Impact of subspecialty elective exposures on outcomes on the American board of internal medicine certification examination

Background

There is increasing interest in online collaborative learning tools in health education, to reduce costs, and to offer alternative communication opportunities. Patients and students often have extensive experience of using the Internet for health information and support, and many health organisations are increasingly trying out online tools, while many healthcare professionals are unused to, and have reservations about, online interaction.

Methods

We ran three week-long collaborative learning courses, in which 19 mental health professionals (MHPs) and 12 mental health service users (MHSUs) participated. Data were analysed using a discursive approach to consider the ways in which participants interacted, and how this contributed to the goal of online learning about using Internet technologies for mental health practice.

Results

MHSUs and MHPs were able to discuss issues together, listening to the views of the other stakeholders. Discussions on synchronous format encouraged participation by service users while the MHPs showed a preference for an asynchronous format with longer, reasoned postings. Although participants regularly drew on their MHP or MHSU status in discussions, and participants typically drew on either a medical expert discourse or a "lived experience" discourse, there was a blurred boundary as participants shifted between these positions.

Conclusions

The anonymous format was successful in that it produced a "co-constructed asymmetry" which permitted the MHPs and MHSUs to discuss issues online, listening to the views of other stakeholders. Although anonymity was essential for this course to 'work' at all, the recourse to expert or lay discourses demonstrates that it did not eliminate the hierarchies between teacher and learner, or MHP and MHSU. The mix of synchronous and asynchronous formats helped MHSUs to contribute. Moderators might best facilitate service user experience by responding within an experiential discourse rather than an academic one.     

Can preschool improve child health outcomes? A systematic review

Early childhood development interventions (ECDIs) have the potential to bring about wide ranging human capital benefits for children through to adulthood. Less is known, however, about the potential for such interventions to improve population health. The aim of this study was to examine the evidence for child health effects of centre-based preschool intervention programs for healthy 4 year olds, beyond the preschool years. Medline, Embase, ERIC, Psych Info, Sociological Abstracts, the Cochrane Library, C2-SPECTR and the Head Start database were searched using terms relating to preschool and health from 1980 to July 2008, limited to English language publications. Reference lists and the journal Child Development were hand searched for eligible articles missed by the electronic search. There were 37 eligible studies identified. The reviewed studies examined a range of interventions from centre-based preschool alone, to interventions also including parenting programs and/or health services. The study populations were mostly sampled from populations at risk of school failure (76%). Only eight of the 37 studies had a strong methodological rating, 15 were evaluated as at moderate potential risk of bias and 14 as at high potential risk of bias. The review found generally null effects of preschool interventions across a range of health outcomes, however there was some evidence for obesity reduction, greater social competence, improved mental health and crime prevention. We conclude that the great potential for early childhood interventions to improve population health across a range of health outcomes, as anticipated by policy makers worldwide, currently rests on a rather flimsy evidence base. Given the potential and the increasingly large public investment in these interventions, it is imperative that population health researchers, practitioners and policy makers worldwide collaborate to advance this research agenda.     

Enhanced susceptibility to arterial thrombosis in a murine model of hyperhomocysteinemia

Hyperhomocysteinemia is a risk factor for thrombosis, but the mechanisms are not well defined. We tested the hypothesis that hyperhomocysteinemia accelerates arterial thrombosis in mice. Mice heterozygous for a targeted disruption of the cystathionine beta-synthase gene (Cbs+/-) and wild-type littermates (Cbs+/+) were fed either a control diet or a high methionine/low folate (HM/LF) diet for 6 to 8 months to produce graded hyperhomocysteinemia. The time to occlusion of the carotid artery after photochemical injury was shortened by more than 50% in Cbs+/+ or Cbs+/- mice fed the HM/LF diet (P < .001 versus control diet). Carotid artery thrombosis was not accelerated in mice deficient in endothelial nitric oxide synthase (Nos3), which suggests that decreased endothelium-derived nitric oxide is not a sufficient mechanism for enhancement of thrombosis. Cbs+/+ and Cbs+/- mice fed the HM/LF diet had elevated levels of reactive oxygen species in the carotid artery, increased aortic expression of the NADPH oxidase catalytic subunit, Nox4, and decreased activation of anticoagulant protein C in the aorta (P < .05 versus control diet). We conclude that hyperhomocysteinemia enhances susceptibility to arterial thrombosis through a mechanism that is not caused by loss of endothelium-derived nitric oxide but may involve oxidative stress and impairment of the protein C anticoagulant pathway.     

Benefits of modest weight or waist circumference loss in a remote North Queensland Indigenous population

Objective : To quantify the potential benefit to individuals of differing magnitudes of weight or waist circumference loss in an Indigenous population. Method : Data were from the Well Person's Health Check, a cohort study in 19 rural Indigenous communities in Far North Queensland. Baseline data were collected between 1998 and 2000 from 2,583 people aged 15 to 75, an estimated participation rate of 44.5%. Follow‐up data were collected between 2004 and 2007 from 729 participants. Associations between change in weight and waist circumference for those who were overweight or obese (n=486) with changes in serum lipids, fasting glucose, blood pressure and Gamma‐Glutamyltransferase (GGT) were estimated using linear regression. Results : Weight or waist circumference loss was associated in a dose response fashion with blood pressure reduction (e.g. 10% or greater weight loss compared with no weight loss was associated with reduction of 11.3 mmHg systolic (95% confidence interval ?17.8, ?4.8). Those with greater waist circumference loss had a greater reduction in GGT (?8.3, 95% confidence interval ?23.5, 6.8) but there was no apparent increase in GGT reduction with increasing weight loss, although these were measured with low precision. There was no apparent effect of either weight or waist circumference loss on serum lipids and fasting glucose in this population. Conclusions : This study shows potentially large beneficial effects of weight or waist circumference loss over several years in a remote living Indigenous cohort. The associations were large enough to be of clinical benefit, despite weight loss being modest for most.     

Factors Influencing Colorectal Cancer Screening in Low-Income African Americans in Tennessee

This study examined demographic and lifestyle factors that influenced decisions and obstacles to being screened for colorectal cancer in low-income African Americans in three urban Tennessee cities. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African Americans 50 years and older (n = 460) were selected from the Meharry CNP community survey database. There were several predictors of colorectal cancer screening such as being married and having health insurance (P < .05). Additionally, there were associations between obstacles to screening and geographic region such as transportation and health insurance (P < .05). Educational interventions aimed at improving colorectal cancer knowledge and screening rates should incorporate information about obstacles and predictors to screening.     

Recurrent gonorrhoea in South Australia, 1987-2003

In Australia, it is unclear if individuals are being recurrently infected with gonorrhoea, a proxy for identifying core groups. We reviewed all notified gonococcal (GC) infections in South Australia between 1987 and 2003. A case of repeated GC infection is one in which at least one further episode of GC infection occurred after 30 days and within 365 days of the first infection. There were 253 recurrent infections (7.26%) from 238 individuals. Men who have sex with men (MSM) and Aboriginal and Torres Strait Islanders (ATSI) were significantly more likely to be recurrently infected with gonorrhoea than the rest of the South Australian population. This method of identifying individuals who have recurrent gonococcal infections can be used to target more frequent screening for individuals in a population who are more likely to be a part of the core group.