The motives, academic performance, and career prospects of Gazan medical students abroad: a cross-sectional study

BACKGROUND

In Gaza, 2 million people have been affected by more than 13 years of strict land, air, and sea blockades and three wars, during which over 4000 people have been killed and many more have been injured. Additional severe effects have been seen on lives, aspirations, and prospects. Given the conditions, medical students have many competing reasons for and against studying medicine abroad. We investigated motives, academic situations, and future plans of the upcoming generation of doctors in Gaza, occupied Palestinian territory.

METHODS

We did a questionnaire-based cross-sectional study involving Palestinian medical students originally from Gaza who were studying at the largest five medical schools in Egypt (Cairo, Ain Shams, Alexandria, Mansoura, and Zagazig Universities). We used a self-designed questionnaire developed from previous similar studies and created on Google Forms (Google, Menlo Park, CA, USA). A pilot study of 37 participants was done to test the comprehensibility of questions and the time needed to complete the questionnaire. After being updated, the questionnaire was distributed in August and September, 2018, to individuals who provided verbal informed decision to participate. Analysis of the results was performed with SPSS version 22.

FINDINGS

Of 453 questionnaires given to students, 340 (75%) were returned completed. The mean age of respondents was 21·7 (SD 1·8) years; 225 (66%) were men and 115 (34%) were women. Excellence was achieved in secondary school examinations (result ≥90%) by 315 (93%) of students, but only 26 (8%) of students achieved excellence in their first year of medical school (examination results ≥85%). 317 students (93%) reported that they chose their medical schools independently without pressure from their families. Among the 115 women, 70 (61%) went to a third party to persuade their parents to allow them to study abroad. Of ten motives to study medicine given in the questionnaire, "to relieve pains" and "childhood dream" were the most frequently selected among the 340 respondents, chosen by 228 (67%) and 208 (61%), respectively. 104 (31%) reported they were seeking freedom more than to study medicine. 214 (63%) of students had at least one relative who had been physically injured in or killed during of one of the wars in Gaza. Most students (n=278 [82%]) were delayed from starting at their medical school due to border closures and 189 (56%) had been unable to attend for at least one semester. Since starting at medical school, 269 (79%) of 340 respondents had visited Gaza only once or not at all. 55 (16%) intended never return to Gaza and 209 (62%) reported that they wanted to specialise and work abroad for a period and then return to Gaza. Of the remainder, 64 (19%) wanted to specialise abroad then return to work in Gaza, and 12 (3%) wanted to specialise and work in Gaza.

INTERPRETATION

The motives, academic performance, and career prospects of Gazan medical students studying in Egypt are influenced in many ways by the situation in Gaza, some of which could worsen the already bad condition of medical care in Gaza. Awareness and supportive programmes for Gazan medical students should be encouraged to improve the quality of health care providers in Gaza.

FUNDING

None.

Sector Retinitis Pigmentosa: Extending the Molecular Genetics Basis and Elucidating the Natural History

Purpose

To determine the genetic background of sector retinitis pigmentosa (RP) natural history to better inform patient counseling.

Design

Retrospective case series.

Methods

Review of clinical notes, retinal imaging including color fundus photography (CFP), fundus autofluorescence (FAF), optical coherence tomography (OCT), electrophysiological assessment (ERG), and molecular genetic testing were performed in patients with sector RP from a single tertiary referral center. Main outcomes measured were demographic data, signs and symptoms, visual acuity, molecular genetics; and ERG, FAF, and OCT findings.

Results

Twenty-six molecularly confirmed patients from 23 different families were identified harboring likely disease-causing variants in 9 genes. The modes of inheritance were autosomal recessive (AR, n=6: USH1C, n=2; MYO7A, n=2; CDH3, n=1; EYS, n=1), X-linked (XL, n=4: PRPS1, n=1; RPGR, n=3), and autosomal dominant (AD, n=16: IMPDH1, n=3; RP1, n=3; RHO, n=10), with a mean age of disease onset of 38.5, 30.5, and 39.0 years old, respectively. Five of these genes have not previously been reported to cause sector RP (PRPS1, MYO7A, EYS, IMPDH1, and RP1). Inferior and nasal predilection was common across the different genotypes, and patients tended to maintain good central vision. Progression on serial FAF was observed in RPGR, MYO7A, CDH23, EYS, IMPDH1, RP1, and RHO-associated sector RP.

Conclusions

The genotypic spectrum of the disease is broader than previously reported. The longitudinal data provided will help to make accurate patient prognoses and counseling as well as inform patients' potential participation in the increasing numbers of trials of novel therapeutics and access to future treatments.

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This is the largest series and longitudinal study in sector retinitis pigmentosa.

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The genotypic spectrum of the disease is broader than previously reported.

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The longitudinal data provided more accurate patient prognosis and counseling.

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The study informed patients' potential participation in the increasing numbers of trials of novel therapeutics and access to future treatments.

Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review

OBJECTIVES

To estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective during the early phases of the pandemic.

DESIGN

Systematic review.

METHODS

Two parallel searches of academic bibliographic databases and grey literature were undertaken until 8 May 2020. Governments were also contacted for further information where possible. There were no restrictions on language, information sources used, publication status and types of sources of evidence. The AACODS checklist or the National Institutes of Health study quality assessment tools were used to appraise each source of evidence.

OUTCOME MEASURES

Publication characteristics, country-specific data points, COVID-19-specific data, demographics of affected HCWs and public health measures employed.

RESULTS

A total of 152 888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%, n=14 058) and nurses (38.6%, n=10 706), but deaths were mainly in men (70.8%, n=550) and doctors (51.4%, n=525). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.2 deaths reported per 100 infections for HCWs aged over 70 years. Europe had the highest absolute numbers of reported infections (119 628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7).

CONCLUSIONS

COVID-19 infections and deaths among HCWs follow that of the general population around the world. The reasons for gender and specialty differences require further exploration, as do the low rates reported in Africa and India. Although physicians working in certain specialities may be considered high risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs.