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PubMed1995

An electronic study guide for problem-based learning.

This paper describes the development and structure of an Electronic Study Guide for Oncology (LETSGO) for undergraduate medical students. LETSGO is aimed at clinical students learning about cancer. The subject of the guide is breast cancer and learning objectives cover structure and function, behavioural science, public health and epidemiology and professional and personal values. LETSGO is designed to follow the steps used in problem-based learning. The student is encouraged to carry out individual brainstorming around cases with the issues identified acting as the first step in an educational audit loop. Clear definition of prior knowledge is available by way of interactive features, and hyper-text links to core text and diagrams (including microscopic sections) precede definition of both broad aims and objectives for the module and specific objectives for assessment purposes. Core knowledge is available via hyper-text links. Assessment has three components: open ended questions asking for free text responses linking to 'model' answers; extended matching items linking to 'model' answers and providing peer-referenced feedback as a bar-chart distribution, and an educational audit loop referring back to the original issues identified at the beginning of the package in brainstorming. Clear mapping throughout the guide is a major feature and the student's progress is clearly displayed at each stage of the guide. The program provides dynamic access to the student's existing knowledge base and stimulates new learning based on the student's own learning needs.

Adult↗
PubMedDate not supplied

Home-Based Life Saving Skills in Ethiopia: an update on the second phase of field testing.

Home-Based Life Saving Skills (HBLSS) was integrated over 3 years into a district-level child survival project coordinated through the Ministry of Health and Save the Children Foundation/US in Liben Woreda, Guji Zone, Oromia Region, southern Ethiopia. During late 2004, the second phase of the program was reviewed for performance, home-based management, learning transfer, and program coverage. The immediate posttraining performance score for HBLSS guides for "First Actions" was 87% (a 78% increase over the pretraining baseline) and 79% at 1 year (a 9% decrease from the immediate posttraining score). The home-based management score of women attended by HBLSS guides for "First Actions" was 89%, compared to 32% for women assisted by other unskilled attendants. HBLSS guides teach women and families in the community as they were taught, by using pictorial Take Action Cards, role-play and demonstration, and a variety of venues. Estimates of HBLSS coverage suggest that HBLSS guides attended 24% to 26% of births, and 54% of women giving birth were exposed to HBLSS training. The HBLSS field tests demonstrate a promising program that increases access to basic care for poor, underserved, rural populations who carry the greatest burden of maternal and neonatal mortality.

Educational Measurement↗
PubMed1995

Mental health/substance abuse treatment in managed care: the Massachusetts Medicaid experience.

Massachusetts was the first state to introduce a statewide specialty mental health managed care plan for its Medicaid program. This study assesses the impact of this program on expenditures, access, and relative quality. Over a one-year period, expenditures were reduced by 22 percent below predicted levels without managed care, without any overall reduction in access or relative quality. Reduced lengths-of-stay, lower prices, and fewer inpatient admissions were the major factors. However, for one population segment--children and adolescents--readmission rates increased slightly, and providers for this group were less satisfied than they were before managed care was adopted. Less costly types of twenty-four-hour care were substituted for inpatient hospital care. This experience supports the usefulness of a managed care program for mental health and substance abuse services, and the applicability of such a program to high-risk populations.

Cost Control↗
PubMed2004

Addressing the urban pipeline challenge for the physician workforce: the Sophie Davis model.

The convergence of numerous trends indicates that a physician shortage by 2020 is likely. There is a 25% growth in the overall population, but that of the college-age sector is increasing by only 5%. The numbers of African Americans and Latinos in that sector will increase more than will members of other population groups; these two groups are most affected by the uneven quality of science education in urban high schools. Challenges to create a pipeline of a large, diverse, and qualified pool of medical school applicants are great, and are influenced by the actual and perceived cost of medical school tuition and the competition from other professions. Since 1973, the Sophie Davis School of Biomedical Education, a seven-year joint BS/MD program, has expanded access to medical school education for talented inner-city youths, including minorities and those with limited financial resources. Students receive a BS degree and their first two years of medical school education and, upon successful completion of the United States Medical Licensing Examination Step 1, transfer to one of five cooperating medical schools in New York State that confer the terminal MD degree. Sophie Davis integrates medical studies in the baccalaureate program, using actual performance in medical studies as a predictor of success. Of the more than 1,400 of its graduates, 25% are African American, 8% are Latino, 28% are Asian American, and 39% are white. Over 25% of its current student body comes from federally defined low-income families, and almost three-quarters qualify for New York State financial aid. The Sophie Davis School of Biomedical Education is a model that offers a partial response to those factors that will challenge the achievement of an adequate supply of physicians for our urban communities. The author describes the model in detail and explains how it helps talented but unevenly educated students rise to the challenge of a medical education.

Cooperative Behavior↗
PubMed2001

Does managed care enable more low income persons to identify a usual source of care? Implications for access to care.

BACKGROUND: By requiring or encouraging enrollees to obtain a usual source of care, managed care programs hope to improve access to care without incurring higher costs. OBJECTIVES: (1) To examine the effects of managed care on the likelihood of low-income persons having a usual source of care and a usual physician, and; (2) To examine the association between usual source of care and access. RESEARCH DESIGN: Cross-sectional survey of households conducted during 1996 and 1997. SUBJECTS: A nationally representative sample of 14,271 low-income persons. MEASURES: Usual source of care, usual physician, managed care enrollment, managed care penetration. RESULTS: High managed care penetration in the community is associated with a lower likelihood of having a usual source of care for uninsured persons (54.8% vs. 62.2% in low penetration areas) as well as a lower likelihood of having a usual physician (60% vs. 72.8%). Managed care has only marginal effects on the likelihood of having a usual source of care for privately insured and Medicaid beneficiaries. Having a usual physician substantially reduces unmet medical needs for the insured but less so for the uninsured. CONCLUSIONS: Having a usual physician can be an effective tool in improving access to care for low-income populations, although it is most effective when combined with insurance coverage. However, the effectiveness of managed care in linking more low-income persons to a medical home is uncertain, and may have unintended consequences for uninsured persons.

Adult↗
PubMed1988

Act (Chapter 13), 9 June 1988.

This Rhode Island Act authorizes and directs the Director of Health to establish a payer of last resort program to cover the cost of outpatient family planning counseling and comprehensive reproductive health services for those ineligible for Medicaid and who lack coverage for these services and whose family income is between 100 and 185% of the federal poverty level. The following services are to be included in the program: 1) patient education and counseling on options for timing and spacing pregnancy; 2) comprehensive medical services to prevent and control the spread of sexually transmitted diseases; and 3) access to safe and effective methods of contraception. Excluded services include, among other things, abortion and infertility related services. No funds are to be expended to support school-based clinics dispensing "contraceptive methods."

Americas↗
PubMed2004

Long-term randomized controlled trials of tailored-print and small-group arthritis self-management interventions.

OBJECTIVE: The objective of this study was to test the effectiveness of a mail-delivered, tailored self-management intervention (SMART) and to compare it with the classic Arthritis Self-Management Program (ASMP). METHODS: We performed 2 randomized controlled trials: 1) a study of 1090 participants randomized to SMART or USUAL CARE, and 2) a study of 341 participants randomized to SMART or ASMP. Dependent variables included disability, pain, depression, role function, global severity, doctor visits, and self-efficacy. SMART interventions were provided in months 0-18 and not reinforced. Results were assessed at 1, 2, and 3 years using analyses of covariance (ANCOVA). RESULTS: Compared with USUAL CARE, SMART participants at 1 year had decreased disability, improved role function, and increased self-efficacy (all P <0.01). At 2 years, decreases in global severity, doctor visits, and increases in self-efficacy (all P <0.01) were noted. At 3 years without reinforcement, no statistically significant effects remained. Compared with ASMP, SMART at 1 year had greater decreases in disability (P = 0.02) and increases in self-efficacy (P = 0.01). There were no differences at 2 years. At 3 years, role function (P = 0.04) and doctor visit (P = 0.03) were improved in ASMP as compared with SMART. Improvements from baseline were seen for nearly all variables in both groups. CONCLUSIONS: A mail-delivered arthritis self-management program, SMART, was similarly effective to the classic ASMP, with slightly better results in the first year and a slightly more rapid attenuation over the next 2 years. Results suggest that both programs are effective, and that the addition of a mail-delivered program could improve accessibility to arthritis self-management treatment.

Activities of Daily Living↗
PubMed2005

Lineage promiscuous expression of transcription factors in normal hematopoiesis.

Hematopoiesis has provided a valuable model for examining how genetic programs are established and executed in terms of cell fate decision. Identification of common myeloid and lymphoid progenitors allows us to directly assess the regulatory mechanisms of lineage commitment. Multiple markers of hematopoietic lineages are coexpressed in hematopoietic stem cells and progenitors, a phenomenon referred to as lineage priming. Promiscuous expression of several lineage-affiliated genes precedes lineage commitment but does not alter the biological potential of hematopoietic stem cells and multipotent progenitors. Promiscuous accessibility of multiple programs allows flexibility in cell fate commitment at the multipotent stages, indicating that transcriptional promiscuity can operate in stem cells and progenitors to control their transition from multipotency to single-lineage commitment.

Cell Lineage↗
PubMed2000

Healthy City Kwachon 21 Project: a community health promotion programme in Korea.

Disease patterns of Koreans changed from infectious disease to non-infectious disease in the 1970's. Even though there has been a need for a health promotion programme, it was hard to find the programme in the community before 1985 in Korea. In 1985, the Public Health Promotion Law was enacted and the Korean government started to encourage local government to plan and conduct community health promotion programs. Healthy City Kwachon 21 (HCK21) is a health promotion programme for all residents in Kwachon, a city which has about 70,000 population and is located adjacent to Seoul, Korea. HCK21 launched in 1998 with three guiding principles: 1) programs should be accessible to all citizens; 2) Programmes should stimulate strong community participation and 3) Programmes should change environment and society. The long term goal of HCK21 is to increase the healthy life span of citizens in Kwachon. HCK21 is a collaborative project between Kwachon and the Institute for Health Promotion of the Graduate School of Health Science and Management, Yonsei University. It has seven components: 1) Publication of Monthly Health Newsletter; 2) Smoking Cessation and Tobacco Prevention Program; 3) Community Nutrition Program; 4) Maternal and Women's Health Programme; 5) Programme for Development of District Health Management Information System; 6) Hypertension Prevention and Control Programme and 7) Physical Activity Programme. HCK21 is now being implemented in the third year program since the program conducted in 1998 and 1999 was successful with received support from the citizens. It is recommended that HCK21 be a model for an integrated community-based health promotion programme in developing countries.

Adolescent↗
PubMedDate not supplied

Charity care: a proposal for reform.

Changing political attitudes and new financing trends jeopardize our commitment to providing equitable access to medical services for all citizens regardless of ability to pay. The commitment is further threatened by the lack of coordination and the fragmentation that make charity care expensive and ineffective. This article proposes that we bring continuity and consistency to our charity care efforts by considering four options for reform: reallocate health spending to emphasize primary, preventive care in the community setting: create special HMOs for the medically disadvantaged through a revitalized community health center program; develop a voucher program to ensure access to the HMOs as well as risk-sharing pools to ensure access to secondary and tertiary care; and radically restructure the public hospital systems and eliminate most hospitals in the veterans administration system.

Charities↗
PubMed2004

Effectiveness of exercise in management of fibromyalgia.

PURPOSE OF REVIEW: Exercise was established as an integral part of the nonpharmacological treatment of fibromyalgia approximately 20 years ago. Since then many studies have investigated the effects of exercise-either alone or in combination with other interventions. This review will discuss the benefits of exercise alone and provide practical suggestions on how patients can exercise without causing a long-term exacerbation of their pain. RECENT FINDINGS: Short-term exercise programs for individuals with fibromyalgia have consistently improved physical function, especially physical fitness, and reduced tenderpoint pain. Exercise has also produced improvements in self-efficacy. These effects can persist for periods of up to 2 years but may require participants to continue to exercise. Most exercise studies have examined the effects of moderately intense aerobic exercise. Only in the past 2 years have muscle-strengthening programs, in isolation, been evaluated. To be well tolerated, exercise programs must start at a level just below the capacity of the participants and then progress slowly. Even with these precautions, exercise may still produce tolerable, short-term increases in pain and fatigue that should abate within the first few weeks of exercising. SUMMARY: Future studies should investigate the possible benefits of low-intensity exercise and test strategies that may enhance long-term compliance with exercise. Individuals with fibromyalgia also need to be able to access community exercise programs that are appropriate for them. This may require community instructors to receive instruction on exercise prescription and progression for individuals with fibromyalgia.

Exercise Therapy↗
PubMedDate not supplied

Detailed peptide characterization using PEPTIDEMASS--a World-Wide-Web-accessible tool.

In peptide mass fingerprinting, there are frequently peptides whose masses cannot be explained. These are usually attributed to either a missed cleavage site during the chemical or enzymatic cutting process, the lack of reduction and alkylation of a protein, protein modifications like the oxidation of methionine, or the presence of protein post-translational modifications. However, they could equally be due to database errors, unusual splicing events, variants of a protein in a population, or artifactual protein modifications. Unfortunately the verification of each of these possibilities can be tedious and time-consuming. To better utilize annotated protein databases for the understanding of peptide mass fingerprinting data, we have written the program "PEPTIDEMASS". This program generates the theoretical peptide masses of any protein in the SWISS-PROT database, or of any sequence specified by the user. If the sequence is derived from the SWISS-PROT database, the program takes into account any annotations for that protein in order to generate the peptide masses. In this manner, the user can obtain the predicted masses of peptides from proteins which are known to have signal sequences, propeptides, transit peptides, simple post-translational modifications, and disulfide bonds. Users are also warned if any peptide masses are subject to change from protein isoforms, database conflicts, or an mRNA splicing variation. The program is freely accessible to the scientific community via the ExPASy World Wide Web server, at the URL address: http://www.expasy.ch/www/tools.html.

Amino Acid Sequence↗
PubMed2002

Substance abuse attitudes and policies in US rehabilitation training programs: a comparison of 1985 and 2000.

OBJECTIVE: To assess and compare the attitudes, beliefs, and policies of physical medicine and rehabilitation (PM&R) training programs toward substance abuse and tobacco use over the last 15 years. DESIGN: A blinded questionnaire was sent to all US rehabilitation medicine training program directors. Results were compared with a survey conducted in 1985. SETTING: US PM&R residency training programs with inpatient rehabilitation training. PARTICIPANTS: Training directors or their designated agents. INTERVENTION: A 35-item questionnaire was mailed between November 1999 and April 2000 to the 81 US training programs identified by the American Board of Physical Medicine and Rehabilitation as having rehabilitation training programs with inpatient rehabilitation units. Responses were pooled by our Survey Research Center to preserve anonymity. Training programs that did not respond received additional mailings and telephone calls to improve the response rate. MAIN OUTCOME MEASURES: Chi-square analysis to assess changes in responses with time. RESULTS: Forty-six of the 79 (58%) eligible training programs responded (1 program had merged, 1 did not provide inpatient rehabilitation). Programs were located in cities ranging from less than 100,000 (n = 2) to greater than a million inhabitants (n = 18). Eighty percent (37/46) of the respondents were "concerned or very concerned" about their patients' alcohol and drug use, and 69% routinely assessed patients for alcohol and drug use compared with only 25% in 1985 (P <.00001). Almost all respondents (43/46) supported written guidelines to prohibit alcohol and drug use by patients in the rehabilitation unit. Eighty-three percent had a prohibition policy, and 72% had written guidelines. Both of those rates represent increases from the 1985 response rates of 65% and 45%, respectively. Ambivalence persisted about appropriate treatment programs for persons with disabilities: in 1985, 51% of the respondents agreed that a person with a disability could be treated appropriately in a substance abuse program designed for persons without a disability; in 2000, the percentage had increased to 64%. All respondents believed that tobacco use is an addiction, but only 25% of their units offered tobacco cessation services to patients on their rehabilitation unit. CONCLUSION: The survey results are encouraging. Since 1985, not only have substance abuse issues been recognized, but also systemic institutionalized approaches (eg, regular screening, written guidelines) have increased markedly. Tobacco is now uniformly accepted as an addiction, but screening and access to cessation programs are similar to that available for alcohol and drug treatment programs 15 years ago.

Alcoholism↗
PubMedDate not supplied

Implementation of a patient medication assistance program in a community pharmacy setting.

OBJECTIVE: To describe the establishment of a community pharmacy-based patient medication assistance program to improve access to medications by indigent patients, lessen the burden placed on physicians in obtaining such medications, reduce the amount of money spent on such medications by area charitable organizations, and improve therapeutic outcomes by improving patient adherence with therapy. SETTING: Supermarket-based pharmacy in Ashland, Ohio. PRACTICE DESCRIPTION: Community pharmacy. PRACTICE INNOVATION: A partnership was developed among Buehler's Pharmacy #3, United Way of Ashland County, and United Way Affiliates to establish a community pharmacy-based medication assistance program to help indigent patients obtain needed medications through manufacturer assistance programs and discount card programs. INTERVENTIONS: Following initial screening by a United Way affiliate agency, patients are seen by appointment by a Certified Pharmacy Technician at the pharmacy. An electronic application is completed, printed, and sent to the patient's physician for signatures and medication orders. The paperwork is returned to the pharmacy, where it is completed, signed by the patient, and filed. The patient pays the United Way agency $10 and the pharmacy $15 for these services. MAIN OUTCOME MEASURES: Number of prescriptions dispensed cumulatively from April 1, 2003, to July 31, 2003, within the program, patients' cumulative savings, and community response. RESULTS: Between April 1, 2003, and July 31, 2003, a total of 123 patients and 47 physicians were served, and 512 medications valued at $112,139.00 were applied for and/or procured. The time lapse between filing of paperwork and receipt of medications varies from 1 to 6 weeks. While some manufacturers ship product to physicians or directly to patients, the process works better when the product is sent to the pharmacy, where it can be added to the patient's profile, screened for drug interactions and allergies, and dispensed with proper labels and counseling. CONCLUSION: Establishing a community pharmacy-based medication assistance program is an innovative spin on the traditional physician office, advocacy, or health-system setting and was found to be beneficial to the patients, physicians and other health care providers, and the community it served.

Charities↗
PubMed2001

Aldrin and dieldrin: a review of research on their production, environmental deposition and fate, bioaccumulation, toxicology, and epidemiology in the United States.

In the last decade four international agreements have focused on a group of chemical substances known as persistent organic pollutants (POPs). Global agreement on the reduction and eventual elimination of these substances by banning their production and trade is a long-term goal. Negotiations for these agreements have focused on the need to correlate data from scientists working on soil and water sampling and air pollution monitoring. Toxicologists and epidemiologists have focused on wildlife and human health effects and understanding patterns of disease requires better access to these data. In the last 20 years, substantial databases have been created and now are becoming available on the Internet. This review is a detailed examination of 2 of the 12 POPs, aldrin and dieldrin, and how scientific groups identify and measure their effects. It draws on research findings from a variety of environmental monitoring networks in the United States. An overview of the ecologic and health effects of aldrin and dieldrin provides examples of how to streamline some of the programs and improve access to mutually useful scientific data. The research groups are located in many government departments, universities, and private organizations. Identifying databases can provide an "information accelerator" useful to a larger audience and can help build better plant and animal research models across scientific fields.

Aldrin↗
PubMed2002

Epidemiology of HIV/AIDS, hepatitis B, hepatitis C, and tuberculosis among minority injection drug users.

OBJECTIVE: This article reviews the literature on the impact of HIV/AIDS, hepatitis B and C viruses (HBV, HCV), and tuberculosis on minority drug injectors in the United States. OBSERVATIONS: Injection drug use is a key factor in the transmission of blood-borne pathogens, and HIV disease is exacerbated by tuberculosis infection. Minority drug injectors are disproportionately represented in the national statistics on these infections. Behavioral epidemiologic studies show that both injection-related risk factors years of injecting drugs, type of drug injected, direct and indirect sharing of injection paraphernalia) and sex-related risk factors (lack of condom use, multiple sexual partners, survival sex) are conducive to the spread of HIV, HBV, and HCV. CONCLUSIONS: Two issues must be addressed to halt the spread of HIV infection and hepatitis B and C. The capacity of syringe-exchange programs to refer participants to drug treatment programs and facilitate access to health and social services must be increased. Culturally appropriate behavioral interventions targeting risk behaviors among ethnic and racial minorities, especially women, must be developed and put in place.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Comparison of characteristics and attitudes of entry-level bachelor's and master's degree students in physical therapy.

BACKGROUND AND PURPOSE: The objective of this study was to examine the relationships between type of entry-level education and selected student variables. SUBJECTS: Students in their final year of education in entry-level bachelor's and master's degree programs in the United States (N = 766) participated in the study. METHODS: Questionnaires were mailed to these students, who represented 22 entry-level physical therapy programs selected at random from the December 1991 issue of Physical Therapy. Two-tailed t tests for independent means and chi-square analyses were performed to determine statistical significance for interval data and categorical data, respectively. RESULTS: Five hundred twelve surveys were returned, for a response rate of 66.8%. Master's degree respondents anticipated greater involvement in research and teaching and felt better prepared to practice across a broad spectrum of clinical practice and to perform activities related to research, teaching, management, and direct access practice. Baccalaureate programs, however, appeared to attract a greater percentage of minority individuals (14.9% versus 5.8%, respectively). CONCLUSION AND DISCUSSION: These results suggest that differences exist between entry-level bachelor's and master's degree students in physical therapy. Findings of this study may have implications for curriculum planning, recruitment and scholarship efforts, and policy formation in physical therapy education.

Attitude↗