Cranberries (Vaccinium macrocarpon Ait.) are an excellent dietary source of phytochemicals that include flavonol glycosides, anthocyanins, proanthocyanidins (condensed tannins), and organic and phenolic acids. Using C-18 and Sephadex Lipophilic LH-20 column chromatography, HPLC and tandem LC-ES/MS, we have analyzed, quantified and separated total cranberry extract (TCE) into fractions enriched in sugars, organic acids, total polyphenols, proanthocyanidins and anthocyanins (39.4, 30.0, 10.6, 5.5, 1.2% composition, respectively). Using a luminescent ATP cell viability assay, the antiproliferative effects of TCE (200 g/mL) vs. all fractions were evaluated against human oral (KB, CAL27), colon (HT-29, HCT116, SW480, SW620) and prostate (RWPE-1, RWPE-2, 22Rv1) cancer cell lines. The total polyphenol fraction was the most active fraction against all cell lines with 96.1 and 95% inhibition of KB and CAL27 oral cancer cells, respectively. For the colon cancer cells, the antiproliferative activity of this fraction was greatest against HCT116 (92.1%) than HT-29 (61.1%), SW480 (60%) and SW620 (63%). TCE and all fractions, showed 50% antiproliferative activity against prostate cancer cells with total polyphenols being the most active fraction (RWPE-1, 95%; RWPE-2, 95%; 22Rv1, 99.6%). Cranberry sugars (78.8 g/mL) did not inhibit the proliferation of any cancer cell lines. The enhanced antiproliferative activity of total polyphenols compared to TCE and its individual phytochemicals suggests synergistic or additive antiproliferative interactions of the anthocyanins, proanthocyanidins and flavonol glycosides within the cranberry extract.

Total Cranberry Extract vs. its Phytochemical Constituents: Antiproliferative and Synergistic Effects against Human Tumor Cell Lines

The Wanless Report â?~Securing Our Future Health: Taking A Long-Term Viewâ?T - an independent review by Derek Wanless - is the first ever evidence-based assessment of the long-term resource requirements for the NHS.
It concludes that in order to meet peopleâ?Ts expectations and to deliver the highest quality over the next 20 years, the UK will need to devote more resources to health care and that this must be matched by reform to ensure that these resources are used effectively.
 - aims: 1. To examine the technological, demographic and medical trends over the next
two decades that may affect the health service in the UK as a whole.
2. In the light of (1), to identify the key factors which will determine the financial
and other resources required to ensure that the NHS can provide a publicly
funded, comprehensive, high quality service available on the basis of clinical
need and not ability to pay.
3. To report to the Chancellor by April 2002, to allow him to consider the possible
implications of th

Securing Our Future Health: Taking a Long-Term View. The Health Service in 2022

Physician migration, also known as “brain drain,” results from a combination of a gap in the supply and demand in developed countries and a lack of job satisfaction in developing countries. Many push and pull factors are responsible for this effect, with media and internet playing their parts. Large-scale physician migration can pose problems for both the donor and the recipient countries, with a resulting reinforcement in the economic divide between developed and developing countries. The main objectives of our study were to determine the prevalence of migration intentions in medical undergraduates, to elucidate the factors responsible and to analyze the attitudes and practices related to these intentions. This was a cross-sectional, observational, questionnaire-based study, conducted at Dow Medical College of Dow University of Health Sciences, Karachi, between January, 2012 and May, 2012. A total of 323 students responded completely. The questionnaire consisted of 3 sections, and was aimed at collecting demographic details, determining students’ migratory intentions, evaluating reasons for and against migration and assessing attitudes and practices of students related to these intentions. Out of 323 respondents, 195 wanted to pursue their careers abroad, giving a prevalence rate of 60.4% in our sample. United States was the most frequently reported recipient country. The most common reasons given by students who wished to migrate, in descending order, were: lucrative salary abroad followed by quality of training, job satisfaction, better way of life, relatives, more opportunities, better working environment, terrorism in Pakistan, harassment of doctors in Pakistan, desire to settle abroad, more competition in Pakistan, better management, peer pressure, longer working hours in Pakistan, religious reasons, parent pressure, political reasons and favoritism in Pakistan. A considerable number of respondents had already started studying for licensing examinations, and were also planning of gaining clinical experience in their desired country of interest. Physician migration is a serious condition that requires timely intervention from the concerned authorities. If considerable measures are not taken, serious consequences may follow, which may pose a threat to the healthcare system of the country.

/pdf/physician-migration-at-its-roots-a-study-on-the-factors-wmkn67tci8.pdf

Physician migration at its roots: a study on the factors contributing towards a career choice abroad among students at a medical school in Pakistan

Background It has been well established that burnout, defined as emotional exhaustion (EE), de-personalisation (DP), and a ‘decreased sense of personal accomplishment (PA) due to work related stress’, is prevalent to a great extent among medical residents. This has been implicated in the delivery of suboptimal patient care. Residents in developing countries work under difficult working and social conditions and therefore examining burnout is important when addressing quality of care and working conditions. Objectives The objectives of the study were to assess the point prevalence of burnout among residents in Lebanon and investigate some of the work and non-work related factors associated with burnout. Methods A cross sectional study of all medical residents was carried out in two major hospitals in the capital city. A total of 155 residents responded, representing all specialities. Maslach Burnout Inventory for Health Services Workers (MBI-HSS) was used. Burnout in three domains was dichotomised into high versus not high burnout. Results The prevalence of burnout was high in all the domains with the highest in the domain of emotional exhaustion (67.7%). 80% of the sample had a high level of burnout in at least one domain. Being female, experiencing a major stress, working for more than 80 h per week, and having more than eight calls per month increased the odds of burnout in at least one domain. Conclusions The high burnout level calls for action. This could be addressed by re-examining workload and other working conditions of residents as well as attending to their psychological wellbeing. The limitations of the study are also discussed.

Prevalence of burnout syndrome among medical residents: experience of a developing country.

Background: To provide the optimum level of healthcare, it is important that the supply of well-trained doctors meets the demand. However, despite many initiatives, Ireland continues to have a shortfall of physicians, which has been projected to persist. Our study aimed to investigate the migration intentions of Irish medical students and identify the factors that influence their decisions in order to design appropriate interventions to sustain the supply of trained doctors in order to maintain a viable medical system. Methods: An online cross-sectional survey was undertaken of all Irish medical students studying in the Republic of Ireland. The survey included nominal, ordinal, and scale items to determine migration intentions, factors influencing their decisions, and understanding of the Irish healthcare system. Results: A total of 2 273 medical students responded (37% response rate), of whom 1 519 were classified as Irish medical students (having completed secondary school in Ireland). Of these, 88% indicated they were either definitely migrating or contemplating migrating following graduation or completion of the pre-registration intern year. Forty percent expressed an intention of returning to Ireland within 5 years. The factors most influencing their decision to leave were career opportunities (85%), working conditions (83%), and lifestyle (80%). Conclusion: The migration intentions expressed in this study predict an immediate and severe threat to the sustainability of the Irish healthcare service. Urgent interventions such as providing information about career options and specialty training pathways are required. These must begin in the undergraduate phase and continue in postgraduate training and are needed to retain medical school graduates.

/pdf/ireland-s-medical-brain-drain-migration-intentions-of-irish-29bkl6hzvh.pdf

Ireland's medical brain drain: migration intentions of Irish medical students.

The international migration of physicians is a global public health problem. Lebanon is a source country with the highest emigration factor in the Middle East and North Africa and the 7th highest in the World. Given that residency training abroad is a critical step in the migration of physicians, the objective of this study was to survey students of Lebanese medical schools about their intentions to train abroad and their post training plans. Our target population consisted of all students of Lebanese medical schools in the pre-final and final years of medical school. We developed the survey questionnaire based on the results of a qualitative study assessing the intentions and motives for students of Lebanese medical schools to train abroad. The questionnaire inquired about student's demographic and educational characteristics, intention to train abroad, the chosen country of abroad training, and post-training intention of returning to Lebanon. Of 576 eligible students, 425 participated (73.8% response rate). 406 (95.5%) respondents intended to travel abroad either for specialty training (330 (77.6%)) or subspecialty training (76 (17.9%)). Intention to train abroad was associated with being single compared with being married. The top 4 destination countries were the US (301(74.1%)), France (49 (12.1%)), the United Kingdom (31 (7.6%)) and Canada (17 (4.2%)). One hundred and two (25.1%) respondents intended to return to Lebanon directly after finishing training abroad; 259 (63.8%) intended to return to Lebanon after working abroad temporarily for a varying number or years; 43 (10.6%) intended to never return to Lebanon. The intention to stay indefinitely abroad was associated male sex and having a 2nd citizenship. It was inversely associated with being a student of one of the French affiliated medical schools and a plan to train in a surgical specialty. An alarming percentage of students of Lebanese medical schools intend to migrate for post graduate training, mainly to the US. A minority intends to return directly to Lebanon after finishing training abroad.

https://link.springer.com/content/pdf/10.1186%2F1471-2458-8-191.pdf

Post-graduation migration intentions of students of Lebanese medical schools: a survey study

In this chapter, we present recent advances on the use of several different kinds of medicinal herbs to treat cancer, Parkinson’s disease (PD), heart disease, and depression. These include recent studies on the use of Vaccinium spp. (blueberries and relatives) for cancer treatment and prevention; blueberries in the diet to improve motor skills and cognitive ability in patients with PD; digitalis (foxglove) to treat patients with heart disease; and St. John’s wort that is used to treat patients with mild-to-moderate depression. The basic conclusion from these studies is that rigorous, well-designed clinical trials are needed to validate the safe use of these and other medicinal herbs for treatment of these and other diseases.

The Use of Selected Medicinal Herbs for Chemoprevention and Treatment of Cancer, Parkinson’s Disease, Heart Disease, and Depression

Objective: To evaluate a conceptual framework portraying the factors underlying the intentions of medical stu- dents to train abroad. Methods: Eligible subjects were students in the pre-final and final years of medical studies in Lebanon. A survey ques- tionnaire based on the conceptual framework inquired about demographic and educational characteristics, influencing fac- tors, and intentions to train abroad. We assessed each of the factors for its frequency, distribution, and association with the intention to train abroad. Results: Of 576 eligible students, 425 (74%) participated. The frequency of the framework factors varied from 16% to 94% and was the highest for factors related to training and professional career. The factors independently associated with the intention to train abroad related to residency training, concern with professional career and political conditions. The intention to train abroad was also associated with thinking that the general public considers doctors trained abroad as more qualified (OR=6.3; 95% CI=1.2-33.2); receiving information about abroad training from doctors trained or training abroad (OR= 9.7; 95% CI=1.7-56.6); having relatives or friends living abroad (OR=6.9; 95% CI=1.4-35.7); and witnessing resi- dents traveling to retrain abroad (OR=22.2; 95% CI=4.5-111.1).

/pdf/factors-influencing-lebanese-medical-students-decisions-to-3y50t8ftvt.pdf

Carl K. Li

Papers

Post-graduation migration intentions of students of Lebanese medical schools: a survey study

The Use of Selected Medicinal Herbs for Chemoprevention and Treatment of Cancer, Parkinson’s Disease, Heart Disease, and Depression

Factors Influencing Lebanese Medical Students' Decisions to Train Abroad: Evaluation of a Conceptual Framework