Multiple impacts of the HIV/AIDS epidemic on the aged in rural Uganda

This paper reports research conducted among theaged residents of a rural, Southwestern Ugandanvillage. It documents their knowledge ofHIV/AIDS, their perceptions of their own riskof infection, and the multiple impacts of thecurrent HIV/AIDS epidemic on their lives. Mostolder individuals have a sound understanding ofthe sexual transmission of HIV, and someconsider themselves to be at risk of infectionthrough having multiple sexual partners. Theyattempt to limit their children's exposure toHIV, but many of these children have left thevillage to live in urban areas of relativelyhigh HIV prevalence. The loss of adult childrendeprives the aged of any support these childrenmight have provided as their parents'capabilities declined with advancing age.Female-headed households were more affected inthis way than were male-headed households. TheAIDS epidemic has increased the number ofburials taking place in the village, and theiraccumulated costs, both in time and money, andcreated new hardships for the aged, who alsohave to cope with grief that accompaniescontinuing deaths among their children andtheir contemporaries' children.

A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: an urban versus rural perspective

A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas. One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpatient dermatology referral -126 patients (46%) were randomized to a telemedicine consultation and 148 (54%) to a conventional hospital outpatient consultation. Of those seen by telemedicine, 61% were registered with an urban practice, compared with 71% of those seen conventionally. The clinical outcomes of the two types of consultation were similar - almost half the patients were managed after a single consultation with the dermatologist. The observed marginal cost per patient of the initial realtime teledermatology consultation was f52.85 for those in urban areas and f59.93 per patient for those from rural areas. The observed marginal cost of the initial conventional consultation was f47.13 for urban patients and f48.77 for rural patients. The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas, mainly because of the fixed equipment costs. Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal, while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation.

An Ethics Core Curriculum for Australasian Medical Schools

Teaching ethics incorporates teaching of knowledge as well as skills and attitudes. Each of these requires different teaching and assessment methods. A core curriculum of ethics knowledge must address both the foundations of ethics and specific ethical topics. Ethical skills teaching focuses on the development of ethical awareness, moral reasoning, communication and collaborative action skills. Attitudes that are important for medical students to develop include honesty, integrity and trustworthiness, empathy and compassion, respect, and responsibility, as well as critical self-appraisal and commitment to lifelong education.

Transient evoked otoacoustic emissions in children studying in special schools

Objectives: The present study aimed to investigate the feasibility and practicalities or testing children in special school settings using transient evoked otoacoustic emissions (TEOAE) and tympanometry. Children studying in special schools, particularly those with intellectual impairment, may be highly susceptible to hearing pathologies and can be difficult to assess using traditional test batteries. Researchers have recently suggested the possible applicability of TEOAE testing. in lieu of conventional behavioral methods, as a hearing screening device for persons with intellectual impairment. However, to date. few publications have detailed the particulars and results of such testing. Methods: A total of 489 children, with a mean age of 9.6 years, were tested in 15 special schools. Case information was obtained regarding birth history, medical history and type,degree of impairment, for later comparison with screening results. TEOAEs were collected using Quickscreen mode of the ILO292 Otodynamics Analyzer, whilst tympanometry was performed utilizing a Madsen Zodiac 901 Middle Ear Analyzer. Results: In total, 80% of students were able to be tested using TEOAEs. Average test time per ear was 2 min. However, a large proportion (40 of those able to be tested) failed TEOAE testing in at least one ear. No significant effects were found between could-not-test (CNT) cases and case history factors, A significant difference in TEOAE failure rates was found across history of neonatal special care nursery residency and history of parental concern regarding possible hearing impairment. Failure rates were higher for those who indicated positive histories. A total of 74% of subjects could be tested using tympanometry, with 25% of those able to be tested failing in at least one ear. Notably, neither type nor degree of impairment had any significant bearing on CNT or failure rates for tympanometry or TEOAE screening. Conclusions: Findings of the present investigation lend support to the review of hearing screening programs for children in special schools. with TEOAEs presenting as a potential alternative procedure. Further examination of the performance measures of protocols incorporating TEOAEs would now be advantageous. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Responding to globalisation: Refugees and the challenges facing Australian schools

This paper explores issues relating to the education of refugee children in Australia within a framework of globalisation. We begin by outlining what we understand to be key dimensions of globalisation. We then move to a consideration of education for refugee children, and the rights to education set out in major international conventions. We argue that there are a number of key challenges to be addressed in policies for the provision of education for refugee children under the current conditions of globalisation in Australia. GLOBALISATION