Impact of non-clinical community-based promotional campaigns on bowel cancer screening engagement: An integrative literature review

OBJECTIVE

This paper reviewed the relationship between non-clinical, client-oriented promotional campaigns to raise bowel cancer awareness and screening engagement.

METHOD

An integrative literature review using predefined search terms was conducted to summarise the accumulated knowledge. Data was analysed by coding and categorising, then synthesized through development of themes.

RESULTS

Eighteen of 116 studies met inclusion criteria. Promotional campaigns had varying impact on screening uptake for bowel cancer. Mass media was found to moderately increase screening, predominately amongst "worried well". Small media used in conjunction with other promotional activities, thus its effect on screening behaviours was unclear. One-on-one education was less effective and less feasible than group education in increasing intention to screen. Financial support was ineffective in increasing screening rates when compared to other promotional activities. Screening engagement increased because of special events and celebrity endorsement.

CONCLUSION

Non-clinical promotional campaigns did impact uptake of bowel cancer screening engagement. However, little is evident on the effect of single types of promotion and most research is based on clinician-directed campaigns.

PRACTICE IMPLICATIONS

Cancer awareness and screening promotions should be implemented at community and clinical level to maximize effectiveness. Such an approach will ensure promotional activities are targeting consumers, thus strengthening screening engagement.

Promoting Influenza Vaccination to Restaurant Employees

PURPOSE

To evaluate an evidence-based workplace approach to increasing adult influenza vaccination levels applied in the restaurant setting

DESIGN

We implemented an intervention and conducted a pre/post analysis to determine effect on vaccination.

SETTING

Eleven Seattle-area restaurants.

SUBJECTS

Restaurants with 25+ employees speaking English or Spanish and over 18 years.

INTERVENTION

Restaurants received influenza vaccination promotion materials, assistance arranging on-site vaccination events, and free influenza vaccinations for employees.

MEASURES

Pre/post employee surveys of vaccination status with direct observation and employer interviews to evaluate implementation.

ANALYSIS

We conducted descriptive analysis of employee survey data and performed qualitative analysis of implementation data. To assess intervention effect, we used a mixed-effects logistic regression model with a restaurant-specific random effect.

RESULTS

Vaccination levels increased from 26% to 46% (adjusted odds ratio 2.33, 95% confidence interval 1.69, 3.22), with 428 employees surveyed preintervention, 305 surveyed postintervention, and response rates of 73% and 55%, respectively. The intervention was effective across subgroups, but there were restaurant-level differences.

CONCLUSION

An access-based workplace intervention can increase influenza vaccination levels in restaurant employees, but restaurant-level factors may influence success.

[The medical dissertation in Germany : A quantitative analysis of promotion regulations in medical faculties]

BACKGROUND

The medical dissertation represents an independently processed scientific project. In the field of medicine this has for many years displayed the basis for controversial discussions. The aim of the study presented here was to evaluate the prerequisites of all current promotion regulations in German medical faculties in order to develop a comparability on the basis of a scoring system.

METHOD

An independent analysis of all promotion regulations from German medical faculties for the year 2014 was carried out according to 12 primary outcome measures and a scoring system.

RESULTS

The average total score of promotion regulations at 37 German medical faculties was 57.2 points (SD ±9.5) out of a possible 100 scoring points. The highest scores with 72-85 points were achieved by 3 faculties and 5 achieved scores of only 42-45 points. The range of the different criteria tested was broad. While the written thesis, the review process, the examination requirements as well as the grading of the thesis were defined in all regulations, the introduction into good clinical practice, knowledge of methodology as well as a check for plagiarism only seem to play minor roles.

CONCLUSION

The promotion regulations at German medical faculties show a great variation using the scoring system presented here for the first time. Standardized federal promotion regulations might help to establish a structured transparency as well as a national equality of opportunity.

The normative power of food promotions: Australian children's attachments to unhealthy food brands

OBJECTIVE

The formation of food brand associations and attachment is fundamental to brand preferences, which influence purchases and consumption. Food promotions operate through a cascade of links, from brand recognition, to affect, and on to consumption. Frequent exposures to product promotions may establish social norms for products, reinforcing brand affect. These pathways signify potential mechanisms for how children's exposure to unhealthy food promotions can contribute to poor diets. The present study explored children's brand associations and attachments for major food brands.

DESIGN

A cross-sectional online survey was conducted. Fourteen study brands were used, with each child viewing a set of seven logos. The questionnaire assessed perceptions of food brands and perceptions of users of brands, using semantic differential scales, and perceived brand 'personalities', using Likert scales.

SETTING

New South Wales, Australia, October-November 2014.

SUBJECTS

Children aged 10-16 years (n 417).

RESULTS

Children demonstrated strong positive affect to certain brands, perceiving some unhealthy food brands to have positive attributes, desirable user traits and alignment to their own personality. Brand personality traits of 'smart' and 'sporty' were viewed as indicators of healthiness. Brands with these traits were ranked lower for popularity.

CONCLUSIONS

Children's brand associations and attachments indicate the potential normative social influences of promotions. While children are aware of brand healthiness as an attribute, this competes with other brand associations, highlighting the challenge of health/nutrition messaging to counter unhealthy food marketing. Restricting children's exposure to unhealthy food marketing and the persuasive nature of marketing is an important part of efforts to improve children's diet-related health.

Identification of higher hospital costs and more frequent admissions among mid-aged Australian women who self-report diabetes mellitus

OBJECTIVE

To ascertain whether the hospital costs for mid-aged Australian women who self-reported diabetes mellitus (DM) and who had one or more hospital admission during an eight and a half year period were higher than the hospital costs for other similarly aged non-DM women.

METHODS

The sample comprised 2,392 mid-aged women, resident in New South Wales (NSW) Australia and participating in the Australian Longitudinal Study on Women's Health (ALSWH), who had any NSW hospital admissions during the eight and a half year period 1 July 2000 to 31 December 2008. Analyses were conducted on linked data from ALSWH surveys and the NSW Admitted Patient Data Collection (APDC). Hospital costs were compared for the DM and non-DM cohorts of women. A generalized linear model measured the association between hospital costs and self-reported DM.

RESULTS

Eight and a half year hospital costs were 41% higher for women who self-reported DM in the ALSWH surveys (p<0.0001). On average, women who self-reported DM had significantly (p<0.0001) more hospital admissions (5.3) than women with no reported DM (3.4). The average hospital stay per admission was not significantly different between the two groups of women.

CONCLUSIONS

Self-reported DM status in mid-aged Australian women is a predictor of higher hospital costs. This simple measure can be a useful indicator for public policy makers planning early-stage interventions that target people in the population at risk of DM.

Promotion of exclusive breastfeeding among HIV-positive mothers: an exploratory qualitative study

Background

Exclusive breastfeeding has the potential to reduce infant and under-five mortality, but research shows the practice is not widespread in resource-poor settings of sub-Saharan Africa. We explored factors influencing the decision to exclusively breastfeed among HIV-positive mothers accessing interventions for prevention of mother-to-child transmission of HIV in selected sites of Zambia.

Methods

This exploratory qualitative study was embedded in research conducted on: HIV and infant feeding; choices and decision-outcomes in the context of prevention of mother-to-child transmission among HIV-positive mothers in Zambia. Thirty HIV-positive mothers and six key informants were recruited from two health facilities providing mother-to-child HIV transmission prevention services. A semi-structured guide was used to conduct interviews, which were digitally recorded and simultaneously transcribed. Data coding and analysis was done with the support of QRS Nvivo 10 version software.

Results

Despite the known benefits of exclusive breastfeeding, gaps in understanding and potential for behaviour change remained. We found that information promoting exclusive breastfeeding may have been understood by mothers as instructions from the health care workers indicating how to feed their HIV-exposed babies rather than as an option for the mothers’ own informed-decision. This understanding influenced a mother’s perceptions of breast milk safety while on antiretroviral medicine, of the formula feeding option, and of the baby crying after breastfeeding. The meanings mothers attached to exclusive breastfeeding thus influenced their understanding of breast milk insufficiency, abrupt weaning and mixed feeding in the context of preventing mother-to-child transmission of HIV.

Conclusion

In order to enhance feeding practices for HIV-exposed infants, our study suggests a broader health campaign supporting all mothers to exclusively breastfeed.

Health Education as an Important Component in the National Schistosomiasis Control Programme in The People's Republic of China

Schistosomiasis control programme in The People's Republic of China had promoted the mass mobilization of health education in various forms, such as films, drama, traditional opera, poems, slogans, posters, exhibits. This paper is trying to review the impacts of those forms on different endemic settings and targeted populations. In the future, health education and health promotion will still be the effective strategy and one of the interventions in the national control programme for schistosomiasis and other infectious diseases, even in the pre- or posttransmission stages. With the social and economic development and improvement of people's living standard, it is necessary to establish a sustainable mechanism, in combination of health education with health guarantee of improving the quality of life, improving the production and living conditions, changing the unhealthy production methods and lifestyle of the residents in the endemic areas, in order to reach the goal of schistosomiasis elimination in The People's Republic of China.

Adolescents' responses to the promotion and flavouring of e-cigarettes

OBJECTIVES

The purpose of the study is to examine adolescents' awareness of e-cigarette marketing and investigate the impact of e-cigarette flavour descriptors on perceptions of product harm and user image.

METHODS

Data come from the 2014 Youth Tobacco Policy Survey, a cross-sectional in-home survey conducted with 11-16 year olds across the UK (n = 1205). Adolescents' awareness of e-cigarette promotion, brands, and flavours was assessed. Perceptions of product harm, and likely user of four examples of e-cigarette flavours was also examined.

RESULTS

Some participants had tried e-cigarettes (12 %) but regular use was low (2 %) and confined to adolescents who had also smoked tobacco. Most were aware of at least one promotional channel (82 %) and that e-cigarettes came in different flavours (69 %). Brand awareness was low. E-cigarettes were perceived as harmful (M = 3.54, SD = 1.19) but this was moderated by product flavours. Fruit and sweet flavours were perceived as more likely to be tried by young never smokers than adult smokers trying to quit (p < 0.001).

CONCLUSIONS

There is a need to monitor the impact of future market and regulatory change on youth uptake and perceptions of e-cigarettes.

Streamlining Appointment, Promotion, and Tenure Procedures to Promote Early-Career Faculty Success

A critical component of the progression of a successful academic career is being promoted in rank. Early-career faculty are required to have an understanding of appointment, promotion, and tenure (APT) guidelines, but many factors often impede this understanding, thwarting a smooth and planned promotion pathway for professional advancement. This article outlines the steps taken by an APT committee to improve the promotion process from instructor to assistant professor. Six sigma's DMAIC improvement model was selected as the guiding operational framework to remove variation in the promotion process. After faculty handbook revisions were made, several checklists developed, and a process review rubric was implemented; recently promoted faculty were surveyed on satisfaction with the process. Faculty opinions captured in the survey suggest increased transparency in the process and perceived support offered by the APT committee. Positive outcomes include a strengthened faculty support framework, streamlined promotion processes, and improved faculty satisfaction. Changes to the APT processes resulted in an unambiguous and standardized pathway for successful promotion.

[On the way to becoming an MD (Dr. med.): What kind of support do doctoral students need? Part 1: Survey and development of a program]

In Germany, medical doctorates are regularly criticized for their insufficient quality. In order to improve the quality of doctorates and to support doctoral candidates, a department-wide doctoral research program was established at the Goethe University of Frankfurt am Main in 2011 taking into account the practical needs of doctoral students at the School of Medicine. The program development proceeded in several steps: in the first step (2009/2010), a pilot study with eleven doctoral candidates was carried out at the Institute of General Practice. Their ratings of the perceived relevance and their own knowledge of 15 topics of scientific work were used to identify a provisional need for support. Subsequently an interdisciplinary panel of experts established the program throughout the faculty. Since its implementation, a requirements analysis in the form of questionnaires has been continuously carried out in order to assess the doctoral students' prior knowledge and their preferences expressed. At the same time, systematic searches for support programs in other medical fields have been conducted throughout Germany on several occasions. On the basis of the pilot study, the research results and the expert panel discussions the following topics were found to be particularly relevant: principles of good scientific practice, literature search, reference management, organization and structure of a doctoral thesis, formatting of Word documents, clinical epidemiology and data management. A specific, stepwise development process was used to design a concept for the faculty of medicine that pays close attention to the knowledge and interests of doctoral candidates. The establishment of the doctoral research program in Frankfurt and the results of its evaluation are presented in a second article (Paulitsch et al., 2016).

[On the way to becoming an MD (Dr. med.): What kind of support do doctoral students need? Part 2: Establishing the program]

The poor quality of medical dissertations has repeatedly been criticized by scientific and higher education institutions. In medicine, doctoral students rated their own knowledge of fundamental scientific issues as low. The establishment of a doctoral research program could solve this problem. However, no scientific paper has yet been published showing how such support programs should be designed. Here we present an example of such a design on the basis of the doctoral research program which the Faculty of Medicine at the Goethe University, Frankfurt am Main, established in 2011. Using requirements analyses, eight basic courses have been developed that can be attended separately but are considered to contain essential information for all doctorates. To ensure a high quality of the doctoral research program and to take into account the needs of doctoral students, both the individual courses and the doctoral research program as a whole were evaluated. The doctoral research program has been very well accepted by doctoral students, with a total of 449 doctoral students, who attended an average of five courses from 2011 to 2014. The total number of participants amounted to 2,302 in 159 courses. The results of the evaluation show that on average all the basic courses were considered to be 'good' or 'very good'. After participating in eight courses, the doctoral students' overall evaluation of the doctoral research program resulted in a very positive assessment of the overall concept. Further aspects, such as the examination of the impact of participation in the doctoral research program on dissertation quality, are pending. Due to the positive feedback from participants, we recommend that other faculties establish similar programs.

Adolescents' responses to the promotion and flavouring of e-cigarettes

OBJECTIVES

The purpose of the study is to examine adolescents' awareness of e-cigarette marketing and investigate the impact of e-cigarette flavour descriptors on perceptions of product harm and user image.

METHODS

Data come from the 2014 Youth Tobacco Policy Survey, a cross-sectional in-home survey conducted with 11-16 year olds across the UK (n = 1205). Adolescents' awareness of e-cigarette promotion, brands, and flavours was assessed. Perceptions of product harm, and likely user of four examples of e-cigarette flavours was also examined.

RESULTS

Some participants had tried e-cigarettes (12 %) but regular use was low (2 %) and confined to adolescents who had also smoked tobacco. Most were aware of at least one promotional channel (82 %) and that e-cigarettes came in different flavours (69 %). Brand awareness was low. E-cigarettes were perceived as harmful (M = 3.54, SD = 1.19) but this was moderated by product flavours. Fruit and sweet flavours were perceived as more likely to be tried by young never smokers than adult smokers trying to quit (p < 0.001).

CONCLUSIONS

There is a need to monitor the impact of future market and regulatory change on youth uptake and perceptions of e-cigarettes.

Tumor Suppressor DLEC1 can Stimulate the Proliferation of Cancer Cells When AP-2ɑ2 is Down-Regulated in HCT116

BACKGROUND

The molecular mechanisms of tumor suppressor gene DLEC1 are largely unknown.

OBJECTIVES

In this study, we established DLEC1 over-expression stable clones to study the cellular function of DLEC1 in the colorectal cancer cell line, HCT116.

MATERIALS AND METHODS

Stable clones with DLEC1 over-expression were first established by the transfection of DLEC1 expression construct pcDNA31DLEC1 in HCT116. On G418 selection, positive stable clones were screened for DLEC1 expression level by conventional reverse transcription-polymerase chain reaction (RT-PCR), and verified by real-time RT-PCR and Western blotting. Subsequently, these stable clones were subjected to colony formation and cell cycle analyses and identification of factors involved in G1 arrest. Lastly, three stable clones, DLEC1-7 (highest DLEC1 expression), DLEC1-3 (lowest expression) and pcDNA31 vector control, were employed to analyze cell proliferation and cell cycle after AP-2α2 knockdown by siRNAs.

RESULTS

The DLEC1 over-expression was found to reduce the number of colonies in colony formation and to induce G1 arrest in seven clones, and apoptosis in one clone in the cell cycle analysis. Furthermore, regardless of the different cell cycle defects in all eight stable clones, the expression level of transcriptional factor AP-2α2 was found to be elevated. More interestingly, we found that when AP-2α2 was knocked down, DLEC1 over-expression neither suppressed cancer cell growth nor induced G1 arrest, yet, instead promoted cell growth and decreased cells in the G1 fraction. This promotion of cell proliferation and release of G1 cells also seemed to be proportional to DLEC1 expression levels in DLEC1 stable clones.

CONCLUSIONS

DLEC1 suppresses tumor cell growth the presence of AP-2α2 and stimulates cell proliferation in the down-regulation of AP-2α2 in DLEC1 over-expression stable clones of HTC116.

Homophily in the career mobility of China's political elite

We argue that leadership promotion in China's political elite relies on homophily for signals of trustworthiness and future cooperative behavior more than on economic performance. We first point to the limitation of the economic performance argument from within the framework of China's specific M-form state structure, and then we proffer a sociological explanation for why higher-level elites in China rely on homophilous associations in recruiting middle-level elites to the top positions of state. Using a unique dataset covering China's provincial leaders from 1979 to 2011, we develop a homophily index focusing on joint origin, joint education and joint work experience. We trace personal similarities in these respects between provincial leaders and members of China's supreme decision-making body, the Politbureau's Standing Committee. We then provide robust evidence confirming the persisting impact of homophilous associations on promotion patterns in post-reform China.

The role of message strategy in improving hand hygiene compliance rates

BACKGROUND

Despite increased attention to hand hygiene over the past decade compliance rates remain relatively low. Although there have been a number of improvements in the science of hand hygiene, very little attention has been devoted to the messages that promote it.

METHOD

A total of 86 health care workers who are members of Association for Professionals in Infection Control and Epidemiology chapters participated in an online evaluation of 6 message strategies. The participants evaluated the strategies on ease of understanding, believability, and whether the message strategies were likely to lead to increased handwashing.

RESULTS

Of the 6 strategies--ego, social, sensory, routine, acute need, and ration--the social strategy was rated the most likely to lead to action. The sensory strategy was seen as not only least likely but also counterproductive.

CONCLUSIONS

ICPs should add a social message strategy to communication programs promoting hand hygiene. Although further testing is needed, ego, routine, and acute need strategies show promise for tapping into motivations that lead to improved compliance.

Expanding the reach of the Quitline by engaging volunteers to market it in hospitals and shopping venues - a pilot study

Background

In Canada, although there are periodic media campaigns to raise awareness of Quitlines, these services are underused. We sought to determine if a dedicated kiosk, similar to that used in the retail industry but staffed by volunteers trained in smoking cessation techniques, would be effective method to enhance Quitline reach.

Methods

We located a kiosk in the foyer of two hospitals and in two shopping malls in Edmonton, Canada between Feb/2012 and July/2014. The cessation intervention was based on the 5 A's approach. Outcome was assessed by number of visits to the kiosk and referral rates to the Quitline. A cross sectional survey among small sample of visitors was used for evaluation. Descriptive statistics were used to summarize visitors’ data.

Results

Of 1091 kiosk visitors, 53.3 % were current smokers, of whom 93.3 % indicated a willingness to quit. Of these, 32.1 % requested a Quitline referral at the time of the kiosk visit. Referral requests to the Quitline were greater when the kiosk was located in the non-hospital setting 39.1 % compared to 31.1 % in hospitals (P = 0.2). Referrals from the kiosk represented 6 % of total referrals received by the provincial Quitline during the study period. Following referral the Quitline was able to reach 50 % of those referred, of those, 17 % refused to proceed. At seven month follow up 30 day abstinence rate was 3.8 % of smokers who wished quit. Visitors agreed that the kiosk design was interesting (89.3 %) and increased their knowledge about tobacco and cessation options (88.8 %) and encouraged them to take action to quit (85.7 %).

Conclusions

A “volunteer manned kiosk” can increase awareness of smoking cessation resources in the community and increase referral rates to Quitline services.

Behaviour change interventions to promote physical activity in rheumatoid arthritis: a systematic review

Research has shown that people who have rheumatoid arthritis (RA) do not usually participate in enough physical activity to obtain the benefits of optimal physical activity levels, including quality of life, aerobic fitness and disease-related characteristics. Behaviour change theory underpins the promotion of physical activity. The aim of this systematic review was to explore behaviour change interventions which targeted physical activity behaviour in people who have RA, focusing on the theory underpinning the interventions and the behaviour change techniques utilised using specific behaviour change taxonomy. An electronic database search was conducted via EBSCOhost, PubMed, Cochrane Central Register of Controlled Trials and Web of Science databases in August 2014, using Medical Subject Headings and keywords. A manual search of reference lists was also conducted. Randomised control trials which used behaviour change techniques and targeted physical activity behaviour in adults who have RA were included. Two reviewers independently screened studies for inclusion. Methodological quality was assessed using the Cochrane risk of bias tool. Five studies with 784 participants were included in the review. Methodological quality of the studies was mixed. The studies consisted of behaviour change interventions or combined practical physical activity and behaviour change interventions and utilised a large variety of behaviour change techniques. Four studies reported increased physical activity behaviour. All studies used subjective methods of assessing physical activity with only one study utilising an objective measure. There has been varied success of behaviour change interventions in promoting physical activity behaviour in people who have RA. Further studies are required to develop and implement the optimal behaviour change intervention in this population.

Effect of distribution of educational material to mothers on duration and severity of diarrhoea and pneumonia, Midlands Province, Zimbabwe: a cluster randomized controlled trial

BACKGROUND

Exclusive breastfeeding rates remain low in most countries in sub-Saharan Africa. We assessed the effects of a mother-based intervention on duration of diarrhoea and pneumonia in communities that were trained and those not trained in community infant and young child feeding (cIYCF) in Midlands Province, Zimbabwe.

METHODS

We evaluated communities with village health workers who received training in cIYCF and the distribution of educational materials (newsletter) to mothers in promotion of exclusive breastfeeding using a two-by-two factorial cluster randomized controlled trial. The trial arms included clusters trained in cIYCF only, clusters with mothers that received a newsletter only, clusters that received both interventions and clusters receiving no intervention. Consenting mother-infant pairs identified within 72 hours of delivery were followed up at 14 and 20 weeks where duration of diarrhoea and pneumonia as well as severity of diarrhoea was assessed. Clusters were facility catchment areas assigned by an independent statistician using randomization generated by a computer using Stata 10. All admitting facilities and facilities at borders were excluded as buffer zones and eight clusters were analysed. Nutritionists who collected data were not aware of the hypothesis being tested and analysis was by intention-to-treat.

RESULTS

A total of 357 mother-infant pairs were available for analysis in all the clusters. The interaction between cIYCF training and the newsletter was statistically significant at 14 weeks (p = 0.022). The mean duration of diarrhoea was 2.9 (SD = 0.9) days among infants of mothers who resided in communities trained and received a newsletter compared to 5.2 (SD = 1.1) days in communities that received neither. The protective efficacy of the cIYCF plus newsletter was 76% during the first 20 weeks of life. In the two way ANOVA, the newsletter was more effective on duration of pneumonia (p = 0.010) at 14 weeks and remained significantly effective at 20 weeks (p < 0.0001).

CONCLUSIONS

A combined community and distribution of a newsletter to mothers on promotion of exclusive breastfeeding reduces duration of diarrhoea at 14 weeks. At 20 weeks, the newsletter worked better for both duration of diarrhoea and pneumonia compared to cIYCF training alone.

Dire need of changes in the methods for assessing university faculty productivity in developing countries

Publishing has become a necessity for promotion of faculty in academia. The faculties in developing countries face considerable difficulties publishing due to their prime focus on clinical approaches and resources for proper research. This often leaves no room for the pressured clinicians but to pursue poor quality publications just for the sake of promotion when the time for their promotion comes. The authors suggest establishing separate promotion tracks besides research in these underprivileged areas in order to avoid infestation of original research with poor ones.

[Doctoral thesis projects for medical students? Retrospective estimation of the fraction of successfully completed medical doctoral thesis projects at Witten/Herdecke University]

BACKGROUND

The German "Dr med" plays a specific role in doctoral thesis settings since students may start the underlying doctoral project during their studies at medical school. If a Medical Faculty principally encourages this approach, then it should support the students in performing the respective projects as efficiently as possible. Consequently, it must be ensured that students are able to implement and complete a doctoral project in parallel to their studies. As a characteristic efficiency feature of these "Dr med" initiatives, the proportion of doctoral projects successfully completed shortly after graduating from medical school is proposed and illustrated.

METHODS

The proposed characteristic can be estimated by the time period between the state examination (date of completion of the qualifying medical examination) and the doctoral examination. Completion of the doctoral project "during their medical studies" was then characterised by a doctoral examination no later than 12 months after the qualifying medical state examination. To illustrate the estimation and interpretation of this characteristic, it was retrospectively estimated on the basis of the full sample of all doctorates successfully completed between July 2009 and June 2012 at the Department of Human Medicine at the Faculty of Health of the University of Witten/Herdecke.

RESULTS

During the period of investigation defined, a total number of 56 doctoral examinations were documented, 30 % of which were completed within 12 months after the qualifying medical state examination (95% confidence interval 19 to 44 %). The median duration between state and doctoral examination was 27 months. The proportion of doctoral projects completed parallel to the medical studies increased during the investigation period from 14 % in the first year (July 2009 till June 2010) to 40 % in the third year (July 2011 till June 2012).

CONCLUSION

Only about a third of all "Dr med" projects at the Witten/Herdecke Faculty of Health were completed during or close to the qualifying medical studies. This proportion, however, increased after the introduction of a curriculum on research methodology and practice in 2010; prospective longitudinal studies will have to clarify whether this is causal or mere chronological coincidence. In summary, the proposed method for determining the process efficiency of a medical faculty's "Dr med" programme has proven to be both feasible and informative.

Awareness of pro-tobacco advertising and promotion and beliefs about tobacco use: findings from the Tobacco Control Policy (TCP) India Pilot Survey

Tobacco companies are utilizing similar strategies to advertise and promote their products in developing countries as they have used successfully for over 50 years in developed countries. The present study describes how adult smokers, smokeless tobacco users, and non-users of tobacco from the Tobacco Control Project (TCP) India Pilot Survey, conducted in 2006, responded to questions regarding their perceptions and observations of pro-tobacco advertising and promotion and beliefs about tobacco use. Analyses found that 74% (n = 562) of respondents reported seeing some form of pro-tobacco advertising in the last six months, with no differences observed between smokers (74%), smokeless tobacco users (74%), and nonsmokers (73%). More than half of respondents reported seeing pro-tobacco advertising on store windows or inside shops. Overall, this study found that a significant percentage of tobacco users and non-users in India report seeing some form of pro-tobacco advertising and promotion messages. Additional analyses found that smokers were more likely to perceive tobacco use as harmful to their health compared with smokeless tobacco users and non-users (p < 0.01). The findings from this study reiterate the need for stronger legislation and strict enforcement of bans on direct and indirect advertising and promotion of tobacco products in India.

Interventions promoting the acceptance and uptake of generic medicines: a narrative review of the literature

OBJECTIVE

The objective of this paper was to undertake a narrative review of the literature regarding strategies and interventions promoting the acceptance and uptake of generic medicines.

METHOD

A literature search was performed between November 2011 and January 2012 to identify published full text original research articles documenting interventions to promote the use of generic medicines. Keywords used were: "generic medicine", "generic drug", "intervention", "promotion", "acceptance", "uptake", "generic/therapeutic substitution" and their related root words. The electronic databases comprised of Embase (1980 - present), Google, Google Scholar, Medline (1948 - present), PubMed, Science Direct, Scopus, Springer Link and The Cochrane Library. An interpretative narrative synthesis was undertaken and emergent themes analysed and reported.

RESULTS

Eighteen studies were included in the final analysis. There were seven main themes which including; education, financial incentives, advertising to promote generic medicines, free generic medicine trials, administrative forms and medicines use review (MUR). These themes were further classified into subthemes. Education was subdivided into consumer and physician education. Financial incentives included the influence of financial incentives on both consumers and physicians. The subthemes in the financial incentives category included the changes in co-payment for consumers, reward payment for physicians and fund-holding schemes. Advertising included the sub-themes of print media and the use of anthropomorphic images, while free generic medicines trial was made up of free vouchers for generic medicines and generic medicines sampling system.

CONCLUSIONS

The studies have mixed results; some interventions in some settings were useful, while others were not. Not all interventions consistently improved the uptake of generic medicines. There was limited literature available and further work is required to develop a range of interventions to support the uptake of generic medicines within and across different countries.

A focus group assessment to determine motivations, barriers and effectiveness of a university-based worksite wellness program

BACKGROUND

This study explores university employee perceptions and under-standing about its Worksite Health Promotion Program (WHPP). The WHPP included a Health Risk Appraisal (HRA), biometric screening, publicity for on-campus health programs and facilities, and health coaching.

METHODS

A qualitative design was used based on a grounded theory ap-proach. Four 90 minutes focus groups with 6-8 participants in each were conducted within a two 2 week period among employees, representing fac-ulty/participants, fac-ulty/nonparticipants, staff/participants, and staff/nonparticipants. Responses to questions about motivations, barriers, and perceived health benefits that impacted participation in the WHPP were digi-tally recorded, transcribed and coded for themes.

RESULTS

Incentives effectively motivated participation. Biometric screening had the largest impact on behavior change, followed by the information learned from the HRA. However, despite two-thirds of the employees partici-pating in the pro-gram, lack of a full understanding of WHPP benefits and services lowered partici-pation in follow-up services and supplemental pro-grams.

CONCLUSIONS

Biometric screening and HRAs effectively motivate program par-ticipation. Communication of benefits and services are important when providing WHPPs.

The evaluation of international relationship role in promotion of health system research

BACKGROUND

Regarding the need for scientific development and achievement our national goals, it is clear that international cooperation has the main role in this way. Here is a report on what we have done during past almost 10 years (2001-2011) in the field of international medical research activities in Deputy Ministry for Research & Technology, Ministry of Health, Iran. Our effort was focused to identify and contact with the prominent scientific centers among the world where could make a connection between our researchers in medical science universities with those centers.

Of money and trust in medical care redux

Should we be concerned about financial conflicts of interest (COI) between doctors and the pharmaceutical industry? Some people will say no as there are clearly doctors who celebrate the relationship. Others say that it does not matter to patients, but the evidence says otherwise. Financial COI is different from other types of conflicts because it is voluntary and can be refused. Finally, it is not just the large gifts that are a problem, the small ones also create a “gift relationship.” Drug companies know about this and spend billions on promotion with good effect from their point of view. Companies also woo doctors who honestly hold pro-industry points of view to speak on behalf of the companies. There are still multiple examples of financial COI, and although there are isolated examples of improvement, this is still an area of deep concern.

Impact of a behaviour change intervention model for promotion of condoms amongst young adult males in an occupational setting

BACKGROUND

Studies have justified that social and cultural factors influence young people not to use condoms. Sexually active people associate condoms with lack of trust, while others believe carrying them could imply sexual inexperience. The aim of this study was to provide an intervention model based on this social perception and assess the impact of the intervention in improving condom use.

METHODS

2083 personnel in the intervention group were subjected to behaviour change intervention based on perception and use of condoms. Using a cluster design, we randomly assigned 40 departments to department-based intervention (20) or assessment (20) groups. Around 100 persons in the same age group of 18-45 years were again randomly assigned to each group. Chi Square test was used to assess the effectiveness of the intervention.

RESULTS

Over 6% individuals in the control group (Table 2) had non-regular partners and out of them 23.5% had used a condom. Again, in the same group (Fig. 1), 45.36% individuals thought it is acceptable for single men to use condoms with their partners and 8.15% agreed that it is alright for married women to use condoms with their husbands. The perception significantly increased in the intervention group (p < 0.001).

CONCLUSION

This study thus highlights the importance of continued behavioural intervention in filling certain gaps in the social and structural perception to improve condom use for effective HIV prevention in the community.

Stem cells and hepatocellular carcinoma

Stem cells are a class of special embryonic or adult cells that are able to self-renew and undergo multi-directional differentiation. Studies have shown that stem cells have selective tropism toward tumor tissue. Previous studies have shown that hepatic stem cells play an important role in hepatocarcinogenesis by participating in regulation of cell growth and differentiation. However, some other studies demonstrated that stem cells could inhibit cell growth in hepatocellular carcinoma. Elucidation of relationship between stem cells and hepatocellular carcinoma could provide new clues to the pathogenesis of hepatocellular carcinoma and help develop new therapeutic strategies for the disease.