Developing cultural competence through self-reflection in interprofessional education: Findings from an Australian university

Interprofessional education and cultural competence are both necessary for health professionals working in interprofessional teams serving diverse populations. Using a pre–post-survey case series design, this study evaluates a novel learning activity designed to encourage self-reflection and cultural competence in an Australian interprofessional education context. Undergraduate health professional students in a large subject viewed three 7–15 minute videos featuring interviews with persons of a minority cultural, linguistic, or sexual group who were living with a disability or managing a health condition. Immediately afterwards, students in interprofessional groups completed a structured activity designed to promote interprofessional and cultural reflection. A localised version of a validated scale measured cultural competence before and after the learning activity. Results suggest the value of video-based learning activities based on real-life examples for improving cultural competence. Despite initially rating themselves highly, 64% of students (n = 273) improved their overall cultural competence, though only by M = 0.13, SD = 0.08, of a 5-point rating-scale interval. A nuanced approach to interpreting results is warranted; even slight increases may indicate improved cultural competence. Suggestions for improving the effectiveness of video-based cultural competence learning activities, based on qualitative findings, are provided. Overall the findings attest to the merit of group discussion in cultural competence learning activities in interprofessional education settings. However, the inclusion of group discussions within such learning activities should hinge on group dynamics.     

Proceedings from the Inaugural Conference of the Society of Women in Maxillofacial Surgery, 18th May 2019, Bristol

The number of women studying in medical schools is increasing, and the relative proportion of female consultants in surgical and leadership roles is lagging behind, relatively, and so a new drive for promoting and supporting women in surgery has evolved. A part of this was the creation of the Society of Women in Oral and Maxillofacial Surgery. This short communication gives proceedings of the inaugural conference of SWiMS and discusses the need for greater promotion of women in the speciality (and the profession at large) and how the society has addressed the need for resilience and community in surgical training and beyond.     

Mapping physical therapy research: The geographical affiliations and methodological quality of 2,959 randomized controlled trials

Evidence suggests that research benefits from diversity, yet science is concentrated to a small group of countries. Diversity in physical therapy research has so far not been studied thoroughly, and this is the first study to map physical therapy research geographically. The objective was to study the frequency and methodological quality of physical therapy-related randomized controlled trials (RCTs) across the world. PEDro was searched for RCTs in physical therapy published between January 1 2015 and December 5 2016. For each trial, the first and last authors’ affiliations and the PEDro scale were extracted. Using the first and last authors’ affiliations, each article was geocoded using the Data Science Toolkit API. The search located 2,959 RCTs, which were affiliated primarily with a small cluster of countries. The median PEDro score for all trials was 5 (IQR 4:7). The geographical spread of the RCTs was focused around Europe, the Middle East, Southeast Asia, Oceania, the United States, and parts of South America. The lack of diversity might be problematic for the research field, even though the average clinical trial in physical therapy is of fair quality.     

Celebrating diversity in early care and education settings: moving beyond the margins

As the USA continues to live up to its historical reputation as a nation of immigrants, early childhood professionals are increasingly faced with the challenge of supporting children and families from diverse cultural milieu. However, to truly celebrate diversity in early childhood settings, early childhood teachers and caregivers must engage in a careful examination of their own cultural biases and assumptions, and be willing to consider differences not as deficient but as potential sources of strength. In short, providing care and education in which all children can thrive requires moving diversity out of the margins of the curriculum, and infusing principles of diversity, equity and social justice into our teaching and our interactions with children and families.     

Ethnic inequalities in psychological distress among urban residents in the Netherlands: A moderating role of neighborhood ethnic diversity?

The main purpose of this study was to investigate whether neighborhood ethnic diversity moderated the association between ethnicity and psychological distress in the four largest cities of Netherlands. Multilevel linear regression analysis was used to assess whether the association between ethnicity and psychological distress differed by levels of neighborhood ethnic diversity. Results showed that the Turkish and Moroccan residents reported significantly higher psychological distress than native Dutch and Surinamese residents. In high ethnic diverse neighborhoods Turkish residents reported significantly less psychological distress than in low ethnic diverse neighborhoods. Ethnic diversity amplifies the risk of depression for some but not all ethnic minorities.     

Dietary Diversity and Vegetable and Fruit Consumption of Households in a Resource-Poor Peri-Urban South Africa Community Differ by Food Security Status

Sociodemographic, living standard measure, consumption of vegetables and fruit, and dietary diversity in relation to household food security were assessed. Using a hunger score, households were categorized as food secure (n = 125) or food insecure (n = 273). Food secure respondents had a higher mean dietary diversity score (3.98; 95%CI [3.79, 4.18] versus 3.65; 95% [CI 3.53, 3.77]), were more likely to eat vitamin A–rich foods (OR 1.15; 95% CI [1.05, 1.26]), a more varied diet (DDS ≥ 4, OR 1.90; 95% CI [1.19, 3.13]), and vegetables daily (OR 3.37; 95% CI [2.00, 5.76]). Cost limited daily vegetable/fruit consumption in food insecure households. Respondents with ≥ 8 years of schooling were more likely (OR 2.07; 95% CI [1.22, 3.53]) and households receiving social grants were less likely (OR 0.37; 95% CI [0.19, 0.72]) to be food secure. Results highlight the association between dietary diversity and household food security.     

Molecular characterization of a recently identified circovirus in zebra finches (Taeniopygia guttata) associated with immunosuppression and opportunistic infections

A recently identified circovirus (family Circoviridae) was detected in 14 zebra finches (Taeniopygia guttata) from seven aviaries and hobbyist breeders using polymerase chain reaction followed by sequencing. Full genome sequences of virus strains from six zebra finches consistently revealed characteristic circoviral genomic features such as a stem-loop structure and two major open reading frames (ORFs) encoding the replication-associated protein and the putative capsid protein. One further ORF encoding a protein of unknown function was additionally identified in all six genomes. Based on full genome nucleotide comparison, zebra finch circovirus was most similar to Finch circovirus originating from a Gouldian finch (Chloebia gouldiae) sharing 78% nucleotide identity. High genetic diversity was detected in the circoviruses from individual zebra finches. Comparison of the six full genome sequences revealed two genetic subgroups, which shared pairwise nucleotide identities between 91.4% and 92.7%. Analyses including partial sequences of the replication-associated protein gene of the zebra finch circovirus strains from all 14 birds supported the existence of two main clusters. Clinical diseases associated with circovirus infection were found in nestlings, fledglings and adult birds and varied from mild to severe with high mortality caused by secondary infections. Macrorhabdus ornithogaster was the most frequently detected opportunistic pathogen. Feathering disorders were seen in two birds. Lymphocytic depletion of the spleen and leukocytopaenia were detected in individual birds, suggesting immunosuppression and a pathogenesis common to circovirus infections in other birds.     

Quasispecies tropism and compartmentalization in gut and peripheral blood during early and chronic phases of HIV-1 infection: possible correlation with immune activation markers

HIV quasispecies was analysed in plasma and proviral genomes hosted by duodenal mucosa and peripheral blood cells (PBMC) from patients with early or chronic infection, with respect to viral heterogeneity, tropism compartmentalization and extent of immune activation. Seventeen HIV-1-infected combined antiretroviral therapy naive patients were enrolled (11 early infection and six chronic infection). V3 and nef genomic regions were analysed by ultra-deep pyrosequencing. Sequences were used to infer co-receptor usage and to construct phylogenetic trees. As markers of immune activation, plasma sCD14 and soluble tumour necrosis factor receptor II (sTNFRII) levels were measured. Median diversity of HIV RNA was lower in patients with early infection versus chronic infection patients. Overall, direct correlation was observed between V3 diversity and X4 frequency; V3 diversity of HIV RNA was inversely correlated with CD4 T-cell count; median sCD14 and sTNFRII values were similar in early and chronic patients, but X4 frequency of HIV RNA was directly correlated with plasma sCD14. The proportion of patients harbouring X4 variants and median intra-patient X4 frequency of proviral genomes tended to be higher in chronic infection than early infection patients. More pronounced compartmentalization of proviral quasispecies in gut compared with PBMC samples was observed in patients with early infection compared with chronic patients. The loss of gut/PBMC compartmentalization in more advanced stages of HIV infection was confirmed by longitudinal observation. More studies are needed to understand the pathogenetic significance of early HIV quasispecies compartmentalization and progressive intermixing of viral variants in subsequent phases of the infection, as well as the role of immune activation in tropism switch.     

Update on the Human Immunodeficiency Virus

At the end of 2011, UNAIDS estimated that 34 million (31.4 to 35.9) individuals were infected by HIV worldwide and that 2.5 million were newly infected during the year. Since 2001, we have observed an increased number of HIV-infected patients in the world, due to an expanded access to antiretroviral drugs. More than 23,5 million (22.1 to 24.8) HIV-infected patients live in Sub-Saharan Africa. The number of HIV-infected patients in France is estimated at 152,000. Two types of HIV cause AIDS: HIV-1 and HIV-2 that are subdivided in groups (M, N, O, P for HIV-1; A to H for HIV-2), subtypes (A-D, F-H, J-K for HIV-1 group M), sub-subtype (A1-A4 for subtype A, F1 and F2 for subtype F in HIV-1 group M), circulating recombinant forms (CRF), and unique recombinant forms in a small number of patients. Virological diagnostic and monitoring techniques have been constantly upgraded since HIV-1 was isolated in 1983 and the first serological tests became available in 1985. This is especially true for HIV-1, the most prevalent worldwide.