In the digital age of learning, new learning ecologies provide students with new web-based learning opportunities and resources. Medical education is reaching a new trend in teaching–learning methods by providing student-centered teaching. Flipped classroom is one among the teaching–learning methods. The contribution of the flipped classroom to education is discussed in relation to the changes in students’ and instructors’ roles. Subsequently, flipped classroom advantages and drawbacks are illustrated. For the current article literature was searched in databases PubMed and Scopus and only articles related to medical teaching were included. Studies on non-academic or informal settings without relevance to flipped classrooms were excluded. The study’s findings suggest that creating successful flipped classroom environments may be aided by carefully considering the cautions and suggestions given in the literature and also this article attempts to inform those who are thinking of using new technologies and approaches to deliver courses.
Tayebe Ghasemi Dehnavi, Zahra Yousefi, Hadi Farhadi
BACKGROUND: Marital satisfaction and positive emotional experience towards one's spouse has always been effective in preserving and surviving the family, therefore one of the concerns of family specialists is to improve these two structures in the family. This research was conducted with the aim of the effectiveness of imago therapy on marital satisfaction and emotional experience towards spouse among married men with conflict in Isfahan city.
MATERIALS AND METHODS: The research was semi-experimental with a pre-test and post-test design with experimental and control groups. The statistical population was all married and conflicted men of Isfahan city in the year 1400, from whom a sample of 40 people was selected as available and non-randomly placed in an experimental group and a control group. The measurement tools were Inridge marital satisfaction scale with Cronbach's alpha above 0.80 and emotional experience towards spouse with Cronbach's alpha above 0.92 for each subscale). Both research groups were evaluated by research tools before and after training. While the control group was on the waiting list, the experimental group received Imago therapy. The collected data were analyzed using descriptive statistics (mean and standard deviation) and inferential statistics (multivariate covariance analysis).
RESULTS: The results showed that imago therapy had a significant effect on the improvement of marital satisfaction and the dimensions of emotional experience towards the spouse (P = 0.01).
CONCLUSION: According to the present results, it can be said that this method can help family counselors to use this method to improve marital satisfaction and emotional experience towards the spouse and thereby reduce marital conflicts. He used this integrated method.
Special aspects of education, Public aspects of medicine
Daniela Andrea Paira, Daniela Andrea Paira, José Javier Olmedo
et al.
Chlamydia trachomatis is an obligate intracellular pathogen and the leading bacterial cause of sexually transmitted infections worldwide. Chlamydia trachomatis genovars L1–L3 are responsible for lymphogranuloma venereum (LGV), an invasive sexually transmitted disease endemic in tropical and subtropical regions of Africa, South America, the Caribbean, India and South East Asia. The typical signs and symptoms of C. trachomatis LGV urogenital infections in men include herpetiform ulcers, inguinal buboes, and/or lymphadenopathies. Since 2003, endemic cases of proctitis and proctocolitis caused by C. trachomatis LGV emerged in Europe, mainly in HIV-positive men who have sex with men (MSM). Scarce data have been reported about unusual clinical presentations of C. trachomatis LGV urogenital infections. Herein, we report a case of a 36-year-old heterosexual, HIV-negative male declaring he did not have sex with men or trans women, who presented to the Urology and Andrology outpatient clinic of a healthcare center from Cordoba, Argentina, with intermittent testicular pain over the preceding 6 months. Doppler ultrasound indicated right epididymitis and funiculitis. Out of 17 sexually transmitted infections (STIs) investigated, a positive result was obtained only for C. trachomatis. Also, semen analysis revealed oligoasthenozoospermia, reduced sperm viability as well as increased sperm DNA fragmentation and necrosis, together with augmented reactive oxygen species (ROS) levels and the presence of anti-sperm IgG autoantibodies. In this context, doxycycline 100 mg/12 h for 45 days was prescribed. A post-treatment control documented microbiological cure along with resolution of clinical signs and symptoms and improved semen quality. Strikingly, sequencing of the ompA gene revealed C. trachomatis LGV L2 as the causative uropathogen. Remarkably, the patient did not present the typical signs and symptoms of LGV. Instead, the infection associated with chronic testicular pain, semen inflammation and markedly reduced sperm quality. To our knowledge, this is the first reported evidence of chronic epididymitis due to C. trachomatis LGV L2 infection in an HIV-negative heterosexual man. These findings constitute important and valuable information for researchers and practitioners and highlight that C. trachomatis LGV-L2 should be considered as putative etiologic agent of chronic epididymitis, even in the absence of the typical LGV signs and symptoms.
Background: Essential medicines are important in the provision of healthcare services. In order to promote effective management of diseases, essential medicines should be consistently available at various healthcare service points. However, in several parts of South Africa and other African countries, there are challenges with essential medicines provisioning, as evidenced by public health sector stock-outs occurring when patients visiting the healthcare services do not get all the medicine prescribed for their health conditions. This research investigated the problems involved in the provision of essential medicines in order to propose strategies that will reduce medicine stock-outs.Aim: This study aimed to investigate the problems involved in the provision of essential medicines within the district healthcare services in order to propose strategies to promote reduction in medicine stock-outs.Method: A qualitative exploratory research design was utilised. Data collection was carried out through semi-structured interviews with pharmaceutical managers identified as information-rich participants, as they have first-hand experience in the provision of essential medicines. The data were analysed using thematic analysis.Results: The study identified the various aspects including inadequate appointment of post-basic pharmacist assistants and manual medicine stock management systems have a negative impact on medicines provisioning in the public health sector. Rural health facilities experience more challenges with essential medicines provisioning.Conclusion: Based on the challenges identified, the study concludes that a comprehensive strategic framework should be implemented including placement of Post-Basic Pharmacist Assistants in the primary healthcare facilities and deployment of electronic medicine stock management system to facilitate consistent provisioning and availability of medicines in particular for the rural health facilities.
Introduction: Violence is an act that can cause an injury and affects other people both physically and psychologically as opposed to the law. Violence can be considered a crime. In general, violence targets groups or parties that are vulnerable. Children are part of vulnerable groups to violent behavior, including child abuse. According to DPKP3A data, there are 38 children victims of sexual abuse. Methods: This research aims to describe the existence of social support for children as victims of domestic violence at the Embun Surabaya Foundation. This foundation focuses on protecting and empowering children and women who are victims of exploitation and violence. This research used a qualitative approach with phenomenology methods supported by data collection using in-depth interviews and observations. The informants of this research were five people consisting of four girls who were victims of domestic violence and one supervisor staff at the Surabaya Embun Foundation. Result: The results indicate that children as victims of domestic violence at the Embun Surabaya Foundation receive excellent social support in informational support, emotional support, appraisal support, and instrumental support. These four supports have brought victims to accept themselves and increase their confidence. Conclusion: The four supports are given by their families (families that are not included in the perpetrators of violence) and the staff of the Embun Surabaya Foundation.
Keywords: Violence, child abuse, social support
Katarzyna Iłowiecka, Monika Maślej, Magdalena Czajka
et al.
Dietary supplements (DS) are used by about 30–50% of adults in developed countries. However, only a few studies have compared the characteristics of DS users in different nations. This study aimed to identify and compare selected health-related behaviors of DS users from three European countries. A total of 3,588 adults (32.08 ± 8.04 years) from Poland (1,030 females, 287 males), Germany (994 females, 190 males), and the United Kingdom (911 females, 176 males) were included in the analysis. The study was based on a self-administered survey consisting of 70 questions regarding baseline characteristics, lifestyle, eating, and health habits. The associations of the obtained results were compared using the Kruskal–Wallis test, Pearson Chi-Square test, and Cramer's V value. The highest percentage of DS users (56.98%, n = 2,044) had a correct body weight, while higher body weight values were observed in 39.19% (n = 1,406). In terms of lifestyle, statistically significant differences (p < 0.05) were noted for alcohol consumption and the level of physical activity. Fruit and vegetables were most often consumed a few times a weeks (34.67%, n = 1,244). A similar result was observed for the consumption of whole grain (37.76%, n = 1,355), dairy (39.99%, n = 1,435), eggs (49.67%, n = 1,782), and meat (51.45%, n = 1,846). Most DS users did not have a chronic disease (66.72%, n = 2,394). Among the other conditions, a frequent occurrence (a few times a weeks) of gastrointestinal problems (28.29%, n = 1,015) and concentration disorders (29.15%, n = 1,046) was noted. Cramer's V values (<0.3) indicated a weak (but significant p < 0.05) relationship between the country of residence and most of the analyzed variables. In conclusion, DS users were characterized by a healthy lifestyle with appropriate behaviors but not healthy eating habits.
AimsTo evaluate current status of prostate cancer incidence and mortality worldwide, and compare the global trends of incidence and mortality in the past two decades and in the most recent period.MethodsData on the incidence and mortality of prostate cancer for 174 countries in 2020 were obtained from the GLOBOCAN 2020 database, and associations with the human development index (HDI) were evaluated. Data for trend analyses in 89 countries from 2000 to 2019 were retrieved from the Global Burden of Disease 2019 platform. Age standardized incidence rate (ASIR) and mortality rate (ASMR) were calculated by using the Segi's population. The average annual percent changes (AAPC) of ASIRs and ASMRs were evaluated by joinpoint regression analysis.ResultsA total of 1 414 259 new cases of prostate cancer and 375 304 related deaths were reported in 2020 globally. HDI was positively correlated with ASIRs (P < 0.001) and negatively correlated with ASMRs (P < 0.001). In the past two decades, ASIRs have been increasing in 65 countries, stable in 15 countries and decreasing in 9 countries, and ASMRs have been increasing in 19 countries, stable in 25 countries and decreasing in 45 countries, respectively. In the most recent period, 44 countries have increasing ASIRs, and 32 countries have decreasing ASMRs, respectively. For instance, in the United States of America, the AAPC of ASIRs significantly decreased by 0.62% and ASMRs significantly decreased by 1.22% from 2000 to 2019, while the AAPC from 2015 to 2019 significantly increased by 0.49% for ASIRs and significantly increased by 0.48% for ASMRs.ConclusionThe magnitude of increasing incidence and decreasing mortality of prostate cancer is attenuated in the recent period. Further study is needed to analyze the absolute effect of risk factors, PSA screening and treatment.
Yara Bagali Alcântara, Willians Walace Fante Toledo, Karoline Ribeiro de Lima
et al.
<h4>Objective</h4> To compare the cortical auditory evoked potential responses pre-and post-Auditory Musical Training associated with hearing aid adaptation in elderly people with presbycusis. <h4>Design</h4> This is a pilot, prospective, randomized, single-blind study. <h4>Study sample</h4> Eight presbiacusis elderly people between 65 and 80 years, new hearing aid users, divided into two groups participated in the study: Hearing Aid Group: use of hearing aid; and Auditory Training Group: use of hearing aid in addition to musical auditory training for 16 sessions. All participants were submitted to cortical auditory evoked potential tests with verbal stimulation in two different moments: Initial assessment, carried out before hearing aid adaptation and auditory training, and after three months, final assessment at the end of the auditory training sessions. All participants were adapted bilaterally with digital mini hearing aids. <h4>Results</h4> There was a decrease in the P3a latency component for the Auditory Training Group when initial and final assessment were compared. <h4>Conclusion</h4> There was a change in the cortical auditory evoked potential in elderly people with presbycusis in response to the Musical Auditory Training associated with the use of hearing aids in elderly people with presbycusis.
Yousif Abdalla Alzubair, Yohannes Hailu, Koku Sisay Tamirat
Introduction: Respiratory Distress Syndrome (RDS) is a frequent neonatal emergency worldwide. The prevalence varies with gestational age (GA) being higher among preterm babies. Preterm birth is the world’s primary cause of newborn deaths and RDS is the leading cause of death in premature infants, including in Ethiopia.
Objectives: To identify the determinant factors of the immediate outcomes of RDS in the neonatal intensive care unit (NICU), University of Gondar Specialized and Comprehensive Hospital (UoGSCH).
Method: A hospital-based prospective descriptive analytical cross-sectional study was conducted from February to September 2020.
Results: A total of 162 neonates were enrolled; there were 87 (53.7%) males and 75 (46.3%) females. Of these 106 (65.4%) were discharged with improvement, 4 (2.5%) discharged with complications, and 52 (32.0%) died; 50% of deaths occurred within the first 24 hours of age. The odds of mortality for those admitted below 6 hours of age was 6.14 times higher (AOR=6.14, 95% CI:1.63 23.03) than those admitted aged 6 hours and above. Babies born to primiparous mothers were more than twice as likely to die (AOR=2.49, 95% CI:1.05 5.87) than babies born to multiparous mothers. Neonates who were delivered in other facilities had 3.78 times increased odds of mortality (AOR=3.78, 95% CI: 1.23 11.57).
Conclusion: Age at admission, site of referral, parity and gestational age (GA) had a significant association with neonatal mortality due to RDS.
Emma Simpson, Richard Brown, Elizabeth Sillence
et al.
Using digital technology to share patient-generated health data has the potential to improve the self-management of multiple long-term health conditions. Sharing these data can allow patients to receive additional support from healthcare professionals and peer communities, as well as enhance their understanding of their own health. A deeper understanding of the concerns raised by those living with long-term health conditions when considering whether to share health data via digital technology may help to facilitate effective data sharing practices in the future. The aim of this review is to identify whether trust, identity, privacy and security concerns present barriers to the successful sharing of patient-generated data using digital technology by those living with long-term health conditions. We also address the impact of stigma on concerns surrounding sharing health data with others. Searches of CINAHL, PsychInfo and Web of Knowledge were conducted in December 2019 and again in October 2020 producing 2,581 results. An iterative review process resulted in a final dataset of 23 peer-reviewed articles. A thorough analysis of the selected articles found that issues surrounding trust, identity, privacy and security clearly present barriers to the sharing of patient-generated data across multiple sharing contexts. The presence of enacted stigma also acts as a barrier to sharing across multiple settings. We found that the majority of literature focuses on clinical settings with relatively little attention being given to sharing with third parties. Finally, we suggest the need for more solution-based research to overcome the discussed barriers to sharing.
Background: Māori kaumātua (elders) face stark health and social inequities compared to non-Māori New Zealanders. The tuakana-teina (older sibling-younger sibling) peer education programme is a strengths-based approach to enhance well-being and social connectedness. The purpose of this study is to present the baseline data from this programme and identify correlates of well-being outcomes.Method: Participants included 128 kaumātua who completed a self-report survey about health-related quality of life, spirituality, social connection and loneliness, life satisfaction, cultural identity and connection, elder abuse, health service utilisation and demographics.Findings: Multiple regression models illustrated the following correlates of outcomes: (a) self-rated health: needing more help with daily tasks (β = −0.36) and housing problems (β = –0.17); (b) health-related quality of life: needing more help with daily tasks (β = –0.31), housing problems (β = –0.21), and perceived autonomy (β = 0.19); (c) spiritual well-being: understanding of tikanga (cultural protocols) (β = 0.32) and perceived autonomy (β = 0.23); (d) life satisfaction: social support (β = 0.23), sense of purpose (β = 0.23), cultural identity (β = 0.24), trouble paying bills (β = –0.16), and housing problems (β = –0.16); (e) loneliness: elder abuse (β = 0.27), social support (β = –0.21), and missing pleasure of being with whānau (extended family) (β = 0.19).Conclusions: Key correlates for outcomes centred on social support, housing problems, cultural connection and perceived autonomy. These correlates are largely addressed through the programme where tuakana/peer educators provide support and links to social and health services to teina/peer recipients in need. This study illustrates needs and challenges for kaumātua, whilst the larger programme represents a strengths-based and culturally-centred approach to address health issues related to ageing in an Indigenous population.
Background: The Post-Operative Symptom Severity (Posse) score is useful in the assessment of patients after third molar surgery.
Objective: To evaluate patients' perceptions of quality of life after surgical extraction of an impacted mandibular third molar by comparing their Post-operative Symptom Severity (PoSSe) scores at Post-operative Weeks (POW) 1 and 4.
Methods: Seventy patients (age 18 to 35 years) at the Out-Patient Department were enrolled in a prospective study prior to surgical removal of third molars. Each patient was given a PoSSe questionnaire to be completed at POW 1 and POW 4. The scale assessed recovery in seven key domains on patients’ subjective feeling about pain, eating, speech, sensation, appearance, sickness and interference with daily activities.
Results: All but one patient returned completely filled questionnaires. The mean age of the study population was 25.7 ± 4.5 years. The mean PoSSe score at POW 1 and POW 4 were 35.0 ± 7.2 and 33.2 ± 6.9 respectively with statistically significant difference (p = 0.010). The PoSSe score was higher among males compared to females at POW 1 (37.2 ± 7.6 vs 33.5 ± 6.6) and also higher among males at POW 4 (33.8 ± 9.4 vs 32.7 ± 4.6).
Conclusion: The severity of symptoms was perceived to be worse at POW 1 when compared to POW4 but the symptoms were still severe at POW4. There is a need for surgeons need to pay more attention to management of symptoms in the post-operative intermediate period.
José Luís Lobato Miguélez, María Victoria San Roman Sigler, Miguel López Valverde
Pyometra is an accumulation of pus in the endometrial cavity. It occurs when there is a stenosed cervical os as a result of malignant growths in the uterus or cervix, surgery or radiation therapy and senile atrophy. We present the case of an 84-year-old female patient referred to the Emergency Service of the Basurto University Hospital in Bilbao, Spain by the doctor of the nursing home where she is institutionalized because of a two-week history of continued fever without apparent cause. She was diagnosed with urinary tract infection and treated with amoxicillin/clavulanate. Based on the imaging tests, a pyometra in bicornuate uterus was diagnosed. She underwent drainage of the pyometra via the vaginal route, under general anesthesia, after mechanical dilation of the cervical canal. Treatment with ertapenen was prescribed. Progression was satisfactory. Given the rarity of this case, we decided to present it.
Matthew Medeiros, Tam Minh Le, Daniel Troup
et al.
Bladder cancer has been associated with chronic arsenic exposure. Monomethylarsonous acid [MMA(III)] is a metabolite of inorganic arsenic and has been shown to transform an immortalized urothelial cell line (UROtsa) at concentrations 20-fold less than arsenite. MMA(III) was used as a model arsenical to examine the mechanisms of arsenical-induced transformation of urothelium. A previous microarray analysis revealed only minor changes in gene expression at 1 and 2 months of chronic exposure to MMA(III), contrasting with substantial changes observed at 3 months of exposure. To address the lack of information between 2 and 3 months of exposure (the critical period of transformation), the expression of select pathway marker genes was measured by PCR array analysis on a weekly basis. Cell proliferation rate, anchorage-independent growth, and tumorigenicity in SCID mice were also assessed to determine the early, persistent phenotypic changes and their association with the changes in expression of these selected marker genes. A very similar pattern of alterations in these genes was observed when compared to the microarray results, and suggested that early perturbations in cell signaling cascades, immunological pathways, cytokine expression, and MAPK pathway are particularly important in driving malignant transformation. These results showed a strong association between the acquired phenotypic changes that occurred as early as 1–2 months of chronic MMA(III) exposure, and the observed gene expression pattern that is indicative of the earliest stages in carcinogenesis.
Luis Camilo Blanco-Becerra, Víctor Miranda-Soberanis, Leticia Hernández-Cadena
et al.
Objective. To analyze the association between daily mortality from different causes and acute exposure to particulate matter less than 10 microns in aerodynamic diameter (PM10), in Bogota, Colombia. Materials and methods. A time-series ecological study was conducted from 1998 to 2006. The association between mortality (due to different causes) and exposure was analyzed using single and distributed lag models and adjusting for potential confounders. Results. For all ages, the cumulative effect of acute mortality from all causes and respiratory causes increased 0.71% (95%CI 0.46-0.96) and 1.43% (95%CI 0.85-2.00), respectively, per 10μg/m3 increment in daily average PM10 with a lag of three days before death. Cumulative effect of mortality from cardiovascular causes was -0.03% (95%CI -0.49-0.44%) with the same lag. Conclusions. The results suggest an association between an increase in PM10 concentrations and acute mortality from all causes and respiratory causes.
Polychlorinated biphenyls (PCBs) were primarily used in transformers and capacitors, lubricants, flame retardants, plasticizers, paint, carbonless papers, etc. These are capable of long-range atmospheric transport and have been designated as persistent organic pollutants by the Stockholm Convention. Due to their characteristic properties, PCBs are found worldwide in all environmental matrices (including human) and biota. Soils are usually considered to be the source as well as sink for environmental pollutants, with cumulative effects of long-range atmospheric transport and local sources. Around the world, comparatively higher concentrations of PCBs have been reported in urban soils than suburban or rural soils. Higher amount of PCBs in urban soils may cause toxicological health risks to urban residents through ingestion, inhalation and skin contact. This paper presents the PCB distribution in soils from Delhi, India, and exposure risk estimates for human health through soil ingestion. The concentration of &Sigma;PCBs ranged between 1.08-100.67 ng g<sup>&ndash;1</sup> (mean 21.16 ng g<sup>&ndash;1</sup>&plusmn;5.24 ng g<sup>&ndash;1</sup>), which was much lower than the Canadian soil quality guideline value of 1.3 mg/kg or 1300 ng g<sup>&ndash;1</sup>. Human health risk estimates through the soil ingestion pathway were made in terms of lifetime average daily dose (LADD), incremental lifetime cancer risks and non-carcinogenic hazard quotient (HQ). The LADD for Delhi adults and children was 3.02x10<sup>&ndash;8</sup> mg kg<sup>&ndash;1</sup> d<sup>&ndash;1</sup> and 1.57x10<sup>&ndash;7</sup> mg kg<sup>&ndash;1</sup> d<sup>&ndash;1</sup>, respectively, which corresponds to toxic equivalent quotients (TEQ) intake of 0.105 pg TEQ kg<sup>&ndash;1</sup> d<sup>&ndash;1</sup> (0.735 pg TEQ kg<sup>&ndash;1</sup> week<sup>&ndash;1</sup>) and 0.543 pg TEQ kg<sup>&ndash;1</sup> d<sup>&ndash;1</sup> (3.801 pg TEQ kg<sup>&ndash;1</sup> week<sup>&ndash;1</sup>), respectively. The estimated LADD for Delhi residents was lower than the acceptable intake values recommended by the World Health Organization (1 pg TEQ kg<sup>&ndash;1</sup> d<sup>&ndash;1</sup>), the European Commission (14 pg TEQ kg<sup>&ndash;1</sup>;1 week<sup>&ndash;1</sup>) and by the Japanese government (4 pg TEQ kg<sup>&ndash;1</sup> d<sup>&ndash;1</sup>). The probability of cancer risk ranges from 6.04x10<sup>&ndash;8</sup> (&Sigma;PCBs) to 1.57x10<sup>&ndash;5</sup> (&Sigma;TEQ) and 3.13x10&ndash;7 (&Sigma;PCBs) to 8.15x10&ndash;5 (&Sigma;TEQ) for adults and children, respectively, and was within acceptable ranges of 10<sup>&ndash;6</sup> to 10<sup>&ndash;4</sup>. The non-carcinogenic risk in terms of health HQ was 0.105 and 0.330 for adults and children, respectively, which was lower than the acceptable limit of 1. The study found lower concentrations of PCBs than guideline values and low health risk estimates through the soil ingestion pathway within acceptable levels, indicating a minimum risk for Delhi residents.
OBJECTIVE: To examine the association between gestational weight gain and maternal body mass index (BMI) among Vietnamese women and the risk of delivering an infant too small or too large for gestational age. METHODS: A prospective health-facility-based study of 2989 pregnant Vietnamese women was conducted in the city of Nha Trang in 2007-2008. Cubic logistic regression was used to investigate the association of interest. Infants were classified into weight-for-gestational-age categories according to weight centiles for the Asian population. Gestational age was based on the date of last menstrual period and adjusted by the results of first-trimester ultrasound. FINDINGS: BMI was low (< 18.5), normal (18.5-22.9) and high (> 23.0) in 26.1%, 65.4% and 8.5% of the women, respectively. In each of these BMI categories, the percentage of women who delivered infants too small for gestational age was 18.1, 10.0 and 9.4, respectively, and the mean gestational weight gain was 12.5 kg (standard deviation, SD: ± 3.6), 12.2 kg (SD: ± 3.8) and 11.5 kg (SD: ± 4.7), respectively. Among women with low BMI, the risk of delivering an infant too small for gestational age ranged from approximately 40% if the gestational weight gain was < 5 kg to 20% if it was 5-10 kg. CONCLUSION: Having a low BMI, commonly found in Viet Nam, puts women at risk of delivering an infant too small for gestational age, especially when total maternal gestational weight gain is < 10 kg.