Formative Evaluation and Learning Achievement in Epidemiology for Preclinical Medical Students.

BACKGROUND: Teaching epidemiology and biostatistics is a challenge for medical teachers. Formative evaluation has been shown to improve the learning outcomes in various medical subjects. However, the effectiveness of formative evaluation in the subject of epidemiology has yet to be clearly demonstrated. OBJECTIVE: The aim of this study is to investigate the association between formative evaluation and learning outcomes of medical students. MATERIALS AND METHODS: We retrospectively reviewed the prospectively collected learning data of 266 third-year medical students who were enrolled in an epidemiology course in 2016. All learning data and outcomes were analyzed. RESULTS: Nearly all students (97.4%) attended the formative evaluation. Learning outcomes were deemed unsatisfactory in 9.8% of cases. Multivariate analysis revealed that gender, the students' medical training program, laboratory attendance, and the amount of calculation students do during the formative examination were factors that were associated with learning outcomes. CONCLUSION: The formative evaluation was effective at improving learning outcomes in the subject of epidemiology. The parameters indicated that the attention of the medical students, such as laboratory attendance, and the amount of calculation done during the formative examination, were associated with learning outcomes.

Diagnostic performance of 2 h postprandial capillary and venous glucose as a screening test for abnormal glucose tolerance.

AIMS: To evaluate the diagnostic performance of postprandial venous and capillary glucose to screen for abnormal glucose tolerance in primary care setting. METHODS: Both post-breakfast venous plasma and capillary blood glucose were taken simultaneously from a consecutive sample of volunteer civil service workers in Khon Kaen, Thailand between June and December 2009. The 75-g oral glucose tolerance test was performed within 3 days of the baseline visit. Both postprandial capillary and venous glucose were assessed for sensitivity, specificity, area under the receiver operating characteristic (ROC) curve and likelihood ratio using the oral glucose tolerance test (OGTT) results for the diagnosis of abnormal glucose tolerance as a gold standard. RESULTS: 1102 volunteers participated, of whom 874 (79.3%) completed the full study protocol. Five-hundred and four (57.8%) of 874 participants were female. The mean age was 39.9 years (SD=12.16) and the mean BMI was 24.3 kg/m(2) (SD=6.86). The sensitivity and specificity at the optimal cut-off point for venous glucose were 68.28% (95% CI 60.04-75.75) and 67.90% (95% CI 64.38-71.28), respectively. The sensitivity and specificity at the optimal cut-off point for capillary glucose were 63.45% (95% CI 55.05-71.28) and 64.06% (95% CI 60.46-67.55), respectively. The area under the ROC curve was 0.73 (95% CI 0.68-0.78) for venous glucose and 0.69 (95% CI 0.64-0.74) for capillary glucose. The subgroup analysis involving individuals with waist circumference>90 cm improved the area under the curve (AUC) to 0.76 (95% CI 0.68-0.83). CONCLUSIONS: Postprandial blood glucose testing had a moderate discriminating characteristic for the diagnosis of abnormal glucose tolerance. Careful consideration is needed when using it to screen for this condition in general population.

Relationship between diabetes mellitus and tooth loss in adults residing in Ubonratchathani province, Thailand.

BACKGROUND: Diabetes mellitus is associated with oral diseases or oral complications leading to tooth loss. Prevalence of diabetes and tooth loss in Thailand is increasing. OBJECTIVE: Determine the relationship between diabetes mellitus and tooth loss in adults residing in Nachaluay district, Ubonratchathani province, Thailand during the year 2010. MATERIAL AND METHOD: A cross-sectional analytic study included 605 adults (130 males and 475 females), aged 20 to 86 years, of which 226 subjects did not have diabetes mellitus, and 379 people were diabetic patients. The subjects received an interview and oral examination. Data analysis was performed using descriptive, bivariate, and multivariable logistic regression analyses. RESULTS: Findings from the final multivariable logistic regression model showed that tooth loss (defined as missing > or =1 teeth) was associated significantly with age, diabetes mellitus, dental caries, loss of clinical attachment level 6 mm > or =2 sides, and use of fluoride toothpaste, with the adjusted odds ratio (95% CI) being 1.067 (1.047, 1.088), 1.729 (1.092, 2.738), 1.149 (1.071, 1.232), 2.436 (1.575, 3.767), and 0.541 (0.321, 0.914), respectively. CONCLUSION: Tooth loss was associated directly with diabetes mellitus in Thai adults. Therefore, prevention and promotion as well as early treatment of diabetes and oral diseases should be achieved to reduce occurrence, severity, and complications resulting from diabetes mellitus and tooth loss.

Multiscale mechanics of hierarchical structure/property relationships in calcified tissues and tissue/material interfaces.

This paper presents a review plus new data that describes the role hierarchical nanostructural properties play in developing an understanding of the effect of scale on the material properties (chemical, elastic and electrical) of calcified tissues as well as the interfaces that form between such tissues and biomaterials. Both nanostructural and microstructural properties will be considered starting with the size and shape of the apatitic mineralites in both young and mature bovine bone. Microstructural properties for human dentin and cortical and trabecular bone will be considered. These separate sets of data will be combined mathematically to advance the effects of scale on the modeling of these tissues and the tissue/biomaterial interfaces as hierarchical material/structural composites. Interfacial structure and properties to be considered in greatest detail will be that of the dentin/adhesive (d/a) interface, which presents a clear example of examining all three material properties, (chemical, elastic and electrical). In this case, finite element modeling (FEA) was based on the actual measured values of the structure and elastic properties of the materials comprising the d/a interface; this combination provides insight into factors and mechanisms that contribute to premature failure of dental composite fillings. At present, there are more elastic property data obtained by microstructural measurements, especially high frequency ultrasonic wave propagation (UWP) and scanning acoustic microscopy (SAM) techniques. However, atomic force microscopy (AFM) and nanoindentation (NI) of cortical and trabecular bone and the dentin-enamel junction (DEJ) among others have become available allowing correlation of the nanostructural level measurements with those made on the microstructural level.

Aspirin therapy as primary prevention in hypertensive patients at Srinagarind hospital.

Aspirin is now a useful therapy for both primary and secondary prevention for cardiovascular events especially in diabetic patients. Hypertension is also one of the major atherosclerotic risk factors. The authors studied the rate of aspirin use as primary prevention in hypertensive cases at Srinagarind Hospital, Khon Kaen University. There were 164 of 231 hypertensive patients who were aged over 50 years old and met the criteria for aspirin therapy with 2003 ESHs guideline. Only 18.9% (31 of 164 cases) were prescribed aspirin. The most common dose of aspirin was 60 mg/day which was lower than the suggested dose. Within one-year follow up, there was no serious side effects of the aspirin such as upper gastrointestinal bleeding.

Correlation study of scanning acoustic microscope reflection coefficients and image brightness intensities of micrographed osteons.

Scanning acoustic microscopy (SAM) of Haversian bone at high frequency clearly shows differences in the brightness (gray) levels of individual osteons, which were observed to correspond to the differences in reflection coefficients measured with the SAM technique: the darker the bony regions on the SAM micrographs, the lower the SAM reflection coefficient values, and vice versa. We studied the correlation between differences in brightness and the related reflection coefficients of osteons on undecalcified transverse sections of goat tibial diaphysis using a 400-MHz burst mode lens on the Olympus UH3 SAM. Results showed that there was a strong linear correlation between brightness intensities and the corresponding reflection coefficients, with a correlation coefficient r = 0.99 ( P << 0.001) using gray level 210 as cutoff. This result suggested that the image brightness intensity of osteonic bone could be measured retrospectively to provide information on the stiffness of the corresponding bone matrix.