Can non-clinical community placements enhance medical students' understanding of the social determinants of ill health?

OBJECTIVES: Teaching the social determinants of health using classroom methods and medical settings is not effectual, yet few institutions require students to undertake placements in non-clinical settings. We sought to understand through qualitative investigation how non-clinical community placements contributed to students' understanding of health disparities. STUDY DESIGN: Qualitative methods. METHODS: Semistructured interviews with eight purposively selected students and a focus group were conducted by an independent, non-medical and non-religiously affiliated researcher. A thematic analysis elicited key themes and findings. RESULTS: On analysis, students valued the placements, reporting a greater understanding of and empathy for the needs of people from marginalised socio-economic, cultural and ethnic groups. Some believed this was better gained in non-clinical settings where doctor-patient barriers were absent. CONCLUSIONS: Non-clinical community placements may provide a special opportunity to teach health determinants and cultural competence to medical students.

Health and pink-collar work.

BACKGROUND: In recent years, there has been a decline in the manufacturing sector of the UK economy with a corresponding growth of service-orientated pink-collar jobs in some regions. While the health outcomes of white- and blue-collar workers are well-established, less is known about this emerging pink-collar group. AIMS: To outline the health of pink-collar workers in comparison to their white-collar counterparts across a range of indicators. METHODS: Area-level percentages for white-, pink- and blue-collar workers were derived from residents' routinely collected employment data in a northern English town. Area-level health data pertaining to male and female life expectancy, respiratory deaths and deaths from cardiovascular and circulatory causes (all age and under 75 years) were obtained from the local authority and public health observatory. Multivariate regression analyses were performed to assess relationships between job collar and health. RESULTS: When adjusted for deprivation, areas with higher percentages of pink-collar workers experienced lower rates of death from circulatory disease under the age of 75 in comparison to white-collar workers. Other relationships between collar status and health outcomes were not statistically significant. CONCLUSIONS: The reasons underlying the apparent protective effect of pink-collar status for deaths from circulatory disease are uncertain and merit further study. Possibilities include differences in age, exposure to occupational hazards and lifestyle behaviours. Our work has a number of limitations and longitudinal studies with detailed exposure data should assess the long-term health outcomes of these workers using agreed definitions.

Associations Between Family of Origin Climate, Relationship Self-Regulation, and Marital Outcomes.

Using dyadic data from 961 married couples from the Relationship Evaluation Questionnaire project, the current study explored the direct association between family of origin climate and marital outcomes and the indirect association via relationship self-regulation (RSR). Results from the actor-partner interdependence model analysis indicated that family of origin climate was positively associated with marital stability directly and indirectly via the effects of RSR and marital satisfaction for both men and women. Results suggest that the experience one has in their family of origin is associated with their marital outcomes through their RSR. Actor-partner direct and indirect effects indicate that spouses' RSR may have important consequences for both partner's evaluation of the marriage. Implications for intervention and future research are discussed.

Veterinary medical student well-being: depression, stress, and personal relationships.

Existing research consistently connects higher relationship satisfaction with improved psychological and physical functioning. Investigations focusing on relational satisfaction within veterinary medicine have been sparse. This study evaluated 240 veterinary medical students at Kansas State University. Results indicate that students within higher-functioning relationships are more likely to report fewer depressive symptoms, lower stress associated with balancing their school and home lives, less relationship conflict, better physical health, and improved ability to cope with academic expectations, while at the same time experiencing more stress from being behind in studies. Based on these findings, Colleges of Veterinary Medicine (CVMs) are encouraged to institute policies and programs which foster relationship-building for students.

Type 1 diabetes: children and adolescents' knowledge and questions.

AIM: This paper is a report of a study conducted to describe what children and adolescents who have type 1 diabetes know and want to know about the disease. BACKGROUND: Research indicates that young people's knowledge of diabetes may minimize their health complications, because with greater knowledge they may engage in more effective management practices and adherence. METHODS: In this qualitative study, a purposive sample of 58 children and adolescents with type 1 diabetes were interviewed in 2005 about what they knew and wanted to know about their disease. Through a process of induction, major themes were identified from the data. FINDINGS: The six major themes were: (a) Care, including both physical and emotional care, (b) Physiology, (c) Consequences, including both short- and long-term, as well as positive and negative consequences, (d) Cure, (e) Effects on the Family and (f) Experience at Diagnosis. Themes related to the unique challenges associated with type 1 diabetes were also identified. CONCLUSION: Nurses, diabetes educators and parents should provide developmentally appropriate information about diabetes care and management, scaffolding on existing knowledge. They should provide child-centred contexts in which children and adolescents can freely ask questions about their condition and problem-solve. Programmes that allow young people to develop coping skills and share experiences could also prove beneficial.

An in vitro investigation into conformational aspects of gabapentin.

Conformational analysis of constrained cyclohexane systems was pioneered fifty years ago by Barton and Hassel. We now report an investigation based on a conformational analysis of a number of novel cyclohexane based Gabapentin analogues coupled with their in vitro evaluation at the Gabapentin binding site. These data are used to propose a possible binding conformation for Gabapentin.

Screening older patients for obstructive airways disease in a semi-rural practice.

BACKGROUND: Obstructive airways disease in older patients is reported to be not only common, but frequently overlooked and untreated by general practitioners. This study examines the value of screening elderly patients in a large semi-rural general practice for potentially treatable asthma and chronic obstructive pulmonary disease (COPD). METHODS: A random sample of 353 patients aged 60-75 years attended a nurse run screening clinic for pulmonary function testing, serial peak flow recording, and completion of a symptom questionnaire. Patients with a low forced expiratory volume in one second (below the fifth centile of their predicted value) or >15% mean diurnal variation in peak flow were referred to a doctor's clinic for further diagnostic assessment and/or to discuss possible treatment where appropriate. RESULTS: Fifty eight patients (16.4%) had obstructive airways disease, the prevalence of asthma being 6.5% and that of COPD 9.9%. Of these, 30 had no previous diagnosis of airways disease and were not on treatment; eight of them had significant airways reversibility and 10 were current smokers. No newly diagnosed patients had severe disease as measured by pulmonary function or quality of life assessment, and six patients accepted treatment. CONCLUSION: Few older patients benefited from a screening programme for obstructive airways disease in a semi-rural general practice.

Identification of novel ligands for the gabapentin binding site on the alpha2delta subunit of a calcium channel and their evaluation as anticonvulsant agents.

As part of a program to investigate the structure-activity relationships of Gabapentin (Neurontin), a number of alkylated analogues were synthesized and evaluated in vitro for binding to the Gabapentin binding site located on the alpha2delta subunit of a calcium channel. A number of other bridged and heterocyclic analogues are also reported along with their in vitro data. Two compounds showing higher affinity than Gabapentin were selected for evaluation in an animal model of epilepsy. One of these compounds, cis-(1S,3R)-(1-(aminomethyl)-3-methylcyclohexyl)acetic acid hydrochloride (19), was shown to be effective in this model with a profile similar to that of Gabapentin itself.

A new fossil fern assignable to Gleicheniaceae from Late Cretaceous sediments of New Jersey.

The recent discovery of well-preserved charcoalified rhizomes, petioles. pinnules, sori, and spores from the Upper Cretaceous of New Jersey provides the basis for the description of a new gleicheniaceous fern, Boodlepteris turoniana. The fossils were collected from unconsolidated sediments of Turonian age (~90 MYBP million years before present; Raritan/ Lower Magothy Formation, Potomac Group). These deposits are rich in angiosperms, but also have a limited representation of fern and gymnosperm remains. Fossil specimens from this locality are particularly remarkable in that minute detail, including anatomical features, are often preserved. Some Boodlepteris specimens have cell by cell preservation that reveals the nature and structure of the stele in rhizomes and petioles, and others show minute details of the sori borne on fertile pinnae. Although these specimens are not in organic connection, there are sufficient structural and anatomical details preserved to confidently suggest that they belong to the same taxon. Cladistic analysis of the fossils, both separately and as a reconstruction, support assignment of Boodlepteris to the extant family Gleicheniaceae.

Alanine scan and N-methyl amide derivatives of Ac-bombesin[7-14]. Development of a proposed binding conformation at the neuromedin B (NMB) and gastrin releasing peptide (GRP) receptors.

Alanine and N-methylation scans together with molecular modelling were implemented in order to propose a binding conformation of the minimum active fragment of bombesin (BB), Ac-BB[7-14], to the gastrin releasing peptide (GRP) and neuromedin B (NMB) receptors. These data are also used to critically evaluate the previously proposed binding conformations such as alpha-helix and antiparallel beta-sheets. This shows that the previously reported conformations do not satisfy the experimental data. A new binding conformation of Ac-BB[7-14] is proposed consisting of three consecutive gamma-turns followed by a bend and finishing with two gamma-turns. This low energy conformation (analogous to a fragment of thymidylate synthase, 2TSC) of bombesin stabilized by five internal hydrogen bonds, and with the side chains of residues Trp8 and Leu13 held on the same side of the peptide, is in agreement with the experimentally observed data. This and the results of molecular modelling may aid in the synthesis of conformationally restricted high affinity bombesin analogues and/or high affinity template-based GRP or NMB receptor agonists and antagonists.

Advantages of an increased dose of MRI contrast agent for enhancing inflammatory synovium.

MRI intravenous contrast enhancement of inflammatory synovium has been studied at two different doses to determine to what extent enhancement is dose dependent. 19 patients with clinically active rheumatoid arthritis involving a knee were scanned twice, one week apart, using 0.1 mmol/kg of gadoteridol (ProHance) on the first occasion and 0.3 mmol/kg on the second. Static pre-and post-contrast images together with dynamic images immediately following injection were obtained on a 1.0T scanner. On subjective assessment, 84% of patients showed improved enhancement. 47% showed more enhancing tissue, a clearer delineation of enhancing tissue or both. Objectively, enhancement was increased significantly at the higher dose, as judged by the percentage increase in mean signal intensity within regions of interest plotted over the suprapatellar pouch (1723% v. 1005% enhancement P < 0.05). In practical terms the better visualization of enhancing tissue achieved with higher doses is likely to reduce margins of error in attempts at quantification from MRI scans, particularly of synovial volume, but emphasizes also the need for care and consistency to be exercised in calculating the exact dose of contrast medium to be administered.

'Targeted' molecular diversity: design and development of non-peptide antagonists for cholecystokinin and tachykinin receptors.

A drug design strategy to non-peptide small molecule antagonists of neuropeptides is described that targets the molecular diversity which exists in the 'privileged' data set of the physico-chemical properties represented by the side-chains of the 20 genetically encoded amino acids. The strategy is exemplified by the design of a selective and high affinity cholecystokinin CCK-A antagonist PD 140548, CCK-B antagonist CI-988 (formerly PD 134308) tachykinin NK-1 antagonist PD 154075 and NK-2 antagonist Cam-2291. The NK-3 antagonists, PD 157672 and the non-peptide PD 161182, were developed from an information-rich dipeptide library constructed from 256 N-protected dipeptides and 64 hydrophobic biased dipeptides.

Use of a dipeptide chemical library in the development of non-peptide tachykinin NK3 receptor selective antagonists.

The use of a dipeptide library as the source of a micromolar chemical lead compound for the human tachykinin NK3 receptor is described. The screening of a dipeptide library through a cloned human NK3 receptor binding assay resulted in the identification of Boc(S)Phe(S)PheNH2 (1), which has subsequently been developed, following a 'peptoid' design strategy, into a series of high-affinity NK3 receptor selective antagonists. The structure-activity relationship of the C-terminal portion of this dipeptide lead was first explored and led to the identification of the urea derivative Boc(S)Phe(R)alphaMePheNH(CH2)7NHCONH2 (41, PD157672). This modified dipeptide has a Ke of 7 nM in blocking senktide-induced increases in intracellular calcium levels in human NK3 receptors stably expressed in CHO cells. Subsequent optimization of the N-terminal BocPhe group and the alphaMePhe residue side chain of 41 led to the identification of [S-(R*,S*)]-[2-(2,3-difluorophenyl)-1-methyl-1-[(7-ureidoheptyl)ca r bamoyl]ethyl]carbamic acid 2-methyl-1-phenylpropyl ester (60, PD161182), a non-peptide NK3 receptor selective antagonist. Compound 60 blocks the senktide-evoked increases in intracellular calcium levels in cloned human NK3 receptors stably expressed in CHO cells with Ke of 0.9 nM.

The design of dipeptide helical mimetics: the synthesis, tachykinin receptor affinity and conformational analysis of 1,1,6-trisubstituted indanes.

The design and synthesis of conformationally constrained, nonpeptide templates (1,1,6-trisubstituted indanes) which allow the incorporation of two adjacent amino acid side chains, plus a third binding group in an orientation similar to that found in alpha-helices are reported. Six racemic and two homochiral Phe-Phe and Trp-Phe mimetics were synthesised and evaluated in tachykinin receptor binding assays as molecular probes for the binding conformation of the endogenous peptides. Several were found to bind with micromolar affinity to the NK1 and/or NK3 receptor. The conformation of one of the homochiral indanes, (1R)-N-((S)-1-hydroxymethylbenzyl)-1,6-dibenzylindan-1-carbo xamide, was analysed by X-ray crystallography and was found to be in an alpha-helix conformation.

Atrio-ventricular dissociation in meningococcal meningitis.

A case is presented of meningococcal meningitis, without septicaemia, which was associated with a transient atrio-ventricular dissociation. The need for cardiac monitoring in similar cases is discussed.