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PubMed1999

Social Security must be reformed.

Today's Social Security system must be reformed not only because it will soon be in financial crisis but also because it is simply a bad deal for most Americans, this author believes. She argues that it should be transformed into a system of personal retirement accounts and uses the example of San Diego, which opted out of Social Security in 1981 and replaced it with a mandatory defined contribution program for city employees, to show the benefits of private accounts.

Aged↗
PubMed1975

Help stamp out mandatory continuing education!

Mandatory continuing education programs for health professionals, as they are now administered, are predictable failures. Such programs may destroy the will to learn. Objective studies indicate that current continuing education programs do not influence the methods of practice of the health professional. Current programs are primarily pedagogical, reflecting the philosophies and techniques of child-youth education. Present methods of program evaluation are sorely inadequate. Adults may be coerced into attendance, but learning and subsequent application of knowledge may not be forced. Future continuing education programs should be problem-centered. The adult practitioner must become actively involved in the planning and execution of these programs.

Adult↗
PubMed2002

Ambulatory medical visits among anthrax-vaccinated and unvaccinated personnel after return from southwest Asia.

The Department of Defense launched a mandatory anthrax immunization program for military personnel in December 1997. This program has been criticized for many reasons, including concern over side effects. This study was designed to give a quick answer to the question of whether vaccinated persons who deployed to southwest Asia were more likely to seek medical care upon their return than their unvaccinated counterparts. The results demonstrated that there was no greater risk for vaccinated persons to have a diagnosis recorded in the Ambulatory Data System (0.96 RR) than unvaccinated persons. In addition, there was no significant increased risk for a recorded diagnosis in any 1 of the 17 International Classification of Diseases, Ninth Revision, categories or for 16 specific adverse health conditions.

Adult↗
PubMed2002

How effectively do managed care organizations influence prescribing and dispensing decisions?

OBJECTIVE: To examine the extent to which managed care organizations (MCOs) use formularies, therapeutic interchange, and prior approval and to determine how effectively these tools influence prescribing and dispensing decisions. RESEARCH DESIGN: Literature review. PATIENTS AND METHODS: Studies relating to effectiveness were identified through a comprehensive literature review using the MEDLINE and International Pharmaceutical Abstracts databases. Only peer-reviewed studies done in outpatient settings were included. Studies measuring extent of use were taken primarily from published and widely available marketing research reports. RESULTS: Closed formularies were found to be effective in decreasing the utilization, but not necessarily the cost, of prescription drugs. Just under half of health maintenance organizations (HMOs) and 10% of employer-sponsored health plans use closed formularies. Prior approval programs have been shown to reduce use of target drugs and drug costs in a small number of drug classes. Nearly all HMOs and most employer-sponsored health plans use prior approval programs. How extensively the programs are used is not reported. About half of HMOs and employer-sponsored health plans use therapeutic interchange. Voluntary programs have been shown to be successful in staff-model HMOs. Mandatory, but not voluntary, programs have been shown to be successful in independent practice association-model HMOs. CONCLUSION: The literature indicates that most MCOs have had limited success using formularies, therapeutic interchange, and prior approval to influence prescribing and dispensing decisions. Although these tools have been effective in some situations, their impact has been limited by their low rate of utilization.

Cost Control↗
PubMed2005

[Infectious diseases risk management].

Surveillance activities first target health problems for which treatment, effective prevention or control measures are available. The data produced by surveillance systems allow prioritising public health actions and defining the objectives of infectious diseases control or prevention. The surveillance of infectious diseases relies on a large number of partners grouped in a public health network in which clinicians have a prominent role. In France, the surveillance of infectious diseases is based on mandatory notification of some diseases, national reference centers, networks of voluntary health professionals and repeated surveys, alerting health authorities in case of threats and identifying the determinants of changes in the population health's status. At hospital, the infectious risk is significant and the risk of epidemic outbreaks very high. A solid system for surveillance is mandatory. An educational program is needed to define the prevention program based on the use of hand disinfection and other standard precautions, antiviral and pneumococcal vaccination. A strong cooperation between general practitioners, healthcare team and relatives is necessary.

Anti-Bacterial Agents↗
PubMed2006

Incidence of male childhood sexual abuse and psychological sequelae in disaster workers exposed to a terrorist attack.

This study documents the prevalence of male childhood sexual abuse (CSA) and psychological sequelae in a sample of disaster workers deployed to the World Trade Center (WTC) site following the September 11, 2001 terrorist attack. There are limited data on male CSA and its psychological impact, especially on a large non-treatment seeking sample. As part of a mandatory medical screening program, workers were assessed with well-validated and widely used clinician interview and self-report measures following their involvement in the restoration of services to Ground Zero and surrounding areas of lower Manhattan. Frequency of CSA measured by the Traumatic Events Interview (TEI) was 4.3% (n = 92). Clinician interview and self-report data were analyzed using t-tests, revealing statistically significant relationships (but not clinically meaningful scores) between CSA and scores on the CAPS, PCL, BDI, STAXI, and SDS. Further analyses revealed that individuals endorsing CSA were three-times more likely to score high (vs. low) on the BDI and CAPS. Since disaster workers traditionally summon images of strength and mastery, professionals may overlook CSA and symptoms of depression and PTSD in this population.

Adult↗
PubMed1991

A comparison of median hearing thresholds from U.S. Navy and U.S. Army audiometric data bases.

This study examined 1984 monitoring audiometric data from U.S. Navy (military and civilian) employees whose workplace required a mandatory hearing conservation program. Median hearing thresholds were compared in U.S. Navy employees, U.S. Army employees also monitored by a hearing conservation program, and a standard population from the First National Health and Nutrition Survey. Age group and frequency-specific comparisons were included. Results at 4 kHz and 6 kHz demonstrated higher median thresholds in the Navy populations that were significantly higher by clinical and statistical criteria. Possible reasons for the differences are given.

Adult↗
PubMed1989

Why mandatory HIV antibody screening cannot work.

In 1985 this country introduced the first serologic screening test [enzyme immunoassays (EIAs)] designed to detect antibodies to the human immunodeficiency virus (HIV), the pathogen of acquired immunodeficiency syndrome (AIDS). Some people now suggest use of this test to identify people within the general population who are infected with the virus. This article will review technical and administrative problems pertaining to the use of EIAs to screen the general population for antibodies to HIV, and will explain why optometrists can provide safe and comprehensive care to all patients without knowledge of a patient's HIV antibody status. Prior knowledge by the optometrist of the patient's serological status is unnecessary if the practitioner 1) adheres to established guidelines pertaining to infection control, and 2) is aware of the various ocular manifestations of HIV disease. It concludes that mandatory HIV screening programs should not be adopted until the benefits to society have been more clearly elucidated and associated technical, administrative, and ethical problems have been resolved.

AIDS Serodiagnosis↗
PubMed1989

Allocative efficiency of case managers for the elderly.

This study presents an analysis of the allocative efficiency of case managers for the community-based elderly in an environment in which case management and a range of home and community-based services were available and directly linked to a mandatory preadmission screening program for nursing home applicants. We collected data for a one-year follow-up period on client placement, health and functional status, informal support, and use of health and social services for clients in two urban and two rural counties that participated in the Minnesota Pre-Admission Screening/Alternative Care Grants Program (PAS/ACG). We found that among those receiving ACG-supported services, the relationship between variation in the level of support for home and community-based services and the length of time elderly clients remained in the community suggested that case managers were allocating home and community-based services in a reasonably efficient manner. This finding offers support for using case managers to target services to the elderly.

Activities of Daily Living↗
PubMed1987

Exercise and sudden death.

Sudden death during exercise is rare, but limited data suggest that vigorous physical activity is associated with an increased risk for this event, particularly in individuals with overt cardiac disease or a high coronary risk profile. The mechanism of exercise-associated sudden death is usually a lethal arrhythmia; however, this may vary depending on the underlying cardiovascular disease. In the great majority of cases, cardiovascular disease is present in persons who die during exercise. In young individuals (less than 35 years old) hypertrophic cardiomyopathy and congenital coronary anomalies are the most common conditions, whereas older victims usually have coronary artery disease. Cardiac disease is typically unrecognized prior to death in young persons; in the older population, most have overt coronary disease or recognizable coronary risk factors. Screening asymptomatic individuals to identify increased risk of a cardiac event during exercise presents major problems in terms of logistics, expense, and accuracy, but careful evaluation, including exercise testing, is mandatory before a program of increased activity in patients with overt cardiac disease. In other cases, the extent of any evaluation must be determined on an individual basis.

Adult↗
PubMed2006

Ophthalmology resident surgical competency: a national survey.

PURPOSE: To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues. DESIGN: Fourteen-question written survey. PARTICIPANTS: Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000. METHODS: Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions. MAIN OUTCOME MEASURES: Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests. RESULTS: One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand-eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal teaching course, and 36% had mandatory practice time. Most programs (76%) did not perform applicant vision or dexterity screening tests; questions existed about the legality and validity of such tests. CONCLUSIONS: The issue of ophthalmology residents who struggle to develop surgical competency appears common. Although many problems appear to be remediable with time, practice, and dedicated, patient teachers, more specific guidelines for a statement of surgical competency are likely necessary to standardize the Board certification process.

Career Choice↗
PubMed2005

Evaluation of the ACRRM national radiology program for Australian rural and remote medical practitioners.

INTRODUCTION: In 2000, the Australian College of Rural and Remote Medicine (ACRRM) developed a national radiology quality assurance (QA) and continuing medical education (CME) program for rural and remote non-specialist Australian doctors. The program commenced on 1 January 2001. It required rural doctors to obtain 30 radiology QA/CME points over a 4 year period. At least 15-20 of these points had to be obtained by one of two mandatory options of the program, either: (1) film interpretation, report and review clinical audit activity; or (2) a radiology clinical attachment. METHOD: Doctors submitted their completed film review forms and clinical attachment logbooks to the program manager as confirmation of their educational activity to receive their professional development points. Data from film review forms and clinical attachment logbooks were de-identified and entered into two Microsoft EXCEL spreadsheets. The data were categorised and analysed in EXCEL. RESULTS: From 1 January 2001 to September 2004, 823 rural and remote doctors enrolled in the ACRRM radiology program. This included 281 locums who enrolled in the short-term locum option of the program and 563 doctors who enrolled in the full program. In September 2004, 419 doctors had completed a radiology film review with a radiologist and 41 doctors completed a radiology clinical attachment in 31 different public and private radiology practices. One hundred and ninety-five doctors completed the short-term locum activity. Ninety-two different specialist radiologists participated in the program and assisted rural and remote doctors to enhance their radiology knowledge, confidence and skills. This article describes results from the two mandatory activities. CONCLUSION: The evaluation of the ACRRM radiology program after its first 3 years and 9 months shows there are a large number of rural and remote Australian doctors undertaking professional development and quality assurance activities in radiology.

Attitude of Health Personnel↗
PubMed1997

The opinion of current and recent internal medicine residents regarding a fourth year of training and the future of general internal medicine. American College of Physicians National Council of Associates.

OBJECTIVE: To determine the opinion of current residents and recent graduates of internal medicine training programs regarding an additional mandatory year of residency training. METHODS: A survey was made of 2,000 associate members of the American College of Physicians from five geographic regions. RESULTS: Of 917 respondents, 70.3% thought a fourth year of training would impact negatively on their choice of a career in internal medicine, and 82.9% believed a mandatory fourth year should not be required of residents choosing a subspecialty career. Furthermore, 58.1% of physicians surveyed thought a mandatory fourth year would discourage individuals from pursuing subspecialty careers. If a mandatory fourth year of training were required, 50.7% respondents indicated that it should consist of ambulatory training in a number of general fields, while 49.6% physicians believed the training should focus on one or two subspecialty fields. CONCLUSIONS: A mandatory fourth year of training is not supported by residents and recent graduates of the programs surveyed.

Attitude of Health Personnel↗
PubMed2001

A mandatory short-term methadone-to-abstinence program in New York City.

In July 1998, Mayor Rudolph Giuliani of New York City introduced a program requiring the 2100 patients in methadone maintenance programs in selected clinics to terminate their use of methadone within 90 days. Previous short-term methadone-to-abstinence programs in California had generally been unsuccessful. Seven months of debate and controversy ensued. And several new ideas received widespread attention because of the public spotlight on this issue. In January 1999, the Mayor announced that his program had been inadequately conceptualized, was not realistic, and was being withdrawn. The wide attention given the Mayor's new program and its criticism by various authorities had led to a thoughtful examination of the whole methadone maintenance situation, with a reasonable likelihood that the situation would improve.

Adult↗
PubMed1986

An evaluation and education program for driving while intoxicated offenders.

This report addresses the development of a mandatory, inpatient, evaluation and education program aimed at reducing Driving While Intoxicated (DWI) at a major Army installation. The program was designed to provide extensive evaluation to all soldiers within a week of the DWI. The majority of soldiers are young males, a population known for heavy drinking and a disproportionate amount of both motor-vehicle accidents and fatalities. Among the initial 490 soldiers admitted to the program, 88% were found to meet DSM-III criteria for alcohol abuse or alcohol dependence. Factors associated with a diagnosis of abuse or dependence were age; scores on the Vaillant alcohol questionnaire, the MacAndrews and F scales of the MMPI, the Mortimer-Filkins questionnaire; BAC at time of arrest; a prior history of alcohol-related problems; and certain blood hematology and chemistry values. Results indicate that DWI is a marker for serious alcohol problems.

Adult↗
PubMed2003

[Public health control of hyperhomocysteinemia and its consequences].

The etiological role of hyperhomocysteinemia in the origin of neural-tube defects was proved, therefore a mandatory flour folic acid fortification program was introduced in the USA since January 1, 1998. In Hungary one kind of breads was fortified with folic acid, vitamin B12 and vitamin B6. The Hungarian randomised controlled trials of periconceptional folic acid containing micronutrient-combination supplementation also indicated a reduction in the occurrence of congenital cardiovascular malformations, urinary tract's defects and congenital limb deficiencies and these findings were confirmed by US teams. Recent studies showed a positive association between cardiovascular diseases and hyperhomocysteinemia as well, thus it is considered as an independent etiological factor in the pathogenesis of ischemic heart diseases, stroke, deep vein thrombosis, in addition of vascular diseases in the placenta during pregnancy. Other studies showed that hyperhomocysteinemia is more prevalent in demented patients and in persons with impaired cognitive performance. Some association was also found between hyperhomocysteinemia and cancers (e.g. colon). There is strong evidence that four vitamins B, such as vitamin B11 (folate-folic acid), vitamin B12, B2 and B6 can reduce the level of serum homocysteine and subsequently neural-tube defects. In addition the results of intervention studies indicated a protective effect of folic acid and other vitamins B for some other congenital abnormalities, cardiovascular diseases, senile dementia and cancers. The flour fortification with these water-soluble vitamins B is appropriate for an effective public health program for the primary prevention of these hyperhomocysteinemia-related disorders. There is no real risk for side effects on the basis of available US, Canadian and Hungarian experiences. In conclusion an urgent task is to introduce a mandatory flour fortification program in Hungary.

Alzheimer Disease↗
PubMed1983

Response of age forty and over military personnel to an unsupervised, self-administered aerobic training program.

The Army recently extended mandatory physical training and testing to include personnel 40 yrs of age and older. The purpose of this study was to describe the profile of aerobic fitness in a representative group from this age population and to evaluate the response of such a group to a self-administered, unsupervised training program. Maximal oxygen uptake (Vo2 max) and percent body fat (%BF) were assessed in 260 military personnel (40-53 yrs of age) before and after 6 mo of physical training consisting of a progressive walk/run mode of exercise. Before training the mean +/- S.D. for Vo2 max and %BF for all subjects was 38.1 +/- 6.2 ml/kg . min and 26.1 +/- 4.7%, respectively. Subjects were divided into three groups based upon their initial level of physical activity determined by interview as follows: inactive, moderately active and active. Upon retesting after 6 mo, 40% of the inactive group had not participated to any appreciable degree in the program and subjects of this group who did participate showed only a slight and insignificant increase (4.4%) in Vo2 max. The pretraining level of Vo2 max for the total population studied was similar to that reported in other studies on comparably aged subjects. However, changes with training were well below those seen with supervised group programs of 6 mo duration.

Adult↗