Stomach cancer and soil metal content.
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Biomedical subjects
Publications and source records attributed to R Philipp.
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Residents of Shipham Village, Somerset, England, are exposed to high soil levels of cadmium. Their health was assessed with respect to cadmium exposure, using routinely available morbidity data. Hospital Activity Analysis data were used to calculate standardized admission ratios for diagnostic groups of morbidity associated with cadmium exposure. A small but statistically significant risk for carcinoma of the ovary was demonstrated. Scrutiny of case records confirmed this finding but emphasized that the risk is unlikely to be explained by exposure to cadmium. Further reassurance about this possible risk was obtained from a review of 25 years of Central Cancer Registry data. The value of HAA data could be improved by address coding of data with postcodes to enable rapid identification of small geographical populations, and by record linkage to permit estimates of duration of exposure.
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When patients use both a standard glass mercury ovulation thermometer and a single-use thermometer to compile separate charts of their daily early morning resting oral temperature, the single-use thermometers are shown to record accurate temperatures. They could be useful in subfertility clinics for women who have difficulty in reading conventional glass thermometers.
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The diagnostic criteria of acute rheumatic fever are reviewed from experience in a New Zealand community. Two-hundred-and-sixty-one first attacks labelled rheumatic fever and 209 other episodes occurred in a defined geographic population during 1962--76. The major importance of heart, joint and brain manifestations is confirmed. Criterior levels for fever, P-R interval prolongation, erythrocyte sedimentation rate, white cell count and antistreptolysin-O titre are suggested. Nodules and evidence of established rheumatic heart disease were not found to be of diagnostic significance because they tended to be equally common among patients with rheumatic fever and patients considered to have another disease. Separate criteria for cases with and without pre-existent rheumatic heart disease are given, to enable assignment of episodes to probable rheumatic fever status.
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As part of their evaluation of the 9-week 'Medicine in the Community' course, final-year medical students completed a terminal evaluation questionnaire. Items and subject groupings were scored using a scale of 1-5 for 'value', 'interest', and 'presentation', and mean evaluations were calculated for each group of students. The results, summarized in tabular form, were posted to the seventy-three course tutors together with the mean evaluations of the course as a whole. It was hoped that this feedback on the course would help tutors to improve the standard of their contributions. After 2 years of this evaluation, a questionnaire was sent to the course tutors to examine whether student opinion is useful to them in the planning of teaching. Findings indicate that student opinion is actively sought and the results are useful, but only if tutors can identify their individual contributions from the tabulated summary.
The clinical features of acute rheumatic fever as seen in Wairoa County 1962--76 are described. The types of cases seen comprised 107 definite first attacks, 78 definite recurrences, and 117 first attacks and 34 recurrences which did not satisfy strict diagnostic criteria. The incidence of the major manifestations, carditis, polyarthritis and chorea were 53 percent, 56 percent and 11 percent in definite first attacks, and 81 percent, 26 percent and 8 percent in definite recurrences, respectively. The ratio of recurrences to first attacks was high (58 percent). The Wairoa population exhibits factors thought to contribute to a high risk of recurrence--young age distribution, non-Caucasian ethnicity, avoidance of parenteral prophylaxis and frequent carditis in the first attack.
Postgraduate students attending a ten-week course in occupational medicine have evaluated all contributions to this course on the basis of value, interest and presentation. Assessments given for the standards of presentation of items of the teaching vary more than the assessments given for interest. Interest in those parts of the course with a direct clinical content is greater than in other sections of the course. Methodological problems necessitate certain assumptions in this form of audit. The results nevertheless provide worthwhile feedback to contributors and co-ordinators that can be used to maintain and improve the quality of courses.
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