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Biomedical subjects

R E Pust

Publications and source records attributed to R E Pust.

At least 19 recordsLinked to original sources
PubMed1995

Medical education for international health. The Arizona experience.

At the University of Arizona we have learned that a systematic approach to educating North Americans for international health roles makes sense. We have focused on an intensive problem-based orientation course for senior medical students and residents about to embark on a field experience. We have shared with and greatly benefited from the International Health Medical Education Consortium (IHMEC). The lessons learned at Arizona focus on the importance of long-term commitment and mentoring and on the direct relationship between health care careers internationally and among our own domestic underserved populations.

Arizona↗
PubMed1993

Arm circumference v. arm circumference/head circumference ratio in the assessment of malnutrition in rural Malawian children.

The arm circumference/head circumference ratio (AC/HC) was compared with arm circumference (AC) alone in the diagnosis of protein-energy malnutrition (PEM) in 685 Malawian children between the ages of 3 and 48 months. The AC/HC ratio correlates well, r = 0.6863 (P < 0.001), with weight-for-age (WA). The sensitivity and specificity were calculated for both indicators compared to the NCHS reference standard of WA. Compared to 80 per cent WA, the 0.310 AC/HC cut-off was 92 per cent sensitive and 41 per cent specific, while the 0.290 AC/HC cut-off was 75 per cent sensitive and 74 per cent specific. AC alone in the 6-12-month-old children was 75 per cent sensitive and 89 per cent specific at a cut-off of 12.5 cm. In the children from 12 to 48 months with a cut-off of 13.5 cm the AC was 82 per cent sensitive and 70 per cent specific. The AC alone was more sensitive than AC/HC at all levels of specificity. Adding the HC to AC offered no advantage in screening for PEM in these children. In fact, if one were to use the standard 0.310 cut-off for AC/HC, the resulting low (41 per cent) specificity would identify such a large proportion of false positives as to make this ratio impractical for field use where it is most needed--in primary health care programmes with low resources which serve populations with high prevalences of PEM.

Anthropometry↗
PubMed1992

Emergency symphysiotomy for the trapped head in breech delivery: indications, limitations and method.

Careful case selection can avoid most obstetrical emergencies. However, even with optimum management of breech labour, the fetal head may become trapped. Since doctors in developing nations must be prepared for this dire situation, this article reviews breech case selection and outlines the steps in breech delivery, illustrating symphysiotomy for the entrapped head. The limitations and precautions associated with symphysiotomy are stressed.

Breech Presentation↗
PubMed1992

Tuberculosis in the 1990's: resurgence, regimens, and resources.

Physicians in the United States must maintain vigilance for the 25,000 annual new cases of tuberculosis, concentrated in the elderly, in immigrants, in migrant and minority populations, and in immunosuppressed patients. Tuberculosis rates in the South remain above the national average. Physicians diagnosing tuberculosis may also treat the disease, working with health departments, which can assist with drugs, follow-up tests, and contact investigation. Powerful short-course regimens have been standard treatments since 1986. The preferred combination is isoniazid, rifampin, and pyrazinamide daily for 2 months, followed by isoniazid and rifampin for 4 more months. A 9-month regimen of isoniazid and rifampin is equally effective. Supplementation or extension of these regimens is mandatory when drug resistance or immunosuppression, respectively, is likely. Isoniazid prophylaxis for 6 to 12 months continues to be a vital but often neglected preventive measure for those infected with Mycobacterium tuberculosis, but without active disease.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The relationship between literacy and health.

In non-industrialized countries, populations with the lowest literacy rates have the poorest health status. In the United States, however, there is no published research on whether illiteracy, independently of other sociodemographic factors, is related to health status. There are numerous plausible mechanisms by which such a relationship could occur. For example, published reports indicate that most information handouts, consent forms, and other materials for patients are written at reading levels too difficult for most American adults. These and other findings may have important implications in the health care of underserved populations. Research is needed to determine the health effects of impaired literacy skills among Americans, and to develop non-literacy-dependent methods for providing patient education, obtaining informed consent, and administering diagnostic tests.

Educational Status↗
PubMed1991

Management of common potentially serious paediatric illnesses by aid post orderlies at Tari, Southern Highlands Province.

Systematic observations were made of a small number of aid post orderlies (APOs) managing children with the common but potentially serious symptoms of cough, fever and diarrhoea. On-site performance was evaluated against recommended management guidelines set out in Dr Keith Edwards' Diagnosis and Treatment of Common Childhood Illnesses for APOs. History taking at the aid post was brief and usually non-exploratory; examination of patients was often neglected. Drug prescription was generally appropriate for the diagnosis made, but drug dosages were often incorrect and treatment principles were rarely explained to guardians. Preventive health issues were rarely tackled. Our study reaffirms the need for on-site assessment of the performance of paramedical workers, sets priority demands for continuing education of health workers, and provides a framework for competency-based problem-solving activities within this context.

Adult↗
PubMed1991

Prevention and treatment of travel-related illness.

Traveler's diarrhea, malaria, acquired immunodeficiency syndrome and jet lag are among the issues for the traveler preparing for a trip to or returning from developing countries. With appropriate measures, most travel-related diseases can be prevented. Diarrheal diseases, schistosomiasis, sexually transmitted diseases and AIDS can be prevented with proper avoidance behavior. Diseases such as hepatitis, rabies, yellow fever and meningitis can be prevented with immunization. Chemoprophylaxis can prevent malaria, altitude sickness and sinus barotrauma. Diagnosing an illness in a returning traveler requires a high index of suspicion regarding diseases that might have been acquired during travel. Resources for accessing up-to-date information concerning prophylaxis, diagnosis and treatment of travel-related illnesses are available.

Adult↗
PubMed1991

Parasitic diseases. International travel. Preparing your patient.

Patients who travel to developing nations are those most likely to encounter parasitic diseases. Using a risk assessment approach and the resources introduced in this article, the primary care physician can prepare them for travel and continue their care on return. Immunizations and patient education are the major modes of prevention, coupled with chemoprophylaxis for malaria and traveler's diarrhea. Traveling pregnant women and young children need special precautions. A large body of preventive and therapeutic knowledge, including parasitology, is at the core of emporiatrics, the science of travel medicine.

Aged↗
PubMed1986

Comprehensive care of travelers.

Travel, especially if it is international, often means major changes for the family. Family physicians should assess the epidemiologic risk and psychosocial significance of travel or relocation in light of the family's life-cycle stage and antecedent health. Using core references, which are kept current in partnership with public health agencies, family physicians are able to provide comprehensive immunization, medications, and patient education for all travel risks. Families are given medical record summaries and recommended sources of care at their destination. Eight weeks after their return patients are reassessed for newly acquired illness and helped to integrate the perspectives gained during the travel into the family's future dynamics. Taking advantage of growing travel medicine opportunities, family medicine educators should base the care of travelers and teaching of residents on defined competence priorities. Travelers' health provides a mutually rewarding model of shared care with public health consultants in the community medicine curriculum.

Bibliographies as Topic↗
PubMed1985

Factors affecting desired family size among preliterate New Guinea mothers.

A random sample of 331 Enga mothers in Papua New Guinea perceived that an average of 5.96 live births (S.D. = 1.88) were needed to achieve their mean desired completed family size (DFS) of 4.65 children (S.D. = 1.32). The mean of the personal child mortality rates projected by the individual mothers. 194/1000, is very close to the rate of 198/1000 (224 deaths among 1134 live births) experienced by the women as a group and the 177/1000 documented in a 1972 prospective study in the area. This suggests that as a group preliterate women may possess an accurate estimate of prevailing child mortality rates. Considerable interest in family planning was shown. However for cultural or linguistic reasons, the majority (except in the case of the pill and tubal ligation) expressed no opinions about their readiness to use specific modern methods. The mean parity of 43 women seeking tubal ligation was 5.98 (S.D. = 1.81). An integrated maternal health and family planning program focusing on the health benefits to mother and child of the current 3-4-year birth interval seems indicated.

Adult↗
PubMed1985

Leprosy in the United States. Risks, recognition, regimens, resources.

Although leprosy is increasing in incidence in the United States, it is confined almost entirely to immigrants from developing countries and their close contacts. While the clinical disease has not changed, leprosy has diffused more widely throughout the United States as a result of migration. Primary care physicians should maintain a high index of suspicion in foreign-born individuals with skin or peripheral nerve problems. Punch biopsy of skin lesions is the most practical diagnostic method for both the multibacillary and paucibacillary types of leprosy. Because of resistance to dapsone, multi-drug treatment is now the rule; most patients are referred to or managed in consultation with a regional Hansen's disease clinic for long-term treatment. Consultation is available to any physician through the National Hansen's Disease Center in Carville, Louisiana.

Diagnosis, Differential↗