Medical students' attitudes toward gay men

ABSTRACT: BACKGROUND: Healthcare providers' attitudes toward sexual minorities influence patient comfort and outcomes. This study characterized medical student attitudes toward gay men, focusing on behavior, personhood, gay civil rights, and male toughness. A cross-sectional web-based anonymous survey was sent to medical students enrolled at the University of California, Davis (N= 371) with a response rate of 68%. RESULTS: Few respondents expressed negative attitudes toward gay men or would deny them civil rights. More negative responses were seen with respect to aspects of intimate behavior and homosexuality as a natural form of sexual expression. Men and students younger than 25 years old were more likely to endorse negative attitudes toward behavior as well as more traditional views on male toughness. CONCLUSIONS: We show that an important minority of students express discomfort with the behavior of gay men and hold to a narrow construction of male identity. These findings suggest that competency training must move beyond conceptual discussions and address attitudes toward behaviors through new pedagogical approaches.     

Traumatic Head Injury in Cluster Headache: Cause or Effect?

Post-traumatic headache (PTH) is a common and well-recognized entity. Tension-type headache and migraine are the commonest phenotypes that can result from head trauma, while the onset of cluster headache (CH) in close temporal relation to a head trauma has only been described in rare cases. Nevertheless, CH patients seem to incur more frequent traumatic head injuries during their lifetimes when compared to migraine controls and the general population. The basis of this association remains unclear, since only a limited number of methodologically robust studies have examined it. However, three main hypotheses can be proposed to explain this association: head trauma is the direct cause of CH; head trauma is a risk factor for the future development of CH; and head trauma is a consequence of a CH trait. A better understanding of the association between head trauma and CH may provide important insights into both the pathophysiology of CH and the mechanisms by which traumatic head injury predisposes patients to developing headaches.     

Acoustic radiation contrast in MR images for breast cancer diagnostics--initial phantom study

Acoustic radiation contrast in magnetic resonance images is an approach to visualize the changes in ultrasonic loss and viscoelastic changes of the sample with the resolution of a magnetic resonance imaging (MRI) system. By irradiating ultrasound (US) into a tissue-mimicking sample, a displacement along the US beam path caused by the acoustic radiation force is obtained. This displacement varies with the US intensity, the duration of irradiation, the US attenuation and the viscoelastic properties of the sample. US pulses of 2.5 MHz with a duration of 20 ms and an intensity of <17 W/cm² are used. An MRI sequence was programmed to produce images in which the magnitude of the displacement is visualized by gray value changes. In addition, a finite element simulation of the measurements was performed to demonstrate the feasibility of the method. Through examination of the measurements and the simulations, information about viscoelastic changes was achieved. In this work, measurements on different breast phantoms are presented. (E-mail: marcus.radicke@gmx.de)     

Serotonergic Agents in the Management of Cluster Headache

Cluster headache is a highly disabling primary headache disorder, characterized by unilateral headache attacks occurring in association with cranial autonomic symptoms. Serotonergic agents, such as the ergot alkaloids, have traditionally been used for the acute and preventive treatment of cluster headache and other primary headaches. Although it initially was thought that their efficacy was due solely to the vasoconstriction of extracranial cerebral vessels, new mechanisms of action of these drugs have been ascertained as a consequence of advances in elucidation of the pathogenesis of primary headaches and the development of triptans. This article reviews the current knowledge about serotonergic agonists and antagonists used in the management of cluster headache, focusing on their mechanisms of action and on the possible role of serotonin system dysfunction in this complex disorder.     

High levels of serum hepatitis B virus DNA in patients with 'anti-HBc alone': role of HBsAg mutants

It remains unclear how the detection of hepatitis B core antibody (anti-HBc) in the absence of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) should be interpreted and whether all patients with this pattern need to be tested for hepatitis B virus (HBV)-DNA. This study aimed at reassessing the significance of 'anti-HBc alone' in unselected sera referred to the clinical laboratory and determining whether significant HBV viraemia can be found in this setting. Of the 6431 patients tested for HBsAg, total anti-HBc and anti-HBs in a Paris hospital over a 1-year period, 362 (5.6%) had 'anti-HBc alone' (24.8% of anti-HBc-positive patients). Only 11 of the 362 sera (3.0%) were found to be false positive. One patient was in the resolving phase of acute hepatitis B. HBV-DNA was detected in 10 of 362 (2.8%) patients, using a commercial standardized assay (threshold: 350 IU/mL). Viral loads exceeded 10(4) copies/mL in 6 of 10 patients. Mutations in the HBsAg immunodominant region were identified in seven of the viraemic patients. HBsAg was detected in only two cases when retested by one of the latest, multivalent assays. Neither human immunodeficiency virus nor hepatitis C virus serostatus distinguished between patients with and without HBV-DNA. In conclusion, 'anti-HBc alone' should be considered a risk marker for a so-called 'false occult' HBV infection with significant viraemia. Indeed, results in this hospital population indicate that a small proportion of patients with 'anti-HBc alone' have high viral loads, revealing the occurrence of infection with HBV mutants that escape detection even by multivalent HBsAg assays.     

Epstein-Barr virus and multiple sclerosis

This review of the considerable evidence linking Epstein-Barr virus (EBV) infection to risk and disease progression in multiple sclerosis (MS) builds on the background to the virus and its interactions with the human host available in the online supplement (see supplement, available online only). The evidence for a similarity in the geographic patterns of occurrence of MS and EBV infection (with infectious mononucleosis or EBV specific serology used as surrogate markers), when reviewed critically, is very limited. There is strong evidence however that people with MS are more likely to report a past history of infectious mononucleosis (thought to represent initial EBV infection at an older age), and higher titres of EBV specific antibodies are associated with an increased risk of developing MS. Elevated levels of the latter are apparent many years before MS onset (compared with non-MS controls) and there is a dose-response relationship between MS risk and antibody titre, with antibodies to the EBV nuclear antigen-1 particularly important. The evidence in relation to EBV DNA load in blood or CSF is conflicting, as is that in relation to T cell responses to EBV. Several hypotheses that have been proposed to explain the links between EBV and MS risk are reviewed and gaps requiring further research are identified.     

Influence of edentulousness on gonial angle, ramus and condylar height

Summary  It has been shown that the shape of the mandible correlates with occlusal condition and the function of the masticatory muscles. Edentulous subjects have a wider gonial angle than dentate subjects, and a gender difference has also been shown. However, some studies have reported differing results. Less is known about the effect of dental status and gender on the ramus and condylar height. The aim of this study was to evaluate the association of tooth loss on the shape of mandible (i.e., gonial angle, ramus height and condylar height) in subjects aged 60 years and older. A total of 1036 subjects (667 dentate, 389 edentulous; 554 women and 482 men) were included in the study. Interviews and clinical and panoramic radiographic examinations were carried out. The gonial angle of the mandible and the mandibular and condylar height were measured using panoramic radiographs. In edentulous subjects, the gonial angle was significantly larger, while the ramus and condylar height was significantly smaller on both sides compared with dentate subjects. Women had a significantly larger gonial angle and smaller ramus and condylar height on both sides compared with men. In conclusion, the morphology of the mandible changes as a consequence of tooth loss, which can be expressed as a widening of the gonial angle and shortening of the ramus and condylar height. These findings highlight the importance of rehabilitation of the masticatory system to maintain good functioning of the masticatory muscles for as long as possible.     

The Oxford medial unicompartmental knee replacement: Survival and the affect of age and gender

Study aimsTo determine the survival and functional outcome for the phase 3 Oxford unicompartmental knee replacement (UKR) performed at a single independent centre and to assess whether age and gender affect survival.Patients and methodsBetween 2000 and 2008, 459 consecutive Oxford UKRs were implanted in 392 patients using a minimally invasive technique.ResultsMean age of patients was 63.0 years and 53% were female. Mean follow-up was 4.4 years (range 0.5–11.2 years). No patient was lost to follow-up and 411 (90%) knees had a minimum follow-up of 2 years. Twenty knees (4.4%) have undergone revision to total knee replacement at a mean time of 3.2 years. Aseptic component loosening (n = 11) accounted for most failures. Cumulative survival was 94.4% at 5 years (95% confidence interval 90.9–97.0) and 93.0% at 8 years (95% confidence interval 84.8–96.2). The median postoperative Oxford knee score was 31.2% (interquartile range 12.2%–52.1%) at latest follow-up. Age and gender had no statistically significant affect on UKR survival.ConclusionsThis large independent series demonstrates good medium-term survival and functional outcome can be achieved with the phase 3 Oxford UKR in appropriately selected patients. Age and gender should not be considered contraindications for performing Oxford UKR.     

Proactive bedside counseling of smokers hospitalized in cardiac intensive care unit

Aim of the study

To offer routine information on smoking cessation and bedside counseling to smokers admitted in cardiac intensive care unit. The objective is to encourage cessation and/or use of smoking cessation services after discharge.

Population and methods

Thirty-three smokers were admitted in cardiac intensive care unit at the Georges Pompidou European hospital (HEGP) in Paris (France) from 1st March to June 30th 2010. Assessment of tobacco use and offer of counseling and follow-up visits during and after hospital stay. Evaluation of tobacco use by telephone at least six months after discharge.

Results

It was found that 30.3% of the patients stopped smoking, mostly without specialized help despite heavy smoking prior to hospitalization. They declared being impressed by their hospital stay. Motives for smoking among continuing smokers were mostly automatic smoking and stress relief. They had declined any smoking aid, despite subsequent hospital stays in cardiac intensive care. Three smokers with a severe profile had died at follow-up. Smokers followed-up at HEGP were in need of nicotine replacement therapy. More than six months after hospital discharge, nearly all smokers remembered being offered bedside counseling to stop smoking.

Conclusion

This experience reveals the importance of routine bedside counseling for smoking cessation in cardiac intensive care unit. Smokers in this unit often continue smoking even though smoking hinders cardiac rehabilitation.