Evaluating a service-learning assignment in a doctor of chiropractic program public health course

ObjectiveDespite the use of service learning in other health care education programs, little is published about its use in doctor of chiropractic programs. Since 2017, the public health course at our institution has included a service-learning assignment in which students volunteer for nonprofit organizations and write an essay about their experience. The objective of this study was to assess the effects of the assignment on students'' self-reported public health knowledge and attitudes.MethodsBetween April 2017 and June 2018, 56 essays were collected from students who volunteered at a nonprofit organization focused on 3 categories: youth, the environment, or poverty. Each essay was deidentified and assigned random 4-digit-number file names. Ten files were randomly selected from each of the 3 categories for qualitative thematic analysis using deductive and inductive coding.ResultsStudent essays demonstrated competency in public health concepts, including organizational systems, levels of prevention, and the social ecological model. In addition, a majority of the students went beyond discussing knowledge gained from this assignment and described the impact of their experience on their personal growth.ConclusionThis study demonstrates that students respond favorably to a service-learning assignment that addresses public health competencies and may foster personal and professional development.     

Patients' perspective of financial benefits following head and neck cancer in Merseyside and Cheshire

The aim of this interview study was to ask patients with head and neck cancer in the Mersey region about their need for financial benefits, the advice they were given about benefits and financial matters, and the financial burden of the disease. Stratified quota sampling was by employment status, whether work had been affected by the cancer, and by sex. Of 51 interviewees (mean (SD) age 61(8) years) 20 were retired, 11 were unemployed, 13 worked full-time, and 7 worked part-time. Cancer had affected the work status of 24. Since diagnosis 57% had suffered financially; this was particularly high in those who had retired (65%), and in those whose work had been affected by cancer (79%). Quality of life had decreased in 53% as a result of the financial impact of the disease. This was most common in the unemployed (64%), and in those whose work was affected by cancer (83%). Only a quarter had been given adequate help and information about finance; this was lowest in the unemployed (18%) and highest in those who were fully employed (39%). One third (17/51) had never claimed benefits. The most common benefits were Disability Living Allowance and Incapacity Benefit. Two-thirds (21/31) had applied for benefits after diagnosis, 18 of these were directly as a result of the disease. The median (IQR) weekly income from benefits was ￡88 (￡60-170). Patients and carers need better access to financial advice. We suggest that each multidisciplinary team should have a designated benefits or financial advisor who is readily available to patients in the clinic and on the ward.     

Stress and welfare: two complementary concepts that are intrinsically related to the animal's point of view

The closely associated concepts of welfare and stress may be considered as opposites since welfare cannot be achieved under stress and vice versa. Stress was first considered as an unspecific response to any challenge taxing the organism's resources where the HPA axis plays a central role [Selye H. A syndrome produced by diverse nocuous agents. Nature 1936:32]. Along the same lines, welfare was considered as the state of an individual on a continuum between poor and good depending on the efforts required to adapt to the environment [Broom DM. Animal welfare: concepts and measurement. J Anim Sci 1991;69:4167-75]. However, these views cannot explain opposite results such as up- vs. down-regulation of the HPA axis and hypo- vs. hyper-behavioural reactivity under chronic stress. Later, it was shown that aversive situations trigger stress responses only if the individual perceives them as aversive. Mason [Mason JW. A re-evaluation of the concept of 'non-specificity' in stress theory. J Psychiatr Res 1971;8:323-33] suggested that the unspecificity of stress responses originates from a common emotion that produces them. Welfare has also been defined in terms of emotional states by Dawkins [Dawkins MS. Animal suffering, the science of animal welfare. London: Chapman and Hall Ltd.; 1980] and Duncan [Duncan IJH. Welfare is to do with what animals feel. J Agric Environ Ethics 1993;6:8-14]. Hence, both concepts are linked to mental states. Recent advances in psychology suggest that the very nature of an emotion results from a series of evaluations of the triggering situation that the individual makes based on criteria including novelty, predictability, controllability, and others [Scherer KR. Appraisal considered as a process of multi-level sequential checking. In: Scherer KR, Schorr A, Johnstone T, editors. Appraisal processes in emotion: theory, methods, research. New York: Oxford University Press; 2001. p. 92-120]. It is therefore suggested that the discrepancies found in the literature in terms of responses of the HPA axis or modification of behaviour under aversive conditions may stem from differences in the way a situation is evaluated. It is argued that stress comes from the animal's evaluation of the outcome of a situation, and that welfare is the state resulting from that evaluation.     

Central nervous system complications of non-Hodgkin's lymphoma. The potential role for prophylactic therapy.

In 38 patients with non-Hodgkin's lymphoma, involvement of the central nervous system (CNS) by malignant lymphoma developed during an eight year period. All patients had lymphomatous meningitis; clinical involvement of the spinal nerves or cranial nerves suggested the diagnosis. Spinal fluid was abnormal in 97 per cent of the patients although a positive cytology could be documented in only 67 per cent by lumbar puncture. The histology in 82 per cent of the patients was diffuse. Involvement of the CNS in nodular lymphoma was uncommon (3 per cent), and the histology in virtually all of these patients had converted to diffuse. At the time of diagnosis of CNS disease, 95 per cent of the patients had other evidence of advanced disease; 66 per cent had bone marrow involvement. In only 18 per cent of the patients did CNS disease develop while they were in clinical remission. Eighty-five per cent of the patients treated with whole brain irradiation and intrathecal chemotherapy had a good clinical response. Knowledge of these risk factors permits definition of a group of patients who may benefit from CNS prophylaxis.     

Effects of Welfare Reform on Children of Adolescent Mothers: Moderation by Maternal Depression,Father Involvement,and Grandmother Involvement

SUMMARY

There are few data available on how effects of welfare reform on children may differ for different kinds of families. This study examined the constructs of maternal depression, father involvement, and grandmother involvement as moderators of the effects of a welfare reform program on children. The sample included 1,602 children between the ages of 3 and 6 ½ whose mothers had participated in New Chance, a multi-site welfare-to-work program with an emphasis on human capital development (i.e., education, job training). Father and grandmother co-residence were investigated, in addition to perceived support from these family members, in predicting cognitive and behavioral child outcomes. The mediating roles of parenting stress and emotional support in parenting were also explored. Although main effects were found for the intervention and for maternal depression, no main effects were found for the family ecology variables. However, interactions suggested complex relationships among New Chance and the family characteristics for both the full sample and for Latina families. Results are discussed in terms of policy implications and possible future research.     

Motivation for work among non-working disabled people in Norway in a life course perspective

The aim of this study is to analyze attitudes towards work among non-working disabled people and to address their motivation in a life course perspective. The background of the study is low employment rates among disabled people. One hypothesis is that a generous welfare system has disincentive effects because replacement rates of social security are too generous. Although the existing evidence is conflicting, some studies of inflow into benefits suggest that the welfare system may have such effects on people in their 50's and 60's. However these studies tend to draw general conclusions. The current article is based on a 2007 Norwegian dataset on the living conditions of disabled people (n = 1652). The findings suggest that age has a profound influence on motivation to work and is undoubtedly the most important predictor. Motivation to work among young disabled people tends to be strong but declines in later life. The substantial age effects are discussed in terms of the experience of exclusion and the availability of alternative social roles. The implication for interpretations of disincentive research is that caution must be exercised when suggesting general conclusions about disincentives based on research examining individuals who are in the final phase of a typical working career.     

Edible safety requirements and assessment standards for agricultural genetically modified organisms.

This paper describes the background, principles, concepts and methods of framing the technical regulation for edible safety requirement and assessment of agricultural genetically modified organisms (agri-GMOs) for Shenzhen Special Economic Zone in the People's Republic of China. It provides a set of systematic criteria for edible safety requirements and the assessment process for agri-GMOs. First, focusing on the degree of risk and impact of different agri-GMOs, we developed hazard grades for toxicity, allergenicity, anti-nutrition effects, and unintended effects and standards for the impact type of genetic manipulation. Second, for assessing edible safety, we developed indexes and standards for different hazard grades of recipient organisms, for the influence of types of genetic manipulation and hazard grades of agri-GMOs. To evaluate the applicability of these criteria and their congruency with other safety assessment systems for GMOs applied by related organizations all over the world, we selected some agri-GMOs (soybean, maize, potato, capsicum and yeast) as cases to put through our new assessment system, and compared our results with the previous assessments. It turned out that the result of each of the cases was congruent with the original assessment.     

The effect of technical and purified pentachlorophenol on the rat liver

Dietary concentrations of 0, 20, 100, and 500 ppm of technical grade pentachlorophenol were fed to male and female Sherman strain rats for 8 months. The same experiment using purified pentachlorophenol was carried out. The food consumption was measured in all rats during the second week of exposure and for one week every 6 weeks thereafter. An autopsy was performed on all rats at the end of the experiment. The brain, lungs, spleen, liver, kidneys, heart, and testes were weighed and examined grossly and microscopically in all rats fed purified pentachlorophenol, all female rats fed technical pentachlorophenol, and in the male rats fed the highest dose of technical pentachlorophenol and the controls. Only the kidneys and livers were examined microscopically in the male rats fed 20 and 100 ppm of technical pentachlorophenol. Although the food intake was comparable, male and female rats fed 500 ppm of technical and male rats fed 500 ppm of purified pentachlorophenol gained less weight. The livers of the male and female rats fed 500 ppm technical pentachlorophenol weighed significantly more than those of the controls. The kidneys of all male rats fed purified pentachlorophenol weighed significantly more than those of the controls; however, there was no dose-related increase. No morphological changes were seen in the kidneys. At the 500-ppm dietary concentrations, technical pentachlorophenol produced a severe effect in the liver of female rats characterized by vacuolation of the hepatocytes, an increase in fibroblasts and other mononuclear cells within sinusoids, bile duct proliferation, periportal fibrosis, degenerated liver cells, increased mitotic figures, and an accumulation of brown pigment in macrophages and in Kupffer cells. In male rats at the 100- or 500-ppm dietary concentrations of technical pentachlorophenol, the predominant lesion consisted of enlarged pleomorphic hepatocytes which had foamy cytoplasm or cytoplasm with large vacuoles. The walls of the hepatic central veins of the livers in animals of both sexes were thickened. At the 100-ppm dietary concentrations similar but less pronounced effects were observed in the livers. Only mild alterations were noted at the 20-ppm dietary concentration. Purified pentachlorophenol caused slightly enlarged liver cells with occasional eosinophilic cytoplasmic inclusions at 500 ppm but no alterations were observed in the livers of rats fed the 100- and 20-ppm dietary concentrations. The results suggest that most of the toxicity associated with feeding technical grade pentachlorophenol to rats at these dietary concentrations stems from toxic contaminants rather than from pentachlorophenol.     

Behaviour of food restricted broilers during rearing and lay--effects of an alternative feeding method

Broiler breeders are subjected to quantitative food restriction in order to control their growth, and this restriction is particularly severe during rearing. While such restriction improves some welfare problems associated with ad libitum feeding, it causes others: birds routinely show abnormal oral behaviours and have elevated plasma corticosterone concentration (PCC) and changes in white blood cell counts (WBCs). The aim of this study was to examine if feeding birds qualitatively restricted diets ad libitum during rearing could reduce signs of impaired welfare, as judged by behaviour and blood indices of stress, while also meeting commercially desired growth rates and uniformity. Furthermore, we examined what carry-over effects such a feeding method had on birds in the laying phase when all birds were fed on a conventional quantitative restriction regime. During rearing (1-20 weeks of age), pens of birds were either fed limited amounts of standard basal diets (Control, i.e. quantitative restriction), or ad libitum diets consisting of standard basal diets with gradually increasing levels of calcium propionate (CaP) and a constant level of oat hulls (OH), designated CaP + OH (i.e. qualitative restriction). Results showed that, during rearing, weights and weight uniformity were similar for the two groups. During feeding motivation tests, Control birds always consumed more food than CaP + OH birds. This suggests that Control birds were more highly motivated to feed than CaP + OH birds, although care has to be taken in interpreting these results. Treatment did not affect PCCs or WBCs, but there was a general decline in PCCs with bird age. All reported behaviours differed significantly between treatment groups during rearing, but disappeared during lay when all birds were fed a similar amount of food. Control birds spent up to 50% of time in object pecking during rearing periods, but this behaviour was virtually non-existent in birds in the qualitative feeding regime. Overall, the results indicate that broiler breeders can be successfully limited in growth rates by qualitative food restriction and this results in significant changes of behaviour that suggest improvements to bird welfare.     

Welfare reform, labor supply, and health insurance in the immigrant population

Although the 1996 welfare reform legislation limited the eligibility of immigrant households to receive assistance, many states chose to protect their immigrant populations by offering state-funded aid to these groups. I exploit these changes in eligibility rules to examine the link between the welfare cutbacks and health insurance coverage in the immigrant population. The data reveal that the cutbacks in the Medicaid program did not reduce health insurance coverage rates among targeted immigrants. The immigrants responded by increasing their labor supply, thereby raising the probability of being covered by employer-sponsored health insurance.