Teaching public health to medical students in the United Kingdom--are the General Medical Council's recommendations being implemented?

BACKGROUND: Despite frequent calls to improve undergraduate medical public health teaching, little is known about whether curricula have changed. We report a survey of undergraduate public health teaching in UK medical schools in 1996. The survey aimed to assess whether the General Medical Council's 1993 recommendations to strengthen undergraduate medical education in public health have been implemented. METHODS: We asked heads of academic departments of public health at all 26 UK medical schools to complete a questionnaire and provide supporting documentation for each undergraduate public health course or module. We compared results from the 1996 survey with those from a similar survey in 1992. RESULTS: Twenty-one out of 26 (81 per cent) medical schools responded. All responding medical schools included public health teaching within their curriculum. The median number of public health courses per medical school was unchanged since 1992. A wide variety of topics were taught. Core public health subjects were taught at most schools, though over a quarter of medical schools did not cover some core topics. Between 1992 and 1996 the proportion of time devoted to teaching by lectures decreased, whereas the following all increased: teaching by small group methods; the proportion of courses using methods of assessment encouraging active learning; and the contribution of public health courses to the final degree assessment. CONCLUSION: The findings suggest that many of the General Medical Council's recommendations for improving the delivery of undergraduate education are being addressed by public health teaching in UK medical schools. However, addressing the gaps in undergraduate public health teaching revealed in this survey is a continuing challenge for academic public health departments. Medical schools should review the content of their undergraduate public health teaching to ensure that tomorrow's doctors are adequately equipped with public health knowledge and skills.     

General practitioners' use of computers during the consultation.

This study documents the extent of reported computer use by general practitioners (GPs) in consultations with patients, and identifies barriers to their use. There was a 65% response rate from a random sample of 600 GPs in the South and West National Health Service (NHS) region who were sent a questionnaire. Ninety-one per cent (357) had a desktop computer terminal in their consulting rooms. Of these, 98% used the computer to look up information or prescribe medication, 75% entered details about selected problems presented by patients, and 36% entered information about the patient's presenting problem at every consultation. Only 18% used computers to access reference information. Use of the computer for anything other than looking up patient information or prescribing was positively associated with fundholding status and use of a personal computer at home, and was independent of number of years in practice. Sixty-five per cent of responders had positive attitudes to the inclusion of management guidelines on the computer software, and 45% of responders held positive views towards the idea of integrating management guidelines with the patient's personal computerized medical record. Consideration should be given to targeting training at those GPs who appear to be reluctant to use computers during the consultation.     

Beer is the cattle of women: Sorghum beer commercialization and dietary intake of agropastoral families in Karamoja,Uganda

Karimojong agropastoralists of Uganda have employed a dual subsistence strategy of cattle herding and sorghum cultivation to survive in an unpredictable environment, one afflicted by a severe humanitarian crisis. Armed raiding since the 1970s has led to devastating cattle losses, high male mortality, and increased sedentarization of women and children in densely populated homesteads, where infectious diseases and malnutrition rates are prevalent. Fieldwork in 1998–1999 confirmed the detrimental effects of armed raiding on child growth and development. During this period, however, women maintained largely traditional subsistence patterns. Follow-up fieldwork in 2004 revealed surprising subsistence changes: sorghum beer, an important food and ritual item, was being brewed for sale, which had not been noted in previous literature on the Karimojong. We outline the role of beer in the diet by analyzing the nutritional profile of Karimojong women and children, nutrients supplied by beer, and those supplied by foodstuffs purchased with sales profits. Commercial beer supplied from 3 to 6% of energy intake, and grains leftover from brewing (dregs) supplied from 3 to 12%. Selling beer was women's preferred form of casual labor, with differing patterns of participation in brewing between rural and peri-urban areas. Women who were paid in currency relied on profits to purchase nutrient-rich supplemental foodstuffs important in an otherwise marginal diet, as well as beer. The households of women who worked for other brewers or purchased beer wholesale and sold it retail relied heavily on dregs for daily subsistence. Nutrient intake was highest among women with cattle and sorghum who brewed and sold beer from their homesteads, and lowest among women who lacked sorghum and worked for commercial brewers in urban centers. Because nutritional status remains marginal in Karamoja, beer commercialization as a consequence of subsistence changes could have dramatic health consequences for women and children.     

Ifenprodil and SL 82.0715 potently inhibit binding of [3H](+)-3-PPP to sigma binding sites in rat brain

SL 82.0715 and ifenprodil are potent anti-ischemic agents, which are believed to be due to non-competitive antagonism of N-methyl-D-aspartate (NMDA). It has been proposed that SL 82.0715 and ifenprodil non-competitively antagonize the actions of NMDA by interacting as antagonists with a polyamine site associated with the NMDA/phencyclidine (PCP)/glycine complex. The present study demonstrates that the actions of SL 82.0715 and ifenprodil may also be due in part to an interaction with sigma binding sites, a property that is not shared with polyamines.     

An epidemic of Oroya fever in the Peruvian Andes

Between February and October 1987, a febrile illness killed 14 persons and seriously affected at least 14 others in Shumpillan, a remote Peruvian mountain village of 353 people. The illness was characterized by fever, headache, chills, and pallor. The fatality rate of untreated cases was 88%. The patients, 71% of whom were male, were 1-75 years of age. Fatal illnesses progressed from lethargy to coma to death in 3-60 days. Patients treated empirically with chloramphenicol survived. Bartonella bacilliformis was isolated from the whole blood of 3 patients. A serologic study revealed a high prevalence of antibodies to B. bacilliformis in the villagers. It is concluded that the villagers suffered from an epidemic of Oroya fever.     

Endotoxin-induced impairment of vascular reactivity in the pithed rat: role of arachidonic acid metabolites.

The effect of endotoxin on vascular reactivity was studied in pithed rats. Endotoxin infusion (1 mg kg-1 h-1) impaired pressor responses to noradrenaline, angiotensin II, BAY K 8644, and stimulation of the spinal sympathetic outflow. The loss of reactivity was prevented by pretreatment with the cyclooxygenase inhibitor flurbiprofen or the dual cyclooxygenase/lipoxygenase inhibitor BW755C. The effect of endotoxin in impairing vascular reactivity to noradrenaline was mimicked by prostaglandin E2 and platelet-activating factor but not by the prostacyclin analogue iloprost. Platelet-activating factor also impaired responsiveness to sympathetic stimulation. These results suggest a role for cyclooxygenase products and, possibly, platelet-activating factor in endotoxin-induced impairment of vascular reactivity.