Infusing the Interdisciplinary into Medical/ Health Sciences Education: Vitamins or Vaccines?

Academic medical institutions have responded to recent changes and challenges confronting the health care system with various recommendations for curricular reform; many grouped under the rubric of interdisciplinary training. The ultimate goal is to create physicians, with mastery over specialized knowledge, who can practice cost-effective, humanized medicine. This article elaborates a conceptual classification system that categorizes curricular reform recommendations into one of two approaches – Vitamins or Vaccines – that highlights differences in the processes of curricular reform programs. Programs seeking the same goal may create different types of practitioners depending on the approach dominating the professional training and socialization process. The Vitamins approach is reactive, supplemental, and incremental, often imparting instruction instead of education. The Vaccines approach is proactive, addresses fundamental factors, and seeks long-term solutions from a preventive perspective. As educators, our choice of approach, Vitamins or Vaccines, for curricular reform will determine how academia prepares physicians for the futur

KNOWLEDGE OF THE DISEASE AMONG TYPE 2 DIABETES PATIENTS IN A TERTIARY CARE HOSPITAL IN MUMBAI, INDIA

Objective: An estimated 72 million in India live with diabetes; the country faces an impending health-care crisis with prevalence and complications of diabetes forecasted to multiply in the next decade. Improving patients' knowledge about diabetes to manage the disease better is an urgent and important public health goal.Methods: Knowledge about diabetes, its complications, and management was surveyed using a structured questionnaire among 167 Type 2 diabetes patients attending a tertiary care hospital in Mumbai, India.Results: None of the participants had ever received any formal diabetes self-management education previously. Respondents' mean and median correct knowledge scores were 20 of 32 test items. Although majority answered statements about blood sugar levels and complications, there was lack of knowledge about the causes and management of diabetes. Around 82% stated that medication was more important than dietary intake and physical activity in managing diabetes. A multiple regression model showed that postgraduate or graduate level education, not being married, having two or less children, and visiting a doctor 1–3 times a year (as compared to more than three visits) was independently associated with higher diabetes knowledge scores (*p<0.05) in this sample.Conclusion: An information disparity exists between patients who have higher levels of education versus those with lesser education. Future research will have to examine the mechanisms by which higher education contributes to better knowledge, and facilitate the design of diabetes education programs that bridge information gaps and improve required competencies in patients to better manage their condition

Perceptions of Risk and Behaviour Change for Prevention of HIV Among Married Women in Mumbai, India

Heterosexual transmission accounts for the majority of cases in India, an epicentre of the HIV/AIDS pandemic, with increasing rates of infection in married women contracting HIV from an infected spouse. Cultural roles and position of married women in Indian society render targeted risk-reduction programmes difficult. To investigate HIV/AIDS-related knowledge, perceptions, and behaviour change among married women in India, an interview-based survey was conducted with 350 married women in Mumbai, of whom 67% (236) were aware of HIV/AIDS. Although 59.3% (140) of those aware mentioned indiscriminate sexual activity as increasing risk of HIV, only two (41%) in five women perceived HIV as a threat to the community; one (12%) in eight perceived personal risk of getting infected as high; and only 7.2% (17) reported behaviour change to avoid infection. When probed for reasons for not changing behaviour, most women cited their personal behaviour of monogamy, not being in an at-risk group, such as commercial sex workers, and trust in their husbands. Education programmes among married women that enable better understanding of risks are urgently required. Since marriage and motherhood are important in the Indian cultural context, male spouses should be included in risk-reduction programmes

Assessment of Metalaxyl migration through vadose zone of alluvial sandy soil using column experiment and HYDRUS numerical modeling

Contemporary research on pesticides/fungicides as potential sources of groundwater contamination, including their migration pathways, especially in the Western Bengal basin (WBB), is scarce. The present research intends to study the vulnerability of groundwater towards pollution from metalaxyl. Metalaxyl is a fungicide added anthropogenically to the sandy soil of WBB for the cultivation of crops like tomatoes, potatoes and mustard. The study explores the mechanics of metalaxyl adsorption in soil and its migration to the associated groundwater system. Chemical analyses show high concentrations of metalaxyl within groundwater (472.9 μg/L, maximum amount) from the study area (Nadia district of WBB). The groundwater ubiquity score of metalaxyl (4.6) depicts that it is very much prone to leach through the sandy soils of WBB to the underlying groundwater system. The results of column leaching experiments and their congruence to the findings of numerical modelling study using HYDRUS software confirm the fact. The adsorptive resilience of the studied soils towards metalaxyl is insignificant (soils of North Chandmari (S1) =0.1087 mg/g, Ghoragacha (S2) =0.21 mg/g, and Khaldarpara (S3) =1.771 mg/g). However, the presence of excess iron concentration may enhance the adsorptive capacity of the soil toward Metalaxyl, thereby limiting its migration toward the zone of saturation

Provider imposed restrictions to clients\u27 access to family planning in urban Uttar Pradesh, India: A mixed methods study

Background Medical barriers refer to unnecessary policies or procedures imposed by health care providers that are not necessarily medically advised; these restrictions impede clients\u27 access to family planning (FP). This mixed methods study investigates provider imposed barriers to provision of FP using recent quantitative and qualitative data from urban Uttar Pradesh, India. Methods Baseline quantitative data were collected in six cities in Uttar Pradesh, India from service delivery points (SDP), using facility audits, exit interviews, and provider surveys; for this study, the focus is on the provider surveys. More than 250 providers were surveyed in each city. Providers were asked about the FP methods they provide, and if they restrict clients\u27 access to each method based on age, parity, partner consent, or marital status. For the qualitative research, we conducted one-on-one interviews with 21 service providers in four of the six cities in Uttar Pradesh. Each interview lasted approximately 45 minutes. Results The quantitative findings show that providers restrict clients\u27 access to spacing and long-acting and permanent methods of FP based on age, parity, partner consent and marital status. Qualitative findings reinforce that providers, at times, make judgments about their clients\u27 education, FP needs and ability to understand FP options thereby imposing unnecessary barriers to FP methods. Conclusions Provider restrictions on FP methods are common in these urban Uttar Pradesh sites. This means that women who are young, unmarried, have few or no children, do not have the support of their partner, or are less educated may not be able to access or use FP or their preferred method. These findings highlight the need for in-service training for staff, with a focus on reviewing current guidelines and eligibility criteria for provision of methods

Provider imposed restrictions to clients' access to family planning in urban Uttar Pradesh, India: a mixed methods study

Abstract Background Medical barriers refer to unnecessary policies or procedures imposed by health care providers that are not necessarily medically advised; these restrictions impede clients’ access to family planning (FP). This mixed methods study investigates provider imposed barriers to provision of FP using recent quantitative and qualitative data from urban Uttar Pradesh, India. Methods Baseline quantitative data were collected in six cities in Uttar Pradesh, India from service delivery points (SDP), using facility audits, exit interviews, and provider surveys; for this study, the focus is on the provider surveys. More than 250 providers were surveyed in each city. Providers were asked about the FP methods they provide, and if they restrict clients’ access to each method based on age, parity, partner consent, or marital status. For the qualitative research, we conducted one-on-one interviews with 21 service providers in four of the six cities in Uttar Pradesh. Each interview lasted approximately 45 minutes. Results The quantitative findings show that providers restrict clients’ access to spacing and long-acting and permanent methods of FP based on age, parity, partner consent and marital status. Qualitative findings reinforce that providers, at times, make judgments about their clients’ education, FP needs and ability to understand FP options thereby imposing unnecessary barriers to FP methods. Conclusions Provider restrictions on FP methods are common in these urban Uttar Pradesh sites. This means that women who are young, unmarried, have few or no children, do not have the support of their partner, or are less educated may not be able to access or use FP or their preferred method. These findings highlight the need for in-service training for staff, with a focus on reviewing current guidelines and eligibility criteria for provision of methods

Improved protocol for plasma microRNA extraction and comparison of commercial kits

MicroRNAs are small, non-coding RNA molecules that are becoming popular biomarkers in several diseases. However, their low abundance in serum/plasma poses a challenge in exploiting their potential in clinics. Several commercial kits are available for rapid isolation of microRNA from plasma. However, reports guiding the selection of appropriate kits to study downstream assays are scarce. Hence, we compared four commercial kits to evaluate microRNA-extraction from plasma and provided a modified protocol that further improved the superior kit’s performance. We compared four kits (miRNeasy Serum/Plasma, miRNeasy Mini Kit from Qiagen; RNA-isolation, and Absolutely-RNA MicroRNA Kit from Agilent technologies) for quality and quantity of microRNA isolated, extraction efficiency, and cost-effectiveness. Bioanalyzer-based Agilent Small RNA kit was used to evaluate quality and quantity of microRNA. Extraction efficiency was evaluated by detection of four endogenous control microRNA using real-time-PCR. Further, we modified the manufacturer’s protocol for miRNeasy Serum/Plasma kit to improve yield. miRNeasy Serum/Plasma kit outperformed the other three kits in microRNA-quality (P < 0.005) and yielded maximum microRNA-quantity. Recovery of endogenous control microRNA i.e. hsa-miR-24-3p, hsa-miR-191-5p, hsa-miR-423-5p and hsa-miR-484 was higher as well. Modification with the inclusion of a double elution step enhanced yield of microRNA extracted with miRNeasy Serum/Plasma kit significantly (P < 0.001). We demonstrated that miRNeasy Serum/Plasma kit outperforms other kits and can be reliably used with a limited plasma quantity. We have provided a modified microRNA-extraction protocol with improved microRNA output for downstream analyses

Craniofacial reconstruction of the Indus valley civilization individuals found at 4500-year-old Rakhigarhi cemetery

Despite academic efforts to study the Indus Valley civilization (IVC), there have as yet been no successful attempts to unveil the IVC people’s craniofacial appearance. We investigated the IVC cemetery area of Rakhigarhi site, which was estimated to be of 2273 ± 38 and 2616 ± 73 years BCE. By craniofacial reconstruction (CFR) procedure using computed tomography (CT) data of two Rakhigarhi skulls (A1 BR02 and A2 BR36), we successfully reconstructed the faces of the IVC individu-als who were buried about 4500 years ago. This is the first attempt to unveil scientifically accurate representations of IVC people’s actual facial morphology

Hundreds of variants clustered in genomic loci and biological pathways affect human height

Most common human traits and diseases have a polygenic pattern of inheritance: DNA sequence variants at many genetic loci influence the phenotype. Genome-wide association (GWA) studies have identified more than 600 variants associated with human traits, but these typically explain small fractions of phenotypic variation, raising questions about the use of further studies. Here, using 183,727 individuals, we show that hundreds of genetic variants, in at least 180 loci, influence adult height, a highly heritable and classic polygenic trait. The large number of loci reveals patterns with important implications for genetic studies of common human diseases and traits. First, the 180 loci are not random, but instead are enriched for genes that are connected in biological pathways (P = 0.016) and that underlie skeletal growth defects (P < 0.001). Second, the likely causal gene is often located near the most strongly associated variant: in 13 of 21 loci containing a known skeletal growth gene, that gene was closest to the associated variant. Third, at least 19 loci have multiple independently associated variants, suggesting that allelic heterogeneity is a frequent feature of polygenic traits, that comprehensive explorations of already-discovered loci should discover additional variants and that an appreciable fraction of associated loci may have been identified. Fourth, associated variants are enriched for likely functional effects on genes, being over-represented among variants that alter amino-acid structure of proteins and expression levels of nearby genes. Our data explain approximately 10% of the phenotypic variation in height, and we estimate that unidentified common variants of similar effect sizes would increase this figure to approximately 16% of phenotypic variation (approximately 20% of heritable variation). Although additional approaches are needed to dissect the genetic architecture of polygenic human traits fully, our findings indicate that GWA studies can identify large numbers of loci that implicate biologically relevant genes and pathways.

Provider imposed restrictions to clients’ access to family planning in urban Uttar Pradesh, India: a mixed methods study

BACKGROUND: Medical barriers refer to unnecessary policies or procedures imposed by health care providers that are not necessarily medically advised; these restrictions impede clients’ access to family planning (FP). This mixed methods study investigates provider imposed barriers to provision of FP using recent quantitative and qualitative data from urban Uttar Pradesh, India. METHODS: Baseline quantitative data were collected in six cities in Uttar Pradesh, India from service delivery points (SDP), using facility audits, exit interviews, and provider surveys; for this study, the focus is on the provider surveys. More than 250 providers were surveyed in each city. Providers were asked about the FP methods they provide, and if they restrict clients’ access to each method based on age, parity, partner consent, or marital status. For the qualitative research, we conducted one-on-one interviews with 21 service providers in four of the six cities in Uttar Pradesh. Each interview lasted approximately 45 minutes. RESULTS: The quantitative findings show that providers restrict clients’ access to spacing and long-acting and permanent methods of FP based on age, parity, partner consent and marital status. Qualitative findings reinforce that providers, at times, make judgments about their clients’ education, FP needs and ability to understand FP options thereby imposing unnecessary barriers to FP methods. CONCLUSIONS: Provider restrictions on FP methods are common in these urban Uttar Pradesh sites. This means that women who are young, unmarried, have few or no children, do not have the support of their partner, or are less educated may not be able to access or use FP or their preferred method. These findings highlight the need for in-service training for staff, with a focus on reviewing current guidelines and eligibility criteria for provision of methods