Biomedical subjects

J A Earp

Publications and source records attributed to J A Earp.

66 records · Page 4Linked to original sources

PubMed1982

Primary health care: perspective of the faculty of a department of medicine.

A full-time faculty in one dependent of medicine, 66 (85%) of whom are subspecialists, were surveyed to determine standards for provision and attitudes toward the teaching and practice of primary health care (PHC). A 40-item questionnaire on specific attributes of PHC provision was given to 70 eligible faculty members; 66 (94%) responded. Of 17 standards, nine were supported by 50 (75%) or more of the faculty and eight by from 24 (44%) to 48 (73%) faculty members. However, 51 faculty members (77%) indicated some discomfort with primary responsibility for the complete, ongoing care of their patients. Most frequent reasons for this discomfort were clinic inefficiency (31 votes [47%]) and competing commitments (29 votes [44%]). Few faculty indicated they did not enjoy PHC (eight [12%] of the faculty) or considered PHC inappropriate for academic physicians (ten [15%] of the faculty). These results indicate the complexity of faculty attitudes toward PHC and point to a need for departments of medicine to examine thier teaching and practice of PHC.

Attitude of Health Personnel↗

PubMed1981

Role disagreement in primary care practice.

To measure the extent of disagreement on roles between nurse practitioners (NPs) and physicians working together and to look for characteristics of joint practices that are associated with disagreement, patient vignettes were sent to 15 NP/M.D. dyads, and both M.D.s and NPs were asked how appropriate it would be for them and for their co-practitioner to provide care for the problem presented in each vignette. Measures of disagreement on patient care roles were developed by comparing responses within the dyad. For all practices, there was moderate agreement on roles, and this agreement seemed to favor a complementary practice. Disagreement on the NP's role was most often in the direction of NP feeling capable of providing more care than the M.D. felt she could provide. Various factors, such as job satisfaction, age differences between providers, and training level of the NP, were associated with the disagreement that was found. Some disagreement on roles exists between NPs and M.D.s practicing together. Resolution of these differences may lead to greater job satisfaction and more effective interaction between providers.

Adult↗

PubMed1981

The association between mothers' social support and provision of stimulation to their children.

Specific forms of maternal social support were analyzed for their relationship to a validated measure of home stimulation (the Inventory of Home Stimulation). The 69 study families were chosen to represent a wide variability of social support at the time of the child's birth. All index children had been discharged from a neonatal intensive care unit 3 years before the study. The overall Maternal Social Support Index (MSSI) developed for the study explained a significant (p less tha 0.1) amount of variance in the home stimulation of 3-year-olds after income, race, maternal age, and other possible confounding variables had been controlled. In addition, specific MSSI items were strongly associated with various forms of environmental stimulation. The data suggest that augmentation of specific aspects of mothers' social support networks may increase their children's informal learning opportunities.

Child Development↗

PubMedDate not supplied

How well do faculty evaluate the interviewing skills of medical students?

OBJECTIVE: To study the reliability and validity of using medical school faculty in the evaluation of the interviewing skills of medical students. DESIGN: All second-year University of North Carolina medical students (n = 159) were observed interviewing standardized patients for 5 minutes by one of eight experienced clinical faculty. Interview quality was assessed by a faculty checklist covering questioning style, facilitative behaviors, and specific content. Twenty-one randomly chosen students were videotaped and rated: by the original rater as well as four other raters; by two nationally recognized experts; and according to Roter's coding dimensions, which have been found to correlate strongly with patient compliance and satisfaction. SETTING: Medical school at a state university in the southeastern United States. PARTICIPANTS: Faculty members who volunteered to evaluate second-year medical students during an annual Objective Structured Clinical Exam. INTERVENTIONS: Interrater reliability and intrarater reliability were tested using videotapes of medical students interviewing a standardized patient. Validity was tested by comparing the faculty judgment with both an analysis using the Roter Interactional Analysis System and an assessment made by expert interviewers. MEASUREMENTS AND MAIN RESULTS: Faculty mean checklist score was 80% (range 41-100%). Intrarater reliability was poor for assessment of skills and behaviors as compared with that for content obtained. Interrater reliability was also poor as measured by intraclass correlation coefficients ranging from 0.11 to 0.37. When compared with the experts, faculty raters had a sensitivity of 80% but a specificity of 45% in identifying students with adequate skills. The predictive value of faculty assessment was 12%. Analysis using Roter's coding scheme suggests that faculty scored students on the basis of likability rather than specific behavioral skills, limiting their ability to provide behaviorally specific feedback. CONCLUSIONS: To accurately evaluate clinical interviewing skills we must enhance rater consistency, particularly in assessing those skills that both satisfy patients and yield crucial data.

Clinical Competence↗

PubMedDate not supplied

What lay health advisors do: An evaluation of advisors' activities.

PURPOSE: Since the 1970s, health promotion and disease prevention programs that rely on lay health advisors have proliferated, making it important to ascertain the levels and types of activity that can reasonably be expected from such advisors. This report describes the activities of lay health advisors participating in a program to increase mammography screening by older African American women and shares lessons that the authors learned about evaluating advisors' activities. DESCRIPTION OF STUDY: Between September 1994 and January 1996, 144 lay health advisors, associated with the North Carolina Breast Cancer Screening Program, were asked to complete, on a periodic basis, a standardized, self-administered activity report that asked about group presentations in the past 3 months and one-on-one contacts in the past week. Eighty-five advisors submitted one or more reports. The authors tabulated responses for lay health advisors overall, for those turning in one or more reports, and for those reporting a specific type of activity. RESULTS: The responses showed that North Carolina Breast Cancer Screening Program lay health advisors made approximately one group presentation every 3 months and had one to three individual contacts per week. Group presentations were commonly in churches and homes, and focused on who needs a mammogram, how then, and where to get one. During one-on-one encounters, advisors primarily encouraged women to get mammograms or discussed fears about mammograms. CLINICAL IMPLICATIONS: Information about lay health advisor activities serves several important purposes. Such information allows programs to identify the types of messages that lay health advisors transmit and the number of contacts they make, while also identifying the groups that are more and less difficult to reach, and the topics and locations favored by advisors and the women they contact. Activity data may indicate what resources or other support the advisors need, whether in-service training is necessary, and how to enhance the recruitment and training of additional lay health advisors.

Black or African American↗

PubMedDate not supplied

Use of maternity services by pregnant women in a small Nigerian community.

Pregnancy is a time when women's health is placed at risk by a host of factors; however, professionals providing antenatal care can reduce that risk by monitoring women's health regularly and offering preventive services. Hygienic delivery services by a qualified attendant also help to reduce risks associated with childbearing. We explored these considerations in a rural Nigerian town by following 60 Yoruba women through pregnancy to childbirth. Although a functioning government maternity center in the community offered a full range of antenatal and delivery services, most of the women did not register for antenatal care until their sixth month of pregnancy or later, and 65% delivered at home. This behavior is explained in terms of (a) fees for delivery services, (b) level of income, (c) cultural beliefs, and (d) education. We conclude that provision of relatively accessible services does not guarantee their use and that other social and cultural considerations must be taken into account.

Adolescent↗

PubMedDate not supplied

Trust and collaboration in the prevention of sexually transmitted diseases.

High rates of sexually transmitted diseases (STDs) are sustained in communities by a relatively small group of people, referred to as the core of transmission. Definitions of the core vary but inevitably include people who are socially marginalized and who distrust people in authority, such as public health practitioners and university researchers. Having an effect on a marginalized group usually depends on effective collaboration with people they trust. Researchers from the University of North Carolina School of Public Health developed a trust-based collaboration with community members of a rural county in North Carolina to implement an STD prevention program that, in turn, relied on trust in local social networks. As part of the STD prevention demonstration project, the research team established a community resource group made up of local African Americans who helped design, implement, and evaluate the intervention. The group identified 21 women to whom others in the community turned for advice on sex and STDs. These women were trained as lay health advisors to disseminate information and skills for preventing STDs among their social networks. Through face-to-face structured interviews before and after the intervention, the authors measured improvements in STD treatment and prevention behaviors. The proportion of people practicing each of the targeted behaviors improved during the evaluation period. In addition to disseminating information through their own social networks, the lay health advisors demonstrated new skills and a desire to interact with local care providers to influence the provision of care for STDs for low-income African Americans in this county. Each participant in the collaboration played a role in establishing or building upon trust with others. These trusting relationships were critical for empowering a marginalized group at high risk for STDs.

Adolescent↗

PubMedDate not supplied

Helmet use among competitive cyclists.

The United States Cycling Federation (USCF) decision in 1986 to mandate helmet use in all sponsored races marked a major initiative in cycling safety. Confirming earlier reports about the effectiveness of helmets in preventing injuries, this study also examines the attitudes of 554 USCF members toward the policy and about helmet use in both racing and nonracing situations. Although 64% of the racers reported some hardshell helmet use in training before the policy, 80% used helmets in training after the ruling. Most cyclists favored the USCF policy, although only 19% favored requiring helmet use in all cycling situations. Attitudes about helmet policy and actual use by racers were inconsistent; large percentages of those opposing mandatory helmet use in racing (51%) and in training (76%) used helmets themselves. We suggest possibilities for incremental expansion of helmet use requirements for all riders.

Adolescent↗

PubMedDate not supplied

Women with cured breast cancer a study of mastectomy patients in North Carolina.

A study of 49 postmastectomy patients in North Carolina, four years following the surgery, revealed that the women did not feel they had been prepared for their postoperative experiences; were not, in general, familiar with Reach to Recovery as a supportive organization, nor perceived it as such; only occasionally examined their remaining breast; and had a number of persisting physical complications. The extent of physical disability was found to be related to the quality of life inasmuch as women with a high number of physical symptoms were much more likely to have a higher number of symptoms of depression than women with fewer complications. Social supports mediated the effects of surgical complications on mental outlook, but only up to a point. Sexual adaptation was found to be associated with the quality of the marital-sexual relationship and its importance to the woman.

Adaptation, Psychological↗

PubMedDate not supplied

Is breast self-examination predicted by knowledge, attitudes, beliefs, or sociodemographic characteristics?

The relationship of women's sociodemographic characteristics, knowledge, attitudes, and beliefs to breast self-examination (BSE) practice is not clear. We therefore studied these variables among older women at risk for developing breast cancer to determine which might be associated with the sensitivity, specificity, and frequency of BSE practice. We interviewed 300 women 40 to 68 years of age and measured BSE sensitivity and specificity using manufactured silicone breast models containing lumps. Of 54 variables and 10 scales examined univariately, six were associated with BSE sensitivity, one was negatively associated with specificity, and 10 were associated with frequency. No variable was associated with more than one component of BSE practice, and BSE frequency was not associated with BSE sensitivity or specificity. Using multivariate analysis, BSE sensitivity was best explained by type of employment, health interest, and perceived vulnerability to breast cancer, which accounted for approximately 16% of the variance. BSE frequency was best explained by intention to perform BSE, knowing how to perform BSE, using the correct method of BSE, self-confidence in the ability to perform BSE monthly, and self-confidence in the ability to find small lumps. These variables accounted for 27% of the variance. Sociodemographic characteristics, knowledge, attitudes, and beliefs poorly predicted how accurately women practiced BSE but somewhat better predicted how often women practiced BSE.

Adult↗

PubMedDate not supplied

Child maltreatment and the use of social services.

A secondary analysis of 100 cases histories selected from social service records in a county department of social services (DSS) was conducted to examine the amount and kind of social services that persons identified as having maltreated a child received. Other objectives of the analysis were to observe the pattern of social service utilization over time and to discover what, if any, factors were associated with receiving social services. To accomplish these study objectives, two groups were selected for analysis: a target group of 50 families that had been reported to the county DSS for child maltreatment and a group of 50 families that had never been so reported. Both groups were composed mainly of young and socioeconomically deprived families that were characterized by poor incomes, little education, and low occupational levels. Analyses revealed significant differences in the amount and type of social services used by families in the target group and the comparison group. Although family structure was found to be related to the total amount of social service utilization, the degree of social disorganization within the family did not correlate with utilization. The study results indicate that the level of social services that protective service clients need and the level that they are actually getting should be re-examined.

Adolescent↗

PubMedDate not supplied

Partner-specific sexual behaviors among persons with both main and other partners.

CONTEXT: If men and women engage in different sexual behavior with main partners than with other types of partners, then programs aimed at preventing the spread of sexually transmitted diseases (STDs) may need to address individuals' differential risk with each partner type. METHODS: Relationship characteristics, partner risk behaviors and sexual behaviors are examined among 123 male and 106 female STD clinic patients who had both main and other partners. Individual-level comparisons are made for two types of partner pairs: main vs. other frequent (side) partners and main vs. casual partners. RESULTS: Among men and women with both main and side partners, the proportion who had known only their main partner for at least a year (48% of men and 41% of women) was significantly higher than the proportion who had known only their side partner for that long (2% and 9%, respectively); no other variable differed significantly by partner type. Among those with main and casual partners, both men and women were more likely to use alcohol or drugs before or during sex with main partners only (15%) than with casual partners only (1-3%). Women with main and casual partners were more likely to have oral sex only with main partners than only with casual partners (37% vs. 3%), and were more likely to use condoms only with casual partners than only with main partners (33% vs. 4%). CONCLUSIONS: Providers need to ask individuals about their sexual behaviors with different partner types, and should tailor prevention messages to an individual's risks and reproductive intentions with each partner.

Chi-Square Distribution↗