Are medical educators in general practice untapped potential to increase training capacity in sexual and reproductive healthcare? Results of a survey in London, UK

Background Long waiting times for training in sexual and reproductive healthcare (SRH) including long acting reversible contraception (LARC) might lead to attrition from training programmes, leading to reduced capacity for sexual health services, and reduced access to such contraception for women. Setting General practice in London, UK. Question Can medical educators in general practice be used as untapped potential to train other health care professionals in sexual and reproductive healthcare? Method We conducted an online survey to find out the qualifications, skills and willingness of established educators in primary care in London to train other clinicians in sexual and reproductive healthcare, including LARC. Results We received 124 responses from medical educators (10.1% response rate from general practitioner (GP) trainers and 59.0% of clinical supervisors for Foundation Year doctors). 86 (69.9%) had diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH) qualification and further 18 (14.6%) were interested in obtaining this qualification. Eleven respondents were trained to fit intrauterine contraception only, three for contraceptive implants only and 37 were trained to fit both. 50 (40.3%) of 124 respondents were willing get involved in DFSRH training; 74% of these were willing to teach on any component of DFSRH including LARC. Discussion There is a shortage of training places and long waiting list for clinicians who wish to train in SRH. This survey suggests there is a pool of GP educators with skills and experience in SRH and are willing to train others. This can potentially increase the training capacity and improve overall access to good contraception and LARC for women. Keywords: Contraception, professional education, general practice, reproductive health, sexually transmitted diseases Impact statement Strategies to reduce unplanned pregnancies and abortions must include timely access to information and wide range of contraception including LARC for women. Improving access to timely care can be accomplished by ensuring there are adequate numbers of healthcare professionals trained to provide SRH and LARC

Causes of severe visual impairment and blindness in Bangladesh: a study of 1935 children.

OBJECTIVE: To identify the anatomical site and underlying aetiology of severe visual impairment and blindness (SVI/BL) in children in Bangladesh. DESIGN: A national case series. METHODS: Children were recruited from all 64 districts in Bangladesh through multiple sources. Causes were determined and categorised using standard World Health Organization methods. RESULTS: 1935 SVI/BL children were recruited. The median age was 132 months, and boys accounted for 63.1% of the sample. The main site of abnormality was lens (32.5%), mainly unoperated cataract, followed by corneal pathology (26.6%) and disorders of the whole eye (13.1%). Lens-related blindness was the leading cause in boys (37.0%) compared with corneal blindness in girls (29.8%). In 593 children, visual loss was due to childhood factors, over 75% being attributed to vitamin A deficiency. Overall 1338 children (69.2%) had avoidable causes. Only 2% of the country's estimated SVI/BL children have access to education and rehabilitation services. CONCLUSIONS: This is the first large-scale study of SVI/BL children in Bangladesh over two-thirds of whom had avoidable causes. Strategies for control are discussed

Epidemiology of Eales Disease in the Central Western India

Objective: To investigate the clinical features and propose a new staging system based on the clinicopathological correlation and formulate new guidelines for management of Eales’ disease in healthy young males. Design: Prospective cohort study. Setting: Vitreo Retinal Department of a tertiary eye care center in Western Central India. Participants: Seventy-four eyes diagnosed with Eales’ disease. Materials and methods: From 2004 to 2010, patients clinically diagnosed with Eales’ disease were enrolled in this study using specific inclusion and exclusion criteria. We examined the patients’ anterior and posterior segments thoroughly. We performed the necessary ocular and systemic investigations. We divided the investigations into three stages: inflammatory, ischemic and complications and the patients were treated accordingly. We treated the patients using medical management, photocoagulation or pars plana vitrectomy. The patients were monitored according to standard schedules and formats. All information was documented using a pre-tested online format and statistical analyses were performed using SPSS ver. 17. A p-value < 0.05 was considered to indicate significance. Outcome measures: Visual acuity. Results: The cohort comprised 74 cases with a mean age of 30 ± 8.73 years. The visual acuity of the presenting cohort was < 3/60 in 64.9% of eyes. The final visual outcome was > 6/12 in 40 eyes (54.1%), 6/60 to 6/18 in 14 eyes (18.9%) and < 1/60 in the remaining 9 eyes at a mean follow-up of 592 days. The visual parameters differed significantly pre-and post-treatment. We evaluated the visual outcome following surgical management. Conclusion: We studied epidemiological facts about anterior and posterior segment findings

Is Homophily a Necessity for Graph Neural Networks?

Graph neural networks (GNNs) have shown great prowess in learning representations suitable for numerous graph-based machine learning tasks. When applied to semi-supervised node classification, GNNs are widely believed to work well due to the homophily assumption ("like attracts like"), and fail to generalize to heterophilous graphs where dissimilar nodes connect. Recent works design new architectures to overcome such heterophily-related limitations, citing poor baseline performance and new architecture improvements on a few heterophilous graph benchmark datasets as evidence for this notion. In our experiments, we empirically find that standard graph convolutional networks (GCNs) can actually achieve better performance than such carefully designed methods on some commonly used heterophilous graphs. This motivates us to reconsider whether homophily is truly necessary for good GNN performance. We find that this claim is not quite true, and in fact, GCNs can achieve strong performance on heterophilous graphs under certain conditions. Our work carefully characterizes these conditions, and provides supporting theoretical understanding and empirical observations. Finally, we examine existing heterophilous graphs benchmarks and reconcile how the GCN (under)performs on them based on this understanding

Self-rating depression during early postoperative period after colostomy following radical surgery for rectal cancer

Introductions: Colorectal cancer (CRC) is 3rd most common cancer. Half of which requires colostomy. It leads to anxiety and depression with less than optimal quality of life. Zung Self-rating Depression Scale is a reliable tool used in Chinese population for identifying and addressing mental health status for appropriate education. The aim of this study is to investigate the depression state in rectal cancer patients after colostomy, then analyze its influence factors. Methods: A cross sectional study in rectal cancer patients who had colostomy after radical surgery for rectal cancer were investigated for depression during early postoperative period within one week using Zung’s self-rating depression scale (SDS). Multiple logistic regression analysis was done to identify the risk factor. Results: There were 55 colostomies patients (male 30 and female 25 patients, age 50.11+/-13.17 years) after rectal cancer surgery during the study period. The SDS score of was higher than national norm (P&lt;0.01). The risk factors for depression were female gender, younger age, lower economic status, and lesser degree of understanding of the disease. Conclusions: The depression level of rectal cancer patients after colostomy was higher than normal population, especially in female, young age, with poor understanding of disease and lower economy status. The effective measures should be targeted to strengthen the health psychosocial health of these patients. Keywords: colorectal cancer, colostomy, early postoperative depression, Zung self-rating depression score SD

Health professionals' perceptions of cultural influences on stroke experiences and rehabilitation in Kuwait

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2012 Informa UK Ltd.Purpose: The aim of this study was to investigate the perceptions of health professionals who treat stroke patients in Kuwait regarding cultural influences on the experience of stroke and rehabilitation in Kuwait. Health professionals interviewed were from a variety of cultural backgrounds thus providing an opportunity to investigate how they perceived the influence of culture on stroke recovery and rehabilitation in Kuwait. Method: Semi-structured interviews were carried out with 12 health professionals with current/recent stroke rehabilitation experience in Kuwait, followed by thematic analysis of the verbatim transcripts. Results: The health professionals identified several features of the Kuwaiti culture that they believed affected the experiences of stroke patients. These were religious beliefs, family involvement, limited education and public information about stroke, prevailing negative attitudes toward stroke, access to finances for private treatment, social stigma and the public invisibility of disabled people, difficulties identifying meaningful goals for rehabilitation, and an acceptance of dependency linked with the widespread presence of maids and other paid assistants in most Kuwaiti homes. Conclusion: To offer culturally sensitive care, these issues should be taken into account during the rehabilitation of Kuwaiti stroke patients in their home country and elsewhere

Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey.

AIM: To estimate the prevalence of visual impairment and blindness caused by cataract, the prevalence of aphakia/pseudophakia, cataract surgical coverage (CSC) and to identify barriers to the uptake of cataract services among adults aged >or=30 years in Pakistan. METHODS: Probability proportional-to-size procedures were used to select a nationally representative sample of adults. Each subject underwent interview, visual acuity measurement, autorefraction, biometry and ophthalmic examination. Those that saw <6/12 in either eye underwent a more intensive examination procedure including corrected visual acuity, slit lamp and dilated fundus examination. CSC was calculated for different levels of visual loss by person and by eye. Individuals with <6/60 in the better eye as a result of cataract were interviewed regarding barriers. RESULTS: 16 507 Adults were examined (95.5% response rate). The crude prevalence of blindness (presenting <3/60 in the better eye) caused by bilateral cataract was 1.75% (95% CI 1.55%, 1.96%). 1317 Participants (633 men; 684 women) had undergone cataract surgery in one or both eyes, giving a crude prevalence of 8.0% (95% CI 7.6%, 8.4%). The CSC (persons) at <3/60, <6/60 and <6/18 were 77.1%, 69.3% and 43.7%, respectively. The CSC (eyes) at <3/60, <6/60 and <6/18 were 61.4%, 52.2% and 40.7%, respectively. Cost of surgery (76.1%) was the main barrier to surgery. CONCLUSION: Approximately 570 000 adults are estimated to be blind (<3/60) as a result of cataract in Pakistan, and 3,560000 eyes have a visual acuity of <6/60 because of cataract. Overall, the national surgical coverage is good but underserved populations have been identified

Towards More Data-Aware Application Integration (extended version)

Although most business application data is stored in relational databases, programming languages and wire formats in integration middleware systems are not table-centric. Due to costly format conversions, data-shipments and faster computation, the trend is to "push-down" the integration operations closer to the storage representation. We address the alternative case of defining declarative, table-centric integration semantics within standard integration systems. For that, we replace the current operator implementations for the well-known Enterprise Integration Patterns by equivalent "in-memory" table processing, and show a practical realization in a conventional integration system for a non-reliable, "data-intensive" messaging example. The results of the runtime analysis show that table-centric processing is promising already in standard, "single-record" message routing and transformations, and can potentially excel the message throughput for "multi-record" table messages.Comment: 18 Pages, extended version of the contribution to British International Conference on Databases (BICOD), 2015, Edinburgh, Scotlan