Ambulatory blood pressure and risk factors for coronary heart disease in black and Indian medical students

BACKGROUND: Coronary heart disease (CHD) has reached 'epidemic' proportions in South Africa. CHD is uncommon in the black population of South Africa, yet the prevalence of hypertension in the adult black population is high. DESIGN: This study compared the blood pressure profile in 154 medical students of which 83 were Indians (1), 71 were black (B), 87 were male (50 I, 37 B), and 67 were female (33 I, 34 B) age 21 (SD+/-1.6), using the cuff method and 24 h ambulatory blood pressure monitoring (ABPM). METHODS: All students underwent ABPM. Biochemical studies for CHD risk factors were done. Electrocardiography (ECG) was performed in all participants and echocardiography in 90. RESULTS: ABPM showed that black students had higher systolic and diastolic blood pressure throughout the day, night and critical time periods compared with the Indian students. Blood pressure load was higher in black (40.8%) than in Indian participants (29.6%; P<0.05) and there was less dipping at night Left ventricular mass was significantly higher in black than in Indian participants (29.6%; P<0.05) and there was less dipping at night. Left ventricular mass was significantly higher in black than in Indian participants. Risk factors leading to CHD were more common in Indian than in black participants. Those with borderline hypertension (blood pressure > or = 130/85 and < or = 140/90 mmHg) had statistically higher serum triglyceride and left ventricular mass than normotensives. CONCLUSIONS: Young black people had higher blood pressure readings than young Indian participants in the absence of metabolic abnormalities and had greater cardiac involvement Borderline hypertension is not innocuous. Metabolic risk factors for CHD in Indian people are apparent at an early age. This study emphasizes the need for prevention of risk factors leading to CHD at an early age.     

Reciprocal teaching goes to college: Effects for postsecondary students at risk for academic failure.

This study investigated the effects of a structured reading comprehension technique, reciprocal teaching, on postsecondary students at risk for academic failure. The sample comprised 50 at-risk students enrolled in a community college who participated in either the reciprocal teaching or cooperative learning condition. The reciprocal teaching group performed significantly better than the comparison group on reading comprehension and strategy acquisition. There were no differences on perception of study skills. In secondary analyses, poorer readers in the reciprocal teaching condition benefited differentially, outperforming poorer readers in the comparison condition on both reading comprehension and strategy acquisition measures. That a structured reading comprehension strategy for college-age students was effective has implications for the design of remedial courses at 2- and 4-year colleges. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Type B hepatitis: the infectivity of blood positive for e antigen and DNA polymerase after accidental needlestick exposure

To determine the relation between the presence of donor DNA polymerase and e antigen, and recipient hepatitis, we tested, under code, serums from a controlled trial of hepatitis B immune globulin used to treat individuals accidentally inoculated with HBs Ag-positive blood. All recipients lacked antibody to HBs Ag. In 29 of 31 donors, both polymerase and e were in perfect agreement; both demonstrated a highly significant correlation with recipient hepatitis (P less than 0.001). DNA polymerase/e-negative blood did not cause hepatitis. Blood containing polymerase or e antigen did not cause hepatitis in six of 31 and four of 18 recipients, respectively. Hepatitis did not correlate with transaminase or duration of antigenemia in the donor. Polymerase and e appear to be indicators of the relative infectivity of HBs Ag-positive serum, particularly after small-volume exposure. They may be important determinants in assessing infectivity of chronic carriers of HBs Ag and in evaluating efficacy of hepatitis B immune globulin and hepatitis B vaccines.     

Cheating in medical school: a survey of second-year students at 31 schools

This study examined mechanisms by which fluoxetine may reduce energy consumption and body weight. Women with binge-eating disorder (BED; n = 38) and age- and weight-matched women without BED (n = 32) monitored their dietary intake and concurrently recorded mood variables on a hand-held computer for 6 d of baseline and for 6 d after being randomly assigned to receive placebo or fluoxetine (60 mg). Fluoxetine reduced eating more than did the placebo on days 4-6 of treatment. The frequency of episodes was not affected, suggesting that fluoxetine affects satiety, not hunger. Fluoxetine did not preferentially reduce carbohydrate intake, did not affect snack consumption as compared with meal consumption, and did not affect negative-mood eating more than positive-mood eating, nor did fluoxetine affect subjects' mood ratings. Benefits of fluoxetine were of approximately equal magnitude for women with and without BED. However, women who reported higher energy consumption at baseline were more responsive to fluoxetine than were women who reported lower energy consumption at baseline, and binge-eating status was associated with greater energy consumption at all time points, including baseline. Fluoxetine affects dietary intake within 4 d of its consumption, and if future research shows that this remains true on repeated applications, this drug may be useful for short periods when difficulty with overeating is anticipated, such as during vacations.     

Analysis of knowledge about the anesthesiology specialty among a population of medical students

OBJECTIVES: To analyze the knowledge of anesthesiology possessed by a group of medical students representative of medically trained individuals who have not yet worked in a hospital. MATERIAL AND METHOD: Students in their fifth year of medical studies at the University of Valencia were invited to voluntarily and anonymously answer a questionnaire with dichotomous and multiple choice responses covering general and specific aspects of anesthesiology. The survey also collected personal and epidemiological data. One hundred eighty-five questionnaires were returned. RESULTS: The results obtained were analyzed for correlations with epidemiological and personal data (sex, information received, prior anesthesia); no significant correlations were found between these data and correct response. It was believed by 78.4% that the anesthesiologist's function during surgery does not go beyond warning the surgeon of changes in vital signs. Nevertheless, 76.2% asserted that the anesthesiologist's function is to protect the patient during the perioperative period. CONCLUSION: In comparison with the general population, medical students' training has left them with inadequate understanding of anesthesiology.     

Academic success among students at risk for school failure.

A sample of 1,803 minority students from low-income homes was classified into 3 groups on the basis of grades, test scores, and persistence from Grade 8 through Grade 12; the classifications were academically successful school completers ("resilient" students), school completers with poorer academic performance (nonresilient completers), and noncompleters (dropouts). Groups were compared in terms of psychological characteristics and measures of "school engagement." Large, significant differences were found among groups on engagement behaviors, even after background and psychological characteristics were controlled statistically. The findings support the hypothesis that student engagement is an important component of academic resilience. Furthermore, they provide information for designing interventions to improve the educational prognoses of students at risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of a method to teach cardiothoracic surgery to medical students

This report describes a method to teach undergraduate students the knowledge base and skills needed to maximize the educational value of a subsequent cardiothoracic surgical clerkship. Sixty-three fourth year medical students underwent a structured teaching programme in which groups of five students rotated through a series of six teaching stations. Subject material, presented during 20 min at each station, covered the key issues relating to coronary artery disease, congenital heart disease, chest trauma, lung cancer, prosthetic heart valves, pacemakers, thoracic sepsis and dysphagia. Group knowledge increased significantly (P < 0.001) from a mean mark of 23% (s.d. 12) in a pre-test to a mean mark of 46% (s.d. 12) in a test conducted 1 month after the teaching. The time taken to conduct the structured teaching/assessment was 5 h compared with 32 h to run the same programme by the traditional ward tutorial system. The dollar cost to stage the structured teaching was less than that to run the traditional tutorial programme. It was concluded that the teaching method is effective, economical and practical and that it has a role in an undergraduate curriculum to prepare students for clinical clerkship.     

Multimedia to teach urology to medical students

OBJECTIVES: To test the hypothesis that an interactive multimedia-based computer application may be used to teach urology to undergraduate medical students. METHODS: Third-year medical students rotating on their urology clerkship were studied. Student knowledge was measured with a multiple choice test administered in a pretest-post-test experimental design. The educational intervention was a multimedia-based application that presented a clinical module on hematuria, using natural language-like entries. Student attitudes toward the multimedia application were assessed by a survey. RESULTS: Twenty-three consecutive third-year medical students participated. Mean pretest and post-test scores +/- standard deviation were 35%+/-11% versus 74%+/-17%, respectively, P<0.0001. Student questionnaire responses indicated highly positive opinions that the multimedia-based module was easy to use, was fun, provided natural patient responses, had clear exercises, provided immediate feedback, was educational, and had a nonthreatening format, and that the multiple choice questions were clear and fair. CONCLUSIONS: Multimedia-based education may be used to teach urology to undergraduate medical students.     

How to take a weapons history: interviewing children at risk for violence at school

BACKGROUND: Malignant melanoma is the most common metastatic tumor of the gastrointestinal tract and can present with abdominal pain, small bowel obstruction, or occult gastrointestinal bleeding. Diagnosing abdominal pain due to metastatic melanoma is best accomplished by intraluminal studies and computed tomography. Surgical resection of the tumor burden limited to the gastrointestinal tract has been shown to extend periods of palliation in this poor long-term survival group. OBJECTIVES: We will review a case of abdominal pain in a melanoma patient and review the literature.     

Accidental exposure of veterinary students to rabies

Accidental exposure to rabies occurred in more than 200 veterinary students at Texas A&M University from 1970 to 1977. Few of the animals to which the students were exposed had typical signs of rabies prior to the exposures. An accelerated preexposure rabies prophylaxis program coupled with retention of suspect tissues suitable for fluorescent antibody procedures has reduced the number of postexposure prophylaxis series.     

Occupational exposure to HIV: experience at a tertiary care center

We examined our hospital-based occupational health clinic's experience with combination antiretroviral therapy for postexposure prophylaxis for human immunodeficiency virus (HIV). Over a 12-month period, 68 workers started postexposure prophylaxis: 23 with zidovudine and lamivudine and 45 with zidovudine, lamivudine, and indinavir. Fifty-one (75%) of the 68 workers starting postexposure prophylaxis reported one or more side effects. Side effects were more common among those taking three drugs. Many workers failed to complete the recommended 28-day regimen because of the side effects of the various treatments. The estimated mean cost for evaluations, prophylaxis, and monitoring of exposed workers was $669 per reported exposure. In our experience, major challenges in carrying out the current HIV postexposure prophylaxis guidelines include expeditious source testing, improved staff education and prevention measures, and scrupulous monitoring of workers taking combination antiretroviral drugs for postexposure prophylaxis, with consideration of alternate regimens for intolerant workers.     

How to teach literature to medical students?

A pair of monozygotic twins suffering from noisy respirations and recurrent wheezes since early infancy were referred for evaluation. Using direct coronal CT and 3-dimensional reconstruction of the airway, congenital tracheobronchial stenosis was found in both twin babies, later confirmed by fibre optic bronchoscopy. The cause of congenital tracheobronchial stenosis remains obscure, but even in monozygotic twins an unidentified environmental factor cannot be excluded and may be responsible for discordant bronchopulmonary abnormalities. CONCLUSION: This case report shows that tracheobronchial stenosis may present in monozygotic twins. The pattern of malformation in twins differs from cases described previously.     

Teaching the principles of behaviour change to medical students: evaluation of a programme

In this paper we describe a method (the Behaviour Change Project) for teaching 'behaviour change' principles to medical students. The project involved their changing a self-identified aspect of their own behaviour. In evaluating the project by an anonymous questionnaire (response rate 84%), most students reported enjoying the project and found it helpful in some way, particularly in learning about their own behaviour and the processes of behaviour change. While nearly all listed positive outcomes for themselves or others, some also listed negative outcomes or difficulties, such as in measuring behaviours related to clinical work. Possible extensions of the project are discussed, including its application to improving relationships with patients, increasing tolerance, strengthening ethical behaviour in clinical or research contexts, and in training specific clinical skills.     

Determinants of plasma anti-oxidant vitamin levels in a population at high risk for stomach cancer

A high-performance liquid chromatographic method was developed for the determination of a new antiulcer agent, YJA-20379-2, in human plasma and urine. The sample preparation was simple: 2.5-volume of acetonitrile was added to the biological sample to deproteinize. A 50-microliter aliquot of the supernatant was injected onto a C18 reversed-phase column. The mobile phase employed was methanol-0.1M S?rensen phosphate buffer of pH 7.0-H2O (75:2:25, v/v/v), and was run at a flow-rate of 1.0 ml/min. The column effluent was monitored by ultraviolet detector at 295 nm. The retention time for YJA-20379-2 was approximately 7.0 min. The detection limits for YJA-20379-2 in human plasma and urine were both 100 ng/ml. The coefficients of variation of the assay (within-day and between-day) were generally low (below 9.16%) for both the human plasma and urine. No interference from endogenous substances was found.     

The relationship between blood pressure and biochemical risk factors in a general population

The relationship between blood pressure, ponderal index, sex, blood glucose, haemoglobin, serum uric acid, calcium cholesterol and creatinine, and albumin has been examined in 698 subjects aged between 44 and 49 years from the register of a group general practice. Sixty per cent of the variation in systolic pressure could be explained by statistically significant associations with diastolic pressure, sex, blood glucose, serum calcium, and cholesterol. The diastolic blood pressure (not corrected for systolic pressure) was significantly related only to ponderal index, haemoglobin in men, and cholesterol in women. Pulse pressure was also positively related to the risk factors blood glucose, serum cholesterol, and calcium. The possibility is discussed that one or more of these variables reduce aortic compliance and that the serum calcium contributes to this end. Diastolic, but not systolic pressure, had a prime association with relative weight, obesity being only basically associated with an increase in diastolic pressure.