Background: Cervical cancer is a common cause of death among women in developing countries, including South Africa. In 2000, the South African National Department of Health introduced the national cervical cancer screening policy, which states that every woman is entitled to three free Papanicolaou (Pap) smears in her lifetime, at 1 0-year intervals starting at the age of 30 years. A number of studies have indicated that the uptake of cervical cancer screening is dependent on the targeted population's knowledge, attitudes and practices (KAP) related to health-seeking behaviours. The aim of the study is to determine the baseline KAP to Pap smears and cervical cancer of women aged 25 years and older in Mitchell's Plain, Western Cape Province. Methods: A cross-sectional survey was undertaken among clients attending primary health care facilities in the Mitchell's Plain district, Cape Town, Western Cape Province. The study population consisted of women aged 25 years and older who presented at the public health care facilities in Mitchell's Plain between 1 April and 31 July 2002 and who consented to participate in the study. The data were analysed using the STAT A version 8 statistical package. Results: A total of 445 women were interviewed, most of whom were above the age of 30 years (72%), married (68%) and unemployed (68%). Ninety-five per cent said they had heard of a Pap smear; however, when asked what part of the body was examined during a Pap smear, only 4% correctly answered. Only 13% of the women knew that a Pap smear was a test for cancer of the cervix, although 52% recognised it as a test for cancer. Of the women interviewed, 73% had heard of cancer of the cervix. A total of 78% of women had had a Pap smear. The results indicated no significant association between ever hearing of a pap smear and the following predictors: age, educational level, marital status, pregnancy and the use of contraception. Women who were significantly more likely to have had a Pap smear included: older women, those who were in a relationship, owned a radio, were employed, had ever been pregnant or had heard of a Pap smear before. Main sources of information regarding Pap smears were reported to be posters (17%) and the radio (16%). Conclusions: The data suggest that although a very high proportion of the women (95%) had heard of Pap smears, a smaller proportion (78%) had actually had a Pap smear. This study showed that there were missed opportunities that the health workers could possibly have utilised to encourage women in the targeted age group to have a Pap smear while at the health facilities for reasons other than reproductive health. Women who had not been afforded the opportunity to have a Pap smear by the health provider reported a great interest in having a Pap smear, showing willingness to improve their health if afforded the opportunity. In order to reduce the high morbidity and mortality from cervical cancer in South Africa, very large numbers of women in the target age group need to be recruited to the screening programme. To be able to achieve an increase in the cervical cancer screening uptake, huge efforts have to be made to actively recruit women who are within reach of the health services, particularly any women who present at the health facilities.

Antiretroviral therapy (ART) first became available in the public sector in the Western Cape Province in Khayelitsha in 2001. This thesis describes the effectiveness of ART in Khayelitsha and the Province, following adult patients for up to five years on ART, and examining temporal trends over seven years during which time the availability of ART in the Province increased dramatically. Associations are explored with a range of clinical outcomes, and regimen durability and tolerability are described, together with regimen effectiveness when ART is administered to patients co-infected with tuberculosis. The results chapters of the thesis are presented in the form of published or submitted papers. The first paper corrects for under-ascertainment of mortality through linkages with the death registry. After five years on ART, four out of five patients were still alive. Survival did not deteriorate in more recent years despite the large increase in patient numbers. Patients who remained virologically suppressed experienced on average continued CD4 count recovery throughout follow-up to five years. The second paper describes the tolerability of each commonly used first-line antiretroviral drug in two townships in the Western Cape. Treatment-limiting toxicities were frequent and continued throughout follow-up in patients on stavudine (21% by 3 years on ART). Symptomatic hyperlactataemia or lactic acidosis as well as lipodystrophy were strongly associated with women initiating ART with a high initial body mass. The third paper explores the effectiveness of ART when co-administered with tuberculosis treatment, identifying that co-infected patients initiating nevirapinebased ART may be at a higher risk of virological failure, but that concurrent tuberculosis treatment did not otherwise compromise ART outcomes. The fourth paper, based on a household survey, provides an in-depth description of the Khayelitsha population demonstrating comparability with many of the urban settings in which ART is provided in the region. The final paper demonstrates that outcomes have not been compromised by the wider availability of ART in the Western Cape Province. The thesis concludes that the Khayelitsha and Provincial analyses provide considerable reassurance that the anticipated benefits of ART have not to date been eroded by health system weaknesses or contextual challenges.

Emerging as a global health crisis, the novel Coronavirus disease 2019 (COVID-19) pandemic has become a great threat to the stability and prosperity of economies and households worldwide. With the World Health Organization (WHO) declaring COVID-19 a Public Health Emergency of International Concern (PHEIC) in the earlier months of 2020 (WHO, 2020), COVID-19 has spread rapidly throughout the world- at a pace that has demanded an understanding of COVID-19 that goes beyond the clinical and pharmacological interventions that have since been put in place. COVID-19 has demanded a need for robust study and implementation of public policy, as well as, personal interventions that would work to contain the spread of the virus. COVID-19 has not only adversely affected the health of individuals- it has also adversely affected the economic standing of households worldwide. These adverse effects show that without active means of rapid mitigation, households in LMICs especially, will continue to experience great economic distress. Now, mitigation cannot start without a well-grounded understanding of the problem at hand. This is what this systematic review aims to address. This study aims to locate, appraise and synthesize the best available evidence relating to the economic impact of COVID-19 on households in low- and middle-income countries, through a mixed-methods narrative systematic review. Evidence from both qualitative and quantitative papers will be combined in a single synthesis. This will be done by adopting an “integrated” mixed-method synthesis methodology, whereby both forms of data- quantitative and qualitative-have been combined into a single mixed-methods synthesis. The quantitative data will be grouped into themes and then presented alongside the qualitative findings (which fall under similar themes) in a mixed-methods synthesis. Upon completing the review, it was found that the COVID-19 pandemic has reduced household income for households in LMICs, whilst also introducing an increased degree of volatility to it as well. The pandemic has also led to disruptions to education and employment, thereby disproportionately affecting the poor more than the well-off, as the former, due to structural constraints, failed to transition to online means of education and employment. There was also an increase in household food insecurity, as well as, female poverty. In order to cope, households have since reduced their consumption, and tapped into some of their savings and investments, amongst other forms of coping mechanisms. In response to this economic shock, many governments across LMICs have offered aid in the form of water and food parcels, as well as, cash transfers. It can therefore be said that households in LMICs have been hard-hit and left in worser economic conditions than they were in prior to the COVID-19 pandemic. This is mainly due to the loss of household income as a result of the lockdown measures that were introducedwhich made it difficult for many informal workers to have means of generating income during the period of the pandemic. The fall in remittances also contributed to the loss of total household income. In response to this, policy-makers and practitioners in LMICs need to tailor their social protection policies in a way that prioritises the implementation of pro-poor policies that work to “soften the (economic) blow” of the COVID-19 pandemic, particularly for the (economically) vulnerable. They also need to put in place policies which support and protect the incomes of existing informal forms of employment.

This pre-conference workshop is designed to provide a foundation in osteopathic principles and practice and basic skills in osteopathic diagnosis and manipulative treatment for medical students, residents and family medicine faculty with little to no training in osteopathic medicine. It is also an excellent opportunity for doctors of osteopathic medicine (DOs) to refresh their skills. Upon completion of this session, participants should be able to: Understand the four tenets of osteopathic medicine and their applicability to allopathic as well as osteopathic medicine. Demonstrate the basic osteopathic assessment and treatment of 3–4 common diagnoses that present in outpatient and inpatient family medicine settings. Produce an outline of a training curriculum in osteopathic assessment and treatment for non-DOs within his/her own program using the tools provided by the workshop.

Background Transgender individuals face numerous health disparities and report negative experiences with health care providers related to their gender identity. Significant gaps in medical education regarding transgender health persist despite calls for increased sexual and gender minority content. The purpose of this student‐led study was to assess the effectiveness of a half‐day educational intervention on first‐ and second‐year medical students’ attitudes and knowledge of transgender health. Methods Students and faculty members collaborated to develop an educational session on transgender health. This content was presented to first‐ and second‐year medical students at Integrated Grand Rounds, a pedagogical method in which basic science and clinical faculty members co‐present didactic content interspersed between live patient interviews and student‐led small group discussions. Student participants (n = 138) completed voluntary 9‐item pre‐ and post‐session surveys assessing comfort with and knowledge of transgender medicine. Results Students’ comfort with and perceived knowledge about transgender patients increased significantly between pre‐ and post‐test. Students’ knowledge of transgender medicine standards of care also improved, though not all items reached significance. Discussion A half‐day educational intervention improved many facets of medical students’ attitudes and knowledge about transgender patients. The significant disparities in physical health, mental health and access to care currently experienced by transgender persons in the United States warrants the continued testing and refinement of educational interventions for future and practising providers.

Background Evaluation of interprofessional education (IPE) has been limited to students’ self-report and rarely assessed content validity using real-world input. Purpose This study compared students who did and did not complete an IPE curriculum using a mock interview. Aims were to compare them: 1) in terms of competencies around team based care, and 2) as rated by clinicians providing team based care. Method Students participated in a mock field placement interview. Study staff rated transcripts on IPE competencies. Clinicians rated and ranked students in terms of their knowledge/values and preference for hiring. Discussion. IPE students had higher ratings on seven of eleven competences than non-IPE students. Clinical experts rated IPE students higher and ranked them as more preferable. Conclusions This study demonstrates the efficacy and validity of foundational IPE beyond self-report. IPE impacted students’ responses in a real-world scenario in a way that discriminated them from their peers.

Objective To assess whether utilization of a validated communication tool corresponds with faculty assessment and resident self-assessment on the pediatric communication milestone continuum. Methods Pediatric residents were recruited to participate in the communication skills assessment. Continuity clinic faculty completed an assessment of each residents communication skills utilizing the 6 pediatric milestones that address interpersonal and communication skills. Each participating resident completed a self-assessment of their own communication skills utilizing the same milestones. After being placed on the milestones, the residents participated in a standardized patient interview that was recorded and subsequently evaluated by a faculty observer utilizing the Common Ground Instrument. Results 16/16 of pediatric residents participated in the study. The milestones and common ground instrument were scored on a scale from 1 to 5 with 5 representing an expert rating. For PGY-1 residents, the average faculty score on the milestones was 3.17, self-assessed average score was 2.92 and common ground average score was 3.67. For PGY-2 residents, the average faculty score on the milestones was 4.40, self-assessed score average was 4.10 and common ground average score was 3.20. For PGY-3 residents, the average faculty score on the milestones was 4.70, self-assessed score average was 4.10 and common ground average score was 3.60. PGY-1s had significantly lower self and faculty assessments than PGY-2s or -3s. There were no significant differences among PGYs on the Common Ground Interview score. Faculty rated residents significantly higher than they rated themselves. Previous clinical skills training, standardized patient training, and English as a first language had no significant effect on the self-assessment, faculty assessment or Common Ground Instrument score. Conclusion Faculty and residents observe an improvement in communication skills as residents progress through training; however, scores on a validated communication tool do not reflect this improvement.

Book Summary:The integration of new technology and global collaboration has undoubtedly transformed learning in higher education from the traditional classroom setting into a domain of support services, academic programs, and educational products which are made available to learners. The Handbook of Research on Transnational Higher Education is a unique compilation of the most recent research done by higher education professionals in the areas of policy, governance, technology, marketing, and leadership development. This publication succeeds in highlighting the most important strategies and policies for professionals, policymakers, administrators, and researchers interested in higher education management.

No description available.

No description available.