'One Health' investigation: outbreak of human Salmonella Braenderup infections traced to a mail-order hatchery - United States, 2012-2013.

Human salmonellosis linked to contact with live poultry is an increasing public health concern. In 2012, eight unrelated outbreaks of human salmonellosis linked to live poultry contact resulted in 517 illnesses. In July 2012, PulseNet, a national molecular surveillance network, reported a multistate cluster of a rare strain of Salmonella Braenderup infections which we investigated. We defined a case as infection with the outbreak strain, determined by pulsed-field gel electrophoresis, with illness onset from 25 July 2012-27 February 2013. Ill persons and mail-order hatchery (MOH) owners were interviewed using standardized questionnaires. Traceback and environmental investigations were conducted. We identified 48 cases in 24 states. Twenty-six (81%) of 32 ill persons reported live poultry contact in the week before illness; case-patients named 12 different MOHs from eight states. The investigation identified hatchery D as the ultimate poultry source. Sampling at hatchery D yielded the outbreak strain. Hatchery D improved sanitation procedures and pest control; subsequent sampling failed to yield Salmonella. This outbreak highlights the interconnectedness of humans, animals, and the environment and the importance of industry knowledge and involvement in solving complex outbreaks. Preventing these infections requires a 'One Health' approach that leverages expertise in human, animal, and environmental health.

Oral health education for medical students.

With a view to improving oral health in Oman, particularly in the interior of the country where dental services are very scarce, medical students have been receiving a grounding in this field since 1988. The results achieved so far have proved encouraging.

Attitudes and reactions of Arab medical students to the dissecting room.

A questionnaire on the emotional and psychological reactions of Arab medical students to the dissecting room (DR) was distributed to 272 students in four successive pre-clinical and clinical years in the same academic year (1993-1994) at Sultan Qaboos University (SQU) Medical College; 205 students responded. Varying degrees of fear on first entering the DR was reported by 46%. The most frequent reactions were recurring visual images of cadavers (total 38%) and temporary loss of appetite (total 22.5%). Students' reactions were most commonly elicited by the smell of the DR (total 91%) and by fear of infection (total 62%). The most frequent method of coping with such fears was by rationalization (total 65%). Significant gender differences (P < 0.05) were found concerning all aspects of the DR experience. Female students showed higher levels of fear, reported stronger physical and behavioral reactions, were more disturbed by certain stimuli in the DR, and used certain coping methods more frequently than their male peers. The need for appropriate psychological preparation of students before studying human cadaveric anatomy is discussed.

The introduction of epidemiology in training future doctors: the oman experience.

This paper highlights the emphasis put on epidemiology in the training of future doctors at Sultan Qaboos University. It describes the special features of the teaching of epidemiology making it needs-oriented with continuous practical application in the field throughout the preclinical period. The students take an active part in planning field studies using their knowledge of epidemiology. Integration of epidemiology with statistics enables the students to analyze and interpret their own data thus obtaining a quick feed-back of the epidemiological studies conducted by them. They apply their knowledge of epidemiology to evaluate the data and formulate intervention programmes.Close collaboration with the Ministry of Health provides an opportunity for the students to orient themselves with the important health problems of Oman and participate in the country's national programs. The scheduling of courses and continuation of application of epidemiology in the clinical years help to reinforce their knowledge of epidemiology and statistics for the clinical period and subsequent postgraduation.

Clinical electives: setting up an overseas programme in a new medical school.

This paper describes the methods used to establish an overseas elective programme in a new medical school, the objectives and the perceived results. The aims and objectives of the programme are listed. The students who participated in the programme were from the charter class and had completed the second year of a 3-year clinical programme. The methods used to establish the programme are described. Destinations were organized through academic staff contacts. Systematic preparation of students was an important feature of the programme. Comparative costs and methods of financing the programme are described in detail. The results of the programme are analysed together with the form of assessment used and feedback from both the host institution and the student. The importance of monitoring progress while students are abroad is described. The discussion focuses on the benefits derived from an overseas elective programme for both students and teachers. The advantages and disadvantages of different destinations are compared. Further refinements to the programme are discussed including alternative methods of obtaining funding. The importance of developing reciprocal arrangements with other medical schools and institutions throughout the world is emphasized.

Teaching clinical skills to new medical students: the Oman experience.

The College of Medicine at the Sultan Qaboos University (SQU) in Oman took up the challenge of moving away from a didactic emphasis in the teaching of family and community health by actively involving students in health care, requiring some clinical skills, as early as possible. This paper describes the experience of the Department of Family and Community Health at SQU of the feasibility of training first-year medical students in the measurement of blood pressure within a few days. Our experience showed that proper training before starting field-work can teach clinical skills to students who have had no prior exposure to medical subjects. There was a strong correlation between the measurements of blood pressure of 638 individuals by the students and the supervisors. This experience at SQU has encouraged us to implement the idea of family- and community-based clinical exposure for every class. Teaching of clinical skills is feasible in the field for new entrants, provided there is adequate orientation beforehand and skilled supervision of the students in small groups.

Clinical data from a psychiatric service to a group of native people.

Clinical data are reported from a psychiatric service to Native Canadian patients, mainly Cree Indians. Eighteen out of 41 had a clinical diagnosis of depression, three of mania and only one of schizophrenia. Thirty-seven percent used alcohol to excess but alcoholism was rarely the primary diagnosis. Reasons are given for the belief that schizophrenia has been over-diagnosed in Native populations in the past. Seventy-eight percent spoke Cree/Inuit as their primary language. The patients usually held their parents in high regard despite often reporting that they were alcoholic. In reply to tentative enquiries into feelings about their Native identity, only 5% of the patients indicated a preference for another identity, but this figure is only considered to give a minimum estimate of the possible dissatisfaction with being Native in Canada today.

A note on the occurrence of pain in psychiatric patients from a Canadian indian and Inuit population.

Fifty patients are reported from a psychiatric service to a Native population. Thirty-two (64%) had pain of whom 19 had physical lesions. The number with pain is thought to be somewhat higher than might have been predicted from a priori considerations. Depression was the commonest psychiatric diagnosis both with and without pain. The head was the commonest site for pain whilst no patient had pain in the back as a primary complaint and only two had back pain as a secondary complaint.

Illness episodes and service delivery in the hudson bay and james bay region.

In examining patterns of illness episode and service delivery in two native populations, a high frequency of respiratory tract infections and a poor obstetrical history with loss of children were found, particularly among the Inuit patients. The work of nurse practitioners, supported by specialist physicians, appeared to be effective in managing patients in isolated communities.

Modification of prenatal stress effects in rats by adrenalectomy, dexamethasone and chlorpromazine.

This study was designed as a 4 (maternal treatments) by 2 (prenatal stress) factorial. The 4 treatment groups were: chlorpromazine (CPZ) 2.1 mg/kg; dexamethasone (DEX) 38.7 mug/kg; adrenalectomy (ADX); and controls (CON). Half of the females in each group were stressed prior to mating and during gestation. Stress significantly reduced birth and weaning weights of CON offspring but did not affect the weight of CPZ, DEX or ADX offspring. At birth, DEX and ADX offsrping, as well as offspring of partially adrenalectomized females, were significantly lighter than controls; at weaning, only the DEX animals displayed a weight deficit. Stress increased open field activity of ADX offspring but decreased the activity of DEX offspring while the performance of CON and CPZ offspring was not affected. In a food deprivation test at 42 days there were significantly more deaths among male offspring of no stress (32 percent) than of stress (4 percent) females and stress offspring in all groups lost less weight than unstressed offspring in a food deprivation test at 69 days. Avoidance conditioning tests showed effects only in female offspring. Stress significantly decreased avoidances made by CON offspring and increased avoidances made by DEX offspring. Treatment with ADX, CPZ or DEX can prevent the effects of prenatal stress on some characteristics of the offspring, but in other cases the effects are potentiated by these manipulations.