Introduction: Health-care associated infections (HCAIs) occur worldwide and affect both patients and health-care workers (HCWs), including medical students. This study aimed to investigate HCAI risks associated with clinical medical students attending Shantou University Medical College (SUMC) and the effectiveness of their learning resources. Methodology: Four cohorts (n = 272) of medical students participated in a questionnaire-based survey was done on (year 5 in the 5-year program and years 5 to 7 in the 7-year program) undergoing internship training in 14 teaching hospitals in Guangdong, China. Results: The mean overall score of the students was 52.54 ± 0.45 (mean ± SE). Students received fairly good scores in hand hygiene (77.57 ± 0.77) and HCAI source (63.16 ± 1.18); relatively weak scores in the isolation precautions (44.59 ± 0.55), HCW safety (45.59 ± 0.86), and personal protective equipment (57.64 ± 0.60); and the weakest scores in HCA-pathogen identification (27.44 ± 0.81). The year of education (r = 0.089, P = 0.144, n = 272) or internship placement (r = 0.077, P = 0.206, n = 272) had no significant influence on their level of knowledge. Conclusions: This study demonstrates that medical students at SUMC have limited knowledge and practice regarding HCAI due to substantial deficiencies in their learning resources. Review of medical curricula, improvement in preclinical and clinical training, and surveillance and monitoring of practicing HCWs are urgently needed to minimize risk of HCAIs in patients and HCWs.

Objective: Individuals with HIV are at increased risk for osteoporosis. A healthy diet with adequate calcium is recommended to promote bone health. However, lengthy nutritional assessments pose barriers to routine screenings in clinical practice. This study aimed to examine the validity and reproducibility of a six-item dietary calcium screening tool among Chinese individuals with HIV. Design: We conducted a two time-point study in an outpatient setting. Volunteers self-administered the six-item tool upon enrollment and again at one-month follow-up. At baseline, participants also completed a validated food frequency questionnaire and surveys regarding demographic and clinical risk factors. Setting: Beijing, China; Shenzhen, Guangdong, China Participants: Upon enrollment, 127 individuals with HIV participated in the study, of whom 83 completed the follow-up screening. Results: Mean age of participants was 35.2±9.3 years, average BMI was 22.8±3.8 kg/m2, and 89% were men. Among the participants, 54.7% reported calcium intake less than 800 mg/day. The six-item tool demonstrated fair-to-moderate relative validity with a correlation of 0.39 and 75.7% of subjects classified in same/adjacent quartiles as the reference, and moderate-to-good reproducibility with a correlation of 0.60 and 83.1% of subjects classified in same/adjacent quartiles. Finally, ROC analyses yielded a sensitivity of 87.0% and a specificity of 39.4% with optimized cut-off level. Conclusions: The six-item tool presented adequate validity and reproducibility to identify individuals with low calcium intake among the target population, providing a convenient instrument for categorizing calcium intake in clinical practice, prompting referrals for further assessment, and raising awareness of dietary calcium in bone disease prevention.

Background: Hospital-acquired infection is a major problem worldwide, particularly in hospitals with limited resources. Hand hygiene is one of the most effective measures to prevent crossinfection but is often practiced poorly, particularly in hospitals in developing countries. Improving hand hygiene behavior amongst hospital staff is difficult. This study aimed to identify obstacles to improved hand hygiene and infection control in a regional hospital.Methods: We conducted a prospective study at a 1000-bed hospital in northeast Thailand from 1th April 2011 to 30th November 2011 using four methods, as following i) directed observation of hand hygiene practices of healthcare workers (HCWs), ii) selfadministered questionnaire to assess personal knowledge and attitude of HCWs toward infection control, iii) focus group discussions to assess culture and group behavior of HCWs towards infection control, and iv) semi-structured interviews to assess obstacles to improvements in infection control.Results: 1,560 hand hygiene opportunities were directly observed amongst HCWs. Hand hygiene compliance was poor and differed markedly among categories of HCWs. Nurses were 3 times more likely to perform hand hygiene following patient contacts than doctors. Of 1,550 HCWs completing the questionnaire, 76% agreed that hand hygiene is effective in preventing HAIs, but the majority showed limited knowledge of infection control (Median score 60% [range 15% to 80%]). For focus group discussions, almost all discussants stated that personal belief about hand hygiene efficacy, and examples and norms provided by senior hospital staff were of major importance for compliance. Some HCWs suggested that improving hand hygiene practice of physicians would be an effective way of improving hand hygiene generally as all HCWs accepted physicians as role models. For semi-structured interviews, the most common suggestions were to enhance engagement with HCWs, and to improve quality and quantity of hand hygiene resources.Conclusion: Norms provided by senior staff and personal beliefs about hand hygiene efficacy were considered to be amongst the most important determinants of hand hygiene behaviour. Physicians were widely considered to be important role models, but had the lowest observed hand hygiene compliance. Hand hygiene knowledge and behaviour amongst HCWs needs to be improved.