Effectiveness of interventions to reduce coronary heart disease risk.

BACKGROUND: Coronary heart disease (CHD) is an important cause of morbidity and mortality in industrialized countries, and its incidence is increasing in the developing world. The effectiveness of interventions in developing countries has been questioned in view of the overwhelming burden of other health problems in such environments. OBJECTIVE: To determine the effectiveness of coronary heart disease risk reduction interventions. METHODS: The effects of lipid lowering interventions as well as dietary and lifestyle modifications on some risk factors of CHD were studied retrospectively in 47 males and 53 female patients [aged 33 to 61 years; mean age 47.20 ±14.17 years] attending a lipid clinic in Saudi Arabia. The main outcome measures were reductions in the values of the body mass index (BMI), blood pressure, blood glucose and lipid levels, as well as absolute reductions of risk category. RESULTS: The interventions were associated with reduced BMI by 2.75 percent (p<0.05), systolic pressure by 3.05% (p=0.12), diastolic pressure by 5.13% (p<0.05), blood glucose by 6.51% (p<0.05), total cholesterol by 16.35% (p<0.05), LDL-cholesterol by 4.81% (p<0.05) and triglyceride by 35.01% (p<0.05). HDL-cholesterol remained within the normal range before and after the interventions in all patients. Following the interventions, the absolute risk reductions in category 1 were 45.51% and 53.35%, for males and females, respectively. In category 2, the absolute risk reductions were 30.05% and 45.67%, for males and females, respectively. In category 3, the absolute risk reductions were 100% for both sexes. For the entire study population, the absolute risk reductions were 48.65% in category 1 and 38.10% in category 2, while the percentage of patients with one or no risk factor (category 3) increased by 62%. CONCLUSION: Lipid-lowering interventions appear to be as effective in reducing CHD risk in Bisha patients as in other populations. Appreciable absolute risk reductions can be achieved within a short period of time in all patients, irrespective of their initial risk status.

Impact of workshops on Themes of World AIDS Days.

BACKGROUND: Abbottonians Medical Association, Abbottabad, Pakistan in collaboration with UNAIDS Pakistan arranged two Workshops, the first in 1999, the Theme of which was "Listen, Learn, Live", and the second in the year 2000 with "Men Make Difference" as the Theme. The aim of these workshops was to create awareness amongst the participants regarding HIV/AIDS. OBJECTIVES: We used the data of the above-mentioned workshops to analyze the gain in knowledge and attitudes of the participants, with an idea to develop recommendations for the use of such workshops for increasing the awareness regarding HIV/AIDS. METHODS: The data of the two above-mentioned workshops were used to assess the percentage gain in knowledge and attitudes of the participants. We also compared our results with the contemporary studies and developed our recommendations. RESULTS: The results show highly significant (p < .001) increase in the HIV/AIDS related knowledge and attitudes in the participants of these workshops. This difference was more significant in the teachers as compared to the students, showing a higher level of awareness in the youngsters. The net gain in the knowledge was very significant. The knowledge about HIV spread increased by 28.96% for the students and 19.54% for the teachers, while the net gain in attitudes was 36.16% for the students and 71.43% in the teachers. CONCLUSIONS: Short workshops on the Themes of World AIDS Days are very beneficial for improvement in the level of awareness for HIV/AIDS prevention and control.

Effect of British-made videotapes on clinical performance of medical students in Pakistan.

The efficacy of videotapes, recorded in Cardiff, in improving the clinical performance of final-year medical students in Abbottabad (Pakistan) was tested, by carrying out a structured, stepwise, clinical assessment before and after video teaching in 32 students. All students examined eight systems/subsystems at eight stations and spent 5 min with each patient, during which their performance was checked against structured check-lists by eight examiners. These students had not received any clinical instruction from a specialist rheumatologist, neurologist or endocrinologist during their clinical apprenticeship. Before the video teaching they performed poorly when examining the knee joint, motor system, hands and thyroid status, but when tested again 2 days after video teaching, there was a transformation in their clinical behaviour and their mean (s.d.) score improved from 40 (6.6 per cent) to 57.6 (9.4 per cent; P = 0.001). In contrast to their pre-video performance, they interacted well with the patients and examiners providing a running commentary of their findings, as demonstrated in the videotapes. Among the residual problems were a poor technique of testing tendon reflexes and percussion. All the examiners and 21 of 32 students thought that the structured examination was fairer than the conventional examination. Of the 32 students, 20 thought that video teaching was less effective than personal bedside teaching, while 12 students thought that video was structured better than bedside instruction. All students would welcome video teaching to supplement their existing teaching and would like the structured examination introduced to their curriculum. This study suggests that videotaped demonstrations can be used effectively in transmitting clinical skills to students not exposed to clinical teaching by specialists in various subjects.