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When establishing a case management program, patient populations were identified; goals and measures defined; and a case manager role developed. A registered nurse and a social worker team manage the patients in the program. After 9 months, a pilot study shows a total savings of $94,159 using case management.
Student recruitment and retention has been given high priority over the last several years. The School of Allied Health Sciences at the University of Texas Medical Branch at Galveston has been involved in recruitment and retention programs that have produced minority student enrollment of over 20% over the past seven years. The programs are supported by federal grants that have provided seed money to design, develop, and implement three specific recruitment and retention programs. These programs have assisted in enrolling over 575 minority students with a retention rate above 90%. Graduation, licensure, and certification rates have been at or above the majority population. These programs are adaptable at other allied health professions schools and have been used as models for several programs across the United States.
INTRODUCTION: Abancay is located at 2,395 m.a.s.l. in the Peruvian Andean Region. It is a hyperendemic area for Hepatitis B virus (HBV) and hepatitis delta virus (HDV) infection, where 7% of the deaths are caused by acute and chronic hepatitis infections. In 1991, a pilot immunization program against HBV infection was started to control the incidence of VHB-VHD, and as a strategy to improve the EPI coverage in general. METHODS: Vaccination population was programmed to include 1,301 children under 1 year old and 3,488 children between 1-4 years old. A total of 3 doses of DNA recombinant vaccine against HBV per child were administered. The vaccination schedule fit within the EPI immunization schedule. For children under one year old, the program includes: Newborn: BCG, Polio 1, HBV1; 2-month old: Polio 2, DPT1, HBV2; 3-month old: DPT2, Polio 3; 4-month old: polio 4, HBV 3 and; 9 month old: Measles. For children aged between 1 and 4 years old, the program includes: HBV1, HBV2 one month after HBV1, and HBV six months after HBV1. RESULTS: One year after the immunization program started, 1,262 (97.0%) children under one year old and 2,529 (72.5%) between 1-4 years old were immunized. No relevant adverse effects have been reported. There were 8 deaths due to acute respiratory infection and acute diarrhea diseases, which are the main causes of death in this area. One of the objectives achieved was an improvement in the EPI vaccination coverage for children younger than 1 year old, with a DPT coverage of 97.0% in 1991 compared to 63.0% in 1988, 26.9% in 1989, and 61.9% in 1990. CONCLUSION: The inclusion of HVB vaccination in the EPI for a HBV and HDV endemic area improves the total EPI coverage and it is safe an effective.
The majority of developing nations in the Third World (including Thailand) face similar medicosocioeconomic situations arising from uncontrolled population growth which outstrips developmental planning. One of the most effective medical means of combating these problems is surgical contraception. This study describes how the Ramathibodi National Training Program was developed and implemented in Thailand to increase the availability of sterilization services by training local physicians to perform the necessary operations. The success of this program is measured by the increase in the number of service delivery stations (182) and in the number of sterilization procedures performed (24 436 in a 32-month period).
When teaching home safety, we selectively highlight those hazards most likely to injure children at various developmental stages. In one of the few studies evaluating this approach, we successfully taught a middle class population appropriate home use of ipecac syrup. The study reported herein replicated that study in a lower socioeconomic population. Although learning occurred, statistical significance was not quite achieved. While this study does not refute the "targeted" approach, it does demonstrate that characteristics of the population are likely to affect the educational outcome. Impressive statistical improvement may not be demonstrated. Individual realistic goals must be established prior to implementation and evaluation of a program.
High-density lipoprotein (HDL) cholesterol distributions were compared among 191 black and 1341 white males and 233 black and 1088 white females, ages 5-44 years, examined in five of the Lipid Research Clinic (LRC) population-based surveys. Mean HDL cholesterol was higher in blacks than whites in each 5-year age group for males and in seven of the eight age groups for females. The black-white mean HDL cholesterol difference was greater for males than females at each age studied. Mean HDL cholesterol was 4.8 mg/dl higher in black than white males ages 5-19 years, after statistical adjustment for age, Quetelet index and plasma total cholesterol differences between blacks and whites (p < 0.001); mean HDL cholesterol was 9.5 mg/dl higher in black than white adult males ages 20-44 years. Adjustment for levels of plasma triglyceride, which were lower in blacks than whites, reduced but did not eliminate the magnitude of the statistical significance in black-white differences: The adjusted means were 2.9 mg/dl higher in black children and 7.9 mg/dl higher in black adults. The finding of higher levels of HDL cholesterol in black males persisted after additional adjustment for alcohol consumption, smoking and educational levels. Adult U.S. black males have lower and black females have higher coronary heart disease mortality rates than their white peers. The magnitude of the black-white difference in HDL cholesterol for males in the LRC studies was within the range associated with coronary heart disease incidence reported in other studies.
The CHAD program, a community health program for the control of cardiovascular risk factors, was planned in 1969 as an experiment in community-oriented primary care (COPC) with the aim of assessing feasibility and effectiveness. The program was instituted in a family practice in Jerusalem in 1970, and has provided a working demonstration of the integration of community health care with the care of individuals and families. Effectiveness was evaluated by comparing changes in risk factor status with those in a comparison population. The program was most effective with respect to the control of hypertension and cigarette smoking. The changes were larger and earlier than those in the comparison population. Positive changes were also observed in the comparison population, which was served by a primary care clinic that also undertook measures for the control of cardiovascular risk factors.
STUDY OBJECTIVE: Tenure was designed to guarantee academic freedom through lifelong job security. Productive research, especially in the basic sciences, is the main criterion for tenure at most institutions; therefore faculty in more clinically focused specialties may experience more difficulty obtaining tenure. We examined the relationship between academic emergency medicine and tenure. METHODS: We used a questionnaire to survey the directors of all 108 approved US emergency medicine residency programs. The surveyed population was asked whether the program was affiliated with a medical school, the number of full-time faculty, and how many faculty members were tenured or on the tenure track. Follow-up mailings were sent to nonresponders. We also conducted a search of the Association of American Medical Colleges (AAMC) database to compare the number of emergency medicine faculty involved in the tenure process in other specialties. RESULTS: One hundred surveys (93%) were returned. At programs in which faculty were eligible for tenure, 9% (95% confidence interval [CI], 4% to 16%) were tenured and 27% (95% CI, 19% to 37%) were on the tenure track. Therefore only 36% of all EM faculty (95% CI, 27% to 46%) were tenured or on the tenure track. Among the 53 residency programs that offered tenure, 45% (95% CI, 32% to 60%) had no tenured faculty. At programs with academic department status, 74% of chairs were tenured, in contrast to only 32% of chiefs at institutions without academic department status (95% CI for difference of 42%, 14% to 71%). The AAMC survey revealed that about one-third as many emergency medicine faculty members were tenured compared with the other specialties. The proportion of faculty on the tenure track, however, was similar between the specialties. CONCLUSION: Most eligible emergency medicine faculty members are not tenured or on track to become tenured, and fewer emergency medicine faculty are tenured compared with the more traditional specialties. Emergency medicine may be vulnerable to being considered less academic unless its faculty members gain access to the tenure process.
Tobacco use is the single most preventable cause of death in the United States. Approximately half of smokers start smoking regularly before 18 years of age; however, among recent birth cohorts, age of smoking initiation has declined, especially among females. Data on tobacco use among adolescents help identify high-risk populations, design tobacco-prevention programs for these populations, and evaluate the effectiveness of broad efforts to prevent tobacco use among youth. This report examines the prevalence of self-reported current tobacco use and frequent cigarette smoking among U.S. students in grades 9-12 during 1990.
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BACKGROUND: Little is known about the cancer control needs of American Samoans. This report provides some of the first data on cancer incidence among American Samoans in Hawaii. METHODS: The Hawaii Tumor Registry, a Surveillance, Epidemiology, and End Results population-based, active cancer surveillance program, provided archival data on American Samoans residing in Hawaii and on those referred to Hawaii for diagnosis and treatment from the U.S. Territory of American Samoa. RESULTS: In American Samoan males, the more commonly encountered cancers included cancer of the lung, prostate, stomach and liver, and leukemia. In American Samoans females, breast carcinoma was most frequent, followed by cancer of the corpus uteri, cervix uteri and thyroid, and leukemia. Females were more likely than males to receive a diagnosis of cancer at an early age: 34.5% of females and 19.9% of males with cancer were diagnosed when they were between the ages of 0 and 44 years. Males were more likely than females to be diagnosed with cancer after metastasis had occurred (45% vs. 33.9%). Compared with other Polynesians (i.e., Western Samoans and Hawaiians), American Samoan males have a relatively higher frequency of lung, prostate, thyroid, and liver cancers and a lower frequency of colon and rectum cancers. American Samoan females, compared with other Polynesians, have a higher frequency of leukemia and corpus uteri, thyroid, and pancreatic cancers and a lower frequency of colon and rectum cancers. CONCLUSIONS: The data provide baseline information that has important public health and research implications for cancer control programs for this population.
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OBJECTIVE: Prior studies have supported that waist circumference correlates better with visceral adipose tissue and is a better predictor of cardiovascular disease than are BMI and waist-to-hip ratio. In this study, we reexamine the role of waist size on the risk of hypertension and type 2 diabetes in African-origin populations from three contrasting environments. RESEARCH DESIGN AND METHODS: A cross-sectional survey was conducted of 5,042 men and women 25-74 years of age from Nigeria, Jamaica, and the U.S. The relationship between waist, blood pressure, and fasting blood glucose was assessed using multiple linear regression analyses. Logistic regression analyses using sex-specific empirical waist cut-points were used to determine the risks of hypertension and type 2 diabetes. RESULTS: Waist circumference was positively correlated with blood pressure and fasting blood glucose (P < 0.05). Increasing waist quartiles were significantly associated with higher risks of hypertension in the three populations, as estimated from age-adjusted odds ratios obtained from sex-specific logistic regression models. A highly elevated risk of type 2 diabetes-10-fold for Jamaican men and 23-fold for African-American women-was observed in the comparison of lowest to highest quartiles of waist circumference. CONCLUSIONS: Substantial reduction in hypertension and diabetes in men and women is achievable if the waist size is decreased in these populations. Intervention programs designed to reduce waist circumference through lifestyle modification, including exercise and diet, may have significant public health significance in reducing the incidence of hypertension and adult-onset diabetes in these populations.
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OBJECTIVE: Our purpose was to describe the incidence of human immunodeficiency virus infection and to assess the cost/benefit ratio of universal antenatal human immunodeficiency virus screening. STUDY DESIGN: Medical records of women in this urban obstetrics population, from the years 1988 to 1993, were examined. The incidence of known human immunodeficiency virus seropositivity at delivery was determined. The costs of performing human immunodeficiency virus screening, evaluating the disease status, and administering therapy were calculated. These costs were compared with an averaged cost for care and follow-up of infants infected through vertical transmission. RESULTS: The incidence of known human immunodeficiency virus seropositivity at delivery approximately doubled since the initiation of a human immunodeficiency virus screening program (0.26% to 0.48%). Obstetric screening added an approximate $100,000 to medical costs. The calculated cost of pediatric follow-up of human immunodeficiency virus-seropositive infants for the first 18 months was estimated at $344,355. In our population, with universal screening and zidovudine therapy, the medical costs could be reduced by $175,500 per year. CONCLUSION: A program of voluntary human immunodeficiency virus screening increases the incidence of known human immunodeficiency virus infection. Offering screening and follow-up to all pregnant patients in an urban setting is both cost-effective and medically beneficial.
Analysis and comparison of genetic screening programs shows that the extent of development of programs varies widely across Europe. Regional variations are due not only to genetic disease patterns but also reflect the novelty of genetic services. In most countries, the focus for genetic screening programs has been pregnant women and newborn children. Newborn children are screened only for disorders which are treatable. Prenatal screening when provided is for conditions for which termination may be offered. The only population screening programs for adults are those for thalassaemia carrier status in Cyprus, Greece and Italy. Social responses to genetic screening range from acceptance to hostility. There is a fundamental tension between individual and community in the debates in various European countries about implementation of screening programs. Opposition to genetic screening is frequently expressed in terms of arguments about "eugenics" with insufficient regard to the meaning of the term and its implications. Only a few countries have introduced explicit legislation on genetic screening. Legislation to address discrimination may provide more safeguards than legislation protecting genetic information itself.
We report the results of a Municipal Immunisation Program in a industrial community. These results were evaluated through the School Health Program. Our immunisation policies resulted in a substantial increase of immunity covering with particular impact on the less wealthy social layers. Immunity rats rose from 32% to 71% of the population. We conclude that our program is an adequate policy for control of infection diseases.
To aid in achieving demographic goals, since 1968 the government of Singapore has passed a series of laws designed to limit family size. Policies were instituted in 1968 to discourage couples from having more than three children; policies introduced in 1973 discouraged having more than two. Trends in fertility rates and in the numbers of abortions and sterilizations in recent years are consistent with the intent of these social policies. Decline in third and subsequent births was the most important factor in fertility decline after 1972, and the numbers of abortions and sterilizations undergone by higher parity women have increased substantially sin"e 1970. Although other factors have affected fertility in Singapore, the data suggest that the disincentives have played a role in continued fertility decline in recent years.