Beyond the surface: unraveling global health curriculum insights through interviews of learners and educators using the CIPP model.

PURPOSE: Our study aimed to delve beyond a surface-level understanding and explore the various dimensions of the global health curriculum from the perspective of both learners and educators using the Context, Input, Process, and Product (CIPP) model. METHODS: From 2020 to 2021, interviews were conducted with a total of 10 individuals, including five students who had taken at least one elective course and at least one elective research course, three teaching assistants (TA), and two faculty members who had taken more than four global health courses in multiple phases in the global health curriculum. Semi-structured interview questions based on the CIPP model were used and qualitative data were analyzed through content analysis. RESULTS: The study identified 12 sub-themes. Students held idealized views of global health careers and sought to bridge the gap through global health classes. They desired early exposure to global health courses, emphasizing both pre-medical and clinical phases. Challenges in adjusting course difficulty and recruiting faculty were identified, along with a preference for interactive teaching methods and offline discussions. The curriculum promoted reflection on medicine's essence, expanded career perspectives, and emphasized competencies like altruism, communication skills, and crisis management in the evolving global health landscape. CONCLUSION: This study showed that a comprehensive approach is possible from the perspective of learners and educators by identifying strengths, weaknesses, and the value of the curriculum's goals, plans, implementations, and results through the CIPP model. For optimal curriculum design, a sequential approach from basic to advanced courses is essential, promoting hands-on global health experiences for students.

Exploring the interest of medical students in global health in South Korea: Does taking a global health course matter?

BACKGROUND: Prioritizing global health is important for positive health outcomes. Doctors play a pivotal role in addressing health issues that they need to recognize the importance of global health practice. However, medical education in global health is still in its early stages in many countries, including South Korea. METHODS: This study is a quantitative cross-sectional study. Medical students were recruited from all 40 Korean medical schools and data collection was conducted in 2021. Stratified proportional quota sampling was employed as the sampling method. The study examined medical students' interest in global health as the dependent variable. Independent variables included whether individuals had taken global health courses as part of their medical curriculum, while covariates included student background and institutional factors. Logistic regression was used to determine if taking a global health class was associated with global health interests. RESULTS: The study included 2450 participants and almost 32% of medical students (n = 781) were interested in global health. Taking global health classes in school was associated with a higher likelihood of developing an interest in global health (OR: 1.29, 95% CI: 1.00-1.67). The likelihood of being interested in global health decreased across the academic year (OR: 0.70, 95% CI: 0.53-0.94). Individuals in graduate entry programs were associated with an interest in global health (OR: 1.32, 95% CI: 1.01-1.72). CONCLUSION: This study provides the first comprehensive nationwide assessment of medical students' perspectives on global health education in South Korea. The findings underscore the importance of early and sustained exposure to global health topics in medical education in fostering interest in global health. These results can serve as valuable evidence for medical educators seeking to integrate global health education into their curricula.

The teamwork structure, process, and context of a paediatric cardiac surgery team in Mongolia: A mixed-methods approach.

INTRODUCTION: Effective teamwork in paediatric cardiac surgery is known to improve team performance and surgical outcomes. However, teamwork in low- and middle-income countries (LMICs), including Mongolia, is understudied. We examined multiple dimensions of teamwork to inform a team-based training programme to strengthen paediatric cardiac surgical care in Mongolia. METHODS: We used a mixed-methods approach, combining social network analysis and in-depth interviews with medical staff, to explore the structure, process, quality, and context of teamwork at a single medical centre. We conceptualised the team's structure based on communication frequency among the members (n = 24) and explored the process, quality, and context of teamwork via in-depth interviews with select medical staff (n = 9). RESULTS: The team structure was highly dense and decentralised, but the intensive care unit nurses showed high betweenness-centrality. In the quality and process domain of teamwork, we did not find a regular joint decision-making process, leading to the absence of common goals among the team members. Although role assignment among the medical staff was explicit, those strictly defined roles hindered active communication about patient information and responsibility-sharing. Most interviewees did not agree with the organisational policies that limited discussions among team members; therefore, medical staff continued to share training and work experiences with each other, leading to strong and trustworthy relationships. CONCLUSION: The findings of this study underscore the importance of well-structured and goal-oriented communication between medical staff, as well as the management of the quality of collaboration within a team to increase teamwork effectiveness in paediatric cardiac surgery teams in LMICs.

Physiological and Behavioral Effects of SiO2 Nanoparticle Ingestion on Daphnia magna.

The increasingly widespread use of engineered nanoparticles in medical, industrial, and food applications has raised concerns regarding their potential toxicity to humans and the environment. Silicon dioxide nanoparticles (SiO2 NPs), which have relatively low direct toxicity, have been increasingly applied in both consumer products and biomedical applications, leading to significantly higher exposure for humans and the environment. We carried out a toxicity assessment of SiO2 NPs using the common water flea D. magna by focusing on physiological and behavioral indicators such as heart rate, swimming performance, and growth. Exposure to SiO2 NPs did not produce acute or chronic toxicity at limited concentrations (<100 µg/mL), but did have statistically significant negative effects on heart rate, swimming distance, and body size. The use of fluorescein isothiocyanate in a silica matrix allowed the tracing and visualization of clear SiO2 NP accumulation in D. magna, which was confirmed by ICP-MS. Although exposure to SiO2 NPs seemed to affect cardiac and swimming performance, such end-point experiments may be insufficient to fully understand the toxicity of these nanoparticles. However, the physiological and behavioral changes shown here suggest potential adverse effects on the aquatic environment by substances previously considered nontoxic.

A novel copper (II) binding peptide for a colorimetric biosensor system design.

Filamentous bacteriophages are viruses infecting only bacteria. In this study, phage display technique was applied to identify highly selective Cu(II) binding peptides. After five rounds of positive screening against Cu(II) and various rounds of negative screenings against competitive metal ions (Al(III), Co(II), Fe(III), Ni(II) and Zn(II)), bacteriophages were enriched. Selective Cu(II) binding of final phages was confirmed by Enzyme Linked Immunosorbent Assay (ELISA), Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray spectroscopy (EDX) analyses. 15 phage plaques were randomly selected and sequenced. Cu-5 peptide (HGFANVA) with the highest frequency of occurrence and the strongest Cu(II) affinity was chosen for further Cu(II) detection and removal tests. Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) confirmed the strong Cu(II) binding potential of engineered viruses. Cu-5 peptides were synthetically synthesized with three Cysteine units at C-terminal and a AuNP-peptide biosensor system was developed based on aggregation behavior of AuNPs upon Cu(II) ion treatment. AuNP-based Cu(II) sensor was selective for Cu(II) and the LOD was 91.15 nM (ca. 5.8 × 10-3 mg/L; 3σ/k, n = 5, R2 = 0.992) for the case study which is considerably lower than the WHO's accepted guideline of 1.3 mg/L. This study provides an interdisciplinary approach to apply short peptides as recognition units for biosensor studies which are user friendly, not bulky and cost-effective.

How do caregivers of children with congenital heart diseases access and navigate the healthcare system in Ethiopia?

BACKGROUND: Surgery can correct congenital heart defects, but disease management in low- and middle-income countries can be challenging and complex due to a lack of referral system, financial resources, human resources, and infrastructure for surgical and post-operative care. This study investigates the experiences of caregivers of children with CHD accessing the health care system and pediatric cardiac surgery. METHODS: A qualitative study was conducted at a teaching hospital in Ethiopia. We conducted semi-structured interviews with 13 caregivers of 10 patients with CHD who underwent cardiac surgery. We additionally conducted chart reviews for triangulation and verification. Interviews were conducted in Amharic and then translated into English. Data were analyzed according to the principles of interpretive thematic analysis, informed by the candidacy framework. RESULTS: The following four observations emerged from the interviews: (a) most patients were diagnosed with CHD at birth if they were born at a health care facility, but for those born at home, CHD was discovered much later (b) many patients experienced misdiagnoses before seeking care at a large hospital, (c) after diagnosis, patients were waiting for the surgery for more than a year, (d) caregivers felt anxious and optimistic once they were able to schedule the surgical date. During the care-seeking journey, caregivers encountered financial constraints, struggled in a fragmented delivery system, and experienced poor service quality. CONCLUSIONS: Delayed access to care was largely due to the lack of early CHD recognition and financial hardships, related to the inefficient and disorganized health care system. Fee waivers were available to assist low-income children in gaining access to health services or medications, but application information was not readily available. Indirect costs like long-distance travel contributed to this challenge. Overall, improvements must be made for district-level screening and the health care workforce.

Establishing Surgical Care Sustainability in Sub-Saharan Africa for Global Child Health: Insights From Pediatric Cardiac Surgical Capacity-Building Programs in Ethiopia and Côte d'Ivoire.

The global surgery research team of the JW LEE Center for Global Medicine, Seoul National University College of Medicine, introduced team-based health workforce training programs for pediatric cardiac surgery in Ethiopia and Côte d'Ivoire. A team-based collaborative capacity-building model was implemented in both countries, and details of the program design and delivery were documented. The research team shared their experiences and identified achievements, lessons, and challenges for cardiac surgical interventions in Sub-Saharan Africa. Future directions were put forward to advance and strengthen the low-and middle-income countries "Safe Surgery."

The feasibility and satisfaction of an online global health education course at a single medical school: a retrospective study.

PURPOSE: The aim of this study was to evaluate the feasibility and satisfaction of an online global health education course for medical students in comparison with an in-person of the course and to assess students' preferences regarding online methods of delivery. METHODS: Second-year medical students enrolled in this course in 2019 (in-person) and 2020 (online). The attendance rate, satisfaction in the course evaluation survey, and academic achievement on the written final examination were utilized to compare the two different methods of course delivery. The medical students who took the online course were also asked about their preferences regarding the method of course delivery and the advantages and drawbacks of each method of online lectures. RESULTS: There was no significant difference in the attendance rate and overall satisfaction between the two groups. The mean score on the written examination of the online course (84.1±19.6) showed comparable effects to the in-person course (78.0±18.3). The percentages of students who achieved high performance (55.5%) and the achieved minimum requirement (95.9%) were also maintained compared to the in-person course (14.6% and 93.6%, respectively). Medical students preferred the online course to the in-person course; in particular, they preferred prerecorded videos over live streaming online lectures. CONCLUSION: The participation, satisfaction, and the academic achievement of the online course were comparable to those of the in-person course. However, the greatest drawback of the online course was the lack of interaction between peer learners. Therefore, diverse methods for online education should be considered to increase students' sense of belonging to a learning community.

Evaluation of a Ten-Year Team-Based Collaborative Capacity-Building Program for Pediatric Cardiac Surgery in Uzbekistan: Lessons and Implications.

Background: Most children who have congenital heart disease in low- and middle-income countries (LMICs), including Uzbekistan, do not receive adequate and timely pediatric cardiac surgical care. To strengthen the surgical capacity of a local pediatric cardiac surgery team in Tashkent, Uzbekistan, the JW LEE Center for Global Medicine at Seoul National University College of Medicine has developed a team-based training program and has been collaboratively conducting surgeries and care in order to transfer on-site knowledge and skills from 2009 to 2019. Objectives: To evaluate the long-term effects of the collaborative program on the cardiac surgical capacity of medical staff (teamwork, surgical complexity, and patients' pre-surgical weights) as well as changes in the lives of the patients and their families. To derive lessons and challenges for other pediatric cardiac surgical programs in LMICs. Methods: To assess the effects of this ten-year long program, a mixed-methods design was developed to examine the trend of surgical complexity measured by Risk Adjustment for Congenital Heart Surgery 1 score (RACHS-1) and patients' pre-surgical weights via medical record review (surgical cases: n = 107) during the decade. Qualitative data was analyzed from in-depth interviews (n = 31) with Uzbek and Korean medical staff (n = 10; n = 4) and caregivers (n = 17). Findings: During the decade, the average RACHS-1 of the cases increased from 1.9 in 2010 to 2.78 in 2019. The average weight of patients decreased by 2.8 kg from 13 kg to 10.2 kg during the decade. Qualitative findings show that the surgical capacity, as well as attitudes toward patients and colleagues of the Uzbek medical staff, improved through the effective collaboration between the Uzbek and Korean teams. Changes in the lives of patients and their families were also found following successful surgery. Conclusions: Team-based training of the workforce in Uzbekistan was effective in improving the surgical skills, teamwork, and attitudes of medical staff, in addition, a positive impact on the life of patients and their families was demonstrated. It can be an effective solution to facilitate improvements in pediatric cardiovascular disease in LMICs if training is sustained over a long period.

Quantitative prediction of mixture toxicity of AgNO3 and ZnO nanoparticles on Daphnia magna.

Once metal-based engineered nanoparticles (NPs) are released into the aquatic environment, they are expected to interact with other existing co-contaminants. A knowledge gap exists as to how the interaction of NPs with other co-contaminants occurs. Here we selected ZnO NPs among various NPs, with Ag ion existing as a contaminant in the aquatic environment by Ag NPs widely used. A novel modeling strategy was demonstrated enabling quantitative and predictive evaluation of the aqueous mixture nanotoxicity. Individual and binary mixture toxicity tests of ZnO NPs and silver (as AgNO3) on Daphnia magna were conducted and compared to determine whether the presence of Ag ions affects the toxicity of ZnO NPs. Binary mixture toxicity was evaluated based on the concentration addition (CA) and independent action models. The CA dose-ratio dependent model was found to be the model of best fit for describing the pattern of mixture toxicity. The MIX I and MIX III suspensions (higher ratios of ZnO NPs to AgNO3) showed a synergism, whereas the MIX II suspension (lower ratio of ZnO NPs to AgNO3) showed an antagonism. The synergistic mixture toxicity at higher ratios of ZnO NPs to AgNO3 was caused by either the physiological or metabolic disturbance induced by the excessive ionic Zn or increased transport and accumulation in D. magna via the formation of complex of ionic Ag with ZnO NPs. Therefore, the toxicity level contributed via their aggregation and physicochemical properties and the dissolved ions played a crucial role in the mixture toxicities of the NPs.

Manifestations of socioeconomic status and its association with physical child punishment- Results from the Multi-Indicators Cluster Survey in Viet Nam, 2006-2014.

Physical child punishment is a critical public health problem that exhibits negative and long-lasting mental and physical health consequences. Yet, the predictors of physical punishment are understudied in developing countries, and disparities that exist between levels of economic status are not known well. The socioeconomic predictors of physical child punishment were investigated using three rounds of the Multiple Indicator Cluster Survey (MICS) results in a lower middle-income country, Viet Nam from 2006 to 2014. A total of 16,784 households that have answered the child punishment questionnaire from MICS data from 2006 to 2014 were included in the analysis. Descriptive statistics, univariate, and multivariate logistic regression analyses were conducted. A secular trend of disparity was investigated with and without the parents' normative values on physical punishment. Children in Viet Nam have been subject to some form of violent physical punishment by their parents or caregivers. About half of the children in the poorest households (44.7%) experienced physical child punishment while lesser percentage of children in the richer households experienced physical child punishment. Disparities existed across different wealth groups as the prevalence of physical child punishment decreased: the gap between the poorest and the richest group widened. Compared to the richest households, the poorest households were more likely to experience physical child punishment AOR 1.58 (95% CI 1.39-1.79). There is a decrease in the prevalence of physical punishment over the recent years in Viet Nam, socioeconomic disparities, in contrast, have increased, and the poorest children have a higher risk of experiencing physical child punishment. Such disparities should be considered in future research and intervention development.

Calix[4]pyrroles bearing proximally meso-meso linking straps: synthesis and anion binding properties.

Calix[4]pyrroles bearing two proximally crossing straps on the same or the opposite sides have been synthesized for the first time. The doubly cis-strapped compound exhibited highly cooperative six-point hydrogen bonding interactions with the anion involving both pyrrolic N-Hs and Ar-Hs.

Aqueous extract of the Helianthus annuus seed alleviates asthmatic symptoms in vivo.

Molecular inflammation is a pivotal process in various degenerative immune diseases, including asthma and atopic dermatitis. In this study, we examined the effects of Helianthus annuus seed (HAS) aqueous extract on an in vivo anti-asthmatic model. Ovalbumin-induced mice were orally administered the aqueous extract of Helianthus annuus seeds, and their lungs were assessed by hematoxylin and eosin staining. Moreover, the expression levels of IL-4/IL-13 cytokines and IgE were determined. HAS extract induced a decrease in CD4+ cell number, IL-4/IL-13 expression, and IgE secretion levels in the lungs. Our findings collectively suggest that the HAS extract has considerable potential in reducing the asthma-like symptoms induced by a mouse ovalbumin challenge model. However, further isolation and purification of the extract is required to determine the specific factor(s) responsible for its anti-asthmatic activity.

Anti-tumor activity of Gastrodia elata Blume is closely associated with a GTP-Ras-dependent pathway.

Gastrodia elata Blume (GEB) is an important medicinal plant in Korea. In order to confirm the anti-tumor activities of GEB extracts, we carried out various in vitro anti-tumor assays, including a wound assay and an invasion assay using an ethyl ether extract of GEB. The results showed that the GEB extract exhibits potent anti-tumor activity in vitro in a dose-dependent manner. The expression of CD44, cdc42, Timp-2 or RhoA mRNA did not change by GEB treatment, compared to that of the control. GTP-Ras, an active form of a G-coupled protein family, however, is associated with the anti-tumor activity of GEB extracts. We examined various molecular markers related to metastasis by reverse transcriptase-polymerase chain reaction with the extract of GEB-treated B16 cells. There was an increase in GTP-Ras expression by the Gastrodia elata Blume extract. Together, these results suggest that the Gastrodia elata Blume extract could have potential in alleviating tumorigenesis, by a GTP-Ras-dependent pathway; although the precise molecular mechanisms are still being examined.

Gastrodia elata Blume protects against stress-induced gastric mucosal lesions in mice.

Gastrodia elata Blume (GEB) is a traditional herbal plant that has been used in Asian countries for centuries as an anticonvulsant, analgesic, and also as a sedative for treating general paralysis, epilepsy, vertigo, and tetanus. Although numerous reports have addressed the effects of GEB against degenerative diseases, no previous study has examined the possible gastroprotective effects of GEB. Here, we examined the effects of pretreatment with GEB (0.02 ml/g, p.o.) in a mouse water immersion restraint (WIR) stress-induced gastric lesion model. Our results revealed that mice pretreated with GEB had significantly fewer gastric lesions than their respective controls. Moreover, GEB-treated mice showed significant decreases in serum and gastric nitric oxide (NO) levels to 50 and 28%, respectively. To examine one possible mechanism underlying this effect, we used reverse transcription-polymerase chain reaction (RT-PCR) to examine NOS mRNA expression in gastric lesion tissues. Our results revealed that the mRNA expression of inducible nitric oxide synthase (iNOS) was reduced by approximately 50% in GEB-pretreated mice versus the controls, whereas the mRNA expression levels of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS) remained unchanged. These findings collectively suggest that GEB significantly protects the gastric mucosa against WIR-induced gastric damage, at least in part by decreasing NO levels via suppression of iNOS mRNA expression.

Dykellic acid inhibits cell migration and tube formation by RhoA-GTP expression.

Dykellic acid, a novel factor initially identified from the culture broth of Westerdykella multispora F50733, has been shown to inhibit matrix metalloprotease 9 activity, caspase-3 activity, B cell proliferation and LPS-induced IgM production, suggesting that this factor may have anti-cancer effects. In an effort to further address the possible anti-tumoral effects of dykellic acid, we used wound healing, invasion and RhoA-GTP assays to examine the effects of dykellic acid on cell migration, invasion and angiogenesis. Our results revealed that dykellic acid dose-dependently inhibits B16 cell migration and motility, and inhibits HUVEC tube formation. Western blot analysis of the active form of RhoA (RhoA-GTP) showed that dykellic acid treatment decreased the levels of RhoA-GTP. These findings collectively suggest that dykellic acid may have both anti-metastatic and anti-angiogenic acitivites, and provides the first evidence for the involvement of RhoA in dykellic acid-induced effects.

Wisteria floribunda gall extract inhibits cell migration in mouse B16F1 melanoma cells by regulating CD44 expression and GTP-RhoA activity.

Extracts from galls grown on Wisteria floribunda are used as an anti-tumoral preparation in oriental traditional medicine. Here, we investigated the molecular mechanism of this anti-tumoral effect by first examining whether the extract inhibited cell migration in a B16 cell-based wound healing assay. The gall extract delayed wound healing in a dose- and time-dependent manner, indicating that one or more components of the fraction inhibited cell migration. Examination of two molecules known to be involved in metastasis, CD44, and RhoA-GTP, revealed that the gall extract decreased CD44 expression in a concentration-dependent manner, and also increased RhoA-GTP activity in comparison to untreated controls. Taken together, these results suggest that the Wisteria gall extract may inhibit cancer cell migration via inhibition of CD44 mRNA expression and activation of the GTP-RhoA protein.