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The mini-internship program cultivates relationships and influence with government officials and other important leaders. Because of the educational experience of seeing the process of medical practice from the inside, hopefully, those who decide how Mississippi health care delivery will be structured are better prepared to make those policy decisions. Sample letters are available to help get your component society started (@MSMAonline.com). For additional infomration about SRH's mini-internship program contact: Cindy Seymour, Singing River Medical Society, Telephone (602) 246-8901 or Karen Evers, Managing Editor (601) 853-6733. Sample initations, letters, and forms can be found on our website: @MSMAonline.com.

The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute are pleased to present the 2011 County Health Rankings, a collection of 50 reports, that reflect the overall health of counties in every state across the country. For the second year in a row, counties can get a snapshot of how healthy their residents are by comparing their overall health and the factors that influence their health with other counties in their state. This allows communities to see county-to-county where they are doing well and where they need to improve. The rankings, based on the latest data available for each county, is the only tool of its kind that measures the overall health of each county in all 50 states on the multiple factors that influence health. It includes snapshots of nearly every county with a color-coded map that compares each county's overall health with other counties in each of the 50 states. People can compare how their county is doing in areas like diabetes screening rates or number of uninsured adults to national benchmarks. Published on-line at www.countyhealthrankings. org by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, the rankings help counties understand what influences how healthy residents are and how long they will live. The rankings look at a variety of measures that affect health such as the rate of people dying before age 75, high school graduation rates, access to healthier foods, air pollution levels, income, and rates of smoking, obesity, and teen births. For a more detailed explanation of the approach and methods used to compile the rankings, information on the action steps communities can take to improve their health, and examples of communities in action, see www.countyhealthrankings.org.

We examined recalled measures of adolescent diet, physical activity, and body size in relation to adult breast density in 201 U.S. Chinese immigrant women recruited in January 2002 to May 2003 from Philadelphia region screening programs. Mammographic images were classified into 1 of 4 categories ranging from "entirely fatty" to "extremely dense." Questionnaires assessed diet and physical activity between ages 12-17, relative weight and height at age 10, and weight at age 18. To estimate odds ratios (ORs), we conducted logistic regression analyses using proportional odds models for polychotomous outcomes. Higher adult breast density was significantly associated with adolescent red meat intake (adjusted 3rd vs. 1st tertile OR = 3.0, 95% confidence interval (CI) 1.5-6.4, trend P = 0.003) but not with other adolescent factors. For the association of adult acculturation with breast density, adjustment for adolescent red meat intake attenuated the OR for the highest vs. lowest level of acculturation from 2.5 (95% CI 1.2-5.3) to 1.9 (95% CI 0.9-4.0). Greater adolescent red meat intake may have increased adult breast density and partly accounted for the strong association between acculturation and breast density in this sample of immigrant Chinese women. If confirmed by further study, dietary prevention efforts for breast cancer should be considered earlier in life.

Background: Women with a family history of breast cancer may be at higher risk for breast cancer, but few previous studies evaluating diet and breast cancer have focused on such women. The objective of the present study was to determine whether diet, a modifiable risk factor, is related to breast density among women at high genetic risk for breast cancer., Methods: Women with at least one first-degree or second-degree relative with breast cancer or ovarian cancer participating in the Fox Chase Cancer Center Family Risk Assessment Program completed health history and food frequency questionnaires and received standard screening mammograms. Cranial-caudal mammographic images were classified into the four Breast Imaging Reporting and Data System categories ranging from 'entirely fatty' to 'extremely dense'. Logistic regression analysis using proportional odds models for polychotomous outcomes provided estimates of odds ratios for having a higher category versus a lower category of breast density., Results: Among 157 high-risk women, breast density was inversely associated with vitamin D intake (odds ratio for third tertile versus first tertile, 0.5; 95% confidence interval, 0.2-1.0). In contrast, intakes above the median level for protein (odds ratio, 3.0; 95% confidence interval, 1.3-6.9) and above the median level for animal protein (odds ratio, 4.3; 95% confidence interval, 1.8-10.3) were associated with higher breast density, but only among women whose family history did not reflect a known familial cancer syndrome or a breast cancer predisposition gene., Conclusion: For women with a strong family history that was not associated with known cancer syndromes, dietary factors may be associated with breast density, a strong predictor of breast cancer risk. Since women with strong family history are often very motivated to change their lifestyle habits, further studies are needed to confirm whether changes in diet will change the breast density and the subsequent onset of breast cancer in these women.

The role of acculturation in the breast cancer risk increase among U.S. Chinese women is unclear. We examined the association between acculturation and breast density in a sample of foreign-born, U.S. Chinese women and examined factors that may explain such an association. Between January 2002 and May 2003, 212 Chinese women were recruited from Philadelphia region screening programs. Cranial-caudal mammographic images were classified into one of four categories ranging from "entirely fatty" to "extremely dense." Questionnaires assessed information on sociodemographic, cultural, reproductive, and lifestyle factors. An index of acculturation was created based on self-reported English proficiency and within- and cross-ethnicity social interactions. To estimate odds ratios (OR) for falling into a higher versus lower category for breast density, we conducted logistic regression analysis using proportional odds models for polychotomous outcomes. We found that women in the highest acculturation category had denser breasts [age-adjusted OR, 3.1; 95% confidence interval (95% CI), 1.6-6.0]. They also had fewer live births, higher age at first live birth, and higher dairy food intake, all factors associated with breast density. In 196 women with complete covariate data, only adjustment for number of live births and dairy food intake attenuated the estimate for acculturation by >10%. With adjustment for both simultaneously, the most acculturated women were still more likely to have denser breasts (age- and menopause-adjusted OR, 2.0; 95% CI, 1.0-4.2). These analyses are the first to show breast density differences by level of acculturation among foreign-born, U.S. Chinese women. Despite reproductive and lifestyle differences by level of acculturation, differences in these factors did not explain the acculturation-breast density association. Future longitudinal research will examine whether the association is due to early-life factors, postmigration lifestyle changes, or perimenopausal exposures.

Purpose: To describe a case of transient lingual and hypoglossal nerve damage following intubation for a trans-sphenoidal hypophysectomy., Clinical Features: A 56-yr-old acromegalic man was scheduled for trans-sphenoidal hypophysectomy. He had been treated with octreotide six months previously which had reduced the swelling of the tongue to an acceptable degree to the patient. During the anesthetic procedure there were no problems. The intubation was performed without any difficulty, no force had been used to place the endotracheal tube, a throat pack was inserted and, before extubation, an oro-gastric tube was inserted. Three days after surgery the patient complained of numbness and swelling of the left side of the tongue, he had difficulty in moving the tongue, speaking difficulties and problems in swallowing food were noted. Also taste was lost on this side of the tongue. Left lingual and hypoglossal nerve damage was diagnosed, which was confirmed by the neurologist. After four months of intensive physiotherapy and speech therapy, the symptoms disappeared., Conclusion: This is a report of a very rare complication of lingual and hypoglossal nerve damage in an acromegalic patient. This incident suggests forceful laryngoscopy, hyperextension of the head and the throat pack (tightly packed in the oropharynx) can result in injury of the lingual and the hypoglossal nerves.

The number of people awaiting a life-saving transplant far outweighs the number of organs available for transplantation. Our organ procurement organization sought to identify the non-heart-beating donor potential at a large urban level 1 trauma center. We modified the death-record reviews for a 2-year period and determined that a total of 23 patients who expired were suitable for non-heart-beating donation. Therefore, it can be hypothesized that if all large urban level 1 trauma centers participated in non-heart-beating donation, more organs would be available for transplantation.

Perforated peptic ulcers are usually managed surgically after failure of more conservative medical treatment of ulcer disease. This case illustrates transnasogastric placement of a drainage catheter through a perforated ulcer, which was successful as definitive therapy.

The peroral pneumocolon examination is a method for obtaining a double-contrast image of the terminal ileum and right colon by insufflating air through a small catheter inserted into the rectum when orally ingested barium reaches the right colon. The examination is indicated if a detailed view of the ileocecal region is required, particularly when inflammatory bowel disease is suspected, when polyps are present in the right colon, or when patients are unable to tolerate barium enema studies.

Patients with esophageal symptoms following drug ingestion underwent double-contrast upper gastrointestinal studies, and radiographic findings are described. Superficial esophageal ulceration and subtle mucosal abnormalities, which have not been seen on single-contrast radiographs, were confirmed on double-contrast radiographs. Erosions or ulcers usually occur in the region of the aortic arch and occasionally lower in the esophagus. Repeat esophagrams after withdrawal of the medication indicate resolution of the symptoms.