Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries

Purpose: African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Method: Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. Results: The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Conclusions: Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments

Development of a Community-Based Oral Health Promotion Program for Non-Institutionalized Older Adults in Medically Underserved Communities in Southeastern Georgia Using the Precede-Proceed Planning Model

The older population in the United States is growing at an unprecedented rate. Majority of older Americans reside in rural communities. Currently, only a small proportion of the population reside in nursing homes, while most older adults continue living in their current homes and communities as they age. There is growing evidence on the bidirectional association between chronic diseases and oral diseases. As multiple chronic diseases are reportedly more prevalent in older adults, it follows that they are at an increased risk of developing oral diseases. Poor oral health can impact quality of life by affecting their physical, psychological, and social well-being. The purpose of this study was: (a) To assess determinants of preventive oral health behavior in noninstitutionalized older adults living in rural/medically underserved communities of southeast Georgia; and (b) To determine essential components of a community-based oral health promotion program for this population. A mixed methods sequential explanatory design was used to complete this two-phased study. Firstly, surveys were administered to a convenience sample of 206 older adults through community-based supportive services in five rural/medically underserved counties in southeast Georgia. Secondly, phone interviews were conducted with 22 individuals from the survey sample and 11 key informants. The older adult participants included were either fully or moderately functionally independent. Results from multivariate logistic regression analysis informed the development of the interview guide used in the second phase of the study. Key findings from the survey included the significant association - between the older adult participants’ preventive oral health behavior and oral health knowledge; and between living alone and preventive oral health behavior. Interview findings revealed that older adult participants did not perceive support from their family, friends, neighbors, and community at large with regards to oral care. Cost was perceived as a major barrier for accessing oral care by older adults and they believed that if one could afford the care, it did not matter whether one lived in a rural or nonrural community. The older adult participants also had a general understanding of the connection between oral health and general health although they did not understand how one affected the other. Key-informants believed a deeper understanding of the oral-systemic link would lead older adults to prioritize oral health more. Other recommended topics for the oral health education program included signs and symptoms of oral diseases, ways to prevent oral diseases, and available oral care resources and associated costs. Key-informants mentioned current challenges with reimbursement of preventive oral care services and with limited scope of practice for dental auxiliaries. Lastly, key-informants also recommended further integration of oral health care with health care in training, practice, financing and delivery of services

Integration of Oral Health Services with Primary Care for Older Adults

The United States is experiencing an unprecedented expansion of its older population (Centers for Disease Control and Prevention, CDC, 2013), which is disproportionately concentrated in its rural areas (Glasgow & Brown, 2012). Many older Americans do not have dental insurance as they lose employer-sponsored dental benefits upon retirement (CDC, 2013). While Medicare and Medicaid do not cover routine dental care (CDC, 2013) majority of the Medicare beneficiaries have a regular source of medical care (Bocuti et al., 2013). If the medical providers are “the only accessible points of entry to the health care system and for others the physician is an important source for all health concerns” (Cohen, 2013) it follows that integrating care will lead to a more effective treatment of oral diseases. The purpose of this study was to describe current state of knowledge on practices and approaches for integration of oral health services with primary care practices for older adults. A narrative literature review was conducted of studies published between 2008-2018 utilizing 7 databases (PubMed with MedLine, PubMed Central, CINAHL, EBSCO, ProQuest Central, JSTOR, and GOOGLE scholar) to identify existing models that demonstrate effective integration of oral care with primary care practices. The results highlight promising practices across the U.S. that have successfully integrated oral health services with primary care practices and can be beneficial to the older adults in rural and remote communities. An integrative approach results in improved quality of care that is more cost-effective and patient-centric with faster diagnoses and appropriate referrals

Documentation of SoTL Trends: A Pilot Investigation in Family Science

Presentation given at the SoTL Commons Conference. This workshop aims to provide attendees with a deeper understanding of student diversity as it relates to academic outcomes. This engaging session is targeted towards students, staff, faculty, and other persons working with students in higher education. Presenters will provide an interactive learning environment where attendees will artificially participate as members of various sub-populations in society to explore the ways in which individual pathways are impacted by sociocultural factors. By doing so, attendees will gain better insight on differing outcome effects affecting students with a range of background and status characteristics (learning outcome #1). Attendees will be prompted to consider the impacts of exposure to certain risk and protective factors as they relate to access to resources along the path to higher education. The workshop will highlight the intersection of multiple levels of social status, identity, as well as privilege, as it pertains to the college experience (learning outcome #2). With this expanded understanding of student diversity and awareness of varying sociocultural contexts, student participants will feel a sense of empowerment regarding their own academic success and professionals will leave better prepared to support students in their endeavors. Students and professionals alike will gain the knowledge necessary to contribute to an improved climate and culture here at Georgia Southern University (learning outcome #3)

Documentation of SoTL Trends at NCFR, 2006-2015

Research indicates that while the Scholarship of Teaching and Learning (SoTL) continues to advance its integration into universities throughout the United States (Huber & Hutchings, 2005; O’Meara & Rice, 2005 as cited in Gurung, Ansburg, Alexander, Lawrence, & Johnson, 2005), some fields have been more receptive than others. Studies have explored faculty members’ perceived support of SoTL at departmental and institutional levels (Gurung et al., 2008; Reinke, Muraco, & Maurer, 2016). However, inquiry on SoTL penetration into traditional disciplinary conferences remains scarce. The paucity of research exploring inclusion or exclusion of SoTL sessions at professional meetings warrants further attention. This investigation examined historical changes in the presence of SoTL topics at National Council on Family Relations (NCFR) annual conferences from 2006-2015. Through content analyses of conference programs, researchers explored ratios of SoTL to non-SoTL sessions and gender ratios of presenters (McKinney & Chick, 2010). Institutional Carnegie classification of presenters of SoTL sessions was also recorded. Discussion addresses implications of findings for growth of SoTL in family science and the interdisciplinary SoTL communit

Documentation of SoTL Trends: A Pilot Investigation in Family Science

Research has indicated that SoTL continues to further its integration into universities nationwide (Huber & Hutchings, 2005; O’Meara & Rice, 2005), although some fields have been more receptive than others. Studies have explored faculty members’ perceived support of SoTL at departmental and institutional levels (Gurung, Ansburg, Alexander, Lawrence, & Johnson, 2008); however, inquiry pertaining to the penetration of SoTL into traditional disciplinary conferences remains scarce. The paucity of research exploring the inclusion or exclusion of SoTL sessions at professional meetings warrants further attention in an effort to advance SoTL throughout academia. This investigation examined historical changes in the presence of SoTL topics at the primary annual conference within the discipline of Family Science as a pilot study for proposed replication in other disciplines. Through content analyses of The National Council on Family Relations conference programs spanning 2006-2015, researchers explored the ratio of SoTL to non-SoTL sessions, as well as the gender ratio of presenters (McKinney & Chick, 2010). Implications of findings for the growth of SoTL within the broader interdisciplinary community are discussed

Use of Mobile Health in Prenatal and Postnatal Care - A Systematic Review

Background: Pre- and post-natal care are essential to mother and child survival from pregnancy-related complications. The use of mobile technology as a health monitoring tool, and service provision tracking device to improve health, healthcare delivery, and health service outcomes, prevent disease, and manage chronic diseases has been well-documented. We conducted a systematic review to examine the use of mobile technology in promoting and educating mothers on prenatal and postnatal care, and the outcomes of these interventions. Methods: PubMed (Medline), CINAHL Complete, and PsycINFO were searched for primary articles on mobile technology interventions for prenatal and postnatal care published from 2000 to 2016. Key search terms included mobile technology, maternal health, pregnancy, prenatal and postnatal. Abstracts and full texts were reviewed by two reviewers using pre-determined inclusion and exclusion criteria. Eleven articles that met the inclusion criteria were assessed for quality and the content was analyzed. Results: All the 11 studies were intervention studies, four of which were randomized control trials. Four studies investigated the influence of mobile phone technologies on behaviors and attitudes among mothers during pregnancy and breastfeeding. Health outcomes attributed to mobile technology included improved breastfeeding practices, increased antenatal care attendance and coverage, and reduced perinatal mortality. Implication/Conclusion: Mobile technology interventions are very applicable in low-income settings where distance and cost of travel restrict access to maternal and newborn services. Thus, mobile phone interventions can facilitate health services by saving time, reduce the financial burden and other social costs for women

Fish Consumption is Associated with a Decreased Risk of Death among Adults with Diabetes, a 15-Year Follow-Up of a National Cohort

Background: Consumption of fish, especially fatty fish with high level of polyunsaturated fatty acids (PUFA), may protect against cardiovascular disease (CVD), but no studies have been conducted to assess this hypothesis among diabetic adults, who experience a substantial risk of CVD. To fill this gap, we describe the CVD - specific mortality of adults with diabetes and assess their relationship with fish consumption. Methodology: We analyzed the data of 1,135 adults aged 19 and older with diabetes who participated in the National Health and Nutrition Examination Survey (1988-1994) as the baseline examination and were followed up through December 31, 2010. With age, sex, race, family income, education attainment, alcohol drinking, cigarette smoking, and health status at baseline included, we used Cox proportional hazards regression to estimate the adjusted hazard ratios (HRs) for the relative risk and compared the risk between participants with different level of fish consumption. Results: A total of 701 deaths were recorded by the end of a 15-year follow-up with a mortality rate of 61.11 per 1000 person year. CVD and stroke were listed as contributing causes for 328, 52 deaths, accounting for 46.4% and 7.4% of the total deaths respectively. Stroke-specific mortality rate among patients who never or rarely ate fish was more than twice as high as that among patients who ate fish more than twice a week, 6.22 vs. 2.38 per 1000 person year.The corresponding CVD-specific mortality rates were 34.54 vs. 22.19 per 1000 person year respectively. After adjusting for covariates, the HRs of dying from stroke were 1.00 (reference), 0.41 (95% confidence interval = 0.20 - 0.87) and 0.28 (0.10 - 0.76) among patients who rare/never, 1-2 times, and more than twice a week. The HRs of dying from CVD were 0.81 (0.61 - 1.08) and 0.67 (0.47 - 0.96), respectively. Further adjustment for dietary supplements of fish oil did not change the estimates, and no significant gender difference was observed. Conclusions: High fish consumption may reduce the risk of dying from CVD, especially, stroke, among diabetic adults

Should the frequency, severity, or both response scales be used for multi-item dental patient-reported outcome measures?

Background The Oral Impacts on Daily Performances (OIDP) index asks the respondents to indicate both, the frequency and severity of the impact. However, it is not clear if the two scaling methods are correlated, and if using one scale is sufficient. The purpose of the study was to investigate the correlation between frequency and severity rating scales of the OIDP instrument, and whether only one of the rating scales can be used instead of both. Methods A battery of patient-reported outcome questionnaires were administered to a consecutive sample of adult dental patients from HealthPartners dental clinics in Minnesota (N = 2,115). Only those who responded to any of the OIDP items were included in the analysis for this study (N = 873). We assessed correlations between the frequency and severity scales for all OIDP items, and for the summary scores of the two OIDP response scales. We additionally fit a categorical structural equation model (SEM) (or an item factor analysis model) and examined the correlation between two latent variables (Frequency and Severity). Results The correlation estimates for all OIDP items were greater than 0.50, indicating large correlations between the frequency and severity scores for each OIDP item. The correlation estimate between the two summary scores was 0.85 (95% CI [0.82–0.86]). When we calculated the correlation coefficient using a latent variable model, the value increased to 0.96 (95% CI [0.93–1.00]). Conclusion Our study findings show that OIDP frequency and severity scores are highly correlated, which indicates the use of one scale only. Based on previous evidence, we recommend applying the frequency rating scale only in research and clinical settings

Breast Cancer Survivorship Resources in Bulloch and Surrounding Counties in Georgia

Presentation given at Georgia Southern University Research Symposium