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PubMedDate not supplied

Second-generation antihistamines: the OTC debate.

OBJECTIVE: To demonstrate that the safety profiles of second-generation antihistamines (SGAs) meet the criteria set by the Food and Drug Administration (FDA) for switching these products to over-the-counter (OTC) status. DATA SOURCES: MEDLINE search of articles published from 1970 through 2000. SUMMARY: Most patients with allergic rhinitis treat their symptoms with first-generation antihistamines (FGAs), which are available over-the-counter (OTC). Yet FGAs are generally considered less safe than the newer drugs. FGAs cause central nervous system (CNS) adverse effects and may increase users' risk for work-related injuries and motor vehicle accidents and, in children, for learning impairment. SGAs cause fewer CNS effects, do not appear to affect learning in children, and do not have significant drug interactions. Several other countries have made SGAs available OTC. Blue Cross of California petitioned FDA in July 1998 to make this class of drugs available OTC in the United States. This petition will finally be heard in May 2001. The 1951 Durham-Humphrey amendment to the original Federal Food, Drug and Cosmetic Act of 1938 requires that "a drug be made available without a prescription if, by following the labeling, consumers can use it safely and effectively without professional guidance." If judged according to this and other criteria promulgated by FDA, SGAs should be strongly considered for being switched to OTC status. CONCLUSION: The safety and efficacy of SGAs have been adequately established. Consumers should have the option of self-treating mild allergic rhinitis symptoms with these products.

Histamine Antagonists↗
PubMed1991

Providing access to blacks and Hispanics in dietetics education.

To increase the number of blacks and Hispanics in dietetics and three other health professions, the Health Sciences Recruitment and Retention Program was developed and implemented in 1985 by the College of Health at Florida International University in Miami. The coordinated undergraduate program assisted in a federal grant to accomplish the objectives of recruiting and retaining minority students. High school and community college students were recruited using a slide/tape presentation featuring black and Hispanic professionals. In addition, the college offered a summer course entitled "Perspectives of the Health Sciences Professions" to students entering their senior year in high school. In this course, students learned how dietitians, medical laboratory scientists, and physical and occupational therapists treat various disease states. Field trips and site visits provided additional exposure to the professions. A summer orientation and tutorial program was established to retain minority students enrolled in the coordinated undergraduate program. We recommend that this program be considered as a model for dietetics educators to use in developing other programs to increase the number of minorities in the profession.

Black or African American↗
PubMed1994

Television viewing and violence in children: the pediatrician as agent for change.

Three decades of research suggest a causal link between exposure of children to violent images on television and subsequent violent behavior. The epidemic of violence in American society mandates a critical reappraisal of the televised images that children see. To slow the cycle of violence, pediatricians can: (1) Help shape parental attitudes toward children's viewing habits; (2) lobby for school systems to adopt curricula that include critical viewing skills; and (3) work with Congress, Federal regulators, television producers, and broadcasters to reduce the exposure of children to televised violence.

Attitude to Health↗
PubMedDate not supplied

Networking health: learning from others, taking the lead.

The Internet provides one of the most compelling examples of the way in which government research investments can, in time, lead to innovations of broad social and economic impact. This paper reviews the history of the Internet's evolution, emphasizing in particular its relationship to biomedical computing and to the nation's health care system. Here I summarize current national research programs, emphasizing the need for greater involvement by the medical research community and leadership from federal health care agencies.

Delivery of Health Care↗
PubMed1991

Origins of DSM-I: a study in appearance and reality.

The author traces the history of psychiatric nosology in the United States from its origins in the early nineteenth century to the introduction of DSM-I in 1952. Until World War I, psychiatrists were not interested in systematic classification, although they were concerned with diagnosis. The first official nosology, adopted in 1918, reflected the need to collect mental hospital data. The federal Bureau of the Census had a role in the development of this nosology in that it required such data. The publication of DSM-I marked an internal transformation that mirrored the growing dominance of psychodynamic and psychoanalytic psychiatry and the relative weakness of the biological tradition. This transformation occurred largely as a result of the lessons learned by psychiatrists during World War II. The author's basic argument is that nosology reflected not only psychiatric ideology but also other, external determinants at any given point in time.

History, 19th Century↗
PubMed2006

Tourette's syndrome and the law.

Diminished legal responsibility and mental capacity have been used in defense of individuals with neurological disorders charged with legal misdemeanors, including criminal behavior. The purpose of this report is to 1) critically examine the mechanisms that may predispose patients with Tourette's syndrome (TS) to potentially, legally liable behaviors; 2) report the results of a nation-wide review of state, federal, and appellate cases involving TS; and 3) instigate awareness within the professional legal community regarding unrecognized organically-based behaviors that may predispose TS patients to unwanted legal disciplinary action. TS is a common neurological movement disorder of childhood onset associated with behavioral comorbidities, including impulse control problems, exhibition of obscene language or gestures, rage attacks, inappropriate obsessions, and other behaviors. To our knowledge, there are no studies (to date) addressing the potential impact of TS on the legal system. A comprehensive review of the neurobehavioral mechanisms underlying comorbid issues in TS is outlined. A comprehensive review of all cases tried in state and federal courts between 1985 and 2003, in which TS was somehow implicated, was conducted using the Westlaw database. As of October, 2003, TS was implicated in more than 150 cases found in the federal and state databases, 21 of which were criminal. Other cases are categorized as civil rights, criminal, education, family, labor, and social security cases. The authors conclude that TS rarely leads to criminal behavior, but patients with TS who have behavioral comorbidities are at risk of being involved with the legal system. The medical-legal community must learn to recognize the vulnerability of this patient population to potential mistreatment by the courts of justice.

Adolescent↗
PubMedDate not supplied

A case study in planning for public health education: the organ and tissue donation experience.

The chasm between the supply and demand of donated organs and tissues continues to grow despite widespread public awareness of transplantation and numerous efforts to educate the public about organ donation. It is fast becoming a significant public health problem in this country. The need for more effective public education is well documented in the literature on transplantation and is a primary objective of organizations in the transplant field. In response to this need, the Division of Organ Transplantation in the Health Resources and Services Administration of the Public Health Service initiated a project to examine the nature and scope of donation education initiatives throughout the country, to identify shortcomings, and to suggest ways the Federal Government could contribute to the effectiveness of public education in organ and tissue donation. The project resulted in the development of a protocol that also is applicable to other health education programs. Its major steps consisted of assessing the status of donation-related public education in the United States, identifying existing needs in donation education by applying principles learned from other public health education programs, and identifying roles that could be assumed to help strengthen the American public's commitment to organ and tissue donation. These roles, which could be adopted by an transplant-related organization, were as broker of knowledge, producer of educational strategies, energizer through communications research, and catalyst by bringing together other groups. This approach to needs assessment and planning may provide useful insights both for those concerned with transplants and for professionals conducting education campaigns related to other public health issues.

Health Education↗
PubMed1989

An outcome evaluation of refusal skills program as a drug abuse prevention strategy.

In recent years successful strategies developed in the antismoking campaign became the basis for widely publicized and federally endorsed antidrug "Just Say No" programs. Similarly, many refusal skills programs have been introduced as a new strategy in adolescent drug abuse prevention. However, none of these programs have been evaluated. While employing a typical refusal skills program entitled "WHOA! A Great Way To Say NO," the effectiveness of the program was examined. Through this outcome evaluation, it has been learned that the program was not able to impact on the "high-risk" attitudinal syndromes that are closely related to student drug involvement. Unexpectedly, a significantly larger proportion of students in the program felt it was more difficult to say "No" at the time of the posttest than during the time of the pretest. This seems to suggest that the program participants became more attentive to the issues surrounding saying "No" or, perhaps, were more sensitized to the whole issue involving saying "No," thereby making it more difficult for them to say "No" during the posttest period.

Assertiveness↗
PubMed1999

A bloodborne pathogen program in civilian aircraft accident investigation.

The Occupational Safety and Health Administration (OSHA) amended 29 CFR Part 1910 in 1991 to include regulations addressing occupational exposure to bloodborne pathogens (BBP). The rule affects all employees that have the potential for occupational exposure to these pathogens. The National Transportation Safety Board (NTSB) and Federal Aviation Administration (FAA) are the primary organizations involved in aircraft accident investigation in the United States. No other organizations in this country have a similar scope or mandate of responsibility. An accident scene presents significant challenges in terms of implementing a program which was primarily envisioned to affect personnel in "traditional" healthcare delivery facilities; the OSHA requirements now had to be met in the chaotic, inhospitable, and logistically difficult environment of an aircraft accident site. Unanticipated issues such as heat-related conditions, performance of physically demanding work in cumbersome gear, biohazard trash disposal from remote sites, and a host of other problems had to be dealt with. The FAA, in close cooperation with other Federal agencies, developed a training and administrative program to meet the requirements of the OSHA BBP rule as it relates to the unique environment of an aircraft accident site. The program has been implemented and successfully tested under actual field conditions at several major aviation accidents that have occurred recently. This article provides observations on the FAA's program and lessons learned from its implementation.

Accidents, Aviation↗
PubMed1996

Experimenting with feasibility of telemedicine in Alaska: successes and lessons learned.

Alaska may be ideally suited as a test site for telemedicine. It is by far the nation's largest state, with a population of only 550,000 clustered around a few cities and towns or widely spread across an area almost two and a half times as large as Texas. Its ratio of doctors to patients is the second lowest in the nation, and the cost of medical care exceeds that in the lower 48 states by 90%. Almost half of its residents are affiliated with the federal government in some way. Active duty and retired members of the military and their families (including children) represent 70,000 of the state's residents, and another 160,000 are affiliated with the Coast Guard, the Indian Health Service, and the Department of Veteran Affairs. In 1995, a telemedicine initiative was launched under the auspices of the 3rd Medical Center at Elmendorf Air Force Base. Its mission was to integrate video conferencing and store-and-forward technology into patient care. Brief but well-documented efforts yielded many valuable lessons on how relatively simple, low-bandwidth technology can be effectively used and its limitations. In addition, unexpected changes were observed in the way health care was delivered. This experience should provide valuable lessons for those embarking on this path to health care delivery.

Alaska↗
PubMed1997

Strengthening partnerships between state programs for children with special health care needs and managed care organizations.

The roles and responsibilities of state Title V Programs for Children with Special Health Care Needs (CSHCN) are changing with the rapid expansion of managed care. The authors surveyed Title V CSHCN programs to learn about critical issues and examples of collaboration with managed care organizations in the following areas: (1) defining and identifying children with special health care needs, (2) enrollment assistance and family participation, (3) pediatric provider and service requirements, (4) education and training, (5) quality of care, and (6) pediatric risk-adjusted capitation mechanisms. This article also includes recommendations developed by the federal Maternal and Child Health Bureau's Work Group on Managed Care.

Capitation Fee↗
PubMed2004

Dentocase - open-source education management system in dentistry.

Since 2001, an interdisciplinary project on multimedia education in medicine has been sponsored by the Federal Ministry of Education and Research at the Charité. One part of the project is on dentistry. In the light of the results of a survey of dental students, an Internet-based education management system was created using open-source back-end systems. It supports four didactic levels for editing documentation of patient treatments. Each level corresponds to the learning abilities of the students. The patient documentation is organized to simulate the working methods of a physician or dentist. The system was tested for the first time by students in the summer semester of 2003 and has been used since the winter semester of 2003 as part of the curriculum.

Computer-Assisted Instruction↗
PubMed2005

One hundred years of the teaching of medicine in Singapore.

The Medical School was founded in 1905 in response to the need to train doctors for Singapore. In 2005, this School, now the Faculty of Medicine in the National University of Singapore, will celebrate her 100th year. This brief review attempts to chronicle the way in which the medical course has been designed over the years to address the principal aims of undergraduate medical education. From the inception of the Straits and Federated Malay States Government Medical School to the present, strong clinically based teaching was the key element, although there was some distinction between the foundational preclinical years and the clinical phases of training. Initially, this was necessitated by the fact that students were too poorly equipped in the sciences to have a more integrated curriculum. Over time, the structure of the course, learning objectives and teaching pedagogy and techniques became better developed. Of late, many of these elements have been revised and better articulated by the Faculty following a review. The method, frequency and emphasis of student evaluations have also changed as medical knowledge grows and the population becomes developed, with attendant disease pattern changes. The clinical relevance of the course and the need to train competent doctors remain the main mission of the Faculty of Medicine even in this age of molecular medicine and a technology-enhanced practice setting. Competency alone is, however, incomplete without good role models in the art of the practice of medicine. It is heartening to note that medical ethics and communications skills continue to be emphasised in the modern curriculum.

Curriculum↗
PubMed2005

Evaluating public participation in environmental decision-making: EPA's superfund community involvement program.

This article discusses an 8-year, ongoing project that evaluates the Environmental Protection Agency's Superfund community involvement program. The project originated as a response to the Government Performance and Results Act, which requires federal agencies to articulate program goals, and evaluate and report their progress in meeting those goals. The evaluation project assesses how effective the Superfund community involvement program is in promoting public participation in decisions about how to clean up hazardous wastes at Superfund sites. We do three things in the article: (1) share our experience with evaluating an Agency public participation program, including lessons learned about methods of evaluation; (2) report evaluation results; and (3) address a number of issues pertaining to the evaluation of public participation in environmental decision-making. Our goal is to encourage more environmental managers to incorporate evaluation into their public participation programs as a tool for improving them. We found that written mail surveys were an effective and economical tool for obtaining feedback on EPA's community involvement program at Superfund sites. The evaluation focused on four criteria: citizen satisfaction with EPA information about the Superfund site, citizen understanding of environmental and human health risks associated with the site, citizen satisfaction with opportunities provided by EPA for community input, and citizen satisfaction with EPA's response to community input. While the evaluation results were mixed, in general, community members who were most informed about and involved in the cleanup process at Superfund sites generally were also the most satisfied with the community involvement process, and the job that EPA was doing cleaning up the site. We conclude that systematic evaluation provides meaningful and useful information that agencies can use to improve their public participation programs. However, there need to be institutionalized processes that ensure evaluation results are used to develop and implement strategies for improvement.

Community-Institutional Relations↗
PubMed2003

Provision of speech-language services in the schools: working with the law.

Decisions regarding eligibility for speech-language services in the schools can be the most difficult decisions facing school-based speech-language pathologists. Clinicians and parents must be informed about the federal mandates for services in the schools for children with special needs in order to make appropriate decisions and to ensure that children with disabilities are receiving the services to which they are entitled. This article discusses the Individuals with Disabilities Education Act (IDEA), the federal law guaranteeing school-based services to children with disabilities, as an educational planning process that promotes meaningful access to the general curriculum for all students. Steps are then outlined for making eligibility decisions by following this established process and using IDEA's goals as the standard by which services are developed and implemented. Examples are given linking speech-language services to state learning standards.

Child↗
PubMed1998

"Crowd-out": what it means for children's health insurance.

As states finalize proposals for the federal Title XXI Children's Health Insurance Program (CHIP), consumers, advocates, legislators, and policymakers across the country are facing the issue of "crowd-out." How can they prevent CHIP's new public funds from "crowding out"--or supplanting--private funds now used to insure children? This issue of States of Health looks at research on crowd-out and reviews what some states have learned as a result of previous Medicaid expansions. Their experiences shed light on the challenge of making sure that Title XXI health care dollars reach the intended consumers, children who lack adequate insurance.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Community outreach, training, and research: the Hawai'i/Pacific Basin area Health Education Center of the University of Hawai'i, John A. Burns SChool of Medicine.

The Hawai'i/Pacific Basin AHEC is a federal grant program that utilizes academic/community partnerships to recruit students to health careers, train students in rural and underserved areas, and assist with workforce development across the region. Ongoing activities and programs include 1) Outreach for recruitment to health careers for students from kindergarten through adulthood; 2) Individual and interdisciplinary health professions student training in rural and underserved areas; 3) Community health education using distance learning; 4) Assessment of and efforts to improve recruitment and retention of providers in rural areas including continuing education; and 5) Health disparities research. The AHEC programs reach more than 4,000 individuals annually, helps to train more than 1,000 individuals a year and assist with placement of up to 20 providers a year in rural and underserved healthcare practices. This article describes the existing AHEC programs that are community based, community driven and inclusive of all who choose to participate. Collaboration is invited and necessary for success and future program development. Future areas for collaboration activities include increased statewide community health worker training, an expanded health careers pipeline, ongoing rural and underserved health needs assessments and an expanded training network for students in healthcare. Additional information is available at www.ahec.hawaii.edu.

Community-Institutional Relations↗