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PubMed2003

Increases in resident and faculty computing skills between 1998 and 2001.

BACKGROUND AND OBJECTIVES: Following a 1998 survey, we hypothesized that family practice residents would soon demand more advanced informatics and computer training than faculty could provide. We repeated the survey in 2001 to test our hypothesis. METHODS: We surveyed 97 first-year medical students, 46 family practice residents, and 18 family medicine faculty at our institution. We compared responses among groups and within groups since 1998. RESULTS: Significantly more respondents owned a computer in 2001 than in 1998. E-mail and Internet use increased dramatically for all groups. Students and faculty had significantly greater confidence in their general computer abilities than residents did in 2001, but third-year residents' confidence had increased significantly since 1998. Respondents cited inadequate computer resources as the most important barrier to effective computer use. CONCLUSIONS: Resident and faculty self-assessed computer skills have increased substantially at our program since 1998. These increases appear due to the current ubiquity of computers in society and improvements in device functionality and ease of use rather than curricular activities. Few residents and faculty need the basic computer training recommended in curricular guidelines. Residency programs should maintain up-to-date computer resources and consider providing selective advanced computer skills training.

Attitude to Computers↗
PubMed1995

The contribution of epidemiology to the definition of health goals and targets for Australia.

Health goals and targets may be used to improve the efficiency of investment of resources for health care and the promotion of health the better to fulfil the values and expectations of society. Australia has been developing health goals and targets since 1985. The first step was the establishment of the Better Health Commission that year. Its proposals led to the states and territories undertaking concerted health promotion activities through the National Better Health Program. Subsequently the health-care system as a whole, through the 1993 Medicare agreement, endorsed the goals and targets approach. Epidemiology has played a major role in every step in this process. Initially it was used to establish health status baselines or to point to serious data deficits which stopped a baseline being set. It provided data about the burden and distribution of illness in the community. It was used critically to appraise evidence about aetiology and the fraction of illness attributable to modifiable risk factors and the effectiveness of interventions, and to provide estimates of potential years of life lost through illness and injury. This has contributed, along with economic analysis which is a critically important corollary, to the definition of health care priorities. Epidemiology, while being necessary for these developments, however, has not been sufficient. This 'insufficiency' has three elements. First, existing epidemiological knowledge and methods have been inadequately applied or the data have been missing, or distorted by inappropriate interpretation. Second, there are now goals and targets in health literacy, the health care system, and the environment where epidemiological methods (and hence data) are poorly developed or non-existent.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed1997

A problem-based preclinical course for dental students.

In September 1994 the Turner Dental School, University of Manchester, introduced a new curriculum in which the first 2 years were problem-oriented. The 82 dental students share the first year and part of the second with 252 medical students, making this the largest cohort of students in a problem-based learning course in the world. It is one of two or three dental courses of its kind. In addition to the problem-oriented work, the course includes a substantial informatics component involving computer skills. The number of lectures has been reduced to a maximum of four per week in the first year and seven per week in the second. Most of the students' learning is achieved by group work in which they study clinical cases and search out the basic biological background to them. At the same time the students consider the social and psychological implications of the cases and develop their own communication skills. Thus far the course has resulted in students having a much broader but less detailed subject knowledge. Students are able to integrate their knowledge more effectively. In the new kinds of examination developed for the course the dental students achieve marks around 5% lower than their medical colleagues, as in more traditional combined courses. The first year of the course was designed for medical students and may not therefore be optimal for dental students but the second year has more specifically dental components.

Biology↗
PubMed1999

Household organization, women's autonomy, and contraceptive behavior in southern Ethiopia.

The Southern Nations, Nationalities, and People's Region of Ethiopia (SNNPR) is home to 11 million people constituting more than 45 language and ethnic groups, most of whom live in extremely poor rural communities. Data for currently married, fecund women aged 15-49 from demographic surveys conducted in the SNNPR in 1990 and 1997 are used to investigate contraceptive knowledge and communication, and the use and future need for family planning services in this population. This study focuses on how these processes are affected by household organization and women's status, and on their implications for population policies and programs. Considerations of the implications of these results for understanding the fertility transition of a highly diverse African population under severe stress are presented. Although household extension and polygamy characterize one-third of the women sampled, they do not affect the women's contraceptive behavior. Women's literacy and autonomy are, by far, the most significant forces in the movement toward lower fertility in the region.

Adolescent↗
PubMed2002

Brains rule! fun = learning = neuroscience literacy.

Brains Rule! Neuroscience Expositions is a project designed to improve neuroscience literacy among children and the general public by applying a model where neuroscience professionals transfer knowledge and enthusiasm about neuroscience through fun, engaging hands-on activities. This educational model draws strength from many national and local partnerships of neuroscience professionals to coordinate expositions across the country in a variety of local communities. Brains Rule! Neuroscience Expositions uses a flexible science fair-like format to engage children in the process of science and teach about neuroscience concepts, facts, and professions. Neuroscience literacy is important to everyday life and helps individuals better understand themselves, make informed decisions about health and drug use, participate knowledgeably in governmental and social issues, and better understand scientific advancements. In this study, children's ratings of Brains Rule! Neuroscience Expositions activities were analyzed both quantitatively and qualitatively. Analysis of the responses revealed that overall the children perceived the learning activities as fun and interesting and believed that they learned something about the brain and nervous system after engaging in the activities. The Brains Rule! Neuroscience Expositions education model can be an effective tool in improving neuroscience literacy for both children and adults.

Adolescent↗
PubMed2002

Evaluation of web-based dental CE courses.

Various organizations offer online continuing dental education (CDE) courses. While previous investigations focused on objective measures to determine the quality of the courses, this exploratory study evaluates the participants' experience with them. We surveyed 436 past course participants from nine online CDE courses (courses provided by six organizations) regarding their experience with the courses taken. Our analysis of the 169 responses (38.8 percent response rate) focuses on how the participants of online CDE courses can be characterized; whether the participants' expectations were met by the courses; how the participants evaluated the content of the courses; why they enrolled; and the participants' experience of the online environment. The results suggest that online CDE courses partially meet the needs and expectations of dental professionals. The lack of communication with peers and instructors as well as the fact that courses appeared outdated were main reasons for dissatisfaction. Most of the participants accomplished their goals of gaining new knowledge and deepening their understanding of the subject. Based on this evaluation, future courses can be tailored to meet more closely the expectations and needs of dental professionals.

Adult↗
PubMed1989

[The role of allied medical personnel in developing a program of primary medical and sanitary services in the Republic of Afghanistan].

When analyzing the role of paramedical and allied medical staff in the development of programmes of primary medical care in the DRA it is pointed out that not only the problems of disease prevention and treatment should be taken into account but also of the resources necessary for this personnel training. Since the DRA has a low literacy level, it is difficult to enroll students into secondary medical schools. As a result the number of medical school-leavers declines. The Ministry of Public Health of the DRA changed the level of general education sufficient for entering secondary medical schools and set up the programme for raising the rates of training of these specialists. At the modern stage of development the DRA should make a wider use of allied medical staff. Examples of such use are found in child and maternal health, control of communicable diseases, etc.

Afghanistan↗
PubMed2006

The uninsured: problems, solutions, and the role of academic medicine.

The number of uninsured persons in the United States--46 million--is more than the number covered by Medicare. The author discusses why there are so many uninsured, the health effects of being uninsured, and strategies to help the uninsured, with an emphasis on changing the safety net and employer-based insurance for smaller businesses. He then asks "What can academic medicine (AM) do now?" and proposes that (1) AM can help eliminate waste in health care. For example, AM can research areas of potential waste such as how often patients with chronic disease need to be seen and what tests they need (not to restrict care, but to determine what is appropriate). AM can also continue to develop electronic medical records that eliminate unnecessary repetition of work and can have embedded national practice guidelines with reminders. (2) AM can act as a large employer and develop novel benefit plans that provide various important choices and develop ways to educate employees to choose the appropriate health plan. The University of Virginia has established the Consumer Health Education Institute, which is researching ways to educate consumers in the format most accessible for them as individuals (i.e., tailored to their health literacy). (3) AM can work with state governments to develop innovative coverage models. Because it appears that innovation in health care may be at the state level at least for the next few years, individuals in AM can be extremely helpful in making suggestions to formulate policy and implement programs. The current estimate is for the United States to have 56 million uninsured by 2013--an increase to 19.4% of the population. Academic medicine can help slow this increase.

Academic Medical Centers↗
PubMedDate not supplied

Applied informatics for quality assessment and improvement.

In our hospital, transition planning for order entry and clinical documentation has presented an opportunity for process changes and the ability to capture quality initiatives into data warehouses, where they can be utilized for building evidence-based practice. For example, the order entry and clinical documentation system allows for data retrieval of performance measures set by organizations including the Joint Commission on Accreditation of Healthcare Organizations, Centers for Medicare & Medicaid Services, and National Quality Forum. These data will reside in one system where they can be mined and extracted for reporting. Details of this magnitude are crucial when developing a CPR that will serve as the primary data source of clinical information. As we continue to seek IT solutions to improve patient safety and provide quality care, the use of informatics as a foundation in quality programs will provide the structure and database needed to support evidence-based practice at the point-of-care and reduce potential for error.

Academic Medical Centers↗
PubMed2001

Improving medical students' communication with limited-literacy patients: project development and implementation.

BACKGROUND: Physicians may not realize that some of their patients have limited reading abilities. The AMC Cancer Research Center and the Primary Care Curriculum at the University of Colorado collaborated to develop and implement a project to teach medical students to identify and effectively communicate with limited-literacy patients regarding cancer screening. METHOD: The project incorporated two standardized-patient (SP) cases on cancer screening and literacy into the existing curriculum for second-year students. A small-group, interactive problem-based learning (PBL) case on breast cancer screening and literacy introduced the concept of communicating about cancer screening and literacy issues. A clinical practice examination on colorectal cancer screening and literacy was given at the end of the year. RESULTS: The collaborative project proved successful in incorporating literacy and cancer screening into a medical school curriculum. Time spent training SPs to play the role of adults with limited literacy was very important, as was time spent pre-testing the cases. The PBL case effectively promoted group discussion of cancer screening and literacy. CONCLUSION: The project succeeded in making students aware of literacy and cancer screening issues. Outcome results are being analyzed.

Communication↗
PubMed1997

Preparing our future physicians: integrating medical informatics into the undergraduate medical education curriculum.

This paper describes how two medical schools have integrated "medical informatics" into their undergraduate medical education programs with the aim of preparing their students for future practice. It describes the components or elements of the informatics programs, how learning opportunities have been integrated into the curricula, how the informatics programs have evolved, and future directions. The medical schools approached the task of introducing informatics in a parallel way. Following needs identification, similar topic areas, goals, and specific informatics learning objectives were developed. These were used as a basis for implementation and evaluation. In general, the topic areas selected are: computer literacy, communications, information retrieval and management, computer-aided learning, patient management, office practice management, and hospital information systems. Learning opportunities in informatics were integrated for the above goals, in accordance with how the curriculum was organized in each school. These opportunities, and the support activities provided will be described.

Alberta↗
PubMed1999

Economic development and health status among the poor in squatter settlements of Karachi.

OBJECTIVE: Socioeconomic status is an important determinant of health outcome measures. This study examines and presents some of the important health outcomes amongst the higher and lower socioeconomic groups within the urban poor. SETTING: Data analysis is based on a Health and Demographic Survey conducted in urban squatter settlements of Karachi in 1996. METHODS: A structured questionnaire was administered to all households in the catchment area. The indicator used to assess economic status is ownership of assets. RESULTS: Comparison between the two economic levels shows that the lower socio-economic group was more likely to experience child mortality, (CI; 1.02-1.29, p = 0.02) have lower contraceptive usage (CI; 2.11-2.64; p < 0.001) and childhood immunization rates (CI; 2.08-2.40, p < 0.001). No significant association was observed between economic levels and prevalence of diarrhea. The housing, literacy and employment status was consistently better in the higher economic stratum who were more likely to be Pushto-Punjabi speaking as compared to the Sindhi speaking population. CONCLUSION: To have sustainable improvement in the health status of the poor, those who are most vulnerable need to be identified and programs aiming to improve health should also undertake broader development initiatives like raising family income.

Child↗
PubMed2004

AHRQ, IOM weigh in on developing a health-literate America.

Low health literacy is "a very underappreciated problem," Institute of Medicine (IOM) president Harvey Fineberg, MD, said at a Washington, DC, media briefing that introduced reports on health literacy from the IOM and the Agency for Healthcare Research and Quality.

Communication↗
PubMedDate not supplied

Developing population health competencies among public health nurses in Georgia.

As part of a new vision for public health in Georgia, the role of the public health nurse (PHN) is shifting from a predominantly individual and clinic-based care model to a population health practice model. Based on focus groups conducted with management and frontline PHNs in 2001, nurses in Georgia were unprepared for this transition and lacked a strong understanding of population health concepts and competencies. To prepare nurses for their new and expanded responsibilities, an online population health course was developed specifically for currently employed PHNs. The Quad Council PHN Competencies (2003) provided the roadmap in identifying the population health online course and continuing education training program priority competencies for PHNs in Georgia. Along with incorporating the competencies into case studies and didactic learning, the required projects served as evidence of competency application. The population health online course was offered from fall 2000 to spring 2005 in collaboration with Georgia schools of nursing and has enabled a cohort of nurses to lead the way as Georgia transitions into a new public health model. Nurses who completed the course reported greater experience with and an understanding of population health competencies.

Attitude of Health Personnel↗
PubMed2002

Help-seeking patterns for children with epilepsy in rural India: implications for service delivery.

PURPOSE: Most people in the world with epilepsy are untreated with antiepileptic drugs (AEDs). In some developing countries, this is because treatment facilities are unavailable or difficult to access. It has even been suggested that indigenous health systems threaten the prospect of the global control of epilepsy with AEDs. We have investigated patterns and costs of help seeking for children with epilepsy in a region of rural India where only 12% of children with epilepsy were in treatment. Our objective was to find out (a) whom families had consulted; (b) if nonconsulting families differed in demographic or child medical factors; (c) if indigenous treatment was taken, exclusive of allopathic treatment; and (d) the direct and indirect cost of various providers. METHODS: We conducted a cross-sectional interview study in a community-based program for childhood epilepsy in rural West Bengal, India. We interviewed parents of 85 children aged 2 to 18 years with untreated epilepsy who had entered a clinical trial of AEDs during 1995 through 1996. RESULTS: Eighty percent of families had sought some help in the past: 62% with an allopathic practitioner, 44% with traditional practitioners. Primary health centres (PHCs) and quacks were not popular. Twenty-four percent of families never sought help of any kind, and this was unassociated with sex, income, maternal literacy, or medical variables. There was evidence of both exclusivity and pluralism: 42% of families first consulting allopathic practitioners also visited traditional practitioners, whereas 30% of families first consulting traditional practitioners also went to allopathic practitioners. One visit to a physician cost a median of 9-13% of monthly income and 5-12 person-hours; the cost of visiting indigenous providers was negligible. CONCLUSIONS: Most families sought some form of help and were motivated to spend large amounts of money and time for allopathic treatments from qualified practitioners. The typical cost of allopathic treatment was unsustainable in the long term. Medical pluralism is common and does not adversely influence use of allopathic treatment. The phenomenon of nonconsulting merits further study. Traditional practitioners play a complementary role and might become involved in community treatment programs. Low-cost, local treatment is essential to the public health control of epilepsy.

Adolescent↗
PubMed2005

The impact of low health literacy on the medical costs of Medicare managed care enrollees.

PURPOSE: To examine the impact of low health literacy on medical care use and costs. METHODS: The study sample consisted of 3260 noninstitutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, Ohio; Houston, Texas; South Florida; and Tampa, Florida. Health literacy--the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions--was measured using the Short Test of Functional Health Literacy in Adults. We used a 2-part regression model to examine the association between health literacy and medical costs, adjusting for age, sex, race/ethnicity, education, income, alcohol and tobacco consumption, and comorbid conditions. Results are presented as mean differences (with 95% confidence intervals [CI]) between the inadequate and adequate groups and, separately, the marginal and adequate groups. RESULTS: When compared to those with adequate health literacy, emergency room costs were significantly higher ($108; 95% CI: $62 to $154; P <0.0001) among those with inadequate health literacy, while differences in total ($1551; 95% CI: -$166 to $3267; P = 0.08) and inpatient ($1543; 95% CI: -$89 to $3175; P = 0.06) costs were marginally significant. Total costs were higher in the marginal health literacy group, but the difference was not significant ($596; 95% CI: -$1437 to $2630; P = 0.57). CONCLUSIONS: Persons with inadequate health literacy incur higher medical costs and use an inefficient mix of services.

Aged↗