Research and teaching in social and preventive medicine and in public health

Both public health and social and preventive medicine are characterised by the common goal of promoting, maintaining and improving health and preventing disease, and both are concerned with a population-related, preventive and environmental perspective. But whereas public health is interdisciplinary and goes far beyond the medical focus, social and preventive medicine is medically based and forms a bridge between public health and medical practice. Research in a department of social and preventive medicine serves to support preventive and medico-social activities in medical practice as well as in public health. This is illustrated by results from research conducted at the author's department during the last twenty years. Examples are research in support of smoking cessation activities, and research used for the planning of care for the elderly. Both the research and the teaching activities of the department take into account the population focus of public health as well as the focus on individual medicine in clinical practice.     

Feedlot health and management

Health programs based solely on vaccination and treatment regimens are often short-lived and unrewarding. The basis of any successful ongoing health program is a working health management system. The key to the success of the system is a functioning record system that generates information meaningful to management. The basic information generated should include morbidity and mortality data categorized by cause, the number of repeat treatments, and the number of chronic animals or railers. Goals should be set for each major category so that a database can be established for a feedlot operation to assess problems and progress. The most common reason for expectations not being achieved is factors that are largely beyond the control of the feed yard. Although attempts to address these factors should be periodically reviewed, attention to the health program and potential modifications are among the factors that we can control and modify as appropriate. BRD is the most important economic disease in the feedlot. Prearrival management is extremely important in assessing the risk category of incoming calves and in applying a preventive health strategy. Good husbandry, proper nutrition, proper pen maintenance, and selective immunization help to ensure that the cattle adapt quickly to the feed yard environment. Careful observation, timely effective therapy, and excellent hospital management increase the opportunity to produce cost-competitive, safe, and wholesome beef in a humane fashion with limited effects of the environment.     

Assigning new meanings to traditional literature: illustrations for HIV educators

PURPOSE: To evaluate training in general preventive medicine and public health, determining which experiences and institutional sponsors best prepare residents for practice and where improvements are most needed. METHOD: A 1991 survey of the 1,070 graduates of preventive medicine residencies from 1979 through 1989 asked the graduates to measure the adequacy of their training in preventive medicine topic areas by using a Likert-type scale of 1 (poor) to 4 (excellent). Adequacy was analyzed for variation against practice emphasis during training, training program sponsor, and other variables. The statistical methods included Student's t-test, analysis of variance and linear regression. RESULTS: A total of 797 graduates (74.5%) responded. The overall mean ratings of adequacy of training were 3.1 (SD, 0.9) for epidemiology, 2.5 (SD, 1.0) for clinical preventive medicine, 2.4 (SD, 0.9) for environmental health, 2.3 (SD, 0.9) for health administration, 2.3 (SD, 0.9) for health education and behavioral sciences, and 2.2 (SD, 0.9) for occupational medicine. Training was rated highest for topics emphasized during practice experiences. Adequacy varied by type of institution sponsoring the residency. Women rated their training as being less adequate than did men in all areas except clinical preventive medicine. The graduates tended ultimately to practice in topic areas emphasized during training. CONCLUSION: The graduates' ratings suggest that improvements are most needed in health administration, environment health, health education, and occupational medicine. Potential improvement strategies include highly focused practice experiences and increased emphasis on training in actual practice settings and community sites.     

Relaxation therapy, biofeedback, and behavioral medicine.

Discusses the major forms of relaxation and biofeedback and describes the current applications for such conditions as pain, cardiovascular disorders, and neurological abnormalities. It is asserted that while relaxation is not a panacea for all medical problems, it has proven to be a useful adjunct to traditional medical treatments for such medical disorders as chronic pain, hypertension, migraine headache, Raynaud's disease, and epilepsy. In some conditions, such as muscle-contraction headache, relaxation therapy and/or biofeedback is the treatment of choice. Relaxation may be considered a cognitive coping skill that is more a preventive procedure than just a technique to modify specific physiological responses. It is noted that since the field of behavioral medicine involves the integration of behavioral and biomedical science knowledge and the application of this knowledge to prevention and treatment to disease, the boundaries of psychology and medicine are no longer sharply defined. (78 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Simple protocols to determine dust potentials from cattle feedlot soil and surface samples

Cattle feedlot dust is an annoyance and may be a route for nutrient transport, odor emission, and pathogen dispersion, but important environmental factors that contribute to dust emissions are poorly characterized. A general protocol was devised to test feedlot samples for their ability to produce dust under a variety of environmental conditions. A blender was modified to produce dust from a variety of dried feedlot surface and soil samples and collect airborne particles on glass fiber filters by vacuum collection. A general blending protocol optimized for sample volume (150-175 cm3), blending time (5 min of pre-blending), and dust collection time (15 s) provided consistent dust measurements for all samples tested. The procedure performed well on samples that varied in organic matter content, but was restricted to samples containing less than 200 to 700 g H2O kg(-1) dry matter (DM). When applied to field samples, the technique demonstrated considerable spatial variability between feedlot pen sites. Mechanistically, dust potential was related to moisture and organic matter content. An alternative protocol also demonstrated differences within pen sites in maximum dust potential and dust airborne residence time. The two protocols were not intended, nor are they suitable, for predicting actual particulate matter emissions from agricultural sources. Rather, the protocols rapidly and inexpensively compared the potential for dust emission from samples of differing composition under a variety of environmental conditions.     

The motivation to use complementary medicine healing methods. Study of a general internal medicine and orthopedic patient sample

436 patients from two different clinics of internal medicine and one orthopaedic unit were asked to fill a questionnaire on their attitude towards and use of alternative medicine. Of the 272 questionnaires returned, 235 could be used for analysis. 42.6% of all analysed persons confirmed use of alternative medicine. About half of them were motivated to do so by their nursing staff. Homeopathy was by far the most frequently used method. Persons who used alternative medicine were characterised by a distinct environmental awareness and regular sports activity. They had also often had positive experience of alternative methods in childhood. On the other hand, age, sex, education, duration of the treated disease and success of conventional therapy did not correlate significantly with the use of alternative medicine. An essential motive for the need to seek help by alternative therapists was the opinion that conventional forms of treatment would concentrate too much on the purely physical side of a health problem. All in all, users of alternative medicine did not seek confrontation with conventional medicine but rather sought a real complement to conventional forms of treatment.     

Brisket disease in yearling feedlot cattle

During all of 1974, we surveyed, for illnesses and deaths, about 407,000 yearling feedlot cattle maintained at 1,600 m altitude. Of 1,988 cattle necropsied, 116 (5.8%) had brisket disease. The malady occurred during all seasons but was most common throughout fall and winter. The gross changes were hypertrophy and dilatation of the right ventricle and generalizaed passive congestion. The postulated causative factors were high genetic susceptibility, rapid growth rate, previous mountain grazing, and hypoventilation with airway hypoxia.     

Immunology and prevention of infection in feedlot cattle

This article reviews the basic types of immunity, the factors relevant to feedlot cattle that have been shown to suppress immune function, and what is known about the basis of protective acquired immunity against the common bovine respiratory pathogens. The characteristics and efficacy of vaccines for respiratory disease pathogens are also reviewed. Recommendations for optimizing vaccination are presented.     

Introduction.

This article introduces the special section on sexual harassment at work. It discusses the importance of sexual harassment as a continuing, chronic occupational health psychology problem to which the public health and preventive medicine notions of prevention may be applied. The article discusses the dilemmas in conducting and reviewing research on harassment, briefly examining some alternative methods of inquiry. The three articles in this section are introduced and the contrasting legal views of the problems in Europe and the United States are addressed. The preventive management of sexual harassment is suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A bimodal preventive intervention for disruptive kindergarten boys: Its impact through mid-adolescence.

Disruptive kindergarten boys from inner-city low socioeconomic neighborhood schools were randomly allocated to a preventive intervention and control condition. The 2-year prevention program included a home-based parent training component and a school-based social skills training component. Ss were followed up to mid-adolescence. Results indicated that a significantly greater percentage of treated Ss remained in an age-appropriate regular classroom up to the end of elementary school and that the treated Ss reported significantly less delinquent behaviors at yearly assessments from 10–25 yrs old, compared with controls. The preventive intervention appeared to have a significant long-term impact on the social development of the Ss. Earlier and more intensive intervention may be necessary for some cases, whereas for all Ss, booster sessions between 12 and 15 years of age are recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oral antipyretic therapy

The basic child-health problems in the shanty towns of Lima are protein-calorie malnutrition and infectious disease. The background of social, economic and cultural conditionsa are related to these main health problems. The basic problems are poverty, lack of sewage disposal and running water, and the maldistribution of public expenditure between city and countryside on one hand and curative and preventive medicine on the other. Despite official statistics, which show a steadily decreasing infant mortality rate in Peru, and all other Latin American countries, it seems that the Infant Mortality Rate is almost twice the official states rate. Health education, particularly in nutritional matters, is not adapted to indigenous foods and customs, but attempts to promote westernized conceptrs. Medical care in Peru is by large directed to the needs of the middle class, and the middle class by and large dictates the type of medical care available.     

Cholera and typhoid vaccine. The current state of play

The field of travel medicine is undergoing rapid change. Vaccination recommendations change with disease outbreaks, emerging infections and the availability of new vaccines. The following information on typhoid and cholera vaccination should be used in conjunction with up to date information and individualised for each traveller. It is emphasised that vaccination forms just part of the pretravel health consultation and does not replace the need for appropriate preventive advice and information.     

Venous disease and its complications

The major focus of preventive medicine in the aged must be on the clinical consequences of peripheral arteriosclerosis rather than the disease process itself. Treating risk factors may be of some limited benefit. However, of most crucial importance is careful attention to premonitory symptoms and the state of the peripheral pulses including the abdominal aorta.     

Broiler industry strategies for control of respiratory and enteric diseases

The commercial broiler industry is a modern day agricultural success due to popular consumer demand, healthy flocks, and least cost production. Preventive medicine is the key for economical control of disease in integrated broiler companies, and includes quarantine-eradication, controlled-exposure, and preventive feed medication. Respiratory and enteric diseases present a continuing, potential threat for economic loss. Most exotic and egg-transmitted poultry diseases have been controlled by reduction or eradication policies. Endemic diseases are controlled by mass vaccination and preventive feed medication. Improvements in genetics, housing, equipment, and disease surveillance has allowed continued improvements in disease prevention. Attention to detail and management of risk is crucial to industry success. With fast industry growth and market maturity of the broiler industry, new challenges have risen. These challenges include increased poultry house density, increasing economic pressures, changing industry attitudes, and increased governmental regulations that will strain the continued success of today's control strategies.     

Contributing concepts and methods across disciplinary boundaries: State-of-the-art reviews III.

Introduces the third special section of state-of-the-art reviews. The conceptual and methodologic contributions of the 3 articles in this section are framed, noting the importance of the public health, preventive medicine, and sociological disciplines represented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bronchiectasis in yearling feedlot cattle

Thoughout all of 1974, we surveyed, for illnesses and deaths, about 407,000 yearling feedlot cattle. From the 3,943 dead cattle, 1,988 necropsies were made; of the cattle necropsied, 32 (1.6%) had bronchiectasis. In this disease, the permanently dilated small bronchi and bronchioles, located in ventral parts of the lungs, were filled with accumulations of exudate and microorganisms, including Pasteurella hemolytica, Pasteurella multocida, Corynebacterium pyogenes, Escherichia coli, Salmonella anatum, Staphylococcus spp, and Mycoplasma arginini.     

Feedlot diseases

This article includes a brief discussion of common diseases, listed by body systems, affecting feedlot cattle. Each disease is approached from a practitioner's point of view. This includes interactions with other management factors, differential list, and practical diagnostic procedures. Also included are guidelines for initiating case management before a definitive diagnosis is made.     

The vital tasks of preventive medicine

The article discusses the actual problems of prophylaxis in common system of troops medical supply and defines the subsequent reformative ways of preventive medicine. First of all, the necessity of organized principles revision of prophylactic direction is connected with the fact of main health indices negative dynamics of Armed Forces personal, indicative of weakening of all types of prophylactic work. These are prophylactic work among recruits during their adaptation to military service conditions, prophylactic medical examination, tempering, fiscal training and prophylaxis of infectious diseases. However, we shouldn't forget about positive experience accumulated in the past, as much as possible we should use the achievements of military medical science. For further development of preventive direction of troops and fleet medical supply the priority ways of essential tasks decision of military medicine have been planned. It is necessary to connect the decision of concrete tasks with general perspective of introduction in Armed Forces of region system of servicemen medical supply.     

The achievements of William Crawford Gorgas

From an obscure frontier surgeon George Crawford Gorgas became internationally acclaimed as a preventive medicine genius. By his initiative in translating the known scientific facts made possible during the blossoming of bacteriology, he performed service not only in the United States but in Cuba, Central and South America, South Africa, and Eastern Europe. He fought for 10 years successfully against yellow fever, malaria, and other diseases during the construction of the Panama Canal, and continued triumphs against disease in other world situations. This is a rather concise account emphasizing his continued devotion and dedication as a humanitarian. He fashioned the Army Medical Department into an efficient machine as Surgeon General, and following his amazing military career of over 38 years, made further contributions in preventive medicine with the Rockefeller Foundation.     

Is access to medical care associated with receipt of HIV testing and counselling?

Lack of timely HIV testing leads to missed prevention opportunities and poor prevention counselling may be related to further disease spread. We examined the association of self-reported access to medical care with receiving HIV testing and preventive counselling services among a sample of patients with HIV disease prior to hospitalization. We conducted a cross-sectional interview of 217 Los Angeles patients hospitalized with HIV-related illness between 1992 and 1993 and abstracted clinical data from the medical record. Eighty-four per cent of patients received HIV testing prior to hospitalization, but only 33% received preventive counselling services. Only 48% of all patients rated outpatient medical care as somewhat or very easy to obtain. Controlling for severity of illness, better access to outpatient medical care (OR = 1.48; 95% CI = 1.02-2.15), having a regular source of care (OR = 3.40; 95% CI = 1.29-8.97) and non-homosexual mode of HIV transmission (OR = 0.31; 0.12-0.83) were associated with receiving HIV testing services prior to hospitalization. Having a regular source of care (OR = 3.55; 95% CI = 1.37-9.22), being VA (Veterans' Administration) insured (OR = 6.16; 1.46-26.05), older age (OR = 0.95; 95% CI = 0.90-0.99) and having a CD4 count between 101-200 (OR = 0.19; 95% CI = 0.06-0.63) were associated with receiving HIV counselling. Limited self-reported access to medical care is associated with fewer patients receiving HIV testing and counselling. Improving timeliness of HIV testing may require removing the barriers to medical care.