Community-based mental health studies have revealed that the point prevalence of depressive disorders in the elderly population of the world varies between 10% and 20%, depending on cultural situations. A retrospective study based on analysis of various study reports was conducted, to determine the median prevalence rates of depressive disorders in the elderly population of India and various other countries in the world. All the studies that constituted the sample were conducted between 1955 and 2005. Included are only community-based, cross-sectional surveys and some prospective studies that had not excluded depression at baseline. These studies were conducted on a homogenous community of the elderly population in the world, who were selected by a simple random sampling technique. After applying the inclusion and exclusion criteria on published and indexed articles, 74 original research studies that surveyed a total of 487 275 elderly individuals, in the age group of 60 years and above, residing in various parts of the world, were included for the final analysis. The median prevalence rate and its corresponding interquartile range were calculated. The chi-square test and chi-square for linear trend were applied. A P value of <.05 was considered as statistically significant. The median prevalence rate of depressive disorders in the world for the elderly population was determined to be 10.3% (interquartile range [IQR], 4.7%-16.0%). The median prevalence rate of depression among the elderly Indian population was determined to be 21.9% (IQR, 11.6%–31.1%). Although there was a significant decrease in the trend of world prevalence of geriatric depression, it was significantly higher among Indians, in recent years, than the rest of the world.

BackgroundLearning styles and approaches of individual undergraduate medical students vary considerably and as a consequence, their learning needs also differ from one student to another. This study was conducted to identify different learning styles and approaches of pre-clinical, undergraduate medical students and also to determine the relationships of learning preferences with performances in the summative examinations.MethodsA cross-sectional study was conducted among randomly selected 419 pre-clinical, undergraduate medical students of the International Medical University (IMU) in Kuala Lumpur. The number of students from Year 2 was 217 while that from Year 3 was 202. The Visual, Auditory, Read/Write, Kinesthetic (VARK) and the Approaches and Study Skills Inventory for Students (ASSIST) questionnaires were used for data collection.ResultsThis study revealed that 343 students (81.9%) had unimodal learning style, while the remaining 76 (18.1%) used a multimodal learning style. Among the unimodal learners, a majority (30.1%) were of Kinesthetic (K) type. Among the middle and high achievers in summative examinations, a majority had unimodal (Kinaesthetic) learning style (30.5%) and were also strategic/deep learners (79.4%). However, the learning styles and approaches did not contribute significantly towards the learning outcomes in summative examinations.ConclusionsA majority of the students in this study had Unimodal (Kinesthetic) learning style. The learning preferences (styles and approaches) did not contribute significantly to the learning outcomes. Future work to re-assess the viability of these learning preferences (styles and approaches) after the incorporation of teaching-learning instructions tailored specifically to the students will be beneficial to help medical teachers in facilitating students to become more capable learners.

BackgroundEffective teaching in medicine is essential to produce good quality doctors. A number of studies have attempted to identify the characteristics of an effective teacher. However, most of literature regarding an effective medical teacher includes student ratings or expert opinions. Furthermore, interdisciplinary studies for the same are even fewer. We did a cross-sectional study of the characteristics of effective teachers from their own perspective across medicine and dentistry disciplines.MethodsA questionnaire comprising of 24 statements relating to perceived qualities of effective teachers was prepared and used. The study population included the faculty of medicine and dentistry at the institution. Respondents were asked to mark their response to each statement based on a 5-point Likert scale ranging from strongly disagree to strongly agree. These statements were grouped these into four main subgroups, viz. Class room behaviour/instructional delivery, interaction with students, personal qualities and professional development, and analysed with respect to discipline, cultural background, gender and teaching experience using SPSS v 13.0. For bivariate analysis, t-test and one way ANOVA were used. Multiple linear regression for multivariate analysis was used to control confounding variables.ResultsThe top three desirable qualities of an effective teacher in our study were knowledge of subject, enthusiasm and communication skills. Faculty with longer teaching experienced ranked classroom behaviour/instructional delivery higher than their less experienced counterparts. There was no difference of perspectives based on cultural background, gender or discipline (medicine and dentistry).ConclusionThis study found that the faculty perspectives were similar, regardless of the discipline, gender and cultural background. Furthermore, on review of literature similar findings are seen in studies done in allied medical and non-medical fields. These findings support common teacher training programs for the teachers of all disciplines, rather than having separate training programs exclusively for medical teachers. Logistically, this would make it much easier to arrange such programs in universities or colleges with different faculties or disciplines.

BackgroundThere is a rapid increase in the population of the elderly globally, and Malaysia is anticipated to become an ageing nation in 2030. Maintaining health, social participation, reducing institutionalization, and improving quality of life of the elderly are public health challenges of the 21st century. Quality of life among elderly in Elderly Homes in Malaysia is under researched. This study aims to determine the quality of life and its associated factors among the Elderly in Elderly Homes in Kuala Lumpur.MethodsThis was a cross-sectional study among 203 residents aged 60 years or more in eight randomly selected Elderly Homes in Kuala Lumpur in September 2014. Stratified simple random sampling was used to select participants. Study instruments included World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF), Multidimensional Scale for Perceived Social Support, and a questionnaire for Socio-demographic variables. Data collection was by face to face interview. Univariate and Multivariate analysis were used to determine associations, and P-value <0.05 was considered statistically significant.ResultsThe mean (Standard deviation) for the physical domain was 14.3 (±2.7), 13.7 (±2.5) for the psychological domain, 10.8 (±3.4) for the social domain, and 13.0 (±2.5) for the environment domain. Factors significantly associated with quality of life included age, gender, level of education, economic status, outdoor leisure activity, physical activity, duration of residence, type of accommodation, co-morbidities, and social support.ConclusionThis study confirms that multiple factors are associated with quality of life among elderly in elderly homes. Social support, chronic co-morbidities, gender and outdoor leisure activity were significantly associated with all the domains of quality of life. Among the four domains of quality of life, the physical domain had the highest score while the social domain had the lowest score. This emphasizes the need for more social support-related interventions in these homes.

ObjectiveTrans-cultural diabetes nutrition algorithm (tDNA) was created by international task force and culturally customized for Malaysian population. This study was designed to evaluate its effectiveness versus usual diabetes care in primary care settings.Research design and methodsWe randomized 230 patients with overweight/obesity, type 2 diabetes, and glycated hemoglobin (A1c) 7%–11% to receive usual care (UC) or UC with tDNA for 6 months. The tDNA intervention consisted of structured low-calorie meal plan, diabetes-specific meal replacements, and increased physical activity. Participants were counseled either through motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice through conventional counseling. All patients were followed for another 6 months after intervention.ResultsAt 6 months, A1c decreased significantly in tDNA-MI (−1.1±0.1%, p<0.001) and tDNA-CC (−0.5±0.1%, p=0.001) but not in UC (−0.2±0.1%, p=NS). Body weight decreased significantly in tDNA-MI (−6.9±1.3 kg, p<0.001) and tDNA-CC (−5.3±1.2 kg, p<0.001) but not in UC (−0.8±0.5 kg, p=NS). tDNA-MI patients had significantly lower fasting plasma glucose (tDNA-MI: −1.1±0.3 mmol/L, p<0.001; tDNA-CC: −0.6±0.3 mmol/L, p=NS; UC: 0.1±0.3 mmol/L, p=NS) and systolic blood pressure (tDNA-MI: −9±2 mm Hg, p<0.001; tDNA-CC: −9±2 mm Hg, p=0.001; UC: −1±2 mm Hg, p=NS). At 1 year, tDNA-MI patients maintained significant reduction in A1c (tDNA-MI: −0.5±0.2%, p=0.006 vs tDNA-CC: 0.1±0.2%, p=NS and UC: 0.02±0.01%, p=NS) and significant weight loss (tDNA-MI: −5.8±1.3 kg, p<0.001 vs tDNA-CC: −3.3±1.2 kg, p=NS and UC: 0.5±0.6 kg, p=NS).ConclusionsStructured lifestyle intervention through culturally adapted nutrition algorithm and motivational interviewing significantly improved diabetes control and body weight in primary care setting.

Background:Depression is a common mental health problem in geriatric population and the overall prevalence rate of depression in this age group varies between 10 and 20%.Objective:To study the socio-demographic factors associated with depression in geriatric population.Materials and Methods:A systematic review was done on 74 community-based mental health surveys on depression in geriatric population, which were conducted in the continents of Asia, Europe, Australia, North America, and South America. All the studies were conducted between 1955 and 2005. The researchers had included only community-based cross-sectional surveys and some prospective studies that had not excluded depression on baseline. These studies were conducted on homogenous community of geriatric population in the world, who were selected by simple random sampling technique. A qualitative analysis was conducted to study the socio-demographic factors of depression.Results and Conclusion:The two non-modifiable risk factors found to be significantly associated with depression in geriatric population were “older age group” and “female gender”. However, the potentially modifiable risk factors for depression in the geriatric population were identified as low socioeconomic status, loss of spouse, living alone, chronic co-morbidities, cognitive impairment, bereavement and restricted activities of daily living (ADL).

Background:The point prevalence of depressive disorders in the elderly population in India varies from 13 to 25%. Since the World Health Organization (five) Well-being Index (1998 version) is simple and easy to administer, an attempt is made to evaluate the Indian version of this instrument to identify depression in the elderly Indian community.Objectives:(1) To determine the prevalence of depression among the elderly population of rural areas of Udupi district, Karnataka, India. (2) To determine the validity and reliability of WHO (five) Well-being Index (1998 version) as a screening instrument to identify depressive disorders in elderly population in this Indian setting.Materials and Methods:This cross-sectional study was conducted over a period of eight months (from March 1 to October 31, 2002) in the three taluks of Udupi, Kundapura, and Karkala; belonging to the Udupi district of South India. We selected 627 people in the age group of 60 years and above for the study. Simple random sampling, without replacement method, using the probability proportionate to size (PPS) technique was used. The WHO (five) well-being index (1998 version) was validated against the major International Classification of Diseases and Related Health Problems 10th Revision (ICD-10) depression inventory of mastering depression in primary care version 2.2. Proportions and their 95% confidence intervals were calculated and Kappa statistics was applied to determine the reliability of the screening instrument. P value<0.05 was considered statistically significant.Results:The prevalence of depression in elderly population was determined to be 21.7% (95% CI = 18.4 - 24.9). The Indian version of WHO-five well-being index (1998 version) showed a sensitivity of 97.0%, specificity of 86.4%, positive predictive value of 66.3% and an overall accuracy of 0.89. The Kappa statistics showed significantly high reliability of k = 0.71.Conclusion:The Indian version of "WHO (five) Well-being Index (1998 version)" was found to be an effective instrument for identifying depression in elderly Indian community.

No abstract