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Biomedical subjects

S Margolis

Publications and source records attributed to S Margolis.

At least 19 recordsLinked to original sources
PubMed2004

Preliminary evidence from Queensland that rural clinical schools have a positive impact on rural intern choices.

INTRODUCTION: The unequal and inequitable distribution of the medical workforce between rural and urban parts of Australia has been well documented. Commonwealth and state governments have introduced several significant initiatives in an attempt to address this imbalance, including recruitment of many overseas trained doctors. One longer-term initiative is the funding of university departments of rural health and rural clinical schools in medical schools. OBJECTIVE: To determine the impact of the rural clinical division of the School of Medicine at the University of Queensland (UQ), Australia, on the intern workforce in central and southern Queensland, Australia. METHODS: Time series analysis of first preferences for intern allocation among UQ graduates and source of interns (UQ, interstate and overseas) from 2001-2005, and comparison of trends between Rockhampton and Toowoomba (UQ student placements since 2003) with Mackay (no placements). RESULTS: First preferences for Rockhampton increased from six in 2001 to 10 in 2005, and for Toowoomba from five in 2002 to 12 in 2005, while for Mackay preferences were stable at two. At Rockhampton while two interns came from overseas in 2001 and three were from interstate in 2002, UQ provided all interns in 2004 or 2005. UQ has provided 12/13 interns in 2004 and 13/14 in 2005 for Toowoomba. Mackay continues to source interns from interstate and overseas with UQ providing only 3/5 interns in 2004 and 2005. At Rockhampton, among non-bonded UQ graduates the number of interns choosing to work there increased from zero in 2001 to six in 2005. For Toowoomba, numbers were seven and 10 respectively, while for Mackay it was zero. CONCLUSIONS: UQ's rural clinical division is having a positive impact on the intern workforce in the regional hospitals most closely allied with it.

Journal Article↗
PubMed2001

Breastfeeding patterns in Fujairah, United Arab Emirates.

The rate of breastfeeding initiation and continuation through the first 6 months of life were assessed via interview and telephone follow-up in a prospective study of 130 mothers who consecutively delivered in hospital in Fujairah, UAE. The rate of initiation (83.2 per cent) and continuation at 2 months (72.6 per cent) was not significantly different from earlier studies. However, the rate of breastfeeding at 6 months (46.9 per cent) was lower than a 1992 study (p = 0.02). There were no significant associated factors with not breastfeeding at discharge from the maternity hospital and 2 months later. However, a significant inverse relationship with the level of general education of the mother for breastfeeding at 6 months was found, which is in contradistinction to Western countries where the rate of breastfeeding rises with increasing general education. This has implications for the type and targeting of future breastfeeding education programmes.

Adult↗
PubMed2001

Partnership for front-line success: a call for a national action agenda on workforce development.

Despite more than a decade of dialogue on the critical needs and challenges in public health workforce development, progress remains slow in implementing recommended actions. A life-long learning system for public health remains elusive. The Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry in collaboration with other partners in federal, state, local agencies, associations and academia is preparing a national action agenda to address front-line preparedness. Four areas of convergence have emerged regarding: (1) the use of basic and crosscutting public health competencies to develop practice-focused curricula; (2) a framework for certification and credentialing; (3) the need to establish a strong science base for workforce issues; and (4) the acceleration of the use of technology-supported learning in public health.

Centers for Disease Control and Prevention, U.S.↗
PubMed2001

Improving performance at the local level: implementing a public health learning workforce intervention.

In an effort to continually improve performance of the essential public health services with community partners, the diverse public health workforce in a major metropolitan area engaged in an organizational learning process. Core public health organizational competencies, identified in a multi-year collaborative applied research initiative, provided the curricula content for the public health learning experience. All members (about 600) of the Columbus and Franklin County (Ohio) Health Departments participated in four one-half day small group, highly interactive modules conducted during a 2-year period. The purpose of this article is to describe the design and implementation of this workforce intervention, the lessons learned, and implications for developing organizational capacity and improved performance.

Competency-Based Education↗
PubMed2001

EKG analysis skills of family practice residents in the United Arab Emirates: a comparison with US data.

BACKGROUND AND OBJECTIVES: Concern has been raised about the electrocardiogram (EKG) analysis skills of family practice residents in the United States. This study examined EKG analysis skills of family practice residents, medical students, interns, and general practitioners (GPs) in the United Arab Emirates (UAE), a different environment. METHODS: The measurement instrument was a set of 10 EKGs, used in a study of US family practice residents. Two of the EKGs were normal, and there were 14 clinical abnormalities in the remainder. RESULTS: There was no significant difference in the correct diagnosis of acute myocardial infarction between US family practice residents and UAE family practice residents, medical students, or GPs. Interns' diagnoses were significantly poorer. The mean score for correctly identifying acute myocardial infarction and both normal EKGs was not significantly different between groups: 2.50 medical students, 2.35 interns, 2.58 UAE family practice residents, 2.67 FD, and 2.55 US family practice residents. However, the US family practice resident mean score of 11.26 for all 16 clinical findings was significantly higher than any group in the UAE: 5.35 medical students, 5.87 interns, 6.08 UAE family practice residents, 5.69 family physicians. CONCLUSIONS: Difficulty in EKG interpretation transcends geographic boundaries, suggesting that new approaches to teaching these skills need to be explored. Improved EKG reading skills by family physicians are generally needed in both the United States and the UAE.

Clinical Competence↗
PubMed2000

Determination of vitamins in food-matrix Standard Reference Materials.

In recent years, the National Institute of Standards and Technology (NIST) has developed several food-matrix Standard Reference Materials (SRMs) characterized for vitamins and other organic nutrients. NIST uses several "modes" for assignment of analyte concentrations in SRMs, one of which includes the use of data provided by collaborating laboratories. Certification modes and liquid chromatographic methods that were used by NIST for value assignment of vitamin concentrations in recently introduced food-matrix SRMs are described in this paper. These materials and methods include vitamins D and E in coconut oil (SRM 1563) by gravimetry and multi-dimensional liquid chromatography (LC); vitamins A, E, and several B vitamins by reversed-phase LC and vitamin C by ion-exchange chromatography in infant formula (SRM 1846); and carotenoids and vitamins A and E by reversed-phase liquid chromatography in a baby food composite (SRM 2383).

Chromatography, Liquid↗
PubMed1996

The conundrum of chronic back pain. One person's story.

Providing effective medical care for chronic back pain patients in the absence of a specific diagnosis is one of the challenges of clinical general practice. The illness, as perceived by the patient, and its associated disability may be only loosely related to the disease pathology.

Back Pain↗
PubMed1994

A comparison of education methods and their impact on behavioral change in patients with hyperlipidemia.

We sought to determine the efficacy of a hospital-based, professionally-taught program emphasizing cardiovascular health. Similar programs are in existence throughout the country without documentation of their long-term benefits. Thirty-six hyperlipidemic individuals were treated as a control group or participated in one of two intensive educational interventions. The educational program was based on information obtained from focus group methodology to elicit attitudes about dietary change and learning style preferences. Behavioral changes in smoking, dietary salt and saturated fat intake, stress and tension, physical activity, and departure from ideal body weight were documented using health questionnaires and Lifestyle Risk Indices. At three months of follow-up, there was no change in serum lipids, total fat intake, or cardiovascular risk behavior in either the control or intervention group. We conclude that a one-day program, whether designed by the target population or experts, did not improve cardiovascular risk behaviors, suggesting that more innovative methods are required to address health behaviors in this high risk group.

Female↗
PubMed1994

Medical education change: a detailed study of six medical schools.

This article reports a comparative case study of six selected USA medical schools, undertaken to identify factors that facilitate or obstruct innovation in medical education. The findings suggest that the culture of each medical school results from a combination of intra-institutional and external factors. Together these forces influence substantially the fate of educational innovations. The institutional culture influences critical elements such as educational philosophy, leadership and resources provided in support of innovation. Equally important, the culture shapes the level and type of change a school considers and implements. The findings also suggest that the availability of resources and the creative impetus present in schools giving priority to research can benefit the educational goals and facilitate educational change.

Curriculum↗
PubMed1992

Early predictors of career achievement in academic medicine.

OBJECTIVE: To identify early personal and scholastic factors that predict academic career choice and long-term career achievement among academic physicians. DESIGN: A longitudinal cohort study. PARTICIPANTS: Nine hundred forty-four male physicians who graduated from The Johns Hopkins University School of Medicine, Baltimore, MD, from 1948 through 1964. OUTCOME MEASURES: Career achievement outcomes included attained faculty rank in 1990 and the number of citations (20 to 24 years after graduation) to published work. RESULTS: Of the 944 physicians, 424 (45%) had chosen academic careers. Scholastic performance and research experience in medical school were independently associated with having chosen an academic career (P less than .001). Among academicians, higher attained rank in 1990 was independently associated with the following: (1) membership in Alpha Omega Alpha (relative risk [RR] = 4.94, P = .0001); (2) rank in the top third of the graduating class (RR = 2.68, P = .01); and (3) research experience in medical school (RR = 3.11, P = .0001). These three factors were also independently associated with more citations to participants' published work (P less than .05). CONCLUSION: These data suggest that scholastic performance and research experience during medical school predict career achievement in academic medicine over 20 years in the future.

Achievement↗
PubMed1991

Effects of pravastatin, a new HMG-CoA reductase inhibitor, on vitamin D synthesis in man.

The HMG-CoA reductase inhibitors, a new class of lipid-lowering agents being used with increasing frequency, inhibit synthesis of cholesterol in vivo. Thus, one potential side effect of these drugs is alteration of other metabolic pathways requiring intermediates in the cholesterol biosynthetic pathway. We hypothesized that pravastatin, a new HMG-CoA reductase inhibitor, may impair vitamin D3 synthesis in the skin and alter mineral homeostasis by diminishing the availability of vitamin D precursors. Basal serum levels of calcium, phosphorus, parathyroid hormone (PTH), vitamin D3, and 1,25-dihydroxyvitamin D were measured, and dietary intakes of calcium and vitamin D were calculated in a control hypercholesterolemic group and an experimental group treated with pravastatin 10, 20, and/or 40 mg orally twice daily for at least 3 months. Basal parameters of mineral metabolism were similar in the two groups. To assess the capacity of the skin to synthesize vitamin D3 and as an indirect measure of its precursors, all subjects received whole body ultraviolet irradiation (UVI) in a phototherapy chamber for varying time intervals. Subjects in both groups showed significant (P less than .001) dose-dependent increases in vitamin D3 production after equivalent UVI exposures. However, for equivalent UVI exposure, the serum vitamin D3 response was identical in controls versus pravastatin-treated subjects. We conclude that hypercholesterolemic patients have normal mineral metabolism and the use of pravastatin at these doses for up to 3 months does not alter vitamin D3 synthesis in the skin.

Adult↗
PubMed1991

Bilateral optic disc neovascularization in association with retinitis pigmentosa.

Bilateral neovascularization of the optic disc developed in a 16-year-old Hispanic girl with retinitis pigmentosa. The neovascularization regressed in both eyes over 1 year without treatment. Ocular and systemic evaluation failed to reveal a recognized cause for the neovascularization. To our knowledge this is only the third case reported of this unusual association.

Adolescent↗
PubMed1990

Efficacy and safety of pravastatin in patients with primary hypercholesterolemia. I. A dose-response study.

This multicenter, double-blind, placebo-controlled, dose-response study was conducted in patients with primary hypercholesterolemia to examine the effects of pravastatin, a selective inhibitor of HMG-CoA reductase, on plasma lipids and lipoproteins. A total of 306 patients on cholesterol-lowering diets received twice daily doses of 5 mg, 10 mg, 20 mg pravastatin, or placebo for 12 weeks. Marked reductions in low density lipoprotein (LDL) cholesterol and total cholesterol were observed after 1 week of treatment; maximum lipid-lowering effects occurred at 4 weeks and were sustained for the duration of the trial. At week 12, pravastatin treatment resulted in dose-dependent mean reductions from baseline in LDL cholesterol of 17.5%, 22.9%, and 30.8% for the 3 doses tested (P less than or equal to 0001 compared with baseline and placebo). The reduction in LDL cholesterol was log-linear with respect to dose; each doubling of dose reduced LDL cholesterol an additional 6.5%. Dose-dependent reductions in total cholesterol from 12.9% to 23.3% also occurred (P less than or equal to 0.001). Triglycerides decreased by as 15.4% (P less than or equal to 0.001) and high-density lipoprotein (HDL) cholesterol increased approximately 7% (P less than or equal to 0.01), but these effects were not dose-dependent. No patient receiving pravastatin was discontinued during the 12-week trial. Transient episodes of rash and headache occurred. Slight increases in mean serum levels of ASAT and ALAT occurred, and 2% of both placebo- and pravastatin-treated patients reported myalgia although there was no clinically significant elevation of creatine kinase. These data indicate that pravastatin favorably affects all lipid parameters and is well tolerated.

Anticholesteremic Agents↗
PubMed1990

Nutritional status and growth in juvenile rheumatoid arthritis.

The specific cause of short stature in juvenile rheumatoid arthritis (JRA) is unknown. One hypothesis links altered growth to inadequate dietary intake. In this study, nutritional status was assessed in 34 children with JRA (8 with systemic JRA, 14 with polyarticular JRA, and 12 with pauciarticular JRA) and 9 healthy controls using 3-day diet records, anthropometrics, and biochemical analyses. Differences in growth were found among the three types of JRA. One third of all subjects were at or below the 10th percentile in height for age (these being predominantly among the systemic and polyarticular groups). With few exceptions, the mean dietary intake for calories and essential nutrients was found to be adequate for each of the three groups. However, more than half of those with systemic JRA reportedly consumed less than the recommended caloric intake for their age and weight. No significant correlations were found linking dietary intake to growth percentiles in any of the groups studied. Biochemical abnormalities were found among the systemic and polyarticular groups. These abnormalities included low plasma levels of vitamins A and C, proteins (albumin, prealbumin, and retinol binding protein) and zinc; and increased levels of copper and glutathione peroxidase activity. Plasma selenium and vitamin E levels were unchanged. The discrepancy between intake and certain circulating nutrient levels may reflect alterations in the requirements, absorption, or use of these nutrients in the presence of chronic inflammation.

Adolescent↗