Tobacco cessation treatment education for dental students using standardized patients.

The use of standardized patients (SPs) shows promise in tobacco cessation treatment (TCT) training by providing a simulated clinical environment for dental students to practice counseling skills with individuals trained to portray patients. The purpose of this study was to determine if there was a difference in attitudes, perceptions, and knowledge between dental students who received a lecture and practice sessions with SPs and those who received a lecture only. Dental students in an introductory clinical course at one dental school were invited to participate in the study by completing a pre and post questionnaire. The pre questionnaire was administered to all students prior to a tobacco cessation lecture. Students were group-randomized to either the intervention or control group. The intervention group completed the post questionnaire after the lecture and practice sessions with SPs, and the control group completed it after the lecture only. Of ninety-eight students who attended the lecture and were invited to participate in the study, a total of ninety-four from the two groups (96 percent) provided two linkable questionnaires for analysis. In the results, training with lecture and SPs increased the students' understanding of barriers, subjective norms, perceived skills, self-efficacy, and intentions to provide TCT more than those in the lecture only; however, it did not significantly increase their attitudes and knowledge. These findings suggest that using SPs is a valuable educational method to promote the provision of TCT by dental students and graduates.

Genome of the human hookworm Necator americanus.

The hookworm Necator americanus is the predominant soil-transmitted human parasite. Adult worms feed on blood in the small intestine, causing iron-deficiency anemia, malnutrition, growth and development stunting in children, and severe morbidity and mortality during pregnancy in women. We report sequencing and assembly of the N. americanus genome (244 Mb, 19,151 genes). Characterization of this first hookworm genome sequence identified genes orchestrating the hookworm's invasion of the human host, genes involved in blood feeding and development, and genes encoding proteins that represent new potential drug targets against hookworms. N. americanus has undergone a considerable and unique expansion of immunomodulator proteins, some of which we highlight as potential treatments against inflammatory diseases. We also used a protein microarray to demonstrate a postgenomic application of the hookworm genome sequence. This genome provides an invaluable resource to boost ongoing efforts toward fundamental and applied postgenomic research, including the development of new methods to control hookworm and human immunological diseases.

Health utility after emergency medical admission: a cross-sectional survey.

OBJECTIVES: Health utility combines health related quality of life and mortality to produce a generic outcome measure reflecting both morbidity and mortality. It has not been widely used as an outcome measure in evaluations of emergency care and little is known about the feasibility of measurement, typical values obtained or baseline factors that predict health utility. We aimed to measure health utility after emergency medical admission, to compare health utility to age, gender and regional population norms, and identify independent predictors of health utility. METHODS: We selected 5760 patients across three hospitals who were admitted to hospital by ambulance as a medical emergency. The EQ-5D questionnaire was mailed to all who were still alive 30 days after admission. Health utility was estimated by applying tariff values to the EQ-5D responses or imputing a value of zero for those who had died. Multivariable analysis was used to identify independent predictors of health utility at 30 days. RESULTS: Responses were received from 2488 (47.7%) patients, while 541 (9.4%) had died. Most respondents reported some or severe problems with each aspect of health. Mean health utility was 0.49 (standard deviation 0.35) in survivors and 0.45 (0.36) including non-survivors. Some 75% had health utility below their expected value (mean loss 0.32, 95% confidence interval 0.31 to 0.33) and 11% had health utility below zero (worse than death). On multivariable modelling, reduced health utility was associated with increased age and lower GCS, varied according to ICD10 code and was lower among females, patients with recent hospital admission, steroid therapy, or history of chronic respiratory disease, malignancy, diabetes or epilepsy. CONCLUSIONS: Health utility can be measured after emergency medical admission, although responder bias may be significant. Health utility after emergency medical admission is poor compared to population norms. We have identified independent predictors or health utility that need to be measured and taken into account in non-randomized evaluations of emergency care.

Hypoxia at the site of abdominal aortic aneurysm rupture is not associated with increased lactate.

The mechanisms of hypoxia-mediated aneurysm wall weakening and rupture are unknown. During hypoxia, strategies to maintain cellular ATP levels include increasing glycolysis (glycolytic strategy) or decreasing ATP consumption (metabolic depression). This study demonstrated that compared to anterior aneurysm sac, rupture edge overexpressed hypoxia-inducible factor-1-alpha (marker of hypoxia) and showed no significant difference in levels of combined ADP and ATP or lactate (glycolytic end product). Further studies are needed to confirm whether hypoxic AAA cells adapt through metabolic depression rather than glycolysis. The downregulation of protein synthesis during such metabolic depression may be a factor in hypoxia-mediated wall weakening.

Increased angiogenesis at the site of abdominal aortic aneurysm rupture.

Abdominal aortic aneurysm (AAA) rupture is associated with elevated levels of matrix metalloproteinase (MMP). Medial neovascularization is a known characteristic of established AAAs and involves proteolytic degradation of extracellular matrix by MMPs to facilitate endothelial cell proliferation and migration. This study evaluated the extent of neovascularization in abdominal aortic aneurysm rupture. Results indicated upregulation of proangiogenic cytokines and increased medial neovascularization at the aneurysm rupture edge compared with paired aneurysm anterior sac. Further investigations into the role of angiogenesis in aneurysm rupture may open novel therapeutic avenues to prevent aneurysm rupture.

Assessment of the training needs of Kentucky public health educators.

A survey to identify the training needs of Kentucky public health educators was conducted during the spring of 2001. Questionnaire items assessed respondents' job title, years of experience in public health education, percentage of work time doing public health education, and educational background. Respondents were asked to rate their perceived level of mastery of 50 public health educator competencies and skills, desire for additional training in each of the competencies and skills, and preferred format for training. Surveys were mailed to 699 health department employees across the commonwealth. A total of 366 questionnaires were completed and returned. Results provide a descriptive profile of Kentucky public health educators and pinpoint competency deficiencies. Grant writing, budgeting, evaluation, managing controversy, and multicultural understanding were identified most frequently as competencies in which more training was needed. An overview of survey results and recommendations regarding the training of Kentucky public health educators is provided.

Developing the skills to implement evidence based practice - a joint initiative between education and clinical practice.

The current political climate stresses the need for health care to be seen to be effective. A joint initiative between a college of nursing and an acute hospital Trust was formed to develop an Evidence Based Practice course. The course aimed to achieve a clear and identifiable outcome that could be used to enhance patient care. Before starting the course the students identified a clinically related question to explore. The course itself introduced the concept of evidence based practice, emphasising the practical skills of information searching and retrieval and of dissemination techniques. The course culminated in a formal presentation, attended by clinical and education staff, and management, including non-executive directors. Discussion followed each presentation to debate how the changes suggested could be implemented, including what resources might be needed. This paper will discuss the development of the course, its content and the benefits for the students, the sponsoring Trust and for patient care. Examples will be given to illustrate the success of the initiative and discussion will take place around the importance of the close partnership that has to be forged between the Trust and college.