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PubMed2004

Communication in ecosystem management: a case study of cross-disciplinary integration in the assessment phase of the interior Columbia Basin Ecosystem Management Project.

Effective communication is essential to the success of collaborative ecosystem management projects. In this paper, we investigated the dynamics of the Interior Columbia Basin Ecosystem Management Project's (ICBEMP) cross-disciplinary integration process in the assessment phase. Using a case study research design, we captured the rich trail of experience through conducting in-depth interviews and collecting information from internal and public documents, videos, and meetings related to the ICBEMP. Coding and analysis was facilitated by a qualitative analysis software, NVivo. Results include the range of internal perspectives on barriers and facilitators of cross-disciplinary integration in the Science Integration Team (SIT). These are arrayed in terms of discipline-based differences, organizational structures and activities, individual traits of scientists, and previous working relationships. The ICBEMP organization included a team of communication staffs (CT), and the data described the CT as a mixed group in terms of qualifications and educational backgrounds that played a major role in communication with actors external to the ICBEMP organization but a minor one in terms of internal communication. The data indicated that the CT-SIT communication was influenced by characteristics of actors and structures related to organizations and their cultures. We conclude that the ICBEMP members may not have had a sufficient level of shared understanding of central domains, such as the task at hand and ways and timing of information sharing. The paper concludes by suggesting that future ecosystem management assessment teams use qualified communications specialists to design and monitor the development of shared cognition among organization members in order to improve the effectiveness of communication and cross-disciplinary integration.

Communication↗
PubMed2006

Risk scores for type 2 diabetes can be applied in some populations but not all.

OBJECTIVE: Risk scores based on phenotypic characteristics to identify individuals at high risk of having undiagnosed diabetes have been developed in Caucasian populations. The impact of known risk factors on having undiagnosed type 2 diabetes differs between populations from different ethnic origin, and risk scores developed in Caucasians may not be applicable to other ethnic groups. This study evaluated the performance of one risk score in nine populations of diverse ethnic origin. RESEARCH DESIGN AND METHODS: Data provided by centers from around the world to the DETECT-2 project were used. The database includes population-based surveys with information on at least 500 people without known diabetes having a 75-g oral glucose tolerance test. To date, 52 centers have contributed data on 190,000 individuals from 34 countries. In this analysis, nine cross-sectional studies were selected representing diverse ethnic and regional backgrounds. The risk score assessed uses information on age, sex, blood pressure treatment, and BMI. RESULTS: This analysis included 29,758 individuals; 1,805 individuals had undiagnosed diabetes. The performance of the risk score varied widely, with sensitivity, specificity, and percentage needing further testing ranging between 12 and 57%, 72 and 93%, and 2 and 25%, respectively, with the worse performance in non-Caucasian populations. This variation in performance was related to differences in the association between prevalence of undiagnosed diabetes and components of the risk score. CONCLUSIONS: A typical risk score developed in Caucasian populations cannot be applied to other populations of diverse ethnic origins.

Body Mass Index↗
PubMedDate not supplied

Centers of Excellence in Bariatric Surgery: design, implementation, and one-year outcomes.

BACKGROUND: Bariatric surgery procedures increased from <20,000 annually in the early 1990s to >100,000 in 2003. The complications related to surgery have increased disproportionately, causing some payers to discontinue coverage for bariatric procedures and reducing patient access to an effective treatment modality. This report describes an alternative approach-the creation of a network of Centers of Excellence (COE) in Bariatric Surgery. METHODS: Blue Cross and Blue Shield of North Carolina developed a COE program by working collaboratively with the bariatric surgery community. Through systematic review, the collaborative identified bariatric surgical programs that appropriately select patients, comprehensively evaluate and prepare patients for surgery, produce superior outcomes, and provide long-term follow-up for patients. RESULTS: Seven practices were selected as Blue Cross and Blue Shield of North Carolina Bariatric Surgery COE. The short-term results comparing the 12 months before COE implementation and the 12 months after implementation included a 14% decline in the number of bariatric procedures performed (693 versus 596), a 23% decrease in the number of surgeons billing for bariatric procedures (53 versus 41), a 30-day readmission rate of 4.7% for COE providers and 8.3% for non-COE providers, and an average inpatient length of stay of 2.5 days for COE providers and 3.0 days for non-COE providers. The proportion of procedures performed by the COE providers increased from 55% to 61%. CONCLUSION: The preliminary results are encouraging, with COE providers demonstrating reduced 30-day readmission rates and, surprisingly, overall reductions in the rate and number of procedures performed and the number of physicians performing them.

Bariatric Surgery↗
PubMed2004

Recommendations on the use of satellite remote-sensing data for urban air quality.

In the last 5 yr, the capabilities of earth-observing satellites and the technological tools to share and use satellite data have advanced sufficiently to consider using satellite imagery in conjunction with ground-based data for urban-scale air quality monitoring. Satellite data can add synoptic and geospatial information to ground-based air quality data and modeling. An assessment of the integrated use of ground-based and satellite data for air quality monitoring, including several short case studies, was conducted. Findings identified current U.S. satellites with potential for air quality applications, with others available internationally and several more to be launched within the next 5 yr; several of these sensors are described in this paper as illustrations. However, use of these data for air quality applications has been hindered by historical lack of collaboration between air quality and satellite scientists, difficulty accessing and understanding new data, limited resources and agency priorities to develop new techniques, ill-defined needs, and poor understanding of the potential and limitations of the data. Specialization in organizations and funding sources has limited the resources for cross-disciplinary projects. To successfully use these new data sets requires increased collaboration between organizations, streamlined access to data, and resources for project implementation.

Air Pollutants↗
PubMed2002

Married couples' risk of same disease: cross sectional study.

OBJECTIVE: To determine whether people whose marital partners have depression, diabetes, hypertension, ischaemic heart disease, stroke, hyperlipidaemia, peptic ulcer disease, or asthma or chronic obstructive pulmonary disease are at increased risk of the same disease. DESIGN: Cross sectional study. SETTING: 10 practices from the Trent Focus Collaborative Research Practice Network. PARTICIPANTS: 8386 married couples (16 772 individuals) from a population of 29 014 participants aged 30-74 years. OUTCOMES: Risk of disease in participants whose marital partner had that disease compared with those whose partner did not. RESULTS: After both partners' age, smoking, and obesity and which general practice they attend were adjusted for, participants whose marital partner had asthma, depression, hypertension, hyperlipidaemia, and peptic ulcer disease were at increased risk of having the same disease. The adjusted odds ratios were 1.69 (95% confidence interval 1.43 to 2.98) for asthma, 2.08 (1.71 to 2.54) for depression, 1.32 (1.04 to 1.67) for hypertension, 1.44 (1.19 to 1.75) for hyperlipidaemia, and 2.01 (1.48 to 2.73) for peptic ulcer disease. CONCLUSION: Partners of people with specific diseases are at increased risk of the disease themselves-at least 70% increased risk for asthma, depression, and peptic ulcer disease. This implicates shared environmental causes in some diseases in addition to any genetic or distant exposure or shared behaviours with respect to seeking health care.

Adult↗
PubMed2000

Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants.

BACKGROUND: Respiratory failure due to lung immaturity is a major cause of mortality in preterm infants. Although intermittent positive pressure ventilation (IPPV) saves lives, lung distortion during its use is associated with lung injury and chronic lung disease (CLD). Conventional IPPV is provided at 30-80 breaths per minute while a newer form of ventilation called high frequency oscillatory ventilation (HFOV) provides 'breaths' at 10-15 seconds. This has been shown to result in less lung injury in experimental studies. OBJECTIVES: The objective of this review is to determine whether the elective use of high frequency oscillatory ventilation (HFOV) as compared to conventional ventilation in preterm infants who are mechanically ventilated for the respiratory distress syndrome decreases the incidence of chronic lung disease (CLD) without adverse effects. SEARCH STRATEGY: Searches were made of the Oxford Database of Perinatal Trials, MEDLINE, EMBASE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching by the Cochrane Collaboration, mainly in the English language. Expert informant's search in the Japanese language was made by Prof. Y. Ogawa. SELECTION CRITERIA: Randomized controlled trials comparing HFOV and CV in preterm or low birth weight infants with pulmonary dysfunction, mainly due to RDS, who are to be given IPPV. Randomization and commencement of treatment should have been as soon as possible after the start of IPPV and usually in the first 12 hours of life. DATA COLLECTION AND ANALYSIS: The methodological quality of each trial was independently reviewed by the various authors. Each author extracted data separately; they were compared and differences were resolved. The standard method of the Cochrane Neonatal Review Group was used to synthesize the data using relative risk (RR) and risk difference (RD). From 1/RD the number needed to treat (NNT) for benefits, and number needed to harm (NNH) for adverse effects, were calculated. MAIN RESULTS: Meta-analysis of the six eligible studies comparing HFOV with CV revealed that there is no difference in mortality. There are trends toward decreases in CLD in survivors at 28-30 days, 'death or CLD at 28-30 days' and CLD in survivors at 36-37 weeks postmenstrual age or discharge in the HFOV group. However, there are trends towards increases in severe (grades 3 & 4) intraventricular hemorrhage (IVH) and in periventricular leukomalacia (PVL) in the HFOV group. HFOV results in a small increase in any air leak syndrome (ALS), [summary RR 1.20 (1.03, 1.39)]. Only 2 trials have included neurodevelopmental follow up and more survivors in the HFOV group are abnormal [summary RR 1.26 (1.01, 1.58)]. In the subgroup of four trials where a high volume strategy (HVS) was used, HFOV results in more favourable pulmonary outcomes. There are significantly lower rates of CLD in survivors at 28-30 days [summary RR 0.53 (0.36, 0.76)] and of 'death or CLD at 28-30 days' [summary RR 0.56 (0.40, 0.77) with a non-significant trend towards a reduction in oxygen use at 36-37 weeks postmenstrual age or discharge [summary RR 0.74 (0.55, 1.01)]. There were no differences in the rates of IVH or PVL. Of the four trials in the subgroup using surfactant routinely, three also used the HVS. The trends in results were similar with surfactant to those for the HVS subgroup analysis. One trial suggests that HFOV may reduce the cost of in-hospital care. In the subgroup of two trials (HIFI 1989, Rettwitz-Volk 1998) not using a HVS there is no effect of HFOV on the rate of CLD; however, there is an increase in the rate of PVL [summary RR 1.64 (1.02, 2.64). REVIEWER'S CONCLUSIONS: The overall meta-analyses is dominated by the large HIFI study which did not use the HVS recommended on the basis of animal studies, and in which surfactant was not available. Studies which used HVS have shown some benefits in short term measures of CLD without an in

High-Frequency Ventilation↗
PubMed1999

Faculty and student cross-cultural learning through teaching health promotion in the community.

Cross-cultural learning for nursing students and faculty increased through a collaborative venture of teaching health promotion classes in a Hmong community. Through the learning process, nursing students and faculty learned about Hmong culture, and Hmong participants learned about health. The purpose of this article is to describe the process and evaluation of health promotion classes in a Hmong community.

Community Health Nursing↗
PubMed2003

Dipyridamole for preventing stroke and other vascular events in patients with vascular disease.

BACKGROUND: Patients with transient ischaemic attacks (TIA) and minor ischaemic strokes are at risk of serious vascular events (death from all vascular causes, non-fatal stroke, or non-fatal myocardial infarction). Their risk of vascular events lies between 4 and 11 percent per year. Aspirin only, in a daily dose of 30 mg or more, offers only modest protection in such patients: it reduces the incidence of major vascular events by 13 percent. In a single trial, adding dipyridamole (an alternative antiplatelet agent) to aspirin was associated with a 22 percent reduction in the risk of major vascular events compared with aspirin alone. However, a systematic review of all trials of antiplatelet agents by the Antithrombotic Trialists' Collaboration showed that, in high risk patients, there was virtually no difference between the aspirin-dipyridamole combination and aspirin alone. We therefore sought to assess the effects of dipyridamole in more detail. OBJECTIVES: 1) To assess the efficacy of dipyridamole versus control in the secondary prevention of vascular events in patients with vascular disease in the presence and absence of other antiplatelet drugs. 2) To assess the safety of dipyridamole versus control in the secondary prevention of vascular events in patients with vascular disease in the presence and absence of other antiplatelet drugs. SEARCH STRATEGY: The Cochrane Stroke Group Trials Register was searched and other relevant Cochrane Groups were contacted to search their specialised registers (last search 29 April 2002). In addition the Cochrane Controlled Trials Register, MEDLINE and EMBASE were searched and Dutch manufacturers of dipyridamole were contacted to identify further published and unpublished studies. SELECTION CRITERIA: Randomised long term secondary prevention trials with concealed treatment allocation, treatment for > 1 month, starting within 6 months after presentation of a arterial vascular disease were selected (coronary artery disease, myocardial infarction, angina pectoris, retinopathy, nephropathy, peripheral arterial disease, stroke, TIA, amaurosis fugax). Therapy consisted of dipyridamole in any dose in the presence or absence of other antiplatelet drugs compared with no drug or an antiplatelet drug(s) other than dipyridamole (control group). DATA COLLECTION AND ANALYSIS: Two reviewers selected trials which met the inclusion criteria and extracted details of randomisation methods, blinding of treatments and assessments, whether intention-to-treat analysis was possible from the published data, whether treatment groups were comparable with regard to major prognostic factors, the number of patients who were excluded or lost to follow-up, definition of outcome events, and entry and exclusion criteria. The methodological quality of each trial was assessed by the two reviewers on the basis of these extracted data. In addition, dose and type of antiplatelet treatments, duration of follow-up and the numbers of defined outcome events were recorded. Data published by the Antithrombotic Trialists' Collaboration were used. The remaining data were independently extracted by the same two reviewers and cross checked. Data were analysed according to the intention-to-treat principle. Relative and absolute risk reductions were calculated by means of the statistical software provided by the Cochrane Collaboration (RevMan). MAIN RESULTS: Twenty-six trials were included, with a total of 19842 patients, among whom 1399 vascular deaths and 3085 fatal and non-fatal vascular events occurred during follow-up. Compared with control, dipyridamole had no clear effect on vascular death (RR 1.02, 95% CI 0.90 to 1.17). This result was not influenced by the dose of dipyridamole or type of presenting vascular disease. Compared with control, dipyridamole appeared to reduce the risk of vascular events (RR 0.90, 95% CI 0.83 to 0.98), but this effect was only statistically significant due to a single large trial in patients presenting with cerebral ischaemia (6602 patients). Comparing dipyridamole plus aspirin with aspirin alone: there was no clear difference in vascular death, the RR was 1.03 (95% CI 0.87 to 1.22); the combination was associated with fewer vascular events with an RR of 0.90 (95% CI 0.80 to 1.00). Combination treatment of dipyridamole and aspirin compared with placebo had an RR of 0.89 (95% CI 0.79 to 1.01) for vascular death and an RR of 0.74 (95% CI 0.68 to 0.80) for vascular events. REVIEWER'S CONCLUSIONS: This review found that, for patients who presented with arterial vascular disease, there was no evidence that dipyridamole, in the presence or absence of an other antiplatelet drug (chiefly aspirin) reduced the risk of vascular death, though it may reduce the risk of further vascular events. However, this benefit was found in only a single large trial and only in patients presenting after cerebral ischaemia. There was no evidence that dipyridamole alone was more efficacious than aspirin. Further trials comparing the effects of the combination of dipyridamole with aspirin with aspirin alone are justified.

Anticoagulants↗
PubMed1998

Analysis of the psychometric properties of the Spanish version of the Beck Depression Inventory in Argentina.

Increased international collaboration in clinical trials has created a need for cross-culturally valid instruments to assess quality of life and behavioral disorders. Cross-cultural studies of depressive symptomatology, in particular, must be preceded by an exhaustive study of the psychometric properties of the instruments, to ensure the validity of the comparison. In this article, we examine the validity, reliability and factor structure of the Spanish version of the Beck Depression Inventory (BDI) in a random stratified sample of 608 community residents in Argentina. Our findings indicate that this version of the BDI is psychometrically strong and appropriate for use in Argentina, and we suggest that it is suitable for assessing depressive symptomatology in Spanish speakers.

Adult↗
PubMed2005

NCBI Reference Sequence (RefSeq): a curated non-redundant sequence database of genomes, transcripts and proteins.

The National Center for Biotechnology Information (NCBI) Reference Sequence (RefSeq) database (http://www.ncbi.nlm.nih.gov/RefSeq/) provides a non-redundant collection of sequences representing genomic data, transcripts and proteins. Although the goal is to provide a comprehensive dataset representing the complete sequence information for any given species, the database pragmatically includes sequence data that are currently publicly available in the archival databases. The database incorporates data from over 2400 organisms and includes over one million proteins representing significant taxonomic diversity spanning prokaryotes, eukaryotes and viruses. Nucleotide and protein sequences are explicitly linked, and the sequences are linked to other resources including the NCBI Map Viewer and Gene. Sequences are annotated to include coding regions, conserved domains, variation, references, names, database cross-references, and other features using a combined approach of collaboration and other input from the scientific community, automated annotation, propagation from GenBank and curation by NCBI staff.

Animals↗
PubMedDate not supplied

Cross-cultural considerations in the conduct of community-based participatory research.

This article explores cross-cultural challenges that arise when university and community members collaborate in community-based participatory research. As part of a project for primary prevention of human immunodeficiency virus (HIV) infection, researchers trained community leaders to jointly develop a research question and conduct a pilot qualitative study in a Puerto Rican community in Massachusetts. Different priorities of the community and university members about HIV as a research topic underscored the need to continuously reflect on developing a research question in community-based participatory research. Recognizing the cultural assumptions of both university and community members is an important component of capacity building among collaborative research teams.

Community-Institutional Relations↗
PubMed2006

The community psychiatrist of the future.

PURPOSE OF REVIEW: The potential contributions of the community psychiatrist are described, via the interdisciplinary team, to individuals and families dealing with mental illness, and to the communities of the future, along with the opportunities for, and barriers to, effective teamwork and community collaborations. RECENT FINDINGS: Health and medical training systems still provide perverse incentives deterring psychiatrists from becoming adequately trained in community psychiatry and full members of interdisciplinary teams, and skilled partners in improving the mental health of the whole community. Sources of potential role conflict should be resolved, and advantages of community collaborations, interdisciplinary leadership, support of teamwork, division of labour, cross-fertilization and hybrid vigour should be realized. SUMMARY: Truly essential and desirable roles and the skill base of community psychiatrists in interdisciplinary teams and local communities could be developed and strengthened by changes in basic and advanced psychiatric training, and by psychiatric professional bodies and training programmes placing greater emphasis and value upon the roles of a community psychiatrist.

Attitude to Health↗
PubMed2005

Prevalence of cardiovascular disease risk factor clustering among the adult population of China: results from the International Collaborative Study of Cardiovascular Disease in Asia (InterAsia).

BACKGROUND: The prevalence of cardiovascular disease (CVD) risk factors has been increasing in China. METHODS AND RESULTS: We examined the prevalence of CVD risk factor clustering among Chinese adults aged 35 to 74 years with data from the International Collaborative Study of Cardiovascular Disease in Asia (InterAsia), a cross-sectional survey of a nationally representative sample (n=14 690) conducted during 2000 to 2001 and compared these data with those of US adults from the National Health and Nutrition Examination Survey of 1999 to 2000. Overall, 80.5%, 45.9%, and 17.2% of Chinese adults had > or =1, > or =2, and > or =3 modifiable CVD risk factors (dyslipidemia, hypertension, diabetes, cigarette smoking, and overweight), respectively. By comparison, 93.1%, 73.0%, and 35.9% of US adults had > or =1, > or =2, and > or =3 of these risk factors, respectively. In a multivariate model including age, sex, and area of residence, the odds ratio (95% confidence interval [CI]) of having > or =1, > or =2, and > or =3 CVD risk factors versus none of the studied risk factors was 2.61 (95% CI, 2.09 to 3.27), 3.55 (95% CI, 2.77 to 4.54), and 4.97 (95% CI, 3.67 to 6.74), respectively, for Chinese adults 65 to 74 years old versus 35 to 44 years old; 3.65 (95% CI, 3.21 to 4.15), 4.67 (95% CI, 4.06 to 5.38), and 5.60 (95% CI, 4.70 to 6.67), respectively, for men compared with women; 1.18 (95% CI, 1.07 to 1.30), 1.34 (95% CI, 1.21 to 1.50), and 1.84 (95% CI, 1.60 to 2.12), respectively, for urban compared with rural residents; and 1.98 (95% CI, 1.76 to 2.22), 2.75 (95% CI, 2.42 to 3.13), and 4.36 (95% CI, 3.68 to 5.18), respectively, for residents of northern compared with southern China. CONCLUSIONS: Clustering of CVD risk factors is common in China. Prevention, detection, and treatment of CVD risk factor clustering should be an important component of a national strategy to reduce the increasing burden of CVD in China.

Adult↗
PubMed2004

Glasgow nursery-based caries experience, before and after a community development-based oral health programme's implementation.

OBJECTIVE: To develop and evaluate NHS-based strategies likely to improve dental health and reduce inequalities in pre-5-year-old's oral health in Greater Glasgow, Scotland, by ecological study of community-based oral health promotion programmes in two of the area's most socio-economically deprived communities. BASIC RESEARCH DESIGN: Following an initial health service-based Oral Health Needs Assessment (OHNA) in a severely deprived community, culturally relevant dental health promotion interventions were initiated with multidisciplinary collaborative networks. Ecological studies to monitor dental health involved cross-sectional caries epidemiology of nursery children aged 36-59 months at baseline (1995/96), after two (1997/98) and four years (1999/00), in the G22 (pilot) and G33 post code areas. These areas had similar socio-economic status (SES), i.e. severe social deprivation. RESULTS: At the outset, mean dmft scores in the pilot area for the age groups 36-47 months and 48-59 months were respectively 3.9 (95% CI 2.8 5.1) and 5.9 (95% CI 5.1-6.8), with the proportions of caries-free children being 38% and 17%, respectively. Reductions in mean dmft of 46% for the 36-47 month-olds and 37% for the 48-59 month-olds occurred in the pilot public health programme area over the four-year period; the proportions of caries-free children increased to 51% and 40%, respectively. During the first two years of the programme, increases in the mean dmft of 36-47 month- and 48-59 month-olds in the G33 (comparator) area were recorded. However, this trend was reversed significantly two years later following the introduction of a similar community development-based caries-prevention programme. CONCLUSION: While not being able to attribute causation, a programme of community development to promote the dental health of pre-school children residing in two socio-economically disadvantaged areas of Glasgow was associated with significant improvements in the dental health of these pre-school populations.

Child, Preschool↗
PubMed1990

Oral health habits of schoolchildren in 11 European countries.

This study is part of the Cross-National Survey on Health Behaviour in Schoolchildren--A WHO Collaborative Study, which started in 1982. The aim of the study was to describe the oral health habits (oral hygiene habits, use of sugar snacks and use of fluorides) in schoolchildren in 11 countries. The data were gathered during the 1985-86 school year, and the age groups studied were 11-, 13- and 15-year olds from Austria, Belgium, Finland, Hungary, Israel, Norway, Scotland, Spain, Sweden, Switzerland and Wales. The data are nationally representative for the age groups concerned. Exact results are presented for toothbrushing frequency and use of dental floss, toothpicks, sweets, soft drinks, fluoride toothpaste, fluoride rinses and fluoride tablets. Toothbrushing was consistently less frequent among boys than among girls. Use of dental floss is still very rare. Efforts must be continued to reduce the consumption of sweets and soft drinks. These findings should be taken into consideration when attempts are made to improve oral health education.

Adolescent↗
PubMedDate not supplied

The focus of improved profit.

The Care Coordinator Model is a differentiated practice, collaborative care nursing model designed to support nurse/physician practice while crossing the entire continuum of care using the underlying concept of case management.

Budgets↗
PubMed2000

Integration of women's health into an internal medicine core curriculum for medical students.

The authors describe their year-long collaboration to analyze and integrate the elements of women's health into their medical school's core curriculum in internal medicine for the third-year clerkship. Such a process was necessary because the current curriculum was inadequate in its treatment of women's health (e.g., little or no coverage of issues pertaining to women in teaching about certain disorders; lack of female subjects in many research studies; study designs' using standards derived from manifestations of diseases in men; the cross-discipline aspects of women's health). The authors illustrate the new curriculum by discussing the revised module in pulmonary medicine; they detail the steps they took to uncover problems and omissions in the existing curriculum and in the literature on the topic, and how they remedied these. (For example, in a case involving a man with pulmonary embolus, one of the new questions for students is "What questions would you ask if this patient were a woman?") They comment on the challenges they faced in revising the curriculum, including lack of protected time, lack of sufficient data about women's health, inherent sex and gender bias in the literature and educational materials, need to make students aware of the importance of sex and gender considerations in patient care, and the ingrained bias of faculty, including the authors. Their process can be adapted and used to integrate curricula in other emerging interdisciplinary fields, such as cross-cultural medicine and gay and lesbian health. The authors conclude that collaboration between students and faculty, as illustrated in their own efforts, is one way to ensure that future practitioners are optimally trained to treat patients in the ever-changing field of medicine.

Attitude of Health Personnel↗