Peri-conceptual and mid-pregnancy drinking: a cross-sectional assessment in two Scottish health board areas using a 7-day Retrospective Diary.

AIMS: The aim of this study was to evaluate the use of a 7-day Retrospective Diary to assess peri-conceptual and mid-pregnancy alcohol consumption. BACKGROUND: Alcohol consumption among women has increased significantly and is of international concern. Heavy episodic ('binge') drinking is commonplace and is associated with unintended pregnancy. Pre-pregnancy drinking is strongly associated with continued drinking in pregnancy. Routine antenatal assessment of alcohol history and current drinking is variable; potentially harmful peri-conceptual drinking may be missed if a woman reports low or no drinking during pregnancy. DESIGN: Cross-sectional study (n = 510) in two Scottish health board areas. METHODS: Face-to-face Retrospective Diary administration from February to June 2015 assessing alcohol consumption in peri-conceptual and mid-pregnancy periods. Women were recruited at the mid-pregnancy ultrasound clinic. RESULTS: Of 510 women, 470 (92·0%) drank alcohol before their pregnancy; 187 (39·9%) drank every week. Retrospective assessment of peri-conceptual consumption identified heavy episodic drinking (more than six units on one occasion) in 52·2% (n = 266); 19·6% (n = 100) reported drinking more than 14 units per week, mostly at the weekend; 'mixing' of drinks was associated with significantly higher consumption. While consumption tailed off following pregnancy recognition, 5·5% (n = 28) still exceeded the recommended daily two-unit limit in pregnancy. Multivariable logistic regression identified that women who 'binged' peri-conceptually were 3·2 times more likely to do this. CONCLUSION: Statistically significant peri-conceptual consumption levels suggest a substantial proportion of alcohol-exposed pregnancies before pregnancy recognition. Not taking a detailed alcohol history, including patterns of consumption, will result in under-detection of alcohol-exposed pregnancies. The Retrospective Diary offers practitioners a detailed way of enquiring about alcohol history for this population.

Peri-Conceptual and Mid-Pregnancy Alcohol Consumption: A Comparison between Areas of High and Low Deprivation in Scotland.

BACKGROUND: Alcohol-related mortality and morbidity among women has increased over recent decades, especially in areas of higher deprivation. Pre-pregnancy alcohol use is associated with continued consumption in pregnancy. We assessed whether general population alcohol consumption patterns were reflected among pregnant women in two Scottish areas with different deprivation levels. METHODS: Cross-sectional study in two health boards (HB1, lower deprivation levels, n = 274; HB2, higher deprivation levels, n = 236), using face-to-face 7-day Retrospective Diary estimation of peri-conceptual and mid-pregnancy alcohol consumption. RESULTS: A greater proportion of women in HB2 (higher deprivation area) sometimes drank peri-conceptually, but women in HB1 (lower deprivation area) were more likely to drink every week (49.6 vs 29.7%; p < 0.001) and to exceed daily limits (6 units) at least once each week (32.1 vs 14.8%; p < 0.001). After pregnancy recognition, consumption levels fell sharply, but women in HB2 were more likely to drink above recommended daily limits (2 units) each week (2.5 vs 0.0%; p < 0.05). However, women in HB1 were more likely to drink frequently. Women with the highest deprivation scores in each area drank on average less than women with the lowest deprivation scores. CONCLUSIONS: Heavy episodic and frequent consumption was more common in the lower deprivation area, in contrast with general population data. Eliciting a detailed alcohol history at the antenatal booking visit, and not simply establishing whether the woman is currently drinking, is essential. Inconsistent messages about the effects of alcohol in pregnancy may have contributed to the mixed picture we found concerning peri-conceptual and mid-pregnancy alcohol consumption.

A randomized trial of specialized versus standard neck physiotherapy in cervical dystonia.

BACKGROUND: Anecdotal reports suggested that a specialized physiotherapy technique developed in France (the Bleton technique) improved primary cervical dystonia. We evaluated the technique in a randomized trial. METHODS: A parallel-group, single-blind, two-centre randomized trial compared the specialized outpatient physiotherapy programme given by trained physiotherapists up to once a week for 24 weeks with standard physiotherapy advice for neck problems. Randomization was by a central telephone service. The primary outcome was the change in the total Toronto Western Spasmodic Torticollis Rating (TWSTR) scale, measured before any botulinum injections that were due, between baseline and 24 weeks evaluated by a clinician masked to treatment. Analysis was by intention-to-treat. RESULTS: 110 patients were randomized (55 in each group) with 24 week outcomes available for 84. Most (92%) were receiving botulinum toxin injections. Physiotherapy adherence was good. There was no difference between the groups in the change in TWSTR score over 24 weeks (mean adjusted difference 1.44 [95% CI -3.63, 6.51]) or 52 weeks (mean adjusted difference 2.47 [-2.72, 7.65]) nor in any of the secondary outcome measures (Cervical Dystonia Impact Profile-58, clinician and patient-rated global impression of change, mean botulinum toxin dose). Both groups showed large sustained improvements compared to baseline in the TWSTR, most of which occurred in the first four weeks. There were no major adverse events. Subgroup analysis suggested a centre effect. CONCLUSION: There was no statistically or clinically significant benefit from the specialized physiotherapy compared to standard neck physiotherapy advice but further trials are warranted.

An intercalated BSc degree is associated with higher marks in subsequent medical school examinations.

BACKGROUND: To compare medical students on a modern MBChB programme who did an optional intercalated degree with their peers who did not intercalate; in particular, to monitor performance in subsequent undergraduate degree exams. METHODS: This was a retrospective, observational study of anonymised databases of medical student assessment outcomes. Data were accessed for graduates, University of Aberdeen Medical School, Scotland, UK, from the years 2003 to 2007 (n = 861). The main outcome measure was marks for summative degree assessments taken after intercalating. RESULTS: Of 861 medical students, 154 (17.9%) students did an intercalated degree. After adjustment for cohort, maturity, gender and baseline (3rd year) performance in matching exam type, having done an IC degree was significantly associated with attaining high (18-20) common assessment scale (CAS) marks in three of the six degree assessments occurring after the IC students rejoined the course: the 4th year written exam (p < 0.001), 4th year OSCE (p = 0.001) and the 5th year Elective project (p = 0.010). CONCLUSION: Intercalating was associated with improved performance in Years 4 and 5 of the MBChB. This improved performance will further contribute to higher academic ranking for Foundation Year posts. Long-term follow-up is required to identify if doing an optional intercalated degree as part of a modern medical degree is associated with following a career in academic medicine.

Cohort study on predicting grades: is performance on early MBChB assessments predictive of later undergraduate grades?

OBJECTIVE: Timely intervention, based on early identification of poor performance, is likely to help weaker medical students improve their performance. We wished to identify if poor performance in degree assessments early in the medical degree predicts later undergraduate grades. If it does, this information could be used to signpost strategically placed supportive interventions for our students. METHODS: We carried out a retrospective, observational study of anonymised databases of student assessment outcomes at the University of Aberdeen Medical School. Data were accessed for students who graduated in the years 2003-07 (n = 861). The main outcome measure was marks for summative degree assessments from the end of Year 2 to the end of Year 5. RESULTS: After adjustment for cohort, maturity, gender, funding source, intercalation and graduate status, poor performance (fail and borderline pass) in the Year 2 first semester written examination Principles of Medicine II was found to be a significant predictor of poor performance in all subsequent written examinations (all P < 0.001). Poor performance in the Year 3 objective structured clinical examination (OSCE) was a significant predictor of poor performance in Year 4 and 5 OSCEs. Relationships between essay-based summative assessments were not significantly predictive. Male gender appeared to significantly predict poor performance. DISCUSSION: Examinations taken as early as mid-Year 2 can be used to identify medical students who would benefit from intervention and support. Strategic delivery of appropriate intervention at this time may enable poorer students to perform better in subsequent examinations. We can then monitor the impact of remedial support on subsequent performance.

Undergraduate medical students: who seeks formative feedback?

OBJECTIVE: This study aimed to monitor which undergraduate students collected formative feedback on their degree essays and to quantify any correlations between gender or summative mark achieved and whether formative feedback was sought. METHODS: We carried out a study at the University of Aberdeen Medical School, involving a total of 360 Year 3 students, comprising all 177 students in the 2004 cohort and 183 in 2005. Data on gender and summative mark were routinely collected during the degree assessment processes in March 2004 and 2005. Students signed on receipt of their feedback. RESULTS: Less than half the students (46%) collected their formative feedback: 47% in 2004, and 45% in 2005. Overall, females were significantly more likely than males to seek formative feedback (P = 0.004). Higher achievers were significantly more likely than lower achievers to seek their feedback (P = 0.020). CONCLUSIONS: Our findings indicate that these medical students, particularly males and poor students, may not use assessment feedback as a learning experience. Female and better students are keener to seek out formative feedback that might be expected to help them continue to do well. We need to explore further why so many students do not access formative feedback, and develop strategies for addressing this issue effectively.

A future career in general practice? A longitudinal study of medical students and pre-registration house officers.

OBJECTIVE: To monitor the future career preferences of medical students throughout their undergraduate years and into their postgraduate career, and to evaluate which factors may influence career choice intentions, and when this happens, over time. DESIGN: Longitudinal study. METHODS: Questionnaire to all Aberdeen, United Kingdom, Medical School entrants in 1996, and five annual follow-ups (four undergraduate, one postgraduate). RESULTS: Response rates: year 1, 100%; year 2, 78%; year 3, 70%; year 4, 64%; year 5, 65%; pre-registration house officer (PRHO), 60%. Throughout the study, females were more positive about a career in general practice. General practice was the first choice for 13% of students in year 1; year 2, 9%; year 3, 22%; year 4, 24%; year 5, 27%; PRHO, 29%. Those choosing general practice were more likely than those choosing other specialties to be female, have their family home in Scotland, rate their academic abilities lower and their non-academic abilities as average, and have decided on their future career earlier. Reasons for general practice included: working in and being part of a community; continuity of patient contact; variety of illnesses and people encountered; undergraduate teaching experiences; dislike of or disillusionment with hospital medicine; and an increasing awareness of part-time opportunities. CONCLUSION: As medical undergraduates progressed through the curriculum and became PRHOs, general practice became more popular as a career choice, particularly with females. This may be partly explained by the increased exposure to general practitioners and patients in the new community-based teaching programme and the increasing awareness of lifestyle advantages with the particular benefits of more regular hours and working part time.

How and why are non-prescription analgesics used in Scotland?

BACKGROUND: UK Government policy increasingly encourages self-care of minor illnesses, including self-medication. Analgesics constitute a quarter of UK over-the-counter medicines sales, but concerns have been expressed about their potential for inappropriate use. OBJECTIVES: To estimate the prevalence of recent use of non-prescription analgesics in Scotland, to describe by whom they are used, and to estimate inappropriate use. METHOD: A cross-sectional postal survey consisting of a self-completed questionnaire that collected data on respondents' use of non-prescription and prescription medicines, as well as demographic and lifestyle data. The sample comprised 2708 subjects of 18 years and over, randomly selected from the Scottish electoral roll. RESULTS: The response rate was 55% (n=1501). Some 37% (555/1501) of respondents had used a non-prescription analgesic in the previous two weeks. Analgesics accounted for 59% (636/1081) of all non-prescription medicines used in that period. After controlling for all other variables, age, sex, level of education, self-reported health status, prescription exemption status, and use of prescription analgesics, remained significant predictors of non-prescription analgesic use. There was evidence of possible inappropriate use of non-prescription analgesics including use of multiple analgesics (n=67), use by individuals self-reporting conditions associated with cautious use of certain analgesics (n=51), and potential drug-drug interactions (n=15). A few respondents appeared to be using non-prescription analgesics to supplement medical treatment of chronic conditions (n=4). CONCLUSIONS: Our findings have demonstrated a high level of use of non-prescription analgesics amongst the general public, with significant potential for inappropriate use. As we move towards a culture of increased self-management of minor illness, this demonstrated need for improved pharmacovigilance of non-prescribed medicines must be addressed.

The use of non-prescription medicines by general practitioner attendees.

PURPOSE: Against a background of increasing availability and use of non-prescription medicines, this study set out to explore: use of such medicines by patients seeing their general practitioner (GP); frequency of GP enquiry about such use; and frequency of recommendations to use a non-prescription medicine. METHOD: Patients attending four general practices in Aberdeen, Scotland, completed separate questionnaires (before and after seeing their GP). RESULTS: Some 461 individuals waiting to see their GP were invited to participate: 427 (93%) completed the pre-consultation questionnaire and 305 (71% of questionnaires issued) completed the post-consultation questionnaire. Almost half (45%) of all participants reported using non-prescription medicines in the 7 days prior to visiting their doctor; with 20% of the medicines purchased from non-pharmacy retail outlets. Thirteen per cent of participants were asked about their use of non-prescribed medicines by their GP. Eight per cent of participants were recommended to use a non-prescription medicine by their GP. CONCLUSION: Although there was a high level of recent use of non-prescribed medicines by the general practice attenders, relatively few reported being asked about such use, or were recommended to use such medicines by their GP.

Epidemiology teaching: student and tutor perceptions.

There is concern that undergraduate medical students are not exposed to appropriate opportunities to learn and understand the fundamental principles of epidemiology. In this study the aim was to explore students' and tutors' perceptions of the epidemiology teaching in the first three years of the Aberdeen, UK, medical undergraduate curriculum, with particular reference to the teaching in the Community Course. The study adopted a qualitative approach: six individual interviews and two focus-group meetings with quota samples of medical students in the fourth year, and one focus-group meeting with a purposive sample of Community Course tutors. It was found that most students acknowledged difficulty in learning epidemiology because they perceive the topic to be dry, boring and difficult to understand. However, there is a dawning awareness that it is important and its relevance becomes more obvious to students as they progress through the medical course, especially if they have undertaken an intercalated BSc Medical Sciences degree. Students want practical and clinically relevant teaching. Most students are exam driven and will only make efforts to learn topics that are assessed. Tutors also find epidemiology to be difficult and want their teaching to be clinically relevant.