Introducing mobile technologies to strengthen the national continuing medical education program in Vietnam

BACKGROUND: In 2009, the Government of the Republic of Vietnam adopted legislation requiring all clinicians to complete continuing medical education (CME) credits in order to maintain licensure. Several CME in-person and distance-based courses have been developed and as of 2015, a national distance-based electronic learning (eLearning) network was being established. However, the uptake of CME courses remained low despite high clinician demand. Vietnam’s high mobile phone ownership rate of 1.4 mobile subscriptions per person presents an opportunity to leverage this for CME. This study investigated how mobile technologies could strengthen delivery of distance-based CME courses and improve national CME program administration. METHODS: A literature and policy review was conducted. Qualitative methods were employed to collect and analyze key informant interviews of 52 global and Vietnamese experts, including selected policy makers. Interviews were supplemented by six focus group discussions with Vietnamese physicians, nurses, midwives and physician assistants. Transcripts were analyzed using an inductive coding methodology. A framework was developed to organize and present results for government consumption. RESULTS: Globally, examples and supporting evidence related to mobile technologies for CME were limited. Experts reported three main use cases for using mobile technology for CME in Vietnam: 1) delivery of CME courses (N=34; 65%); 2) registration and tracking of CME credits (n=28; 54%); and 3) sending alerts and reminders on CME opportunities (n=23; 44%). The national CME policy environment in Vietnam was supportive of introducing mobile technologies within the eLearning network. However, there was a widespread lack of awareness and capacity to design and deliver distance-based CME courses. Mobile phone ownership was high and health workers reported interest in acquiring CME credits via mobile. Financing options to develop and implement distance-based CME courses were limited. CONCLUSION: Despite the paucity of evidence related to mobile technologies for learning, there is potential to innovate and strengthen the evidence base using these technologies for CME in Vietnam. Introducing mobile technologies within the national eLearning network would improve clinicians’ access to CME, particularly in rural areas, and can strengthen national CME program administration. Key recommendations were developed to provide the government with concrete steps for national level adoption

Genes Associated with Honey Bee Behavioral Maturation Affect Clock-Dependent and -Independent Aspects of Daily Rhythmic Activity in Fruit Flies

BACKGROUND: In the honey bee, the age-related and socially regulated transition of workers from in-hive task performance (e.g., caring for young) to foraging (provisioning the hive) is associated with changes in many behaviors including the 24-hour pattern of rhythmic activity. We have previously shown that the hive-bee to forager transition is associated with extensive changes in brain gene expression. In this study, we test the possible function of a subset of these genes in daily rhythmic activity pattern using neural-targeted RNA interference (RNAi) of an orthologous gene set in Drosophila melanogaster. PRINCIPAL FINDINGS: Of 10 genes tested, knockdown of six affected some aspect of locomotor activity under a 12 h:h light:dark regime (LD). Inos affected anticipatory activity preceding lights-off, suggesting a possible clock-dependent function. BM-40-SPARC, U2af50 and fax affected peak activity at dawn without affecting anticipation or overall inactivity (proportion of 15-min intervals without activity), suggesting that these effects may depend on the day-night light cycle. CAH1 affected overall inactivity. The remaining gene, abl, affected peak activity levels but was not clearly time-of-day-specific. No gene tested affected length of period or strength of rhythmicity in constant dark (DD), suggesting that these genes do not act in the core clock. SIGNIFICANCE: Taking advantage of Drosophila molecular genetic tools, our study provides an important step in understanding the large set of gene expression changes that occur in the honey bee transition from hive bee to forager. We show that orthologs of many of these genes influence locomotor activity in Drosophila, possibly through both clock-dependent and -independent pathways. Our results support the importance of both circadian clock and direct environmental stimuli (apart from entrainment) in shaping the bee's 24-hour pattern of activity. Our study also outlines a new approach to dissecting complex behavior in a social animal

Tracking working status of HIV/AIDS-trained service providers by means of a training information monitoring system in Ethiopia

Abstract Background The Federal Ministry of Health of Ethiopia is implementing an ambitious and rapid scale-up of health care services for the prevention, care and treatment of HIV/AIDS in public facilities. With support from the United States President's Emergency Plan for AIDS Relief, 38 830 service providers were trained, from early 2005 until December 2007, in HIV-related topics. Anecdotal evidence suggested high attrition rates of providers, but reliable quantitative data have been limited. Methods With that funding, Jhpiego supports a Training Information Monitoring System, which stores training information for all HIV/AIDS training events supported by the same funding source. Data forms were developed to capture information on providers' working status and were given to eight partners who collected data during routine site visits on individual providers about working status; if not working at the facility, date of and reason for leaving; and source of information. Results Data were collected on 1744 providers (59% males) in 53 hospitals and 45 health centres in 10 regional and administrative states. The project found that 32.6% of the providers were no longer at the site, 57.6% are still working on HIV/AIDS services at the same facility where they were trained and 10.4% are at the facility, but not providing HIV/AIDS services. Of the providers not at the facility, the two largest groups were those who had left for further study (27.6%) and those who had gone to another public facility (17.6%). Of all physicians trained, 49.2% had left the facility. Regional and cadre variation was found, for example Gambella had the highest percent of providers no longer at the site (53.7%) while Harari had the highest percentage of providers still working on HIV/AIDS (71.6%). Conclusion Overall, the project found that the information in the Training Information Monitoring System can be used to track the working status of trained providers. Data generated from the project are being shared with key stakeholders and used for planning and monitoring the workforce, and partners have agreed to continue collecting data. The attrition rates found in this project imply an increased need to continue to conduct in-service training for HIV/AIDS in the short term. For long-term solutions, retention strategies should be developed and implemented, and opportunities to accelerate the incorporation of HIV/AIDS training in pre-service institutions should be explored. Further study on reasons why providers leave sites and why providers are not working on HIV at the sites where they were trained, in addition to our project findings, can provide valuable data for development of national and regional strategies and retention schemes. Project findings suggest that the development of national and region-specific human resources for health strategy and policies could address important human resources issues found in the project.</p