COVID-19 Vaccine Intent Among Health Care Professionals of Queen Elizabeth Hospital, Barbados

INTRODUCTION

Due to increased exposure risk and the potential impact of COVID-19 infection, health care professionals (HCP) are a target group for COVID-19 vaccination. This study aimed to examine the acceptability of COVID-19 vaccines among HCP at the Queen Elizabeth Hospital, Barbados.

DESIGN AND METHODS

A cross-sectional survey of HCP was conducted between February 14 and 27, 2021 using an online questionnaire. The questionnaire included demographic information, knowledge of novel coronavirus, intention to accept the COVID-19 vaccination, vaccine literacy (VL), and perceptions and attitudes regarding COVID-19 vaccines. Mean VL scores were calculated. The relationship between socio-demographic variables and vaccine intent was assessed using a multivariable logistic regression model.

RESULTS

Of 343 HCPs, 55.1% indicated they would accept the COVID-19 vaccine if it were available; 44.9% expressed hesitancy towards the COVID-19 vaccine. We assessed the impact of socio-demographic factors and previous vaccine behavior on vaccine intent; after adjustment of the multivariable logistic regression model, non-Barbadian nationality and previous flu vaccine uptake were statistically significant predictors of reported intent to take the COVID-19 vaccine. Persons who indicated that they would take the vaccine had a higher mean vaccine literacy score [3.46 95% CI (3.40, 3.52)] than those who were not ready to take the vaccine immediately [3.23 95% CI (3.15, 3.30)]. VL scores were higher among the 29.5% of HCPs who believed vaccines should be mandatory.

CONCLUSION

This study highlighted vaccine hesitancy among HCPs in the sole public tertiary hospital of Barbados. As HCP perceptions may help or hinder the campaign to promote vaccine uptake in Barbados, vaccine promotion programs targeting HCPs are needed to ensure the success of the country's COVID-19 vaccination drive.

Anthropometric measures of obesity and associated cardiovascular disease risk in the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study

BACKGROUND

Accurately defining obesity using anthropometric measures that best capture obesity-related risk is important for identifying high risk groups for intervention. The purpose of this study is to compare the association of different anthropometric measures of obesity with 10-year cardiovascular disease (CVD) risk in adults in the Eastern Caribbean.

METHODS

Data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were analyzed. The ECS is comprised of adults aged 40 and older residing in the US Virgin Islands, Puerto Rico, Barbados, and Trinidad. 10-year CVD risk was calculated using the American Heart Association (ACC/AHA) ASCVD Risk Algorithm and categorized in the following high-risk groups: > 7.5, > 10, and > 20%. Logistic regression was used to examine associations between four anthropometric measures of obesity (BMI, waist circumference, waist-to-hip ratio, waist-to height ratio) and 10-year CVD risk.

RESULTS

Mean age (SD) of participants (n = 1617) was 56.6 years (±10.2), 64% were women, 74% were overweight/obese, and 24% had an ASCVD risk score above 10%. Elevated body mass index (BMI, > 30 kg/m2) and waist circumference were not associated with CVD risk. Elevated waist-to-hip ratio (WHR, > 0.9 men, > 0.85 women) and elevated waist-to-height ratio (> 0.5) were associated with all three categories of CVD risk. Area under the receiver curve was highest for WHR for each category of CVD risk. Elevated WHR demonstrated odds of 2.39, 2.58, and 3.32 (p < 0.0001) for CVD risk of > 7.5, > 10 and > 20% respectively.

CONCLUSION

Findings suggest that WHR is a better indicator than BMI of obesity-related CVD risk and should be used to target adults in the Caribbean, and of Caribbean-descent, for interventions.

Use of an Adaptive e-Learning Platform as a Formative Assessment Tool in the Cardiovascular System Course Component of an MBBS Programme

BACKGROUND

Technology-enhanced learning includes the adaptive e-learning platform, a data-driven method with computer algorithms, providing customised learning enhancing critical thinking of individual learners. "Firecracker" - an online adaptive e-learning platform, and assessment software, promotes critical thinking, helps prepare students for courses and high-stakes examinations, and evaluates progress relative to co-learners. The objectives of this study were to determine the usage rates of Firecracker, examine the performance of Firecracker formative quizzes, identify the correlation between Firecracker use and performance with that of performance at summative course assessments, and assess students' satisfaction with Firecracker usage.

METHODS

Study participants were Year-2 MBBS (Bachelor of Medicine, Bachelor of Surgery) students (n=91) of the Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados. The Firecracker Administrator uploaded quizzes covering basic science content in the Cardiovascular System course. Access, usage, and performance on Firecracker formative quizzes were retrieved from the Firecracker dashboard. A questionnaire sought the views of study participants.

RESULTS

Seven sets of quizzes were administered over nine weeks, with weekly student completion rates ranging from 53% to 73%. Mean quiz scores ranged from 52% to 72%. Students completing >4 quiz sessions compared to those completing ≤4 demonstrated significantly better performance in Firecracker quizzes (P<0.01), final examinations (P<0.01) and in-course assessment plus final examination (P<0.05) scores. Correlations between overall Firecracker performance and in-course assessment marks (P<0.05); between total overall Firecracker performance and final examination (P<0.01); and overall Firecracker performance and total course marks (P<0.01) were all significant. Most students (70%) were happy using Firecracker and felt it complemented coursework (78%) and prepared them for course exams (58%) (P<0.01).

CONCLUSION

Overall, Firecracker was perceived very positively and welcomed by the students. Students were satisfied with the Firecracker as a formative assessment tool, and its use correlated with improved performance in the course examinations.

An evaluative study of objective structured clinical examination (OSCE): students and examiners perspectives

Background: The objective structured clinical examination (OSCE) is the gold standard and universal format to assess the clinical competence of medical students in a comprehensive, reliable and valid manner. The clinical competence is assessed by a team of many examiners on various stations of the examination. Therefore, it is found to be a more complex, resource- and time-intensive assessment exercise compared to the traditional examinations. Purpose: The objective of this study was to determine the final year MBBS students' and OSCE examiners' perception on the attributes, quality, validity, reliability and organization of the Medicine and Therapeutics exit OSCE held at the University of the West Indies (Cave Hill) in June 2017. Methods: At the end of the OSCE, students and examiners were provided with a questionnaire to obtain their views and comments about the OSCE. Due to the ordinal level of data produced by the Likert scale survey, statistical analysis was performed using the median, IQR and chi-square. Results: A total of 52 students and 22 examiners completed the questionnaire. The majority of the students provided positive views regarding the attributes (eg, fairness, administration, structure, sequence, and coverage of knowledge/clinical skills), quality (eg, awareness, instructions, tasks, and sequence of stations), validity and reliability (eg, true measure of essential clinical skills, standardized, practical and useful experiences), and organization (eg, orientation, timetable, announcements and quality of examination rooms) of the OSCE. Similarly, majority of the examiners expressed their satisfaction with organization, administration and process of OSCE. However, students expressed certain concerns such as stressful environment and difficulty level of OSCE. Conclusion: Overall, the OSCE was perceived very positively and welcomed by both the students and examiners. The concerns and challenges regarding OSCE can be overcome through better orientation of the faculty and preparation of the students for the OSCE.

Teaching anatomy using an active and engaging learning strategy

BACKGROUND

Various evidence-based and student-centered strategies such as team-based learning (TBL), case-based learning (CBL), and flipped classroom have been recently applied to anatomy education and have shown to improve student engagement and interaction. These strategies shift the focus of teaching from knowledge transmission to knowledge construction by students and encourage the use of tasks. This study discusses the use of an active and engaging learning strategy to teach the musculoskeletal system to Year 1 MBBS students (Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados) and examines the correlation between assessment modalities and student performance.

METHODS

The "Active and Engaging Learning Strategy" was used to assess student learning in the form of oral presentations. Students had presentations on muscle attachments, muscle actions, blood and nerve supply, and applied anatomy of the limb musculature. Questions on the limbs (Locomotor System) were included in pre and post-presentation spotters, in-course assessments, and final examinations. Percentages, paired t-test, independent sample t-test, and zero-order correlations were performed to confirm the results for the different objectives of the study.

RESULTS

The main modes of presentation chosen were poems (37.1%), followed by stories (21.2%), songs (11.4%), and skits (10.6%). The majority of students (84%) found the strategies beneficial and recommended such sessions for future cohorts (92%). Students achieved significantly better scores in post-presentation spotters (p < 0.01) and the marks of in-course and final examinations also showed significant improvement (p < 0.01).

CONCLUSION

Our study highlighted that the active and engaging learning strategy can be used as an effective learning tool in anatomy. Students were proactive in preparing the muscle presentations by utilizing their own creativity, curiosity, and intelligence. Further studies should be conducted using randomized controlled trials to assess the effectiveness of various learning strategies which could open a new door to medical education.

Barbados Insulin Matters (BIM) study: Perceptions on insulin initiation by primary care doctors in the Caribbean island of Barbados

AIMS

With regards to insulin initiation in Barbados we explored primary care doctor (PCD) perception, healthcare system factors and predictors of PCD reluctance to initiate insulin.

METHODS

PCDs completed a questionnaire based on the theory of planned behaviour (TPB) and a reluctance to initiate insulin scale. Using linear regression, we explored the association between TPB domains and the reluctance to initiate insulin scale.

RESULTS

Of 161 PCDs, 70% responded (75 private and 37 public sector). The majority felt initiating insulin was uncomplicated (68%) and there was benefit if used before complications developed (68%), but would not use it until absolutely necessary (58%). More private than public sector PCDs (p<0.05) thought that the healthcare system allowed enough flexibility of time for education (68 vs 38%) and initiating insulin was easy (63 vs 35%), but less thought system changes would help initiating insulin (42 vs 70%). Reasons for reluctance to initiate insulin included patient nonadherence (83%) and reluctance (63%). Only the attitudes and belief domain of the TPB was associated with the reluctance to initiate insulin scale (p<0.001).

CONCLUSIONS

Interventions focusing on PCD attitudes and beliefs and restructuring services inclusive of the use of diabetes specialist nurses are required.

Risk behaviour, healthcare access and prevalence of infection with Chlamydia trachomatis and Neisseria gonorrhoeae in a population-based sample of adults in Barbados

OBJECTIVES

To estimate the prevalence of urogenital infection with Chlamydia trachomatis and Neisseria gonorrhoeae in people 18 to 35 years of age in Barbados, and to examine factors associated with infection.

METHODS

Cross-sectional survey of randomly selected people from the voters' register of one electoral district and the collection of urine samples for testing by PCR.

RESULTS

The response rate was 82%; 408 people (195 males and 213 females) completed a questionnaire and had their urine collected. 397 urine samples were satisfactorily tested. Prevalence of C trachomatis urogenital infection was 11.3% (95% CI +/-2.9) and N gonorrhoeae 1.8% (95% CI +/-1.2) with 12.6% (95% CI +/-3.1) having either or both infections. The difference in prevalence by gender was not significant. Multivariate logistic regression showed that prevalence of C trachomatis and/or N gonorrhoeae decreased with increasing age (per year OR 0.89, 95% CI 0.84 to 0.96, p = 0.001), and decreasing time (</=6 months vs >6 months) since last medical consultation (OR 0.44, 95% CI 0.22 to 0.88, p = 0.02). Most (76%) infected people were asymptomatic. Condom use at last intercourse with a partner not being lived with was not protective (reported by 52%, p = 0.617). The usual source of health care was evenly distributed between the public and private sectors and was not associated with infection. Only 30% of people had ever heard of chlamydia, whereas 92% were aware of gonorrhoea.

CONCLUSIONS

Asymptomatic infection with C trachomatis is an important reservoir of infection, which will remain undetected unless physicians and young people are made aware of this and screening is introduced.

Necrotizing haemorrhagic colitis caused by resistant Shigella flexneri. Report of a case

A case of fatal infection with Shigella flexneri is reported. The 19-year-old male patient who presented with fulminating haemorrhagic colitis died nine days after the onset of symptoms. The infecting strain of Shigella flexneri was resistant to multiple antimicrobial agents, including amoxycillin, co-trimoxazole and chloramphenicol.