Problem-management questionnaires as a student learning tool in environmental medicine

Environmental medicine can be defined as the science and art of medicine applied to the interaction between environment and health. In support of the WHO Health for All strategy, the educational programmes encourage closer links between epidemiology, clinical practice and environmental protection, and utilize problem-based learning. For tuition, problem-management questionnaires are a worthwhile tool to assist student learning. Examples are given and a model answer for one of these is appended. Their development, use and evaluation are described. They can be readily prepared from different clinical and environmental problems, and they help to meet identified needs in community-oriented medical education.     

The AMES test in environmental and occupational medicine

The authors review the use of the gene mutation test on Salmonella typhimurium, better known as the Ames test, in environmental and occupational health. This test, which was originally intended as a predictive test of the carcinogenicity of chemical substances, has been widely applied in in vitro screening of complex mixtures of substances present in the environment and in the biological monitoring of high risk populations. Data are reported on the main environmental exposures that were positive with the Ames test and it is stressed how this biological assay has contributed to the identification of new classes of genotoxic compounds (nitropyrenes, mutagen X). The Ames test performed on extracts of human urine was used to study exposure to carcinogenic substances in the working environment. Many occupational exposures can cause an increase in mutagenic activity in the exposed subjects (cytostatic drugs, rubber manufacture, polycyclic aromatic hydrocarbons). It is recommended to restrict the use of the urinary mutagenesis test to group studies and carefully check confounding factors (e.g., smoking and diet).     

The use of orchids in Chinese medicine

In this article, the therapeutic uses of five Chinese medicines that contain orchids are discussed, together with a brief report of some of the animal experimentation undertaken. The impression that these preparations have no therapeutic use may be incorrect. However, herbal preparations have not usually been subject to the rigorous characterization and standardization necessary for clinical study, and persuading practitioners that substances in use for many centuries still need to be tested in randomized controlled clinical trials is proving a significant challenge.     

Characteristics of non-responders to diabetes service use questionnaires

Postal surveys of service use are likely to overestimate health service use and may also underestimate health needs in the population. A historical cohort study, using postal questionnaires and medical records, showed that non-respondents are registered at addresses in more-deprived wards, they are less likely to have attended a hospital diabetes clinic (38% vs 45%) and much less likely to have had a diabetes review in general practice (11% vs 26%). An analysis based on questionnaire respondents would only therefore both underestimate the level of material deprivation and overestimate the proportion receiving routine reviews in general practice in a population with a chronic condition.     

The use of exit questionnaires,a survey at 7 hospital centers

Measuring the satisfaction of hospitalised patients has been mandatory in France since 1996. The most common tool for assessing the level of satisfaction is the use of self-administered questionnaires given to the patient upon his/her release from the hospital. A survey was conducted among seven public hospitals to appraise the development and use of such questionnaires, their results and the way in which these results are taken into account in order to improve the quality of care. The survey's results illustrate that the policy with respect to their construction varies between hospitals, without any evaluation of the validity of the questionnaires produced. In most cases, the questionnaires are passively distributed to the patient at the time of discharge. The response rates are low (ranging from 4 to 18%), and the analysis of the collected questionnaires, to the extent to which it is done, is not necessarily used to improve the quality of care. An appropriate evaluation strategy, one capable of effecting change and improving hospital care, still remains to be established in the hospitals which participated in the survey.