Журнал исследований и разработок в области медицинского образования

Introduction:

Risk-taking provides young people with a chance to test their skills and abilities and the opportunity for self-discovery. Some risks, such as early or unprotected sex, pregnancy, and abortion, can have harmful and long-lasting effects on a teen’s health and well-being. Despite this, adolescent sexual health remains neglected, marginalized, and ignored in many countries. The purpose of this study was to assess the magnitude & factors associated with early sexual debut of high and preparatory school students in Shire-Endasellassie town, Tigray region, from March to June 2013.

Methods: A school-based cross-sectional study was conducted among 550 high and preparatory school students in Shire-Endasellassie town. Two-stage cluster sampling was used to select participating classes from preparatory and high schools. A self-administered, structured questionnaire was used to collect the data. It was pre-tested for clarity among 26 students in a nearby town. Eleven data collectors (12th grade graduates) and two supervisors (BSc nurses) facilitated the data collection. Data was entered, cleaned, and analyzed using SPSS Version 16. Frequency distributions and binary and multiple logistic regressions were done. OR and 95% confidence interval was computed.

Results: About 19% of the students (109/550, 95% CI: 15.46%, 21.96%) had early sexual debut. Income, access to pornography media, female gender, prior experience of discussing reproductive health topics, and having a boyfriend or girlfriend were significant predictors of early sexual debut.

Conclusion: There was relatively low prevalence of early sexual debut, but high prevalence of premarital sex. Female students should be targeted with messages. Access to pornographic media encourages students to start sexual intercourse earlier, so we recommend taking action to limit access to such media.

Objective: This study examined the influence of demography such as gender, age, marital status and religion on medical education among final year medical students in different geopolitical zones of Nigeria.

Methods: This is a cross sectional descriptive study that drew a total of seven hundred and fifty seven (757) final year medical students from ten (10) randomly selected fully accredited medical schools out of a total of twenty seven (27) fully accredited medical schools in Nigeria. Demographic information was obtained from the medical students following completion of their final year postings.

Results: The total population of female final year medical students was 300 (39.6%) and 457 (60.4%) for males. The minimum and maximum ages were 19 and 42 years respectively with a mean age of 25.30 ± 2.90 year. Seventy (9.2%) of the 757 final year medical students were married, while 687 (90.8%) were still single. The religion distribution revealed 181 (23.9%) of the final year medical students to be practicing Islam. Five hundred and seventy five (76.0%) of these students practice Christianity and only 1 (0.1%) of the students practices traditional religion.

Conclusion: The findings have implication for policy formulation to reduce inequalities observed in medical education in Nigeria.

Background: Breast milk not only is an ideal nutrition for the infant, but also can protect against some diseases. Exclusive breastfeeding (EBF) is the best nutrition for the children during the first 6 months of life. However EBF remains a challenge. The aim of the study was to assess Knowledge, Attitude and Practice towards exclusive breastfeeding among Lactating mothers in Mizan Aman town, South West Ethiopia.

Methods: A Community based cross-sectional study was conducted among 350 mothers in Mizan Aman town, South West Ethiopia, in April 2015 using a structured interviewer administered questionnaire using ‘recall since birth’ method. Systematic random sampling was used to select the study participants and descriptive statistics was carried out using SPSS for windows version 20.0.

Results: Three hundred and fourteen mothers with their index child less than 2 years were enrolled. Even though 93.6% of study participants had ever heard about EBF only about 34.7% were knowledgeable with recommended duration. About 89.5% of have positive attitude but only 59.3% believe that only EBF is enough for child up to 6 months and EBF on child less than six months was about 26.4%.

Conclusion: In this study even though majority of mothers were knowledgeable about EBF and have positive attitude towards EBF, knowledge with recommended duration of EBF, attitude of mothers towards sufficiency of EBF and EBF for 6 months was found to be low. This study concluded poor knowledge and practice to EBF for the first six months postpartum. So that improving access to information on recommended infant feeding and fulfilling the minimum enabling conditions the WHO advocated such as paid maternity leave, part-time work arrangements, facilities for expressing and storing breast milk and breastfeeding breaks for women in paid employment is recommended.

The Institute of Public Health (IPH) in Tirana, Albania and its Department of Epidemiology of Non-Infectious Disease and Health Systems: Policy and Programs; received an overall average score of 2.94 from 3.2 that was in IBM Global CEO Study average of 756 interviewed managers. There were nine people who were interviewed, although the IPH has over 200 employees overall. Most of the people who were interviewed shared their concerns in some of the following anonymous comments: “More innovation is needed, publications, international cooperation. Healthcare is going in the bad direction; we need better management of it”. Another one says: “We are not interconnected, everyone does on his own head, and these do not serve in meeting the objectives.” The fourth person says: “We need to work hard in order to achieve results; this is done through cooperation of various institutions. Up to this moment the situation is dim”. One other person pointed out: “There is no transfer of knowledge and short-term, mid-term, and long-term plans. There is much to be done”. The seventh person who was interviewed made these remarks: “We need to seek deeper in the research and scientific development, there is place for innovation, creativity, entrepreneurship, and new foresight; despite from what we have achieved so far.” The last person said: “More incentives for innovation, more room for initiatives, as well as moral and material rewards”.

The IPH and the department in word have a very satisfactory score in collaboration and partnering with other institutions at their initiatives and programs. Although, they still need to work better at measuring their progress with an evaluation metrics system for Total Quality Management (TQM) to be achieved. Innovation is on the rise if steps are taken to reach it.

Objectives:

To identify barriers to the practice of continuous medical education (CME) by primary health care physicians in Alahsa region, Saudi Arabia.

Methods: In this analytic cross-sectional study, 121 participants answered a self-administered questionnaire which measures the level of practice of CME and the prevalence of a number of factors that affect CME practice. The prevalence of the factors that affect CME practice was compared between those who practice CME frequently and those who do not, using appropriate statistical methods.

Results: 93 participants (76.9%) practice CME frequently and 28 participants (23.1%) practice CME rarely/never. The factors that have impact on CME practice include the physician's qualification (p-value 0.03), medical knowledge (p-value<0.001), satisfaction with available CME methods (p-value<0.001), CME method preference (pvalue 0.021), belief that group CME activities are provided with poor teaching technique (p-value 0.011), patient load (p-value<0.001) and job satisfaction (p-value 0.014).

Conclusion: The most important barriers to practicing CME include lack of post-graduate education, dissatisfaction with the medical information, dissatisfaction with available CME methods, preference for self-taught CME, group CME activities with poor teaching technique, low patient load and job dissatisfaction. The Ministry of health and the Saudi Commission for Health Specialties should work on those factors to improve the practice of continuous medical education by primary health care physicians.

Objectives

The primary purpose of this study was to determine if there is a positive correlation between incorporating a professional motivational speaker in the National Board Dental Exam Part 1 (NBDE-1) preparation course and the students’ pass rate on the NBDE-1. The secondary purpose was to determine the effect of the motivational speaker on students’ (1) motivation to prepare for the NBDE-1 (2) self-perceived ability to control their own stress on exam day, and (3) perception of the effectiveness of the dental school curriculum and the NBDE-1 review course in preparing them for the NBDE-1.

Methods

The subjects in this study consisted of 99 second year dental students enrolled in the NBDE-1 Review Course during the 2014. Summer Session at the University of XXX. Survey Monkey was utilized to distribute the same survey at three time points.

Results

Incorporating a professional motivational speaker positively correlated with an increase in the pass rate on NBDE-1 from the following percentages in the past five years: 96%, 96%, 96%, 95%, and 96% to the following pass rate on NBDE-1 in 2014:99%. A participation rate of at least 60% was achieved for all three surveys. Results also indicated a positive correlation between the utilization of a professional motivational speaker and students’ motivation, perceived ability to control their stress, and perception of preparedness for NBDE-1.

Conclusion

Although the NBDE-1 pass rate in 2014 increased compared to the past five years, a larger sample size is needed for statistical significance.

A comparison has been made simultaneously of high speed films, acoustical analysis and overtone analysis with “VoceVista” and “Sygyt Ltd”. The overtones software was compared with acoustical analysis. Till now formants from 1000 Hz-5000 Hz seems to be interesting using fundamental frequency of speech with 110Hz in males and 220 Hz in females. The variation of the 3 formants from 1000 Hz-5000 Hz was between 18-25% for normal persons. Glottal analysis tools from Erlangen showed no evidence of traditional acoustical voice analysis. With the new overtone analyzer (Sygyt Ltd.) we have a tool for measuring pathological voices combined with high speed films.

Background and purpose

Primary Medical Care is first contact medical care concerned with the total health care of the individual and family in their community. Clinical encounter needs research to practice evidence based medicine. The ultimate purpose of primary care health workers is to provide high-quality patient care. There is a need for all health care providers to appreciate the value of research in their everyday practice and make healthcare efficient and cost effective. The purpose of this study was to identify attitude and barrier towards research amongst primary care health workers and to explore self-reported experience of research.

Methods

A cross sectional study conducted in primary health care set up in North Batinah region Oman. Data was collected with self-filled questionnaire incorporating important barriers and attitudes in research. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. Data was expressed in frequencies and percentages for questionnaire responses. Mann-Whitney test was used to compare differences between groups.

Results

A total of 557 participants were enrolled in which 425 were from the Oman and 132 were non Omani with a mean age of 33.13 ± 6.16 years and age range of 20-61 years. Among all 23.2% (129) were males and 76.8% (428) were females More than half of the participants were nurses (54.9%) and rest were physicians (19.3%), pharmacist (6.6%), and lab and radiology technicians (16.7). Responses of male participants were not significantly different (p=0.153) to the females regarding perceived value of research. However, significant difference (p=0.001) was observed regarding barrier of research. 14.9% were currently involved in the research. Nearly one third of participants feel that research allotted time (31.8%), financial support (32.3%) and financial incentives (30.3%) are the main barriers of research. Participants who had undergraduate (p=0.007) and postgraduate (p=0.001) research training did differ significantly in their response about self-experience of research and barrier of research.

Conclusion

Majority participants were currently not involved in research and a very small proportion of them received any training. Research allotted time, financial support and financial incentives are the main barriers of research. Research output may improve if identified barriers are rectified. Further studies are recommended in this field.

Absence of appropriate sanitary materials to absorb menstrual flow does not only affect female’s reproductive health but their acquisition of education. The government of Ghana is proposing provision of free disposable sanitary pads to assist brilliant but poor school girls remain in school. This study assessed female university students in northern Ghana’s opinion on this policy and factors that would influence their opinions. To achieve these objective data was collected in a cross-sectional study after administering a questionnaire to 293 randomly selected students. The data was analyzed and association between the various variable were tested using Graph Pad 5.01. The study showed that 78.2% of respondents used disposable sanitary pads during their first year of menstruation with the rest using toilet tissue and re-useable cloth. Majority, 53.2% of respondents agreed with the free sanitary pad policy with their main reason for the support being the high cost of disposable sanitary pads. For the minority, 27.0% who opposed the policy, their reasons include unsustainability, being a misplaced priority and that it is the responsibility of parents to provide sanitary pads for their children. Followers of Islam were significantly more supportive of the free sanitary pad policy than Christians (p=0.003).

Purpose

The aim of this study was to evaluate acculturative stress, depression, and quality of life, and investigate the relationship between these factors in North Korean refugees who settled in South Korea.

Methods

A total of 232 North Korean refugees residing in South Korea participated in the study. Participants completed a series of questionnaires, including measures of acculturative stress, depression, and quality of life. Data were analyzed using SPSS WIN 20.0.

Results

The results showed that Acculturative stress, depression, and quality of life were interrelated. In our sample, 40.9% of participants scored ≥ 16 on the BDI-II, and the mean depression score was 15.42 (range 0-55), which indicates mild depressive symptoms. The mean total acculturative stress score was 2.88 (SD=0.02). The mean total QOL total score was 3.02 (SD=0.03). The most powerful predictor of quality of life was depression in North Korean refugees. Conclusion: The results suggest that acculturative stress is a factor in preventing depression and promoting quality of life, especially mental health, in North Korean refugees.

Background

Many tools are available to estimate prediction quality, but none are available to assess the ability, of a predictive model to identify completely missing or unknown prognostic factors, designated as ghost factors (GFs). However, it may be possible to predict whether a subject carries a GF.

Methods

To simulate the presence of a GF, a significant prognostic factor and all variables correlated with it were removed prior to model analysis. Public datasets and simulated data were used. A predictive statistical model was developed to assess the relationship between the presence of a GF and the predictive capacity of a given model based on the correlation between predicted outcome and GF presence. Five statistical models were compared using this procedure.

Results

After evaluating 6 real databases, the only statistical method consistently able to identify subjects with GFs was the use of optimized regression models. Using simulated, linearly correlated data, optimized regression models exhibited up to a 92% success rate, whereas conventional linear models had less than 53% success. Random forest and classification tree models had the highest success rates compared to the other evaluated models.

Conclusions

Model-based outcome prediction was assessed with respect to the presence of GFs. As GFs are unknown, only subjects who are carriers of significant unknown prognostic factors can be identified. As complex models outperformed linear models in identifying GF presence, we assume that the associations between GFs and outcome-predictive factors are also complex and not linear.

The Green Card Project is a small randomized controlled trial (RCT) designed to test the effectiveness of an intervention to aid diabetes self-management carried out in a general practice setting in rural New South Wales. Participants were given a card with four key predictors of long term diabetes health and offered incentives for positive changes in these indicators. Controls received standard care. Fifty four participants and 68 controls completed the project. There was an average decline of 0.20 (se 0.15) in HbA1c for males in the intervention group compared to an average increase of 0.23 (se 0.13) in the control group. For women, the opposite occurred, with the intervention women exhibiting an average increase of 0.24 (se 0.13) and the controls an average reduction of 0.12 (se 0.127). For lipids, there was a significant reduction in both intervention and control. Both males and females in the intervention group demonstrated a significant reduction in waist circumference, whereas the control group had a non-significant increase in waist circumference. Male participants saw the program in a competitive light, while women were focused on the discount voucher. Education strategies for diabetes may benefit from research into gender specific information delivery systems. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) as ACTRN12613000414718.

Aim: The concept of metabolic syndrome (MetS) is useful in encouraging modification of patient’s lifestyle. In order to detect prophase in MetS (pre-MetS), we evaluated waist circumference index (WCI) that was calculated by division of waist circumference (WC) by height in meter squared.

Methods: A multiple logistic regression analysis was performed a the prevalence of risk factors for MetS (high blood pressure, abnormal lipid metabolism, high blood glucose) and age, WC, body mass index, WCI and intraabdominal fat area (IAFA) in 111 subjects in whom IAFA was measured at umbilicus level by CT scan.

Results: WCI was the second most strongly correlated factor with the prevalence of risk factors after IAFA in terms of P values, and according to the odds ratios WCI was the most significantly correlated.

Conclusion: The results suggested that the WCI might be capable of serving as an index that can substitute for a CT scan as a means of detecting pre-MetS.

The present research work is an attempt to find out the concentration of Iodine (I) in soil and water phases of the natural environment and its relationship with the human health in the foot hill settlements of Pir Panjal Range in Anantnag district of Kashmir valley. Also, socio-economic determinants of health were taken into due account. Firstly, the area was divided into altitudinal zones and soils classes. Then, the soil and water samples were taken from each soil type in each altitudinal zone and were analyzed by Atomic Absorption Spectrophotometer. The socioeconomic character of the area was analyzed through surveying the area by using structured household schedules. In this area, people rely mostly on locally cultivated food items because of their economic condition. The study highlights that about 19.5%, 42.9% and 37.6% households in the study area have low (Rs.<5, 000 month-1), medium (Rs. 5, 000-10, 000 month-1) and high (Rs.>10, 000 month-1) income status respectively. The study reveals that iodine content in all the soil (0.970-1.230 mg kg-1) and water (1.6-4.2 μg L-1) samples in all the altitudinal zones is less than the average values in the world soils (2.8 mg kg-1) and fresh waters (8.7 μg L-1). About 17.6% of the population in sample villages suffers from Iodine Deficiency Disorders (IDDs). These IDDs can be ascribed to the scarcity of iodine in soils and drinking waters (and hence diet), and lifestyle. Attempts have been made to suggest certain remedial measures to minimize the magnitude of IDD sufferers in the study area.

The homeostatic signaling system in Homo sapiens is highly complex involving diverse physiological processes which are what enables the biological regulation of life. Human body is a highly dynamic system, the normal functioning of which is coordinated and maintained by a well-established mechanism of homeostatic regulation. Disorder genesis and progression has an underlying disruption in homeostatic regulation, even though pathophysiology and clinical presentations may vary. Progressive neurodegenerative conditions are an outcome of disrupted homeostatic regulation, which triggers accumulation of dysfunctions and impairment of neuroplasticity. Ayurveda considers neurodegenerative conditions to be brought by the imbalance of 'Vata', the energy that moves through the brain and the nerves. The scholars behind classical ayurvedic literature considered neural impulses to be a kind of air traveling through the body, controlling both voluntary and involuntary functions. Oxygen is the real time mediator of homeostatic signaling system and defective oxygen transport; thereby impairment in oxygenation is the prime underlying factor in neurodegenerative conditions. The broad spectrum therapeutic effects demonstrated by Withania Somnifera or Ashwagandha are a result of its profound mechanism of enhancement of oxygenation. Also the ayurvedic branch of medicine known as 'Rasa Shastra' uses 'Bhasma', traditionally prepared Nano medicines, some of which shows influential enhancement in oxygenation.

Background: Science teachers from multiple kindergartens through twelfth grade (K-12) schools participated in a two-day environmental health training introducing them to newer methods of engagement and interaction adaptable for the classroom environment. This paper describes the use of Liberating Structures (LS) in the two day training for interaction between trainers and K-12 teachers, and the LS structures preferred by these K-12 teachers. These liberating structures are also compared to current engagement and learning techniques or strategies commonly used by teachers in any classroom and to encourage and promote science and health education that could ultimately improve the health and well-being of individuals and families.

Results: Teachers describe the selection of liberating structures they felt would be most useful in a classroom environment for teaching science and health related topics, promoting critical thinking and developing ownership of environmental and health science topics. The most popular structure that appealed to teachers was the ‘1-2-4-ALL’ structure. In general, the teachers felt that this structure could be useful to the critical thinking process as students could use this structure to, first, independently think about a science project idea and then develop this idea in a small and then large group, progressively. “Shift and Share” and ‘Impromptu Networking’ were also appealing as structures for the scientific inquiry method, where students could be led through the critical thinking process to develop and test a challenging science or health related project hypothesis.

Conclusion: This was a pilot study to look at the potential for use of LS in the classroom and for teaching science and health through improved engagement. Further research is recommended to determine which of these structures are better matched with the scientific method, and education and improved learning in the classroom. Sustained follow-up training for teachers on these strategies is also recommended with more intense training and practice, along with evaluation on using these structures in the classroom. The use and application of these liberating structures in community setting to promote ownership over environmental and health issue is also encouraged.