Clinical characterisation of a novel paroxysmal dyskinesia in Welsh terrier dogs.

Breed specific paroxysmal dyskinesias are increasingly recognised in veterinary medicine. We aimed to characterise the phenomenology, clinical course and prevalence of a previously unreported paroxysmal dyskinesia in the Welsh terrier breed. Clinical records of five Welsh terriers with paroxysmal episodes were reviewed. Additionally, owners of Welsh terriers were invited to complete a questionnaire with the aim of characterising paroxysmal episodes in the wider breed population. Clinical examinations (n = 5) and diagnostic investigations (n = 3) of affected Welsh terriers were within normal limits, apart from mild-moderate ventriculomegaly on cranial magnetic resonance imaging (n = 3). The survey of Welsh terrier owners revealed episodes consistent with a paroxysmal dyskinesia in 41 (22.8%) of 177 respondents. Median age of onset was 59 months. Episodes were predominantly characterised by sustained hypertonicity with periods of limb flexion, abnormal head and body posture, with preserved consciousness. Episode duration ranged from 30 s to 30 min (median, 3 min 30 s), with frequency varying widely between dogs. Affected dogs demonstrated a stable to improving clinical course in most cases. This study investigated a previously unreported paroxysmal dyskinesia in Welsh terriers. Similar clinical signs within the breed were potentially consistent with an inherited cause, worthy of further investigation.

Students' attitudes to small-group work in community health.

To encourage fourth-year medical students to review their ethnocentric attitudes to the politicized issues of population and undernutrition in South Africa, small-group work (SGW) was introduced during a month's teaching in community health at the University of Cape Town. We tested several formats for these sessions and chose one which seemed effective. This study examined the remaining students' attitudes to SGW as a means of briefly examining complex emotive topics. Sixty-nine students of a class of 168 were asked to complete a Likert questionnaire on their attitudes to SGW. Fifty-five students (79.7%) agreed that group work had allowed them to engage the topics briefly but usefully and 62 (90%) thought that the topics lent themselves to SGW. While 52 (75.3%) were not confused, 5 (7.2%) were confused by SGW. Thirty-nine students (56.5%) preferred lectures, tutorials or seminars to SGW. Thirty-seven students (53.6%) needed more fact to benefit fully from the SGW. Students found SGW appropriate for briefly examining these topics but wanted more fact to benefit fully from the sessions. The survey yielded valuable feedback from students on SGW as a means of addressing controversial and attitude-laden issues of central importance to the delivery of effective health care in Southern Africa.

Access to health care in Nourivier, Namaqualand.

We surveyed health in Nourivier, Namaqualand, to see whether poverty prevented people from obtaining the care they needed. We interviewed families at 65 of the 74 households, and obtained satisfactory health information from 37. Health in Nourivier is generally good; 93% of the children aged 0-5 years are fully immunized. However, 20 children in this age group (35%) were below the third percentile (weight for age, National Center for Health Statistics' standards), while the clinical condition of 4 (7%) gave cause for concern. The water supply and sanitation were satisfactory. Twenty-one individuals reported having been ill in the preceding 2 months. People treat themselves before resorting to the herbalist, the clinic nurse or the general practitioner (GP). Money for transport to the GP in Garies and antenatal care and hospital delivery has to be scraped up by the population, although the police in Kamieskroon will take people to hospital in an emergency. The mean monthly cash income in 35 households was R194 (range R0-1-035). People there would like a nurse in the village or a weekly visit by a doctor. Their tradition of self-care is a sound basis for a village-based primary health care service.

Aims and attitudes--teaching primary health care at UCT.

The objective of this study was to determine the attitude of student interns completing their exposure to primary health care (PHC) to: (i) the need for the teaching of PHC; (ii) whether or not the aims of the block had been realized in their case; (iii) the tutors as clinicians and as teachers; (iv) the structure of the exposure; and (v) the PHC emphasis they would have liked. Of a class of 188 student interns, 156 completed an attitude questionnaire (a statement is given and students indicate whether they agree, disagree, or are uncertain). It was found that 96% wanted teaching in PHC, 90% thought that they had improved their skill in assessing and managing PHC problems, 82% thought that they had improved their consultation technique, 88% thought that their tutors were competent clinically and 79% that they were competent as teachers, 61% wanted more exposure to Third World PHC, 47% wanted more exposure to Western family practice, and 41% were dissatisfied with sections of the exposure. An attitude survey can provide useful feedback from student interns on the relevance, aims, effectiveness, structure and teaching of PHC block.

The cost effectiveness of the Philani Nutrition Day Centre in Crossroads squatter camp, Cape Town.

One hundred and seventeen children aged 0-7 years who had been treated at Philani Nutrition Day Centre were sought in Crossroads squatter camp near Cape Town after discharge; 61 were traced and complete records were obtained for 42. Twenty-seven (64,2%) of the 42 were below the third percentile (weight for age, National Center for Health Statistics standards) at the time of admission to the centre and 3 (7,1%) were still below it at discharge 1-26 (mean 7,8) months later. Six (14,3%) were below the third percentile when they were traced 1-23 months (mean 10,3 months) later. Total attendances from 1982 to 1983 were estimated at 12 300 child-days. Expenditure on the centre for this period was estimated at R29 759, of which R20 282 (68,2%) was spent on salaries, R6 340 (21,3%) on food and R3 137 (10,5%) on sundries (including R2 500 on drugs). The estimated cost per child per day's attendance was R2,42. The duration of treatment was estimated to be 80 attendances for a severe and 32 attendances for a moderate case of undernutrition, giving an estimated cost of between R194 and R73 per child for complete treatment. We conclude that this expenditure: (i) benefited most of the children who were originally below the third percentile; (ii) sustained children not actually admitted to the centre by feeding them or their siblings, probably resulting in there being more food available at home; and (iii) prevented the (costly) admission to hospital of some children.