression analysis. CONCLUSIONS: Although women in the less urbanized areas in the Gulf Arab populations are more disadvantaged with respect to socio-economic characteristics than women in the more urbanized areas, there were no significant differences in family size in these contrasting communities. The impact of socio-demographic characteristics on family size was minor compared to factors related to fertility and the husband's desire to have more children. Fertility and family planning policies should consider these issues in order to promote more effective programmes.

Overweight and obesity among adolescents in Bahrain.

A cross-sectional study was conducted to assess the prevalence of overweight and obesity amongst adolescents in Bahrain. The subjects consisted of grades 1-3 secondary school students (336 males and 396 females) between the ages 15-18 years, selected using a multi-stage stratified random sampling technique from government schools from all the governorates of Bahrain, representing about 3% of the target population. The mean height in males and females ranged between 162.9-171.3 cm and 157.4-159.9 cm, respectively, while the mean weight ranged between 59-72 kg and 59-66 kg, respectively. The proportion of those underweight was higher in males (8.6%) compared to that in females (2.3%). The highest proportion of normal weight was observed at the age of 15 years in both the male and female adolescents (66.0%). The prevalence of overweight and obesity was higher in female (17.4% and 19.4%) compared to the male (15.8% and 13.7%) adolescents. Although compared to previous reports, a decline in the body mass index (BMI) was observed for both the genders in Bahrain. We believe that the launch of intervention programs at a national level to educate school authorities, parents and concerned health professionals alike, is urgently required.

Anticonvulsant therapy for status epilepticus.

AIMS: To determine whether a particular anticonvulsant is more effective or safer than another or placebo in patients with status epilepticus, and to summarize the available evidence from randomized controlled trials, and to highlight areas for future research in status epilepticus. METHODS: Randomized controlled trials of participants with premonitory, early, established or refractory status epilepticus using a truly random or quasi-random allocation of treatments were included. RESULTS: Eleven studies with 2017 participants met the inclusion criteria. Lorazepam was better than diazepam for reducing risk of seizure continuation [relative risk (RR) 0.64, 95% confidence interval (CI) 0.45, 0.90] and of requirement of a different drug or general anaesthesia (RR 0.63, 95% CI 0.45, 0.88) with no statistically significant difference in the risk of adverse effects. Lorazepam was better than phenytoin for risk of seizure continuation (RR 0.62, 95% CI 0.45, 0.86). Diazepam 30 mg intrarectal gel was better than 20 mg in premonitory status epilepticus for the risk of seizure continuation (RR 0.39, 95% CI 0.18, 0.86). CONCLUSIONS: Lorazepam is better than diazepam or phenytoin alone for cessation of seizures and carries a lower risk of continuation of status epilepticus requiring a different drug or general anaesthesia. Both lorazepam and diazepam are better than placebo for the same outcomes. In the treatment of premonitory seizures, diazepam 30 mg intrarectal gel is better than 20 mg for cessation of seizures without a statistically significant increase in adverse effects. Universally accepted definitions of premonitory, early, established and refractory status epilepticus are required.

Diabetic neuropathy, foot ulceration, peripheral vascular disease and potential risk factors among patients with diabetes in Bahrain: a nationwide primary care diabetes clinic-based study.

BACKGROUND: Although epidemiological studies have persistently shown a high prevalence of diabetes in Arabs, the control of diabetes is still poor and complications of diabetes are common. We examined the prevalence of diabetic peripheral neuropathy (DN), neuropathic foot ulceration (FU) and peripheral vascular disease (PVD), and potential risk factors for these complications among patients attending primary care diabetes clinics in Bahrain. PATIENTS AND METHODS: We studied 1477 diabetic patients (Type 2 diabetes 93%); to, including 635 men and 842 women, with ages ranging from 18-75 years in a cross-sectional study. The main predictor variables were demographic and clinical data, including assessment of foot and blood parameters. RESULTS: Mean age of the patients and duration of diabetes were 57.3 +/- 6.32 and 9.5 +/- 8.4 years, respectively. DN was present in 36.6% of the population, FU in 5.9%, and PVD in 11.8%. Diabetic patients with neuropathy were older than patients without neuropathy (P=0.001) and had had diabetes longer (P=0.002). Diabetic patients with foot ulcers had more severe neuropathy and higher vibration perception thresholds values than patients without foot ulcers (P<0.05). Older age, poor glycemic control, longer duration of diabetes, elevated cholesterol levels, current smoking, obesity defined by body mass index, large waist circumference, elevated triglycerides levels and hypertension but not gender, were significant risk factors for DN in both the univariate and the multivariate analyses (P< 0.05). DN and PVD also remained significant risk factors for foot ulceration in the multiple logistic regression analysis. CONCLUSION: Rates of DN and PVD are high among diabetic patients in Bahrain. Implementation of strategies for prevention, early detection, and appropriate treatment at the primary health care level are urgently needed.

Student generated learning objectives: extent of congruence with faculty set objectives and factors influencing their generation.

CONTEXT: A problem-based learning strategy is used for curriculum planning and implementation at the Arabian Gulf University, Bahrain. Problems are constructed in a way that faculty-set objectives are expected to be identified by students during tutorials. Students in small groups, along with a tutor functioning as a facilitator, identify learning issues and define their learning objectives. PURPOSE: We compared objectives identified by student groups with faculty-set objectives to determine extent of congruence, and identified factors that influenced students' ability at identifying faculty-set objectives. METHOD: Male and female students were segregated and randomly grouped. A faculty tutor was allocated for each group. This study was based on 13 problems given to entry-level medical students. Pooled objectives of these problems were classified into four categories: structural, functional, clinical and psychosocial. Univariate analysis of variance was used for comparison, and a p > 0.05 was considered significant. RESULTS: The mean of overall objectives generated by the students was 54.2%, for each problem. Students identified psychosocial learning objectives more readily than structural ones. Female students identified more psychosocial objectives, whereas male students identified more of structural objectives. Tutor characteristics such as medical/non-medical background, and the years of teaching were correlated with categories of learning issues identified. CONCLUSION: Students identify part of the faculty-set learning objectives during tutorials with a faculty tutor acting as a facilitator. Students' gender influences types of learning issues identified. Content expertise of tutors does not influence identification of learning needs by students.