In New York City, the incidence of tuberculosis has more than doubled during the past decade. We examined the incidence of tuberculosis and the acquired immunodeficiency syndrome (AIDS) and the rate of death from all causes in a very-high-risk group--indigent subjects who abuse drugs, alcohol, or both.In 1984 we began to study prospectively a cohort of welfare applicants and recipients 18 to 64 years of age who abused drugs or alcohol. The incidence rates of tuberculosis, AIDS, and death for this group were ascertained through vital records and New York City's tuberculosis and AIDS registries.The cohort was followed for eight years. Of the 858 subjects, tuberculosis developed in 47 (5.5 percent), 84 (9.8 percent) were given a diagnosis of AIDS, and 183 (21.3 percent) died. The rates of incidence per 100,000 person-years were 744 for tuberculosis, 1323 for AIDS, and 2842 for death. In this group of welfare clients, the rate of newly diagnosed tuberculosis was 14.8 times that of the age-matched general population of New York City; the rate of AIDS was 10.0 times as high; and the death rate was 5.2 times as high. There was no significant difference in the rate of new cases of tuberculosis between subjects with positive skin tests and those with negative skin tests at examination in 1984.Among indigent alcohol and drug abusers in New York City, the rates of tuberculosis, AIDS, and death are extremely high. In this population, a single positive or negative skin test does not predict the development of tuberculosis, probably because both anergy and new infections are common. If programs to control tuberculosis and AIDS are to be effective in groups of indigent substance abusers, health services must be integrated into the welfare delivery system.
The diagnosis of enteric fever poses several problems due to the non-specific and wide array of clinical features. A five-year retrospective study enrolling 136 culture-proven cases of enteric fever was undertaken in order to estimate the clinical and laboratory characteristics, fever clearance time and outcome. The common symptoms and signs were: fever, vomiting, cough, anorexia, diarrhoea, abdominal pain, hepatomegaly, splenomegaly and coated tongue. Enteric fever should be considered in the differential diagnosis of febrile patients with abdominal symptoms.
With the emergence of the novel SARS-CoV-2 and the disease it causes; COVID-19, compliance with/adherence to protective measures is needed. Information is needed on which measures are, or are not, being undertaken. Data collected from the COVID Impact Survey, conducted by the non-partisan and objective research organization NORC at the University of Chicago on April, May, and June of 2020, were analyzed through weighted Quasi-Poisson regression modeling to determine the association of demographics, socioeconomics, and health conditions with protective health measures taken at the individual level in response to COVID-19. The three surveys included data from 18 regional areas including 10 states (CA, CO, FL, LA, MN, MO, MT, NY, OR, and TX) and 8 Metropolitan Statistical Areas (Atlanta, GA; Baltimore, MD; Birmingham, AL; Chicago, IL; Cleveland and Columbus, OH; Phoenix, AZ; and Pittsburgh, PA). Individuals with higher incomes, insurance, higher education levels, large household size, age 60+, females, minorities, those who have asthma, have hypertension, overweight or obese, and those who suffer from mental health issues during the pandemic were significantly more likely to report taking precautionary protective measures relative to their counterparts. Protective measures for the three subgroups with a known relationship to COVID-19 (positive for COVID-19, knowing an individual with COVID-19, and knowing someone who had died from COVID-19) were strongly associated with the protective health measures of washing hands, avoiding public places, and canceling social engagements. This study provides first baseline data on the response to the national COVID-19 pandemic at the individual level in the US. The found heterogeneity in the response to this pandemic by different variables can inform future research and interventions to reduce exposure to the novel SARS-CoV-2 virus.
India has the highest number of medical schools in the world. Teacher shortages and inadequate training of existing faculty are a major problem. On-line faculty development and learning is a plausible component of developing medical teachers in the essentials of pedagogy.An on-line faculty development learning process utilized by Regional Institute Fellows of the Foundation for Advancement of International Medical Education and Research (FAIMER) is described. This faculty development program begins with a face-to-face meeting followed by an 11-month intersession on-line experience, then another face-to-face meeting and a second 11-month intersession on-line experience. During each on-line session, Fellows participate in discussions on topics which they identify based on their learning needs. The on-line program is highly interactive and Fellows and faculty serve as moderators. Discussions have a conversational tone and a semi-structured format which Fellows develop along with the faculty moderator. The participants share their personal and professional experiences and the moderator 'wraps up' with a summary of the learning posted at the end of the month. Faculty facilitate the discussion, sharing appropriate resources and clarifying issues when necessary.More than the content exchanged, the interpersonal learning environment facilitated effective learning, and rejuvenated the learning experiences and network established during the face-to-face sessions. In view of its cost-effectiveness and the flexible choices it offers, focused, moderated, interactive on-line faculty development and learning needs to be considered seriously as a medium offering opportunities to medical educators and other professionals.
Online teaching has the potential to transcend geographical boundaries, is flexible, learner centered and can help students develop self-directed learning skills. The recently introduced competency-based curriculum has also advocated e-learning as an indispensable tool for self-directed learning. For effective online learning, good online teaching practices should be adopted. These include alignment of online teaching and learning with delivery of curriculum and objectives, synchronous, and asynchronous interaction between teacher and student, encouraging the development of higher-order thinking skills, active learning, and self-directed learning in students. In addition, good online teaching practices should have an inbuilt component of feedback and provide for effective time management, respect for diverse talents and ways of learning with continuous monitoring and mentoring of the learners. Online assessments, both formative and summative should also aim to ensure student involvement in the process. Capacity building of faculty through faculty development programs for the development of specific competencies such as social competency, pedagogical competency, managerial competency, and technical competency in the times of COVID-19 is now recognized as the need of the hour. Although online teaching and learning in medical education is new, it has the potential to become mainstream in future.
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