Search

Premature morbidity and mortality from chronic diseases account for a major proportion of expenditures for health care cost in the United States. The purpose of this study was to measure the effects of a disease management program on physiological and behavioral health indicators for Medicaid patients in Florida. A two-year prospective study of 15,275 patients with one or more chronic illnesses (congestive heart failure, hypertension, diabetes, or asthma) was undertaken. Control of hypertension improved from baseline to Year 1 (adjusted odds ratio = 1.60, p less than 0.05), with maintenance at Year 2. Adjusted cholesterol declined by 6.41 mg/dl from baseline to Year 1 and by 12.41 mg/dl (p less than 0.01) from baseline to Year 2. Adjusted average medication compliance increased by 0.19 points (p less than 0.01) in Year 1 and 0.29 points (p less than 0.01) in Year 2. Patients in the disease management program benefited in terms of controlling hypertension, asthma symptoms, and cholesterol and blood glucose levels. (Contains 3 tables.)

Background: Quality measurement and improvement in practice are requirements for Maintenance of Certification by the American Board of Medical Specialties boards and a component of many pay for performance programs. Objective: To describe the development of the American Board of Internal Medicine (ABIM) Practice Improvement Module (PIM[superscript SM]) and the average performance of ABIM diplomates who have completed the Preventive Cardiology PIM[superscript SM]. Design: Observational study of self-administered practice quality improvement. Setting: Office practices through the United States. Participants: A total of 179 cardiologists and general internists completing requirements for ABIM Maintenance of Certification from 2004 through 2005. Measurements: Physicians self-audited at least 25 charts to obtain performance measures, patient demographics, and coronary heart disease risk factors. At least 25 patients completed surveys regarding their experience of care in the physician's practice. Physicians completed a self-assessment survey detailing the presence of various practice systems. Results: The mean rate for systolic blood pressure control was 48%, for diastolic blood pressure 84%, and for low-density lipoprotein (LDL) cholesterol at goal 65%. Of patients 61% rated the quality of care as excellent and 58% rated the practices excellent at encouraging questions and answering them clearly. More than 85% of patients reported "no problem" obtaining a prescription refill, scheduling an appointment, reaching someone in the practice with a question, or obtaining lab results. Targets for improvement were increasing the rates for LDL cholesterol or systolic blood pressure at goal, improving patients' physical activity, patient education, and accuracy of risk assessment. Improvement strategies included implementing chart forms, patient education, or care management processes. Limitations: Patients and charts were selected by physicians reporting their performance for the purpose of MOC. Conclusions: The Preventive Cardiology PIM[superscript SM] successfully provides a self-assessment of practice performance and provides guidance in helping physicians initiate a cycle of quality improvement in their practices. (Contains 1 figure and 4 tables.)

The aim of this research is to assess the relative influence of mothers' coping strategies in everyday life and mothers' specific coping acts on toddlers' adjustment behavior to pain and distress during a routine immunization. The population is 41 mothers with toddlers (23 girls, 18 boys; mean age, 22.7 months) undergoing a routine immunization in private pediatrician practices. Mothers completed questionnaires about their own coping tendencies and about their toddler's preparation for the immunization. Toddlers' emotional adjustment to the situation was assessed by pediatricians. Results show that children who were informed by their mothers beforehand about the immunization were less distressed. Mothers were more likely to inform their toddler when their general coping options were rather self-oriented than child-oriented and when they were not using avoidant coping strategies. Mothers' own emotional regulation is thus related to coping with medical procedures in their young children. (Contains 3 tables, 1 figure and 2 notes.)

Objective and Participants: In 2006, the authors examined intention to receive an HPV vaccine among 340 college students. Methods: A total of 138 men and 202 women completed questionnaires. The authors measured intention by asking participants how likely they would be to accept an HPV vaccine that prevented against (1) all HPV, (2) cervical cancer but not genital warts, (3) genital warts but not cervical cancer, and (4) both genital warts and cervical cancer. Results: Men and women reported high intent to receive an HPV vaccine, although women did so at a significantly higher rate (77.5% vs 88.6%, respectively; p less than 0.01). Men were less willing to receive a vaccine that prevents cervical cancer alone than they were to receive one that prevents cervical cancer and genital warts (34.1% vs 77.5%, p less than 0.001). Intent to receive the vaccine was significantly greater among participants who reported more than 5 sex partners and correctly answered 2 or 3 HPV knowledge questions. Conclusions: Interest varied according to sexual history, according to knowledge about HPV, and (in men) according to vaccine target. (Contains 3 tables and 1 figure.)

Objective: (1) to provide a commentary on a conference held at the University of Manchester entitled Researching Water Fluoridation: Evaluation and Surveillance; (2) to synthesize from the proceedings of the meeting suggestions for future research and public health surveillance. Method: The main points and problematic issues raised by the speakers were documented and, together with information from other sources, used to construct an operational framework for the next stages in developing fluoridation research/ surveillance. Results: Critical areas were identified from the speakers' presentations and plenary discussions for which suggested ways forward were proposed. Important areas needing to be covered in future research/surveillance were then abstracted and tabulated. These included: participants, interventions, outcomes, sampling (sample frame and strategy), stratification, sample size, minimization of bias (blinding, examiner consistency), statistical methods, confounding variables, data requirements for ancillary analyses, and principal measurable adverse events. Conclusions: Covering the full range of criteria for comprehensive evaluation and surveillance would involve a number of complex, logistically demanding and costly procedures, including dietary intake monitoring and medical/dental clinical investigations. These would call for positive consent and compliance of target populations. It is suggested that a piecemeal research strategy, involving pilot studies and a series of separate, though probably linked, projects would be the optimum approach. The extent to which all the identified research/surveillance requirements could be met would depend on the availability of the necessary financial resources. (Contains 2 tables.)

A multi-site study of 351 children with Autism Spectrum Disorders (ASD) and 31 typically developing children used caregiver interviews to describe the children's early acquisition and loss of social-communication milestones. For the majority of children with ASD who had experienced a regression, pre-loss development was clearly atypical. Children who had lost skills also showed slightly poorer outcomes in verbal IQ and social reciprocity, a later mean age of onset of autistic symptoms, and more gastrointestinal symptoms than children with ASD and no regression. There was no evidence that onset of autistic symptoms or of regression was related to measles-mumps-rubella vaccination. The implications of these findings for the existence of a "regressive phenotype" of ASD are discussed.

Poor oral health is an important public health issue. Adolescents represent a challenging group in terms of oral health because they have vulnerable permanent teeth erupting at a time when they are establishing their independence from parental influence. Preventing oral disease by attempting to influence the behaviours that impact adversely on oral health requires an understanding of the attitudes and beliefs that underpin those behaviours. Very few studies have investigated adolescents' attitudes and beliefs in relation to dental issues. This study aimed to examine the attitudes and beliefs of adolescents towards dentistry and oral disease in order to inform future health promotion interventions. Data were collected through focus groups involving 22 13- to 14-year olds from selected secondary schools in Liverpool. A thematic analysis was applied to the data. The themes identified illustrated the attitudes and beliefs of adolescents in relation to oral health and demonstrated how adolescents justify and personally operationalize these attitudes and beliefs. A need to encourage this group to take action to perform oral health behaviours was demonstrated. (Contains 4 tables.)

The Kids First program at the University of Arkansas Medical School (UAMS) is an outgrowth of the Infant Health and Development Program, a randomized trial of an early intervention approach for premature, low birth weight children, which showed that intensive intervention had significant initial benefits in the cognitive development and behavior of these children, particularly for those in undereducated and poor families. When the UAMS decided to expand the Kids First network of early intervention centers, it considered four key indicators of child well-being in determining where to establish new sites: (1) the local rates of low birth weight; (2) low maternal education; (3) children living in poverty; and (4) special education placements. Kids First services can include nursing; speech, occupational, and physical therapy; and nutritional intervention, along with the daily classroom educational interventions. Interdisciplinary teams work with parents. Core developmental services address cognitive, gross and fine motor, language, social-emotional, and self-help domains of development. UAMS has resources that are not available to many rural early intervention programs--for example, the ability to offer above-average salaries to professionals and paraprofessionals, and access to high-speed Internet and e-mail connections. The authors recommend even more extensive use of technology in rural areas, including: (1) the use of video conferencing for professional development of staff members located in rural areas; (2) sending residents in pediatrics, community, and preventive medicine, and other specialties to local centers; and (3) continuing medical education in rural communities for Kids First referring physicians.

Science instructors sometimes avoid inquiry-based activities due to limited classroom time. Inquiry takes time, as students choose problems, design experiments, obtain materials, conduct investigations, gather data, communicate results, and discuss their experiments. While there are no quick solutions to time concerns, the 5E learning cycle seeks to minimize time demands (Bybee 1997). The author used the phases of the 5E learning cycle--engagement, exploration, explanation, extension, and evaluation--as a guide when creating a lesson that teaches students about sunscreens and ultraviolet (UV) radiation. The beginning of the school year is a good time to discuss the importance of sunscreen and ultraviolet radiation because summer is still fresh in the minds of students who are returning from an extended vacation. This lesson would also work well as an end-of-the-year, presummer reminder for students to take care of their skin during the hot summer months. Teachers can also discuss sunscreens and UV radiation at anytime throughout the school year, especially during lessons about the sun and as a reminder for students that sunscreens should be used year-round. This lesson addresses the National Science Education Standards.

The resurgence of infectious diseases and the emergence of infectious diseases raise questions on how to cope with the situation. The germ or clinical approach is the hegemonic biomedical paradigm. In this article, the author argues that the spread of infectious diseases has posted a challenge to the biomedical paradigm and shows how lock-in procedures maintain alternative and complementary medicine paradigms in the backyard.

The era of technical and scientific progress ushered in with the twentieth century brought new medical knowledge such as the Halstead 'radical' mastectomy, which promised a cure for breast cancer. These advances in medical knowledge were premised on an epidemiological model of disease, which shaped the treatment and public understanding of breast cancer through most of the twentieth century--to be replaced by a systemic model of breast cancer in the later years of the century. This article traces how this shift was both influenced by and influential on public understandings of medicine and disease. The author argues that, while the epidemiological model of disease shaped treatment options and public health campaigns through most of the century, current treatment regimes and health campaigns are shifting to reflect changes in the underlying model of disease (toward a systemic model).

An education and screening program is described that teaches pregnant women about child abuse and domestic violence in an attempt to break the family cycle of abuse. Using a family centered approach, the Child Protection Center Program offers a model for social workers and medical providers to address the needs of abused children and battered parents. (JDM)

Examines Sudden Infant Death Syndrome (SIDS), including: (1) story of a victim's family; (2) risk factors; (3) known preventive measures; (4) change in traditional behaviors to ensure infants are put to sleep on their backs; and (5) the role child care providers should play to educate and ensure the safety of clients. (SD)

Reviews methods of teaching preventive medicine in pediatrics and highlights innovative programs. Methods of teaching prevention in pediatrics include patient interactions, self-directed learning, case-based learning, small-group learning, standardized patients, computer-assisted instruction, the Internet, student-centered learning, and lectures. Urges change in curriculum, evaluation, and resources as part of a vertically and horizontally integrated curriculum. (Author/DB)

A survey of 142 U.S. and Canadian medical schools compared medical school curricula since 1991, especially in schools moving to the new interdisciplinary format. Thirty- five schools had retained preventive medicine teaching as a separate course; 25 schools integrated preventive medicine concepts into many courses; and 10 schools appeared to have lost preventive medicine in the curriculum change. (DB)

Discussion of teaching preventive medicine through electives describes four prototypes of innovative programs: (1) population health, (2) international health, (3) American Medical Student Association opportunities, and (4) public health degree programs. These electives enable students to participate in preventive services through experiential learning in such areas as community health, continuous quality improvement, and interprofessional teamwork. (Author/DB)

Suggested resources for planning and creating curricula in disease prevention and health promotion in medical schools are grouped into three categories: (1) national initiatives (such as the "Healthy People 2010" and "Put Prevention Into Practice" programs); (2) teaching immunization (including materials for physicians and nurses); and (3) key organizations (addresses and Web sites of 12 organizations). (DB)

Discusses formats to teach preventive medicine in obstetrics and gynecology (including learning objectives, lectures/seminars, and rounds/office practice) and evaluation methods (oral examinations, computerized question banks, objective structured clinical examinations). Offers examples from specific programs at American medical schools, including the universities of Alabama, Oklahoma, and New Mexico. (DB)

Reviews the rationale for including prevention in the clinical medicine clerkship. Summarizes current guidelines, presents examples of curricula in several medical schools, and proposes a future direction that stresses integrating teaching preventive medicine into internal medicine clerkships and across the entire four-year medical curriculum. (DB)

Discusses the role of departments of family medicine in teaching preventive medicine through required clinical experiences, required nonclinical courses, electives, collaborative interdisciplinary clerkships, and interdisciplinary nonclinical courses. Offers examples of innovative programs at the Universities of Michigan, Wisconsin, Vermont, Illinois, and Colorado; the State University of New York; Duke University (North Carolina); and Wayne State University (Michigan). (Author/DB)

Discusses the scope of the surgeon's involvement in teaching disease prevention and health promotion to medical students, enumerates possible learning objectives, and describes seven examples of programs that have used innovative methods to include prevention teaching in surgery curricula. Examples include the universities of Kentucky, South Carolina, and Texas; the Medical College of Wisconsin, and Jefferson Medical College (Pennsylvania). (DB)

Defines and examines a communication model for enhancing the provision and adoption of preventive practices in the primary care setting and discusses teaching that model in the medical school context. Methods for integrating communication skills for prevention into the medical school curriculum are discussed, using examples from Dartmouth (New Hampshire), Brown (Rhode Island), and Hahnemann (Pennsylvania). (DB)

Discusses the importance of assessing medical students' competence in prevention knowledge, skills, and attitudes. Provides general guidance for programs interested in evaluating their prevention instructional efforts, and gives specific examples of possible methods for evaluating prevention education. Stresses the need to tailor assessment methods to local institutional objectives. (Author/DB)

Discussion of faculty development and integration of prevention into medical school curriculum considers sound educational models, role of the institution, faculty development activities (including program components, processes, needed expertise, and barriers to participation), and faculty rewards and recognition. (DB)

A survey of American medical school preventive medicine curricula found more emphasis on teaching and evaluation of students in areas of clinical preventive services and quantitative methods and less emphasis on community services and health services organization and delivery. Written tests and unstructured observation were the most common methods of student evaluation. (DB)

Discusses the importance of teaching preventive medicine and presents a set of core competencies in preventive medicine for undergraduate medical education recommended by a 1997 task force of medical educators. Also reviews the Medical School Objectives Project, which describes in broad terms the knowledge, attitudes and skills students must master, and develops recommendations in specific curricular areas. (CH)

With federal officials leading high profile efforts to encourage HIV/AIDS prevention and new funding, blacks in academia are hopeful that more colleagues will join the fight. Notes some well-established models of community education, the emerging HIV/AIDS research agenda, the critical role of historically black medical schools in the HIV infrastructure, and the role of undergraduate AIDS education programs. (DB)

Argues that current training in child safety, health, and emergency response are not adequate for family childcare providers. Concludes that preventing sudden infant death syndrome (SIDS), preventing injury, providing safe outdoor play areas, controlling the spread of illness, and being prepared for emergencies must be of major concern and ongoing training. (SD)

This report by the President's Council on Physical Fitness and Sports examines the effects of various forms of physical exercise on the knee joint which, because of its vulnerability, is especially subject to injury. Discussion centers around the physical characteristics of the joint, commonly used measurements for determining knee stability, muscular and ligament strength. The deep knee bend, an exercise of highly questionable value in conditioning regimens, is criticized on the grounds that it contributes to chronic synovitis, promotes early arthritic onset, and produces gross knee instability. Exercise regimens are proposed and discussed for the treatment and prevention of knee injuries. Practical advice for the development of physical education and athletic programs justifiable from this review of knee joint exercise is given, and includes: (1) Exercises that unduly stretch or damage the ligaments of the knee should be avoided; (2) The deep knee bend should be used sparingly, if at all, in physical education and athletic conditioning, and substitutes should be developed such as bench stepping and weight training routines; (3) In performing knee bends for developing and maintaining the strength and endurance of the quadriceps muscles, a half knee bend is recommended; (4) Progressive resistance exercises of the muscles activating the knee joint should be routinely employed for the prevention of knee injuries and for the rehabilitation of the knee during postinjury or postsurgical rehabilitation. A bibliography of 37 citations is appended. (MB)