1
|
Bernard A, Indig G, Byl N, Abdu AN, Mengesha DT, Admasu BA, Holman E. COVID-19 and medical education in Africa: a cross sectional analysis of the impact on medical students. BMC Med Educ 2021; 21:605. [PMID: 34879844 PMCID: PMC8654489 DOI: 10.1186/s12909-021-03038-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The African continent currently experiences 25% of the global burden of disease with only 1.3% of the world's healthcare workers. The COVID-19 pandemic has caused unprecedented disruption to medical education systems, increasing the strain on already-vulnerable regions. Our study examines the impact of COVID-19 on medical students across 33 countries in the African continent. METHODS A 39-item anonymous electronic survey was developed and distributed to medical students across Africa through social networks to assess the impact of the COVID-19 pandemic on medical education. The survey assessed the domains of: class structure changes and timing, patient interactions, exam administration, learning environment satisfaction, mental health impacts, and volunteer opportunities/engagement. RESULTS 694 students across 33 countries participated. 80% of respondents had their classes suspended for varied lengths of time during the pandemic, and from these students 59% of them resumed their classes. 83% of students felt they were in a supportive learning environment before the pandemic, which dropped to 32% since the start. The proportion of students taking exams online increased (6-26%, p<0.001) and there was a decrease in the proportion of students seeing patients as a part of their education (72-19%, p<0.001). CONCLUSIONS COVID-19 is harming medical students in Africa and is likely to worsen the shortage of the future's healthcare workforce in the region. Pandemic-related impacts have led to a degradation of the learning environment of medical students. Medical schools have shifted online to differing degrees and direct patient-care in training of students has decreased. This study highlights the urgent need for flexible and innovative approaches to medical education in Africa.
Collapse
Affiliation(s)
- Alec Bernard
- University of Michigan Medical School, 48103, Ann Arbor, MI, USA
| | - Gnendy Indig
- University of Michigan Medical School, 48103, Ann Arbor, MI, USA
| | - Nicole Byl
- University of Michigan Medical School, 48103, Ann Arbor, MI, USA
| | - Amani Nureddin Abdu
- St.Paul's Hospital Millennium Medical College, 1271 Swaziland Street, Addis Ababa, Ethiopia
| | | | | | - Elizabeth Holman
- University of Michigan Medical School, 48103, Ann Arbor, MI, USA
| |
Collapse
|
2
|
Tufa TH, Prager S, Wondafrash M, Mohammed S, Byl N, Bell J. Comparison of surgical versus medical termination of pregnancy between 13-20 weeks of gestation in Ethiopia: A quasi-experimental study. PLoS One 2021; 16:e0249529. [PMID: 33793655 PMCID: PMC8016219 DOI: 10.1371/journal.pone.0249529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 03/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Dilation and evacuation is a method of second trimester pregnancy termination introduced recently in Ethiopia. However, little is known about the safety and effectiveness of this method in an Ethiopian setting. Therefore, the study is intended to determine the safety and effectiveness of dilation and evacuation for surgical abortion as compared to medical abortion between 13–20 weeks’ gestational age. Methods This is a quasi-experimental study of women receiving second trimester termination of pregnancy between 13–20 weeks. Patients were allocated to either medical or surgical abortion based on their preference. A structured questionnaire was used to collect demographic information and clinical data upon admission. Procedure related information was collected after the procedure was completed and before the patient was discharged. Additionally, women were contacted 2 weeks after the procedure to evaluate for post-procedural complications. The primary outcome of the study was a composite complication rate. Data were collected using Open Data Kit and then analyzed using Stata version 14.2. Univariate analyses were performed using means (standard deviation), or medians (interquartile range) when the distribution was not normal. Multiple logistic regression was also performed to control for confounders. Results Two hundred nineteen women chose medical abortion and 60 chose surgical abortion. The composite complication rate is not significantly different among medical and surgical abortion patients (15% versus 10%; p = 0.52). Nine patients (4.1%) in the medical arm required additional intervention to complete the abortion, while none of the surgical abortion patients required additional intervention. Median (IQR) hospital stay was significantly longer in the medical group at 24 (12–24) hours versus 6(4–6) hours in the surgical group p<0.001. Conclusion From the current study findings, we concluded that there is no difference in safety between surgical and medical methods of abortion. This study demonstrates that surgical abortion can be used as a safe and effective alternative to medical abortion and should be offered equivalently with medical abortion, per the patient’s preference.
Collapse
Affiliation(s)
- Tesfaye Hurissa Tufa
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- * E-mail:
| | - Sarah Prager
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mekitie Wondafrash
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Shikur Mohammed
- Department of Public Health, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Nicole Byl
- University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Jason Bell
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
| |
Collapse
|
3
|
Byl N. P2.121 Enhancing safe mobility in patients with Parkinson's disease: effect of dual task training during aerobic and moderate exercise. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70472-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
4
|
|
5
|
Strata F, Coq JO, Byl N, Merzenich MM. Effects of sensorimotor restriction and anoxia on gait and motor cortex organization: implications for a rodent model of cerebral palsy. Neuroscience 2005; 129:141-56. [PMID: 15489037 DOI: 10.1016/j.neuroscience.2004.07.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2004] [Indexed: 10/26/2022]
Abstract
Chronic or acute perinatal asphyxia (PA) has been correlated with the subsequent development of cerebral palsy (CP), a developmental neurological disorder characterized by spasticity and motor abnormalities often associated with cognitive deficits. Despite the prevalence of CP, an animal model that mimics the lifetime hypertonic motor deficits is still not available. In the present study, the consequences of PA on motor behavior, gait and organization of the primary motor cortex were examined in rats, and compared with the behavioral and neurological consequences of early postnatal movement-restriction with or without oxygen deprivation. Rats subjected to PA had mild increases in muscular tone accompanied by subtle differences in walking patterns, paralleled by significantly altered but relatively modest disorganization of their primary motor cortices. Movement-restricted rats, suffering PA or not, had reduced body growth rate, markedly increased muscular tone at rest and with active flexion and extension around movement-restricted joints that resulted in abnormal walking patterns and in a profoundly distorted representation of the hind limbs in the primary motor cortex. Within the sensorimotor-restricted groups, non-anoxic rats presented the most abnormal pattern and the greatest cortical representational degradation. This outcome further supports the argument that PA per se may represent a substrate for subtle altered motor behaviors, and that PA alone is sufficient to alter the organization of the primary motor cortex. At the same time, they also show that early experience-dependent movements play a crucial role in shaping normal behavioral motor abilities, and can make a powerful contribution to the genesis of aberrant movement abilities.
Collapse
Affiliation(s)
- F Strata
- Keck Center for Integrative Neuroscience, Coleman Laboratory and Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, 513 Parnassus Avenue HSE-832, San Francisco, CA 94143-0732, USA.
| | | | | | | |
Collapse
|
6
|
Nagarajan SS, Blake DT, Wright BA, Byl N, Merzenich MM. Practice-related improvements in somatosensory interval discrimination are temporally specific but generalize across skin location, hemisphere, and modality. J Neurosci 1998; 18:1559-70. [PMID: 9454861 PMCID: PMC6792718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/1997] [Revised: 11/11/1997] [Accepted: 11/24/1997] [Indexed: 02/06/2023] Open
Abstract
This paper concerns the characterization of performance and perceptual learning of somatosensory interval discrimination. The purposes of this study were to define (1) the performance characteristics for interval discrimination in the somatosensory system by naive adult humans, (2) the normal capacities for improvement in somatosensory interval discrimination, and (3) the extent of generalization of interval discrimination learning. In a two-alternative forced choice procedure, subjects were presented with two pairs of vibratory pulses. One pair was separated in time by a fixed base interval; a second pair was separated by a target interval that was always longer than the base interval. Subjects indicated which pair was separated by the target interval. The length of the target interval was varied adaptively to determine discrimination thresholds. After initial determination of naive abilities, subjects were trained for 900 trials per day at base intervals of either 75 or 125 msec for 10-15 d. Significant improvements in thresholds resulted from training. Learning at the trained base interval generalized completely across untrained skin locations on the trained hand and to the corresponding untrained skin location in the contralateral hand. The learning partially generalized to untrained base intervals similar to the trained one, but not to more distant base intervals. Learning with somatosensory stimuli generalized to auditory stimuli presented at comparable base intervals. These results demonstrate temporal specificity in somatosensory interval discrimination learning that generalizes across skin location, hemisphere, and modality.
Collapse
Affiliation(s)
- S S Nagarajan
- Coleman Laboratory, Keck Center for Integrative Neuroscience, University of California, San Francisco, California 94143-0732, USA
| | | | | | | | | |
Collapse
|
7
|
Spengler F, Roberts TP, Poeppel D, Byl N, Wang X, Rowley HA, Merzenich MM. Learning transfer and neuronal plasticity in humans trained in tactile discrimination. Neurosci Lett 1997; 232:151-4. [PMID: 9310302 DOI: 10.1016/s0304-3940(97)00602-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Adult humans were unilaterally trained in a tactile discrimination task of sequentially applied multi-finger stimuli. Magnetic source imaging (MSI) was performed before and after the training to evaluate use-dependent neuronal plasticity. All subjects showed fast improvements in performance and complete transfer of the learned task. MSI recordings revealed an unilateral decrease in current dipole strength in the somatosensory system contralateral to the trained hand. Attenuation of sensory evoked fields and a complete learning transfer indicate learning in associative and secondary cortices rather than perceptual plasticity operating on neuronal populations involved in early sensory processing. This findings are discussed with respect to an equivalent animal model and to learning specificity and generalization.
Collapse
Affiliation(s)
- F Spengler
- Institut für Neuroinformatik, Ruhr-Universität Bochum, Germany
| | | | | | | | | | | | | |
Collapse
|
8
|
Byl N, Wilson F, Merzenich M, Melnick M, Scott P, Oakes A, McKenzie A. Sensory dysfunction associated with repetitive strain injuries of tendinitis and focal hand dystonia: a comparative study. J Orthop Sports Phys Ther 1996; 23:234-44. [PMID: 8775368 DOI: 10.2519/jospt.1996.23.4.234] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Repetitive strain injuries are reaching epidemic levels among workers who perform heavy schedules of rapid alternating movements (eg., computer programmers, data entry workers) or repetitive, sustained, coordinated movements (eg., editors, writers, salespeople). The purpose of this study was to determine if patients with repetitive strain injury demonstrated degraded sensory motor performance with their hands. Sixty age-matched adults were recruited, with 15 each assigned to a healthy adult control group, a healthy musician control group, a tendinitis group, or a focal dystonia group. Four sensory motor subtests from the Sensory Integration and Praxis Test were given to the subjects according to a standardized protocol. Using multiple one-factor analyses of variance in the parametric or nonparametric mode followed by post hoc pairwise testing, no significant differences were found between the healthy controls and the musician controls. On the test of kinesthesia, using the left hand, subjects with tendinitis performed significantly worse than controls and subjects with focal dystonia. Compared with controls, subjects with focal dystonia did significantly worse on graphesthesia and manual form perception (part 1 and part 2). Subjects with focal dystonia also did significantly worse than subjects with tendinitis when using the left hand on graphesthesia and manual form perception (part 2). When treating patients with repetitive strain injury, discriminative sensory motor skills must be carefully assessed and may need to be addressed as part of an effective treatment program.
Collapse
Affiliation(s)
- N Byl
- Physical Therapy, University of California, San Francisco 94143-0736, USA
| | | | | | | | | | | | | |
Collapse
|
9
|
Byl N, Hamati D, Melnick M, Wilson F, McKenzie A. The sensory consequences of repetitive strain injury in musicians: focal dystonia of the hand. J Back Musculoskelet Rehabil 1996; 7:27-39. [PMID: 24572553 DOI: 10.3233/bmr-1996-7105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Some individuals with repetitive strain injury (RSI) develop focal dystonia of the hand (FDh), a disorder of motor control manifested in a specific context during skilled, hand movements. This descriptive study was designed to determine if musicians with FDh had reduced tactile discrimination. Ten healthy adults and ten patients with FDh participated in the study. From the standardized Sensory Integration and Praxis Test, five subtests were selected to measure tactile discrimination. The Paired Wilcoxon Test was used to analyze, meaningful, planned pairwise differences by side and by group. The two groups performed similarly on the three tests measuring tactile motor perception (Finger Identification, Localization and Kinesthesia). However, those with FDh performed significantly worse than the healthy comparison group on two tactile perceptual tasks: (1) Graphesthesia, right affected (P < 0.003) and left unaffected (p < 0.005); and (2) Manual Form Perception (stereognosis) on the right affected (P < 0.002) and left unaffected (P < 0.002). It is possible that the somatosensory differences as measured by tactile discrimination tasks represent some degradation of the hand representation following prolonged, repetitive, near simultaneous sensory stimulation of adjacent digits. Tactile discrimination should be tested in patients with RSI to detect potential risks for developing FDh. Effective treatment of patients with RSI including FDh may need to target the somatosensory deficits in order to restore stress-free motor movements.
Collapse
Affiliation(s)
- N Byl
- Graduate Program in Physical Therapy, University of California, San Francisco, CA 94122, USA
| | - D Hamati
- Department of Physical Therapy, Kaiser Permanente Medical Center, Oakland, CA, USA
| | - M Melnick
- Graduate Program in Physical Therapy, University of California, San Francisco, CA 94122, USA San Francisco State University, San Francisco, CA, USA
| | - F Wilson
- Department of Neurology, University of California, San Francisco, CA 94122, USA Department of Neurology, Kaiser Permanente Northern California, San Francisco, CA, USA
| | - A McKenzie
- Graduate Program in Physical Therapy, University of California, San Francisco, CA 94122, USA Division of Physical Therapy, Chapman University, San Francisco, CA, USA
| |
Collapse
|
10
|
Merzenich M, Wright B, Jenkins W, Xerri C, Byl N, Miller S, Tallal P. Cortical plasticity underlying perceptual, motor, and cognitive skill development: implications for neurorehabilitation. Cold Spring Harb Symp Quant Biol 1996; 61:1-8. [PMID: 9246429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M Merzenich
- Keck Center for Integrative Neurosciences, University of California, San Francisco 94143-0732, USA
| | | | | | | | | | | | | |
Collapse
|
11
|
Grady D, Halloran B, Cummings S, Leveille S, Wells L, Black D, Byl N. 1,25-Dihydroxyvitamin D3 and muscle strength in the elderly: a randomized controlled trial. J Clin Endocrinol Metab 1991; 73:1111-7. [PMID: 1939527 DOI: 10.1210/jcem-73-5-1111] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An unexplained loss of muscle strength occurs with aging. Vitamin D deficiency can cause myopathy and administration of 1,25-dihydroxyvitamin D3 [1,25-(OH2)D3] to persons with low serum concentrations can improve strength. To test the hypothesis that the weakness associated with aging is in part due to inadequate serum concentrations of [1,25-(OH2)D3], we conducted a randomized, controlled, double blinded trial in 98 men and women volunteers over 69 yr old. Treatment consisted of 0.25 micrograms 1,25-(OH)2D3, orally, twice per day or identical placebo for 6 months. Leg muscle strength of the quadriceps was measured with an isokinetic dynamometer. There was no difference between the two groups at 1 week, 1 month, or 6 months of treatment in any of the measures of muscle strength. We conclude that oral administration of 0.5 micrograms 1,25-(OH)2D3/day does not improve muscle strength in older persons. Further research is needed to determine the etiology of the decline in muscle strength associated with aging.
Collapse
Affiliation(s)
- D Grady
- Department of Epidemiology, Veterans Administration Medical Center, University of California School of Medicine, San Francisco 94121
| | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
In July 1975, the Division of Ambulatory and Community Medicine at the University of California, San Francisco, initiated an interdisciplinary team education program as part of a required core medical clerkship in primary care. Significant emphasis was placed on evaluation of student and patient service outcomes. Overall, students rated the teaching in the program as moderately effective. The major measured gain for students was in their formal knowledge of the principles of teamwork, with secondary gains in patient problem-solving skills. The gains in knowledge were greatest for medicine and pharmacy students. During the team education program, the average number of patients seen by student providers was greater than it had been during previous clerkships. Similarly, the comprehensiveness of care provided was higher during the team education program. Although no significant differences were found between student teams and individual providers, those teams with consistent membership from all three participating disciplines (medicine, pharmacy, and nursing) delivered more comprehensive care.
Collapse
|
13
|
Byl N, Sykes B. Work and health problems: an approach to management for the professional and the community. Community Health (Bristol) 1978; 9:149-58. [PMID: 630835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
14
|
Brodsky CM, Byl N. Treatment of work-related health problems in a work clinic. Hosp Community Psychiatry 1976; 27:116-20. [PMID: 767242 DOI: 10.1176/ps.27.2.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Little is known about patients who chronically express work problems through medical complaints or who develop or exaggerate physical problems to avoid work, the authors say. In 1973 a university-affiliated medical clinic set up a multidisciplinary work clinic to study and treat patients with work-related health problems. In general the clinic's first 18 patients showed emotional immaturity and social or psychiatric dysfunction, often severe. After treatment nine of the 18 returned to work, and two began vocational retraining and later took jobs. The authors believe that because of the close relationship between work and health, medical-care institutions must deal with work problems that patients present.
Collapse
|