A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project

Background

Little research has been conducted to investigate role stress experienced by faculty members in medical schools in developing countries. This becomes even more important when the process of reform in medical education has already taken place, such as the case of Iran. The objectives of this study were to investigate and assess the level and source of role-related stress as well as dimensions of conflict among the faculty members of Iranian medical schools. Variables like the length of academic work, academic rank, employment position, and the departments of affiliation were also taken into consideration in order to determine potentially related factors.

Methods

A survey was conducted at three different ranks of public medical schools. The validated Organizational Role Stress Scale was used to investigate the level of role stress and dimensions of role conflict among medical faculty members. The response rate was 66.5%.

Results

The findings show that role stress was experienced in high level among almost all faculty members. All three studied medical schools with different ranks are threatened with relatively the same levels of role stress. Specific differences were found among faculty members from different disciplines, and academic ranks. Also having permanent position and the length of services had significant correlation with the level of role stress. The major role- related stress and forms of conflict among faculty members were role overload, role expectation conflict, inter-role distance, resource inadequacy, role stagnation, and role isolation.

Conclusion

The most role-related stressors and forms of conflict among faculty members include too many tasks and everyday work load; conflicting demands from colleagues and superiors; incompatible demands from their different personal and organizational roles; inadequate resources for appropriate performance; insufficient competency to meet the demands of their role; inadequate autonomy to make decision on different tasks; and a feeling of underutilization. The findings of this study can assist administrators and policy makers to provide an attractive working climate in order to decrease side effects and consequences of role stress and to increase productivity of faculty members. Furthermore, understanding this situation can help to develop coping strategies in order to reduce role-related stress.     

Improved glucose metabolism in mice lacking α-tocopherol transfer protein

Background Conflicting evidence suggests a possible role for vitamin E in mammalian glucose metabolism and the protection from type 2 diabetes. The alpha-tocopherol transfer protein (α-TTP) mediates the transfer of α-tocopherol (α-TOH) from hepatocytes to very-low-density lipoproteins, thereby controlling plasma levels of α-TOH. Aim of the study The aim of this study was to investigate the putative impact of α-TTP knock-out on glucose metabolism in mice. Methods Mice deficient for α-TTP and wild-type control littermates were fed a diet containing 200 mg α-tocopheryl acetate per kg to ameliorate α-TOH deficiency in knock-out mice. We investigated fasting and postprandial plasma glucose, insulin and triglyceride levels of both groups of mice at different ages. All genotypes and age groups were further subjected to glucose and insulin tolerance tests, and number of insulin-producing islets of Langerhans were determined. Results Plasma α-TOH levels of knock-out mice were 34% the levels of wild-type controls: Any signs of α-TOH deficiency were absent at any age. Unexpectedly, serum glucose levels both in the fasted and in the fed state were lower in α-TTP-deficient mice at any age. Removal rates for intraperitoneally injected glucose were found to be significantly increased in young α-TTP-deficient mice. This improved glucose tolerance was caused by increased insulin secretion in response to an intraperitoneal glucose challenge due to an increased number of pancreatic islets, as well as by increased sensitivity to intraperitoneally injected insulin, both significantly promoting glucose metabolism in α-TTP-deficient mice. Conclusions Our findings suggest that α-TTP-deficiency in states of α-TOH supplementation unexpectedly promotes glucose tolerance in mice due to both increased insulin secretion and insulin action, suggesting differential roles of α-TTP and α-TOH in the pathogenesis of type 2 diabetes mellitus. Marc Birringer and Doreen Kuhlow have contributed equally to this publication.     

Applicability of the abbreviated version of the World Health Organization's quality of life questionnaire in Hungary

INTRODUCTION: Quality of life, as a subjective parameter of the general condition, is suitable for characterization of the health status of populations or patient groups, and for studying the effects of therapeutic or preventive interventions. AIMS: To test the applicability and reliability in Hungary of the abbreviated form of the quality of life questionnaire developed by WHO, one of several ways to measure the quality of life. METHODS: Questionnaire-based cross-sectional investigation was performed among altogether 814 persons, in small settlements of population under 1000 and 2000, and in a small town for control, in Csongrád county, Hungary. The reliability and validity of the quality of life questionnaire was tested, within each group of questions, by means of Cronbach's alpha, ANOVA and Kruskal-Wallis tests, and by Spearman's rho correlation coefficient. RESULTS: The mean values of the four domains of quality of life - physical, psychological, social and environmental - showed no noteworthy differences. The Cronbach's alpha figures of the internal consistency test on separate groups of questions and on all questions were in all cases above the expected minimum of 0.7. The means calculated for each domain of quality of life were decreasing with increasing age. Healthy people estimated each aspect of quality of life as significantly better, compared to the sick. Correlation tests showed that all dimensions of the quality of life were in close positive correlation with the general quality of life, with the level of satisfaction with the own health, with the self-assessed health, and with the responses given on other questions related to the social or health situation of the questioned. CONCLUSION: The variation of the questionnaire, adapted to Hungarian conditions, proved to be suitable for testing the quality of life of persons with various demographical, social and health conditions, and for distinction between the healthy and the sick. The sheet, which can be filled in quickly and easily, enables the measurement of quality of life in the Hungarian population, and the comparison of that with international data.     

Worker's life before and after repetive cumulative trauma (RCT) and osteomuscular work-related disease (OWRD)

This is a qualitative work, which focused on workers routine before and after being affected by RCT/ OWRD. The study aimed at verifying and analyzing if workers' lives had changed after the disease diagnostic. The research took place at sections of the TRT-AL--a Court responsible for labor conciliations in Maceió - Alagoas. The information was collected based on semi-structured interviews and data were analyzed based on the following tematics: life before RCT/OWRD; the activity that caused it; the diagnosis; an answer to the repetitive work and a new perspective to the horizon. Results enabled researchers to suggest preventive care, as well as to contribute for reducing damages caused by repetitive activities and high pressure on workers.     

Capture of culicids in urban areas: evaluation of the resting box method

OBJECTIVE: To evaluate the occurrence of adult culicid populations in urban areas and measure the sensitivity of the resting box collection method. METHODS: Mosquito were collected in 1999 and 2000, in two cities in the State of S?o Paulo, Brazil: Ocau?u and Uchoa. In each city, 15 blocks were drawn by lots and then one home in each block was drawn. Two resting boxes were installed at each home: one inside and the other outside the house. Monthly collections were carried out at each home, over a 13-month period, using manual aspirators inside and outside the home and inside the boxes. The captured specimens were taken to the laboratory for screening and identification according to species and sex. RESULTS: Out of the 2,112 culicid specimens collected, 99.7% were of four species: Culex quinquefasciatus, Aedes aegypti, Cx. declarator and Cx. coronator. The distribution of these species in Ocau?u was 83.3%, 3.2%, 10.8% and 24%, respectively, and in Uchoa it was 83.8%, 8.4%, 4.4% and 3.0%, respectively. Among the females of the genus Culex, 34.3% were captured in the resting boxes and 59.9% were collected from inside the house. Among the females of Ae. aegypti, 17.6% were found in the resting boxes and 82.4% inside the home. CONCLUSIONS: The great majority of the specimens collected belonged to four species of culicids, and Cx. quinquefasciatus was the most common. Proportionally, the females of Ae. aegypti were found more inside the home than were those of the genus Culex. Resting boxes present potential for use as surveillance devices, but their use needs to be more thoroughly evaluated.     

Quality of life and vocal health of teachers

OBJECTIVE: To evaluate aspects of teachers' quality of life and describe associated factors to their vocal health. METHODS: A sample comprising 128 high school teachers from four state schools in the city of Rio Claro, Southeastern Brazil, was studied in 2002. The World Health Organization Quality of Life/bref and Voice-Related Quality of Life questionnaires were applied and there were calculated the averages, standard deviation values for the first questionnaire scores and the self-evaluation question of the Voice-Related Quality of Life. The Wilcoxon's test was used to compare teachers' genders; the Kruskal-Wallis's test was used to compare schools and Spearman's correlation coefficient and t-test were performed to assess the association between the domains of quality of life, the vocal self-evaluation question and age, and the number of working shifts by a teacher. RESULTS: Most teachers evaluated their voice as good (42.2%) and the mean score of the quality of life questionnaire was 66, with the highest scores in the domain of social relations, and the lowest ones in the environment domain. The most affected aspects were leisure opportunities, financial conditions, work environment and access to information. The number of hours worked by a teacher had a positive significant correlation with vocal self-evaluation. There were no significant differences between genders. There were significant differences in the physical domain when comparing schools. CONCLUSIONS: Although teachers showed to be reasonably satisfied with their vocal and life quality, they showed misperceptions of their health disorder process and evidenced neglected aspects of life quality and health needs that may compromise teachers' voice/vocal health.     

Plasmodium vivax infection among Duffy antigen-negative individuals from the Brazilian Amazon region: an exception?

We present evidence for Plasmodium vivax infection among Duffy blood group-negative inhabitants of Brazil. The P. vivax identification was determined by both genotypic and non-genotypic screening tests. The Duffy blood group was genotyped by PCR/RFLP and phenotyped using a microtyping kit. We detected two homozygous FY*B-33 carriers infected by P. vivax, whose circumsporozoite protein genotypes were VK210 and/or P. vivax-like. Additional efforts are necessary in order to clarify the evidence that P. vivax is being transmitted among Duffy blood group-negative patients from the Brazilian Amazon region.     

Dietary factors and oral cancer: a case-control study in Greater Metropolitan São Paulo, Brazil

Dietary factors associated with oral cancer were investigated in a case-control hospital-based study in the city of S?o Paulo, Brazil, from 1998 to 2002. A total of 835 subjects, 366 with histologically confirmed incident cases of oral-cavity or pharyngeal cancer and 469 controls participated in the study. Dietary data were collected with a food frequency questionnaire (FFQ). Odds ratios (OR) and 95% confidence intervals (95%CI) were obtained from unconditional logistic regression, adjusted for potential confounders. Inverse associations with risk of oral cancer were found for the highest intake of beans, OR = 0.37 (95%CI: 0.22-0.64), raw vegetables, OR = 0.51 (95%CI: 0.29-0.93) and the intermediate tertile of rice and pasta intake, OR = 0.56 (95%CI: 0.38-0.83). Positive associations were observed for the highest intake of eggs, OR = 1.84 (95%CI: 1.23-2.75), potatoes, OR = 2.22 (95%CI: 1.53-3.25), and milk, OR= 1.80 (95%CI: 1.09-2.98). Some traditional Brazilian foods like rice and beans emerged as protective factors against oral cancer, independently of other risk factors.