Cultural factors that affected the spatial and temporal epidemiology of kuru

Kuru is a prion disease which became epidemic among the Fore and surrounding linguistic groups in Papua New Guinea, peaking in the late 1950s. It was transmitted during the transumption (endocannibalism) of dead family members at mortuary feasts. In this study, we aimed to explain the historical spread and the changing epidemiological patterns of kuru by analysing factors that affected its transmission. We also examined what cultural group principally determined a family’s behaviour during mortuary rituals. Our investigations showed that differences in mortuary practices were responsible for the initial pattern of the spread of kuru and the ultimate shape of the epidemic, and for subsequent spatio-temporal differences in the epidemiology of kuru. Before transumption stopped altogether, the South Fore continued to eat the bodies of those who had died of kuru, whereas other linguistic groups, sooner or later, stopped doing so. The linguistic group was the primary cultural group that determined behaviour but at linguistic boundaries the neighbouring group’s cultural practices were often adopted. The epidemiological changes were not explained by genetic differences, but genetic studies led to an understanding of genetic susceptibility to kuru and the selection pressure imposed by kuru, and provided new insights into human history and evolution

A model for self-directed problem-based learning for renal therapeutics

Objective To introduce a new approach to problem-based learning (PBL) for self-directed learning in renal therapeutics. Design This 5-week course, designed for large student cohorts using minimal teaching resources, was based on a series of case studies and subsequent pharmaceutical care plans, followed by intensive and regular feedback from the instructor. Assessment Assessment of achievement of the learning outcomes was based on weekly-graded care plans and peer review assessment, allowing each student to judge the contributions of each group member and their own, along with a written case-study based examination. The pharmaceutical care plan template, designed using a “tick-box” system, significantly reduced staff time for feedback and scoring. Conclusion The proposed instructional model achieved the desired learning outcomes with appropriate student feedback, while promoting skills that are essential for the students' future careers as health care professionals

Avaliação de pacientes com queixa de tontura e eletronistagmografia normal por meio da estabilometria Evaluation of patients with dizziness and normal electronystagmography using stabilometry

As causas de tontura são de difícil diagnóstico. Atualmente dispomos de uma variedade de exames complementares, contudo, nenhum avalia bem a função vestibular. Os testes mais utilizados para este fim são as provas eletronistagmográficas e posturográficas. OBJETIVO: O objetivo do trabalho foi o de analisar os resultados da estabilometria de pacientes com queixa de tontura que apresentaram eletronistagmografia normal e compará-los aos de um grupo controle. FORMA DE ESTUDO: Prospectivo, do tipo seccional transversal. MATERIAL E MÉTODO: Realizou-se no SME do Serviço de Otorrinolaringologia do HUCFF/UFRJ. No total foram avaliados 22 pacientes (15 mulheres e sete homens) com idade média de 47,6±9 anos. O grupo controle foi de 25 sujeitos saudáveis (18 mulheres e sete homens) com idade média de 46,8±7 anos. Todos os indivíduos foram submetidos à estabilometria com os olhos abertos, em seguida por olhos fechados, durante 30 segundos cada. RESULTADOS: O grupo de pacientes apresentou resultados estatisticamente significativos em todos os parâmetros estabilimétricos avaliados quando comparados ao grupo controle. Na comparação dos resultados com os olhos fechados e abertos, apenas a velocidade média ântero-posterior no grupo controle foi significativa. CONCLUSÃO: Conclui-se que o grupo de pacientes apresentou resultados estatisticamente significativos em relação ao grupo controle em todos os parâmetros estabilométricos analisados, demonstrando, assim, que o grupo de pacientes com queixa de tontura apresentou maior instabilidade na posição ortostática do que o grupo de sujeitos saudáveis.<br>The causes of dizziness are difficult to be diagnosed. At present we have a variety of tests and exams but none of them can adequately evaluate the vestibular function. The most commonly used tests are electronystagmography and posturography. AIM: The objective of this study was to analyze the results of stabilometry in patients with complaints of dizziness who had normal results in electronystagmography and to compare them with a control group. STUDY DESIGN: The study was prospective and transversal. MATERIAL AND METHOD: It was conducted at the ENT department, University Hospital, Federal University of Rio de Janeiro. Twenty-two patients (fifteen women and seven men) aged on average 47.6±9 were evaluated. The control group was made up of twenty-five healthy individuals (eighteen women and seven men) aged on average 46.8±7. RESULTS: In all analyzed parameters, there were statistically significant differences between the groups. Comparing the results with closed and opened eyes, the anterior-posterior mean velocity in the control group was the only statistically significant result. CONCLUSION: We concluded that the group of patients had statistically significant results in relation to the control group in all the analyzed parameters, showing that the group of patients with complaints of dizziness had more instability in standing position than the group of healthy individuals