Effect of variations in sequencing of clinical tutorials

The sequence in which different specialties are presented to medical students may influence their impact. However, the subject has been rarely examined. In the present study a variety of educational outcomes were evaluated for a second-year medical school class. They followed a series of eight clinical tutorials but did so in four different sequences. The outcomes assessed were: (1) student achievement during their tutorial year and in several major clinical courses taken in the third medical school year; (2) student perceptions of the tutorial experiences and the impact of the tutorials on subsequent clinical training; and (3) student choices of clinical courses and programmes in their third and fourth years.
The results indicated that the sequence of the eight tutorials had no adverse effect upon the educational outcomes examined.     

Development and exploratory trials of a cognitive preference inventory for medical students

A medical cognitive preference inventory was developed and tested with two samples, one in Israel and the other in the United States. Acceptable levels of internal consistency of the whole test and of its three subtests were demonstrated. Direct and indirect evidence for the validity of the test was provided. The potential uses of the test for student selection and evaluation as well as for programme evaluation were discussed. Two forms, E and F, each consisting of eighteen items, are recommended for use with medical students. A combination of these two forms is designed as form G. Administration of one form to half of a sample and the other form to the other half, followed by pooling the individual scores, thereby obtaining results comparable to those of form G, is recommended when time to administer the inventory is limited.     

Predictors of the use of dental services by older veterans

By the year 2000, it is likely that more than 66% of all US males will be veterans as a result of the large World War II cohort. This growing population of older veterans will have a major influence on the use of dental services at Veterans Administration facilities. The objectives of the project reported here were to identify and examine factors that explain use of dental services by noninstitutionalized veterans older than 55 years; this was a secondary analysis of a VA commissioned survey of 3,013 community-based veterans older than 55 years.
A behavioral model developed by Anderson and Aday that identified predisposing, enabling, and need factors that determined use of health care services was adopted to analyze the data. A linear regression analysis showed that need factors accounted for the greatest degree of explained variance in use of dental services (R²= .15), whereas enabling factors accounted for the least degree of variance (R²= .02). Perception of dental problems, positive perception of physical health, perception of ability to meet expenses, and levels of education and income were significant predictors of use of dental services.
The findings of this study show the use of dental services by noninstitutionalized veterans and other noninstitutionalized older populations is influenced by similar factors. The findings can be useful in discussing and formulating dental health care policy for older veterans.     

Persistent nausea and food aversions in pregnancy

In a retrospective study the mothers of twenty-one children with well-defined cow's milk allergy and an equal number of matched controls were asked about their health and diet in pregnancy and the pattern of feeding of their children in infancy. Corroborative evidence was obtained from the medical notes. Nausea in pregnancy was found to be more persistent and atopic disease more common among the mothers of the milk allergic children; in this group food aversions during pregnancy were also more common particularly to dairy produce. The milk-allergic infants had been breast-fed for longer and had cow's milk introduced into feeds later than the control group. It is suggested that nausea in pregnancy may be a physiological response to foetal sensitization by dietary antigens such as cow's milk protein, due to impaired placental permeability in atopic pregnant women. A larger prospective study is indicated to substantiate this hypothesis.     

HYDATID PULMONARY EMBOLISM1

The clinical features and autopsy findings of a case of ruptured hydatid cyst of the liver, with recurrent pulmonary embolism and terminal anaphylaxis, are described.