Public health matters: Innovative approaches for engaging medical students.

BACKGROUND: Public health faces the paradox of being increasingly emphasized by the key health and social care regulators and stakeholders, while remaining a largely under-represented discipline in the context of medical curricula. Enhancing medical student engagement in public health teaching is one way to address this concern. METHODS: We discuss four key solutions to the challenges faced by public health educators in medical schools, and present five case studies which demonstrate innovative approaches to engaging medical students in our discipline. RESULTS: Four different approaches have been piloted by members of the Public Health Educators in Medical Schools (PHEMS) network: (i) ensuring social accountability, (ii) demonstrating clinical relevance, (iii) mapping the core curriculum, and (iv) using technology enhanced learning. Preliminary student feedback suggests that these approaches can be used to position public health as an enabler of modern medical practice, and promote a more holistic understanding of medicine by linking patient-centred care to the population level. CONCLUSIONS: The zeitgeist in both academia and the healthcare system supports the teaching of public health within the medical curriculum; there is also consensus at the political and pedagogical level. The challenge of ensuring engagement now needs to be met at the student-teacher interface.

Deradelphous Cephalothoracoomphalopagus in kittens: case report / Cefalotoraconfalopago derafelfo em gatos: relato de caso

The present report describes a case of conjoined twins of the cephalo-thoraco-omphalopagus deradelphous type in cats. A feline female was transferred to our veterinary hospital as an emergency for dystocic labor. The stillborn was subjected to radiographic evaluation, and a single skull and two complete distinct vertebral columns were found. Anatomopathological examination revealed that the twins presented the head, chest, and umbilicus as the main points of union and were classified as the cephalo-thoraco-omphalopagus type. In addition, the twins had unique and well-developed faces, which allowed them to be classified as deradelphous. This malformation is rare in domestic animals, and to the best of our knowledge, this type has not been reported in felines. Further studies are warranted on this embryonic alteration, primarily because its etiology remains unknown.(AU)

O presente relato descreve um caso de gêmeos siameses do tipo cefalotoraconfalopago deradelfo em gatos. Uma fêmea felina foi atendida na emergência do hospital veterinário em trabalho de parto distócico. Os natimortos foram encaminhados para avaliação radiográfica e constatou-se que apresentavam um único crânio e duas colunas vertebrais completas e distintas. O exame anatomopatológico evidenciou que os gêmeos possuíam cabeça, tórax e umbigo como principais pontos de união, sendo classificados como cefalotoraconfalopago. Além disso, os gêmeos apresentaram face única e bem desenvolvida, o que permitiu classificá-los como deradelfos. Esse tipo de malformação é raro em animais domésticos, e não foi encontrado nenhum trabalho em felino com a mesma classificação do presente relato. Há necessidade de mais estudos sobre essa alteração embrionária, pois a etiologia do processo ainda não foi esclarecida.(AU)

Interval cancers in a randomized controlled trial of screening for colorectal cancer using a faecal occult blood test.

BACKGROUND: The sensitivity of unhydrated Haemoccult II has been examined in the context of a randomized controlled trial of faecal occult blood screening for colorectal cancer in Nottingham, UK. METHOD: Both traditional and proportional incidence methods were used to calculate sensitivity separately for both sexes, for two age groups at entry to the trial, for first screen and repeat screens and for three subsites within the large bowel. RESULTS: The traditional method of estimation yielded a sensitivity of 59% whereas the corresponding figure obtained using the proportional incidence method was 54%. The difference between the estimates using the two methods was greatest in subjects aged > or = 65 at entry to the trial and in cancers of the distal colon. CONCLUSIONS: The results suggest that there may be a higher proportion of slower growing tumours in subjects aged > or = 65 and that cancers occurring in the distal colon may have a longer mean sojourn time than cancers proximal to the sigmoid colon.

Oral cancer in the UK: to screen or not to screen.

Although oral squamous cell carcinoma accounts for only a small proportion of malignant neoplasms in the UK, oral cancer incidence and mortality rates have been rising in recent years. The natural history of oral cancer is not adequately understood at present and there is very little information about the epidemiology of precancerous lesions in the UK. There are also insufficient data to provide firm evidence that the percentage of cases arising de novo is greater in the UK and the Western world as compared to the Indian subcontinent. Screening for oral cancer by visual examination is simple, inexpensive and causes little discomfort; however, there is no evidence for the effectiveness of screening for oral cancer either in reducing mortality from the disease or in reducing the incidence of invasive disease by detection and treatment of precancerous lesions. There is currently insufficient evidence to recommend population screening for oral cancer in the UK. Measures aimed at primary prevention of the disease may be a more feasible method of disease control at present.

Faecal occult blood screening for colorectal cancer at Nottingham: details of the verification process.

Cause specific mortality statistics derived from death certificates are highly dependent upon the accuracy of certification by the attending physician. In the Nottingham colorectal cancer screening trial, there were 12,624 deaths among the screening group and 12,515 among the control group during the period under consideration. There was no significant difference in all cause mortality rate (excluding deaths due to colorectal cancer) between the two study groups (rate ratio = 1.01, 95% confidence interval = 0.99 to 1.03). Disease specific mortality rates did not differ significantly between the two groups either. Overall, the agreement between verified and certified cause of death was 86%. Using the certified cause of death would have resulted in an underestimation bias of 6.27% for colorectal cancer deaths.

Influence of parental literacy and socio-economic status on infant mortality.

The influence of parental literacy and socio-economic status (SES) on infant mortality rate (IMR) was studied. This report is only a part of much larger community-based prospective study conducted to determine the factors influencing infant mortality in Dakshina Kannada district of Karnataka, by the Department of Community Medicine, Kasturba Medical College, Manipal, with the financial assistance form IDRC, Canada. A total of 12,857 livebirths during the period of October 1, 1991, to September 30, 1992, where registered and followed up for one year. There were 391 infant deaths which gives an IMR of 30.4 per 1,000 livebirths. Univariate analysis and subsequent stepwise multiple logistic regression analysis revealed that, literacy and SES have a very significant role in reducing IMR.

Utility of arm circumference as a screening instrument to identify women at nutritional risk.

Anthropometric measurements of 567 healthy nonpregnant women aged 20-40 years were studied to assess the utility of mid-upper-arm-circumference as a screening test to detect malnutrition. The prevalence of malnutrition in the study sample was 38.4%. A cut-off point of 24 cm was found to be most appropriate in the study setting as at that level the sensitivity, specificity and positive predictive values were 71.1%, 69.6% and 59.4%, respectively.

[Approach to the reality of life and health at "Recanto de Alegria" community: understanding and defining the strategy of intervention]. / Aproximação da realidade de vida e de saúde da comunidade "Recanto da Alegria": da sua apreensão à definição de estratégias de intervenção.

This article presents a process of investigation that was developed to identify life and health conditions of a community in order to propose changing strategies to the situation. It took place in Distrito do Grajaú (SP)--Brazil. All families were interviewed through the application of a survey in order to find personal/life conditions, and a health disease process profile. Data reveal a determined profile that was presented to the people to implement integrated actions to solve the main problems/issues at the community.

Diversidade e equitabilidade de Plantas Alimentícias Não Convencionais na zona rural de Viçosa, Minas Gerais, Brasil / Diversity and equivalence of unconventional food plants in rural zone of Viçosa, Minas Gerais, Brazil

O presente estudo analisou a diversidade e equitabilidade de plantas alimentícias não convencionais (PANCs) na zona rural de Viçosa, Minas Gerais, Brasil. A pesquisa foi conduzida utilizando a amostragem Bola de Neve com entrevistas semiestruturadas aplicadas à 20 moradores de nove comunidades rurais. Avaliou-se a frequência relativa de citação das espécies (Fr); a diversidade e equitabilidade das mesmas, utilizando os índices de Shannon-Wiener (H') e de Pielou (J'), respectivamente. As espécies foram listadas pela família, nome científico, nomes populares, ambiente de propagação, hábito de crescimento, formas de consumo, estado de domesticação, ciclo de produção e registro por meio de consultas em herbários do bioma Mata Atlântica. Foram encontradas 59 espécies de PANCs, distribuídas em 30 famílias botânicas e 48 gêneros. As famílias asteraceae e myrtaceae se destacaram pela riqueza florística, contribuindo com 11 e 7 espécies, respectivamente. Espécies da família asteraceae obtiveram as maiores frequências relativas (32,2). Obteve-se índice de diversidade Shannon-Wiener de 1,65 (Base 10), e de equitabilidade de Pielou de 0,93. Os resultados encontrados estão similares à de outros estudos desenvolvidos no bioma Mata Atlântica, observou-se ampla diversidade de PANCs na área de estudo, e o conhecimento sobre estas encontra-se distribuído uniformemente entre os moradores

This study analyzed the diversity and the equity of unconventional food plants (UFPs) in the rural area of Viçosa, Minas Gerais, Brazil. The research was performed using the Snowball sampling with semi-structured interviews, applied to 20 residents from nine rural communities. We evaluated the relative frequency of citation of the species (Fr); the diversity and equity of the same species, using the Shannon-Wiener (H') and Pielou (J') indexes, respectively. The species were listed by its family, scientific name, common denominations, propagation environment, growth habit, application methods, domestication state, production cycle and finally registration through consultation in herbaria in the Atlantic Forest biome. We found 59 species of UFPs, distributed in 30 botanical families and 48 genera. The Asteraceae family and the Myrtaceae one stood out for their floristic richness, contributing to 11 and 7 species, respectively. Species from the Asteraceae family got the highest relative frequencies (32.2). It was obtained the Shannon-Wiener diversity index of 1.65 (Base 10), and the Pielou equity index of 0.93. The results are similar to other studies developed in the Atlantic Forest biome, where there was a wide diversity of UFPs in the study area, and the knowledge of these plants is evenly distributed among the residents

Qualidade da carne de bovinos superprecoces terminados em confinamento / Quality of meat from super-young cattle finished in feedlot

Avaliou-se a qualidade da carne de 10 bovinos F1 Guzerá-Nelore e 10 F2 Pardo Suíço-Guzerá-Nelore, inteiros, e abatidos precocemente. Na avaliação da carne, foi utilizado o músculo Longissimus dorsi. O delineamento experimental foi o inteiramente ao acaso. Verificaram-se para F1 e F2, respectivamente, médias para umidade de 75,3 e 75,1, extrato etéreo de 1,4 e 1,5, proteína de 23,7 e 23,6 e cinzas de 1,04 e 1,06. Cor em L* de 28,9 e 30,3, médias para cor em a* de 22,6 e 23,4 e cor em b* de 15,3 15,4, força de cisalhamento de 3,4 e 3,5, perda de peso pelo descongelamento de 9,8 e 10,5 e perda pelo cozimento de 15,9 e 15,6. Não houve diferença estatística para nenhuma das variáveis analisadas entre os grupos genéticos.

The purpose of this study was to use instrumental analysis to evaluate the chemical composition and fatty acid profile of 10 cattle Guzerath-Nellore (F1) and 10 Brown Swiss-Guzerath-Nellore (F2), intact and feedlot finished and slaughtered at 13 months. The Longissimus dorsi was used for meat evaluation. The experimental design was completely randomized. Humidity for F1 and F2 was respectively 75,3 and 75,1 averages, 1,4 and 1,5 averages for ether extract, proteins were 23,7 and 23,6 and 1,04 and 1,06 averages for ash. The results for F1 and F2, respectively, with averages for color to L * of 28,9 and 30,3, averages for the color to a* of 22,6 and 23,4 and color to b * 15,3 and 15,4, averages for shear force of 3,4 and 3,4, weight loss by thawing of 9,8 and 10,5 and weight lost by cooking of 15,9 and 15,4. There were no differences in genetic groups analysis.

Health of children looked after by the local authorities.

Objectives. To assess the healthcare needs of looked-after children in East Surrey. Methods. Epidemiological, comparative and corporate approaches were used to study the healthcare needs of looked-after children. Information was obtained from published and unpublished sources, case note review, cross-referencing with records from specialist services, and interviews with stakeholders. Results. Of the 136 children whose case notes were reviewed, only 64% had undergone statutory medical examinations. Several physical health problems were identified, emotional and behavioural problems were present in 34% of children, 25% of school-aged children had a statement of special educational need, and 36% had ever used child and adolescent mental health services. Immunization coverage was lower than that of children who were not in care. Several unmet needs and gaps in service provision were identified. Conclusions. Children in care have a higher degree of physical and mental health needs than their not-in-care counterparts. The local service for children in care needs to be improved to meet these health needs and lead to better health and health-related outcomes for the children.

Impaired sulphated glycosaminoglycan metabolism in a patient with GM-2 gangliosidosis (Tay-Sachs disease).

An abnormal urinary excretion of sulphated glycosaminoglycans in a patient with GM-2 gangliosidosis (Tay-Sachs disease) is described. Besides the accumulation of GM-2 ganglioside in liver and lack of hexosaminidase A, the patient shows an abnormal urinary excretion of an iduronic acid-rich low molecular weight heparan sulphate. Also, no dermatan sulphate could be detected in the urine, whereas this compound was the main sulphated glycosaminoglycan in the liver of the patient. Heparan sulphate was the main glycosaminoglycan of normal liver. The total amount of sulphated glycosaminoglycans in the urine and liver of the patient did not differ significantly from the amounts found in the liver and urine of normal subjects. Several plasma glycosidases have been assayed and the activities did not differ significantly from the values obtained for the plasma of normal subjects.

Number of chromosomes, Feulgen-DNA content, and nuclear phenotypes in domestic and wild specimens of Panstrongylus megistus.

Specimens of Panstrongylus megistus with different levels of adaptation to a domestic way of life had some of their nuclear and chromosomal characteristics compared, in an attempt to differentiate them by cytological means. The number of chromosomes in male testes was found not to differ. The nuclear frequency and phenotypes of the Malpighian tubules were also found to be the same. On the other hand, Feulgen-DNA values of metaphase chromosomes in insects from a population with a sylvatic distribution were found to be larger than those in specimens from a domestic population. The differences in Feulgen-DNA values, however, may not represent real differences in DNA content, but may possibly be due to differences in DNA-protein complexes.