Predictors of leadership styles of medical students: implications for medical education.

Providing effective health care services for a population involves a great deal of team-work among health care workers and leadership of physicians. The primary purpose of this study was to assess the leadership styles of medical students, and to explore factors that may be associated with them. Leadership questionnaires were used to assess leadership styles of 97 sixth-year medical students of the 1995 class at Chulalongkorn University attending the community medicine III program which was designed to introduce basic knowledge and skills in health care management. The baseline leadership styles of the students were more people-oriented than task-oriented. Multivariate analyses revealed that administrative experiences from extracurricular activities and perceived importance of a health administration course were significantly associated with leadership styles. Medical students should be encouraged to participate in extracurricular activities during their medical studies, taking leader positions, in order to develop an optimal leadership style to be effective health team leaders.

Maternal risk factors for low birth weight newborn in Thailand.

The present study assesses the risk approach for maternal risk factors for LBW newborn in Thailand. This study can be considered as a managerial tool for developing local strategies and is particularly useful in the field of maternal and child health care. A summary of maternal risk factors for LBW newborn as listed in Table 7 and can be used as a health educational tool for pregnant women and as basic data for marital counseling. It can also be used to keep the public informed about the maternal risk factors for LBW newborn which will help Thai women of reproductive age avoid the chance of having such babies.

PIP: This multi-center, unmatched, case-control study was conducted at all the 5 maternal-child health care centers in Thailand by administering questionnaires by trained interviewers. Additionally, Chulalongkorn Hospital Medical School and the Maharaj Hospital were also included. The entire sample of 2000 cases were recruited from all pregnant women who delivered a low birth weight (LBW) newborn weighing 2500 gm. 4095 controls were selected from pregnant women in the same hospitals who delivered neonates weighing 2500-4000 gm. Among biological factors influencing LBW, small maternal stature and weight ( 45 kg) was highly associated with LBW neonates (113 cases and 50 controls, relative risk [RR] = 7.15). Maternal age of less than 18 years and 35 years and over ranked 2nd for relative risk (390 cases and 499 controls, RR = 1.75). The other risk factors were parity of 1 or greater than 4 (1379 cases and 2396 controls, RR = 1.68), Quetelet's index of less than 20 (1696 cases and 3259 controls, RR = 1.37). These were all statistically significant risk factors. An accident during the 2nd trimester (RR = 1.34) was also a risk factor. The maternal psychosocial risk factors for LBW newborns were: low family income (RR = 1.75), education ( 4 years of formal education, RR = 1.35), hard work such as agricultural labor (RR = 1.46), and the need to travel (RR = 1.50) or to walk more than 2 hours to the work place (RR = 1.29). Paternal status of being a laborer, an agricultural worker, unemployed (RR = 1.39), or under 19 years old (RR = 1.74) were also risk factors. Pregnancy weight gain of 10 kg had the highest degree of association with having an LBW newborn (RR = 2.21). Other risk factors were: decreased food intake during pregnancy, maternal hematocrit count below 30%, and interpregnancy interval of less than 12 months. Maternal obstetrical risk factors for LBW included: vaginal bleeding during early pregnancy (RR = 3.28), maternal hypertension (RR = 3.48), convulsion during pregnancy (RR = 3.29), no prenatal care or less than 4 visits, maternal drug addiction (RR = 5.13), cigarette smoking (RR = 2.04), coffee or tea drinking during pregnancy, and repeated induced abortions (RR = 2.16).

The effectiveness of chemoprophylaxis against malaria for non-immune migrant workers in eastern Thailand.

A randomized, double-blind field trial was carried out to compare the effectiveness of mefloquine plus sulfadoxine-pyrimethamine (MSP) with that of sulfadoxine-pyrimethamine (SP) in chemoprophylaxis against malaria. The study was conducted in 193 migrant workers in the eastern rural areas of Thailand which are known to be highly endemic for multidrug-resistant Plasmodium falciparum infection. MSP was found to be more effective than SP in the suppression of both P. falciparum and P. vivax parasitaemias, when administered weekly for 12 weeks (P = 0.0014). Complete suppression of P. falciparum was achieved by MSP while 8 subjects receiving SP developed parasitaemia. One subject in the MSP group developed P. vivax parasitaemia, compared with 4 in the SP group. However, in view of the reported complications associated with the use of long-acting sulphonamides, some of which can be life threatening, prophylactic regimens containing sulfadoxine, though proved efficacious, must be used with extreme caution.