Paramedical Personnel and Private Practitioners

A unique program in rural medicine is demonstrating how poor people can be trained as health aides to increase the output of professionals in private practice. Benefiting solo practitioners, group practice clinics, and small community hospitals, such aides can also help break down barriers that keep the poor from seeking and receiving care.     

Manipulating meat quality and composition.

Meat quality describes the attractiveness of meat to consumers. The present paper focuses on two major aspects of meat quality, tenderness and flavour. Both aspects of quality can be influenced by nutrition, principally through its effects on the amount and type of fat in meat. In several countries, high levels of intramuscular fat (marbling fat), i.e. above 30 g/kg muscle weight in longissimus, are deemed necessary for optimum tenderness, although poor relationships between fat content and tenderness have generally been found in European studies, where fat levels are often very low, e.g. below 10 g/kg in UK pigs. Muscle lipid may be a marker for red oxidative (type 1) muscle fibres which are found at higher concentrations in tender muscles and carcasses. Nutritional treatment can be used to manipulate the fatty acid content of muscle to improve nutritional balance, i.e. increase the polyunsaturated (PUFA): saturated fatty acid value and reduce the n-6:n-3 PUFA value. Increasing PUFA levels may also change flavour because of their greater susceptibility to oxidative breakdown and the generation of abnormal volatile compounds during cooking. This situation particularly applies to the n-3 PUFA which are the most unsaturated meat lipids. In pigs, a concentration of 3 mg alpha-linolenic acid (18:3)/100 mg in muscle and fat tissue fatty acids can easily be achieved by including whole linseed in the diet. This level has led to abnormal odours and flavours in some studies, but not in others. In cattle and sheep, feeding whole linseed raised 18:3 concentrations in muscle fatty acids from about 0.7 mg/100 mg to > 1 mg/100 mg. As with pigs, this diet also increased levels of long-chain n-3 PUFA formed from 18:3, including eicosapentaenoic acid (20:5). Although this increase led to greater oxidative breakdown of lipids during storage and the generation of large quantities of lipid-derived volatile compounds during cooking, there were no deleterious effects on odour or flavour. When 18:3 levels are raised in lamb and beef because of grass feeding, the intensity of the flavours increases in comparison with grain-fed animals which consume and deposit relatively more linoleic acid (18:2). In ruminants, very high levels of 18:2 produced by feeding protected oil supplements cause the cooked beef to be described as oily, bland or pork-like.     

Academic performance of mature-age and other students in a physiotherapy program

Students enrolled in the physiotherapy undergraduate program of the University of Sydney comprise school leavers (students who have completed secondary school-category A) and non-school leavers (category B), including mature-age students (23 years and older). Student selection is based upon academic performance (categories A and B) and personal interview (category B only). Statistical evaluations of the academic performance of 799 students who commenced the undergraduate course between 1982 and 1986 revealed a) no significant difference between the time taken to complete the undergraduate program; b) in 26 of 31 compulsory subjects, category A and category B students performed equally well; in one subject category, B students performed significantly better; in three subjects, the mature-age students performed significantly better; and only in one subject did mature-age students perform less well; c) no difference in the academic performance of male and female students; d) the Higher School Certificate aggregate provided a poor to moderate indicator of academic performance. The results justify both the reservation of places offered to nonschool leavers and the system used for their selection.     

Crucial questions for physiotherapy in Finland.

When planning for health services, questions of production and distribution as well as cost and quality are key issues for health planners and decision makers. The lack of available objective data often makes this work difficult. This paper presents recent efforts in Finland to improve the collection of information needed for planning in the field of physiotherapy.     

Views of survivors of stroke on benefits of physiotherapy.

OBJECTIVE--To describe the components of physiotherapy valued by survivors of a stroke. DESIGN--Qualitative study using in-depth interviews. SETTING--Two adjacent districts in North East Thames Regional Health Authority. PATIENTS--82 survivors of stroke taken consecutively from a stroke register when they reached the tenth month after their stroke, 40 of whom agreed to be interviewed. MAIN MEASURES--Content analysis of interviews. RESULTS--Patients who agreed to the interview were significantly less likely to be disabled 12 months after stroke than those who did not. Twenty four patients had received physiotherapy, and these were more disabled than those who had not. Patients appreciated physiotherapy. It was believed to bring about functional improvement; the exercise component was valued because it was perceived to keep them active and busy and exercise programmes to follow at home were also valued for the structure they gave to each day; and therapists were considered a source of advice and information and a source of faith and hope. CONCLUSIONS--Many of the positive aspects of caring which patients described in the context of physiotherapy could be incorporated into the mainstream of rehabilitation care and training. However, health professionals need to be careful not to promote false expectations about recovery. IMPLICATIONS--The outcome of treatment is of critical importance to patients and should become a central dimension of patient satisfaction questionnaires. The impact of physiotherapy is not confined to reducing physical disability but may also affect wellbeing. The choice of outcome measures in rehabilitation research should reflect this situation.     

配子/胚胎操作和管理的安全性

辅助生殖技术（ART）的特点是通过对配子、胚胎的体外操作获得受精卵和早期胚胎,并将胚胎移植入子宫,以解决不孕不育夫妇的生育问题,对配子/胚胎操作和管理的安全性问题显得尤为重要。从配子的获取至胚胎的体外培养、冷冻保存和胚胎移植,是多步骤、多操作的工作流程,潜在着巨大的误差风险,牵涉到社会伦理问题,因此需建立明确的操作流程和管理制度将潜在风险最小化。初步探讨如何提高在辅助生殖技术流程中对配子/胚胎操作和管理的安全性,以最大程度地保证患者的利益,并使中国辅助生殖技术能够在符合社会伦理道德范畴内获得长足发展。     

配子/胚胎操作和管理的安全性

辅助生殖技术（ART）的特点是通过对配子、胚胎的体外操作获得受精卵和早期胚胎,并将胚胎移植入子宫,以解决不孕不育夫妇的生育问题,对配子/胚胎操作和管理的安全性问题显得尤为重要。从配子的获取至胚胎的体外培养、冷冻保存和胚胎移植,是多步骤、多操作的工作流程,潜在着巨大的误差风险,牵涉到社会伦理问题,因此需建立明确的操作流程和管理制度将潜在风险最小化。初步探讨如何提高在辅助生殖技术流程中对配子/胚胎操作和管理的安全性,以最大程度地保证患者的利益,并使中国辅助生殖技术能够在符合社会伦理道德范畴内获得长足发展。