The academic environment: the students' perspective.

Dental education is regarded as a complex, demanding and often stressful pedagogical procedure. Undergraduates, while enrolled in programmes of 4-6 years duration, are required to attain a unique and diverse collection of competences. Despite the major differences in educational systems, philosophies, methods and resources available worldwide, dental students' views regarding their education appear to be relatively convergent. This paper summarizes dental students' standpoint of their studies, showcases their experiences in different educational settings and discusses the characteristics of a positive academic environment. It is a consensus opinion that the 'students' perspective' should be taken into consideration in all discussions and decisions regarding dental education. Moreover, it is suggested that the set of recommendations proposed can improve students' quality of life and well-being, enhance their total educational experience and positively influence their future careers as oral health physicians. The 'ideal' academic environment may be defined as one that best prepares students for their future professional life and contributes towards their personal development, psychosomatic and social well-being. A number of diverse factors significantly influence the way students perceive and experience their education. These range from 'class size', 'leisure time' and 'assessment procedures' to 'relations with peers and faculty', 'ethical climate' and 'extra-curricular opportunities'. Research has revealed that stress symptoms, including psychological and psychosomatic manifestations, are prevalent among dental students. Apparently some stressors are inherent in dental studies. Nevertheless, suggested strategies and preventive interventions can reduce or eliminate many sources of stress and appropriate support services should be readily available. A key point for the Working Group has been the discrimination between 'teaching' and 'learning'. It is suggested that the educational content should be made available to students through a variety of methods, because individual learning styles and preferences vary considerably. Regardless of the educational philosophy adopted, students should be placed at the centre of the process. Moreover, it is critical that they are encouraged to take responsibility for their own learning. Other improvements suggested include increased formative assessment and self-assessment opportunities, reflective portfolios, collaborative learning, familiarization with and increased implementation of information and communication technology applications, early clinical exposure, greater emphasis on qualitative criteria in clinical education, community placements, and other extracurricular experiences such as international exchanges and awareness of minority and global health issues. The establishment of a global network in dental education is firmly supported but to be effective it will need active student representation and involvement.

Dietary practices of adolescents in Singapore and Malaysia.

INTRODUCTION: This study sets out to investigate any differences in dietary practices between adolescents in Singapore and Malaysia. METHODS: An adolescent dietary practices survey was conducted in Singapore and Malaysia involving 200 adolescents (100 from each country) aged 11 to 21 years in order to have a better understanding of the adolescents' dietary practices. Dietary practices were assessed by a self-administered dietary practices questionnaire (DPQ). RESULTS: The major differences identified between adolescents' dietary practices in Singapore and Malaysia are related to alcohol consumption and venue for taking of lunch. More Malaysian adolescents have their lunch prepared at home (32.9 percent), compared with 7.2 percent of Singaporean adolescents. More adolescents in Malaysia drink alcohol (49.4 percent), compared with only 21.7 percent of Singaporean adolescents. CONCLUSION: From the dietary practices survey of adolescents from Singapore and Malaysia, it may be concluded that while general dietary practices are similar, the major differences identified were significantly (p-value is less than 0.05) higher alcohol consumption by Malaysian adolescents and significantly (p-value is less than 0.05) more Malaysians took their lunch at home compared with Singaporeans. The reasons for the differences are discussed in the paper.

Dietary zinc intake of a group of long-stay mentally handicapped women: some bioavailability considerations.

Dietary factors affecting zinc bioavailability were evaluated according to their relative distribution in the individual daily meals making up the basic diet of 17 institutionalized, mentally handicapped adult women. Mean intake values of zinc, phytate, nonstarch polysaccharides (NSP), calcium, protein, and energy were calculated from a dietary survey of 7 consecutive days, which also served to obtain values for the two zinc bioavailability predictor formulas, phytate/Zn millimolar ratio and [Ca][phytate]/[Zn][energy] ratio. Mean daily zinc intake was 8.5 +/- 1.8 mg, with noon and evening meals accounting for the highest contribution to this value (45% and 35%, respectively), whereas breakfast meals' contribution was 16%. The mean protein intake was 55 +/- 13 g, with noon and evening meals being the major contributors to total daily intake (42% and 38%, respectively). Breakfast meals accounted for 77% of daily phytate intake, giving a respective phytate/Zn millimolar ratio of 20.4 +/- 7.6 and a [Ca][phytate]/[Zn][energy] ratio of 336 +/- 127 mmol/Mcal. Values for both ratios based on noon and evening meals were negligible in comparison. The mean daily NSP intake was 9.8 +/- 4.2 g, with 53% of total daily intake supplied from breakfast meals, whereas noon and evening meals accounted for 30% and 14%, respectively. The results, while suggesting that zinc bioavailability is unlikely to be adversely affected, indicated that dietary fiber intake levels are probably inadequate, particularly in view of the nonambulant condition and low physical activity prevalent in such individuals, who may, as a consequence, be susceptible to health disorders associated with impaired bowel function and constipation.

Iron status in a group of long-stay mentally handicapped menstruating women: some dietary considerations.

As part of a longitudinal study aimed at assessing the dietary intakes and nutritional status of a group of long-stay mentally handicapped subjects, 15 women of menstruating age were considered for a substudy to assess the influence of intake levels of dietary iron, energy, tea, coffee and vitamin C on their iron status. The assessment comprised a week-long weighed dietary survey and the measurement of a number of haematological indices that included serum ferritin concentration. Information on duration of menses was also collected and included in the assessment. Two-fifths of the subjects assessed had a serum ferritin concentration less than 12 micrograms/l indicating iron deficiency, including one who was considered anaemic as suggested by a haemoglobin level less than 12 g/dl. Duration of menses showed a negative significant correlation with serum ferritin concentration. The mean iron intake in the group was 9.5 +/- 1.5 mg/day. Energy intakes were low and positively correlated with iron intake. Although serum ferritin showed no correlation with iron intake, it showed significant negative correlations with the daily and meal-time intakes of tea and a significant positive correlation with the meal-time intakes of vitamin C. The six iron-depleted subjects were assessed as a separate group (Group I) in comparison with the other nine subjects who had a serum ferritin concentration greater than 12 micrograms/l. The results of this assessment showed that, while there were no significant differences in duration of menses or the mean daily intakes of iron and energy between the two groups. Group I subjects had significantly higher daily and meal-time intakes of tea and significantly lower meal-time intakes of vitamin C compared to Group II subjects. The study provides some evidence suggestive of an association between the iron deficiency states observed and tea intake in adversely affecting iron status, particularly in the absence of adequate meal-time intakes of vitamin C. The findings from the study also suggest that long-stay mentally handicapped women of menstruating age, in addition to their handicap and dependency states which may often predispose them to a low dietary intake, are at particular risk of iron deficiency.

Trace metal abnormalities in long-stay hyperactive mentally handicapped children and agitated senile dements.

Gross metal poisoning as a causative factor in mental handicap is now relatively rare although historically it was important. Currently attention is being focused on the importance of chronic metal poisoning, there being much debate on, for instance, the possible effects of low levels of lead on intelligence in childhood. This paper examines the levels of a number of metals, both toxic and essential, in two groups of agitated patients in a long-stay psychiatric hospital in the UK. The two groups examined comprise 'hyperactive' mentally handicapped children and senile dementia patients, all of whom showed moderate to severe agitation. Blood and hair tissue were used to assess the body status of a number of metals and the results were compared with controls matched as closely as possible and from a similar hospital environment. The most significant findings are the raised levels of aluminium in the agitated senile dementia patients and the low levels of zinc and raised levels of lead in the hyperactive children.

Trace elements in hair in the UK: results and interpretation in the preconception situation.

The paper examines the high incidence of birth defects that still occur in the UK and suggests that it might be possible to reduce this by preparing prospective mothers for parenthood prior to conception. One test in particular is suggested as having a part to play in this preconception screening-that being the hair metals analysis. Such a screening test is useful in identifying both excesses of toxic metals and deficiencies of essential metals. The results from our studies seem to indicate a high proportion of potential mothers as having low levels of manganese, iron and possibly zinc in their hair. The significance of these findings is discussed in relation to the possible effect on birth defects and the possible routine use of hair metal testing in the pre-conception situation is suggested.

A pilot study on the metal levels in the hair of hyperactive children.

The concentration of a number of metals has been determined in the hair of sixty eight children who have been described as 'hyperactive'. These are compared with a control group. The most important findings would appear to be a raised level of manganese and a reduced level of zinc in the hyperactive children. The possible significance of this is discussed. A high manganese level in learning disabled children has also recently been reported and may be of direct relevance to the present study.

Hair trace metal levels in Down syndrome patients.

The concentration of a range of metals has been determined in the hair of a population of Down syndrome patients. These results are compared with a control group and the findings discussed. There does seem to be an abnormally low level of manganese, calcium and possibly copper in the DS patients. To date, the significance of these findings is not known but it is suggested that the results are worthy of further investigation.