Integrating population health into a family medicine clerkship: 7 years of evolution.

A population health curriculum using methodologies from community-oriented primary care (COPC) was developed in 1994 as part of a required third-year family medicine clerkship at the University of New Mexico. The curriculum integrates population health/community medicine projects and problem-based tutorials into a community-based, ambulatory clinical experience. By combining a required population health experience with relevant clinical training, student careers have the opportunity to be influenced during the critical third year. Results over a 7-year period describe a three-phase evolution of the curriculum, within the context of changes in medical education and in health care delivery systems in that same period of time. Early evaluation revealed that students viewed the curricular experience as time consuming and peripheral to their training. Later comments on the revised curriculum showed a higher regard for the experience that was described as important for student learning.

Improved methods for typing nontypeable isolates of group B streptococci.

Group B streptococci (GBS) are classified by capsular polysaccharide (CPS) type and by cell surface-expressed proteins (c and R). Isolates lacking detectable CPS are considered nontypeable (NT) although they frequently express surface proteins. Immunological and genetic methods were used to study 91 NT GBS isolates collected during surveillance studies for invasive disease or colonization in pregnant or non-pregnant women and neonates less than seven days of age. CPS production was upregulated by the addition of glucose and sodium phosphate to Todd-Hewitt broth (THB) and cells were extracted using hot HCl or mutanolysin. Extracts were tested with antisera for specific CPS types Ia, Ib, and II - VIII by double immunodiffusion (DD) in agarose. By mutanolysin extraction, 12 (13.2%) of the 91 isolates were typeable. In contrast, only four of these 12 newly typeable isolates tested positive for CPS with the HCl extracts of cells grown in modified THB. DNA was analyzed by pulsed-field gel electrophoresis (PFGE) using SmaI restriction with NT isolates grouped by protein profile to facilitate analysis. PFGE results of the NT isolates were compared to DNA profiles of typeable isolates and were correlated with the DD results. The DNA profiles of the newly typeable isolates were similar to profiles of isolates with corresponding defined CPS type. Of the remaining 78 NT isolates digested by SmaI, 63 (80.8%) had DNA profiles that resembled those of specific types of GBS. These approaches will be useful for classification of NT isolates in continued epidemiological surveillance associated with GBS vaccine trials.