Australasian Medical Journal
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Introducing Geriatric Health in Medical Training in Ajman, United Arab Emirates
Get PDFBackgroundMedical students’ knowledge and understanding of the elderly will affect the quality of care to the rising population of older adults which points to a need to identify geriatric health training methods appropriate for the region and curriculum. Therefore the study assessed the effect of a co-curricular introductory workshop on knowledge regarding geriatric health and attitude towards the elderly among fourth year medical students in a medical universityMethod A quasi-experimental before-after study, with control was conducted at Gulf Medical College among 60 medical students from discipline-based curriculum in year IV during May–June 2010 of whom 16 had opted (attendees) to undergo the introductory course, a five day workshop of 10 hours duration. Pre- and post-testing used self-administered questionnaires for demographic variables: age, gender, nationality, close contact with older people; a quiz on old people’s health, and Kogan’s Old People Scale (KOPS) for attitude. The difference in scores on quiz and KOPS were compared for the attendees and 26 non-attendees who participated in both pre and post testing.ResultsThe attendees group had 38% male and 62% female participants and the non-attendees group had 21% and 79% respectively. The groups were not significantly different in age, sex, nationality and close contact with the elderly. The scores on the quiz and KOPS showed no statistically significant difference between the two groups before or after the workshop. Almost all the participants evaluated the workshop very positively especially the interaction with healthy elderly and inmates of old people’s home.ConclusionA 10-hour introductory co-curricular workshop made no significant change in the knowledge on geriatric health or attitude of fourth year medical students though they reported it as a very enriching experience. A reflective report may have been a better assessment tool and the impact on their clinical practice cannot be predicted
Big Tobacco "Pull Out All Stops" for a Landmark Example
Get PDF Background With the aid of internal tobacco industry documents, this paper provides a chronology of events documenting the role of the Philip Morris tobacco company in the 1993 litigation case against the Burswood International Resort Casino (BIRC). The paper also examines the implications of this case for the regulation of second hand smoke exposure. Method A systematic keyword search and analysis of internal tobacco industry documents was conducted using documents available on the World Wide Web through the Master Settlement Agreement. Results The industry documents provide comprehensive evidence that the Philip Morris tobacco company provided assistance to the BIRC in its defence against action by the Western Australian government. The Philip Morris tobacco company, along with others, sought to publicise and promote the outcome as a ‘landmark example’ to lobby against the implementation of indoor smoking bans. Conclusion Philip Morris’ investment in the BIRC defence demonstrated the industry’s recognition of the potential significance of the case beyond Western Australia. Involvement in the BIRC case assisted the wider tobacco industry by helping to prolong smoking at casinos and other Australian hospitality venues. The findings contribute to our understanding of the history of tobacco industry strategies implemented in Western Australia and internationally to slow tobacco control progress, and the preparedness of the tobacco industry to exploit favourable developments originating anywhere in the world.
Prevention Practices and HIV/AIDS in Karnataka
No full textBackground Understanding positive prevention practices among people living with HIV (PLHIV) can provide useful insights to guide our efforts in preventing further HIV transmission, and helps to enable PLHIVs to lead healthy and responsible lives.MethodA cross-sectional study was conducted in three sites of Karnataka: namely Belgaum (North Karnataka), Bellary (Central Karnataka) and Hassan (South Karnataka) districts. The study period was from March to September 2010. A total of 477 PLHIV were sampled and interviewed with the help of a structured interview schedule. The interviews were conducted by trained PLHIV community interviewers.ResultsDisclosure of status was fairly good among the studied population. The majority of men disclosed their HIV status first with their spouses, whereas women disclosed first with their mothers. Status disclosure was less among urban PLHIV when compared to rural PLHIV. Knowledge about Sexually Transmitted Infections (STIs) among unmarried men and women was low; higher proportions among them were involved in sexual relationships; and they reported no condom use with their regular partners. Condom use with regular partners is found to be more effective when public health messages are given through peers. Status disclosure is having a role in motivating communities for Regular CD4 testing and ART uptake.ConclusionUnmarried PLHIV need to be prioritised in our prevention efforts, to enable them to adopt safe sex practices through appropriate peer-mediated strategies. As status disclosure with family members has an important role in adhering to ART, status disclosure with family members needs to be emphasized in our programmes
Pneumococcal meningitis induced neuronal injury in Wistar rats - a study on neurodegenerative changes in the sub-regions of the hippocampus
No full textBackgroundBacterial meningitis is known to cause neurodegenerations in the hippocampus, motor cortex and cerebellum. Aim of the present study was to investigate quantitatively the effect of pneumococcal meningitis on hippocampal sub regions in Wistar rats.Method Thirty days old rats were divided into normal control (NC) and meningitis (M) groups. Rats in the meningitis group were infected with Streptococcus pneumoniae intracisternally on postnatal day 31. The concentration of the bacterial suspension in phosphate-buffered saline (PBS) was 1×106 cfu/ml (colony forming units/ml). The rats were kept under observation for 18 hrs for clinical symptoms of meningitis to develop. After 18-24 hrs of incubation, 10-50µl of the CSF sample was collected. Gram's staining of the CSF smear was done and observed under oil immersion objective (100X) for Gram positive, lanceolate diplococci. The rats were perfused transcardially with saline followed by 10% formalin. Brains were removed, processed for paraffin sectioning and stained with cresyl violet stain. Neurodegeneration in the hippocampal CA1, CA3 and dentate hilus were quantified. ResultsThe hippocampal sub-regions showed neurodegeneration. Significant fractions of neurons in the above regions were darkly stained and were irregular in shape. There was 56-81% neuronal loss in these regions. The surviving neurons showed 34-45% decrease in cell diameter and 28-29% decrease in the cross-sectional area in the hippocampal sub regions. ConclusionMeningitis affects the hippocampal subregions equally and may be the neural basis of cognitive deficit. The mechanism of such neurodegeneration could have been due to necrosis or apoptosis. Word count: [Abstract: 243; Full text: 3597]Figures and Tables: [6]
HIV Seroprevalence Among Pregnant Women in Rural Maharashtra
No full textBackgroundHuman Immunodeficiency virus (HIV) transmission is widespread across the globe. Millions of pregnant women are affected due to the high risk behaviour of their partners. Mother-to-child vertical transmission, has increased the burden of paediatric HIV population. Method A retrospective analysis of data on the utilisation of Integrated Counselling and Training Centre (ICTC) services by pregnant women at a tertiary care hospital in Ahmednagar district of Maharashtra, India from 1 January 2003 to 31 December, 2009. Pre-test counselling, HIV testing and post-test counselling was done by the trained staff of an ICTC centre as per National AIDS Control Organisation (NACO) guidelines. Anti-retroviral prophylaxis in the form of single dose oral Nevirapine (200mg) was given to seropositive women during active labour. Nevirapine syrup was administered to newborn babies. Analysis of the demographic profile of seropositive women was done.ResultsOut of 12,719 pregnant women attending the antenatal clinic, 10,491 (82.48%) accepted pre-test counselling and HIV testing. One hundred and forty-five women were found to be seropositive with a seroprevalence rate of 1.38%; 11% did not come for collection of the laboratory report and missed the post-test counselling. Most of the seropositive women belonged to rural areas (81.37%), had low-socioeconomic status (77.93%), were illiterate, and were unaware of their serostatus and their husband’s risk behaviour. Less than 30% of women were using contraceptives. After registration, the majority of seropositive women (89.65%) attended the antenatal clinic regularly; 11% opted for pregnancy termination; 76% delivered vaginally and 12% underwent Caesarean section. A further 86% of women and 80% of newborns received Nevirapine prophylaxis. Postnatal follow-up of babies was very limited.ConclusionHIV seroprevalence among the pregnant population is declining steadily. More and more women are availing the facilities of ICTC centres. Integration of PPTCT (Prevention of Parent To Child Transmission) and RNTCP (Revised National Tuberculosis Control Programme) has improved the uptake of services. Free Anti-Retroviral Treatment (ART) for seropositives will help in controlling the disease progression and will reduce the vertical transmission
Rasch Analysis on OSCE Data: An Illustrative Example
Get PDFBackgroundThe Objective Structured Clinical Examination (OSCE) is a widely used tool for the assessment of clinical competence in health professional education. The goal of the OSCE is to make reproducible decisions on pass/fail status as well as students’ levels of clinical competence according to their demonstrated abilities based on the scores. This paper explores the use of the polytomous Rasch model in evaluating the psychometric properties of OSCE scores through a case study. Method The authors analysed an OSCE data set (comprised of 11 stations) for 80 fourth year medical students based on the polytomous Rasch model in an effort to answer two research questions: (1) Do the clinical tasks assessed in the 11 OSCE stations map on to a common underlying construct, namely clinical competence? (2) What other insights can Rasch analysis offer in terms of scaling, item analysis and instrument validation over and above the conventional analysis based on classical test theory?ResultsThe OSCE data set has demonstrated a sufficient degree of fit to the Rasch model (χ2 = 17.060, DF=22, p=0.76) indicating that the 11 OSCE station scores have sufficient psychometric properties to form a measure for a common underlying construct, i.e. clinical competence. Individual OSCE station scores with good fit to the Rasch model (p > 0.1 for all χ2 statistics) further corroborated the characteristic of unidimensionality of the OSCE scale for clinical competence. A Person Separation Index (PSI) of 0.704 indicates sufficient level of reliability for the OSCE scores. Other useful findings from the Rasch analysis that provide insights, over and above the analysis based on classical test theory, are also exemplified using the data set. ConclusionThe polytomous Rasch model provides a useful and supplementary approach to the calibration and analysis of OSCE examination data.
