Barriers to utilization of sexual and reproductive health services among young deaf persons in Ghana.

Despite significant progress made to improve access to sexual and reproductive health (SRH) services to the general populace in Ghana, information on the accessibility of such services to deaf persons is limited. This study investigated access to and utilization of SRH services among young female deaf persons in Ghana. Sixty deaf persons were interviewed from six metropolis/municipalities/districts in three regions of Ghana. The data were collected using focus group discussion and one-on-one interviews. The data were subjected to content analysis, leading to the identification of two broad themes. The study identified barriers at two levels: point of service delivery and barriers at the individual level. For instance, at the point of service delivery, they were claims that deaf women were victims of negative attitudes from health workers. The study concludes on the need for health policymakers to consider collaborating with the Ghana National Association of the Deaf in an effort towards designing inclusive SRH programmes.

Gonadotropin inhibitory hormone receptors (GnIHRs): Molecular characterization and synergistic effect of different drugs in Indian major carp, Labeo catla.

After the discovery of Gonadotropin-inhibitory hormone (GnIH) in birds in 2000, it showed different roles in different vertebrate classes and even in different species of same classes. In birds and mammals, GnIH inhibits the expression of gonadotropins during reproduction, while in fishes it exerts both inhibitory and stimulatory effect on reproduction. The current study evaluates the role of GnIH during reproduction in Labeo catla. The partial cDNA sequence of GnIHR1 and GnIHR3 receptor genes was identified by degenerate PCR. The mRNA expression analysis of GnIHRs during different reproductive phases showed that the expression of all three GnIH receptor genes is highest during spawning phase. The expression of GnIH receptors is detected in both brain and gonads except for GnIHR3 which only expressed in gonads. The in vivo experiments with GnIH antagonist, RF313 drastically reduced the expression level of reproduction related genes like LH, FSH, and GnRH at 1 h post-injection. In another experiment the surge induced by cGnIH-III peptide on gonadotropins gene expression is further increased when co-injected with LHRHa. However, co-injection of melatonin along with cGnIH-III peptide had opposite effects. These results showed that the GnIH/GnIHRs system has positive effect on reproduction in L. catla.

Characterization, Docking and Molecular Dynamics Simulation of Gonadotropin-Inhibitory Hormone Receptor (GnIHR2) in Labeo Catla.

BACKGROUND/AIMS: GnIH receptors (GnIHRs) belong to the family of G-protein coupled receptors (GPCRs) and play a key role in the regulation of reproduction from fishes to mammals, either by inhibiting or stimulating the expression of gonadotropins. The aim of this study was to characterize GnIH receptor (GnIHR2) from Indian Major Carp, Labeo catla and its docking and simulation with GnIH antagonist RF313. METHODS: The full length sequence of GnIHR2 was obtained with RACE PCR. The docking analysis of RF313 with GnIHR2 receptor was performed with AutoDock v. 4.2.6 and molecular dynamics (MD) simulation with GROMACS 5.0. RESULTS: In the present study, we cloned full-length cDNA (1733 bp) of GnIHR2 from the brain of L. catla. The phylogenetic analysis showed clustering of catla GnIHR2 with goldfish and zebrafish in the GPR147 group. L. catla GnIHR2 receptor comprised seven transmembrane domains and the 3D-structure was predicted by I-TASSER tool. The docking analysis revealed high binding affinity (-11.6 kcal/mol) of GnIH antagonist, RF313 towards GnIHR2 receptor. The primary bonds involved were alkyl and hydrogen bonds while the amino acids participated were proline 43, 210, 339, cysteine 214, leucine 211, serine 213 and phenylalanine 338. The MD simulation analysis of docked complex for 100 nano-seconds (ns) in the lipid membrane environment showed the stability of the complex with time. CONCLUSION: Our study showed that GnIH antagonist, RF313 interact tightly with the GnIH receptor, GnIHR2 of L. catla. To the best of our knowledge, this is the first report on computational modelling and MD simulation of GnIH receptor in fishes. This will help in functional characterization studies of GnIH/GnIHR system in vertebrates.

Ontogenetic and tissue-specific expression of gonadotropin-inhibitory hormone (GnIH) and its receptors in Catla catla.

Gonadotropin-inhibitory hormone (GnIH) is an RFamide peptide, and its role in reproduction is well studied from fish to mammals, but very few reports are available about the function of GnIH during larval development. In this study, we examined the GnIH and GnIH receptors (GnIHRs) expression from embryogenesis to adult stage and tissue-specific expression in adult Catla catla using quantitative real-time (qRT) PCR. The qRT PCR analysis of GnIH mRNA during ontogenetic development showed the increasing trend from early developmental stages to the adult stage with the highest expression in 24 months fish. However, the expression of two GnIH receptors, GnIHR1 and GnIHR2 also increased from larval stages to the adults with a peak at 17 days post-hatching, while GnIHR3 showed the higher mRNA expression during embryogenesis and then decreasing gradually. Tissue distribution analysis of GnIH showed the highest mRNA expression of GnIH in the brain, followed by gonads of both the sexes. GnIHR1 and GnIHR2 were also highly expressed in the brain and gonads of both the sexes, while GnIHR3 showed the highest expression in gonads of both the sexes without any expression in the brain. These results suggest that the brain is the primary site of action for GnIH, GnIHR1 and GnIHR2, while gonads for GnIHR3.

Molecular characterization of gonadotropin-inhibitory hormone (GnIH) gene and effect of intramuscular injection of GnIH peptide on the reproductive axis in Catla catla.

Gonadotropin-inhibitory hormone (GnIH) plays an important role in reproduction by inhibiting the expression of gonadotropins in birds and mammals, but in fishes, it is ambiguous. In this study, we cloned 606 bp long cDNA of GnIH from Catla catla brain (cGnIH). The encoded preproGnIH peptide generated three putative peptides (cGnIH-I, -II, -III) of different size. Phylogenetic analysis of GnIH showed clustering of different peptide sequence with its orthologs in separate clades. The real-time PCR analysis showed the expression of cGnIH in brain, gonads, intestine, stomach, heart, gill and liver with the highest expression in the brain and gonads of both sexes. The basal GnIH mRNA expression was higher in spawning and spent phase of the male brain and spawning phase of the female brain. In testis, the expression was highest in spent phase, while in ovary the expression did not change significantly during reproductive phases. The in vivo experiment of cGnIH-III peptide exhibited the higher expression of HPG axis genes, lhb, fshb, cgnrh, kiss2 and kiss1r and serum hormone level of LH and FSH as soon as 3 h after the intramuscular delivery. These results suggest that the GnIH is positively involved in regulation of reproduction in HPG axis of C. catla.

Implementation of Fee-Free Maternal Health-Care Policy in Ghana: Perspectives of Users of Antenatal and Delivery Care Services From Public Health-Care Facilities in Accra.

In 2008, the government of Ghana implemented a national user fee maternal care exemption policy through the National Health Insurance Scheme to improve financial access to maternal health services and reduce maternal as well as perinatal deaths. Although evidence shows that there has been some success with this initiative, there are still issues relating to cost of care to beneficiaries of the initiative. A qualitative study, comprising 12 focus group discussions and 6 interviews, was conducted with 90 women in six selected urban neighborhoods in Accra, Ghana, to examine users' perspectives regarding the implementation of this policy initiative. Findings showed that direct cost of delivery care services was entirely free, but costs related to antenatal care services and indirect costs related to delivery care still limit the use of hospital-based midwifery and obstetric care. There was also misunderstanding about the initiative due to misinformation created by the government through the media.We recommend that issues related to both direct and indirect costs of antenatal and delivery care provided in public health-care facilities must be addressed to eliminate some of the lingering barriers relating to cost hindering the smooth operation and sustainability of the maternal care fee exemption policy.

Effects of Water pH on Life History Parameters of a New Bosminid Cladocera: Bosmina (Bosmina) Tripurae (Korinek, Saha and Bhattachaya, 1999) in Laboratory Condition.

The effects of water pH on life history parameters of Bosmina tripurae have been studied to determine the most suitable water pH desired for the maximum growth and development of this newly discovered cladoceran species. The study was carried out under the laboratory condition at 20 ± 2°C. Five pH ranges 5.0 ± 0.2, 6.0 ± 0.2, 7.0 ± 0.2, 8.0 ± 0.2 and 9.0 ± 0.2 with six replicates for each pH consisting of one animal in each Petri dish (80 × 15 mm) were used for the study. 20 mL of respective test medium was maintained with Chlorella sp. (2 × 104 ± 0.03 cells mL-1) in each Petri dish throughout the experiment. Thirty (30) animals were observed daily to investigate different life history parameters like total life span, age at maturity, number of eggs, neonates and egg batches etc. at different condition. From the study it was found that acidic water (pH 5 ± 0.2) is more suitable for the culture of Bosmina tripurae in laboratory condition.

Foodborne Microbiological Hazards in Ghana: A Scoping Review.

Background: Foodborne diseases pose a significant public health threat, particularly in regions with poor sanitation and food handling practices. These diseases, mainly caused by microbiological hazards like bacteria, fungi, and parasites, affect millions globally. Despite the global burden, the true extent of these hazards remains underestimated, especially in low- and middle-income countries like Ghana. This study aimed to map the available literature on foodborne microbiological hazards in Ghana, providing an overview of the evidence and identifying areas where further research is needed. Method: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews. A detailed search was done in PubMed, Scopus, Web of Science, and Google Scholar, and articles were exported to Rayyan for screening. A three-phase screening process was used to identify relevant articles. Data from the included articles were extracted and analysed, with specific information related to food type, specific hazards, sample population, and hazard groups summarised using proportions and tables. Results: This review included 72 studies which were published between 2001 and 2023. Eighty-five percent of these studies (85%) reported on bacterial hazards, while 19%, 11%, and 6% reported on fungi, parasites, and mycotoxins, respectively. The most reported bacterial, fungal, and parasitic hazards were Escherichia coli, Aspergillus spp. and Trichuris trichiura, respectively. Aflatoxins were reported in maize, groundnut, and spices, with prevalence ranging from 61% to 100% and at levels exceeding standards set by Ghana Standards Authority and European Food Safety Authority. Conclusion: This review highlighted the spectrum of microbiological hazards in foods in Ghana. The hazards identified pose significant public health risks, particularly among vulnerable populations. It is crucial that stricter enforcement of food safety laws and improved food handling practices are implemented in the country, particularly in the informal food sector, to protect consumers.

Exploring the Joint Association of Road Traffic Noise and Air Quality with Hypertension Using QGIS.

There is growing evidence linking exposure to air pollution and traffic noise with hypertension. The aim of this study was to examine the associations of registered hypertension cases and hypertension rate with exposure to air pollution and road noise. In this cross-sectional study, we linked the information from the NHS Scotland database of 776,579 hypertension patients' registrations and rates per 13.80 people at the Scottish NHS Board, HSCP, Cluster, and GP practice levels. Based on the geospatial attributes, the data on residential areas were added by modelling annual average air pollutant concentrations, including particulate matter (PM10 and PM2.5), nitrogen dioxide (NO2), and road-traffic noise at different frequency components (Lden). The relationships between exposure to road noise, air pollution, and hypertension were examined using multiple regression and multivariate analysis. Traffic noise and air pollution at various frequency components positively and negatively predicted registered hypertension cases and hypertension rate. Based on the canonical loading technique, the variance explained by the canonical independent variable at a canonical correlation of 0.342 is 89%. There is a significant correlation between joint air pollution and noise at different frequency components and combined registered hypertension cases and hypertension rate. Exploring the combined effects of the two environmental exposures and the joint modelling of noise and air pollutants with hypertension in geospatial views provides an opportunity to integrate environmental and health data to support spatial assessment strategies in public and environmental health.

Vaccination Utilization and Subnational Inequities during the COVID-19 Pandemic: An Interrupted Time-Series Analysis of Administrative Data across 12 Low- and Middle-Income Countries.

BACKGROUND: During and after the SARS-CoV-2 (COVID-19) pandemic, many countries experienced declines in immunization that have not fully recovered to pre-pandemic levels. This study uses routine health facility immunization data to estimate variability between and within countries in post-pandemic immunization service recovery for BCG, DPT1, and DPT3. METHODS: After adjusting for data reporting completeness and outliers, interrupted time series regression was used to estimate the expected immunization service volume for each subnational unit, using an interruption point of March 2020. We assessed and compared the percent deviation of observed immunizations from the expected service volume for March 2020 between and within countries. RESULTS: Six countries experienced significant service volume declines for at least one vaccine as of October 2022. The shortfall in BCG service volume was ~6% (95% CI -1.2%, -9.8%) in Guinea and ~19% (95% CI -16%, 22%) in Liberia. Significant cumulative shortfalls in DPT1 service volume are observed in Afghanistan (-4%, 95% CI -1%, -7%), Ghana (-3%, 95% CI -1%, -5%), Haiti (-7%, 95% CI -1%, -12%), and Kenya (-3%, 95% CI -1%, -4%). Afghanistan has the highest percentage of subnational units reporting a shortfall of 5% or higher in DPT1 service volume (85% in 2021 Q1 and 79% in 2020 Q4), followed by Bangladesh (2020 Q1, 83%), Haiti (80% in 2020 Q2), and Ghana (2022 Q2, 75%). All subnational units in Bangladesh experienced a 5% or higher shortfall in DPT3 service volume in the second quarter of 2020. In Haiti, 80% of the subnational units experienced a 5% or higher reduction in DPT3 service volume in the second quarter of 2020 and the third quarter of 2022. CONCLUSIONS: At least one region in every country has a significantly lower-than-expected post-pandemic cumulative volume for at least one of the three vaccines. Subnational monitoring of immunization service volumes using disaggregated routine health facility information data should be conducted routinely to target the limited vaccination resources to subnational units with the highest inequities.

The efficacy of pharmacological interventions to improve cognitive and behavior symptoms in people with dementia: A systematic review and meta-analysis.

Background and Aims: Dementia is becoming a major global public health menace in the aging population affecting 47 million people globally. Dementia has no cure and effective interventions. Treatment of dementia is a big problem. The most common symptomatic medications for cognition, behavior, and global functioning among patients with dementia currently are cholinesterase inhibitors and memantine. However, Information on the effectiveness of cholinesterase inhibitors for dementia is conflicting and controversial. Thus, this makes it difficult for decision-makers, healthcare providers, patients, and caregivers to decide on the most effective intervention. The current meta-analysis sought to investigate the efficacy of pharmacologic interventions to improve cognitive and behavioral symptoms in people with living dementia. Methods: This current systematic review and meta-analysis used the preferred reporting items for systematic reviews and meta-analyses to ensure accuracy and comprehensiveness. The Cochrane MEDLINE, Database of Systematic Reviews, and other databases were thoroughly searched for relevant studies. We selected Studies such as randomized controlled trials published in English with a sample size of at least 20 subjects. We selected and applied the random-effects meta-analysis as the most preferred model because of the heterogeneity across studies. The computation of the weighted effect size was based on the result from the test of heterogeneity. Results: Twenty-two studies were finally used in the meta-analysis. The study subjects who received donepezil 5 mg/day, donepezil 10 mg/day, and galantamine 24 mg/day had improved cognition symptoms (ADAS-cog) score of -1.46 (95% CI = -2.24, -0.68, z = 3.67, p < 0.001), -2.31 (95% CI = -3.30, -1.31, z = 5.45, p < 0.001) and -3.04 (95% CI = -4.16, -1.92, z = 5.31, p < 0.001) respectively. Conclusion: The current meta-analysis suggests significant benefits of cholinesterase inhibitors such as donepezil (5 and 10 mg/day) and galantamine on cognitive symptoms.

Exploring the Combined Association between Road Traffic Noise and Air Quality Using QGIS.

There is mounting evidence that exposure to air pollution and noise from transportation are linked to the risk of hypertension. Most studies have only looked at relationships between single exposures. To examine links between combined exposure to road traffic, air pollution, and road noise. A Casella CEL-63x instrument was used to monitor traffic noise on a number of locations in residential streets in Glasgow, UK during peak traffic hours. The spatial numerical modelling capability of Quantum GIS (abbreviated QGIS) was used to analyse the combined association of noise and air pollution. Based on geospatial mapping, data on residential environmental exposure was added using annual average air pollutant concentrations from local air quality monitoring network, including particulate matter (PM10 and PM2.5), nitrogen dioxide (NO2), and road-traffic noise measurements at different component frequencies (Lden). The combined relationships between air pollution and traffic noise at different component frequencies were examined. Based on Moran I autocorrelation, geographically close values of a variable on a map typically have comparable values when there is a positive spatial autocorrelation. This means clustering on the map was influenced significantly by NO2, PM10 and PM2.5, and Lden at the majority of monitoring locations. Studies that only consider one of these two related exposures may exaggerate the impact of the individual exposure while underestimating the combined impact of the two environmental exposures.

Teleost Nonapeptides, Isotocin and Vasotocin Administration Released the Milt by Abdominal Massage in Male Catfish, Clarias magur.

In the present work the nonapeptides i.e., isotocin and vasotocin alone or in a combination were tested in C. magur to evaluate their effect on stripping by abdominal massage. Also, we used chitosan-carbon nanotube nanocomposites to conjugate the nonapetides isotocin (abbreviated as COOH-SWCNTCSPeP) and isotocin and vasotocin (COOH-SWCNTCSPePs) with the aim of sustaining the effect for a longer duration. The conjugation of nonapeptides with nanocomposites was confirmed by Fourier-transform infrared spectroscopy (FTIR), Scanning electron microscopy (SEM), Transmission electron microscopy (TEM), Thermogravimetric analysis (TGA) and X-ray photoelectron spectroscopy (XPS). Two experiments were conducted to study the effect of naked (without nanoparticles) and conjugated nonapeptides on the milt release by stripping. Both the experiments consisted of eight treatments which included four naked groups two nanoconjugated groups and two controls. Both naked and nonconjugated formulations were successful in stripping the male catfish. The mRNA expression of selected reproductive genes was analysed to decipher the effect of nanopeptides at the molecular level. Nonapeptide treatment either naked or nanoconjugated, resulted in the upregulation of the transcript level of genes. Histological analysis revealed the concentration of spermatozoa was more in peptide injected groups than in the controls. The synergistic effects of nonapeptides and Ovatide had a positive impact on GSI. Thus, the present formulations were successful in stripping the male catfish to obtain the milt with significant reproductive success. Even though the naked groups perform better but the number of males required to fertilize the eggs in nanoconjuagted groups was smaller making it worth using for the delivery of nonapeptides.

Chitosan grafting onto single-walled carbon nanotubes increased their stability and reduced the toxicity in vivo (catfish) model.

The present work was aimed to develop the tissue benign, modified acid-functionalized single-walled carbon nanotube (COOH-SWCNT) chitosan (CS) hybrid (COOH-SWCNT-CS). Chitosan-nanotube hybrids were characterized by Fourier-transform infrared spectroscopy (FTIR), Thermogravimetry Analysis (TGA), Raman spectroscopy, Emission Gun-Scanning Electron Microscopes (FEG-SEM), Transmission Electron Microscopy (TEM) and Energy-dispersive X-ray spectroscopy (EDS). Micronuclei test of blood cells, comet assay of liver tissue and histological analysis of liver and kidney tissues were conducted after different treatments to evaluate the toxicity. Fish receiving COOH-SWCNT developed more numbers of micronuclei than COOH-SWCNT-CS treatments. Similarly, more DNA damage was observed in fish injected with nanotubes alone than chitosan hybrid groups. Histological observations revealed severe liver cell damage at higher concentrations of COOH-SWCNT whereas, in COOH-SWCNT-CS, no such damage was observed. However, kidney tissue remained unaffected in all groups. The study suggests that the nanohybrid developed will be safe and useful for delivery of micro or macro biomolecules in fish and higher animals.

Knowledge of obstetric fistula among prenatal clinic attendees and midwives in Mfantsiman municipality, Ghana.

OBJECTIVE: To determine obstetric fistula knowledge among prenatal attendees and midwives in Mfantsiman municipality, Ghana. METHODS: An analytical cross-sectional study was conducted among prenatal clinic attendees and midwives in Mfantsiman municipality from March to April, 2016. Women were selected by systematic sampling and consenting midwives were recruited. Respondents were interviewed using a pretested structured questionnaire. Data were analyzed using the χ2 test and Poisson regression with a robust error variance to generate relative risks (RRs) with 95% confidence intervals (CIs). P<0.05 was considered statistically significant. RESULTS: Altogether, 393 prenatal attendees and 45 midwives were studied. Mean age of attendees was 28.1 ± 7.1 years. About 29% of prenatal attendees knew of, 37.2% had poor knowledge of, and 56.6% had some misconceptions about obstetric fistula. Women who had attained some level of education (P trend=0.001), were employed (adjusted RR 4.92; 95% CI, 1.98-12.21), or had given birth before (P trend=0.01) were more likely to have heard of obstetric fistula. All midwives knew of obstetric fistula and its preventive measures; however, up to 73.3% had some misconceptions about it. CONCLUSION: Educating prenatal attendees and organizing regular refresher courses on obstetric fistula for midwives should be a priority in the municipality.

Caregiving experiences and expectations of parents with in-school children with intellectual disability in Ghana.

BACKGROUND: The literature suggests that there are challenges faced by parents of children with intellectual disabilities (ID), which have resulted in calls for support services to be made available to parents and their children with ID. Although regular schools in Ghana are unable to admit students with ID, it is believed that special schools have the necessary facilities to support parents and their children with ID. However, little has been documented on the experiences and expectations of parents whose children with ID are enrolled in a special school. METHOD: In this qualitative study, one-on-one semi-structured interviews were conducted with purposively recruited parents (n = 20) from the second most populous city in Ghana to explore their caregiving experiences and expectations regarding the education of their school-going children with ID. RESULTS: Although the parents acknowledged that access to education has some benefits, such as the protection of their children with ID from negative societal attitudes and a reduction of their caregiving burden, they had low expectations for their children's education. Furthermore, the parents encountered considerable challenges in catering for their children with ID, such as financial problems and limited access to caregiving skills. CONCLUSION: There is a need to intensify efforts at public education in relation to disability acceptance as well as to develop formidable social support systems.

A comparison of global versus disease-specific quality-of-life measures in patients with NIDDM.

OBJECTIVE: This study was conducted to compare the Short Form 36 (SF-36) (a global measure of health-related quality of life) and the Diabetes Care Profile (DCP) (a diabetes-specific measure of self-care and diabetes-related quality of life) in patients with NIDDM. RESEARCH DESIGN AND METHODS: This study was conducted as part of a larger study initiated in 1991 using a randomly selected sample of communities, physicians, and patients with diabetes located throughout Michigan. A total of 255 patients with NIDDM participated. The study examined the relationship between the two measures and diabetes variables, such as glycosylated hemoglobin level and number of complications. RESULTS: The SF-36 and the DCP have both common and discrete measurement domains. Both instruments have acceptable subscale reliability. The DCP has predictive validity regarding glycemic control, whereas the SF-36 does not. Both measures correlate with the number of complications for patients who have NIDDM treated with insulin. CONCLUSIONS: This study suggests that for examining relationships within diabetes, e.g., the impact of acute complications and/or regimen on quality of life, the DCP is the appropriate measure. Conversely, when examining relationships between the patient's experience of living with diabetes and quality of life and other chronic diseases, the SF-36 would be an appropriate measure. Both instruments can be used to illuminate the experience and behavior of patients living with and caring for NIDDM.

Comparison of laboratory test frequency and test results between African-Americans and Caucasians with diabetes: opportunity for improvement. Findings from a large urban health maintenance organization.

OBJECTIVE: To compare African-American and Caucasian patients with preexisting diabetes in a health maintenance organization (HMO) on: 1) frequency with which they received a subset of recommended laboratory tests according to the American Diabetes Association (ADA) consensus guidelines and 2) the results of laboratory test values (glycosylated hemoglobin, cholesterol, and creatinine). RESEARCH DESIGN AND METHODS: A cross-sectional study of 2,312 HMO members with diabetes continuously enrolled during 1991 was conducted using computerized medical record and billing data. Receipt of the ADA recommended tests for glycosylated hemoglobin, cholesterol, and creatinine was compared between African-Americans and Caucasians, stratified by insulin requirements. In addition, group comparisons were made based on the laboratory test results. RESULTS: Less than 20 percent of all subjects received the recommended number of ADA tests. This did not differ by race except for creatinine and cholesterol testing in insulin users only, where African-Americans had more tests. On average, after adjusting for covariates, African-Americans had significantly higher glycosylated hemoglobin and creatinine laboratory values. Both groups had elevated cholesterol values. CONCLUSIONS: The opportunity exists to improve the process of care for both African-Americans and Caucasians with diabetes in an HMO setting. The need to improve glycosylated hemoglobin results and subsequently limit complications is especially pressing among the African-American population.

Assessing the consistency and educational benefits of students' clinical experiences during an ambulatory care internal medicine rotation.

BACKGROUND: Although ambulatory care settings are being used increasingly in undergraduate clinical education, variability in the depth and breadth of students' contacts with basic medical problems may compromise the educational benefits of this teaching modality. The present study examines the nature of such variation and the educational effectiveness of ambulatory care education. METHOD: During the one-month ambulatory care component of the third-year internal medicine rotation at the University of Michigan Medical School, 43 students in 1989-90 and 1990-91 recorded the patient problems they saw at a hospital and satellite clinics. In addition, the students' diagnostic-recognition abilities were assessed before and after the component. The extents of the students' experiences in various categories of patient problems were quantified and correlated with their diagnostic abilities in relevant content areas. RESULTS: The students saw many categories of problems but few instances in any given category. There were numerous and potentially worrisome gaps in their exposure to several typical ambulatory care problems. Although the students showed significant increases in diagnostic-recognition abilities, these increases were not correlated with the students' levels of experience in any of the relevant problem categories. CONCLUSION: The variability and potentially worrisome gaps in the students' experiences in the ambulatory care settings studied are probably representative of students' experiences in such settings, and should be considered in the implementation and evaluation of educational experiences in ambulatory care.

Using focus groups to identify psychosocial issues of urban black individuals with diabetes.

The purpose of this focus group research was to identify issues that could serve as topics for a series of educational videos portraying psychosocial issues of urban black individuals with diabetes. Four focus groups involving 34 black adults were conducted in the Detroit area. Psychosocial issues were identified and rated in order of priority by an expert panel. The major psychosocial issues identified were the importance of food and eating in the black culture, the necessity for learning more about diabetes and its complications, learning to interact effectively with healthcare providers and systems, and the need for help and support in managing psychosocial issues related to diabetes. Black individuals with diabetes face unique psychosocial challenges. Focus groups are an effective method for obtaining relevant, culturally specific, in-depth information about living with diabetes from patients who are members of minority groups.