Inclusivity and decolonisation of the post-graduate public health curriculum: Reflections from a student-led approach.

The future of successful public health practice requires public health students to be educated within a decolonised curriculum that challenges the historical biases and inequalities that are deeply embedded within global public health and society. In this commentary, we reflect on what it can mean and why it's important to decolonise and diversify a public health curriculum. We describe how we used a student-led approach to begin this process, and share recommendations that are applicable to national and international curricula.

Looking in the mirror for the first time after facial burns: a retrospective mixed methods study.

Appearance-related concerns are common following burns. However, there is minimal research that has specifically investigated patients' reactions when they looked in the mirror for the first time following facial burns. The current study aimed to investigate patients' reactions and factors associated with distress. Burns patients (n=35) who had sustained facial injuries completed a questionnaire which examined their reactions when looking in the mirror for the first time. Data were collected between April and July 2013. Participants had sustained their burns 12 months prior to participating, on average (ranging from one to 24 months). Forty-seven percent (n=16) of patients were worried about looking for the first time, 55% (n=19) were concerned about what they would see, and 42% (n=14) held negative mental images about what their faces looked like before they looked. Twenty-seven percent (n=9) of patients initially avoided looking, 38% (n=13) tried to 'read' others' reactions to them to try to gauge what they looked like, and 73% (n=25) believed that it was important for them to look. Mean ratings suggested that patients found the experience moderately distressing. Patients most often found the experience less distressing compared to their expectations. Distress was related to feeling less prepared, more worried and increased negative mental images prior to looking. In conclusion, patients' reactions to looking in the mirror for the first time vary. Adequately preparing patients and investigating their expectations beforehand is crucial. The findings have a number of important implications for practice.

A qualitative study of patients' motivations and expectations for dental implants.

OBJECTIVE: To explore patients' motivations and expectations for dental implants. DESIGN: Single-setting, qualitative interview study. SUBJECTS, SETTING AND METHOD: Semi-structured, telephone interviews were conducted with nine patients who had consulted a restorative dental practitioner with an interest in implantology about the possibility of replacing their missing teeth with dental implants. OUTCOME MEASURE: Interview transcripts were subjected to thematic analysis to identify relevant themes. RESULTS: The main theme to emerge was 'normality'. Participants expected implants to restore their oral-related quality of life to 'normal'. However, individual definitions of normality differed; some were appearance focused, while others were more concerned with functioning. Several participants who had completed implant treatment regarded their new prostheses as 'just like natural teeth'. CONCLUSIONS: Patients' belief that dental implants are just like natural teeth could be cause for concern if it leads them to treat them as such, and thereby not follow the recommended specialist care they require. The findings emphasise the importance of good dental practitioner-patient communication in assessing expectations of treatment and outcomes. Further studies should explore the expectations of patients of different ages and socioeconomic backgrounds and consider ways of eliciting patients' beliefs about implants before treatment takes place.

Male circumcision for HIV prevention in Papua New Guinea: a summary of research evidence and recommendations for public health following a national policy forum.

In 2005, a clinical trial in South Africa found that circumcision of young men could reduce their risk of acquiring HIV (human immunodeficiency virus) infection by over 60%. In the following year, two more trials in Africa confirmed this finding, leading the World Health Organization to recommend male circumcision as a public health strategy for HIV prevention in high-incidence countries. In order to inform public health policy in Papua New Guinea (PNG), two major research projects were initiated with the goals of investigating the status of penile cutting practices and assessing understandings, acceptability, feasibility and cost-effectiveness of male circumcision for HIV prevention. In addition, behavioural surveillance surveys systematically asked questions on penile cutting practices and an ethnographic literature review informed historical perspectives of penile cutting in PNG. Key findings from these research activities were presented at a National Policy Forum on Male Circumcision for HIV Prevention held in Port Moresby in November 2011. The Forum made three key recommendations: (1) the formation of a joint National Department of HealthlNational AIDS Council Secretariat Policy Committee on male circumcision; (2) the establishment of an integrated harm reduction program; and (3) that future policy on wide-scale roll-out of male circumcision for HIV prevention in PNG be informed by a combination of data from (a) male circumcision intervention pilot programs and (b) research on the potential protective effect of other forms of penile cutting.

Consumption of carbonated drinks in adolescents: a transtheoretical analysis.

BACKGROUND: Adolescents consume a high level of carbonated drinks and this may have significant adverse effects for their weight and oral health. Therefore, we examined the application of key constructs of the Transtheoretical Model (stages of change, decisional balance and self-efficacy) and health as a value (both general and oral) to adolescent carbonated drink consumption and to identify any gender differences. METHODS: A total of 399 adolescents (mean age 12.57 years, SD=1.54) completed a questionnaire measuring: stage of change, decisional balance, self-efficacy, carbonated drink consumption and attitudes to health and healthy teeth. RESULTS: Over half of the adolescents (55%) were classified into one of the pre-action stages (i.e. precontemplation or contemplation) and males were more likely to be represented in the precontemplation stage than females. Significant associations with stage of change, decisional balance and self-efficacy were found, though there was no association with attitudes to health (general or oral). CONCLUSION: The findings suggest that the Transtheoretical Model (and its key constructs) may be a useful framework through which more tailored health promotion interventions can be designed.

The Huntington's disease quality of life battery for carers: reliability and validity.

Research into the experience of the Huntington Disease (HD) spousal carer has established that carers experience several unique obstacles within their care-giving role. However, there is still a need to establish methodically the factors that impact on the HD spousal carers' situation and ultimately their quality of life. The aim of this pilot study, which was a result of three previous exploratory studies, was to validate a HD-specific quality-of-life (QoL) measure, the Huntington disease quality-of-life battery for carers (HDQoL-C) for use (initially) with spousal carers of HD patients. Eighty-seven HD spousal carers took part in the piloting of the HDQoL-C to assess its reliability and validity as a tool for use within QoL research. Results established the HDQoL-C as a multidimensional and psychometrically sound disease-specific and subjective QoL assessment tool that incorporates the individual's physical health, psychological state, level of independence, social relationships and personal beliefs. The HDQoL-C demonstrates good internal consistency, test-re-test reliability and congruent validity.

Development of a computerised dental anxiety scale for children: validation and reliability.

OBJECTIVE: To provide reliability and validity data on a computerised dental anxiety scale (the Smiley Faces Program or SFP) for children using faces as a response set. SETTING: Five schools across Derby, Newcastle-upon-Tyne and Shropshire. SUBJECTS AND METHOD: The SFP was completed by 464 children (mean age 10.8 years). For validity purposes, 241 children also completed two other children's dental anxiety measures (the Modified Child Dental Anxiety Scale and the Dental Fear Survey). For test-retest purposes 100 of the children completed the SFP two weeks later. RESULTS: The SFP demonstrated good internal consistency (alpha = 0.8), test-retest reliability was good and significant correlations were found between the SFP and the other measures. The children rated the local anaesthetic and drill as the most anxiety-provoking items. CONCLUSION: This study suggests that the SFP is a valid and reliable measure for assessing children's trait dental anxiety and may help encourage dentists to formally assess dental anxiety.

Prevalence of faecal excretion of verocytotoxigenic Escherichia coli O157 in cattle in England and Wales.

During the decade to 1999, the incidence of human infections with the zoonotic pathogen verocytotoxin-producing Escherichia coli O157 (VTEC O157) increased in England and Wales. This paper describes the results of a survey of 75 farms to determine the prevalence of faecal excretion of VTEC O157 by cattle, its primary reservoir host, in England and Wales. Faecal samples were collected from 4663 cattle between June and December 1999. The prevalence of excretion by individual cattle was 4.2 per cent (95 per cent confidence interval [CI] 2.0 to 6.4) and 10.3 per cent (95 per cent CI 5.8 to 14.8) among animals in infected herds. The within-herd prevalence on positive farms ranged from 1.1 to 51.4 per cent. At least one positive animal was identified on 29 (38.7 per cent; 95 per cent CI 28.1 to 50.4) of the farms, including dairy, suckler and fattening herds. The prevalence of excretion was least in the calves under two months of age, peaked in the calves aged between two and six months and declined thereafter. The phage types identified most widely were 4, 34 and 2, which were each found on six of the 29 positive farms.

Self-report treatment techniques used by dentists to treat dentally anxious children: a preliminary investigation.

OBJECTIVE: To investigate the extent to which dentists report their encouragement to dentally anxious children to blunt (distract from the procedure) or monitor (give information about the procedure) during treatment. SETTING: British Society of Paediatric Dentistry conference. SUBJECTS AND METHODS: One hundred and two of 155 delegates (66% response rate) completed a Monitor Blunter Treatment Checklist (MBTC), which was included in their conference pack. Participants were asked to tick all of the 10 statements (five monitoring and five blunting) that reflected how, in general, they would treat a dentally anxious child. RESULTS: Dentists chose significantly more monitoring than blunting statements. Treatment strategies relating to explaining procedures were endorsed by the majority of dentists, while distraction was chosen by less than a third. CONCLUSION: Dentists tend to use monitoring strategies that adhere generally to the principles of the Tell-Show-Do technique. This may have implications if the anxious child has a 'blunting' coping style.

Validation of a Facial Image Scale to assess child dental anxiety.

OBJECTIVE: To examine the validity of a scale that uses faces as an indicator of children's dental anxiety. SETTING: Department of Child Dental Health waiting room, Newcastle Dental Hospital. SUBJECTS AND METHODS: 100 children (aged 3-18 years) completed the Facial Image Scale (FIS) and the Venham Picture Test (VPT) in the dental hospital waiting room. RESULTS: A strong correlation (0.7) was found between the two scales, indicating good validity for the FIS. Findings also showed that a small, but significant, number of children are anxious in the dental context. CONCLUSION: The findings suggest that the FIS is a valid means of assessing child dental anxiety status in a clinical context.

Butorphanol tartrate acts to decrease sow activity, which could lead to reduced pig crushing.

The objective of this study was to determine whether administration of an analgesic to sows immediately after farrowing would allow them to lie more restfully. Sows lying on their pigs, causing them to be "crushed," is a major cause of pig mortality. Most deaths due to crushing occur during the first 3 d postpartum. For modern, lean-type sows, farrowing crates are relatively hard and unforgiving, even though they may be equipped with plastic-coated, expanded metal flooring. Indeed, many sows develop pressure sores on their shoulders, and this may contribute to the sows' discomfort. These sores may cause a sow to change position frequently to alleviate pain, thus increasing its chances of crushing pigs. Sixteen production sows were assigned to either a control group (C, n = 8) with litter size 11.71+/-.78 or an experimental group (B, n = 8) with litter size 11.63+/-1.22. Pigs born to C and B sows weighed 1.60+/-.04 and 1.37+/-.04 kg, respectively. The C sows were given no treatment, whereas the B sows were administered an i.m. injection of butorphanol tartrate at a dose of .15 mg/kg BW every 6 h until 3 d after farrowing. Data were collected on all sows using time-lapse photography (1 frame/.4 s) for a 3-d duration upon the initiation of farrowing. To assess the degree of comfort of each sow, body position changes were recorded when sows switched between lying, sitting, and standing. Data were analyzed by 12-h periods using Wilcoxon-Mann-Whitney equations. During the 72-h period, B sows tended to perform fewer position changes than C sows (P = .10). Specifically, position changes were fewer for B sows from 48 to 72 h postpartum (P<.06). There were no differences in position changes between treatments from 0 to 48 h postpartum (P>.50). There was no difference in the rate of crushing between treatments (C = 5, B = 5). The butorphanol did not seem to affect pig activity or normal behaviors or to create adverse effects, such as diarrhea. Although the sows given butorphanol showed a reduced number of position changes, the dose was intermediate, and a higher dose may have a greater effect. If pig mortality can be decreased, an analgesic protocol that is simple to administer and readily available to producers can be developed. Alternatively, using of more pliable flooring or an increase in sow body fat may allow sows to lie more stationary.

Danger to pigs due to crushing can be reduced by the use of a simulated udder.

Sows that lie on their young, pig "crushing", is a significant cause of pig mortality in current production systems. Although mortality rates of pigs in farrowing crates are lower than mortality rates of pigs in pens, loss due to crushing is still estimated to be between 4.8 and 18%. During the first few days after parturition, pigs are highly attracted to the odor of their dam's udder. Thus, our research was designed to move the pigs away from the sow by competing with the sow's udder using a "simulated" udder. Fifteen Yorkshire x Landrace sows and their litters (11.4+/-.78 pigs) were assigned to either a control (C, n = 9) or an experimental group (SU, n = 6). The C pigs had access to a heat lamp, whereas the SU pigs' crate had a simulated udder. Data were collected using time-lapse photography (1 frame/.4 s) for a 3-d duration at the initiation of farrowing. When a sow stood, data were recorded by 1-min scan samples to record the number of pigs using either the heat lamp or the simulated udder. In addition, stillborn pigs, pig crushing, and death by other means also were recorded. Data were analyzed by 12-h periods using generalized estimating equations. Results indicate that from 12 to 72 h postpartum, excluding 24 to 36 h postpartum, the estimated probability that pigs were in a safe area (simulated udder or heat lamp) was .89 for SU pigs, compared with only .72 for C pigs (P = .005). During the 24- to 36-h period, it was more probable to find pigs on a simulated udder (.77) than under only a heat lamp (.61, P = .016). Stillborn pigs, pig crushing, and death by other means were not different between treatments (mean = .87, .60, 1.2; P>.20). The simulated udder drew pigs away from the sow's udder better than heat lamps alone. Considering these findings, mortality of pigs due to crushing may be decreased substantially using a simulated udder. These results are promising, but further refinement should be done, including improved udder design and investigation of the attractiveness of various stimuli.

MBC / UNAIDS / SPC Pacific Islands AIDS / STD strategic planning. Project update.

PIP: This article presents an update of the Pacific Islands AIDS/sexually transmitted disease (STD) Strategic Planning Project. It also provides specific stories on the strategic planning experiences and achievements of four countries namely New Caledonia, Kiribati, Solomon Islands, and Nauru. The project began in 1998 when 17 Pacific Island countries participated in a workshop where each country developed an action plan which contained the following common elements: 1) a plan on how to integrate the strategic planning process into existing structures for HIV/AIDS activities; 2) strategies to gain political and other organizational support into HIV/AIDS and STD planning; 3) a summary of the factors contributing to HIV and STD risk; and 4) a review of what has been done to address these problems. In 1999, these plans were put into action. Each country was challenged at the planning and execution of situational analysis and response review. A project review conducted in June 1999 resulted in a decision to hold individual country workshops in the future which will allow more participants and facilitators to concentrate their efforts on developing an individual strategic plan for each country.^ieng