Diabetic foot self-care knowledge and practice among patients with diabetes attending diabetic clinic in the Gambia.

Diabetic foot ulcer is the most common complication causing lots of admissions among diabetic patients. Understanding patients' level of foot self-care knowledge, practice and associated factors is important for planning interventions to control and prevent diabetic foot complications. This study aimed to assess the level of knowledge and practice of foot self-care among diabetic patients attending diabetic clinics in The Gambia. Two hundred and seventeen patients attending diabetic clinics in two public hospitals were selected using a successive sampling technique. Data were collected using a validated interviewer-administered questionnaire. Descriptive statistics were used to summarize the demographic and clinical data. Multivariate logistic regression was used to identify factors associated with foot self-care knowledge and practice. The findings showed a poor level of foot self-care knowledge (n = 114; 52.5%) and practice (n = 149; 68.7%). Patients' educational level was statistically significantly association with diabetic foot self-care knowledge (p = 0.02). Diabetic foot ulcer history (aOR = 0.23, 95% CI: 0.08-0.63; p < 0.001), diabetic hospitalization (aOR = 2.41, 95% CI: 1.23-4.75, p = 0.01) and diabetic foot care education (aOR = 2.65, 95% CI: 1.39-5.06, p < 0.001) were statistically significantly associated with foot self-care practice. The poor diabetic foot self-care knowledge and practice among these patients emphasize the need for a diabetic health education program in these clinics.

Women's empowerment and nutritional status of children in the Gambia: further analysis of the 2020 Gambia demographic and health survey.

Empowering women and the promotion of children's health are key components of the Sustainable Development Goals targeted for achievement by 2030. The survival of young children, which depends on their nutrition, is influenced by an interaction of factors at the household level. This study aims to investigate the association between women's empowerment and undernutrition among children under age 5 using The Gambia Demographic Health Survey (GDHS) 2019-20.Children's undernutrition was measured with two indicators: stunting and underweight. The women's empowerment indicators were educational status, employment, decision making, age at first sex and age at first birth, and acceptance of wife beating. StataSE software Version 17 was used for data analysis. Analyses were cluster-adjusted, sample-weighted, with confounding/moderating variables. Descriptive statistics and cross-tabulations were computed for all variables. Bivariate and multivariate analysis of the outcomes and women's empowerment were conducted.The prevalence of stunting and underweight among the children under age 5 was 17% and 12%, respectively. The results of the multiple logistic regression show that women with no education had 51% (OR = 1.51; 95% CI = 1.11-2.07; p = 0.009), and 52% (OR = 1.52; 95% CI = 1.06-2.14; p = 0.022) greater odds of having children under age 5 who were stunted or underweight compared to those women with primary and higher level of education, respectively. Mothers with a body mass index classified as thin were associated with an increased odds of having stunted (OR = 1.44; 95% CI 1.01-2.05; p = 0.033) and underweight (OR = 1.69; 95% CI = 1.58-3.52; P < 0.001) children. In addition, women who reported accepting wife beating had 69% (OR = 1.69; 95% CI 1.22-2.35; p = 0.002) and 66% (OR = 1.66; 95% CI 1.15-2.40; p = 0.006) greater odds of having stunted and underweight children respectively compared to those who did not accept wife beating.In conclusion, the result of this study shows that women's empowerment is associated with undernutrition among children under age 5 in The Gambia. This is suggesting that implementing policies and interventions that increase the empowerment of women will contribute to the improvement of child nutrition in the country.

Predictive value of genetic variants XRCC1 rs1799782, APEX1 rs1760944, and MUTYH rs3219489 for adjuvant concurrent chemoradiotherapy outcomes in oral squamous cell carcinoma patients.

Genetic variations in DNA base excision repair (BER) genes may affect tumor sensitivity to chemotherapy and radiotherapy. Thus, we investigated the effects of single-nucleotide polymorphisms (SNPs) in key BER pathway genes on clinical outcomes in male patients who received concurrent chemoradiotherapy (CCRT). Seven SNPs from XRCC1, OGG1, APEX1, and MUTYH were genotyped using the Sequenom iPLEX MassARRAY system in samples from 319 men with advanced oral squamous cell carcinoma. The disease-free survival (DFS) rates of the MUTYH rs3219489 genotypes and those of the other genotypes differed significantly (log-rank test p = 0.027). Multivariate Cox proportional hazard analysis showed that the MUTYH rs3219489 GG genotype was associated with poor DFS (recessive model: hazard ratio [HR] = 2.01, 95% confidence interval [CI] = 1.31-3.10; p = 0.002). The CT + TT genotypes of XRCC1 rs1799782 (dominant model: HR = 0.65, 95% CI = 0.43-0.99; p = 0.044) and GG genotype of APEX1 rs1760944 (recessive model: HR = 1.64, 95% CI = 1.00-2.70; p = 0.050) were associated with overall survival (OS). Carrying the two risk genotypes, CC and GG of XRCC1 rs1799782 and APEX1 rs1760944, respectively, (HR = 2.95, 95% CI = 1.47-5.88; p = 0.002) increased mortality risk. Our findings showed that carrying the two risk genotypes of XRCC1 rs1799782 and APEX1 rs1760944 was associated with poor OS, while the GG genotype of MUTYH rs3219489 was associated with poor DFS. Patients carrying the risk genotypes may not benefit from CCRT; therefore, they will need alternative treatments.

Prevalence and factors associated with intimate partner violence against women in The Gambia: a population-based analysis.

Although intimate partner violence (IPV) against women is prevalent in sub-Saharan Africa, studies that investigated factors associated with IPV among Gambian women are limited. In this study, we examined the prevalence and factors associated with the different forms of IPV against Gambian women. We used a sample of 3,116 currently married women age (15 ~ 49 years) from The Gambia Demographic and Health Survey 2013. Logistic regression models were used to examine factors associated with Physical Violence (PV), Sexual Violence (SV), and Emotional Violence (EV). Over 40% (n = 1,248) of women reported at least one form of IPV. The prevalence of PV, SV and EV was 20.6%, 4.3%, and 15.1% respectively. Women married at age 18 ~ 24 (adjusted Odds Ratio [aOR]SV = 1.55), lived with 3 ~ 4 (aORPV = 1.69; aOREV = 2.10) and ≥5 (aORPV = 1.77; aOREV = 2.64) children, witnessed parental violence (aORPV = 1.66; aORSV = 2.75; aOREV = 2.25), partner's primary education (aORPV = 1.76), accused of unfaithfulness (aORPV = 2.42; aORSV = 3.62; aOREV4.10), and partner's alcohol consumption (aORPV = 2.56; ORSV = 3.91; aOREV = 2.82) are more likely to report IPV. Conversely, women who lived in Kerewan area (aORPV = 0.43; aORSV = 0.38; aOREV = 0.50), had high income (aORPV = 0.65), Wolof (aORPV = 0.68) and Jola (aORPV = 0.65) ethnicity and unemployed (aORPV = 0.59; aORSV = 0.56) were less likely to report IPV. Interventions to prevent IPV should focus on education on its effects, and programs that reject sociocultural practices as determinants of IPV.

Maternal overweight and obesity and the risk of caesarean birth in Malawi.

BACKGROUND: Overweight and obese women are at risk of pregnancy and delivery complications. This study investigates the trend and association between maternal overweight and obesity on caesarean births in Malawi. METHODS: We utilised cross-sectional population-based Demographic Health Surveys (DHSs) data collected from mothers aged 18-49 years in 2004/05, 2010, and 2015/16 in Malawi. The outcome measure was caesarian birth within 5 years preceding the surveys. The main independent variable was maternal Body Mass Index (BMI) measured as weight in kilograms by height in meters squared (kg/m2) and categorized according to the World Health Organization (WHO) guidelines. Generalized estimating equations (GEE) regression models were constructed to analyze total samples of 6795, 4474 and 4363 in 2004/05, 2010 and 2015/16 respectively. RESULTS: There was an observed increase in the trend of caesarean births as well as maternal overweight and obesity from 2004 to 2015. The results of the multivariate analyses showed that maternal overweight (adjusted odds ratio [aOR] = 1.35; 95% Confidence Interval [CI] 1.01-1.83) in 2015/16 and (aOR = 1.36; 95% CI: 1.10-1.65) from 2004 to 2015 were risk factors for caesarean births in Malawi. In addition, being obese (aOR = 2.15; 95% CI: 1.12-4.11) in 2004/05, (aOR = 1.66; 95% CI: 1.08-2.55) in 2010, (aOR = 2.18; 95% CI: 1.48-3.21) in 2015/16, and (aOR = 2.16; 95% CI: 1.65-2.84) from 2004 to 2015) increased the risk of caesarean births. In addition, women who had one parity, and lived in the northern region were significantly more likely to have undergone caesarean birth. CONCLUSIONS: In order to reduce non-elective cesarean birth in Malawi, specific public health programs should be focus on reducing overweight and obesity among women of reproductive age. More focus attention may be given to women with one parity, particularly in the urban and the northern region of Malawi.

Maternal anemia is a potential risk factor for anemia in children aged 6-59 months in Southern Africa: a multilevel analysis.

BACKGROUND: The effect of maternal anemia on childhood hemoglobin status has received little attention. Thus, we examined the potential association between maternal anemia and childhood anemia (aged 6-59 months) from selected Southern Africa countries. METHODS: A cross-sectional study using nationally representative samples of children aged 6-59 months from the 2010 Malawi, 2011 Mozambique, 2013 Namibia, and 2010-11 Zimbabwe demographic and health surveys (DHS) was conducted. Generalized linear mixed models (GLMMs) were constructed to test the associations between maternal anemia and childhood anemia, controlling for individual and community sociodemographic covariates. RESULTS: The GLMMs showed that anemic mothers had increased odds of having an anemic child in all four countries; adjusted odds ratio (aOR = 1.69 and 95% confidence interval [CI]:1.37-2.13) in Malawi, (aOR = 1.71; 95% CI: 1.37-2.13) in Mozambique, (aOR = 1.55; 95% CI: 1.08-2.22) in Namibia, and (aOR = 1.52; 95% CI: 1.25-1.84) in Zimbabwe. Furthermore, the odds of having an anemic child was higher in communities with a low percentage of anemic mothers (aOR = 1.52; 95% CI: 1.19-1.94) in Mozambique. CONCLUSIONS: Despite the long-standing efforts to combat childhood anemia, the burden of this condition is still rampant and remains a significant problem in Southern Africa. Thus, public health strategies aimed at reducing childhood anemia should focus more on addressing infections, and micronutrient deficiencies both at individual and community levels in Southern Africa.

Dietary factors associated with being overweight and obese among school-going adolescents in Region One, The Gambia.

BACKGROUND: The purpose of this study was to determine the dietary factors associated with being overweight and obese among school-going adolescents in Region One, The Gambia. METHOD: This was a school-based cross-sectional study and 1008 students from eight Senior Secondary Schools in Region one of The Gambia participated in it. Data were collected through questionnaire self-administered method, and weight and height measurements. Using the age and gender-specific cutoff points proposed by World Health Organization, body mass index (BMI) was calculated using the weight and height measures. The data were analyzed using frequencies for underweight, overweight, and obesity, and the association between dietary factors and weight status of participants was determined using the Chi-square test. FINDINGS: Out of the 1008 students recruited in the study, 981 of them completed and returned the questionnaires, resulting in a total response rate of 97%. The mean age of the participants was 17.3 years (SD = 1.9) and 385 of them (39.2%) were from grade 10. There were 627 (63.9%) females. The mean BMI for all the students was 20.0 ± 3.4 kg/m2. Most of the students (n = 672; 68.5 %) had normal body weight, but 226 (23%), 76 (7.7 %) and 7 (0.7%) of them were underweight, overweight and obese respectively. There was a significantly higher number of female students who were overweight (n = 64, 10.2%) than their male counterparts (χ2 = 72.336, p < 0.001). The frequency of drinking sugar added juices and full cream milk, eating fish, shrimps, oysters, lobsters, and snacks such as cakes and biscuits were significantly associated with overweight and obesity among the participants (p < 0.05). In conclusion, the problem of under-nutrition and over-nutrition co-existed among the students which were associated with poor eating habits.

Association of XRCC2 rs2040639 with the survival of patients with oral squamous cell carcinoma undergoing concurrent chemoradiotherapy.

OBJECTIVE: To investigate the association between the variants of DNA double-strand break repair genes and the clinical outcomes of patients with oral squamous cell carcinoma (OSCC) undergoing concurrent chemoradiotherapy. METHODS: Five variants of DNA double-strand break repair genes in samples from 319 patients with OSCC were genotyped using the Sequenom iPLEX MassARRAY system. Kaplan-Meier curves and Cox proportional hazards analysis were used to identify the factors associated with patient survival. RESULTS: The XRCC2 rs2040639 (G3063A) polymorphism in the codominant model was associated with decreased recurrence risk (hazard ratio [HR] = 0.55, 95% confidence interval [CI] = 0.31-0.98; p = 0.042). A marginally significant interaction was observed between XRCC2 rs2040639 and PRKDC rs7003908 in patients carrying the AA and AA genotypes; these patients showed reduced recurrence risk (HR = 0.36, 95% CI = 0.17-0.79; p = 0.010). CONCLUSION: The A-allele of XRCC2 rs2040639 is a favorable prognostic factor for disease-free survival. Patients with these genotypes may benefit from concurrent chemoradiotherapy. Additional confirmation from studies with larger samples or other ethnic populations is warranted.

Polymorphisms of Mismatch Repair Pathway Genes Predict Clinical Outcomes in Oral Squamous Cell Carcinoma Patients Receiving Adjuvant Concurrent Chemoradiotherapy.

BACKGROUND: We aimed to investigate the association between single-nucleotide polymorphisms (SNP) in mismatch repair (MMR) pathway genes and survival in patients with oral squamous cell carcinoma (OSCC) who received adjuvant concurrent chemoradiotherapy (CCRT). METHODS: Using the Sequenom iPLEX MassARRAY system, five SNPs in four major MMR genes were genotyped in 319 patients with OSCC who received CCRT treatment. Kaplan-Meier survival curves and Cox proportional hazard regression models were used to assess overall survival (OS) and disease-free survival (DFS) among MMR genotypes. RESULTS: The results of Kaplan-Meier survival analysis revealed that the MutS homolog 2 (MSH2) rs3732183 polymorphism showed a borderline significant association with DFS (log-rank p = 0.089). Participants with the MSH2 rs3732183 GG genotype exhibited a relatively low risk of recurrence (hazard ratio (HR) = 0.45; 95% confidence interval (CI) = 0.22-0.96; p = 0.039). In addition, the MutL homolog 1 (MLH1) rs1800734 GG genotype carriers exhibited higher OS (HR = 0.52, 95% CI = 0.27-1.01; p = 0.054) and DFS (HR = 0.49, 95% CI = 0.26-0.92; p = 0.028) rates. CONCLUSIONS: Our results indicated that the GG genotypes of MSH2 rs3732183 and MLH1 rs1800734 are associated with relatively high survival in OSCC patients treated using adjuvant CCRT. These polymorphisms may serve as prognosis predictors in OSCC patients.

Polymorphisms in ERCC5 rs17655 and ERCC1 rs735482 Genes Associated with the Survival of Male Patients with Postoperative Oral Squamous Cell Carcinoma Treated with Adjuvant Concurrent Chemoradiotherapy.

The nucleotide excision repair (NER) pathway plays a major role in the repair of DNA damaged by exogenous agents, such as chemotherapeutic and radiotherapeutic agents. Thus, we investigated the association between key potentially functional single nucleotide polymorphisms (SNPs) in the NER pathway and clinical outcomes in oral squamous cell carcinoma (OSCC) patients treated with concurrent chemoradiotherapy (CCRT). Thirteen SNPs in five key NER genes were genotyped in 319 male OSCC patients using iPLEX MassARRAY. Cox proportional hazards models and Kaplan⁻Meier survival curves were used to estimate the risk of death or recurrence. Carriers of the XPC rs2228000 TT genotype showed a borderline significant increased risk of poor overall survival under the recessive model (hazard ratio (HR) = 1.81, 95% confidence interval (CI) = 0.99⁻3.29). The CC genotypes of ERCC5 rs17655 (HR = 1.54, 95% CI = 1.03⁻2.29) and ERCC1 rs735482 (HR = 1.65, 95% CI = 1.06⁻2.58) were associated with an increased risk of worse disease-free survival under the recessive model. In addition, participants carrying both the CC genotypes of ERCC5 rs17655 and ERCC1 rs735482 exhibited an enhanced susceptibility for recurrence (HR = 2.60, 95% CI = 1.11⁻6.09). However, no statistically significant interaction was observed between them. Our findings reveal that the ERCC5 rs17655 CC and ERCC1 rs735482 CC genotypes were associated with an increased risk of recurrence in male patients with OSCC treated with CCRT. Therefore, CCRT may not be beneficial, and alternative treatments are required for such patients.

Predictors of exclusive breastfeeding knowledge and intention to or practice of exclusive breastfeeding among antenatal and postnatal women receiving routine care: a cross-sectional study.

BACKGROUND: Despite consistent evidence showing the importance of exclusive breastfeeding (EBF) for six months, it remains a sub-optimal practice in The Gambia. This study aimed at investigating the determinants of EBF knowledge and intention to or practice of EBF. METHODS: A cross-sectional study was conducted among 334 women receiving care at the Edward Francis Small Teaching Hospital (EFSTH) from December 2015 to February 2016. Using a structured interviewer-administered questionnaire, knowledge on EBF was determined and scored. Participants scoring above or equal to the median were determined to have sufficient EBF knowledge. Multivariate logistic regression analyses were used to identify predictors of EBF knowledge and intention to or practice of exclusive breastfeeding. RESULTS: The proportion of women with sufficient exclusive breastfeeding knowledge and intended to or practice EBF were 60.2% and 38.6% respectively, while only 34.4% received EBF counseling. Earning ≥1500 GMD monthly (Adjusted Odds Ratio [aOR] 1.98; 95% Confidence Interval [Cl] 1.24, 3.16), having positive attitude (aOR 2.40; 95% Cl 1.40, 4.10) and partner supporting EBF (aOR 2.18; 95% Cl 1.23, 3.87) predicted sufficient EBF knowledge. Mothers aged 26-34 years (aOR 0.50; 9 5% Cl 0.31, 0.82) and EBF counseling (aOR 2.68; 95% Cl 1.68, 4.29) significantly associated with intention to or practice of exclusive breastfeeding. CONCLUSION: In conclusion, improving EBF rates will, therefore, require improved access to information on EBF targeting low socio-economically disadvantaged and older mothers. In addition, emphasis on strengthening the ongoing EBF counseling already within the health system is required.

Associations Between MTHFR Polymorphisms and the Risk of Potentially Malignant Oral Disorders.

AIM: The study aimed to investigate the role of two polymorphisms of methylenetetrahydrofolate reductase (MTHFR), C677T and A1298C, in the risk of potentially malignant oral disorders (PMODs). MATERIALS AND METHODS: Genotypes of the MTHFR C677T and A1298C polymorphisms were determined using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) for 224 PMOD cases and 485 age-matched controls. RESULTS: The C677T T allele-carrying genotypes were significantly associated with a decreased risk of PMODs [odds ratio (OR)=0.62, 95% confidence interval (CI)=0.44-0.86]. Haplotype analysis also indicated that the 677T/1298A haplotype was associated with a decreased risk of PMODs (OR=0.56, 95%CI=0.40-0.80). No significant interaction was observed between MTHFR polymorphisms and lifestyle factors. CONCLUSION: Our findings suggest that the T-allele-carrying MTHFR C677T genotype or haplotype may reduce the risk of PMODs. However, these observations require further confirmation using larger samples.

Biomarkers of Oxidative Stress Associated with the Risk of Potentially Malignant Oral Disorders.

AIM: To investigate the effect of oxidative stress biomarkers on the risk of potentially malignant oral disorders (PMODs). MATERIALS AND METHODS: A total of 208 male adults with PMODs and an equal number of same-age control patients were enrolled. Plasma biomarkers of oxidative stress, measured with 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 8-isoprostane (8-ISO), were determined using enzyme-linked immunosorbent assay (ELISA) kits. PMODs were diagnosed in accordance with the World Health Organization (WHO) guidelines. RESULTS: A significant association between a high level of 8-ISO and an increased risk of PMODs was identified [odds ratio (OR)=1.71, 95% confidence interval (CI)=1.12-2.63; p=0.013]. This positive association was stronger among patients with PMOD subtype of leukoplakia (OR=1.94, 95% Cl=1.24-3.06; p=0.004). However, no significant association was observed between plasma 8-OHdG levels and overall risk of PMODs or subtypes. CONCLUSION: Increased plasma 8-ISO levels may indicate the prominence of lipid peroxidation in the development of PMODs, particularly leukoplakia.

Biomarkers of Oxidative Stress Associated with the Risk of Potentially Malignant Oral Disorders.

AIM: To investigate the effect of oxidative stress biomarkers on the risk of potentially malignant oral disorders (PMODs). MATERIALS AND METHODS: A total of 208 male adults with PMODs and an equal number of same-age control patients were enrolled. Plasma biomarkers of oxidative stress, measured with 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 8-isoprostane (8-ISO), were determined using enzyme-linked immunosorbent assay kits. PMODs were diagnosed in accordance with the World Health Organization (WHO) guidelines. RESULTS: A significant association between a high level of 8-ISO and an increased risk of PMODs was identified [odds ratio (OR)=1.71, 95% confidence interval (CI)=1.12-2.63; p=0.013]. This positive association was stronger among patients with PMOD subtype of leukoplakia (OR=1.94, 95% Cl=1.24-3.06; p=0.004). However, no significant association was observed between plasma 8-OHdG levels and overall risk of PMODs or subtypes. CONCLUSION: Our findings suggest that increased plasma 8-ISO levels may indicate the prominence of lipid peroxidation in the development of PMODs, particularly leukoplakia.

Estilos de aprendizaje de preferencia entre estudiantes de Medicina en La Gambia / Learning styles proffered by medical students in The Gambia

Introducción: En las últimas tres décadas, la proposición de que los estudiantes aprenden siguiendo diferentes estilos se ha convertido en un prominente tema en pedagogía a nivel mundial. En La Gambia no se conoce cuáles son los estilos de aprendizaje en estudiantes de Medicina. Objetivo: Caracterizar los estilos de aprendizaje de preferencia en estudiantes de la Escuela de Medicina y Ciencias Afines de la Salud en La Gambia. Métodos: Se aplicó un diseño transversal mediante el cuestionario estandarizado VARK para la recolección de datos, cuyo análisis se realizó con el uso del software SPSS. Resultados: La mayoría de los estudiantes prefirieron variantes multimodales de aprendizaje; la variante bimodal se escogió con más frecuencia. No se obtuvieron asociaciones significativas entre las puntuaciones VARK y el sexo o la edad de los estudiantes (p > 0,05). Se alcanzaron diferencias significativas para las puntuaciones kinestésicas entre estudiantes de preclínica y clínica (p = 0,031). Además, se logró una asociación significativa con relación a las variantes unimodales preferidas entre los estudiantes de preclínica y clínica. No fueron encontradas diferencias significativas en cuanto al rendimiento académico entre estudiantes con preferencias unimodales o multimodales (p > 0,05). Conclusiones: La aplicación del cuestionario VARK permitió la identificación de los estilos preferidos de aprendizaje para modos particulares de presentación de la información en estudiantes de Medicina en La Gambia. Los estilos de aprendizaje difirieron entre los estudiantes, la mayoría de los cuales tuvieron preferencia por los estilos multimodales, que incluían la variante kinestésica. Estos hallazgos pudieran emplearse para mejorar la calidad de la enseñanza(AU)

Introduction: In the last three decades, the proposition that students learn by following different styles has become a prominent topic in pedagogy worldwide. In The Gambia, learning styles in medical students are not known. Objective: To characterize the learning styles preferred by the students of the School of Medicine and Allied Health Sciences of The Gambia. Methods: A cross-sectional design was applied using the standardized VARK questionnaire for data collection, the analysis of which was performed using the SPSS software. Results: Most students preferred multimodal variants of learning; the bimodal variant was chosen more frequently. No significant associations were obtained between VARK scores and the sex or age of the students (p>0.05). Significant differences were reached for kinesthetic scores between preclinical and clinical students (p=0.031). In addition, a significant association was achieved in relation to the preferred unimodal variants among preclinical and clinical students. No significant differences were found regarding academic performance among students with unimodal or multimodal preferences (p>0.05). Conclusions: The application of the VARK questionnaire allowed the identification of preferred learning styles for particular ways of presenting information among medical students in The Gambia. Learning styles differed among students, most of whom had a preference for multimodal styles, which included the kinesthetic variant. These findings could be used to improve the quality of teaching(AU)