How much vitamin B6 is toxic?

Vitamin B6 (pyridoxine) causes neuropathy at intakes of 1000 mg per day or more, which is about 800 times the daily intake from foods. There have also been occasional reports of toxicity at intakes of 100-300 mg per day. The US authorities set the no-observed-adverse-effect-level at 200 mg per day and the safe upper limit at 100 mg per day. A report of neurotoxicity in 2 patients who had taken 24 mg and 40 mg of vitamin B6 per day respectively, may be coincidence rather than a true toxic effect of such relatively low doses. However, physicians need to remain alert to high intakes of vitamin B6 as a cause of unexplained neuropathy.     

How much uncompensated care do doctors provide?

The magnitude of provider uncompensated care has become an important public policy issue. Yet existing measures of uncompensated care are flawed because they compare uninsured payments to list prices, not to the prices actually paid by the insured. We address this issue using a novel source of data from a vendor that processes financial data for almost 4000 physicians. We measure uncompensated care as the net amount that physicians lose by lower payments from the uninsured than from the insured. Our best estimate is that physicians provide negative uncompensated care to the uninsured, earning more on uninsured patients than on insured patients with comparable treatments. Even our most conservative estimates suggest that uncompensated care amounts to only 0.8% of revenues, or at most $3.2 billion nationally. These results highlight the important distinction between charges and payments, and point to the need for a re-definition of uncompensated care in the health sector going forward.     

How much of the paediatric core curriculum do medical students remember?

Few educational studies have investigated how well information learned by medical students is retained over time. The primary aim of this study was to investigate how much of the paediatric core curriculum undergraduates remembered a year after originally passing their paediatrics examination. In addition, we looked at whether students’ repeat performance is related to their approach to learning. Medical students were presented with 8 out of a possible 46 core curriculum short answer questions (Mark 1). A year later these same students were re-tested, without prior warning, on the same 8 questions (Mark 2) and a further 8 questions (Mark 3) from the bank of 46. The participants also completed the Revised two-factor Study Process Questionnaire to characterise their approach to learning. After a year, students scores had diminished by 51.2 % (95 % CI 48.2–54.2 %, p < 0.0001) from a Mark 1 average of 89.1 % (standard deviation, SD = 9.2 %) to a Mark 2 average of 37.9 % (SD 6.1 %). Students who reported a superficial approach to learning achieved higher scores for mark 1 (4.1 % increase (95 % CI 0.9–7.4 %) per one standard deviation unit increase in Surface Approach score (p = 0.01)). Neither deep nor surface approach to learning significantly predicted performance a year later (Marks 2 and 3). Students had forgotten more than half of the paediatric core curricular content that they had previously proven that they knew for their summative assessment. Adopting either a deep or superficial approach to learning did not predict ability to retain this information a year later.     

How much do they need to be the same? What parents believe about continuity between home and childcare environments

This study explores the associations among parental education, weekly work hours, child behaviours, and parental daily hassles and parents desires for continuity between home and childcare. Data were collected using questionnaires from 82 parents with a child attending centre-based childcare in the Midwestern US. Results indicate that parent education and work hours are directly and indirectly related to the desire of continuity of practice between home and childcare programme and parental daily hassles. Path analysis results show higher parental education decreases parents desire for continuity of practices, while more weekly work hours increases parents desire for continuity of practices. Additional findings related to education, parental daily hassles and child behaviours are reported. Future research should investigate the perceptions of parents and the fit between the offerings of the centre and parental expectations for both familial and child adjustment.     

The health status of the elderly population: what do we need to know?

The objective of this research was to evaluate the data on the health of the elderly population available in the Brazilian information system and their correspondence with the North American statistics using the Internet. The North American publication "Older Americans 2000: Key Indicators of Well-Being" was used as a standard. The databases and instruments used in the North American and Brazilian surveys are presented. The North American data are based on the Supplement on Aging and Second Supplement on Aging; Health and Retirement Study; National Health Interview Survey and National Long Term Care Survey. The Brazilian data were collected from the Mortality Information System; Information System of the National Program of Immunizations; National Household Sample Survey conducted in 1998 and 2003 and from the Household Survey on Risk Behavior and Morbidity from Not Transmissible Diseases of 2002-2003. There is a great number of Brazilian information about the aged population of the Country available in the Internet and with few exceptions the information on aged Brazilians corresponds to the information available about aged North Americans.     

How much do medical students know about infection control?

Changes in undergraduate medical training mean that students have direct patient contact from an early stage of their training. This study aimed to assess the knowledge of third-year medical students at the University of Birmingham Medical School, UK on infection control policy and procedures. A semi-structured questionnaire was distributed to medical students. Out of 322 students, 156 returned completed questionnaires (48%). Results showed that 58% of medical students did not know the correct indications for using alcoholic hand gel, 35% did not know the correct use of gloves, and 50% did not know the exclusion period after an episode of diarrhoea and vomiting. Sixty-four percent of medical students reported formal teaching on hand hygiene, 12% reported informal teaching, 19% reported both types of teaching and 5% reported no hand hygiene teaching at all. Forty-nine percent of medical students thought that there was insufficient emphasis on infection control in their course. These results raised concerns about medical students' knowledge about infection control. The University is currently reviewing the need for a more structured model for the teaching and assessment of infection control.     

How much protein do parenteral amino acid mixtures provide?

It is commonly assumed that the weight of the amino acids in a parenteral amino acid mixture equals the amount of protein they provide. This assumption ignores the fact that the molecular weight of free amino acids is 18 mass units greater than when they are protein bound. The actual amount of protein substrate provided by commonly used free amino acid mixtures was determined by analyzing the amino acid composition of 3 commonly used parenteral amino acid solutions and the proteins that would be formed from them, and comparing the results with similar data from 3 nutritionally important proteins. After correction for hydration status, the ratio of essential amino acid mass to total mass of the amino acid mixtures was similar to albumin, myosin, and actin. However, all of the amino acid mixtures provided 17% less protein and energy than is now widely assumed. Current parenteral nutrition guidelines recommend 0.8-1.5 g mixed amino acids/kg normal weight per day, on the assumption that they are equivalent to formed proteins, but they are not equivalent. Clinicians who aim to provide 0.8-1.5 g protein/kg must administer 1.0-1.8 g mixed amino acids/kg.     

How much do Nepalese mothers know about child development?

Parental knowledge on child development is important for maximal developmental potential. This study was conducted to assess mothers’ knowledge on child development in Nepal. The Caregivers Knowledge of Child Development Inventory (CKCDI) was used to interview mothers. Total of 1272 mothers were interviewed. Out of the total CKCDI score of 40, mean score (SD) obtained by mothers was 20 (4.8). Mothers’ knowledge on the developmental milestone composite was better than stimulation composite with scores of 11.14 (3.09) and 8.9 (3.17), respectively (p?<?.005). Few mothers (38%) identified the correct ages of developmental milestones. Although most of the mothers knew about teaching their children to count or name colors, few knew when to start to read with children. With low level of knowledge on child development among Nepalese mothers, early childhood development programmes should be considered integrated with other health care programmes targeting young children and families.     

How much do doctors know about consent and capacity?

To assess knowledge of capacity issues across different medical specialties we conducted a cross-sectional survey with a structured questionnaire at academic meetings, lectures and conferences. Of 190 individuals who received the questionnaire 129 (68%) responded-35 general practitioners, 31 psychiatrists, 29 old-age physicians [corrected] and 34 final year medical students. Correct answers on capacity to consent to or refuse medical treatment were given by 58% of the psychiatrists, 34% of the geriatricians, 20% of the general practitioners and 15% of the students. 15% of all respondents wrongly believed that a competent adult could lawfully be treated against his or her will, with no obvious differences by specialty. As judged by this survey, issues of capacity and consent deserve more attention in both undergraduate and postgraduate medical education.     

How much do condoms protect against sexually transmitted diseases?

The UN 1994 International Conference on Population and Development has encouraged the provision of services for syndromic treatment for clients with symptoms or signs of infection, laboratory screening and sexually transmitted disease (STD) risk assessment to guide contraceptive counseling. This proposal was raised in the light of the growing HIV and STD global concern and the use of contraceptive methods for STD prevention. Despite recommendations on using barrier methods for STD/HIV prevention, many family planning providers hesitate about endorsing barrier methods because of lesser efficacy in preventing unintended pregnancies. However, several studies have demonstrated the effectiveness of male and female condoms when used consistently and correctly. In addition, accumulated data on condom use and HIV infection revealed that consistent use of male condoms protect against HIV acquisition (protection ranging from 50% to 100%). These findings underscore the effectiveness of condoms in preventing STD/HIV when used consistently and correctly and should be encouraged at every opportunity.