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Institution wide comparisons of students who leave university before completing their degree and students who complete their studies, have identified "wrong course selection" and a lack of vocational focus as common reasons for non-completion. It is not fully understood, though, whether these trends are constant across different disciplines and programs and whether all relevant contributing factors, in particular career intentions, have been considered. This study was undertaken to explore reasons for student non-completion in more detail in one program. Students enrolled in an undergraduate health sciences degree completed a questionnaire at enrolment and another 12 months later, regarding their reasons for enrolment, career intentions and expectations for/experiences of learning. Students who did not re-enrol after the first year were invited to complete a separate exit questionnaire regarding their reasons for not re-enrolling. Many students who did not re-enrol after the first year of study transferred to another degree that was more aligned with their career intentions. In this context rather than a "wrong" selection, non-completion of the initial undergraduate degree formed part of a career plan. (Contains 6 tables.)

Despite a profusion of recommendations regarding the quality of web sites and guidelines related to ethical issues surrounding health-related sites, there is little guidance for the design and evaluation of sites relating to loss and grief This article, which addresses these deficiencies, results from a community consultation process of designing and evaluating a web site--GriefLink--for bereaved consumers and for the professionals who help them. It presents the literature review that informed the project, the recommendations for design and content, the lessons learned through the process itself, and the difficulties of evaluating the benefits of a grief-related web site. Some ethical and legal dilemmas in developing grief-related web sites are discussed and issues of design, content, process, evaluation, and general features are addressed, which may also be applied to other communication forms for loss and grief matters, such as the print media. [ABSTRACT FROM AUTHOR]

Specific IgE measurements obtained from patients suffering from respiratory allergy (n = 952) show that, despite similar climatic conditions, there are clear regional differences in pollen sensitization between North Rhine-Westphalia and Bavaria. The data on sensitization levels and pollen concentration was taken from the research and development project Ufoplan 3710 61 228 of the German Environment Agency for North Rhine-Westphalia and Bavaria (2011 - 2014). Most poly-sensitized patients have already shown sensitization, both in the form of cross-reactivity and species-specific sensitization, to "new" pollen allergens, such as Bermuda grass and olive tree. These plants are currently not common in Germany, but may become considerably more widespread due to the increase in average yearly temperatures caused by the global warming. The other "new" aeroallergens discussed here are plants that can be found throughout Germany, such as nettle, cypress, and pine. Their current sensitization levels are higher than 8%; however, their clinical impact appears to be underestimated. For clinical practice it is important to identify when patients' symptoms are typically severe and which regional plants might be responsible for the patients' complaints in this period of time, as this affects further diagnostic strategy. Allergens having an immune effect can then be targeted by specific immunotherapies. The information on complaints of the patients should be regularly recorded in symptom diaries. Recording this information for at least 1 year may allow to discover a correlation between specific types of pollen and allergy symptoms., (© Dustri-Verlag Dr. K. Feistle.)

Background: Problem-based curricula have provoked controversy amongst educators and students regarding outcome in medical graduates, supporting the need for longitudinal evaluation of curriculum change. As part of a longitudinal evaluation program at the University of Adelaide, a mixed method approach was used to compare the graduate outcomes of two curriculum cohorts: traditional lecture-based 'old' and problem-based 'new' learning., Methods: Graduates were asked to self-assess preparedness for hospital practice and consent to a comparative analysis of their work-place based assessments from their intern year. Comparative data were extracted from 692 work-place based assessments for 124 doctors who graduated from the University of Adelaide Medical School between 2003 and 2006., Results: Self-assessment: Overall, graduates of the lecture-based curriculum rated the medical program significantly higher than graduates of the problem-based curriculum. However, there was no significant difference between the two curriculum cohorts with respect to their preparedness in 13 clinical skills. There were however, two areas where the cohorts rated their preparedness in the 13 broad practitioner competencies as significantly different: problem-based graduates rated themselves as better prepared in their 'awareness of legal and ethical issues' and the lecture-based graduates rated themselves better prepared in their 'understanding of disease processes'.Work-place based assessment: There were no significant differences between the two curriculum cohorts for 'Appropriate Level of Competence' and 'Overall Appraisal'. Of the 14 work-place based assessment skills assessed for competence, no significant difference was found between the cohorts., Conclusions: The differences in the perceived preparedness for hospital practice of two curriculum cohorts do not reflect the work-place based assessments of their competence as interns. No significant difference was found between the two cohorts in relation to their knowledge and clinical skills. However results suggest a trend in 'communication with peers and colleagues in other disciplines' (χ2 (3, N = 596) =13.10, p = 0.056) that requires further exploration. In addition we have learned that student confidence in a new curriculum may impact on their self-perception of preparedness, while not affecting their actual competence.

Despite a profusion of recommendations regarding the quality of web sites and guidelines related to ethical issues surrounding health-related sites, there is little guidance for the design and evaluation of sites relating to loss and grief. This article, which addresses these deficiencies, results from a community consultation process of designing and evaluating a web site--GriefLink--for bereaved consumers and for the professionals who help them. It presents the literature review that informed the project, the recommendations for design and content, the lessons learned through the process itself, and the difficulties of evaluating the benefits of a grief-related web site. Some ethical and legal dilemmas in developing grief-related web sites are discussed and issues of design, content, process, evaluation, and general features are addressed, which may also be applied to other communication forms for loss and grief matters, such as the print media.

Objective: We sought to summarise the evidence for an association between rural background and rural practice by systematically reviewing the national and international published reports., Design: A systematic review., Setting: A search of the national and international published reports from 1973 to October 2001., Subject: The search criteria included observational studies of a case-control or cohort design making a clear and quantitative comparison between current rural and urban doctors, this resulted in the identification of 141 studies for potential inclusion., Results: We systematically reviewed 12 studies. Rural background was associated with rural practice in 10 of the 12 studies, in which it was reported, with most odds ratios (OR) approximately 2-2.5. Rural schooling was associated with rural practice in all 5 studies that reported on it, with most OR approximately 2.0. Having a rural partner was associated with rural practice in 3 of the 4 studies reporting on it, with OR approximately 3.0. Rural undergraduate training was associated with rural practice in 4 of 5 studies, with most OR approximately 2.0. Rural postgraduate training was associated with rural practice in 1 of 2 studies, with rural doctors reporting rural training about 2.5 times more often., Conclusions: There is consistent evidence that the likelihood of working in rural practice is approximately twice greater among doctors with a rural background. There is a smaller body of evidence in support of the other rural factors studied, and the strength of association is similar to that for rural background.

Objective: To determine the association between rural undergraduate training, rural postgraduate training and medical school entry criteria favouring rural students, on likelihood of working in rural Australian general practice., Methods: National case-control study of 2414 rural and urban general practitioners (GPs) sampled from the Health Insurance Commission database. Participants completed a questionnaire providing information on demographics, current practice location and rural undergraduate and postgraduate experience., Results: Rural GPs were more likely to report having had any rural undergraduate training [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.32-1.95] than were urban GPs. Rural GPs were much more likely to report having had rural postgraduate training (OR 3.14, 95% CI 2.57-3.83). As the duration of rural postgraduate training increased so did the likelihood of working as a rural GP: those reporting that more than half their postgraduate training was rural were most likely to be rural GPs (OR 10.52, 95% CI 5.39-20.51). South Australians whose final high school year was rural were more likely to be rural GPs (OR 3.18, 95% CI 0.99-10.22)., Conclusions: Undergraduate rural training, postgraduate training and medical school entry criteria favouring rural students, all are associated with an increased likelihood of being a rural GP. Longer rural postgraduate training is more strongly associated with rural practice. These findings argue for continuation of rural undergraduate training opportunities and rural entry schemes, and an expansion in postgraduate training opportunities for GPs.

Objective: To determine the association between rural background on practice location of general practitioners (GPs) (rural or urban)., Design: Comparison of data from two postal surveys., Subjects: 268 rural and 236 urban GPs practising in South Australia., Main Outcome Measures: Association between practice location (rural or urban) and demographic characteristics, training, qualifications, and rural background., Results: Rural GPs were younger than urban GPs (mean age 47 versus 50 years, P < 0.01) and more likely to be male (81% versus 67%, P = 0.001), to be Australian-born (72% versus 61%, P = 0.01), to have a partner (95% versus 85%, P = 0.001), and to have children (94% versus 85%, P = 0.001). Similar proportions of rural and urban GPs were trained in Australia and were Fellows of the Royal Australian College of General Practitioners, but more rural GPs were vocationally registered (94% versus 84%, P = 0.001). Rural GPs were more likely to have grown up in the country (37% versus 27%, P = 0.02), to have received primary (33% versus 19%, P = 0.001) and secondary (25% versus 13%, P = 0.001) education there, and to have a partner who grew up in the country (49% versus 24%, P = 0.001). In multivariate analysis, only primary education in the country (odds ratio [OR], 2.43; 95% CI, 1.09-5.56) and partner of rural background (OR, 3.14; 95% CI, 1.96-5.10) were independently associated with rural practice., Conclusion: Our findings support the policy of promoting entry to medical school of students with a rural background and provide an argument for policies that address the needs of partners and maintain quality primary and secondary education in the country.

The nutritional status of 69 Nigerians, age 1 month to 75 yr was assessed with the Krumdieck trichotillometer, which measures the force required to epilate a hair (epilation force, EF). EF of normal subjects (serum albumin greater than or equal to 3.5 g/dl) was 36.5 +/- 9.5 mg (mean +/- SD)). EF was significantly lower (25.7 +/- 10.6 g) in malnourished subjects (serum albumin less than or equal to 3.0 g/dl). EF correlated significantly with weight-for-height, mid-arm circumference, mid-arm muscle circumference, and serum albumin (r = 0.36, 0.32, 0.30, and 0.30, respectively, (p less than 0.05), but did not correlate significantly with triceps skinfold. These findings are in agreement with the clinical impression that hair pluckability is affected more by protein depletion than by energy depletion. The trichotillometer may be a useful tool in assessment of protein nutritional status in the field since it requires little training, and no laboratory.

In a clinical setting where malnutrition and far-advanced tuberculosis are common, experience with fluorescence microscopy of gastric washings was evaluated in 536 specimens. These specimens were obtained from 191 Haitian children whose illness was difficult to diagnose. Using the culture of gastric washings as a disease indicator, the prevalence of positive specimens was 24 per cent. The sensitivity, specificity, and predictive value were 58 per cent, 95 per cent, and 81 per cent, respectively. The agreement (J statistic) was +53 per cent. Combining the results of several series showed no differences in the sensitivity and specificity between fluorescence microscopy of gastric washings and fluorescence microscopic examination of sputum specimens. Among 49 children with positive fluorescence microscopy of gastric washings, pulmonary tuberculosis was bacteriologically confirmed in 85 per cent. Positive fluorescence microscopy of gastric washings was more frequent among children with far-advanced and miliary disease than children with less severe disease. The sensitivity and specificity of fluorescence microscopy of gastric washings make it a useful diagnostic tool in childhood tuberculosis, particularly in the presence of negative cutaneous reaction to purified protein derivative, extensive disease, or severe malnutrition.

This study was designed to help clinicians establish objective guidelines for meeting the nutritional requirements of spinal cord injury (SCI) patients during their initial hospitalizations. The nutritional status of 51 SCI patients treated between 1983 and 1986 was assessed at two, four, and eight weeks after injury. Nutrient deficiencies such as albumin (100% of patients), carotene (62%), transferrin (37%), ascorbate (25%), thiamine (24%), folate (20%), and copper (11%) were documented most frequently at two weeks postinjury. There was an average of 2.0, 1.6, and 1.2 nutrient abnormalities per patient at two, four, and eight weeks postinjury, respectively. Although most depressed nutrient parameters improved with time, diet-dependent plasma proteins such as albumin and transferrin remained low throughout the entire eight-week period. Mean body weight declined 1.3 +/- 3.9 kg during the first two weeks, 2.0 +/- 4.4 kg between two and four weeks, and 0.4 +/- 2.0 kg between four and eight weeks after injury. Significant findings also included a strong correlation between plasma albumin, ascorbate, and carotene levels and maximal inspiratory and expiratory pressure (p less than .05). Although nutrient status usually improved with time and was not definitely associated with an increased risk of secondary medical complications, prudence dictates that these deficiencies should be prevented by appropriate intervention.