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Biomedical subjects

P Freeman

Publications and source records attributed to P Freeman.

At least 37 records · Page 2Linked to original sources
PubMed1999

Patient-centeredness and its correlates among first year medical students.

OBJECTIVE: This research was performed to study the attitudes that medical students hold concerning their relationships with patients, and whether such attitudes are gender-related, affect career plans, and influence their evaluation of psycho-social and biomedical issues. METHODS: One hundred fifty-three first year students at the Boston University School of Medicine completed the Patient-Practitioner Orientation Scale (PPOS), a scale that differentiates between a patient-centered vs. doctor-centered orientation toward medical practice, indicated their interest in community and primary care practice, and rank ordered psycho-social and biomedical clinical issues in terms of their perceived relative importance. RESULTS: The data revealed that female medical students were more patient-centered, and that (across sexes) patient centeredness was positively associated with an interest in community and primary care practice and the ranking of psycho-social issues. CONCLUSIONS: These findings indicate that differences in the practice attitudes of males and females exist very early on in medical training, and that these differences are associated with anticipated career choices. They also suggest that the PPOS may prove useful in measuring the attitudes of practicing physicians toward their clinical roles and might predict physicians' behavioral strategies and patient medical outcomes.

Adult↗
PubMed1998

High ideals & perverse consequences: risk adjustments, encounter data & Medicare+Choice.

Why should you take on the risks and complications of developing a PSO? Is it worth it? Will it mean assuming undue risk? The answer to this question gets complicated. This article will introduce more uncertainties than you had before. But, you need to have your eyes wide open. It's not just a question of your capability as a health system or a medical group. It's a question of HCFA's ability to administer the program. Even without knowing the capabilities of HCFA, most organizations would say that they don't trust the government to follow through with any program. In this article by Bruce Fried, we get a rare look at the inner thoughts and gyrations of government, as they attempt to risk-adjust Medicare payments to PSOs and HMOs. In ordinary language, that means, if you happen to have a very sick population of seniors, you will be paid more to take care of them. But, read this and weep.

Aged↗
PubMed1997

The effects of gender, menstrual phase and practice on the perceived location of the midsagittal plane.

Women show menstrual phase-related cognitive changes that suggest altered hemispheric activation for a particular task, such that they demonstrate the greatest lateral performance differences on prototypical left hemisphere tasks during the luteal phase and on prototypical right hemisphere tasks during menstruation. Additionally, menstrual phase may alter total cerebral responsiveness, such that response times and performance accuracy for many tasks are best during the luteal phase and most impaired during the menstrual phase. We evaluated the effect of menstrual phase on spatial bisection (a perceptuospatial task) to help further understand hormonally-mediated changes in interhemispheric dynamics. Healthy young adult women and men blindly pointed to their midsagittal plane with either hand. Women were repeatedly tested according to menstrual phase, and men were tested at similar intervals. The mean pointing error in the luteal phase differed significantly from that of all other phases and did not differ significantly from those of men, who pointed significantly to the left across test sessions. These findings suggest that, in space bisection tasks, women are more likely to have asymmetric hemispheric activation during the luteal phase than during the menstrual phase. Thus, space bisection did not resemble other prototypical right hemisphere behaviors. The luteal phase may have nonspecifically activated both hemispheres on this task instead of suppressing right hemisphere function, and a slight functional asymmetry favoring the right hemisphere may have been promoted. In addition, intermanual pointing discrepancies in both subject groups decreased over repeated sessions. This suggests that, while practice alters an internal kinesthetic reference, it does not influence an imaginal extrapersonal spatial reference.

Adolescent↗
PubMed1995

Case management quality assessment in rural areas of Papua New Guinea.

A study was carried out to assess the quality of case management of malaria, malnutrition, diarrhoea and acute respiratory tract infections in children in rural primary health services in Papua New Guinea. In particular, the study focused on the knowledge and skills of different categories of rural health workers (HW) in history taking, examination, diagnosis, treatment and patient education. Quality criteria were defined and health centre (HCW) and aidpost workers' (APWs) knowledge and practices were assessed. Primary health workers' (PHW) knowledge of case management was weak, but in all cases better than their actual practice. History taking and examination practices were rudimentary. HWs tended not to make or record diagnoses. Treatment knowledge was often incorrect, with inappropriate or insufficient drugs prescribed, being worst at aidpost level. These findings raise serious questions about the effectiveness of providing health services through small, isolated health units. Far greater attention must now be directed to focus on the institutionalization of problem-based training, continuous supportive supervision and maintenance of clinical skills and provision of essential drugs, supplies and equipment to ensure that rural health workers (RHW) can provide sound care.

Child↗
PubMed1995

The clinical competency of community health workers in the eastern highlands province of Papua New Guinea.

A case study of the clinical competency of community health workers employed in the Eastern Highlands Province of Papua New Guinea was conducted in March 1993. Of the 79 who graduated from the Onamuga Community Health Worker Training School between 1989 and 1992, only 24 were currently employed in the province. Current knowledge and clinical competency were compared with results on completion of basic community health worker training. Results showed that 22 of the 24 maintained their knowledge competency, and 15 maintained clinical competency. It was found that those community health workers (CHWs) employed at a health subcentre use 40% to 50% of their skills, whilst those at a district health centre or provincial hospital use only 20% to 30% of their skills. Only 8% of the CHWs studied used all the skills obtained in their basic training. This study indicates that the CHW is being viewed by some health managers as a replacement for the nurse aide. If CHWs' skills are to be maintained, certainly good supervision, inservice training and adequate logistic support are needed, but so also is a change in management thinking. The CHW has been trained specifically to improve the access to essential primary health care services of people living in rural areas, especially in preventive and maternal and child health care. If in practice the CHW is not given the opportunity to practise and hence maintain these skills, the whole logic of the CHW training scheme will need to be reexamined.

Adult↗
PubMed1995

The clinical diagnosis and treatment of important childhood diseases in rural Papua New Guinea.

This study used multiple standardized instruments to evaluate the quality of the clinical management of the common childhood diseases in rural Papua New Guinea. The findings indicate major inadequacies in the quality of history taking, examination, record keeping, diagnosis and treatment of the common causes of childhood morbidity and mortality. To improve case management by health workers in rural clinical situations everything possible must be done to make good clinical management easy and practical. This should involve provision of practical reinforcing tools, training and supervision which target rural health workers as valuable human resources, and community education which maximizes the contribution that community members can make to early diagnosis and good management.

Case Management↗
PubMed1994

Modulation of morphine-induced antinociception in mice by histamine H3-receptor ligands.

The effects of compounds active at histamine H3-receptors on morphine-induced antinociception have been investigated in thermal and chemical tests in mice; tail-immersion (50 degrees C) and hot-plate (49 degrees and 55 degrees C) tests and acetic acid-induced writhing. Neither (R)alpha-methylhistamine, a specific agonist, (S)alpha-methylhistamine, a chemical control, nor thioperamide, an antagonist, had any antinociceptive action alone but thioperamide (3 mg kg-1) attenuated the effects of morphine in the tail-immersion test while (R)alpha-methylhistamine (1 mg kg-1), but not the (S) isomer, potentiated its effects in the hot-plate test at 55 degrees C. These results are consistent with the morphine potentiation seen with H1-antagonists and suggest that central histaminergic mechanisms can modulate opioid actions.

Analgesics↗
PubMed1994

Modulation of the intracellular and H3-histamine receptors and chemically-induced seizures in mice.

Central histaminergic modulation of H1 rather than H2-receptors has been shown to modify epileptic activity. Compounds acting on the HIC- and H3-receptors were tested against chemically-induced seizures in mice. Compounds antagonising the microsomal and nuclear intracellular receptors (HIC) only modified seizures at doses where toxicity was observed. Antagonists of the histamine H3-receptor (thioperamide and burimamide) only potentiated the severity of clonic convulsions induced by picrotoxin, while impromidine (i.c.v.), an antagonist with H2-agonist activity, inhibited leptazol-induced seizures. The H3-agonist, (R)alpha-methylhistamine, potentiated chemically-induced seizures, but at lower doses there was slight inhibition.

Animals↗
PubMed1994

Introduction: vaccine technologies and public health. Why a critical review now?

Since Jenner's time, there have always been enthusiasts and skeptics about the role of vaccines in the prevention of disease. This introduction explains why, at this time, it is crucial to assess the historical role vaccines have played in limiting damage caused by infectious diseases, the role they can play in the future, and the technologies that are best suited to achieving optimal gains for public health and development worldwide.

Child Welfare↗
PubMed1994

The role of vaccine research and development in the scientific development of middle-income countries.

As a new global strategy for improving public health, the Children's Vaccine Initiative implicitly raises, once again, the question of the role of science in developing countries. If there are to be new and improved vaccines, better delivery systems, and simplified immunization schedules, there must be substantial analysis, laboratory activity, and fieldwork to ensure that the new products are ready for effective use. In the context of these requirements, this paper reviews the possibilities for vaccine research and development in middle-income countries and the benefits in terms of fostering socioeconomic development through integrated scientific health research.

Delivery of Health Care↗
PubMed1994

Consequences of the North American Free Trade Agreement for health services: a perspective from Mexico.

OBJECTIVES: The purposes of the study were to assess the potential impact of the North American Free Trade Agreement (NAFTA) on medical care in Mexico and to identify internal measures Mexico could take to increase the benefits and minimize the risks of free trade. METHODS: The dual nature of the health sector is examined; the Mexican, Canadian, and US health care systems are compared; and modes and consequences of international exchange of health services are analyzed. RESULTS: Four issues require immediate attention: accreditation of health care facilities, licensing and certification of professionals, technology assessment, and financial equity. CONCLUSIONS: NAFTA offers opportunities for positive developments in Mexico, provided risks can be anticipated and preventive measures can be taken to avoid negative impacts on the health system. Medical services, like other elements of the Mexican economy, must be modernized to respond to the demands of global competition. The Mexican National Academy of Medicine has recommended to the Mexican government (1) internal strengthening of the Mexican health care system to improve its ability to respond to the new conditions created by NAFTA and (2) a gradual process to facilitate equitable and mutually beneficial interactions among the three countries.

Canada↗
PubMed1994

National health care reform minus public health: a formula for failure.

Universal access to medical services will not address all important health needs. Impending health care reform, guided by public health strategies, could achieve many previously unattainable health goals. However, such a public health role seems unlikely. Public health reaches beyond the current popular notion of prevention focused on individual lifestyle, yet attention to public health authority has waned. The history of immunization, a personal health service effective only within a public health strategy, illustrates the dilemma. Britain required 40 years of National Health Service before it invoked a public health strategy to assure effective immunization. Reformed health care must perform certain functions systematically that in the past were optional for medical practitioners or left to health departments by default. Reformers must rebuild public health authority in states, to assure that medical services we will pay for under health care reform accomplish functions critical to the health of the public.

Health Care Reform↗
PubMed1994

Replicative Legionella pneumophila lung infection in intratracheally inoculated A/J mice. A murine model of human Legionnaires' disease.

The role of host immune responses in the pathogenesis of Legionnaires' disease is incompletely understood, due in part to the current lack of an animal model that is both susceptible to replicative Legionella pneumophila-induced lung infection and for which species-specific immunological reagents are available. We have developed a model of replicative L. pneumophila lung infection in intratracheally inoculated A/J mice. L. pneumophila was obtained in the exponential growth phase and inoculated into the trachea of 6- to 8-week-old female A/J mice. Microbiological and histopathological evidence of infection was demonstrated in mice inoculated with 10(6) colony-forming units. Development of an acute pneumonia that resembled human Legionnaires' disease coincided with exponential growth of the bacteria in the lung 24 to 48 hours after intratracheal inoculation of L. pneumophila. This was associated with increased plasma levels of interferon-gamma at 24 hours after inoculation. After 48 hours, the bacteria were gradually eliminated from the lung over the next 5 days, corresponding with resolution of the inflammatory response in the lung, thereby mimicking the outcome frequently seen in the immunocompetent human host. Treatment of animals with anti-interferon-gamma antibody enhanced bacterial replication and disease progression, indicating an important role of host immune response in resolution of the infection. Because of the availability of murine-specific reagents, this model of replicative L. pneumophila lung infection in A/J mice after intrapulmonary inoculation of L. pneumophila potentially provides an important tool for future studies investigating the role of host immune responses in the pathogenesis of Legionnaires' disease in the immunocompetent host.

Animals↗