Investigating the Use of M-Health for Learning and Clinical Training by Medical Students in Ghana

There is a challenge with healthcare access in most developing countries. With the high rate of mobile technology penetration in these countries, there is a strong belief that mobile technology can help address this and other health system and education challenges. This study investigated how clinical year medical students in Ghana used m-health and with what outcomes. This was a mixed-methods study to assess what technologies students used, what the impact of use was, what enablers and barriers they encountered, what factors explained m-health adoption and what the attitudes of students, staff and faculty members were towards m-health use. The study was conducted in four out of five medical schools in Ghana with clinical year students, namely, Kwame Nkrumah University of Science and Technology School of Medical Sciences (KNUST-SMS), University of Cape Coast School of Medical Sciences (UCC-SMS), University of Development Studies School of Medicine and Health Sciences (UDS-SMHS) and University of Ghana School of Medicine and Dentistry (UG-SMD). Online and paper questionnaires were distributed to 828 students and 291 questionnaires were returned. Questionnaires from dental students at UG-SMD (n = 5) were excluded from the analysis.Two focus group discussions were held involving seven students while three students, seven faculty members and five staff were interviewed. Qualitative data were analyzed using thematic analysis. Only one student did not own a mobile device. About 78% of students reported using m-health at some point during their medical education. The most popular devices used by students were laptop computers (90.8%), smartphones (66.2%), cellular phones (46.6%) and tablets (44.1%). Over 84% of the students owned Android devices, while 21% owned iPhones and iPads. Majority of students owned three devices or less. Students used mobile technologies in ways that suited their learning needs and contexts. M-health helped students to participate better in lessons and improve their knowledge, skills and efficiency in various contexts. The main drawbacks of m-health use were distraction and time wasting, difficulty in determining credibility of some online information and the risk of using these technologies inappropriately around patients and during assessments. The main facilitating conditions for m-health use were availability, quality and reliability of technological services, technical support, security, price value, technology competence and training, portability, task and goal fit, social influence and organizational factors. Habit and Hedonic Motivation were the only significant factors that explained intention to use m-health and actual m-health use respectively in the UTAUT2 model, in the presence of age, gender and experience. Students, staff and faculty members were open to using m-health in teaching and learning, although they recommended regulation of use through policies and guidelines to ensure effective teaching and learning and ethical m-health use. Considering the benefits offered by m-health, the study encourages medical schools in Ghana to explore mobile learning with the possibility of incorporating it into their curricula. This should be accompanied by development of policies and guidelines to spell out how mobile technologies should be used in order to mitigate most of the drawbacks identified. This study contributed empirical evidence from the Ghanaian context regarding m-health adoption and use in medical education. This evidence will contribute to theory regarding benefits, drawbacks, facilitating conditions and factors that influence m-health adoption among medical students in a developing country context. Understanding how medical students use mobile technology in learning will be useful in planning how m-health can be incorporated into their curricula. It will also help in informing development and deployment of m-health in healthcare in contexts similar to Ghana

Pain Bloc-R Alleviates Unresolved, Non-Pathological Aches and Discomfort in Healthy Adults—A Randomized, Double-Blind, Placebo-Controlled, Crossover Study

The lack of effective treatment for chronic discomfort without negative side effects highlights the need for alternative treatments. Pain Bloc-R is a natural health product composed of vitamins B6, B12, D, white willow bark extract, Angelica root extract, acetyl L-carnitine HCl, caffeine, L-theanine, Benfotiamine, and L-tetrahydropalmatine. The objective of this study was to compare the effects of Pain Bloc-R, acetaminophen, and placebo on unresolved aches and discomfort as assessed by the brief pain inventory (BPI) and modified Cornell musculoskeletal discomfort questionnaires. This randomized, double-blind, placebo-controlled, crossover study consisted of three 7-day periods with Pain Bloc-R, acetaminophen, or placebo, each separated by a 7-day washout. Twenty-seven healthy adults (ages 22–63 years) were randomized to receive the three interventions in different sequences. The BPI “pain at its worst” scores were significantly lower when participants took Pain Bloc-R than when they took acetaminophen (21.8% vs. 9.8% decrease, p = 0.026) after seven days of supplementation. Pain Bloc-R achieved a significant improvement in the “pain at its least” score, significantly decreased the interference of discomfort in walking, and significantly decreased musculoskeletal discomfort total scores (34%, p = 0.040) after seven days. In a post hoc subgroup analysis based on age and gender, male participants ≤45 years taking Pain Bloc-R reported significant reductions in pain severity and pain interference vs. acetaminophen. Pain Bloc-R performed as well as acetaminophen in managing unresolved non-pathological pain in otherwise healthy individuals

Effect of a Euglena gracilis Fermentate on Immune Function in Healthy, Active Adults: A Randomized, Double-Blind, Placebo-Controlled Trial

Euglena gracilis produce high amounts of algal β-1,3-glucan, which evoke an immune response when consumed. This study investigated the effect of supplementation with a proprietary Euglena gracilis fermentate (BG), containing greater than 50% β-1,3-glucan, on immune function as measured by self-reported changes in upper respiratory tract infection (URTI) symptoms. Thirty-four healthy, endurance-trained participants were randomized and received either 367 mg of BG or placebo (PLA) for 90 days. Symptoms were assessed by the 24-item Wisconsin Upper Respiratory Symptom Survey and safety via clinical chemistry, hematology, vitals, and adverse event reporting. Participants supplemented with BG over 90 days reported fewer sick days (BG: 1.46 ± 1.01; PLA: 4.79 ± 1.47 days; p = 0.041), fewer URTI symptoms (BG: 12.62 ± 5.92; PLA: 42.29 ± 13.17; p = 0.029), fewer symptom days (BG: 5.46 ± 1.89; PLA: 15.43 ± 4.59 days; p = 0.019), fewer episodes (BG: 2.62 ± 0.67; PLA: 4.79 ± 0.67; p = 0.032), and lower global severity measured as area under curve for URTI symptoms (BG: 17.50 ± 8.41; PLA: 89.79 ± 38.92; p = 0.0499) per person compared to placebo. Sick days, symptoms, and global severity were significantly (p < 0.05) fewer over 30 days in the BG group compared to PLA. All safety outcomes were within clinically normal ranges. The study provides evidence that supplementation with a proprietary Euglena gracilis fermentate containing greater than 50% β-1,3-glucan may reduce and prevent URTI symptoms, providing immune support and protecting overall health

A randomized trial of artesunate-amodiaquine versus artemether-lumefantrine in Ghanaian paediatric sickle cell and non-sickle cell disease patients with acute uncomplicated malaria

BACKGROUND: Sickle cell disease (SCD) is a genetic disorder common in malaria endemic areas. In endemic areas, malaria is a major cause of morbidity and mortality among SCD patients. This suggests the need for prompt initiation of efficacious anti-malarial therapy in SCD patients with acute malaria. However, there is no information to date, on the efficacy or safety of artemisinin combination therapy when used for malaria treatment in SCD patients. METHODS: Children with SCD and acute uncomplicated malaria (n = 60) were randomized to treatment with artesunate-amodiaquine (AA), or artemether-lumefantrine (AL). A comparison group of non-SCD children (HbAA genotype; n = 59) with uncomplicated malaria were also randomized to treatment with AA or AL. Recruited children were followed up and selected investigations were done on days 1, 2, 3, 7, 14, 28, 35, and 42. Selected clinical and laboratory parameters of the SCD patients were also compared with a group of malaria-negative SCD children (n = 82) in steady state. RESULTS: The parasite densities on admission were significantly lower in the SCD group, compared with the non-SCD group (p = 0.0006). The parasite reduction ratio (PRR) was lower, clearance was slower (p < 0.0001), and time for initial parasitaemia to decline by 50 and 90% were longer for the SCD group. Adequate clinical and parasitological response (ACPR) on day 28 was 98.3% (58/59) in the SCD group and 100% (57/57) in the non-SCD group. Corresponding ACPR rates on day 42 were 96.5% (55/57) in the SCD group and 96.4% (53/55) in the non-SCD group. The fractional changes in haemoglobin, platelets and white blood cell counts between baseline (day 0) and endpoint (day 42) were 16.9, 40.6 and 92.3%, respectively, for the SCD group, and, 12.3, 48.8 and 7.5%, respectively, for the non-SCD group. There were no differences in these indices between AA- and AL-treated subjects. CONCLUSIONS: The parasite clearance of SCD children with uncomplicated malaria was slower compared with non-SCD children. AA and AL showed similar clinical and parasitological effects in the SCD and non-SCD groups. The alterations in WBC and platelet counts may have implications for SCD severity. TRIAL REGISTRATION: Current controlled trials ISRCTN96891086