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IQ variability in children with SLI: implications for use of cognitive referencing in determining SLI.

The practice of cognitive referencing assumes that IQ scores can be used as a measure of intellectual potential from which language scores may deviate. To test the validity of this assumption the WISC scores of children with specific language impairment were compared over time. The variability of WISC scores from children with SLI from their initial evaluation and from the federally-mandated three year re-evaluation was analyzed. Significant differences in the performance scale scores were found. This indicates that the IQ scores of these children are more properly interpreted as reflecting current abilities rather than potential for language learning. This further calls into question the practice of cognitive referencing as a method of determining the presence of a language impairment, eligibility for services, and the service delivery model for which a child qualifies.

Adolescent↗

The current state of medical education in the Federal Republic of Germany and some of its problems.

The current problems facing medical education in the Federal Republic of Germany can be accounted for largely by the effects of the Regulations for Doctors' Licences introduced in 1970. The causes are complex, but the most important factors include: centralised multiple choice examinations which make students orientate their learning towards memorizing facts rather than acquiring medical skills; too little clinical experience, a scarcity of training opportunities (the intake of medical students has grown sharply over the last few years to between 11 000 and 12 000 a year); too few patients; and insufficiently experienced teachers.

Curriculum↗

Conference report. Patient re-entry into the community.

The National Assoication of Private Psychiatric Hospitals, in cooperation with 19 other national health-related associations, held a conference last June in Washington, D.C., on the issues involved in patient re-entry into the community. Representatives of the legal and medical professions, the insurance industry, allied health and mental health organizations, and federal, state, and local officials discussed the complex legal, social, and treatment problems that have resulted from the national movement of deinstitutionalization. As a start toward solving those problems, most of the speakers mentioned the need for partnerships among state, local, federal, and private providers, between the hospitals and community-based facilties, and among all mental health professionals. Several speakers emphasized the need for an effective advocacy system for the mentally ill and the need for mental health professionals to learn to use the political system in order to secure benefits for patients re-entering the community.

Chronic Disease↗

University research and the new federalism.

In this brief article we have touched on some of the solutions to problems universities are encountering in working with the expanding "new federalism." These arrangements will bring faculties into new kinds of relationships, which they can find stimulating if they are prepared ahead of time to accept the kind of public scrutiny that they have not encountered at the national level and to learn about the political system and the politician (13). Universities will find advantages for their academic programs if they involve faculty and students in programs that promote the advancement of public good provided that caution is exercised to prevent the development of arrangements that restrict academic freedom, push the university into the political arena, and drain its financial resources. Faculties need to work closely with their university administrations to make sure that valid academic principles are upheld. The exercise will be time-consuming and frustrating, but vital to the objective and the high quality support the public expects from universities.

Costs and Cost Analysis↗

A comparison of smoking control strategies in Korea and the United States.

The purpose of this study was to compare smoking control strategies between Korea and the United States. Korea and other developing countries may learn from the experience of the United States in dealing with the growing epidemic of cigarettes. In particular, smoking control objectives, structures, laws and regulations, funds, programs and activities, research, and surveillance systems were compared. The comparison was conducted at the federal, states/provincial, and county levels of the two countries. The data were collected through various governmental websites, contact with people directly, and a literature review. Based on the comparison, seven recommendations for smoking control strategies were made primarily for Korea.

Cross-Cultural Comparison↗

Hospitals and prisons. An action plan for the liberation of our patients.

Each day about 24,000 people are imprisoned in America's penal institutions. The experience for those people is humiliating, disturbing, and degrading. I know. I used to put them there. When I resigned from the United States District Attorney's office in 1975 after serving for three years as a federal prosecutor (and later as a night court judge) and started my new role as a hospital executive, I thought I was leaving the process of imprisonment behind. In the winter of 1975-76, as I went about the task of learning how hospitals functioned, I visited the emergency room. I visited the admitting area. I visited the floors. I watched doctors, nurses, and X-ray technologists at work. Gradually, a disturbing thought came to me: Hospital patients are treated much like convicted felons.

Hospital-Patient Relations↗

Medicare Part D: exceptions and appeals process.

Once enrolled in a Medicare Part D prescription plan, the focus changes to access to medically necessary medications through the prescription plan. In many situations, this will involve the exceptions and appeals process. Each Medicare plan has its own drug formulary and differentiates itself through various parameters within those formularies. The federal government has rules in place for what may or may not be covered in a formulary, and has specified parameters for an exceptions and appeals process. It is the responsibility of the patient, along with his or her physician, to learn about and take advantage of mechanisms built into the system to ensure access to medically necessary medications. As physician reimbursement moves to an outcome-based through pay-for-performance system, physicians will have a financial incentive for assuring that their patients receive the necessary medications.

Gatekeeping↗

Community decision-making about critical access hospitals: lessons learned from Montana's Medical Assistance Facility Program.

Limited-service hospitals have been used as a means of maintaining health care services in rural communities with full-service hospitals at risk of closure. The Medical Assistance Facility (MAF) limited-service hospital model has been implemented in 12 communities in Montana and has been evaluated by the Health Care Financing Administration as a viable alternative to a full-service hospital in frontier communities. The 1997 federal Critical Access Hospital (CAH) legislation is the most recent nationwide alternative for maintaining health care in rural communities, and it incorporates many of the features of the MAF model. The purpose of this study was to examine rural community decision making regarding MAF conversion from the perspectives of key informants who were involved in the decision-making process. A descriptive multiple case study design was used. Data were obtained through interviews with community members during site visits. The research focused on identification of local issues that were influential in the decision to convert to or reopen as an MAF, features of the MAF model that made it a locally acceptable alternative, and elements that characterized the decision-making process. The issues found to be influential in the conversion decision and the features that made the MAF locally acceptable were those that made the provision of basic services more stable and sustainable. The study suggests that programs to maintain health care services in isolated communities should allow for and encourage an expanded role for nonphysician providers. The lessons learned from the communities included in this study are instructive to rural communities nationwide that are considering a CAH as well as to policy-makers, researchers, and regional and national health care decision makers.

Community-Institutional Relations↗

Introducing integrated product and process development into the education of science and engineering undergraduates: a lecture course with an accompanying case-study programme at the ETH chemistry department.

Increased quality requirements in the development of chemical products and a growing awareness within society of the activities of chemical companies present a new challenge to the education of young scientists. Nowadays, the teaching of chemists, chemical engineers and environmental scientists at universities has to go beyond the traditional, discipline-orientated knowledge acquisition. The students also have to learn to work and communicate in interdisciplinary teams, to solve application-oriented tasks and to integrate scientific, economical, ecological and social aspects into their work. For this reason, a case-study programme was launched at the chemistry department of the Swiss Federal Institute of Technology. In this paper, we describe the organisational aspects of the programme, its inclusion into academic and industrial environments and summarise some of the scientific methodologies applied. One of the seven case-studies, an assessment of a modern insecticide, is presented in more detail. Finally, we discuss how far the case-study programme is suitable for introducing a new mode of knowledge production to universities.

Agriculture↗

[Medical expert assessment in civil and criminal law from the medical viewpoint].

The demands on a medical witness are discussed. Physicians have to learn to deal with the legal conditions of their profession but lawyers have to be ready to understand the circumstances of the medical activity. Since 1975, independent medical bodies in the form of arbitration committees and expert boards have been founded in the Federal Republic of Germany. This extended the field of action for medical experts. However, a definition of the term "expert" is missing. There are rules for the continuing medical training by the German societies of physicians which should guide the courts.

Civil Rights↗

What is left of professionalism after managed care?

Modern American medicine has wedded scientific advance to a small business model of the individual practitioner, defining professionalism as technical understanding. If the profession is to survive, it must draw on older ideals of the learned professions as acting on behalf of the community, and reinvigorate a ovic understanding of professional life.

Capitalism↗

Education rights and the special needs child.

A child with a disability has a federally protected right to special education and related services when he or she needs them to benefit from education. The term "disability" is not limited to physical disability but rather includes mental disability, including mental retardation, serious emotional disturbance, autism, traumatic brain injury, specific learning disabilities, and other health impairments. A parent may request that a child be evaluated by the school district for special education and related services. The law sets forth specific guidelines for the evaluation, assessment, and eligibility determination. Unique to each child, the IEP is the written plan that documents the child's special education and related services. The initial IEP is developed at a meeting among parents, various school personnel, and others whom the parents may wish to invite. Parents are an integral part of the team and are involved in all decisions by the team. The IEP must be reviewed annually, with attention given to whether educational objectives have been met. For a child with mental health issues, the IEP likely contains "related services," such as counseling, and measurable goals to improve behaviors in the school setting. When a child's condition is such that he or she cannot benefit from education in the regular school setting, other placements are considered. The school district maintains the ultimate responsibility of the cost of all such education placements, including residential care. A child with behaviors that result in frequent suspensions should have a functional analysis assessment by the school psychologist. The results of the assessment can be used to create a behavioral intervention plan. (If the school refuses to perform an assessment or develop a plan, the usual remedy of a due process hearing is available to the parents.) This plan should address problem behaviors and include strategies for redirecting the child's behavior. Even if a special education child is "expelled" from school, the district maintains the responsibility of providing FAPE. For this reason, districts--even in their own interests--should be proactive in dealing with these children, which often has not been the case. The Supreme Court has said that a child with services under IDEA (a child with an IEP) must receive some benefit from his or her education [31]. The issue of "how much benefit is enough benefit" is still troubling to parents and schools alike. The court also has ruled that related services, even costly ones such as a one-to-one nursing aide, must be provided if a qualifying child needs such services to access education [29]. Children with disabilities were long excluded from the public education system in this country. Obvious exclusion rarely occurs in the current education system, although exclusion through isolation does. Children with disabilities, especially mental disabilities, need and deserve the same educational benefit offered to children without those differences.

Adolescent↗

Jails as important but constrained venues for addressing women's health.

Women in US jails have many social and health risks that merit attention from public health agencies. This article: (1) reviews national and local data on this population for indicators of social disadvantage and of several health risks/conditions (substance abuse, risky sex, and mental illness), (2) describes the impact of federal mandatory sentencing for drug violations and recent developments in states on the numbers of incarcerated women, (3) outlines the similarities and differences between jails and prisons, focusing on characteristics of jails that facilitate and constrain intervention and evaluation activities, and (4) adds lessons learned in six years of experience in county and state jails in Texas.

Adult↗

Epilepsy self-help groups: collaboration with professionals.

Two sequential cases of professional-self-help/mutual aid collaboration are described. The first was a federally funded demonstration project to develop epilepsy self-help groups in 15 cities. It involved a "mixed strategy" of national and local collaboration, where decision-making, and problem solving was vested in persons with epilepsy. The second related case was the "action learning workshop" that combined research with extension work. Knowledge about self-help group development and persons with epilepsy was advanced at the same time that a national network and alliance of epilepsy self-help groups was developed.

Chicago↗

Teaching residents to care for culturally diverse populations.

The authors discuss the growing need for primary care residents to learn how to care for patients of many cultural backgrounds. To effectively learn the needed skills, residents must incorporate insights from areas outside medicine. The authors focus on three such areas: cultural competency, public health, and community-oriented primary care. Regarding cultural competency, the authors make clear that on the one hand, physicians must be trained to be sensitive to cultural differences and patterns, but on the other, they cannot be expected to know the many cultures of their patients in depth. They discuss the Core Curriculum Guidelines on Culturally Sensitive and Competent Health Care created by the Society of Teachers of Family Medicine. Regarding community-oriented primary care (COPC), a process introduced from Europe in 1982, the authors state that one of its key elements is to provide accessible care to diverse and often underserved populations. However, various factors have kept COPC, and the federally funded community health centers that address the concerns of COPC, from having the widespread effects they could have. Regarding public health, the authors review the various services and orientations of public health and show how these help foster care for diverse populations. The authors then briefly describe their own residency program and its work with diverse populations. They conclude by emphasizing the importance for residents of learning the principles and practices embodied in cultural competency, public health, and COPC in order to effectively communicate with their patients.

Attitude to Health↗

A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI.

OBJECTIVES: To test the hypothesis that selected older women with mild-to-moderate stress urinary incontinence (SUI) can learn to demonstrate significantly reduced urine loss in 1 week by intentionally contracting the pelvic floor muscles before and during a cough (a skill we have termed "The Knack"). DESIGN: A prospective, randomized, single-blind interventional study. SETTING: The Older American Independence Center, a federally sponsored research program affiliated with the University of Michigan in Ann Arbor, Michigan. PARTICIPANTS: Twenty-seven women with a mean (SD) age of 68.0 (5.5) years, self-reported SUI, and demonstrable urine loss during a deep cough. INTERVENTION: Women were randomized to an immediate intervention group (Group I: n=13) who were taught the Knack after their first clinic visit, or a wait-listed control group (Group II: n=14) who were taught the Knack after 1 month. MEASUREMENTS: At 1 week after instruction, we tested the efficacy of the Knack in a standing stress test by (1) comparing the volumes of cough-related urine loss leaked by all subjects, with and without use of the Knack, and (2) comparing the volumes of cough-related urine loss leaked by Group I, using the Knack, with Group II, which had not yet been taught the Knack. RESULTS: Intra-individual results showed that at 1-week follow-up, the Knack was used to reduce urine loss resulting from a medium cough by an average of 98.2%, compared with that of a similar cough performed 1 minute before without the Knack (P=.009); likewise urine loss was reduced by an average of 73.3% (P=.003) in a deep cough. Reduction in urine loss was not significantly correlated with a digital measure of pelvic floor muscle strength. CONCLUSION: Within 1 week, selected older women with mild-to-moderate SUI can acquire the skill of using a properly-timed pelvic floor muscle contraction to significantly reduce urine leakage during a cough.

Aged↗

The developing brain and the environment: an introduction.

mental retardation: timing and thresholds; (italic)b(/italic)) endocrine dysfunction and developmental disabilities: dose and target implications; (italic)c(/italic)) attention-deficit disorder-ADHD and learning disabilities; and (italic)d(/italic)) new horizons: extending the boundaries. Support for the Rochester conference came from both public and private sources. The National Institute of Environmental Health Sciences (NIEHS), the National Institute of Child Health and Human Development, and the EPA represented the federal government. The conference also received grants from several foundations: the Jennifer Altman Foundation, the Heinz Family Foundation, the National Alliance for Autism Research, the Violence Research Foundation, the Wacker Foundation, and the Winslow Foundation. The second of these conferences helped launch a new Center for Children's Health and the Environment at the Mount Sinai School of Medicine. It was held in New York City on 24-25 May 1999, and was convened specifically to consider the intersection between neurodevelopmental impairment, environmental chemicals, and prevention. Over 300 health scientists, pediatricians, and public health professionals examined the growing body of evidence linking environmental toxins to neurobehavioral disorders. The conference title was Environmental Influences on Children: Brain, Development, and Behavior. The conference began by reviewing well-known examples of deleterious effects of environmental chemicals, including lead and PCBs, on children's brains. The conferees then considered the potential impact of environmental chemicals on neurological disorders with particular focus on ADHD, autism, and Parkinson's disease. The inclusion of Parkinson's disease was intended to signal the notion that exposures in early life may have an influence on the evolution of neurological disease in later life. Support for the Mount Sinai conference came from the Superfund Basic Research Program (NIEHS); The Pew Charitable Trusts; the Institute for Health and the Environment at the University of Albany School of Public Health; the Agency for Toxic Substances and Disease Research (ATSDR); the Ambulatory Pediatric Association; Myron A. Mehlman, PhD; the National Center for Environmental Assessment (EPA); the National Center for Environmental Health (CDC); the National Institute of Child Health and Human Development; the Office of Children's Health Protection (EPA); Physicians for Social Responsibility; The New York Academy of Medicine; The New York Community Trust; and the Wallace Genetic Foundation. The impact of environmental toxins on children's health has become a topic of major concern in the federal government. Eight new research centers in children's environmental health have been established in the past 2 years with joint funding from EPA and NIEHS. Clinical units that specialize in the treatment of children with environmentally induced illness have been developed across the nation with grant support from ATSDR. The American Academy of Pediatrics has just published its (italic)Handbook of Pediatric Environmental Health (/italic)((italic)17(/italic)), the "Green Book," which is available to pediatricians throughout the Americas. Children's environmental health has climbed to a critical position as we launch the new millennium. This monograph marks a significant milestone in the evolution of this emerging discipline.

Brain↗

Enhancing reading ability to prevent students from becoming "low-functioning deaf" as adults.

Recent research on reading instruction in general and special education, collectively referred to as "scientifically based reading research," is emphasized in two new federal programs, Reading First and Early Reading First. The findings of this research, as it relates to the education of students who are deaf or hard of hearing, are reviewed. Noteworthy is the stress placed on intervening early in children's lives, focusing on active learning opportunities, teaching strategies for reading fluency, and applying teacher interventions such as miscue analysis. The urgent need for educators to identify and implement effective techniques is highlighted by the continuing problem of "low-functioning deaf" (LFD) individuals being unable to secure gainful employment absent functional reading skills.

Adult↗