Global Health Education and Advocacy: Using BMJ Case Reports to Tackle the Social Determinants of Health

Assessment of Global Health Education: The Role of Multiple-Choice Questions

Introduction: The standardization of global health education and assessment remains a significant issue among global health educators. This paper explores the role of multiple choice questions (MCQs) in global health education: whether MCQs are appropriate in written assessment of what may be perceived to be a broad curriculum packed with fewer facts than biomedical science curricula; what form the MCQs might take; what we want to test; how to select the most appropriate question format; the challenge of quality item-writing; and, which aspects of the curriculum MCQs may be used to assess. Materials and Methods: The Medical School for International Health (MSIH) global health curriculum was blue-printed by content experts and course teachers. A 30-question, 1-h examination was produced after exhaustive item writing and revision by teachers of the course. Reliability, difficulty index and discrimination were calculated and examination results were analyzed using SPSS software. Results: Twenty-nine students sat the 1-h examination. All students passed (scores above 67% - in accordance with University criteria). Twenty-three (77%) questions were found to be easy, 4 (14%) of moderate difficulty, and 3 (9%) difficult (using examinations department difficulty index calculations). Eight questions (27%) were considered discriminatory and 20 (67%) were non-discriminatory according to examinations department calculations and criteria. The reliability score was 0.27. Discussion: Our experience shows that there may be a role for single-best-option (SBO) MCQ assessment in global health education. MCQs may be written that cover the majority of the curriculum. Aspects of the curriculum may be better addressed by non-SBO format MCQs. MCQ assessment might usefully complement other forms of assessment that assess skills, attitude and behavior. Preparation of effective MCQs is an exhaustive process, but high quality MCQs in global health may serve as an important driver of learning.

Barriers to dementia diagnosis and care in China

In China, the ageing population and the prevalence of dementia are projected to escalate significantly by 2050 resulting in a substantial increase in health and economic burden on caregivers, healthcare facilities, healthcare providers and communities. There is no published national dementia policy or strategy in China. This case report describes significant barriers contributing to diagnostic problems and inadequate care of dementia through the case of an older female in rural China, whose condition deteriorated due to neuropsychiatric and functional symptoms of undiagnosed dementia. Intersectoral collaboration between care organisations facilitated delivery of a non-pharmacological intervention programme which was associated with improvements in the patient's functional and neuropsychiatric symptoms. The case demonstrates that recruitment and training of a wider range of health and care professionals and caregivers in a systematic approach to non-pharmacological interventions could help overcome barriers to the specialised care needs of people with dementia where resources are lacking.

The transcendent voice of recovery mentors in mental health: a philosophical reflection

In a globalized world health and illness know no frontiers. Pandemics have never been limited to political borders and the contemporary campaigns to prevent them can be effective only when addressed not only internationally but also with the application of integrated disease management in order to respond to problems caused by the silo approach. In any case, it appears that global health has been constantly in redefinition. With this commentary a phenomenological redefinition of global health is proposed as an integrative strategy. Phenomenology prioritizes and investigates from the first-person point of view how the human being experiences the world, as it explores the unique meaning of the lived experience of being human. We are particularly interested in verifying if and how, from a first-person point of view, the lived experience of mental illness and of recovery can contribute to a more integrated definition of global health. In the field of mental health, formal peer support is a mentor/mentee relationship, and as such it is an emotional and practical support between two people who share a common experience of a mental health challenge or illness. Peer support is a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful. It is about understanding another's situation empathically through the shared experience of emotional and psychological pain. And when speaking in public, a recovery mentor accepts to disclose and to be recognized as a (former) mental health service user. That person knows that there is a possibility of being stigmatized, but yet remains courageously engaged towards the promotion of change and in solidarity with people who are suffering worldwide and who may not have this opportunity to speak freely.