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BACKGROUND: The inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how to prepare preclinical students for real-world screening and referrals for addressing social determinants of health.
OBJECTIVE: This pilot project\'s objective was to evaluate the feasibility of using a real-world, service-based learning approach for training preclinical students to assess social needs and make relevant referrals via the electronic medical record during the COVID-19 pandemic (May to June 2020).
METHODS: This project was designed to address an acute community service need and to teach preclinical, second-year medical student volunteers (n=11) how to assess social needs and make referrals by using the 10-item Social Determinants of Health Screening Questionnaire in the electronic health record (EHR; Epic platform; Epic Systems Corporation). Third-year medical student volunteers (n=3), who had completed 6 clinical rotations, led the 2-hour skills development orientation and were available for ongoing mentoring and peer support. All student-patient communication was conducted by telephone, and bilingual (English and Spanish) students called the patients who preferred to communicate in Spanish. We analyzed EHR data extracted from Epic to evaluate screening and data extracted from REDCap (Research Electronic Data Capture; Vanderbilt University) to evaluate community health workers\' notes. We elicited feedback from the participating preclinical students to evaluate the future use of this community-based service learning approach in our preclinical curriculum.
RESULTS: The preclinical students completed 45 screening interviews. Of the 45 screened patients, 20 (44%) screened positive for at least 1 social need. Almost all of these patients (19/20, 95%) were referred to the community health worker. Half (8/16, 50%) of the patients who had consultations with the community health worker were connected with a relevant social service resource. The preclinical students indicated that project participation increased their ability to assess social needs and make needed EHR referrals. Food insecurity was the most common social need.
CONCLUSIONS: Practical exposure to social needs assessment has the potential to help preclinical medical students develop the ability to address social concerns prior to entering clinical clerkships in their third year of medical school. The students can also become familiar with the EHR prior to entering third-year clerkships. Physicians, who are aware of social needs and have the electronic medical record tools and staff resources needed to act, can create workflows to make social needs assessments and services integral components of health care. Research studies and quality improvement initiatives need to investigate how to integrate screening for social needs and connecting patients to the appropriate social services into routine primary care procedures.

BACKGROUND: Apparel exports bring in sizeable foreign income to Sri Lanka. To protect and promote this industry is a paramount need. This can be carried out by applying Human Factors/Ergonomics (HFE) which has proved to control negative effects at work places.
OBJECTIVE: This paper reports a case study which describes the demands and benefits of HFE in MAS Holdings which owns a large share of the apparel industry in Sri Lanka.
METHODS: The study consisted of walk through observation survey, a questionnaire survey and ergonomic work place analysis followed by a training programme to selected employees in three companies.
RESULTS: Positive responses to questionnaires revealed good ergonomic practices in the work places surveyed. Ergonomically unfit chairs and potential hazards e.g. exposure to noise and hot environment were detected. It is seen that MAS have introduced strategies originated by Toyota Production System viz. 5S, Kaizen, six sigma etc., which are in fact ergonomic methods. A progressive project MAS boast of viz. \'MAS Operating System\' (MOS) empowers training and development to employees.
CONCLUSIONS: MAS Holdings has adequately realized the benefits of applying HFE as evident by the number of awards received. Relevant companies were advised to take appropriate corrective measures to control the potential hazards.

Our objective was to explore the needs and value of case management according to patients with amyotrophic lateral sclerosis (ALS), their spousal caregivers, and health care professionals in the context of multidisciplinary ALS care. We undertook semi-structured interviews with 10 patients with ALS, their caregivers (n = 10) and their ALS health care professionals (n = 10), and held a focus group (n = 20). We transcribed the audio-taped interviews and analysed all data thematically. Participants indicated that in certain circumstances case management can have an added value. They identified factors for receptiveness to case management: adequacy of usual care, rate of disease progression, and degree of social network support and personal factors of patients and spousal caregivers. Participants valued the time for consultation, house calls and proactive approach of the case manager. Patients with ALS and caregivers appreciated emotional support, whereas professionals did not mention the importance of emotional support by the case manager. In conclusion, ALS teams can consider implementation of valued aspects of case management (accessibility, ample time, proactive approach, emotional support) in the usual multidisciplinary ALS care. Additional support might be provided to patients with rapidly progressive disease course, passive coping style and small social network.

There is an increased interest in supporting persons with dementia with technical services in daily life. The aim of this case study was to explore the complex issues involved in the process from a user driven development to the acceptance and usage of a new digital assistive device for persons with mild dementia. Even though it was developed in a user driven process and personalized to meet their individual needs they rarely used it. To deepening the understanding of this disparity between actual usage and perceived usefulness, the participants were studied whilst performing daily life activities through participant observations and interviews. Their partners were interviewed two years after the first observations to clarify the change in needs over time. The results show that the participant needs encompassed occupation, safety, social interaction, and memory support together with the receipt of general support. The overriding requirement for both participants was a need to maintain their self-image. When the digital assistive device did not correspond with the participants\' expectations or view of themselves, their interest in using it faded, since the digital assistive device failed to support their self-image. The acceptance of a digital assistive device by a person with dementia is a process that begins with identifying and personalizing the functions of the device according to individual needs, and then supporting the usage and the gradual integration of the device into daily life. During this process, the person\'s self-image must be taken into consideration and supported.

The family planning program of the Republic of Korea has been quite successful, yet it has not been able to extend its services to all couples of childbearing age. There still exists a group of couples who want no more children and yet are not currently using any contraceptive method. The word pong-eem which literally means being neglected, i.e. untouched by the family planning program, was coined to describe this group. National surveys have shown that the proportion of women of reproductive age in this group is significant. The study on which this article is based focuses on the psychosocial characteristics of the group to provide policy makers, family planning administrators and workers with the specific information they need in order to reduce its size. Among the factors affecting the family planning decisions of couples is demographic pressure. However, there was no statistically significant relationship between demographic pressure and family planning status. With regard to the couples\' knowledge about contraception, the higher the respondents\' level of knowledge was, the lower was their proportion in the pong-eem group. In both the urban and rural areas, the proportion of women in the pong-eem group was higher among those who disapproved of the Government\'s population policies. The proportion of women in the pong-eem group was much higher among those who were least motivated to limit family size. The lower the level of social support for family planning, the higher was the proportion of women in the pong-eem group in both the urban and rural areas. Among the psychosocial characteristics, social support for family planning was the most closely related to the family planning status of couples no matter what measure of social support was used.

The central question to be addressed when discussing the adequacy and relevance of pharmaceutical action in a country, or in the world generally, is what are the objectives of such pharmaceutical action. The central and overwhelmingly preeminent objective is to restore the health of suffering and sick people. There is consensus among practitioners worldwide that health services in 3rd World countries have followed an urban-centered, hospital-based pattern. The consumption has, therefore, followed a similar pattern. In 1979, the urban hospitals of Thailand, both public and private, accounted for 30% of the total drug consumption, or an estimated US$85 million. The urban population within reach was less than 15% of the total population. The primary health care (PHC) policies adopted at Alma Ata resulted in the establishment of a special PHC unit in 1981 and a number of pharmaceutical studies were undertaken at the time. In 1982, the urban hospitals\' share of drug consumption had slightly decreased. Overconsumption of unnecessary products by urban elites leaves the poor majority underserved and bearing very high levels of morbidity for which no treatment is accessible, despite the availability of drugs in the country as a whole. During 1969-81, there has been a 10-fold increase of the pharmaceutical market.

This study, which attempts to shed some light on population policies adopted by the Egyptian government since 1962, examines 3 factors, which include: congruency of population policies with the prevalent religious beliefs; responsiveness of these policies to the actual needs of the people of Egypt; and legitimacy of the policies. 3 stages of the population policy are identified. The 1st stage started in 1962 when the Egyptian government adopted a policy which aimed at fertility reduction. The 2nd stage began in 1973 and involved a socioeconomic approach to fertility reduction, which considered 9 factors with known effects on fertility. These factors include: the socioeconomic standard of the family; education; women\'s status; mechanization of agriculture; industrialization; infant mortality reduction; social security; information, education, and communication (IEC); and family planning services. The 3rd stage was initiated in 1975 and involved a developmental approach to Egypt\'s population problem. This approach defined the problem as a reduction in the level of welfare of the people, attributable to any of the population factors such as size, distribution, and characteristics. The government took these factors into consideration when the Strategy of National Development was formulated for the 1978-82 period. In discussing family planning from the religious perspective, 2 levels should be distinguished. The first is the level of the individual family which involves its social, economic, and health conditions. The second is the level of the society as a whole, when birth control is viewed as a public policy adopted and enforced by the state. At this level, there is a consensus among Moslem Ulemas to disapprove such policies completely. The population policy failed to distinguish between these 2 levels. The agencies charged with the responsibility of policy implementation have misued the permission granted for the 1st level in propagating the cause of family planning for the whole society. The Egyptian government has long controlled the policy making process, despite the fact that government documents emphasize the right of the people to share the objectives of government institutions and control their activities. Population and family planning activities continue to remain some distance from real monitoring and control by popular councils, particularly at the local level. Regarding legitimacy of population policy, Egyptian farmers, who formed more than 60% of the population at the time when the 1st population policy was adopted in 1962, were given only 25% of the seats in the National Conference of Popular Forces, which approved that policy. Subsequent population policies were made and approved by the Supreme Council for Population and Family Planning without any participation from elected councils. Effectiveness of population policy can be improved by increasing the degree of congruency of policy with religious beliefs, its responsiveness to the needs of the people, and its legitimacy.

In Uganda, university students interviewed 1180 abortion cases admitted to the gynecological emergency ward at New Mulago Hospital in Kampala during 1983-1987 to examine the magnitude of induced abortion at this referral/teaching hospital. Obvious induced abortions, probable induced abortions, and spontaneous abortions comprised 25.4% (300), 40.7% (480), and 33.9% (400), respectively. Further analysis was only conducted on the 300 induced abortion cases. All but 4% (12) of induced abortion cases were younger than 25. Adolescents comprised 67.7% of all induced abortion cases. No one over 34 had an induced abortion. Most induced abortion cases (79%) had never been married. Induced abortion was most common among students (49.7%) and single working women (30.3%) and least common among full-time housewives (5.7%). Induced abortion had a positive association with education (no schooling = 1.3%, primary = 2%, secondary = 53.7%, and university = 23.7%). Christians were more likely to undergo induced abortion than Moslems (43.3% for Protestants and 46.3% for Catholics vs. 10.3% for Moslems). Most of the induced abortion cases had been pregnant with their first pregnancy (57.3%). The main method of pregnancy termination was dilatation and curettage (53.3%). Physicians (91%) performed most of the induced, albeit illegal, abortions. 56.6% of induced abortion patients stayed in the hospital for no more than 13 days. Patients who stayed for more than two days had serious complications, including hemorrhage (39.7%), sepsis (21%), and genital perforation (15.3%). The main reasons the women sought an induced abortion were desire for more education (48.7%) and fear of parents (25.7%). The induced abortion related mortality rate was 3.3%. These induced abortion cases were probably faced with an unwanted pregnancy. Most knew about family planning, but had not used any of family planning methods. Liberalization of contraception and reform of the abortion law should occur to provide women family planning and legal, inexpensive, and safe abortion services.

Management Sciences for Health has published a case study on reducing client waiting time, case discussion questions, and a case analysis for training and group discussion for family planning (FP) managers. A married mother of 3 children carries her 5-week-old son as she walks for 1 hour on a hot day to a FP clinic. She wants to learn how to prevent another birth too soon. After registering, she joins at least 35 other women and children under a tree. She sits next to a good friend who has been waiting for 2 hours. They listen to another woman who tells about waiting for 3 hours only to be told she needed to return the following day because too many people wanted to visit the physician. The woman adds that she just wanted a new supply of oral contraceptives. The long walk to the clinic was not the problem, leaving her children alone by themselves was the problem. The new client begins to be concerned about waiting for 3 hours while her children are also home alone; plus, she had chores to do. The case discussion questions ask participants how the waiting time can discourage the new client from using FP, what the clinic can do to ameliorate the situation, and what programs and policies can reduce long client waits. Some solutions to improving the waiting situation include providing transportation, appointments, and fast routes for resupplying contraceptives as well as analyzing client flow and implementing the findings. Mid- and senior-level managers could begin a community-based service delivery program in villages, support a triage policy, and implement higher level training for nurses to perform more medical functions.