Knowledge and attitude regarding stem cell research and its application among medical students in Pakistan

Background The utilization of stem cells (SCs) has led the way into a new era of therapeutics known as regenerative medicine. Their renewal property offers exciting possibilities in reversing tissue damage caused by metabolic and degenerative changes. Research should be conducted increasingly to explore the possibilities of SC utilization in Pakistan. Objectives To assess the level of knowledge, perception, and attitude of medical students regarding stem cell research (SCR) and its application, to obtain a better insight into the future of stem cell therapy in Pakistan as it is a rapidly emerging field in medicine. Materials and Methods This cross-sectional study was carried out using a self-administered questionnaire filled by 206 medical students from different medical colleges in Pakistan. A convenience sampling method was used. Knowledge and attitude scores were calculated based on answers to 28 well-structured questions. Data was analyzed using SPSS. Results The mean values of the answers showed that 60.2% (n=124) of the students had a good knowledge and 39.8% (n=82) had poor knowledge of stem cells. Whereas, 56.8% (n=117) expressed a positive attitude and 43.2% (n=89) expressed a negative attitude towards SCR. Independent t-test applied on knowledge score and attitude showed that the mean knowledge score of people with a positive attitude is higher i.e. 21.25 as compared to the mean knowledge score of people with negative attitude i.e. 19.21. And the difference of the means is significant at p=0.007. Thus, the attitude of students was observed to be significantly dependent on their knowledge about SCR. Conclusion The results show that medical students have baseline knowledge about SC therapy and a positive attitude towards it. Seminars, workshops should be conducted and this topic should be added to their syllabus so that they obtain proper information about SCR and encourage further research.

[2]. The sources to obtain these cells can be Placenta (Cord SCs), Fetal tissue or 47 blastocyst (Embryonal SCs) and Blood, tissue or bone marrow (Adult SCs) [3]. 48 Hematopoietic stem cell transplantation is an established treatment method for 49 bone marrow failure diseases. The first allogeneic transplantation was performed by E. 50 Donnall Thomas in 1957 and in Pakistan, the first transplant was done in 1995 at Dr. 51 Ziauddin Hospital by Dr. Tahir Shamsi [4,5]. Recently, advances have been made 52 towards the application of SC therapy for the treatment of diseases like Alzheimer's, 53 diabetes, immune-genetic conditions, cancers, Parkinson's etc [6,7,8]. 54 Research is being conducted increasingly in the field of cell biology worldwide in 55 the light of its potential therapeutic benefit. It is becoming a popular option for treatment 56 of those diseases that did not have adequate management available in the past. The    The questionnaire consisted of three sections; the Section A collected the socio-85 demographic data including age, sex, ethnicity, religion, institute and year of study. The 86 religiosity and consideration of ethical aspect of SC research was also questioned.

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The Section B included 18 questions regarding the students' general and specific 88 knowledge of stem cells. Score '2' was set to the correct answer, score '1' was set if the 89 answer was 'don't know' and score '0' was set for the wrong answer. Thus the highest 90 possible score for each student was 36. Mean of the total knowledge score(x=20) was 91 taken as a cut-off value for good knowledge and poor knowledge. A score greater than 5 | P a g e 92 20 was considered as good knowledge while a score of 20 and below was considered 93 as poor knowledge.

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Section C comprised of 10 questions structured after literature review to assess the 95 attitude of students towards stem cell research and therapy. Mean of x=32 was 96 considered as a cut-off value for a positive attitude. A score of greater than 32 was 97 considered as positive attitude and a score of 32 and below was considered as negative 98 attitude.

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Data was analyzed using SPSS version 23.0. To assess the internal consistency 100 of the questionnaire the Cronbach Alpha coefficient was calculated to be 0.75.

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Descriptive statistics (frequency and percentages) identified demographic 102 characteristics and students' responses to the questionnaire. Paired t tests were used to 103 analyze the relationships and statistical significance was considered to be as p value < 104 0.05. Pearson Test was used to find the correlation between knowledge and attitude of 105 students towards stem cell research. Analysis included chi-square test to find significant 106 association between knowledge and attitude of medical students towards stem cell 107 research.

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A total of 206 students from all five years of MBBS participated in this survey.

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The mean age of the respondents was 21 ± 1.43 years. Majority of them were females 112 76.7% (n=158) and 23.3% were males (n=48). All of them were Muslims. There were 113 more responses from Year 3 and 4 as illustrated in Table 1. Religiosity was self-reported by the respondents and most of them (76.2%) 119 characterized themselves to as moderately religious. They were further inquired whether they considered stem cell research to be 123 ethical and 66% of the respondents did agree that SCR is ethical.    To study the attitude and perception of students towards stem cell research, they were 147 given a list of statements to rank their views on a 5 point Likert scale.  research which involves the destruction of embryo is immoral. There were also 156 concerns by some students (n=77) about the potential of misuse of stem cell research 157 for commercial purposes benefitting others.

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The mean of the answers was taken and was calculated to be 32. Scores above 159 32 were considered to be a positive attitude and a score of 32 or below was considered  where it was seen that 92% respondents supported stem cells derived from IVF as 209 opposed to cloned embryos [15].

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The students expressed concern over the misuse of stem cells research for The limitations should also be taken into account for the results that have been 238 presented. The small sample size presents a limitation and therefore the results may 239 not be generalizable.