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Biomedical subjects

L A Crandall

Publications and source records attributed to L A Crandall.

At least 19 recordsLinked to original sources
PubMed1995

Expanding rural primary care training by employing information technologies: the need for participation by medical reference librarians.

The use of rural sites to train badly needed primary care providers requires access to sophisticated medical information not traditionally available outside of academic health centers. Medical reference librarians can play a key role in the development of primary care training sites in rural settings. Electronic information technologies, with proactive support from medical reference librarians, can provide current and detailed information without concern for distance from the health science center library. This paper discusses recent developments in technology, describes current challenges to the application of this technology in rural settings, and provides policy recommendations for medical reference librarians to enhance rural primary care training.

Area Health Education Centers↗
PubMed1995

Roles of physicians, genetic counselors, and nurses in the genetic counseling process.

A self-administered questionnaire was mailed to 325 genetic counseling professionals in the southeastern United States and 204 (63%) completed it. Among those responding, 32% held master's degrees in genetic counseling, 30% M.D. degrees, 23% degrees in nursing, and 3% master's degrees in social work. While genetic counseling typically involves team effort, members were generally unclear regarding their roles in the process. Respondents rarely referred their clients to social workers but believe they should. Most did not believe that master's trained genetic counselors should be the only health professional who provide counseling. The respondents strongly supported goals that dealt with the educative aspect of counseling and protection of patient autonomy.

Academic Medical Centers↗
PubMed1995

Sickle cell screening policies as portent: how will the human genome project affect public sector genetic services?

The Human Genome Project holds much promise for providing dramatic improvements in our understanding of and means to diagnose and treat many diseases. As this enormously important endeavor proceeds, research on ethical, legal, and social implications of this new science is being conducted to forecast problems and recommend policy option solutions to avoid what might otherwise become adverse consequences. Sickle cell screening is an example of a technology that was introduced in a manner that raised poignant issues. On the basis of sickle cell issues, we examined policy issues likely to occur as new genetic technologies are incorporated into medical practice. Discussion and development of a national consensus on the appropriate content and just delivery of public sector genetic services is vital; otherwise, the impact of Human Genome Project-derived technology may result in misadventures that amplify problems currently evident in newborn screening programs. New DNA-based diagnostic technologies and therapies will soon enter the stream of commerce. The recommendations offered here, while based on examination of sickle cell disease policies, are intended to address both current inequities as well as potential future issues related to stigmatization and distributive justice.

Anemia, Sickle Cell↗
PubMed1994

Impact of new information technologies on training and continuing education for rural health professionals.

Recently developed and emerging information and communications technologies offer the potential to move the clinical training of physicians and other health professionals away from the resource intensive urban academic health center, with its emphasis on tertiary care, and into rural settings that may be better able to place emphasis on the production of badly needed primary care providers. These same technologies also offer myriad opportunities to enhance the continuing education of health professionals in rural settings. This article explores the effect of new technologies for rural tele-education by briefly reviewing the effect of technology on health professionals' education, describing ongoing applications of tele-education, and discussing the likely effect of new technological developments on the future of tele-education. Tele-education has tremendous potential for improving the health care of rural Americans, and policy-makers must direct resources to its priority development in rural communities.

CD-ROM↗
PubMed1994

Older Floridians' attitudes toward and use of dental care.

Older Floridians (mean age 78 years) were interviewed regarding their use of dental care, attitudes toward dental care, and other characteristics hypothesized as being explanatory of dental care use. Fifty-two percent of respondents reported having been to a dentist within the past year, and 31% had not been within the previous 5 years. Five constructs measured attitudes toward dental care and dental health: (a) the importance placed on regular dental care and oral hygiene, (b) the importance of avoiding tobacco to prevent oral cancer, (c) the value of dental care, (d) negative aspects of dental care, and (e) satisfaction with the last dental visit. In a multivariate model, the value of dental care and importance of regular care and oral hygiene wer significantly correlated with dental care use. These findings are consistent with the conclusion that attitudes contribute to understanding dental care use in later life, a contribution that is independent of the direct effects of socioeconomic status and dentate status.

Aged↗
PubMed1993

Ethical and practical implications of the human genome initiative for family medicine.

Major advances in predictive genetic testing resulting from the Human Genome Initiative could change significantly the routine practice of family medicine. Family physicians should be aware that increased genetic information may affect patients' abilities to acquire and maintain insurance and employment and that interested parties will have incentives to seek this information. The social consequences of genetic information, as well as increased health promotion efforts, may raise problems of informed consent and confidentiality. In addition to their ethical implications, these developments will also affect the practice of family physicians in practical ways such as record keeping. We discuss cases that illustrate the potential impact of these emerging technologies on the practice of family medicine.

Adult↗
PubMed1993

Attitudinal and behavioral characteristics of older Floridians with tooth loss.

In this cross-sectional study of Floridians aged 65 yr or older, 600 persons were interviewed to identify the characteristics of individuals who survived into old age with an intact or nearly intact dentition. Persons with total or partial tooth loss reported less frequent dental care, less ability to pay dental care fees, less frequent dental hygiene, and were more likely to have been smokers or diabetic. Persons with tooth loss also had less positive attitudes toward dentists and dental care. These cross-sectional findings are consistent with tooth loss being the result of disease-, behavior-, and attitude-related causes, and/or their interactions. Tobacco use, diabetes, and infrequent oral hygiene and dental care may increase risk for dental disease; decreased ability to pay for dental treatment may impair utilization of non-extraction treatment options, and negative attitudes toward dental treatment may influence the desire for non-extraction treatment options. Research targeted toward modifying attitudes toward dental treatment may be useful in preventing or delaying tooth loss, and measurement of attitudes may be a useful way to identify individuals at the greatest risk for tooth loss for intervention studies.

Aged↗
PubMed1993

Insurance and genetic testing: where are we now?

Basic research will spur development of genetic tests that are capable of presymptomatic prediction of disease, disability, and premature death in presently asymptomatic individuals. Concerns have been expressed about potential harms related to the use of genetic test results, especially loss of confidentiality, eugenics, and discrimination. Existing laws and administrative policies may not be sufficient to assure that genetic information is used fairly. To provide factual information and conceptual principles upon which sound social policy can be based, the Human Genome Initiative established an Ethical, Legal, and Social Issues Program. Among the first areas to be identified as a priority for study was insurance. This paper provides a review of life, health, and disability insurance systems, including basic principles, risk classification, and market and regulatory issues, and examines the potential impact of genetic information on the insurance industry.

Persons with Disabilities↗
PubMed1990

Recruitment and retention of rural physicians: issues for the 1990s.

This paper briefly describes a number of structural and economic changes in the profession of medicine and in the rural medical care delivery system that have occurred since about 1970. Changes in the national physician supply; in the training, work, and practice characteristics of physicians; in the demographic characteristics of physicians; in the medical resources available in rural communities; and in federal and state support for the provision of medical services are noted. Four conceptual models that underlie physician recruitment and retention programs for small towns and rural communities are described. These include affinity models, which attempt to recruit rural persons into training or foster interest in rural practice among trainees; economic incentive models, which address reimbursement or payment mechanisms to increase economic rewards for rural practice; practice characteristics models, which address technical, collegial, referral, and other structural barriers to rural practice; and indenture models, which recruit temporary providers in exchange for scholarship support, loan forgiveness, or licensure. Examples of applications of each model are provided and the effects of changes in the medical care system on the effectiveness of each model are assessed. Finally, it is argued that elements of an optimal model for the recruitment of physicians to rural practice include the promotion of medical careers among rural high school students, the provision of financial and cultural support for their training, the development of technical and collegial support systems, and the limited use of indenture mechanisms to meet the needs of the most impoverished or isolated rural settings.

Career Choice↗
PubMed1989

Effect of nicotine on in vitro human sperm penetrability through cervical mucus and motility parameters.

Nicotine at concentrations found in the cervical mucus of female smokers appeared to enhance in vitro human sperm penetrability through ovulatory bovine cervical mucus. Sperm motility parameters were not affected by the addition of nicotine to semen samples incubated with BWW medium. Overall, these results suggest that a direct inhibitory effect of nicotine on sperm penetrability through cervical mucus is not responsible for the apparent increase in cervical factor infertility present in smoking women.

Cervix Mucus↗
PubMed1989

Impact of a required family medicine clerkship on medical students' attitudes about primary care.

A study of 314 medical students before and after a required third-year clerkship in family medicine explored relationships among exposure to the clerkship and changes in attitudes toward primary care. The survey instrument contained 29 statements distinguishing the philosophy of primary care from that of subspecialty-oriented medicine and asked students' to state their future residency plans. The responses of the primary care and subspecialty-oriented groups were the most disparate, whereas the students who were uncertain about residency plans shifted on several items from an alignment with the specialty group toward an alignment with the primary care group. This study shows that experience in a family medicine clerkship may be associated with changes in attitudes that represent development of a more informed image of primary care.

Clinical Clerkship↗
PubMed1988

Ethnicity and Food Stamp program participation: effect upon dietary intakes of low-income mothers served by a north Florida family practice center.

Ethnic differences in self-reported dietary intake between blacks and whites (participants and non-participants in the Food Stamp program) were studied in a group of 102 low-income mothers presenting themselves for treatment at an urban family practice center. The study population included 51 whites, of whom 21 were participants in the Food Stamp program, and 51 blacks, of whom 29 were Food Stamp program participants. The mean age of white and black mothers was approximately 29 years. Mean numbers of children per family were 2.1 for whites and 2.82 for blacks. Food and nutrient intake data were collected using a 24-hour recall and a food frequency questionnaire. Mean intakes of calcium, iron, riboflavin, and thiamin were found to be less than the RDAs for both groups. Whites additionally had mean intakes of vitamin A and niacin that fell below the RDAs. Blacks had significantly higher mean intakes of niacin and protein and a significantly higher 24-hour mean intake of soft drinks than whites. Being a member of the black race was positively associated with consumption of chicken, hot dogs, collard/mustard greens, and white rice. Being a member of the white race was positively associated with consumption of broccoli, potatoes, and whole wheat bread. Among participants in the Food Stamp program, mean intakes of protein, niacin, and soft drinks were significantly higher for blacks than for whites. This study suggests that ethnic differences in food preferences do exist but that those preferences do not translate into major differences in daily reported nutrient intakes.

Adult↗
PubMed1986

Faculty time allocation in rural primary care training sites.

This investigation examined the allocation of time by medical school faculty who served as attending physicians on a rotating basis in rural primary care centers where medical students and house staff were trained. Two quite different methods of studying faculty time allocation produced relatively consistent results. Travel and direct care of patients (with no medical students present) accounted for the largest share of faculty time. Much of the teaching time was spent in direct student contact with no patient present. Simultaneous care of patients by an attending faculty member and a medical student accounted for less than ten percent of faculty effort. It appears that in a busy rural primary care center, faculty whose mission is intended to emphasize teaching may often be thrust into the role of care providers. Despite this problem, faculty-student contact appears to be greater than that which typically occurs in the tertiary care teaching hospital environment.

Clinical Clerkship↗
PubMed1986

Socioeconomic influences in patient assignment to PA or MD providers.

Previous research conducted in solo fee-for-service physicians' offices in southern Appalachia reports that physicians treat patients of higher socioeconomic status and PAs treat those of lower status. However, these findings may not necessarily apply to other types of primary care practices, and the data were compiled more than ten years ago. Since then, the PA profession has greatly expanded, necessitating more current investigation (especially into publicly subsidized primary care settings). The original research reported here was undertaken to provide a more contemporary analysis of patient triage based on socioeconomic status. Three rural primary care centers in northern Florida were examined. Data show no consistent or substantively significant relationships between the patients' social status and the type of provider.

Black or African American↗
PubMed1984

Physician assistants in primary care. Patient assignment and task delegation.

This paper reports a concurrent self-report study of 2,456 office encounters with physicians and/or physician assistants (PAs) in 16 primary care, private practices in Florida. Initial patient assignment to either a physician or PA varies according to demographic and visit-specific characteristics. Patients who are male, younger than 65 years, new patients, seeking help for acute problems, and those who are "walk-in" or "work-in" patients are more likely to be assigned to a PA. Among frequently performed procedures, physicians are more likely to perform the partial histories, partial physicals, and pelvic examinations, as well as counsel patients on diet and psychosocial problems. PAs are more likely to perform the complete physical examinations, record vital signs, conduct diagnostic tests, and perform therapeutic procedures (administer injections, change dressings, etc.). Most tasks performed by PAs receive supervision through chart review rather than direct oversight. The typical patient visit in a practice employing a PA involves the receipt of services from only one provider. Approximately 50% of patient services are performed by physicians only, while 35% of the services are performed solely by PAs, and 15% are performed by both. Most patients have received care from both the physician and the PA.

Age Factors↗
PubMed1984

Nonmedical drug use patterns among medical students.

Interrelationships in the use of nonmedical drug use and tobacco use are explored based on self-reports by 165 medical students at an average-sized southeastern medical school. Lifetime and current use of drugs among these students appears consistent with earlier studies. Several background and demographic characteristics are correlated with drug use; higher rates of use are found among males, older students, and students who frequently miss classes. No correlation is observed between drug use and class standing, sibling position, social relationships, or family drug use patterns. Tobacco use was found to be low among these medical students but was highly correlated with nonmedical drug use. Drug use patterns appear to have developed in high school and college, and to persist, albeit at a diminished rate, during medical school. The findings provide little support for the belief that marijuana or cocaine use substitutes for alcohol use; higher consumption of virtually any recreational drug is predictive of higher use of other recreational drugs.

Humans↗