RESUMEN
OBJECTIVES: The objectives of the study were to assess differences in utilization of maternal serum screening (MSS) and prenatal diagnostic testing between population subgroups and to determine the impact on chromosomal anomaly birth rates. METHODS: This population-based cohort study included all female residents from Saskatchewan, Canada, who delivered a baby, experienced a fetal loss, or had a pregnancy termination between 2000 and 2005. In total, 93 171 women were included in the study dataset, with a subset (n = 35 527) evaluated to identify predictors of screening and diagnostic testing. Incidence and live birth prevalence of Down syndrome were compared across populations. RESULTS: MSS uptake was lower in First Nations (FN) women (9.6% vs 28.4%), and living in a rural health region moderated the difference (p < 0.001). Consequently, fewer chromosomal anomalies were prenatally diagnosed in FN women than in the rest of the population (8.3% vs 27%). Terminations of pregnancy for fetal anomaly occurred at a lower frequency amongst FN women (0.64 vs 1.34, per 1000 pregnancies), resulting in a smaller effect on Down syndrome birth rates. CONCLUSION: Utilization of MSS and diagnostic testing was lower in FN and rural populations. Further research will be necessary to understand the relevance of value preferences and access barriers. © 2016 John Wiley & Sons, Ltd.
Asunto(s)
Aborto Inducido/estadística & datos numéricos , Anomalías Congénitas/diagnóstico , Indígenas Norteamericanos/estadística & datos numéricos , Pruebas de Detección del Suero Materno/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Adulto , Amniocentesis/estadística & datos numéricos , Estudios de Cohortes , Síndrome de Down/etnología , Femenino , Humanos , Embarazo , Resultado del Embarazo , Saskatchewan/epidemiologíaRESUMEN
BACKGROUND: The popularization of problem-based learning (PBL) has drawn attention to the motivational and cognitive skills necessary for medical students in group learning. This study identifies the effect of motivational and cognitive factors on group productivity of PBL tutorial groups. DESCRIPTION: A self-administered questionnaire was completed by 115 students at the end of PBL tutorials for 4 themes. The questionnaire explored student perceptions about effect of motivation, cohesion, sponging, withdrawal, interaction, and elaboration on group productivity. We further analyzed (a) differences in perceptions between male and female students, (b) effect of "problems," and (c) effect of student progress over time on group productivity. EVALUATION: There were linear relations between a tutorial group's success and the factors studied. Significant differences were noted between male and female student groups. CONCLUSIONS: Students and tutors need to recognize symptoms of ineffective PBL groups. Our study emphasizes the need to take into account cultural issues in setting ground rules for PBL tutorials.
Asunto(s)
Cultura , Educación de Pregrado en Medicina/métodos , Procesos de Grupo , Aprendizaje Basado en Problemas/métodos , Percepción Social , Estudiantes de Medicina/estadística & datos numéricos , Cognición , Eficiencia , Docentes Médicos , Femenino , Humanos , Masculino , Motivación , Evaluación de Programas y Proyectos de Salud , Factores Sexuales , Estudiantes de Medicina/psicología , Tiempo , Emiratos Árabes UnidosRESUMEN
Occupational exposures to organic dusts, gases, welding fumes and agricultural chemicals result in farmers' increased risk of respiratory health problems compared to other workers. The Respiratory Health Program for Saskatchewan farmers addresses the difficulties of delivering an occupational health program to a sparsely distributed population on the Prairies. We summarized their pulmonary function and respiratory health by spirometry and questionnaire respectively. The necessity of the program was demonstrated by the frequency of lower than predicted pulmonary function tests and referrals to family physicians (1996 through 1999). Age, years in farming, usual cough, wheezing on most days and nights, bringing up phlegm from the chest, breathlessness, and cigarette smoking were associated significantly with pulmonary function results. We evaluated the Respiratory Health Program (1994 through 2000) with respect to acceptability, accessibility, appropriateness, continuity, effectiveness, efficiency, and risk/safety by using questionnaires and evaluations by farm families.