Undergraduate dental students’ perspectives on teaching and learning during the COVID-19 pandemic: Results from an online survey conducted at a South African university using a mixed-methods approach

Background. Many institutions of higher education transitioned from classroom-based settings to remote settings as a response to the COVID-19 pandemic. However, it is unclear how undergraduate dental therapy and oral hygiene students responded to this transition in the learning environment. Objectives. To explore undergraduate dental students’ knowledge, perceptions, attitudes and practices related to clinical and theory-based learning at a South African university. Methods. A mixed-methods approach comprising a concurrent dominant status design (QUAN/qual) was used. Therefore, the study was a cross-sectional quantitative survey with descriptive qualitative data. An online, self-administered questionnaire with open- and closed-ended questions was developed to gain insights into students’ knowledge, perceptions, attitudes and learning practices during the COVID-19 pandemic. Results. Most respondents (n=86; 80.4%) agreed that they had the necessary skills to engage with online learning (p=0.04). Respondents in the first year (n=25; 76%), second year (n=24; 73%) and third year (n=32; 28%) were either unsure or did not agree that they understood online platform-based lectures better than classroom-based lectures. The major emergent themes included external (internet connectivity) and internal (students’ coping skills) barriers to online learning. Conclusions. This study highlighted dental student challenges in embracing the blended approach of teaching and learning. While this may be a new norm for curriculum delivery, it is important to include student input in curriculum-related decision-making processes

Percutaneous exposure incidents - prevalence, knowledge and perceptions of dental personnel and students at a dental training site in KwaZulu-Natal

Healthcare workers, including dental practitioners and dental students, are at risk of occupational exposure to blood-borne pathogens such as hepatitis B, C and HIV. The present study set out to determine the prevalence, knowledge, management and perceptions of percutaneous injuries among staff and students at a dental training institute in Durban, KwaZulu - Natal with a view to identifying policies aimed at reducing the incidence. The prevalence of percutaneous injuries experienced by dental staff and students from 2001 to 2011 was determined. The levels of knowledge and their management of percutaneous injuries were determined among current dental staff and students. The dental department sustained 40% of total Hospital injuries, and of these 76% were suffered by students and 24% by staff. 22% of the sample had sustained a percutaneous injury, and of these, 57% had endured more than one and 24%, three or more injuries. Most current respondents had reported the incident (81%) and had taken the initial dose of post exposure prophylaxis; however, only 22% had taken the medication for the recommended period of four weeks. Avoiding percutaneous injuries by adopting safe work practices is probably the best practice to prevent transmission of blood-borne infections such as Hepatitis and HIV.DHE

A case study: Promoting interprofessional community-based learning opportunities for health sciences students at the University of KwaZulu-Natal, Durban, South Africa

Background. Preventing disease and promoting health call for interprofessional collaboration of health professionals working in a team, making it important for student health professionals to experience collaborative teamwork while in training, rather than learning and working in silos. Objectives. To describe the opinions of participating students and supervising staff in an intraprofessional community-based initiative involving the disciplines of physiotherapy and dentistry at the University of KwaZulu-Natal (UKZN), Durban, South Africa. Methods. This was a qualitative descriptive study demonstrating teamwork of students from two health sciences disciplines, giving a joint health education talk to patients at a local community health centre. Data were collected from focus group discussions. Three such discussions were held with purposively selected samples: (i) 5 physiotherapy students; (ii) 6 dental therapy students; and (iii) 6 staff members from both disciplines who supervised the students. These data were analysed using thematic analysis. Ethical approval was obtained from UKZN. Results. By working collaboratively, the students believed that they learnt more about the other health professionals and obtained a deeper understanding of their roles within the healthcare team. Staff believed that the collaborative project could break down professional barriers to work cohesively in the work environment. The main difficulties encountered were the language barrier and rigid timetables. Conclusion. This case study provides an example of intraprofessional collaboration and teamwork, capable of positively influencing participating students, emphasising the need for interprofessional learning opportunities for students across all health sciences disciplines while in training

Assessment consolidates undergraduate students’ learning of community-based education

Background. Community-based education (CBE) is an empirical education experience that shifts clinical education from traditional to community settings to provide health sciences students with meaningful learning opportunities. However, assessing the effectiveness of these learning opportunities is a challenge.Objectives. To describe the methods used for assessment of CBE by the various disciplines in the School of Health Sciences, University of KwaZulu-Natal (UKZN), Durban, South Africa, and to determine how they were aligned to the anticipated learning outcomes. Methods. This qualitative study consisted of a purposively selected sample of 9 academics who participated in audio-taped interviews and focus group discussions, with the data being thematically analysed. Ethical approval was obtained from UKZN.Results. The disciplines in the School of Health Sciences used various assessment methods, ranging from simple tests, assignments and case presentations to more complex clinical assessments, blogging and portfolio assessments. Multiple methods were required to meet the anticipated learning outcomes of CBE, as a single assessment would not achieve this.Conclusion. The study findings indicated that assessment plays an important role in consolidating student learning at CBE sites, with multiple assessment methods being required to achieve graduate competencies in preparation for the workplace. Choice of assessment methods must be contextual and fit for purpose to allow for overall student development

Exploring community-based training opportunities for dental therapy students in non-governmental and private sectors in KwaZulu-Natal Province, South Africa

Background. The current health system in South Africa (SA) struggles to meet the healthcare demands of its nation adequately, especially in KwaZulu-Natal (KZN) Province, South Africa. Local communities in KZN have long since recognised the need to supplement the public health system by means of community-driven initiatives of non-governmental organisations (NGOs) and the private sector. Projects by these sectors can also provide a platform for experiential learning for dental therapy students.Objective. To explore learning opportunities for dental therapy students through the community-driven health initiatives of NGOs and the private sector in KZN.Methods. This qualitative study used face-to-face interviews with key stakeholders organising community-based initiatives in the NGO and private sectors. The interviews were audio-recorded and analysed using thematic analysis. Ethical clearance was obtained from the University of KwaZulu-Natal, Durban, SA.Results. According to the participants, there were many innovative service delivery modes, ranging from a mobile health bus, a container turned into a clinic, to well-established clinics that provided meaningful learning opportunities for dental students. By participating in these projects, respondents believed that students could gain real-world experiences and a greater sense of social accountability.Conclusion. This study showed that there are many opportunities in the private and NGO sectors that could provide support for community-driven learning initiatives for undergraduate dental therapy students

The association between headache presentation, normal examination and neuroimaging findings: a retrospective analysis of patients presenting to a tertiary referral centre

Background: There is a high worldwide burden of headaches. Selection of patients with headaches for neuroimaging, in the absence of traditional red flags, is imperative in guiding further management. Objectives: Determine the yield of neuroimaging findings in patients with headache and normal examination; and potentially identifying additional red flags. Methods: A retrospective consecutive chart review of patients with a main complaint of headaches and normal clinical examination were assessed at a tertiary hospital, over a 10-year period. Results: Cohort consisted of 114 patients. Unexpected or normal variants found in 20.2% of patients (23/114) and 11.4% (13/114) required change in management. The absence of nausea and vomiting (p=0.009) and absence of sharp type headaches in unexpected or normal variants group (p=0.03) were statistically significant. There was a higher chance of an abnormal neuroimaging study in men and HIV seropositive patients. Conclusions: Decision to neuroimage should be determined on an individual basis (demographic factors, history of headache and examination) as normal examination cannot preclude patients from unexpected findings on neuroimaging. Headache with nausea and vomiting in isolation may be associated with normal neuroimaging reflecting primary type headaches. Findings support a lower threshold to neuroimage men and HIV seropositive patients with headaches despite normal clinical examination. Keywords: Headache; normal clinical examination; neuroimaging; headache red flags

Modulation of oxazolone-induced hypersensitivity in mice by selective PDE inhibitors

The effects of PDE inhibitors on oxazolone-induced contact hypersensitivity (CS) were studied in mice. Rolipram, Ro 20-1724 and theophylline dose dependently inhibited CS but none caused >53% inhibition. ED30 values at 24 h before challenge for rolipram, Ro 20-1724 and theophylline were 2.1, 5.4 and 30.4 mg/kg, p.o., respectively. Milrinone and SKF 94836 at 30 mg/kg caused a small, but significant inhibition of 13% and 18%, respectively, although the inhibition (8%) caused by zaprinast was not significant. Betamethasone (10 mg/kg, p.o.) caused a marked inhibition (80%) as did indomethacin (65% at 5 mg/kg, p.o.). Rolipram and Ro 20-1724 inhibited proliferation of mouse lymphoblasts with IC50 values of 0.08 μM and 0.83 μM, respectively. In contrast, zaprinast caused only a weak inhibition (IC50 = 119 μM) of lymphocyte proliferation, whereas SKF 94836 and theophylline failed to cause any significant inhibition at 100 μM (26% and 2%, respectively). These findings suggest that PDE IV isozymes play a principal role in mediating CS by inhibiting lymphocyte activation

Human papillomavirus (HPV) vaccination of adolescents in the South African private health sector: Lessons from the HPV demonstration project in KwaZulu-Natal

In South Africa (SA), >4 000 women die annually of cervical cancer, a disease caused by the human papillomavirus (HPV). Infections caused by certain genotypes of HPV increase the risk of cervical cancer. HIV-infected women in particular are more likely to have persistent HPV infection, with higher-risk genotypes. In SA, two vaccines (HPV quadrivalent (types 6, 11, 16, and 18) vaccine, recombinant (Gardasil) and HPV bivalent (types 16 and 18) vaccine, recombinant (Cervarix)) are currently registered for the prevention of HPV-related disease. In the past, there have been significant challenges to achieving high coverage and uptake of vaccination – contributory factors include cost and lack of awareness. An HPV demonstration project among schoolgirls in rural KwaZulu-Natal showed that high vaccine uptake is achievable. In 2014, the National Department of Health launched the national HPV vaccination programme among female learners attending public schools. Awareness of HPV vaccination among healthcare providers, education of parents, teachers and learners, and avoidance of missed opportunities for vaccination are vital to the success of the programme. Primary healthcare practitioners may play an important role in cervical cancer prevention by identifying and offering vaccination to girls who miss the opportunity to be vaccinated at school. HPV vaccination should be considered as one arm of a comprehensive programme of cervical cancer prevention and control

The costs of delivering human papillomavirus vaccination to Grade 4 learners in KwaZulu-Natal, South Africa

Background. The national human papillomavirus (HPV) vaccination roll-out in South Africa provides two doses of Cervarix to all female Grade 4 learners in state schools. This study estimated the costs of vaccinating all learners in KwaZulu-Natal Province (females or males and females) using either the two- or three-dose strategies for both the bivalent and quadrivalent vaccines.Objective. To determine costs of the HPV vaccination programme in KwaZulu Natal.Methods. Costs were determined adapting World Health Organization vaccination costing guidelines.Results. The 2014 current cost of delivering three doses of Gardasil was ZAR510 per learner. The projected cost of delivering Cervarix to female learners at two or three doses over the period 2014 - 2018, adjusted for inflation, was ZAR172 717 342 and ZAR250 048 426, respectively. Similarly, the cost for Gardasil at these doses was ZAR197 482 200 and ZAR287 194 361, respectively. For male and female learners the cost for Cervarix over this period at two or three doses was ZAR337 101 132 and ZAR540 150 713, respectively. Similarly, the cost for Gardasil at these doses was ZAR426 597 971 and ZAR620 392 784, respectively. Accounting for population variation for females over 5 years, the cost of two doses of Cervarix ranged from ZAR168 888 677 to ZAR 176 545 977 at the lower and upper 95% confidence intervals (CIs), respectively. For three doses the cost ranged from ZAR244 505 544 to ZAR255 591 263 at the lower and upper 95% CIs, respectively. Similarly, the cost for two doses of Gardasil ranged from ZAR193 104 566 to ZAR201 859 798. For three doses the cost ranged from ZAR280 828 057 to ZAR293 560 614.Conclusion. This study gives decision makers a basis for structured planning and cost apportionment to ensure effective roll-out of the HPV vaccination programme

Pituitary function tests in black patients with pseudocyesis

Pituitary function was evaluated in a group of 10 patients with pseudocyesis. One patient was postmenopausal; the remainder demonstrated normal basal prolactin, luteinising hormone (LH) and follicle-stimulating hormone (FSH) levels and also normal pituitary-adrenal, pituitary-thyroid axes. Oestradiol deficiency was present in 6 patients, while 2 patients demonstrated elevated serum progesterone values, suggestive of a luteal phase. Gonadotrophin-releasing hormone administration resulted in exaggerated stimulation of LH and FSH in 4 and 2 patients, respectively. Impaired growth hormone (GH) secretion was present in 6 patients after insulin-induced hypoglycaemia and L-dopa administration. GH impairment is probably a consequence of the oestrogen deficiency that commonly occurs in this condition. It thus appears that there are aberrations in specific pituitary hormone responses after provocation in pseudocyesis