Family Medicine Resident Experience Toward Workplace-Based Assessment Form in Improving Clinical Teaching: An Exploratory Qualitative Study

Background

Workplace-Based Assessment (WPBA) has been widely utilized for assessing performance in training sites for both formative and summative purposes. Currently, with the recently updated duration of the family medicine (FM) training program in Saudi Arabia from four years to three years, the possible impact of such a change on assessment would need to be investigated. This objective was to explore the experiences of FM residents regarding the usage of WPBA as an assessment tool for improving clinical teaching at King Abdulaziz Hospital (KAH), Al Ahsa, Saudi Arabia.

Methods

The study involves an exploratory qualitative phenomenological approach targeting family medicine resident in KAH was used. Purposive sampling techniques were used. In this descriptive study, data was collected through the utilization of 1:1 semi-structured interviews guided by directive prompts. All recorded interviews were transcribed verbatim. An inductive analytical approach was applied for thematic analysis of transcripts.

Results

Fifteen participants were individually interviewed until data saturation was reached. The themes that emerged were organized into the categories of underlying principles of WPBA, the impact of the learning environment, associated opportunities and challenges, and making WPBA more effective. Participants expressed that the orientation provided by the program was insufficient, although the core principles were clear to them. They valued the senior peers' support and encouragement for the creation of a positive learning environment. However, time limit, workload, and a lack of optimum ideal implementation reduced the educational value and effectiveness of WPBA among senior residents.

Conclusion

The study examined residents' experiences with WPBA and concluded that low levels of satisfaction were attributed to implementation-related problems. Improvements should be made primarily in two areas: better use of available resources and more systematic prior planning. Revision and assignment of the selection process were suggested, in addition to the implementation of the new curriculum. The research will assist stakeholders in selecting and carrying out evaluation techniques that will enhance residents' abilities.

The Prevalence of Mood Disorders Among Health and Non-health Undergraduate Students in King Saud University, Riyadh, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Mood disorders (MDs) are among the most common of all mental health diagnoses, with increasing prevalence and a devastating impact on individuals, families, and the community. This study aimed to estimate the frequency of MDs among health and non-health profession students.

MATERIALS AND METHODS

A cross-sectional survey was conducted on 391 students to estimate the self-reported prevalence of different MDs and to screen for bipolar disorder (BD) using the mood disorder questionnaire (MDQ) and for depressive, anxiety, and stress symptoms using the Depression, Anxiety, and Stress Scale - 21 items (DASS-21).

RESULTS

MDs were reported by 24.9% (n=50) of health profession students and 22.8% (n=31) of non-health profession students. For BD, it affected 35.3% of students in the health profession and 47.4% (n=46) of students without the health profession, although the difference was not statistically significant. The most reported MDs among health and non-health profession students were major depression (4.9% vs. 4.2%), seasonal affective disorder (SAD) (3.3% vs. 2.1%), dysthymia (2.4% vs. 2.8), and BD (2% vs. 2.8%), respectively. None of the observed differences between the two groups were statistically significant. According to DASS-21 scores for health and non-health profession students, severe depressive and severe anxiety symptoms were more common among non-health students (45.1% and 59.3%, respectively) than among health profession students (41.4% and 51.1%, respectively). However, stress was higher among health-related than non-health-related students (19.4% and 18.1%, respectively).

CONCLUSIONS

MDs constitute a high burden among university students regardless of their field of study, creating an increased urgency to incorporate ways to promote the mental well-being of students and to manage those with an MD. Further research is needed to identify effective preventive strategies for depression in the future.

Comparing Knowledge Acquisition and Retention Between Mobile Learning and Traditional Learning in Teaching Respiratory Therapy Students: A Randomized Control Trial

PURPOSE

Mobile learning (m-learning) is one of the trends in health professions' education. It has a promising future in education, but it also presents various challenges and risks. This research seeks to highlight some of the greatest accomplishments, opportunities, and issues related to m-Learning in teaching and learning. We believe the findings help us maximize the positive effects of m-Learning while minimizing any potential drawbacks associated with the technological changes taking place in education. The study aimed to compare respiratory therapy students' knowledge acquisition and retention between using m-learning and traditional learning.

PARTICIPANTS AND METHODS

Randomized pre-test, post-test, control group design was used. All 3rd year (N = 46) respiratory therapy students in one governmental university in Saudi Arabia were randomly assigned to either intervention or control group. Both groups took the same content of arterial blood gas lecture for 2 hours. The intervention group took the lecture using m-learning; two mobile apps: (1) ABG Book, (2) Arterial Blood Gas (Lite). The traditional learning (lecture-based learning) was used for the control group. The same test was conducted before, immediately after, and two weeks after the lecture. The duration of the test was 30 minutes. The data were analyzed using independent t-test and repeated measured ANOVA using p < 0.05. IRB Approval was obtained.

RESULTS

Forty-five students participated. Although no statistically significant difference was found on knowledge acquisition and retention between the two types of learning (p = 0.305, p = 0.904, respectively), it was found among the three time-points within each group (p < 0.001).

CONCLUSION

Both m-learning and traditional learning are effective in increasing knowledge acquisition and retention. However, no one is better than the other. Further researches were needed with larger sample size through multi-institutional studies to validate the results of this study.

Medical Education in the Context of the Eastern Mediterranean Region: Professional Development Activity of Health Professionals

Background

The development and maintenance of a high-quality medical education workforce depend on continuing medical education (CME). Traditionally, CME is delivered face-to-face, but due to COVID-19 and geographical distances, it is challenging to conduct professional development activities for several days. Using a webinar on advancement in medical education in the context of the eastern Mediterranean, we aimed to assess the participants' perspectives towards the professional development activity using a synchronous learning approach.

Methods

We used a cross-sectional survey-based study design. We invited faculty members from King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) and United Arab Emirates University for Health Sciences (UAEU). We assessed their perspectives on the relevance of the content and effectiveness of the activity on their knowledge and skills after the two days' webinar series. A self-designed questionnaire was administered post-webinar immediately. Open-ended responses were analyzed thematically.

Results

One hundred thirty-six registered healthcare professionals attended day 1, and 97 registered participants joined on the second day of the webinar. Most participants appreciated the diversity of the contents, the quality of the presentations, and the expertise of the facilitators. They reported that the content optimized their knowledge and understanding of new concepts such as assessment in simulation teaching, programmatic assessment, insight into the implementation of IPE and EPAs in CBME, and so on. The e-learning platform's user accessibility, online tutor interaction, and the addition of more scenario-based case studies were all recommended for improvement.

Conclusion

Overall the two days webinar series presentations were informative and highlighted the transformation in medical practices. Suggestions to improve the quality of the webinars and content were discussed.

The Job Demands in Predicting Burnout During COVID-19 Among Teaching Faculty at KSAU-HS, Jeddah, Saudi Arabia

PURPOSE

This study aimed to assess the burnout among faculty members of King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, during the COVID-19 pandemic and investigate their adaptations to online teaching.

PATIENTS AND METHODS

The study utilized a survey research design, and a validated questionnaire was e-mailed to faculty members. The Maslach Burnout Inventory - Educators Survey was used to assess burnout in three domains (emotional exhaustion, depersonalization, and personal accomplishment), in addition to their adaptations to online teaching.

RESULTS

A total of 112 faculty members completed the survey with a response rate of 25%. Females comprised 50.9% of the sample. Burnout assessment among faculty showed moderate emotional exhaustion and personal accomplishment. In contrast, the level of depersonalization was low. When assessing the impact of the shift to online education during the pandemic, 87.5% of the respondents reported increased confidence in online teaching and learning effectiveness.

CONCLUSION

Faculty members at KSAU-HS reported moderate emotional exhaustion. Fortunately, this had a moderate impact on students' intellectual development and well-being. Most of the faculty feedback supported online teaching during the pandemic.

Orientation of Healthcare Educators Towards Using an Effective Medical Simulation-Based Learning: A Q-Methodology Study

PURPOSE

This study explores the healthcare educators' orientations about medical simulation in clinical skills training -its benefits, needs, challenges, and implications for proper implementation and integration into curricula.

METHODS

The study used a Q-sort technique, allowing quantitative and qualitative representation of the participants' orientations and was conducted at King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A total of 22 healthcare educators from different roles were included. Participants pre-sorted into three categories and then ranked statements related to medical simulation, by level of agreement, and they answered open-ended and demographic questions. Data was uploaded to Ken-Q Analysis application to conduct Q-factor analysis.

RESULTS

A total of 22 healthcare educators participated in the study. Q-factor analysis was performed with principal component analysis and varimax rotation, identifying three factors. Most educators shared a similar orientation regarding the benefits of using simulation-based learning. Most participants considered medical simulation a simple, effortless, and beneficial method of learning. However, challenges in scheduling sessions and obtaining the necessary resources, such as human resources and funds, and lack of training had a negative impact on some participants' motivation to use medical simulation.

CONCLUSION

Healthcare educators shed light on the influence of multiple factors on using medical simulation. The possibility for students to learn practical and clinical skills was a leading factor. Financial resources, funds, and faculty training were identified as challenges and needs. It is important for institutions and leaders to be aware of the variations in faculty perceptions and to provide resources and training to improve the current use of medical simulation.

Knowledge and Attitude Towards Corneal Donation

Objectives

To attain more local corneal donations, awareness of corneal donations must be raised among doctors and medical students. This study aimed to evaluate the knowledge and attitude of medical students regarding corneal donations.

Methods

This cross-sectional study was conducted among male fifth- and final-year medical students at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia, between August and October 2019. Non-probability convenience sampling was used and an English-language self-administered questionnaire was administered to evaluate different aspects of the participants’ knowledge regarding and attitudes towards corneal donation. Data were analysed using descriptive statistics, analysis of variance, and independent samples t-test.

Results

A total of 141 students participated in this study (response rate: 53%). A mean score of 3.24 ± 1.86 was achieved by the participants on the knowledge test. Approximately 47% of the sample correctly recognised that people who die of AIDS cannot donate an eye. The most common reason for eye donations was to provide vision to a blind person (47%), while a lack of understanding of benefits to others (55%) and religious beliefs (44%) were seen barriers. The internet was identified by 56% as the most common source of information. There was no significant difference in the knowledge of fifth-year and final-year medical students (3.31 ± 1.84 versus 3.17 ± 1.89; P = 0.65).

Conclusion

This study showed a low level of knowledge of corneal donations among the participants. Raising awareness among medical students is important to increase donation rates. However, media and the internet are not enough to achieve this. Basic knowledge of corneal donations to students by organising awareness-raising activities and motivating them for voluntary participation is important to fill this knowledge gap.

Emotional Intelligence and its Association with Academic Success and Performance in Medical Students

Background

Emotional intelligence (EI) is potentially associated with higher academic performance. However, no study from the Gulf region has previously assessed if EI affects academic success and academic performance in medical students.

Objectives

To examine the relationship between EI and academic success and academic performance in a sample of Saudi Arabian medical students.

Methods

This cross-sectional, questionnaire study included all 4^th-6^th year medical students enrolled at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia, in the academic year 2017-18. Eligible students were invited to complete the self-administered Schutte Self-Report Emotional Intelligence Test and the Academic Success Inventory for College Students (ASICS) along with a questionnaire eliciting demographic information between January and April 2018. Academic achievement was assessed based on each student's self-reported grade point average in the most recent examination.

Results

Of 377 eligible students, 296 (78%) completed the questionnaires. A significant association was identified between overall EI and ASICS scores (r = 0.197; P < 0.001). EI scores were constant in males and females and the year of study. No statistically significant association was observed between EI and academic success across gender and academic years (P > 0.05 for all values). However, in terms of external motivation and career decidedness by level of study, final-year students had higher scores compared with students in the other two study years (P = 0.02 and P = 0.01, respectively).

Conclusion

This study offers primary data on the impact of EI scores on academic success in medical education, and it identified several factors associated with EI and academic success. The findings of this study suggest that EI and academic success are linked, and that both are vital for increasing academic performance.

Introducing free response short answer questions in anatomy spot tests: experiment study

PURPOSE

A spot test is commonly used to assess practical knowledge through a series of specific questions related to the marked anatomical structures on cadavers. However, the continuous reviewing and developing of the medical curricula demands the need to improve the assessment method of the practical examination of anatomical knowledge. Therefore, the aim of the study was to examine the effectiveness of a free response short-answer questions (FRSAQs) test and traditional questions on medical students' performance.

METHODS

This is an experimental study using a Randomized Posttest-Only Control Group Design to compare the mean of students' performance in addition to their perceptions about the two versions of the spot tests. Two hundred and ninety preclinical-year medical students were invited to participate in this study.

RESULTS

Only 109 (38%) students participated in this study. The data analysis showed a significant improvement in students' performance in the FRSAQs test (5.3 ± 2.7) than the traditional spot test (4.7 ± 2.6), (P = 0.04). The majority of the students (70%) preferred the FRSAQs spot test, citing that it is good test to assess practical knowledge. The psychometric analysis revealed that the FRSAQs produced more ideal stations (60%) when compared to the traditional spot test (10%).

CONCLUSION

The current study found that the FRSAQs spot test had a significant impact on students' performance, and it was considered an ideal, flexible, and stress-free assessment method when compared to the traditional spot test. Implementation of the strategy in teaching and in assessment is recommended.

Why psychiatry as a career: Effect of factors on medical students' motivation

Context

The number of Saudi psychiatrists in Saudi Arabia is not sufficient to keep up with the increasing need.[1] Approximately out of 6873 physicians, only 148 are psychiatrists, which is barely 2.1%.[2] Despite the high number of medical students graduating each year and the high demand for psychiatry physicians, only few medical graduates choose psychiatry as a career option.[3].

Aims

To investigate the profile of final year medical students of both sexes at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. In terms of their decisions regarding specialization, this study aimed to identify the motivators and deterrents that impact the choice of psychiatry as specialty.

Subjects and Methods

Students filled in a self-reported questionnaire focusing on the several factors that act as motivators, deterrents, or have no impact on psychiatry career choice.

Statistical Analysis Used

Statistical analysis was done using Statistical Package for Social Sciences (SPSS)^® version 20. Different factors were expressed in terms of numbers and percentages. Chi-square test was used to compare responses to the questionnaire between male and female students and whether the GPA had an effect on their choice. P value less than 0.05 was considered significant.

Results

It was noted that 85% did not choose psychiatry, with the most important deterrent being "Family member is psychologically ill" and "Available job position" being the most common motivator for choosing a specialty.

Conclusion

In conclusion, there are many factors that play an important role in career choice. No difference was found among male and female students, and no effect was identified while comparing GPA with career choice.

Effect of simulation based education for learning in Medical Students: A mixed study method

This mixed method study was planned to assess the medical students' experience with simulation-based learning and to identify the issues associated with the application of simulation-based education for experiential learning. Quantitative and qualitative data was collected respectively through a structured questionnaire answered by 145 undergraduate medical students and focus group interviews with six internees who experienced and practised clinical skills with simulators during academic years at King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, between March and April 2017. Although overall respondents were satisfied with simulation-based education, lower satisfaction was identified in areas of available facilities, allocated time for skill labs and debriefing sessions. Three emerging themes that affected simulation-based education were identified as: shared benefits, professional development, and support and improved governance. Several important areas that needed improvement were recognised. The outcome of the study can be used to include more practice on simulators and skilled tutors.

Prevalence of primary headache among medical students at King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Background

Headache is among the commonest complaints in medical students; it could be due to many physical or psychological stressors. It has two main types: primary (including tension-type, migraine, and cluster) and secondary. The aim of this study is to assess the prevalence of headache among male and female medical students.

Materials and Methods

This study was conducted at KSAU-HS, COM, in January 2018. Third- and fourth-year medical students from both genders who have experienced headache throughout their life or are experiencing it for the past 3 months were included in this study. All medical students completed filling the questionnaire, which consisted of demographical data, headache characteristics and triggers, and associated symptoms.

Results

A total of 264 [150 (56.81%) males and 114 (43.19%) females] students were evaluated. The prevalence of headache was 53.78%, and the prevalence of tension-type headache was 41.66%. The prevalence of migraine headache was 7.1%. Only one case of cluster headache was detected. Those who did not fit the criteria for the primary types were categorized as unspecified headache. The prevalence of unspecified headache was 3.78%.

Conclusion

We can conclude from the study that tension-type headache is commonly reported in medical students. It is imperative to provide a stress-free study environment where students can perform more effectively, and sessions on how to reduce stress and alleviate fatigue are highly recommended.

Breeding for robustness: investigating the genotype-by-environment interaction and micro-environmental sensitivity of Genetically Improved Farmed Tilapia (Oreochromis niloticus)

Robustness has become a highly desirable breeding goal in the globalized agricultural market. Both genotype‐by‐environment interaction (G × E) and micro‐environmental sensitivity are important robustness components of aquaculture production, in which breeding stock is often disseminated to different environments. The objectives of this study were (i) to quantify the degree of G × E by assessing the growth performance of Genetically Improved Farmed Tilapia (GIFT) across three countries (Malaysia, India and China) and (ii) to quantify the genetic heterogeneity of environmental variance for body weight at harvest (BW) in GIFT as a measure of micro‐environmental sensitivity. Selection for BW was carried out for 13 generations in Malaysia. Subsets of 60 full‐sib families from Malaysia were sent to China and India after five and nine generations respectively. First, a multi‐trait animal model was used to analyse the BW in different countries as different traits. The results indicate a strong G × E. Second, a genetically structured environmental variance model, implemented using Bayesian inference, was used to analyse micro‐environmental sensitivity of BW in each country. The analysis revealed the presence of genetic heterogeneity of both BW and its environmental variance in all environments. The presence of genetic variation in residual variance of BW implies that the residual variance can be modified by selection. Incorporating both G × E and micro‐environmental sensitivity information may help in selecting robust genotypes with high performance across environments and resilience to environmental fluctuations.

Muscle lipid metabolism in two rabbit lines divergently selected for intramuscular fat

A divergent selection experiment for intramuscular fat (IMF) of LM at 9 wk of age was performed in rabbits. The objective of this work was to compare the lipid metabolism in muscles and fat tissues of the high-IMF and low-IMF lines. Lipogenic, catabolic, and lipolytic activities were studied in 2 muscles with different oxidative patterns (LM and semimembranosus proprius) and in the perirenal fat depot at 2 ages, 9 and 13 wk. In addition, adipocytes were characterized in perirenal fat. In the fifth generation, direct response to selection was 0.26 g IMF/100 g muscle. Lines showed differences in their lipogenic activities of muscles and fat tissues at 13 wk but not at 9 wk. The high-IMF line showed greater glucose-6-phosphate dehydrogenase (G6PDH), malic enzyme (EM), and fatty acid synthase (FAS) activities in LM than the low-IMF line, with probabilities = 1.00, 0.93, and 0.90, respectively. Differences between lines were particularly great for G6PDH activity, representing 1.13 SD. The high-IMF line also showed greater G6PDH and FAS activities in semimembranosus proprius (P = 0.98 for G6PDH and 0.95 for FAS) and perirenal fat (P = 0.91 for G6PDH and 0.96 for FAS). However, in perirenal fat, EM activity was greater in the low-IMF line (P = 0.90). No differences between lines were found in almost any catabolic or lipolytic activities of muscles. Regarding adipocyte characteristics, the high-IMF line showed larger adipocytes in perirenal fat depot tissue (P = 0.97) compared to the low-IMF line, but no differences between lines were observed in the number of adipocytes. This study sheds light on the metabolic activities involved in the genetic differentiation of lipid deposition in rabbits. This study shows that lipogenic activities in muscles and fat tissues, in particular G6PDH in LM, are involved in the lipid accumulation in muscle and adipose tissues.

Are Saudi medical students aware of middle east respiratory syndrome coronavirus during an outbreak?

Recently, an outbreak of MERS-CoV occurred in King Abdulaziz Medical City (KAMC), Riyadh. This outbreak contributed to the students at the King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) becoming more involved in promoting health awareness in their communities. This was a cross-sectional study that evaluated students in the clinical phase of medical school. The data were collected by an online questionnaire. The measurements were obtained using a researcher-administered and a self-reported questionnaire that had been previously validated. A p-value of less than 0.05 was considered statistically significant. One hundred and thirty-six students participated and showed good awareness regarding the clinical aspects of MERS, such as etiology, diagnosis, management, and prevention. However, 76% of the students were not aware of the mortality rate. Conversely, this study uncovered a low level of awareness in the basic sciences. Interestingly, fifth year medical students were more familiar with the incubation period than final year students (p-value <0.05). Regarding gender differences, more female students were knowledgeable about the incubation period and the possible asymptomatic presentation of the disease than male students (p-value <0.05). However, male students were more aware of the diagnostic tests for MERS than their female counterparts. Medical students were knowledgeable about the clinical aspects of MERS but were lacking background awareness in the basic sciences.

Satisfaction of medical students with simulation based learning

Objectives:

To evaluate medical students’ satisfaction with simulation based learning strategy (SBL).

Methods:

A cross-sectional survey was conducted between October and November 2013 at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. All third and fourth year medical students (n=185) both males and females were included. A self-developed questionnaire on the effect of SBL was used. Items included were related to knowledge, skill, environment, resources, and faculty. The questionnaire was validated by an expert reviewer, and the reliability was calculated for all the questionnaire items. Responses were measured on a 5 point Likert-type scale, and statistical analysis was carried out.

Results:

The response rate for this study was 62% (n=115). The alpha coefficient for all items was 0.73. Overall, respondents from both years’ students were satisfied with teaching strategy, use of mannequins, and learning environment. The challenges reported were lack of skill-laboratories facilities, students’ cooperation, allocated time for skill-laboratories, and knowledge of instructor. There was a small, but significant difference between the satisfaction scores among genders (p=0.001). Whereas no difference was identified between the participants’ scores on satisfaction with SBL and year of education (p=0.62).

Conclusion:

Although there were few challenges, most of the students were satisfied that SBL improved their knowledge retention, skills, and communication.

The impact of a mass media campaign on personal risk perception, perceived self-efficacy and on other behavioural predictors

To determine whether an AIDS prevention mass media campaign influenced risk perception, self-efficacy and other behavioural predictors. We used household survey data collected from 2,213 sexually experienced male and female Kenyans aged 15-39. Respondents were administered a questionnaire asking them about their exposure to branded and generic mass media messages concerning HIV/AIDS and condom use. They were asked questions concerning their personal risk perception, self-efficacy, condom effectiveness, condom availability, and their embarrassment in obtaining condoms. Logistic regression analysis was used to determine the impact of exposure to mass media messages on these predictors of behaviour change. Those exposed to branded advertising messages were significantly more likely to consider themselves at higher risk of acquiring HIV and to believe in the severity of AIDS. Exposure to branded messages was also associated with a higher level of personal self-efficacy, a greater belief in the efficacy of condoms, a lower level of perceived difficulty in obtaining condoms and reduced embarrassment in purchasing condoms. Moreover, there was a dose-response relationship: a higher intensity of exposure to advertising was associated with more positive outcomes. Exposure to generic advertising messages was less frequently associated with positive health beliefs and these relationships were also weaker. Branded mass media campaigns that promote condom use as an attractive lifestyle choice are likely to contribute to the development of perceptions that are conducive to the adoption of condom use.

Psychological problems and family functioning as risk factors in addiction

OBJECTIVES

The purpose of the present research was to determine the role of family functioning and psychological problems of drug addicts and non addicts by assessing the difference between the two groups. After detailed literature review it was hypothesized that scores on the variable of communication, affective expression and control among family members of addicts will be higher than non addicts. Furthermore scores on the variables of anger control problems, emotional distress and positive self will also be higher of addicts.

METHODS

This was a cohort study. A cluster sampling method was used. Sample of present research consisted of 240 adolescents divided into two groups of 120 addicts and 120 non-addicts each from different socio-economic status. General scale of Family Assessment Measure-Version III (FAM-III) was administered in order to measure the level of communication, value and norms whereas dyadic Relationship Scale was used to measure affective expression and control among the family members of addicts and non addicts. Renold Adolescent Adjustment Screening Inventory was administered in order to assess anger control problems, emotional distress and positive self in addicts and non addicts. t-test was calculated in order to determine the difference in the level of communication, value and norms, affective expression and control among families of addicts and non addicts. Furthermore difference in anger control problems, emotional distress and positive self between the addicts and non addicts was also determined by calculating t-test.

RESULTS

Results showed significant differences in the variables among the family members and there is also a significant difference between addicts and non addicts.

CONCLUSION

Avenues for further research have been suggested.

Selection procedure as predictor of performance in university examination

OBJECTIVE

To determine the correlation of SSC, HSC, ZMU achievement test and interview scores with the scores achieved in MBBS 1st, 2nd and 3rd Professional Examinations.

METHOD AND PROCEDURE

The SSC, HSC, ZMU admission test and interview scores of 159 MBBS students admitted in 1995, 1996 and 1997 were correlated with the scores of the 1st, 2nd and 3rd professional examinations. Data analysis was done on SPSS Software.

RESULTS

No significant relationship was found between the SSC, HSC, ZMU admission test and interview scores and the scores obtained in the professional examinations. SSC scores did not correlate with any variables/matrices, whereas for batches 1 and 2 the HSC school leaving examination scores correlated significantly with ZMU interview score (p < 0.05). No correlation was found between ZMU test and ZMU interviews. Results showed significant relationship (p < 0.01) between all 1st, 2nd and 3rd professionals of all three batches.

CONCLUSION

None of the admission criteria (SSC, HSC, ZMU admission test and interview scores) predict the performance of medical students in the professional examinations.

The promotion of condom use in non-regular sexual partnerships in urban Mozambique

This study uses data from a representative sample of sexually active adults in urban Mozambique to examine the effectiveness of the JeitO condom social marketing (CSM) project in increasing condom use among men and women at risk of contracting HIV. More specifically, this study tests the hypothesis that exposure to programme interventions (communications and access) increases condom use with non-regular partners. Exposure to the CSM programme is high, and multivariate analyses show that exposure to CSM advertising and communications and knowledge of a condom source are associated with higher reports of condom use with non-regular partners. Analyses of regional differences in condom use show that knowledge and use of condoms with non-regular partners are higher than the national average in all four provinces where the CSM project has been operating for longer (18 months vs. 6 months). Multivariate analyses show that the above-average level of condom use in the capital, Maputo, can be attributed to the higher socioeconomic status of this population, but the above-average level of condom use among men and women in Sofala and Manica provinces is due, in part, to their high level of exposure to the CSM programme. These findings indicate that the JeitO CSM project's behaviour-change communications and condom distribution are effective in encouraging safer sex practices among persons engaged in sex with non-regular partners.

Medical management of a large aortic thrombus in a young woman with essential thrombocythemia

Aortic thrombus formation is rare in the patients with essential thrombocytosis (ET); therefore, no guidelines for its management have been established. Embolism from ET-associated large vessel thrombi is potentially lethal and has been managed surgically in a few reported cases. We describe herein a 45-year-old black woman with ET found to have a 3.5-cm, pedunculated intra-aortic thrombus at the thoracoabdominal junction. How to treat this potentially devastating aortic thrombus was a management dilemma. We believed, based on the patient's diagnosis of ET and the histology of similar thrombi in 1 reported series, that the aortic thrombus was a "white thrombus" consisting primarily of aggregated platelets with a minimal fibrin network and almost no entrapped erythrocytes. The patient was treated with aspirin, 325 mg daily, as a platelet antiaggregating agent and hydroxyurea, 1,500 mg daily, to reduce the platelet count to less than 450 x 10(9)/L. The thrombus resolved without severe thromboembolic events. To our knowledge, this is the first reported case of a large intra-aortic thrombosis associated with ET that has been successfully managed with medical therapy alone.

Intention to use the female condom following a mass-marketing campaign in Lusaka, Zambia

OBJECTIVES

This report examines intention to use the female condom among men and women in Lusaka, Zambia, who were exposed to mass-marketing of the female condom.

METHODS

The study used data from a representative sample of consumers at outlets that sell or distribute the female condom and the male condom.

RESULTS

In spite of a high level of awareness of the female condom, use of this method in the last year was considerably lower than use of the male condom. Intention to use the female condom in the future was highest among respondents who had used only the female condom in the last year.

CONCLUSIONS

The female condom is likely to be most important for persons who are unable or unwilling to use the male condom.

Patterns of use of the female condom after one year of mass marketing

The female condom is an effective new contraceptive method that can reduce HIV transmission. This study examines use of the female condom after 1 year of its mass marketing and compares this with use of the male condom. It is based on exit interviews conducted among a random sample of male and female customers visiting outlets that sell the female condom. Compared with reported use of the male condom, which was five to eight times as high in nonmarital as in marital partnerships, reported use of the female condom varied less by partnership type (it was twice as high in nonmarital compared with marital partnerships). In marital and regular partnerships, use of the female and the male condom increased with socioeconomic status (SES). In casual partnerships, use of the male condom increased with SES, but use of the female condom was higher for those with lower SES. Men reported higher levels of male condom use than women, but there were no gender differences in use of the female condom. These findings suggest that the largest contribution to HIV protection through use of the female condom may be within marital partnerships and among low SES men and women who engage in casual sex. The absence of gender differentials in use of the female condom suggests that women are able to exert greater control over the use of the female condom than they are over the use of the male condom. However, the overall low levels of female condom use among relatively affluent persons at outlets that sell the female condom indicate that the introduction of the female condom will be resource intensive.

The determinants of infant mortality in Pakistan

This study examines factors associated with infant survival in Pakistan. It uses data from the Pakistan Integrated Household Survey 1991, a nationally representative sample survey of the Government of Pakistan, funded by the World Bank. The infant mortality rate was still very high in Pakistan until the early 1990s, at 100 deaths per 1000 live births. The study shows that there is no evidence of a secular decline in infant mortality during the 1980s. Large differentials in infant survival by socio-economic factors and access to water and sanitation indicate that social and gender inequities are the underlying cause of the stagnation of infant mortality in Pakistan. Economic and social policies of earlier decades have resulted in tremendous disparities in wealth and access to resources in Pakistan. The low social, economic and legal status of women is intimately tied to the well-being of their children. Health interventions in Pakistan should be designed to reach the most under-served: women and children. Systematic evaluations of health interventions will be necessary to make informed decisions about health investments in the future.

Is low income a constraint to contraceptive use among the Pakistani poor?

This paper examines whether low income is a barrier to contraceptive use in Pakistan, a country in which economic conditions are deteriorating at a time when the private sector is becoming a more important supplier of contraception. Multivariate regression analysis performed using the Pakistan Contraceptive Demand Survey suggests that low income is a deterrent to modern contraceptive use in Pakistan. This is particularly the case for contraceptive methods supplied through the private sector. It is concluded that, if the aim of family planning programmes is to reach low-income people, the prices of contraceptives supplied through the private sector should be kept as low as possible.

Perforation of jejunal diverticulum: case report and review of literature

We report the case of a 90-year-old woman, previously diagnosed with jejunal and colonic diverticula, who presented with left lower quadrant abdominal pain suggesting either colonic diverticulitis or ischemic colitis. A computed tomography scan revealed a perforated jejunal diverticulum with abscess formation. The patient promptly was treated surgically without complications. A review of the literature indicates the rarity of perforation of jejunal diverticula and the difficulty of early diagnosis. We discuss the etiology, pathogenesis, diagnosis, and management of this rare entity. It is important for primary care physicians to be familiar with this disease. Delay in work-up often results in catastrophic consequences.

Correlation of serum hepatitis C virus RNA titre with aminotransferases and liver histopathological findings in HCV-seropositive cases with end-stage chronic liver disease

The quantity of circulating hepatitis C virus (HCV) RNA, aminotransferases and the degree of liver cell injury in relation to HCV serotype have not been fully studied. In this work, we estimated the HCV RNA titre in serum and correlated the findings with levels of aminotransferases, gamma glutamyltransferase (GGT), and liver histopathological changes and with HCV serotype. HCV RNA was found in 22 out of 30 HCV-seropositive cases included in this study (73. 3%) and serotype 4 represented 90.9% (20/22). Levels of aminotransferases and GGT correlated with the levels of serum HCV RNA. Noticeably, GGT showed the highest positive correlation with the level of HCV RNA. Liver histopathological findings of 15 patients showed that eight had hepatocellular carcinoma and seven had cirrhosis. There was no significant difference between these two groups regarding levels of enzymes or serum HCV RNA titre.

Left atrial myxomas presenting with right hand weakness

A 63-year-old man with multiple left atrial myxomas presenting with right hand weakness is described. Two-dimensional echocardiography obtained during the evaluation for his stroke showed a large left atrial mass. At surgery, two separate left atrial myxomas were excised. Pathology confirmed the diagnosis. Although left atrial myxomas are uncommon, they should be included in the differential diagnosis of stroke, especially in patients who present without cardiovascular or cerebrovascular risk factors. The absence of cardiac symptoms and signs does not rule out a cardiac myxoma.

Evaluation of cell mediated immunity in advanced pancreatic carcinoma before and after treatment with interleukin-2 (IL-2)

BACKGROUND/AIMS

The administration of high doses of Interleukin-2 (IL-2) either alone or in combination with other cytokines demonstrated that immunologic manipulation is capable of mediating the regression of established cancer in humans. Thus, there is an urgent need to develop and evaluate the effect of treatment with IL-2 on immunological parameters and outcome of patients with inoperable pancreatic carcinoma.

METHODOLOGY

Twenty-one patients with advanced pancreatic cancer were the subjects of this study and all patients were diagnosed as unresectable pancreatic carcinoma on a clinical, surgical, radiological and laboratory basis. The patients were classified as group I: 10 patients treated by IL-2, and group II: 11 non-treated patients. We used a novel method of intra-arterial therapy. Patients in group I were subjected to surgical exploration for assessing the inoperability and catheterization of the splenic artery, gastroduodenal artery and hepatic artery in patients with liver metastasis. The course of therapy that started 15 days after catheterization included the following for 10 days, lipiodol 2.5ml, 0.5ml urographin 58%, and IL-2 1ml. After 15 days of immunostimulation bolus injection of chemotherapy was given including, lipiodol 10ml, urographin 2ml, mitomycin C 0.2mg/kg, carboplatin 1.5mg/kg, farmorubicin 1mg/kg, 5-fluorouracil 10mg/kg, and leukovorin 1.5mg/kg. Forty-five days following locoregional chemotherapy, the same procedure was followed in the same sequence with 10 daily courses of locoregional immunotherapy.

RESULTS

The results showed that there is a 70% relief of pain in group I compared to 0% in group II. Also, there is an improvement in body weight in 50% of group I in comparison to group II. Tumor size was decreased in 70% of the cases in group I. The mean survival was 11.9+/-4.9 months in group I compared to 5.6+/-1.5 in group II (p<0.0008). A highly significant increase of CD3 (p<0.0001), CD4 (p<0.001), CD8 (p<0.0001), CD16 (p<0.001), CD14 (p<0.0001), NK cytotoxicity (p<0.0001), T cell cytotoxicity (p<0.001), ICAM-1 (p<0.001), TNFalpha (p=0.001) IL-2 (p<0.001), and IL-2R (p=0.001) was seen in group I patients compared to group II patients.

CONCLUSIONS

Immunotherapy is a new modality for treatment of pancreatic carcinoma. Local administration of therapy seems to be an attractive way for delivering the optimum concentration of IL-2 target tissues avoiding the toxic side effects associated with high dose systemic treatment.

Transplacental transmission of hepatitis C virus in HIV-negative mothers

The aim of this work was to evaluate transplacental transmission of hepatitis C virus (HCV) in HIV-negative pregnant women who were HCV-PCR-positive, and also to determine the serotypes of the virus in these cases. Therefore, 767 pregnant women were screened for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and anti-HIV antibodies. HCV PCR was performed for HCV-positive women. Those who were PCR-positive were tested for anti-HCV IgM. Neonates of PCR-positive mothers were tested for virus transmission by the PCR test. Virus serotyping was done for mothers and neonates. Anti-HCV antibodies were detected in 105 out of 767 (13.7%) pregnant women. PCR was positive in 18 out of 67 HCV-positive women (26.9%). Transplacental transmission occurred in 11.1% of HIV-negative pregnant women. HCV type 4 predominates in Egypt (83.3%). Mothers who are PCR-positive and have high aspartate aminotransferase and positive anti-HCV IgM are most likely to transmit HCV to their babies.

Comparison of serum bile acids with standard liver function tests in the diagnosis of liver disease

Postprandial sera of seventy patients with liver disease (hepatitis 30, cirrhosis 19, liver cancer 21) were analysed for total serum bile acids. The mean values observed in hepatitis (169.0 mumol/L), cirrhosis (112.15) and liver cancer (86.44) were significantly higher (p less than 0.001) than in normal (19.45). The frequency of abnormal bile acids was greater than that of the standard liver function tests except for alkaline phosphatase in liver cancer.

Acute pulmonary oedema. A complication of upper airway obstruction

A case of postoperative laryngeal spasm is presented in which severe pulmonary oedema developed after the laryngeal spasm was relieved. The management is discussed and some suggestions for prevention of pulmonary oedema in similar circumstances made. The pathophysiology of pulmonary oedema after acute upper airway obstruction is described.