Comparison of public health specialty training in Australia and England.

OBJECTIVES: The objective of the study is to explore common challenges and distinct features of specialty public health training in Australia and England, given similarities in public health issues faced, shared histories and common political structures. STUDY DESIGN: The study design used in the study is a document review. METHODS: Using current curricula, along with other publicly available documents, we reviewed organisational, selection and content elements of public health specialty training in these two countries. RESULTS: In both countries, specialist public health training is coordinated and accredited through Faculties of Public Health housed within Royal Colleges of Physicians. However, eligibility, recruitment to training and funding routes differ. In England, entrants are accepted from a range of backgrounds including medicine, whereas only medical doctors are eligible in Australia. England has a national, annual recruitment process; Australia does not and has a less structured training path. In Australia, specialty advanced training is three years (excluding a Master's in Public Health [MPH]), whereas in England, training is generally five years (including an MPH). Curricula cover broadly common domains of public health practice although there are differences. Methods to assess readiness for consultant practice differ. CONCLUSIONS: Fostering an understanding of the specialist role of public health professionals in different countries establishes routes to share learning, encourage greater collaboration and creates opportunities for benchmarking.

The long duration response to levodopa in Parkinson's disease.

The duration of effect of levodopa has been reported by some authors to be shorter in fluctuating parkinsonian patients with long standing disease than in stable patients. Other authors report no difference in the two groups of patients. We assessed motor fluctuations and response duration in 15 Parkinson's disease patients. Three patterns of response were observed: deterioration within one day on placebo and marked fluctuations on levodopa; deterioration after one day on placebo and moderate fluctuations on levodopa; no deterioration during 3 days of placebo and no fluctuations on levodopa. One patient who did not deteriorate or fluctuate did both when restudied 12 years later. This study confirms that, in addition to the short duration response to a single dose of levodopa, there is a long duration response to levodopa which is lost as the disease progresses. Loss of this long duration response to levodopa may be a key factor in the emergence of fluctuations in Parkinson's disease.

CQI in the internist's office.

Five ASIM members relate their experiences with using continuous quality improvement (CQI) theory in their practices. Although critics grumble about paperwork and data collection, supporters claim that CQI is a lifesaver for private practice.

Perinatal 'TORCH' infections identified by serology: correlation with abnormalities in the children through 7 years of age.

A matched case-control methodology was used to assess the risk for a wide range of abnormalities in children associated with serological evidence for 'TORCH' infections in the mothers. Specimens were selected from the large bank of sera from the approximately 54,000 pregnant women who participated in the Collaborative Perinatal Project. There was no clear association between any of the antigens studied and any specific damage to the child. These 'negative' findings are consistent with the absence of frequent significant effects due to these agents in the second and third trimesters of pregnancy.

A revealing look at the realities of reform.

Attendees of ASIM's 35th Annual Meeting in Washington heard first hand from two leading health policy figures--Gail Wilensky and Sen. Jay Rockefeller--about what's ahead for health care reform. Vermont Gov. Howard Dean, MD, an internist, looked at the roles that states--and physicians--can take.

Increased peripheral lymphocytes, lymphoid hepatitis and anaemia in African vervet monkeys seropositive to retroviruses.

Wild-caught African Vervet monkeys are commonly infected by Simian T-lymphotropic virus I (STLV1) and Simian immunodeficiency virus (SIV), yet the natural histories of these infections are largely unknown. Seropositivity was associated with increased total, T and atypical lymphocytes. In seropositive females there was mild, normocytic, normochromic anaemia. Lymphoid hepatitis was present in seven seropositive cases. African Vervets used in biomedical research, vaccine production and organ transplantation research are often infected by exogenous retroviruses which can be oncogenic and immunosuppressive in captive monkeys. Elimination of these infections may be possible by breeding Vervets in captivity.

Serological survey for viral diseases in the Cayo Santiago rhesus macaque population.

The free-ranging population of rhesus monkeys (Macaca mulatta) on Cayo Santiago was sero-surveyed for human measles, simian virus 40, B virus (Herpes simiae), rhesus cytomegalovirus, human and simian retroviruses and encephalomyocarditis virus to determine the prevalence of these viruses in the colony. The results of this study indicate that the colony is free of SV40, HTLVIII (HIV-1), STLVIII (SIV) and SRV1; has a low prevalence of measles and EMCV; and high prevalence rates for B virus, CMV and HTLVI.