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Challenges and opportunities for educating health professionals after the COVID-19 pandemic
The education of health professionals substantially changed before, during, and after the COVID-19 pandemic. A 2010 Lancet Commission examined the 100-year history of health-professional education, beginning with the 1910 Flexner report. Since the publication of the Lancet Commission, several transformative developments have happened, including in competency-based education, interprofessional education, and the large-scale application of information technology to education. Although the COVID-19 pandemic did not initiate these developments, it increased their implementation, and they are likely to have a long-term effect on health-professional education. They converge with other societal changes, such as globalisation of health care and increasing concerns of health disparities across the world, that were exacerbated by the pandemic. In this Health Policy, we list institutional and instructional reforms to assess what has happened to health-professional education since the publication of the Lancet Commission and how the COVID-19 pandemic altered the education process.
Journal Article
Retinoblastoma
Retinoblastoma is an aggressive eye cancer of infancy and childhood. Survival and the chance of saving vision depend on severity of disease at presentation. Retinoblastoma was the first tumour to draw attention to the genetic aetiology of cancer. Despite good understanding of its aetiology, mortality from retinoblastoma is about 70% in countries of low and middle income, where most affected children live. Poor public and medical awareness, and an absence of rigorous clinical trials to assess innovative treatments impede progress. Worldwide, most of the estimated 9000 newly diagnosed patients every year will die. However, global digital communications present opportunities to optimise standards of care for children and families affected by this rare and often devastating cancer. Parents are now leading the effort for widespread awareness of the danger of leucocoria. Genome-level technologies could make genetic testing a reality for every family affected by retinoblastoma. Best-practice guidelines, online sharing of pathological images, point-of-care data entry, multidisciplinary research, and clinical trials can reduce mortality. Most importantly, active participation of survivors and families will ensure that the whole wellbeing of the child is prioritised in any treatment plan.
Journal Article
Work Schedule Unpredictability: Daily Occurrence and Effects on Working Parents' Well‐Being
Objective To investigate the pervasiveness and frequency of work schedule unpredictability among workers in low‐wage hourly jobs and the effects of work schedule unpredictability on worker and family well‐being. Background Family science has long considered the ways in which parents' experiences in the workplace can affect families. Although unpredictability in work schedules has increased over time, especially for low‐wage workers, the effects of schedule unpredictability on worker and family well‐being have been understudied. Method Ninety‐two workers with children aged 2–7, recruited using a new venue‐time sampling technique, were asked to complete once‐a‐day surveys for 30 consecutive days (N = 2,221 person‐days for analysis). Descriptive analyses and regression models with family fixed effects were utilized. Results Work schedule unpredictability was common in the context of families' lives: over the 30 days, parents experienced an unanticipated work schedule change on 13.3% of days, and 87% of parents experienced at least one unanticipated work schedule change. Within families, unpredictable work schedule changes on a given day were associated with worse outcomes that day for parents, including increased negative mood and decreased perceived sleep quality. Conclusion Work schedule unpredictability is ubiquitous in the lives of low‐wage hourly workers and is negatively related to working parents' well‐being. Implications These results provide evidence that unscheduled and canceled shifts typical of low‐wage service jobs may harm parents' well‐being, which could ultimately affect their children's development and well‐being.
Journal Article
Parity, dental caries and implications for maternal depletion syndrome in northern Nigerian Hausa women
Female reproductive history, especially high parity, affects general health and may impact negatively on oral health. While parity has been positively linked to tooth loss, the specific association between parity and caries has not been adequately investigated.
To determine the association between parity and caries in a population of higher parity women. Influences of likely confounders (age, socio-economic status, reproductive parameters, oral health practices and sugar consumption between meals) were considered.
This was a cross-sectional study involving 635 Hausa women of varying parity aged 13-80 years. Socio-demographic status, oral health practices and sugar consumption were obtained using a structured interviewer-administered questionnaire. All decayed, missing and filled teeth due to caries (excluding third molars) were noted, and tooth loss etiology was queried. Associations with caries were evaluated through correlation, ANOVA, post hoc analyses and Student's t tests. Effect sizes were considered for magnitude of differences. Multiple regression (binomial model) was used to investigate predictors of caries.
Hausa women had a high prevalence of caries (41.4%) despite low sugar consumption; nonetheless the overall mean DMFT score was very low (1.23 ± 2.42). Older, higher parity women experienced more caries, as did those with longer reproductive spans. Additionally, poor oral hygiene, use of fluoride toothpaste and frequency of sugar consumption were significantly associated with caries.
Higher parity (>6 children) was associated with higher DMFT scores. These results suggest that a form of maternal depletion, expressed as heightened caries susceptibility and subsequent tooth loss, occurs with higher parity.
Journal Article
Current tools available for investigating vaccine hesitancy: a scoping review protocol
IntroductionVaccine hesitancy, defined as the delay in acceptance or refusal of vaccination despite availability of vaccination services is responsible in part for suboptimal levels of vaccination coverage worldwide. The WHO recommends that countries incorporate plans to measure and address vaccine hesitancy into their immunisation programmes. This requires that governments and health institutions be able to detect concerns about vaccination in the population and monitor changes in vaccination behaviours. To do this effectively, tools to detect and measure vaccine hesitancy are required. The purpose of this scoping review is to give a broad overview of currently available vaccine hesitancy measuring tools and present a summary of their nature, similarities and differences.Methods and analysisThe review will be conducted using the framework for scoping review proffered by Arksey and O’Malley. It will comply with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews’ guidelines. The broader research question of this review is: what vaccine hesitancy measuring tools are currently available?Search strategies will be developed using controlled vocabulary and selected keywords. PubMed, Web of Science, Scopus and reference lists of relevant publications will be searched. Titles and abstracts will be independently screened by two authors and data from full-text articles meeting the inclusion criteria will be extracted independently by two authors using a pretested data charting form. Discrepancies will be resolved by discussion and consensus. Results will be presented using descriptive statistics such as percentages, tables, charts and flow diagrams as appropriate. Narrative analysis will be used to summarise the findings of the review.Ethics and disseminationEthics approval is not required for the review. It will be submitted as part of a doctoral thesis, presented at conferences and published in a peer-reviewed journal.Trial registration number https://osf.io/x8fjk/
Journal Article
CGM in the Hospital: Is It Ready for Prime Time?
Purpose of ReviewThe use of continuous glucose monitoring (CGM) in the hospital setting is growing with more patients using these devices at home and when admitted to the hospital, especially during the COVID-19 pandemic.Recent FindingsHistorically, most evidence for CGM use in the inpatient setting was limited to small studies utilizing outdated CGM technology and analyzing accuracy of sensor measurements. Previous studies have shown reduced sensor accuracy during extreme hypo- or hyperglycemia, rapid fluctuations of glucose, compression of the sensor itself, and in those who are critically ill. Studies that are more recent have shown CGM to have adequate accuracy and may be effective in reducing hypoglycemia in hospitalized patients; some studies have also showed improvement in time in target glycemic range. Furthermore, CGM may reduce nursing workload, cost of inpatient care, and use of personal protective equipment and face-to-face patient care especially for patients during the COVID-19 pandemic.SummaryThis review will describe the evidence for use of CGM in hospitalized critically ill or non-critically ill patients, address accuracy and safety considerations, and outline paths for future implementation.
Journal Article
Long-term dynamics of CA1 hippocampal place codes
The authors use Ca
2+
imaging in freely behaving mice to look at the long-term dynamics of CA1 hippocampal place codes. They find that, in a familiar environment, there is substantial change in the population of place-coding cells over time, but the ensembles of these cells are sufficiently stable to preserve an accurate spatial representation across weeks.
Using Ca
2+
imaging in freely behaving mice that repeatedly explored a familiar environment, we tracked thousands of CA1 pyramidal cells' place fields over weeks. Place coding was dynamic, as each day the ensemble representation of this environment involved a unique subset of cells. However, cells in the ∼15–25% overlap between any two of these subsets retained the same place fields, which sufficed to preserve an accurate spatial representation across weeks.
Journal Article
Type 1 Diabetes: Management in Women From Preconception to Postpartum
Abstract
Context
This review presents an up-to-date summary on management of type 1 diabetes mellitus (T1DM) among women of reproductive age and covers the following time periods: preconception, gestation, and postpartum.
Evidence acquisition
A systematic search and review of the literature for randomized controlled trials and other studies evaluating management of T1DM before pregnancy, during pregnancy, and postpartum was performed.
Evidence synthesis
Preconception planning should begin early in the reproductive years for young women with T1DM. Preconception and during pregnancy, it is recommended to have near-normal glucose values to prevent adverse maternal and neonatal outcomes, including fetal demise, congenital anomaly, pre-eclampsia, macrosomia, neonatal respiratory distress, neonatal hyperbilirubinemia, and neonatal hypoglycemia.
Conclusion
Women with T1DM can have healthy, safe pregnancies with preconception planning, optimal glycemic control, and multidisciplinary care.
Journal Article