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A familiarity with musculoskeletal disorders is vital for medical school graduates. The purpose of this study was to investigate perceived deficiencies in undergraduate education to provide motivation for a restructuring of the curriculum. A basic competency examination in musculoskeletal medicine was used. Group 1 comprised 79 interns in their first postgraduate year. The recommended passing score for the examination was 73.1%. The score for the interns in Group 1 was 45.3%. Seventy-two (91%) of the 79 interns failed to demonstrate basic competency. The examination was reapplied to 53 interns (Group 2), to establish whether a two-month orthopaedic rotation during internship improved performance. The score for the group was 56.8%. 85.7% (18/21) of those who had completed an orthopaedic rotation and 93.8% (30/32) of those who had not completed an orthopaedic rotation failed the assessment. The additional exposure to musculoskeletal medicine during internship did not show statistical benefit (95% CI 58.0-79.5). In summary, 91% of medical-school graduates failed a basic competency examination, and no benefit was found from completing an internship rotation. We believe that undergraduate musculoskeletal education in South Africa is inadequate and that programmes throughout the country should be reassessed.

Background: This study examined trends for all first hospital admissions for peripheral artery disease (PAD) in Scotland from 1991 to 2007 using the Scottish Morbidity Record. Methods: First admissions to hospital for PAD were defined as an admission to hospital (inpatient and day-case) with a principal diagnosis of PAD, with no previous admission to hospital (principal or secondary diagnosis) for PAD in the previous 10 years. Results: From 1991 to 2007, 41 593 individuals were admitted to hospital in Scotland for the first time for PAD. Some 23 016 (55.3 per cent) were men (mean(s.d.) age 65.7(11.7) years) and 18 577 were women (aged 70.4(12.8) years). For both sexes the population rate of first admissions to hospital for PAD declined over the study interval: from 66.7 per 100 000 in 1991-1993 to 39.7 per 100 000 in 2006-2007 among men, and from 43.5 to 29.1 per 100 000 respectively among women. After adjustment, the decline was estimated to be 42 per cent in men and 27 per cent in women (rate ratio for 2007 versus 1991: 0.58 (95 per cent confidence interval 0.55 to 0.62) in men and 0.73 (0.68 to 0.78) in women). The intervention rate fell from 80.8 to 74.4 per cent in men and from 77.9 to 64.9 per cent in women. The proportion of hospital admissions as an emergency or transfer increased, from 23.9 to 40.7 per cent among men and from 30.0 to 49.5 per cent among women. Conclusion: First hospital admission for PAD in Scotland declined steadily and substantially between 1991 and 2007, with an increase in the proportion that was unplanned. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Objective: To examine whether the 1-year prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), and their comorbidity were associated with subsequent all-cause and cardiovascular disease (CVD) mortality during 15 years in Vietnam veterans. Methods: Participants (N = 4256) were from the Vietnam Experience Study. Service, sociodemographic, and health data were collected from service files, telephone interviews, and a medical examination. One-year prevalence of MDD and GAD was determined through a diagnostic interview schedule based on the Diagnostic and Statistical Manual of Mental Disorders (version IV) criteria. Mortality over the subsequent 15 years was gathered from US army records. Results: MDD and GAD were positively and significantly associated with all-cause and CVD mortality. The relationships between MDD and GAD and CVD mortality were no longer significant after adjustment for sociodemograhics, health status at entry, health behaviors, and other risk markers. Income was the covariate with the strongest impact on this association. In analyses comparing comorbidity and GAD and MDD alone, with neither diagnosis, comorbidity proved to be the strongest predictor of both all-cause and CVD mortality. Conclusion: GAD and MDD predict all-cause mortality in a veteran population after adjusting for a range of covariates. However, those with both GAD and MDD were at greatest risk of subsequent death, and it would seem that these disorders may interact synergistically to affect mortality. Future research on mental disorders and health outcomes, as well as future clinical interventions, should pay more attention to comorbidity.