Click it: assessment of classroom response systems in physician assistant education

The effect that classroom response systems, or clickers, have on knowledge retention and student satisfaction was studied in a physician assistant program. A clicker, a device similar to a remote control, was used by students to answer questions during lectures. This new technology has been marketed to educators as beneficial in keeping students actively involved and increasing their attentiveness in the classroom. To date, the results of studies on knowledge retention with the use of clickers have been mixed. For this pilot study, the students were divided into two groups with a pre- and post-test given in order to evaluate knowledge retention. One group received lectures in a traditional format, while the other group received the lectures incorporating clicker response questions. After the test scores from four lectures were analyzed, the incorporation of clickers did not alter knowledge retention. Retention of knowledge from both groups was similar and no statistical difference was found. However, student satisfaction regarding the use of clickers was positive. Students reported that clickers kept them more actively involved, increased attentiveness, and made lectures more enjoyable. Although the pilot study did not show a greater improvement in knowledge retention with the use of clickers, further research is needed to assess their effectiveness.     

天津市流动人口艾滋病相关知识及态度和行为特征分析

摘要：目的　了解天津市流动人口艾滋病防治知识认知水平、行为特征及影响因素，为开展有针对性的流
动人口艾滋病预防和控制工作提供科学依据。方法　对天津市南开区、河北区以及东丽区的四类流动人口
进行整群抽样，共抽取４８０４名调查对象，收集流动人口艾滋病相关知识、态度以及性行为等资料，采用
ＳＰＳＳ１５．０软件进行χ
２ 检验和多因素ｌｏｇｉｓｔｉｃ分析，犘＜０．０５为差异有统计学意义。结果　天津市流动人
口中对艾滋病传播途径和防治知识的认知水平相对较高，答对６个及以上问题的比例为７９．８９％ （３８３８／
４８０４），不同人群的艾滋病知晓率差异有统计学意义（犘＜０．０５）；有４６．８３％ （２２４９／４８０４） 的流动人口不
愿意与感染艾滋病的同事继续共事，其中以建筑工人的比例最高，达５０．１４％ （２４０８／４８０４）；天津市流动
人口不安全性行为的发生率主要受年龄、婚姻状况以及文化程度的影响，而安全套的使用率则与文化程度
有关。结论　流动人口已被视为艾滋病感染和传播的脆弱人群和桥梁人群，因此应加强流动人口艾滋病宣
教工作，开展有针对性的预防控制措施，从而控制艾滋病在流动人口中的传播。
关键词：流动人口；艾滋病；高危行为
中图分类号：Ｒ１８１．３　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０５ ０４１２ ０４     

Evaluation of an audience response system for the continuing education of health professionals

INTRODUCTION: Continuing medical education (CME) for physicians and other health personnel is becoming increasingly important in light of recertification requirements. Interactive learning is more effective and may be useful in a continuing education setting. This study examines the use of an audience response system (ARS) as an interactive learning tool for health care providers. METHOD: We conducted a national randomized controlled trial to evaluate the utility of an ARS to enhance attention and learning. Speakers at 42 clinical round table (CRT) programs in five regions across the United States were randomized to "use" or "no use" of an ARS during their lectures. We surveyed participants to collect data regarding presentation and speaker quality, impressions of the ARS, and knowledge of the material presented. We collected information from speakers regarding ease of use and overall opinions of the ARS. RESULTS: A total of 283 surveys were completed (164 from participants using the ARS and 119 from participants not using the ARS). ARS participants rated the quality of the presentation, the quality of the speaker, and their level of attention more highly than non-ARS participants (p < .05). Knowledge scores (of material presented) were not significantly different between the two groups. Both participants and speakers felt that the ARS was easy to use and preferred to use the system in future CRTs. DISCUSSION: Participants in CRTs with the ARS rated presentation and speaker quality more favorably than those participants in CRTs without the tool. Participant knowledge scores, however, were not significantly different. ARSs may provide easy-to-use tools to enhance attention and enthusiasm in CME learners.     

HIV and AIDS in Bangladesh

Bangladesh initiated an early response to the HIV epidemic starting in the mid-1980s. Since then, the response has been enhanced considerably, and many HIV-prevention interventions among the most at-risk populations and the general youth are being undertaken. Alongside prevention activities, gathering of data has been a key activity fostered by both the Government and individual development partners. This paper reviews available sources of data, including routine surveillance (HIV and behavioural among most at-risk populations), general population surveys, and various research studies with the aim to understand the dynamics of the HIV epidemic in Bangladesh. Available data show that the HIV epidemic is still at relatively low levels and is concentrated mainly among injecting drug users (IDUs) in Dhaka city. In addition, when the passively-reported cases were analyzed, another population group that appears to be especially vulnerable is migrant workers who leave their families and travel abroad for work. However, all sources of data confirm that risk behaviours that make individuals vulnerable to HIV are high--this is apparent within most at-risk populations and the general population (adult males and youth males and females). Based on the current activities and the sources of data, modelling exercises of the future of the HIV epidemic in Dhaka suggest that, if interventions are not enhanced further, Bangladesh is likely to start with an IDU-driven epidemic, similar to other neighbouring countries, which will then move to other population groups, including sex workers, males who have sex with males, clients of sex workers, and ultimately their families. This review reiterates the often repeated message that if Bangladesh wants to be an example of how to avert an HIV epidemic, it needs to act now using evidence-based programming.     

Disaster preparedness for limited English proficient communities: medical interpreters as cultural brokers and gatekeepers

Current disaster and emergency response planning does not adequately address the needs of limited English proficient (LEP) communities. The complexities of language and cultural differences pose serious barriers to first responders and emergency providers in reaching LEP communities. Medical interpreters are potential key cultural and linguistic linkages to LEP communities. This project established a collaborative partnership with the Interpreter Services department of Harborview Medical Center in Seattle, Washington. In summer 2004, a pilot assessment of the training background and work experiences of medical interpreters was conducted that focused on training needs for disaster/emergency situations. Overall, medical interpreters identified a need for disaster preparedness training and education. Medical interpreters further reported that LEP communities are not prepared for disasters and that there is a need for culturally appropriate information and education.     

Optimal design features for surveying low-income populations

Improving Medicaid program effectiveness for underserved populations is hampered by low survey response rates. This study determined how to maximize Medicaid consumer satisfaction survey response rates to the Consumer Assessment of Health Plans Study (CAHPS) survey. In a public immunization clinic, 8 focus groups and 15 extended interviews were used to assess consumer-preferred survey design features and incentives. To test hypotheses, we conducted the following trial. Out of 10,733 total participants in a Kansas Medicaid managed care plan, 3,685 eligible for CAHPS were unduplicated by household. After randomization of the 968 households with valid addresses to one of three groups, a controlled trial was conducted to assess response rates to CAHPS survey formats and incentives. Response rates were 35% for a standard mailing, 44% for a user-friendly low-literacy mailing, and 64% for a user-friendly low-literacy mailing with a $10 contingent incentive. Both experimental arms significantly improved response compared with the control; the response rate of the mailing group with the incentive was higher than the response rate of the group receiving that mailing without any incentive (p<0.0001). Using consumer-based preferences significantly increased response rates to this Medicaid satisfaction survey. Raising CAHPS response rates may increase validity of Medicaid consumer satisfaction information.     

Occupational noise exposure and hearing loss: A study of knowledge,attitude and practice among Tanzanian iron and steel workers

Abstract

We assessed Knowledge Attitude and Practice (KAP) regarding occupational noise exposure, Noise-induced hearing loss, audiometry and use of hearing protection devices among iron and steel factory workers exposed to high noise level. A modified, validated, structured questionnaire was used to collect information from 253 male workers randomly selected from the four factories. The sum scores for each domain of KAP were computed. Scores above 75% were defined as good knowledge and positive attitude. For practice, scores of >50% were defined as good. Independent samples t-test and Chi-squared test were used to analyze association between KAP and continuous/categorical variables respectively. Majority of workers displayed poor knowledge and poor practice (94%), but 76% displayed a positive attitude. Most of the workers (86%) had never been provided with hearing protection devices. The mean scores for attitude and practice differed significantly between the four factories (one-way ANOVA, p?<?0.001). Implementation of hearing conservation program with provision of hearing protection devices are suggested.     

Assessment of Tribal Bison Worker Hazards Using Trusted Research Facilitators

ABSTRACT

Objectives: Agriculture is one of the most hazardous industries in the United States. Within agriculture, livestock handling is particularly dangerous. While injury and fatality rates for bison handlers have not been reported, workers in many of the newly established tribal bison herds have limited safety training and animal handling experience, making this a vulnerable workforce. Veterinarians and herd managers, working with tribal bison herds, recognized the need for improvement in the working environment and for worker safety training. In response, partnerships were established and a pilot project was developed in order to characterize risks and hazards associated with bison handling under contemporary reservation field conditions. Individuals and organizations working as change agents included veterinarians at the University of Nebraska – Lincoln School of Veterinary Medicine, a tribal advocacy organization, the Intertribal Buffalo Council and researchers at the Central States Center for Agricultural Safety and Health at the University of Nebraska Medical Center. Methods: This is a mixed-methods study and data were gathered through closed and open-ended questions pertaining to bison worker safety hazards. A veterinarian gathered data through observational safety audits at bison herding locations. American Indian bison herd managers completed surveys using a convenience sampling method. Results: Findings indicate that the most common worker safety risks are associated with the use of high-stress handling methods and substandard facilities and equipment. Adverse environmental conditions also contribute to worker health risks. Most common causes of injuries included those caused by equipment and tools, adverse weather, and direct contact with animals. Conclusion: This collaborative research study contributes to a better understanding of hazards faced by tribal bison workers. Findings from this research influenced the ITBC in their decision to add worker safety and health training to the agenda of their yearly conference and promote tailgate trainings for their workers. UNL veterinarians have taken the lessons learned from this research and provided safety and health information to mangers of other non-tribal bison herds. This research partnership will continue with a 5-year research study focusing on best management practices and establishing training to improve the health and safety bison workers.     

推广使用安全套预防性病艾滋病干预项目基线调查分析

目的：掌握江苏某县级市桑拿浴室中按摩小姐基本情况及危险行为，为干预项目的终期评价提供依据。方法：对被纳入此次调查范围的桑拿浴室按摩小姐进行一对一深入访谈，收集人口学、性行为、吸毒、自我防护、安全套使用、性病感染和既往求医史资料，并采集标本进行性病艾滋病检测。结果：在接受访谈的385名小姐中，64．8％为外省人，未婚占54．1％。最近一周平均每天性伴数为1个的占36．6％。最后一次性行为使用安全套的占51．0％。总的性病发病率为28．1％，未发现HIV阳性感染者。结论：该地区桑拿浴室内按摩小姐中普遍存在与艾滋病相关的高危行为，严重缺乏自我防护知识，必须尽快采取有效措施。     

Implementation, outcomes, and lessons learned from a collaborative primary health care program to improve diabetes care among urban Latino populations

A collaborative primary health care service demonstration program was conducted to improve diabetes care among limited English-proficient (LEP) Latino patients. The intervention provided a multilevel approach aimed at patients and health care providers: Community health workers (CHWs) were mobilized to offer diabetes education in Spanish to LEP Latino diabetes patients, and health professions students and providers were offered intensive Spanish language training and cultural competency workshops. Positive outcomes for patients included a significant decrease in HbA1c. Health care providers reported improved patient communication and greater appreciation for cultural influences on health. Collaborating institutions realized ongoing benefits from expansion of CHWs' role and incorporation of cultural and language classes into health professions students' and house officers' training programs. Lessons learned included the importance of working together at every stage to identify and provide for the CHWs' training and support needs and to link the program's intervention with evaluation of multilevel outcomes.     

Variance Estimation,Design Effects,and Sample Size Calculations for Respondent-Driven Sampling

Hidden populations, such as injection drug users and sex workers, are central to a number of public health problems. However, because of the nature of these groups, it is difficult to collect accurate information about them, and this difficulty complicates disease prevention efforts. A recently developed statistical approach called respondent-driven sampling improves our ability to study hidden populations by allowing researchers to make unbiased estimates of the prevalence of certain traits in these populations. Yet, not enough is known about the sample-to-sample variability of these prevalence estimates. In this paper, we present a bootstrap method for constructing confidence intervals around respondent-driven sampling estimates and demonstrate in simulations that it outperforms the naive method currently in use. We also use simulations and real data to estimate the design effects for respondent-driven sampling in a number of situations. We conclude with practical advice about the power calculations that are needed to determine the appropriate sample size for a study using respondent-driven sampling. In general, we recommend a sample size twice as large as would be needed under simple random sampling.     

Pacific Northwest Health Professionals Survey on Pesticides and Children

Abstract

The Pacific Northwest includes several regions of pesticide-intensive agriculture, and the health risks of pesticides to children have become a focus of scientific inquiry and public health concern. To prepare a curriculum for regional health care providers on pesticides and child health, we sought to review the experience, attitudes and needs in this subject from the intended target audience. Forty-nine key informants serving high volumes of farmworkers and farm families in agricultural areas of the region were identified: 23 physicians, nine physician assistants, five nurse practitioners, and 12 community health workers completed telephone surveys (98% response rate). These informants serve a high-risk group of children, yet only 49% had any pesticide related health training and only 22% had received child specific information. Regardless of previous training, 55% affirmed the statement, “I use pesticide information in my profession or practice.” However, 61% were not comfortable responding to patient/client questions based on their training, background, and experience. Ninety-two percent of the informants endorsed that more pesticide information would be useful in their work, particularly information specific to child health. Format preferences for future training varied. Physicians most frequently mentioned Web-based training materials while mid-level clinicians'most highly requested format was written summaries. The option of a conference/workshop was particularly popular among community health workers. This key informant survey indicates an important pesticide training gap among health care workers serving children at high risk of pesticide exposure.     

Food safety knowledge and behavior of emergency food relief organization workers: effects of food safety training intervention

The food safety knowledge and food-handling behaviors of 267 volunteer and staff workers in emergency food relief organizations in western New York State were assessed before and after food safety training. Training was voluntary and emphasized basic food safety and prevention of foodborne illness. Results from the pre-test showed major gaps in the knowledge and behaviors of those working with physically vulnerable populations in emergency food services. These gaps, particularly failure to use food thermometers and unsafe use of hands, could lead to outbreaks of foodborne disease. Independent-samples t-tests, used to compare pre- and post-test scores, indicated that workers' knowledge and reported behaviors significantly improved followin good safety training (p < .0001). There is a need for relevant and ongoing food safety education in this group.     

Information needs for OVC program management and evaluation: a framework

Programs serving orphans and vulnerable children (OVC) have become increasingly complex over the last decade, necessitating programs to collect more information to ensure adequate management. Programs are also facing greater pressure to demonstrate an interest in understanding impact and value for money, which is similarly leading to changes in the ways programs collect information and the types of information collected. In order to gather such information and contain costs, governments and programs are collecting increasing amounts of information at every interaction with program beneficiaries. This has led to a high burden on those providing, gathering, and inputting information and low data quality overall.

In this paper, we present a framework for categorizing different information needs for OVC program management and evaluation. The purpose of this framework is to support OVC program staff and donors to more clearly define information-collection strategies based on the information needed, why it is needed, and by whom it is needed. This will improve the efficiency of data-collection efforts, and improve the availability of the right (high-quality) data for various decision-making processes.     

Medical interpretation for immigrant workers

Foreign-born workers have high rates of occupational mortality and morbidity, despite downward trends for the U.S. workforce overall. They have limited access to health care services. Medical interpreters (MIs) facilitate care of acutely injured, low-English-proficiency (LEP) patients, including those sustaining occupational injuries. Our goal was to assess the potential for MIs to serve as advocates of LEP patients injured at work and to deliver preventive messages. We conducted interviews and a focus group of MIs regarding their attitudes toward foreign-born workers, knowledge of occupational health, and perceived roles. They were familiar with occupational injuries and sympathetic toward foreign-born workers, and they described their roles as conduits, cultural brokers, and advocates for hospitals, providers, and patients. More detailed and representative data would require a larger investigation. However, the time-sensitive nature of policy-making at this point mandates that occupational health stakeholders participate in the national dialogue on standards, training, and licensure for MIs to promote improved access and quality of health care for LEP patients who have been injured at work.     

Facilities available for surveillance of the side effects of fertility regulating agents in the United States

A number of techniques utilizing currently available facilities may be employed to assess the extent of use and side effects of contraceptive agents. Interpretation of vital statistics and survey information describes trends in mortality from selected causes and choice of contraceptive agent. The use of adverse drug reaction surveillance and multiphasic screening programs may identify more specific relationships between drugs, devices and diseases. Such findings may stimulate the development of in-depth clinical evaluations or epidemiological studies of specific subjects such as thromboembolism and cancer. A number of representative studies are identified which may yield information not only describing elements of risk but also of demographic value. Full and coordinated use of these opportunities for information gathering will generate more accurate assessments of contraceptive status in large populations and form a more adequate baseline for future evaluations.     

Workers with occupational contact dermatitis: workplace characteristics and prevention practices

Background There are many gaps in knowledge related to prevention practices in place for workers who subsequently develop occupational contact dermatitis (OCD). Aims To describe the workplace characteristics and the prevention practices in workplaces where workers developed hand dermatitis. Methods Consecutive cases of probable OCD were enrolled from a specialist occupational health clinic. At the time of the initial assessment, questionnaires were administered to collect information about clinical presentation, workplace characteristics and prevention practices at work. Results 100 workers with hand dermatitis were enrolled in the study and 78 were considered to have OCD. Two-thirds of these had had some occupational health and safety or Workplace Hazardous Materials Information System (WHMIS) training in their workplace, however, training related to glove use and skin care was less common. Unionized workers were more likely to have received training. Workers involved in wet work were less likely to report training. Conclusions These findings suggest that there are gaps in prevention programs for work-related skin disease. Research is needed on effective strategies that are sustainable in the workplace.     

北京市丰台区114名女性性服务工作者艾滋病相关知识信念行为调查

目的了解女性性服务工作者的艾滋病（AIDS）相关知识信念行为情况，探索在该人群中开展AIDS宣传教育和行为干预的适合模式。方法对经确认的114名女性性服务工作者进行问卷调查。结果114名女性性服务工作者年龄最小的14岁，最大的39岁；51．8％的未婚；83．3％的文化程度为初高中生。调查对象具有一定艾滋病知识，性生活频率高而安全套使用率低，存在吸毒现象。109名女性性服务工作者接受性病艾滋病检测，查出梅毒阳性6人，HIV抗体均阴性。结论女性性服务工作者是艾滋病高危人群而自我防范意识差，应深入其中开展宣传教育和行为干预工作。