William George Hart

Adopting a blended learning approach to teaching evidence based medicine: a mixed methods study

BackgroundEvidence Based Medicine (EBM) is a core unit delivered across many medical schools. Few studies have investigated the most effective method of teaching a course in EBM to medical students. The objective of this study was to identify whether a blended-learning approach to teaching EBM is more effective a didactic-based approach at increasing medical student competency in EBM.MethodsA mixed-methods study was conducted consisting of a controlled trial and focus groups with second year graduate medical students. Students received the EBM course delivered using either a didactic approach (DID) to learning EBM or a blended-learning approach (BL). Student competency in EBM was assessed using the Berlin tool and a criterion-based assessment task, with student perceptions on the interventions assessed qualitatively.ResultsA total of 61 students (85.9%) participated in the study. Competency in EBM did not differ between the groups when assessed using the Berlin tool (p = 0.29). Students using the BL approach performed significantly better in one of the criterion-based assessment tasks (p = 0.01) and reported significantly higher self-perceived competence in critical appraisal skills. Qualitative analysis identified that students had a preference for the EBM course to be delivered using the BL approach.ConclusionsImplementing a blended-learning approach to EBM teaching promotes greater student appreciation of EBM principles within the clinical setting. Integrating a variety of teaching modalities and approaches can increase student self-confidence and assist in bridging the gap between the theory and practice of EBM.

Association of general and abdominal obesity with age, endocrine and metabolic factors in Asian men

Abstract Objective: This study made use of the percent abdominal fat to define abdominal obesity (AbO) and examined the differential associations of general obesity (GOb) and AbO with age, metabolic and endocrine factors. Methods: Metabolic, endocrine and anthropometric factors and body composition were measured in 481 Asian men. Results: A DEXA-derived ≥25% abdominal fat (PAbdF) was used to define men with AbO. Age was directly associated with PAbdF and percent total body fat (PBF). Exercise intensity was negatively associated with PBF. Both PBF and PAbdF were associated with HDL and LDL, but have opposite correlation with triglyceride. Furthermore, both PBF and PAbdF were associated with the number of metabolic syndrome (MetS) risk factors. Men with GOb had lower levels of percent lean mass (PLM), testosterone and bioavailable testosterone, and higher insulin and glucose levels. Men with AbO had lower arm and leg fat, higher insulin levels and triglycerides. Conclusions: Men with GOb and AbO had different pattern of body composition. Age may be a contributory factor in AbO and a sedentary lifestyle may contribute to GOb. Both GOb and AbO are associated with an increased risk of MetS, with GOb more predispose to risk of diabetes, while AbO more at risk for cardiovascular diseases.

Associations of physical exercise as a lifestyle habit with lean and fat body mass and handgrip strength and age in Asian men.

Abstract Background: We evaluated how the intensity of physical exercise as a lifestyle habit is associated with age, body composition and handgrip strength. Methods: Total body composition was analyzed using DEXA. Exercise scores were derived from an administered questionnaire and the scoring was calculated using the Metabolic Equivalent of Task (MET). Handgrip strength was measured using a dynamometer. Results: Age, independent of exercise intensity, was associated with declining lean mass, and handgrip strength and with increasing total body fat. A regular physical exercise regime of intensity greater than 1230 MET-min/week was associated with higher total lean mass and lean mass in the limbs, and handgrip strength and lower fat mass in the limbs. Discussion: We have shown that age was associated with lower lean mass especially in the limbs and handgrip strength and higher total fat mass. Regular physical exercise as a lifestyle habit of any type and of sufficient intensity could help improve muscle strength in the limbs.

Community-based practice program in a rural medical school: Benefits and challenges

Background: Community-based education is a component of many medical curricula and may contribute to the solution of inequity in health services. Aims: This article evaluates a Community-based practice program (CBPP) conducted at Gippsland Medical School, Monash University. Students gain exposure to the community and conduct a community-based research project. The principal objective of the CBPP is to provide students with an opportunity to develop an interprofessional perspective on the application of social equity, justice and models of health interventions in the community. Methods: Students and representatives from community organisations (community educators) evaluated the CBPP using questionnaires, focus groups and interviews. Results: Students agree that participating in the CBPP improves understanding of community services, barriers and social determinants of health and the roles of health professionals. Community educators view the CBPP as a valuable platform for mutual learning for all parties involved, with students gaining real life experience. Challenges in the CBPP include formulating and conducting a research project and contextualisation of didactic material at community sites. Conclusion: From this evaluation, based as it is on 1 year and limited data, we cannot unequivocally claim that the program fully meets its overall objective; however, there are positive outcomes and pointers to success.

The association of metabolic syndrome and aging with cognition in Asian men

Abstract Background: The present cross-sectional study examined the associations of individual metabolic factors and age with the short-term memory and perceptual capacity in 472 healthy Asian men. Methods: The symbol digit and digit span tests from the Swedish Performance Evaluation System were used to assess the perceptual capacity and memory cognitive domains. Linear regression with the stepwise method, and multivariate analyses of the General Linear Model with the Bonferroni correction for multiple comparisons were carried out with the SPSS 21.0 package. Results: High blood pressure and HDL were not significantly associated with either short-term memory or perceptual capacity. Age and glucose level were negatively associated but regular physical exercise was positively associated with perceptual capacity. On the other hand, high triglyceride level (TG) was positively associated but high waist/height ratio was negatively associated with short-term memory. When men without any component of the metabolic syndrome (MetS) were compared with men with one, two or three or more components of MetS, no significant differences in cognitive performance were noted. Conclusion: Not all the metabolic factors were significantly associated with short-term memory or the perceptual capacity domains. Those that were did not show a sufficiently consistent pattern of association to support a role for MetS as a whole in cognitive decline with aging. It may not be meaningful to evaluate the association of MetS as a whole with cognition.

Effects of a brief action and coping planning intervention on completion of preventive exercises prescribed by a physiotherapist among people with knee pain

OBJECTIVES The present study aimed to test the efficacy of action and coping planning in promoting engagement with preventive exercises among a sample of people with knee pain. DESIGN Experimental trial. METHODS Individuals who presented to a physiotherapist with knee pain (N=373, 57% female; M age=31.54, SD=10.06, age range=18-69 years) completed two assessments separated by 14 days. At baseline, participants completed measures of severity of problems associated with the knee (e.g., pain, symptoms) and past behavior. Subsequently, participants were randomly assigned to an action and coping planning or control group. Two weeks later, participants retrospectively reported their preventive exercise behavior over the past 14 days. Analyses revealed that the experimental group reported a higher number of preventive exercise sessions over the 14day period when compared with the control group. RESULTS Participants who planned action and coping strategies reported a greater frequency of completed preventive exercises over a 2-week period than people who did not. CONCLUSIONS The results of this study underscore the importance of action and coping planning for the enactment of preventive exercises that are designed to manage or prevent knee pain.

Aging and bone health in Singaporean Chinese pre-menopausal and postmenopausal women

OBJECTIVE The study evaluated relationships between menopausal statuses, hormone replacement therapy (HRT), body mass index (BMI), percent body fat (PBF), and exercise with osteoporosis and bone mineral density (BMD) in Singaporean women. STUDY DESIGN This is a cross-sectional study. MAIN OUTCOME MEASURES The spine BMD, and femoral neck BMD as well as the prevalence of osteoporosis are the main outcome measures studied. RESULTS Age, BMI, PBF and exercise intensity were independently associated with spine and femoral neck BMD. Women with higher BMI and lower PBF had higher BMD and lower prevalence of osteoporosis. Postmenopausal women without HRT had lower BMD and higher prevalence of osteoporosis while those on HRT had similar BMD and prevalence of osteoporosis as premenopausal women. CONCLUSION This study shows that BMI and PBF are powerful predictors of BMD. Osteoporosis is site-specific in the Singapore population, being higher in the femoral neck than in the lumbar spine. The bone status after menopause may not be worse than that dictated by age alone and both ERT and E/PRT could sustain the BMD to levels corresponding to those of women a decade younger. A strategy to improve bone health should include dieting and physical exercise program that focuses on selectively reducing fat mass and increasing lean mass.

Aging, lifestyle factors, hormones and bone health in Singaporean men

Purpose The present study examined how age, bodyweight, body fat, regular exercise and some endocrine factors are associated with osteoporosis, spine bone mineral density (Sbmd) and femoral neck bone mineral density (Fnbmd) in Singaporean men. Methods Body composition and bone scans of lumbar spine at L2-L4 and hip were carried out with duel-energy X-ray absorptiometry (DXA). Anthropometric parameters were measured and demographic data, medical history and exercise schedule were collected via a questionnaire. Results Osteoporosis prevalence was higher and Sbmd and Fnbmd were lower in men with high percent body fat (PBF) and conversely osteoporosis prevalence was lower and Sbmd and Fnbmd were higher in men with higher body mass index (BMI). Age was negatively associated with Fnbmd but not Sbmd. On the other hand, PBF and insulin levels were negatively associated with both Sbmd and Fnbmd. Body mass index and exercise intensity were positively associated with both Sbmd and Fnbmd. Sex hormones were significantly associated with only Sbmd but not Fnbmd. Both estradiol and DHEAS were positively, while testosterone was negatively associated with Sbmd. Conclusion The study shows that the prevalence of osteoporosis and some of the determinants of bone mineral density (BMD) in Singaporean men was site-specific. Further, BMI and PBF are opposing predictors of BMD. Therefore, any strategy for improving bone health should include modalities that increase lean and bone mass and decrease fat mass. The bone health of Singaporean men is comparable to non-Hispanic whites and better than some other Asian men.

Endocrine factors, memory and perceptual capacities and aging in Asian men

Abstract Background: This cross-sectional study examined the associations of hormones and age with short-term memory and perceptual capacity in 472 healthy Asian men. Methods: The symbol digit and digit span tests from the Swedish Performance Evaluation System were used to assess perceptual capacity and memory. Linear regression analyses with the stepwise method were carried out with the SPSS 21.0 package. Results: Age was associated with lower dehydorepiandrosterone sulphate (DHEA/S), insulin growth factor-1 (IGF-1), thyroxine (T4), testosterone (T), bioavailable T (BioT) and error rate (Err) but higher glucose (GLU), sex hormone binding globulin (SHBG), estradiol (E2) and retention time (RT). High GLU was associated with higher error rate, longer RT of the perceptual capacity domain and shorter digit span (DSpan) of the short-term memory domain. Higher insulin-like growth factor binding protein-3 (BP3) was associated with longer DSpan. High cortisol (Cor) was associated with higher Err, while high DHEA/S was associated with shorter RT. All other hormones from the adrenal, somatotrophic and gonadal were not significantly associated with cognition. Conclusion: The findings suggest (1) a role for tighter control of blood glucose levels in cognitive decline with aging in men, (2) different hormones may be related to different parameters of cognition and “cognition” is not a unitary phenomenon and (3) further investigation of the potential for exogenous DHEA/S to slow cognitive decline in aging, especially as it relates to reaction time.

Excess fat in the abdomen but not general obesity is associated with poorer metabolic and cardiovascular health in premenopausal and postmenopausal Asian women

OBJECTIVES To examine the associations of various metabolites and hormones and hormone replacement therapy (HRT) with obesity. METHODS This is a cross-sectional study of 1326 Singaporean women. A DXA-derived percent body fat (PBF) of ≥35% and percent abdominal fat (PAbdF) of >21.8% were used, respectively, to define women with general (GOb) and abdominal (AbdOb) obesity. RESULTS Higher levels of insulin and glucose, lower levels of HDL, higher levels of TC/HDL and HOMA values, and different levels of some hormones were noted only in the women with abdominal, and not general obesity. The incidence of general and abdominal obesity was higher in postmenopausal women with or without HRT, except that those who were on conjugated estradiol-only HRT had no increase in the incidence of general obesity compared with premenopausal women. CONCLUSIONS Abdominal obesity is associated with insulin resistance and with higher risks of metabolic syndrome and cardiovascular diseases, whereas general obesity is not. Abdominal obesity may predispose to a higher risk of diabetes. The onset of the menopause tends to increase the incidence of general and abdominal obesity, except that postmenopausal women on conjugated estradiol HRT appear to be relatively protected from general obesity.