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Sample records for reaching medically underserved

  1. A National Longitudinal Survey of Medical Students' Intentions to Practice Among the Underserved.

    Science.gov (United States)

    O'Connell, Thomas F; Ham, Sandra A; Hart, Theodore G; Curlin, Farr A; Yoon, John D

    2018-01-01

    To explore students' intentions to practice in medically underserved areas. In January 2011, 960 third-year medical students from 24 MD-granting U.S. medical schools were invited to participate in a survey on their intention to practice in a medically underserved area. A follow-up survey was sent to participants in September 2011. Covariates included student demographics, medical school characteristics, environmental exposures, work experiences, sense of calling, and religious characteristics. Adjusted response rates were 564/919 (61.4%, first survey) and 474/564 (84.0%, follow-up survey). Among fourth-year medical students, an estimated 34.3% had an intention to practice among the underserved. In multivariate logistic regression modeling, predictors for intentions to practice among the underserved included growing up in an underserved setting (odds ratio [OR] range: 2.96-4.81), very strong sense of calling (OR range: 1.86-3.89), and high medical school social mission score (in fourth year: OR = 2.34 [95% confidence interval (CI), 1.31-4.21]). International experience was associated with favorable change of mind in the fourth year (OR = 2.86 [95% CI, 1.13-7.24]). High intrinsic religiosity was associated with intentions to practice primary care in underserved settings (in fourth year: OR = 2.29 [95% CI = 1.13-4.64]). Growing up in medically underserved settings, work experience in religiously affiliated organizations, very strong sense of calling, and high medical school social mission score were associated with intentions to practice in underserved areas. Lack of formative educational experiences may dissuade students from considering underserved practice.

  2. 77 FR 43127 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2013

    Science.gov (United States)

    2012-07-23

    ... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved... determination of the States that qualify as Medically Underserved Areas under the Federal Employees Health... law that mandates special consideration for enrollees of certain FEHB plans who receive covered health...

  3. 78 FR 50119 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2014

    Science.gov (United States)

    2013-08-16

    ... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved... determination of the states that qualify as Medically Underserved Areas under the Federal Employees Health... law that mandates special consideration for enrollees of certain FEHB plans who receive covered health...

  4. Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions

    Directory of Open Access Journals (Sweden)

    Bärnighausen Till

    2009-06-01

    Full Text Available Abstract In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments; promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers; selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals; placement (programmes should match participants to areas in order to maximize participant satisfaction and

  5. Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions.

    Science.gov (United States)

    Bärnighausen, Till; Bloom, David E

    2009-06-26

    In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes

  6. Continuing interprofessional education in geriatrics and gerontology in medically underserved areas.

    Science.gov (United States)

    Toner, John A; Ferguson, K Della; Sokal, Regina Davis

    2009-01-01

    There is a widening gap between the health care needs of older persons and the treatment skills of the health care professionals who serve them. This gap is especially severe in rural areas, where there is a shortage of and inadequate collaboration between health care professionals and poor access to services for older persons. There is also a special opportunity in rural areas, particularly those designated as "medically underserved," for continuing interprofessional education as a vehicle for retaining health care professionals who tend to leave medically underserved areas for more lucrative professional opportunities elsewhere. In collaboration with the Consortium of New York Geriatric Education Centers, the Columbia-New York Geriatric Education Center at the Stroud Center of Columbia University has developed the Program for Outreach to Interprofessional Services and Education (POISE). The purpose of POISE is to develop, implement, evaluate, and sustain interprofessional education and training for health care learners, while emphasizing improved access to health services for the geriatric population in medically underserved areas. The POISE model was designed as an effective approach to teaching the core geriatrics and gerontology curriculum endorsed by the national (U.S. Department of Health and Human Services) network of Geriatric Education Centers to health care learners in medically underserved areas of upstate New York. This article describes the adaptation and implementation of the POISE model.

  7. 76 FR 31998 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2012

    Science.gov (United States)

    2011-06-02

    ... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved... Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2012. This is... certain FEHB plans who receive covered health services in States with critical shortages of primary care...

  8. 75 FR 32972 - Federal Employees Health Benefits Program; Medically Underserved Areas for 2011

    Science.gov (United States)

    2010-06-10

    ... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program; Medically Underserved... Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2011. This is... certain FEHB plans who receive covered health services in States with critical shortages of primary care...

  9. Clinical medical education in rural and underserved areas and eventual practice outcomes: A systematic review and meta-analysis.

    Science.gov (United States)

    Raymond Guilbault, Ryan William; Vinson, Joseph Alexander

    2017-01-01

    Undergraduate medical students are enrolled in clinical education programs in rural and underserved urban areas to increase the likelihood that they will eventually practice in those areas and train in a primary care specialty to best serve those patient populations. MEDLINE and Cochrane Library online databases were searched to identify articles that provide a detailed description of the exposure and outcome of interest. A qualitative review of articles reporting outcome data without comparison or control groups was completed using the Medical Education Research Study Quality Instrument (MERSQI). A meta-analysis of articles reporting outcome data with comparison or control groups was completed with statistical and graphical summary estimates. Seven hundred and nine articles were retrieved from the initial search and reviewed based on inclusion and exclusion criteria. Of those, ten articles were identified for qualitative analysis and five articles included control groups and thus were included in the quantitative analysis. Results indicated that medical students with clinical training in underserved areas are almost three times as likely to practice in underserved areas than students who do not train in those areas (relative risk [RR] = 2.94; 95% confidence interval [CI]: 2.17, 4.00). Furthermore, medical students training in underserved areas are about four times as likely to practice primary care in underserved areas than students who do not train in those locations (RR = 4.35; 95% CI: 1.56, 12.10). These estimates may help guide medical school administrators and policymakers to expand underserved clinical training programs to help relieve some of the problems associated with access to medical care among underserved populations.

  10. Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas.

    Science.gov (United States)

    Barclift, Songhai C; Brown, Elizabeth J; Finnegan, Sean C; Cohen, Elena R; Klink, Kathleen

    2016-05-01

    Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program. Methods Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)-funded training positions. Results More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas. Conclusions The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014-2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities.

  11. Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

    Science.gov (United States)

    Metz, Anneke M

    2017-01-01

    Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U.S. physician diversity and practice within underserved communities. MEDPREP recruits disadvantaged and underrepresented in medicine students to complete a 2-year academic enhancement program that includes science coursework, standardized test preparation, study/time management training, and emphasis on professional development. Five hundred twenty-five disadvantaged or underrepresented students over 15 years completed MEDPREP and were tracked through entry into medical practice. MEDPREP accepts up to 36 students per year, with two thirds coming from the Midwest region and another 20% from nearby states in the South. Students complete science, test preparation, academic enhancement, and professionalism coursework taught predominantly by MEDPREP faculty on the Southern Illinois University Carbondale campus. Students apply broadly to medical schools in the region and nation but are also offered direct entry into our School of Medicine upon meeting articulation program requirements. Seventy-nine percent of students completing MEDPREP became practicing physicians. Fifty-eight percent attended public medical schools, and 62% attended medical schools in the Midwest. Fifty-three percent of program alumni chose primary care specialties compared to 34% of U.S. physicians, and MEDPREP alumni were 2.7 times more likely to work in medically underserved areas than physicians nationally. MEDPREP increases the number of disadvantaged and underrepresented students entering and graduating

  12. Evaluation of the Program in Medical Education for the Urban Underserved (PRIME-US) at the UC Berkeley-UCSF Joint Medical Program (JMP): The First 4 Years.

    Science.gov (United States)

    Sokal-Gutierrez, Karen; Ivey, Susan L; Garcia, Roxanna M; Azzam, Amin

    2015-01-01

    Medical educators, clinicians, and health policy experts widely acknowledge the need to increase the diversity of our healthcare workforce and build our capacity to care for medically underserved populations and reduce health disparities. The Program in Medical Education for the Urban Underserved (PRIME-US) is part of a family of programs across the University of California (UC) medical schools aiming to recruit and train physicians to care for underserved populations, expand the healthcare workforce to serve diverse populations, and promote health equity. PRIME-US selects medical students from diverse backgrounds who are committed to caring for underserved populations and provides a 5-year curriculum including a summer orientation, a longitudinal seminar series with community engagement and leadership-development activities, preclerkship clinical immersion in an underserved setting, a master's degree, and a capstone rotation in the final year of medical school. This is a mixed-methods evaluation of the first 4 years of the PRIME-US at the UC Berkeley-UC San Francisco Joint Medical Program (JMP). From 2006 to 2010, focus groups were conducted each year with classes of JMP PRIME-US students, for a total of 11 focus groups; major themes were identified using content analysis. In addition, 4 yearly anonymous, online surveys of all JMP students, faculty and staff were conducted and analyzed. Most PRIME-US students came from socioeconomically disadvantaged backgrounds and ethnic backgrounds underrepresented in medicine, and all were committed to caring for underserved populations. The PRIME-US students experienced many program benefits including peer support, professional role models and mentorship, and curricular enrichment activities that developed their knowledge, skills, and sustained commitment to care for underserved populations. Non-PRIME students, faculty, and staff also benefited from participating in PRIME-sponsored seminars and community-based activities

  13. Precommitting to Serve the Underserved

    Science.gov (United States)

    Eyal, Nir; Bärnighausen, Till

    2014-01-01

    In many countries worldwide, especially in Sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas. PMID:22548519

  14. Precommitting to serve the underserved.

    Science.gov (United States)

    Eyal, Nir; Bärnighausen, Till

    2012-01-01

    In many countries worldwide, especially in sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas.

  15. Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients.

    Science.gov (United States)

    Seo, Joann; Goodman, Melody S; Politi, Mary; Blanchard, Melvin; Kaphingst, Kimberly A

    2016-05-01

    Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population. We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician directed or patient involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association. Adequate health literacy (odds ratio [OR] = 1.7;P= 0.009) was significantly associated with preferring patient-involved decision making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision making (OR = 0.65;P= 0.024). Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy. © The Author(s) 2016.

  16. Recruiting Underserved Mothers to Medical Research: Findings from North Carolina

    Science.gov (United States)

    Spears, Chaya R.; Sandberg, Joanne C.; O’Neill, Jenna L.; Grzywacz, Joseph G.; Howard, Timothy D.; Feldman, Steven R.; Arcury, Thomas A.

    2014-01-01

    Representative samples are required for ethical, valid, and useful health research. Yet, recruiting participants, especially from historically underserved communities, can be challenging. This paper presents findings from in-depth interviews with 40 mothers about factors that might influence their willingness to participate or allow their children to participate in medical research. Saliency analysis organizes the findings. Frequent and important salient themes about research participation included concerns that it might cause participants harm, hope that participants might gain a health benefit, and recognition that time and transportation resources could limit participation. Ultimately, we propose that a theoretical model, such as the Theory of Planned Behavior (TPB), will facilitate more systematic evaluation of effective methods for recruitment and retention of participants in medical research. Future research should explore the utility of such a model for development of effective recruitment and retention strategies. PMID:24185171

  17. Factors Associated With Medical School Graduates' Intention to Work With Underserved Populations: Policy Implications for Advancing Workforce Diversity.

    Science.gov (United States)

    Garcia, Andrea N; Kuo, Tony; Arangua, Lisa; Pérez-Stable, Eliseo J

    2018-01-01

    Given projected U.S. physician shortages across all specialties that will likely impact underserved areas disproportionately, the authors sought to explore factors most correlated with medical school graduates' intention to work with underserved populations (IWUP). Data from the 2010-2012 Association of American Medical Colleges Medical School Graduation Questionnaire (n = 40,846) were analyzed. Variables (demographics, career preference, debt burden, intention to enter loan forgiveness programs) were examined using chi-square tests and logistic regression models. Respondents included 49.5% (20,228/40,846) women, 16.6% (6,771/40,837) underrepresented minorities (URMs), and 32.4% (13,034/37,342) with primary care intent. The median educational debt was $160,000. Respondents who were women (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.49, 1.70), URMs (aOR 2.50, 95% CI 2.30, 2.72), intended to enter loan forgiveness programs (aOR 2.44, 95% CI 2.26, 2.63), intended to practice primary care (aOR 1.65, 95% CI 1.54, 1.76), and intended to emphasize nonclinical careers (aOR 1.23, 95% CI 1.11, 1.37) had greater odds of reporting IWUP. Among those who chose specialties and careers with a nonclinical emphasis, and among those with greater burdens of educational and consumer debt, URMs were nearly twice as likely as other minorities and whites to report IWUP. Findings suggest physician characteristics that may be associated with filling workforce gaps in underserved areas. Restructuring financial incentive programs to support physician leaders and specialists with characteristics associated with IWUP may complement similar policies in primary care and could have key impacts on health equity in underserved areas.

  18. Cancer screening promotion among medically underserved Asian American women: integration of research and practice.

    Science.gov (United States)

    Yu, Mei-yu; Seetoo, Amy D; Hong, Oi Saeng; Song, Lixin; Raizade, Rekha; Weller, Adelwisa L Agas

    2002-01-01

    Mammography and Pap smear tests are known to be effective early detection measures for breast and cervical cancers, respectively, but Asian Americans are reluctant to make visits for routine preventive care. Quantitative and qualitative research conducted by the Healthy Asian Americans Project (HAAP) between 1996 and 1999 indicated that Asian residents in southeastern Michigan, like the general Asian population in the US, underutilized early cancer screening programs due to cultural, psychosocial, linguistic, and economic barriers. This article reports how the HAAP's research findings guided the Michigan Breast and Cervical Cancer Control Program (BCCCP) promotion (conducted from 2000 to 2001 among medically underserved Asian women residing in southeastern Michigan), and how evaluation of the HAAP's BCCCP promotion will direct future research and health promotion programs. The article presents strategies used to improve access to cancer screening programs for diverse Asian sub-groups as well as outcomes of the 2-year HAAP's BCCCP promotion among the target population. Discussion regarding lessons and experiences gained from integration of research and practice has implications on design and implementation of the cancer screening promotion for the rapidly increasing Asian American population as well as other medically underserved minority populations in the US.

  19. Evaluation of a student-run smoking cessation clinic for a medically underserved population

    Directory of Open Access Journals (Sweden)

    Ebbert Jon O

    2011-03-01

    Full Text Available Abstract Background Smoking is common among medically underserved populations. Accessible resources to encourage and support smoking cessation among these patients are limited. Volunteer medical student-run free smoking cessation clinics may provide an effective option to help these individuals achieve smoking abstinence. In order to demonstrate the feasibility and cost-effectiveness of a student-run clinic, we analyzed a case series of patients receiving care in a medical student-run Smoking Cessation Clinic (SCC at the Rochester, Minnesota Salvation Army Good Samaritan Health Clinic (GSHC. Findings Between January 2005 and March 2009, 282 cigarette smokers seeking care at the SCC were analyzed. Student providers at the SCC conducted 1652 weekly individual counseling sessions averaging 18 minutes per encounter. Patients were offered a choice of pharmacotherapies including nicotine replacement therapy (NRT, bupropion, and varenicline for up to 12 weeks. Smoking abstinence was confirmed with exhaled carbon monoxide (CO. Thirty-two patients completed the entire 12-week program (11.3%. At last contact, 94 patients (33.3% abstained from smoking for ≥ 7 days and 39 patients (13.8% were continuously abstinent for ≥ 4 weeks. The 7-day point prevalence abstinence rates at last contact were 58.6% for varenicline, 41.2% for bupropion, 33.9% for NRT, and 23.5% for bupropion and NRT. Analyzing missing patients as smoking, the 7-day point prevalence abstinence rates were 7.1%, 8.9%, and 8.2%, at 1 month, 2 months, and 3 months after program enrollment, respectively. No serious adverse drug reactions were recorded. Conclusions Our medical student-run smoking cessation clinic provided an effective and safe experience for medically underserved patients who might not otherwise have access to conventional smoking cessation programs because of high cost, lack of insurance, or other disparities. Similar medical student initiatives focusing on healthy lifestyles

  20. Educational and individual factors associated with positive change in and reaffirmation of medical students' intention to practice in underserved areas.

    Science.gov (United States)

    Boscardin, Christy K; Grbic, Douglas; Grumbach, Kevin; O'Sullivan, Patricia

    2014-11-01

    The projected U.S. physician shortage will disproportionately affect underserved areas. This study examined the impact of medical school educational experiences on positive changes in and reaffirmation of students' intention to practice in underserved areas (practice intention). Medical students (n = 7,361) from 113 U.S. MD-granting medical schools who graduated in 2009-2010 and responded to both the Association of American Medical Colleges' 2006 Matriculating Student Questionnaire and 2010 Graduation Questionnaire were included. Multilevel logistic regression analyses were conducted to determine factors associated with change in and reaffirmation of practice intention. After controlling for individual characteristics, community health field experience (adjusted odds ratio [OR]: 1.36; 95% CI: 1.18, 1.57), learning another language (OR: 1.41; 95% CI: 1.22, 1.63), cultural competence/awareness experience (OR: 1.38; 95% CI: 1.21, 1.58), becoming more aware of perspectives of individuals from different backgrounds (OR: 1.24; 95% CI: 1.04, 1.48), and attending schools with higher social mission scores (OR: 1.66; 95% CI: 1.28, 2.16) were all significantly associated with positive changes in practice intention from matriculation to graduation. Field experience in community health (OR: 1.24; 95% CI: 0.99, 1.53), learning another language (OR: 1.29; 95% CI: 1.01, 1.65), and attending schools with higher social mission scores (OR: 1.62; 95% CI: 1.09, 2.43) were all significantly associated with reaffirmation of practice intention at graduation. Multifaceted factors are associated with practice intention. This study suggests medical schools can play active roles in alleviating the physician shortage in underserved areas through targeted curricular interventions and recruitment.

  1. Diet and Exercise Adherence and Practices among Medically Underserved Patients with Chronic Disease: Variation across Four Ethnic Groups

    Science.gov (United States)

    Orzech, Kathryn M.; Vivian, James; Huebner Torres, Cristina; Armin, Julie; Shaw, Susan J.

    2013-01-01

    Many factors interact to create barriers to dietary and exercise plan adherence among medically underserved patients with chronic disease, but aspects related to culture and ethnicity are underexamined in the literature. Using both qualitative ("n" = 71) and quantitative ("n" = 297) data collected in a 4-year, multimethod study…

  2. Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?

    Science.gov (United States)

    Laraque-Arena, Danielle; Frintner, Mary Pat; Cull, William L

    2016-01-01

    To examine whether resident characteristics and experiences are related to practice in underserved areas. Cross-sectional survey of a national random sample of pediatric residents (n = 1000) and additional sample of minority residents (n = 223) who were graduating in 2009 was conducted. Using weighted logistic regression, we examined relationships between resident characteristics (background, values, residency experiences, and practice goals) and reported 1) expectation to practice in underserved area and 2) postresidency position in underserved area. Response rate was 57%. Forty-one percent of the residents reported that they had an expectation of practicing in an underserved area. Of those who had already accepted postresidency positions, 38% reported positions in underserved areas. Service obligation in exchange for loans/scholarships and primary care/academic pediatrics practice goals were the strongest predictors of expectation of practicing in underserved areas (respectively, adjusted odds ratio 4.74, 95% confidence interval 1.87-12.01; adjusted odds ratio 3.48, 95% confidence interval 1.99-6.10). Other significant predictors include hospitalist practice goals, primary care practice goals, importance of racial/ethnic diversity of patient population in residency selection, early plan (before medical school) to care for underserved families, mother with a graduate or medical degree, and higher score on the Universalism value scale. Service obligation and primary care/academic pediatrics practice goal were also the strongest predictors for taking a postresidency job in underserved area. Trainee characteristics such as service obligations, values of humanism, and desire to serve underserved populations offer the hope that policies and public funding can be directed to support physicians with these characteristics to redress the maldistribution of physicians caring for children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All

  3. Impact of a regional distributed medical education program on an underserved community: perceptions of community leaders.

    Science.gov (United States)

    Toomey, Patricia; Lovato, Chris Y; Hanlon, Neil; Poole, Gary; Bates, Joanna

    2013-06-01

    To describe community leaders' perceptions regarding the impact of a fully distributed undergraduate medical education program on a small, medically underserved host community. The authors conducted semistructured interviews in 2007 with 23 community leaders representing, collectively, the education, health, economic, media, and political sectors. They reinterviewed six participants from a pilot study (2005) and recruited new participants using purposeful and snowball sampling. The authors employed analytic induction to organize content thematically, using the sectors as a framework, and they used open coding to identify new themes. The authors reanalyzed transcripts to identify program outcomes (e.g., increased research capacity) and construct a list of quantifiable indicators (e.g., number of grants and publications). Participants reported their perspectives on the current and anticipated impact of the program on education, health services, the economy, media, and politics. Perceptions of impact were overwhelmingly positive (e.g., increased physician recruitment), though some were negative (e.g., strains on health resources). The authors identified new outcomes and confirmed outcomes described in 2005. They identified 16 quantifiable indicators of impact, which they judged to be plausible and measureable. Participants perceive that the regional undergraduate medical education program in their community has broad, local impacts. Findings suggest that early observed outcomes have been maintained and may be expanding. Results may be applicable to medical education programs with distributed or regional sites in similar rural, remote, and/or underserved regions. The areas of impact, outcomes, and quantifiable indicators identified will be of interest to future researchers and evaluators.

  4. Impact of selection strategies on representation of underserved populations and intention to practise: international findings.

    Science.gov (United States)

    Larkins, Sarah; Michielsen, Kristien; Iputo, Jehu; Elsanousi, Salwa; Mammen, Marykutty; Graves, Lisa; Willems, Sara; Cristobal, Fortunato L; Samson, Rex; Ellaway, Rachel; Ross, Simone; Johnston, Karen; Derese, Anselme; Neusy, André-Jacques

    2015-01-01

    Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions. A cross-sectional questionnaire was administered to students starting medical education in five institutions with a social accountability mandate in five different countries. The questionnaire assessed students' background characteristics, rurality of background, and practice intentions (location, discipline of practice and population to be served). The results were compared with the characteristics of students entering medical education in schools with standard selection procedures, and with publicly available socio-economic data. The selection processes of all five schools included strategies that extended beyond the assessment of academic achievement. Four distinct strategies were identified: the quota system; selection based on personal attributes; community involvement, and school marketing strategies. Questionnaire data from 944 students showed that students at the five schools were more likely to be of non-urban origin, of lower socio-economic status and to come from underserved groups. A total of 407 of 810 (50.2%) students indicated an intention to practise in a non-urban area after graduation and the likelihood of this increased with increasing rurality of primary schooling (p = 0.000). Those of rural origin were statistically less likely to express an intention to work abroad (p = 0.003). Selection strategies to ensure that members of underserved communities

  5. Increasing Medical Trainees’ Empathy Through Volunteerism and Mentorship

    Directory of Open Access Journals (Sweden)

    Kathleen Bronson Dussán

    2017-11-01

    Full Text Available Background: Within medical education, there have been recent calls for increased understanding and exposure to poverty to increase trainees’ empathy toward the underserved. Students participating in Michigan Cardiovascular Outcomes Research and Reporting Program research program volunteered at World Medical Relief (WMR in Detroit, Michigan, a nonprofit organization which recycles medical equipment for developing countries and within greater Detroit. Participants’ perceptions of the underserved were measured before and after the experience. Methods: Preliminary questionnaires were given to participants prior to and after exposures at WMR. Questionnaires examined participants’ attitudes toward the underserved, knowledge of medical supply reuse, and their perceived ability to impact change. P values of 4× more likely than previously to have knowledge of the variety of recycled medical supplies at WMR. Prior to volunteering, 48.7% of participants gave little thought to how excess medical supplies could be collected versus 0% after exposure. Participants were 1.5× more likely to agree that the experience was enhanced working with their peers and 2.7× more likely to consider starting their own organization/intervention for medical supply donations. Those participants that never previously volunteered were 1.3× more likely to do so with encouragement from a mentor. Conclusions: Encouraging exposure to such service programs resulted in enhanced knowledge of community resources and increased motivation to participate in outreach and belief of individual responsibility to care for the underserved. Incorporating volunteerism into traditional education programs offers the opportunity to build awareness and interest in students reaching out to the underserved.

  6. Web usability testing with a Hispanic medically underserved population.

    Science.gov (United States)

    Moore, Mary; Bias, Randolph G; Prentice, Katherine; Fletcher, Robin; Vaughn, Terry

    2009-04-01

    Skilled website developers value usability testing to assure user needs are met. When the target audience differs substantially from the developers, it becomes essential to tailor both design and evaluation methods. In this study, researchers carried out a multifaceted usability evaluation of a website (Healthy Texas) designed for Hispanic audiences with lower computer literacy and lower health literacy. METHODS INCLUDED: (1) heuristic evaluation by a usability engineer, (2) remote end-user testing using WebEx software; and (3) face-to-face testing in a community center where use of the website was likely. Researchers found standard usability testing methods needed to be modified to provide interpreters, increased flexibility for time on task, presence of a trusted intermediary such as a librarian, and accommodation for family members who accompanied participants. Participants offered recommendations for website redesign, including simplified language, engaging and relevant graphics, culturally relevant examples, and clear navigation. User-centered design is especially important when website developers are not representative of the target audience. Failure to conduct appropriate usability testing with a representative audience can substantially reduce use and value of the website. This thorough course of usability testing identified improvements that benefit all users but become crucial when trying to reach an underserved audience.

  7. FHFA Underserved Areas

    Data.gov (United States)

    Department of Housing and Urban Development — Federal Housing Finance Agency's (FHFA) Underserved Areas establishes underserved area designations for census tracts in Metropolitan Areas (MSAs), nonmetropolitan...

  8. Collaboration with pharmacy services in a family practice for the medically underserved

    Directory of Open Access Journals (Sweden)

    Campbell K

    2009-12-01

    Full Text Available Objectives: Pharmacist-managed collaborative services in a family practice setting are described, and diabetes and hypertension outcomes are assessed.Methods: Pharmacist-managed clinics, pharmacotherapy consultations, and drug information services are provided for a medically underserved, predominantly African American population. A pharmacy residency director, an ambulatory care pharmacy resident and three PharmD candidate student pharmacists work directly with physicians, nurse practitioners, nurses, and social workers to form an interdisciplinary health care team. Providers utilize pharmacy services through consultations and referrals. Collaboration outcomes were evaluated in twenty-two patients with diabetes and thirty hypertensive patients. Patients were retrospectively followed throughout their history with pharmacy service. Hemoglobin A1c (A1C was tracked before referral to pharmacy services, 3 to 6 months after, and as the most current measure after at least 6 months. Blood pressure (BP was observed before pharmacy involvement, 2 to 4 months later, and then currently for at least 4 months with the service. The mean of the most current markers was calculated, and the percent of patients at their goal marker was compared to national averages.Results: Fifty percent of pharmacy service patients met the American Diabetes Association hemoglobin A1c goal of less than 7% in our evaluation compared to the national mean of 49.8% overall and 44% in African Americans. Thirty percent of patients were at their BP goal while 33.1% of patients without diabetes and 33.2% of patients with diabetes nationally are at goal. Conclusion: The medically underserved patients under the care of pharmacy services achieved a higher percentage at their A1C goal than the national mean. The percentage of patients who achieved their BP goals was comparable to the national average. Increasing utilization of pharmacy services in the family practice setting allows for

  9. Empowering underserved populations through cancer prevention and early detection.

    Science.gov (United States)

    Rivera-Colón, Venessa; Ramos, Roberto; Davis, Jenna L; Escobar, Myriam; Inda, Nikki Ross; Paige, Linda; Palencia, Jeannette; Vives, Maria; Grant, Cathy G; Green, B Lee

    2013-12-01

    It is well documented that cancer is disproportionately distributed in racial/ethnic minority groups and medically underserved communities. In addition, cancer prevention and early detection represent the key defenses to combat cancer. The purpose of this article is to showcase the comprehensive health education and community outreach activities at the H. Lee Moffitt Cancer Center and Research Institute (Moffitt) designed to promote and increase access to and utilization of prevention and early detection services among underserved populations. One of Moffitt's most important conduits for cancer prevention and early detection among underserved populations is through its community education and outreach initiatives, in particular, the Moffitt Program for Outreach Wellness Education and Resources (M-POWER). M-POWER works to empower underserved populations to make positive health choices and increase screening behaviors through strengthening collaboration and partnerships, providing community-based health education/promotion, and increasing access to care. Effective, empowering, and culturally and linguistically competent health education and community outreach, is key to opening the often impenetrable doors of cancer prevention and early detection to this society's most vulnerable populations.

  10. Knowledgeable Neighbors: a mobile clinic model for disease prevention and screening in underserved communities.

    Science.gov (United States)

    Hill, Caterina; Zurakowski, David; Bennet, Jennifer; Walker-White, Rainelle; Osman, Jamie L; Quarles, Aaron; Oriol, Nancy

    2012-03-01

    The Family Van mobile health clinic uses a "Knowledgeable Neighbor" model to deliver cost-effective screening and prevention activities in underserved neighborhoods in Boston, MA. We have described the Knowledgeable Neighbor model and used operational data collected from 2006 to 2009 to evaluate the service. The Family Van successfully reached mainly minority low-income men and women. Of the clients screened, 60% had previously undetected elevated blood pressure, 14% had previously undetected elevated blood glucose, and 38% had previously undetected elevated total cholesterol. This represents an important model for reaching underserved communities to deliver proven cost-effective prevention activities, both to help control health care costs and to reduce health disparities.

  11. Telemed: Ehealth applications applied to underserved areas in Latin America

    International Nuclear Information System (INIS)

    Sachpazidis, Ilias; Ohl, Roland; Binotto, Alecio Pedro Delazari; Torres, Marcio Soares; Messina, Luiz Ary; Sales, Alexandre; Gomes, Ricardo; Sakas, Georgios

    2006-01-01

    Access to medical care is sometimes very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Brazil. Citizens have no access to health care. They have to travel hundreds of kilometres to receive medical care. In this paper, we will propose a medical network based on state-of-the-art medical imaging application that addresses the problems of providing health care from a distance. Additionally, we are going to show preliminarily results of the first year of the system deployment and utilization in undeserved regions in Brazil. The total number of patients submitted to ultrasound examinations, during the 10 months of projects' medical trials, is 321. The exams have begun with the elderly people (hypertension and diabetes cases) with 90% above 50-years-old. Fifty-four percent were male and 46% were female. From those exams, 67 exams (21%) needed a second medical opinion and were transmitted to Santa Casa hospital in Porto Alegre, Brazil, one of the referral medical centres. From those second opinions of Santa Casa, 12 exams had to be repeated since the acquired images were not sufficient to give a correct diagnosis. The Lagoa Tres Cantos medical doctor performed also preventive exams with patients who had not presented any symptoms (70%)

  12. Telemed: Ehealth applications applied to underserved areas in Latin America

    Energy Technology Data Exchange (ETDEWEB)

    Sachpazidis, Ilias [Fraunhofer Institute for Computer Graphics, Fraunhoferstr. 5, D-64283, Darmstadt (Germany)]. E-mail: Ilias.Sachpazidis@igd.fraunhofer.de; Ohl, Roland [MedCom Gesellschaft fuer medizinische Bildverarbeitung mbH, Rundeturmstr. 12, D-64283, Darmstadt (Germany); Binotto, Alecio Pedro Delazari [Centro de Excelencia em Tecnologias Avancadas Av. Assis Brasil, 8450, 91, 140-000 Porto Alegre (Brazil); Torres, Marcio Soares [Centro de Excelencia em Tecnologias Avancadas Av. Assis Brasil, 8450, 91, 140-000 Porto Alegre (Brazil); Messina, Luiz Ary [Messina Informatica e Comercio Ltda., Rua Castelo Branco 330, 29100-040 Praia da Costa, Vila Velha (Brazil); Sales, Alexandre [Fundacao de Apoio ao Hospital Universitario da UFES-Fahucam, Av. Marechal Campos 1355, 29042-715 Santos Dumont, Vitoria (Brazil); Gomes, Ricardo [Complexo Hospitalar Santa Casa de Porto Alegre Rua Prof. Annes Dias 285, Porto Alegre (Brazil); Sakas, Georgios [Fraunhofer Institute for Computer Graphics, Fraunhoferstr. 5, D-64283, Darmstadt (Germany)

    2006-12-20

    Access to medical care is sometimes very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Brazil. Citizens have no access to health care. They have to travel hundreds of kilometres to receive medical care. In this paper, we will propose a medical network based on state-of-the-art medical imaging application that addresses the problems of providing health care from a distance. Additionally, we are going to show preliminarily results of the first year of the system deployment and utilization in undeserved regions in Brazil. The total number of patients submitted to ultrasound examinations, during the 10 months of projects' medical trials, is 321. The exams have begun with the elderly people (hypertension and diabetes cases) with 90% above 50-years-old. Fifty-four percent were male and 46% were female. From those exams, 67 exams (21%) needed a second medical opinion and were transmitted to Santa Casa hospital in Porto Alegre, Brazil, one of the referral medical centres. From those second opinions of Santa Casa, 12 exams had to be repeated since the acquired images were not sufficient to give a correct diagnosis. The Lagoa Tres Cantos medical doctor performed also preventive exams with patients who had not presented any symptoms (70%)

  13. Pop Up/Drill Down: A Traveling Exhibit Designed to Reach Underserved Communities through Art and Geosciences

    Science.gov (United States)

    Kurtz, N.

    2017-12-01

    Scientists observe the world around them in an attempt to understand it. Artists observe the world around them in an attempt to create a reflection or response to the environment. It is critical for the two fields to work together in order to engage and inform the general population. The Consortium for Ocean Leadership, the International Ocean Discovery Program and a series of collaborators are designing a traveling exhibit that will inspire underserved communities in the excitement of exploration, the process of science, and the people and tools required to get there. The project aims to learn more about how to increase access to and awareness of ocean/earth science by bringing a pop-up style museum exhibit to local libraries and public events. As an artist with a science and education background and the graphic designer for this exhibit, this author will highlight the ways this project utilizes art and design to educate underserved populations in ocean and geosciences.

  14. A novel educational strategy targeting health care workers in underserved communities in Central America to integrate HIV into primary medical care.

    Science.gov (United States)

    Flys, Tamara; González, Rosalba; Sued, Omar; Suarez Conejero, Juana; Kestler, Edgar; Sosa, Nestor; McKenzie-White, Jane; Monzón, Irma Irene; Torres, Carmen-Rosa; Page, Kathleen

    2012-01-01

    Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs). We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities. The training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions. Of 258 initially active participants, 225 (225/258=87.2%) successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200=85%) attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (pstructure, and effectiveness in improving their HIV-related knowledge and skills. This innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills acquired through the process, and could continue working within their underserved communities while participating in the online component and then implement interventions that successfully converted theoretical knowledge to action to improve integration of HIV care into primary care.

  15. T@lemed: Ehealth applications applied to underserved areas in Latin America

    Science.gov (United States)

    Sachpazidis, Ilias; Ohl, Roland; Binotto, Alécio Pedro Delazari; Torres, Márcio Soares; Messina, Luiz Ary; Sales, Alexandre; Gomes, Ricardo; Sakas, Georgios

    2006-12-01

    Access to medical care is sometimes very difficult to be reached from people living in rural and underserved areas. This problem is very well known in rural areas in Brazil. Citizens have no access to health care. They have to travel hundreds of kilometres to receive medical care. In this paper, we will propose a medical network based on state-of-the-art medical imaging application that addresses the problems of providing health care from a distance. Additionally, we are going to show preliminarily results of the first year of the system deployment and utilization in undeserved regions in Brazil. The total number of patients submitted to ultrasound examinations, during the 10 months of projects' medical trials, is 321. The exams have begun with the elderly people (hypertension and diabetes cases) with 90% above 50-years-old. Fifty-four percent were male and 46% were female. From those exams, 67 exams (21%) needed a second medical opinion and were transmitted to Santa Casa hospital in Porto Alegre, Brazil, one of the referral medical centres. From those second opinions of Santa Casa, 12 exams had to be repeated since the acquired images were not sufficient to give a correct diagnosis. The Lagoa Tres Cantos medical doctor performed also preventive exams with patients who had not presented any symptoms (70%).

  16. Do health information technology self-management interventions improve glycemic control in medically underserved adults with diabetes? A systematic review and meta-analysis.

    Science.gov (United States)

    Heitkemper, Elizabeth M; Mamykina, Lena; Travers, Jasmine; Smaldone, Arlene

    2017-09-01

    The purpose of this systematic review and meta-analysis was to examine the effect of health information technology (HIT) diabetes self-management education (DSME) interventions on glycemic control in medically underserved patients. Following an a priori protocol, 5 databases were searched. Studies were appraised for quality using the Cochrane Risk of Bias assessment. Studies reporting either hemoglobin A1c pre- and post-intervention or its change at 6 or 12 months were eligible for inclusion in the meta-analysis using random effects models. Thirteen studies met the criteria for the systematic review and 10 for the meta-analysis and represent data from 3257 adults with diabetes (mean age 55 years; 66% female; 74% racial/ethnic minorities). Most studies ( n  = 10) reflected an unclear risk of bias. Interventions varied by HIT type: computer software without Internet ( n  = 2), cellular/automated telephone ( n  = 4), Internet-based ( n  = 4), and telemedicine/telehealth ( n  = 3). Pooled A1c decreases were found at 6 months (-0.36 (95% CI, -0.53 and -0.19]; I 2  = 35.1%, Q  = 5.0), with diminishing effect at 12 months (-0.27 [95% CI, -0.49 and -0.04]; I 2  = 42.4%, Q  = 10.4). Findings suggest that medically underserved patients with diabetes achieve glycemic benefit following HIT DSME interventions, with dissipating but significant effects at 12 months. Telemedicine/telehealth interventions were the most successful HIT type because they incorporated interaction with educators similar to in-person DSME. These results are similar to in-person DSME in medically underserved patients, showing that well-designed HIT DSME has the potential to increase access and improve outcomes for this vulnerable group. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  17. Giving Voice to the Medically Under-Served: A Qualitative Co-Production Approach to Explore Patient Medicine Experiences and Improve Services to Marginalized Communities.

    Science.gov (United States)

    Latif, Asam; Tariq, Sana; Abbasi, Nasa; Mandane, Baguiasri

    2018-01-27

    With an aging population, the appropriate, effective and safe use of medicines is a global health priority. However, "'medically under-served" patients continue to experience significant inequalities around access to healthcare services. This study forms part of a wider project to co-develop and evaluate a digital educational intervention for community pharmacy. The aim of this paper is to explore the medicine needs of patients from marginalized communities and suggest practical way on how services could be better tailored to their requirements. Following ethical approval, qualitative data was gathered from: (1) workshops with patients and professionals ( n = 57 attendees); and (2) qualitative semi-structured interviews (10 patients and 10 pharmacists). Our findings revealed that patients from marginalized communities reported poor management of their medical conditions and significant problems with adherence to prescribed medicines. Their experience of pharmacy services was found to be variable with many experiencing discrimination or disadvantage as a result of their status. This study highlights the plight of medically under-served communities and the need for policy makers to tailor services to an individual's needs and circumstances. Furthermore, patients and professionals can work in collaboration using a co-production approach to develop educational interventions for pharmacy service improvements.

  18. Relationships Between Health Literacy and Genomics-Related Knowledge, Self-Efficacy, Perceived Importance, and Communication in a Medically Underserved Population.

    Science.gov (United States)

    Kaphingst, Kimberly A; Blanchard, Melvin; Milam, Laurel; Pokharel, Manusheela; Elrick, Ashley; Goodman, Melody S

    2016-01-01

    The increasing importance of genomic information in clinical care heightens the need to examine how individuals understand, value, and communicate about this information. Based on a conceptual framework of genomics-related health literacy, we examined whether health literacy was related to knowledge, self-efficacy, and perceived importance of genetics and family health history (FHH) and communication about FHH in a medically underserved population. The analytic sample was composed of 624 patients at a primary care clinic in a large urban hospital. About half of the participants (47%) had limited health literacy; 55% had no education beyond high school, and 58% were Black. In multivariable models, limited health literacy was associated with lower genetic knowledge (β = -0.55, SE = 0.10, p interval [CI; 0.28, 0.90], p = .020), and greater perceived importance of genetic information (OR = 1.95, 95% CI [1.27, 3.00], p = .0022) but lower perceived importance of FHH information (OR = 0.47, 95% CI [0.26, 0.86], p = .013) and more frequent communication with a doctor about FHH (OR = 2.02, 95% CI [1.27, 3.23], p = .0032). The findings highlight the importance of considering domains of genomics-related health literacy (e.g., knowledge, oral literacy) in developing educational strategies for genomic information. Health literacy research is essential to avoid increasing disparities in information and health outcomes as genomic information reaches more patients.

  19. A novel educational strategy targeting health care workers in underserved communities in Central America to integrate HIV into primary medical care.

    Directory of Open Access Journals (Sweden)

    Tamara Flys

    Full Text Available BACKGROUND: Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs. We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities. METHODS: The training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions. RESULTS: Of 258 initially active participants, 225 (225/258=87.2% successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200=85% attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (p<0.001. The mean pre- and post-test scores evaluating clinical knowledge were 70.9% and 90.3%, respectively, with an increase in knowledge of 19.4% (p<0.001. A survey of Likert scale and open-ended questions demonstrated overwhelming participant satisfaction with course content, structure, and effectiveness in improving their HIV-related knowledge and skills. CONCLUSION: This innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills

  20. Personal values of family physicians, practice satisfaction, and service to the underserved.

    Science.gov (United States)

    Eliason, B C; Guse, C; Gottlieb, M S

    2000-03-01

    Personal values are defined as "desirable goals varying in importance that serve as guiding principles in people's lives," and have been shown to influence specialty choice and relate to practice satisfaction. We wished to examine further the relationship of personal values to practice satisfaction and also to a physician's willingness to care for the underserved. We also wished to study associations that might exist among personal values, practice satisfaction, and a variety of practice characteristics. We randomly surveyed a stratified probability sample of 1224 practicing family physicians about their personal values (using the Schwartz values questionnaire), practice satisfaction, practice location, breadth of practice, demographics, board certification status, teaching involvement, and the payor mix of the practice. Family physicians rated the benevolence (motivation to help those close to you) value type highest, and the ratings of the benevolence value type were positively associated with practice satisfaction (correlation coefficient = 0.14, P = .002). Those involved in teaching medical trainees were more satisfied than those who were not involved (P = .009). Some value-type ratings were found to be positively associated with caring for the underserved. Those whose practices consisted of more than 40% underserved (underserved defined as Medicare, Medicaid, and indigent populations) rated the tradition (motivation to maintain customs of traditional culture and religion) value type significantly higher (P = .02). Those whose practices consisted of more than 30% indigent care rated the universalism (motivation to enhance and protect the well-being of all people) value type significantly higher (P = .03). Family physicians who viewed benevolence as a guiding principle in their lives reported a higher level of professional satisfaction. Likewise, physicians involved in the teaching of medical trainees were more satisfied with their profession. Family physicians

  1. The Effect of Volunteering at a Student-Run Free Healthcare Clinic on Medical Students' Self-Efficacy, Comfortableness, Attitude, and Interest in Working with the Underserved Population and Interest in Primary Care.

    Science.gov (United States)

    Tran, Kelvin; Kovalskiy, Aleksandr; Desai, Anand; Imran, Amna; Ismail, Rahim; Hernandez, Caridad

    2017-02-23

    The number of primary care physicians in the United States continues to lag behind the number of uninsured people. There has been a growing demand for medical students to improve their self-efficacy, comfortableness, attitude, and interest in working with the underserved and in primary care. This study aims to discern whether volunteering at a student-run, free healthcare clinic has a positive impact on these five variables of interest or not. A 95-item survey was distributed through Qualtrics Survey Software (Qualtrics, Provo, UT, USA) to medical students from the Class of 2018 and Class of 2019 at the University of Central Florida College of Medicine. They were recruited via emails, Facebook, and in-classroom announcements. Mean responses on a Likert-like scale to different survey items were collected and compared between two study cohorts: Keeping Neighbors In Good Health Through Service (KNIGHTS) Clinic volunteers and non-volunteers. Results from 128 students showed no significant differences in the means between the two cohorts (p-values were not significant). When volunteers were asked the survey item, "KNIGHTS Clinic positively influenced my attitude towards working with underserved patients," 62% strongly agreed, 26% agreed, 10% were neutral, and 2% disagreed. Based on the results, volunteering at KNIGHTS Clinic may not have a positive impact on the five variables of interest. However, the lack of significance may also be due to certain limitations of this study addressed elsewhere in this paper. With the majority of KNIGHTS Clinic volunteers agreeing that "KNIGHTS Clinic positively influenced […their] attitude towards working with underserved patients," there may be a positive impact of volunteering on volunteers' attitude towards working with the underserved.

  2. "We can see a future here": Place attachment, professional identity, and forms of capital mobilized to deliver medical education in an underserviced area.

    Science.gov (United States)

    Hanlon, Neil; Halseth, Greg; Snadden, David

    2010-09-01

    Community-integrated undergraduate medical education is becoming a more common option for students predisposed to practice in rural and small town places. One such initiative, the Northern Medical Program, has been operating since 2004 in the northern interior of British Columbia, Canada. The NMP's curriculum relies heavily on the involvement of practicing physicians in its host community, Prince George. Drawing on Bourdieu's conceptualization of capital in its different forms, the commitment of the local physician community is understood as social capital derived from cultural capital centred on a collective sense of professional identity forged by conditions of practice in an underserviced area. The findings of this study are discussed with respect to the long-term operation and success of community-integrated medical education programs. Copyright 2010 Elsevier Ltd. All rights reserved.

  3. Implementing academic detailing for breast cancer screening in underserved communities

    Directory of Open Access Journals (Sweden)

    Ashford Alfred R

    2007-12-01

    Full Text Available Abstract Background African American and Hispanic women, such as those living in the northern Manhattan and the South Bronx neighborhoods of New York City, are generally underserved with regard to breast cancer prevention and screening practices, even though they are more likely to die of breast cancer than are other women. Primary care physicians (PCPs are critical for the recommendation of breast cancer screening to their patients. Academic detailing is a promising strategy for improving PCP performance in recommending breast cancer screening, yet little is known about the effects of academic detailing on breast cancer screening among physicians who practice in medically underserved areas. We assessed the effectiveness of an enhanced, multi-component academic detailing intervention in increasing recommendations for breast cancer screening within a sample of community-based urban physicians. Methods Two medically underserved communities were matched and randomized to intervention and control arms. Ninety-four primary care community (i.e., not hospital based physicians in northern Manhattan were compared to 74 physicians in the South Bronx neighborhoods of the New York City metropolitan area. Intervention participants received enhanced physician-directed academic detailing, using the American Cancer Society guidelines for the early detection of breast cancer. Control group physicians received no intervention. We conducted interviews to measure primary care physicians' self-reported recommendation of mammography and Clinical Breast Examination (CBE, and whether PCPs taught women how to perform breast self examination (BSE. Results Using multivariate analyses, we found a statistically significant intervention effect on the recommendation of CBE to women patients age 40 and over; mammography and breast self examination reports increased across both arms from baseline to follow-up, according to physician self-report. At post-test, physician

  4. Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve.

    Science.gov (United States)

    Odom Walker, Kara; Ryan, Gery; Ramey, Robin; Nunez, Felix L; Beltran, Robert; Splawn, Robert G; Brown, Arleen F

    2010-11-01

    We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work-life balance.

  5. 5 CFR 894.801 - Will benefits be available in underserved areas?

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Will benefits be available in underserved... Underserved Areas § 894.801 Will benefits be available in underserved areas? (a) Dental and vision plans under FEDVIP will include underserved areas in their service areas and provide benefits to enrollees in...

  6. A psychosocial approach to dentistry for the underserved: incorporating theory into practice.

    Science.gov (United States)

    Flaer, Paul J; Younis, Mustafa Z; Benjamin, Paul L; Al Hajeri, Maha

    2010-01-01

    Dentistry for the underserved is more than an egalitarian social issue--it is a key factor in the health and social progress of our nation. The first signs or manifestations of several diseases such as varicella (i.e., chicken pox and shingles), STDs, and influenza become apparent in the oral cavity. The value of access to quality dentistry is an immeasurable factor in maintaining general medical health of people and fulfilling their psychosocial needs of pain reduction and enhanced cosmetics. In the United States, for the most part, only the middle and upper classes receive non-extraction, restorative, and prosthetic dentistry that is economically within their ability to pay. In addition, uninsured and poverty-level individuals often must face overwhelming long waiting lists, unnecessary referrals, lack of choice, and bureaucratic hurdles when seeking primary dental care. Therefore, it seems pertinent to put forth the question: What are the critical values and beliefs of psychosocial theory that can underscore the practice of dentistry for underserved populations in the United States? The widely employed public health theory, the health belief model (HBM), is applied to evaluate psychosocial factors in dental care for the underserved. The HBM is used to predict and explain behavioral changes in dental health and associated belief patterns. The HBM as applied to dentistry for the underserved predicts self-perceptions of susceptibility and seriousness of dental disease, health status, cues to action, and self-efficacy. Furthermore, patients can make judgments about benefits, costs, and risks of dental treatment. A theoretical approach to dentistry employing the HBM, mediated by values and culture, can provide significant insights into patient thinking, beliefs, and perceptions. These insights can mediate access to and use of primary care dental services by underserved populations. Evidence-based practice (i.e., based on research using the scientific method) has been

  7. Disseminating relevant health information to underserved audiences: implications of the Digital Divide Pilot Projects.

    Science.gov (United States)

    Kreps, Gary L

    2005-10-01

    This paper examines the influence of the digital divide on disparities in health outcomes for vulnerable populations, identifying implications for medical and public libraries. The paper describes the results of the Digital Divide Pilot Projects demonstration research programs funded by the National Cancer Institute to test new strategies for disseminating relevant health information to underserved and at-risk audiences. The Digital Divide Pilot Projects field-tested innovative systemic strategies for helping underserved populations access and utilize relevant health information to make informed health-related decisions about seeking appropriate health care and support, resisting avoidable and significant health risks, and promoting their own health. The paper builds on the Digital Divide Pilot Projects by identifying implications for developing health communication strategies that libraries can adopt to provide digital health information to vulnerable populations.

  8. Impact of Patient Empathy Modeling on Pharmacy Students Caring for the Underserved

    Science.gov (United States)

    Chen, Judy T.; LaLopa, Joseph

    2008-01-01

    Objective To determine the impact of the Patient Empathy Modeling pedagogy on students' empathy towards caring for the underserved during an advanced pharmacy practice experience (APPE). Design Pharmacy students completing an APPE at 2 primary care clinics participated in a Patient Empathy Modeling assignment for 10 days. Each student “became the patient,” simulating the life of an actual patient with multiple chronic diseases who was coping with an economic, cultural, or communication barrier to optimal healthcare. Students completed the Jefferson Scale of Physician Empathy (JSPE) before and after completing the assignment, and wrote daily journal entries and a reflection paper. Assessment Twenty-six students completed the PEM exercises from 2005-2006. Scores on the JSPE improved. Students' comments in journals and reflection papers revealed 3 major themes: greater appreciation of the difficulty patients have with adherence to medication and treatment regimens, increased empathy for patients from different backgrounds and patients with medical and psychosocial challenges, and improved ability to apply the lessons learned in the course to their patient care roles. Conclusion A Patient Empathy Modeling assignment improved pharmacy students' empathy toward underserved populations. Integrating the assignment within an APPE allowed students to immediately begin applying the knowledge and insight gained from the exercise. PMID:18483606

  9. Re-Presenting Slavery: Underserved Questions in Museum Collections

    Science.gov (United States)

    Levenson, Cyra

    2014-01-01

    This article looks at the notion of what, not who, is underserved in museum education. The importance of looking through, in, and from objects in order to uncover underserved questions and themes is vital. A willingness to consider new ways to approach collections and display is necessary to have a dialogue with our audiences about how museums can…

  10. Evaluation of community provision of a preventive cardiovascular programme - the National Health Service Health Check in reaching the under-served groups by primary care in England: cross sectional observational study.

    Science.gov (United States)

    Woringer, Maria; Cecil, Elizabeth; Watt, Hillary; Chang, Kiara; Hamid, Fozia; Khunti, Kamlesh; Dubois, Elizabeth; Evason, Julie; Majeed, Azeem; Soljak, Michael

    2017-06-14

    Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England's National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups. Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs). We assessed variation between local authorities in terms of age, sex, deprivation and ethnicity structures using two sample t-tests and within local authority variation in terms of ethnicity and deprivation using Chi squared tests and two sample t-tests respectively. Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p successful in recruiting ethnic minority groups. The mean proportion of men screened was 11.39% lower (p successful in motivating the under-served groups to improve lifestyle, it may reduce health inequalities therein.

  11. Reaching those most in need: a review of diabetes self-management interventions in disadvantaged populations.

    Science.gov (United States)

    Eakin, Elizabeth G; Bull, Sheana S; Glasgow, Russell E; Mason, Mondi

    2002-01-01

    There has been increased recognition of the importance of developing diabetes self-management education (DSME) interventions that are effective with under-served and minority populations. Despite several recent studies in this area, there is to our knowledge no systematic review or synthesis of what has been learned from this research. An electronic literature search identified five formative evaluations and ten controlled DSME intervention trials focused on under-served (low-income, minority or aged) populations. The RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) evaluation framework was used to evaluate the controlled studies on the dimensions of reach, efficacy, adoption, implementation, and maintenance. Fifty percent of the studies identified reported on the percentage of patients who participated, and the percentages were highly variable. The methodological quality of the articles was generally good and the short-term results were encouraging, especially on behavioral outcomes. Data on adoption (representativeness of settings and clinicians who participate) and implementation were almost never reported. Studies of modalities in addition to group meetings are needed to increase the reach of DSME with under-served populations. The promising formative evaluation work that has been conducted needs to be extended for more systematic study of the process of intervention implementation and adaptation with special populations. Studies that explicitly address the community context and that address multiple issues related to public health impact of DSME interventions are recommended to enhance long-term results. Copyright 2002 John Wiley & Sons, Ltd.

  12. Disseminating relevant health information to underserved audiences: implications of the Digital Divide Pilot Projects*

    Science.gov (United States)

    Kreps, Gary L.

    2005-01-01

    Objective: This paper examines the influence of the digital divide on disparities in health outcomes for vulnerable populations, identifying implications for medical and public libraries. Method: The paper describes the results of the Digital Divide Pilot Projects demonstration research programs funded by the National Cancer Institute to test new strategies for disseminating relevant health information to underserved and at-risk audiences. Results: The Digital Divide Pilot Projects field-tested innovative systemic strategies for helping underserved populations access and utilize relevant health information to make informed health-related decisions about seeking appropriate health care and support, resisting avoidable and significant health risks, and promoting their own health. Implications: The paper builds on the Digital Divide Pilot Projects by identifying implications for developing health communication strategies that libraries can adopt to provide digital health information to vulnerable populations. PMID:16239960

  13. Navigating the digital divide: A systematic review of eHealth literacy in underserved populations in the United States.

    Science.gov (United States)

    Chesser, Amy; Burke, Anne; Reyes, Jared; Rohrberg, Tessa

    2016-01-01

    eHealth provides an important mechanism to connect medically underserved populations with health information, but little is known about gaps in eHealth literacy research in underserved adult populations within the U.S. Between June and July 2013, three systematic literature reviews of five databases were conducted and a subsequent hand search was completed. Identified literature was screened and studies meeting exclusion and inclusion criteria were synthesized and analyzed for common themes. Of the 221 articles critically appraised, 15 met these criteria. Thirty-five of these studies were excluded due to international origin. Of the articles meeting the inclusion criteria, underserved populations assessed included immigrant women, the elderly, low-income, the un- and underemployed, and African-American and Hispanic populations. eHealth literacy assessments utilized included one or two item screeners, the eHEALS scale, health information competence and cognitive task analysis. Factors examined in relation to eHealth literacy included age, experience, overall health literacy, education, income and culture. The majority did not assess the impact of locality and those that did were predominately urban. These data suggest that there is a gap in the literature regarding eHealth literacy knowledge for underserved populations, and specifically those in rural locations, within the U.S.

  14. Text4baby program: an opportunity to reach underserved pregnant and postpartum women?

    Science.gov (United States)

    Gazmararian, Julie A; Elon, Lisa; Yang, Baiyu; Graham, Megan; Parker, Ruth

    2014-01-01

    Text4baby was launched in 2010 to promote healthy pregnancies and babies by the use of text messaging. The primary objective of this study was to assess factors related to the enrollment process and reception of text4baby. A prospective cohort study was conducted in two Women, Infant and Children clinics in Atlanta (April 2010-July 2011). Randomly selected pregnant and postpartum women (n = 468) were queried on cell phone use and instructed on text4baby enrollment. Self-enrollment issues were assessed at one-week follow-up (n = 351, 75.0 %), and message reception and reading patterns at two-month follow-up (n = 209, 44.7 %). Forty-two percent of the women had some college education and 82 % had household income education (80 % with some college vs. 62 % with less education), with household income above $10,000 (61 %  $20,000), and among women living in smaller households (77 % 1-3 members vs. 58 % > 3 members) (all p 90 % reported uninterrupted reception and regular reading of messages, and 88 % planned to continue using text4baby. Results also suggested that respondents who were younger (educated and had lower health literacy skills were more likely to have interrupted messages. Despite substantial interest in the text4baby program in an underserved population, innovative ways to help women with significant disadvantages enroll and receive uninterrupted messages are needed.

  15. Against Cursory Treatments in Ethics of Medical Migration from Underserved Countries.

    Science.gov (United States)

    Yuksekdag, Yusuf

    2017-06-01

    In a recent paper, Mpofu, Sen Gupta, and Hays (2016) attempt to outline the obligations of recruiting high-income countries (HICs) and would-be emigrant health workers (HWs) to tackle the effects of mass exodus of health workers from underserved regions. They reconstruct (i) Rawlsian and Kantian global justice approaches to argue for moral obligations of HICs and (ii) an individual justice approach to point to non-enforceable social responsibilities of HWs to assist their compatriots. This critical commentary demonstrates that the argumentation within their individual justice approach is problematic on the basis of three reasons: (1) their discussion under-theorizes and undervalues individual rights and more specifically the right to exit, (2) their argumentation in the latter part, even if problematically, does rather point to moral obligations in lieu of social responsibilities of HWs, and (3) they overlook many other important freedoms, interests, and values pertinent to the issue of retention.

  16. Sleep duration of underserved minority children in a cross-sectional study

    Science.gov (United States)

    Short sleep duration has been shown to associate with increased risk of obesity. Childhood obesity is more prevalent among underserved minority children. The study measured the sleep duration of underserved minority children living in a large US urban environment using accelerometry and its relation...

  17. Pediatric Obesity Empowerment Model Group Medical Visits (POEM-GMV) as Treatment for Pediatric Obesity in an Underserved Community.

    Science.gov (United States)

    Geller, Jeffrey S; Dube, Eileen T; Cruz, Glavielinys A; Stevens, Jason; Keating Bench, Kara

    2015-10-01

    This is a retrospective cohort study to evaluate a novel group medical visit (GMV) program using an empowerment curriculum as treatment for pediatric obesity in a federally qualified community health center. Biometric and self-reported data were reviewed from 417 overweight or obese children ages 5-18 attending the pediatric obesity empowerment model GMV program (POEM-GMV) at least twice during a 3-year period. Variables were evaluated using paired means t-test. Pearson's correlation test was used to evaluate variables and the BMI z-score. Subanalysis by gender was performed. The average participant was 10.48 ± 2.53 years old and participated for 301 ± 287 days. BMI z-score reduced from 2.99 ± 0.96 to 2.88 ± 0.88 (p pediatric obesity in an underserved community. There were statistically significantly improved outcomes in obesity, especially for boys. Significant improvement was observed in many lifestyle factors associated with obesity. Weight loss most closely correlated with reduced stress levels and sugary beverage consumption. Additional studies are needed to further evaluate the efficacy of POEM-GMV.

  18. Assessing internet access and use in a medically underserved population: implications for providing enhanced health information services.

    Science.gov (United States)

    Zach, Lisl; Dalrymple, Prudence W; Rogers, Michelle L; Williver-Farr, Heather

    2012-03-01

    The relationship between health information seeking, patient engagement and health literacy is not well understood. This is especially true in medically underserved populations, which are often viewed as having limited access to health information. To improve communication between an urban health centre and the community it serves, a team of library and information science researchers undertook an assessment of patients' level and methods of access to and use of the Internet. Data were collected in 53 face-to-face anonymous interviews with patients at the centre. Interviews were tape-recorded for referential accuracy, and data were analysed to identify patterns of access and use. Seventy-two percentage of study participants reported having access to the Internet through either computers or cell phones. Barriers to Internet access were predominantly lack of equipment or training rather than lack of interest. Only 21% of those with Internet access reported using the Internet to look for health information. The findings suggest that lack of access to the Internet in itself is not the primary barrier to seeking health information in this population and that the digital divide exists not at the level of information access but rather at the level of information use. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

  19. Healthcare provider perceptions of the role of interprofessional care in access to and outcomes of primary care in an underserved area.

    Science.gov (United States)

    Wan, Shaowei; Teichman, Peter G; Latif, David; Boyd, Jennifer; Gupta, Rahul

    2018-03-01

    To meet the needs of an aging population who often have multiple chronic conditions, interprofessional care is increasingly adopted by patient-centred medical homes and Accountable Care Organisations to improve patient care coordination and decrease costs in the United States, especially in underserved areas with primary care workforce shortages. In this cross-sectional survey across multiple clinical settings in an underserved area, healthcare providers perceived overall outcomes associated with interprofessional care teams as positive. This included healthcare providers' beliefs that interprofessional care teams improved patient outcomes, increased clinic efficiency, and enhanced care coordination and patient follow-up. Teams with primary care physician available each day were perceived as better able to coordinate care and follow up with patients (p = .031), while teams that included clinical pharmacists were perceived as preventing medication-associated problems (p care model as a useful strategy to improve various outcomes across different clinical settings in the context of a shortage of primary care physicians.

  20. Creating A Sustainable Model of Spine Care in Underserved Communities

    DEFF Research Database (Denmark)

    Haldeman, Scott; Nordin, Margareta; Outerbridge, Geoff

    2015-01-01

    The world lacks sustainable models of care to manage spinal disorders in poor and underserved communities. The purpose of this article is to: (1) review the rationale and importance of developing a sustainable evidence-based model of care at low cost for people with spinal disorders in underserved...... adequate care, World Spine Care (WSC) was established to "improve lives in underserved communities through sustainable, integrated, evidence-based, spinal care." WSC is comprised of volunteers and institutions from 6 continents and several countries, and incorporates a Board of Directors, an executive...... are adapted to and integrated within each community in collaboration with local decision makers, existing health care workers and traditional healers. Cornerstones of WSC's emphasis on long-term sustainability are (1) education of community partners, governments and local health professionals, and (2...

  1. Faculty Promotion and Attrition: The Importance of Coauthor Network Reach at an Academic Medical Center.

    Science.gov (United States)

    Warner, Erica T; Carapinha, René; Weber, Griffin M; Hill, Emorcia V; Reede, Joan Y

    2016-01-01

    Business literature has demonstrated the importance of networking and connections in career advancement. This is a little-studied area in academic medicine. To examine predictors of intra-organizational connections, as measured by network reach (the number of first- and second-degree coauthors), and their association with probability of promotion and attrition. Prospective cohort study between 2008 and 2012. Academic medical center. A total of 5787 Harvard Medical School (HMS) faculty with a rank of assistant professor or full-time instructor as of January 1, 2008. Using negative binomial models, multivariable-adjusted predictors of continuous network reach were assessed according to rank. Poisson regression was used to compute relative risk (RR) and 95 % confidence intervals (CI) for the association between network reach (in four categories) and two outcomes: promotion or attrition. Models were adjusted for demographic, professional and productivity metrics. Network reach was positively associated with number of first-, last- and middle-author publications and h-index. Among assistant professors, men and whites had greater network reach than women and underrepresented minorities (p advancement and retention in academic medicine. They can and should be investigated at other institutions.

  2. Examining the Influence of Cost Concern and Awareness of Low-cost Health Care on Cancer Screening among the Medically Underserved.

    Science.gov (United States)

    Best, Alicia L; Strane, Alcha; Christie, Omari; Bynum, Shalanda; Wiltshire, Jaqueline

    2017-01-01

    African Americans suffer a greater burden of mortality from breast, cervical, and colorectal cancers than other groups in the United States. Early detection through timely screening can improve survival outcomes; however, cost is frequently reported as a barrier to screening. Federally qualified health centers (FQHCs) provide preventive and primary care to underserved populations regardless of ability to pay, positioning them to improve cancer screening rates. The purpose of this study was to examine the influence of concern about health care cost (cost concern) and awareness of low-cost health care (awareness) on cancer screening among 236 African Americans within an FQHC service area using self-report surveys. Multiple logistic regression indicated that awareness was positively associated with cervical and colorectal cancer screening, while cost concern was negatively associated with mammography screening. Results indicate that improving awareness and understanding of low-cost health care could increase cancer screening among underserved African Americans.

  3. Financial incentives for return of service in underserved areas: a systematic review

    Directory of Open Access Journals (Sweden)

    Bärnighausen Till

    2009-05-01

    Full Text Available Abstract Background In many geographic regions, both in developing and in developed countries, the number of health workers is insufficient to achieve population health goals. Financial incentives for return of service are intended to alleviate health worker shortages: A (future health worker enters into a contract to work for a number of years in an underserved area in exchange for a financial pay-off. Methods We carried out systematic literature searches of PubMed, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, and the National Health Services Economic Evaluation Database for studies evaluating outcomes of financial-incentive programs published up to February 2009. To identify articles for review, we combined three search themes (health workers or students, underserved areas, and financial incentives. In the initial search, we identified 10,495 unique articles, 10,302 of which were excluded based on their titles or abstracts. We conducted full-text reviews of the remaining 193 articles and of 26 additional articles identified in reference lists or by colleagues. Forty-three articles were included in the final review. We extracted from these articles information on the financial-incentive programs (name, location, period of operation, objectives, target groups, definition of underserved area, financial incentives and obligation and information on the individual studies (authors, publication dates, types of study outcomes, study design, sample criteria and sample size, data sources, outcome measures and study findings, conclusions, and methodological limitations. We reviewed program results (descriptions of recruitment, retention, and participant satisfaction, program effects (effectiveness in influencing health workers to provide care, to remain, and to be satisfied with work and personal life in underserved areas, and program impacts (effectiveness in influencing health systems and health outcomes

  4. Occupational safety and health education and training for underserved populations.

    Science.gov (United States)

    O'Connor, Tom; Flynn, Michael; Weinstock, Deborah; Zanoni, Joseph

    2014-01-01

    This article presents an analysis of the essential elements of effective occupational safety and health education and training programs targeting underserved communities. While not an exhaustive review of the literature on occupational safety and health training, the paper provides a guide for practitioners and researchers to the key factors they should consider in the design and implementation of training programs for underserved communities. It also addresses issues of evaluation of such programs, with specific emphasis on considerations for programs involving low-literacy and limited-English-speaking workers.

  5. Medical specialists' choice of location: the role of geographical attachment in Norway.

    Science.gov (United States)

    Kristiansen, I S; Førde, O H

    1992-01-01

    The relation between current place of work (area of the country) and factors that might possibly represent doctors geographical attachments was studied in a sample of 322 Norwegian medical specialists. Location of hospital residency, age and geographical origin of spouse were associated with current location. Geographical attachment seems to influence doctors' locational choices from start of medical school until the end of their residency. The probability that a doctor shall locate in peripheral areas may increase from less than 10% to more than 50% if the doctor has the residency training in the periphery. Hence, favoring entrance to medical schools of students from the underserved areas, and location of graduate and postgraduate medical training in the underserved areas, as far as it is feasible while still maintaining medical standards, is suggested by the study.

  6. Factors associated with differential uptake of seasonal influenza immunizations among underserved communities during the 2009-2010 influenza season.

    Science.gov (United States)

    Vlahov, David; Bond, Keosha T; Jones, Kandice C; Ompad, Danielle C

    2012-04-01

    Influenza vaccination coverage remains low and disparities persist. In New York City, a community-based participatory research project (Project VIVA) worked to address this issue in Harlem and the South Bronx by supplementing existing vaccination programs with non-traditional venues (i.e., community-based organizations). We conducted a 10 min survey to assess access to influenza vaccine as well as attitudes and beliefs towards influenza vaccination that could inform intervention development for subsequent seasons. Among 991 participants recruited using street intercept techniques, 63% received seasonal vaccine only, 11% seasonal and H1N1, and 26% neither; 89% reported seeing a health care provider (HCP) during the influenza season. Correlates of immunization among those with provider visits during the influenza season included being US-born, interest in getting the vaccine, concern about self or family getting influenza, an HCP's recommendation and comfort with government. Among those without an HCP visit, factors associated with immunization included being US born, married, interest in getting the vaccine, understanding influenza information, and concern about getting influenza. Factors associated with lack of interest in influenza vaccine included being born outside the US, Black and uncomfortable with government. In medically underserved areas, having access to routine medical care and understanding the medical implications of influenza play an important role in enhancing uptake of seasonal influenza vaccination. Strategies to improve vaccination rates among Blacks and foreign-born residents need to be addressed. The use of non-traditional venues to provide influenza vaccinations in underserved communities has the potential to reduce health disparities.

  7. Leadership Advocacy: Bringing Nursing to the Homeless and Underserved.

    Science.gov (United States)

    Porter-OʼGrady, Tim

    Nurses have historically played a key role in advocacy and service for all members of the community, including those who are traditionally underserved by other providers or the health system. Nurses from a local Atlanta community health system, both clinical and administrative, have continued this tradition by developing an advocacy and service program for the downtown homeless of Atlanta. From its beginnings as a highly informal volunteer program to its current structure as a strongly integrated community health center for the underserved and homeless of Atlanta, local nurses have demonstrated their strong value of service advocacy. Their leadership, insight, discipline, and strategic development have facilitated the growth of a focused, viable health service network for marginalized people of the city of Atlanta.

  8. Effectiveness of interventions for diagnosis and treatment of tuberculosis in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review

    NARCIS (Netherlands)

    Heuvelings, Charlotte C.; de Vries, Sophia G.; Greve, Patrick F.; Visser, Benjamin J.; Bélard, Sabine; Janssen, Saskia; Cremers, Anne L.; Spijker, René; Shaw, Beth; Hill, Ruaraidh A.; Zumla, Alimuddin; Sandgren, Andreas; van der Werf, Marieke J.; Grobusch, Martin P.

    2017-01-01

    Tuberculosis is over-represented in hard-to-reach (underserved) populations in high-income countries of low tuberculosis incidence. The mainstay of tuberculosis care is early detection of active tuberculosis (case finding), contact tracing, and treatment completion. We did a systematic review with a

  9. Examining e-Health literacy and the digital divide in an underserved population in Hawai'i.

    Science.gov (United States)

    Connolly, Kathleen Kihmm; Crosby, Martha E

    2014-02-01

    Seeking health information is one of the leading uses for the Internet and World Wide Web (WWW). Research has found the amount one benefits from e-Health information (health information from electronic sources) is directly related to the level of e-Health literacy. e-Health literacy is defined as "the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem." In order to gain a further understanding of the effects and use of technology, the digital divide, and the relationship between technology utilization and health outcomes, focus group interviews were conducted with participants diagnosed with diabetes and currently residing in a Medically Underserved Area. Overall, 25 volunteers participated in the four focus group meetings. Based on the focus group discussions, a general low e-Health literacy rate was identified. This was demonstrated by the lack of access to the Internet and the skills needed to retrieve health information. Of the 25 participants, 64% reported having Internet access at some level, but, only one reported going on the Internet every day. When the barriers to using the Internet were discussed, many participants expressed a lack of knowledge in how to retrieve information. Results of this study further show that having access to technology is not necessarily associated with usage. This dynamic is evolving into a new form of digital divide, gap in information retrieval and usage, versus gap in access. This is the first known study to examine e-Health literacy in an underserved population in Hawai'i. With the proliferation of information and communication technology and the transformation of information retrieval to be mobile and "on demand", a multi-pronged communication and education strategy is needed to explore how technology can improve e-Health literacy and health outcomes among underserved populations.

  10. Examining e-Health Literacy and the Digital Divide in an Underserved Population in Hawai‘i

    Science.gov (United States)

    Crosby, Martha E

    2014-01-01

    Seeking health information is one of the leading uses for the Internet and World Wide Web (WWW). Research has found the amount one benefits from e-Health information (health information from electronic sources) is directly related to the level of e-Health literacy. e-Health literacy is defined as “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem.” In order to gain a further understanding of the effects and use of technology, the digital divide, and the relationship between technology utilization and health outcomes, focus group interviews were conducted with participants diagnosed with diabetes and currently residing in a Medically Underserved Area. Overall, 25 volunteers participated in the four focus group meetings. Based on the focus group discussions, a general low e-Health literacy rate was identified. This was demonstrated by the lack of access to the Internet and the skills needed to retrieve health information. Of the 25 participants, 64% reported having Internet access at some level, but, only one reported going on the Internet every day. When the barriers to using the Internet were discussed, many participants expressed a lack of knowledge in how to retrieve information. Results of this study further show that having access to technology is not necessarily associated with usage. This dynamic is evolving into a new form of digital divide, gap in information retrieval and usage, versus gap in access. This is the first known study to examine e-Health literacy in an underserved population in Hawai‘i. With the proliferation of information and communication technology and the transformation of information retrieval to be mobile and “on demand”, a multi-pronged communication and education strategy is needed to explore how technology can improve e-Health literacy and health outcomes among underserved populations. PMID:24567867

  11. Effects of a psychological skills training programme for underserved ...

    African Journals Online (AJOL)

    Effects of a psychological skills training programme for underserved rugby ... The development of psychological skills is an important, but often neglected part of ... Repeated measures two-way ANOVAs revealed significant main time effects, ...

  12. Chronic disease management in rural and underserved populations: innovation and system improvement help lead to success.

    Science.gov (United States)

    Bolin, Jane; Gamm, Larry; Kash, Bita; Peck, Mitchell

    2005-03-01

    Successful implementation of disease management (DM) is based on the ability of an organization to overcome a variety of barriers to deliver timely, appropriate care of chronic illnesses. Such programs initiate DM services to patient populations while initiating self-management education among medication-resistant patients who are chronically ill. Despite formidable challenges, rural health care providers have been successful in initiating DM programs and have discovered several ways in which these programs benefit their organizations. This research reports on six DM programs that serve large rural and underserved populations and have demonstrated that DM can be successfully implemented in such areas.

  13. The challenges of working in underserved areas: a qualitative exploratory study of views of policy makers and professionals.

    Science.gov (United States)

    AbuAlRub, Raeda F; El-Jardali, Fadi; Jamal, Diana; Iblasi, Abdulkareem S; Murray, Susan F

    2013-01-01

    The inadequate number of health care providers, particularly nurses, in underserved areas is one of the biggest challenges for health policymakers. There is a scarcity of research in Jordan about factors that affect nurse staffing and retention in underserved areas. To elucidate the views of staff nurses working in underserved areas, directors of health facilities in underserved areas and key informants from the policy and education arena on issues of staffing and retention of nurses in underserved areas. An exploratory study using a qualitative approach with semi-structured interviews was utilized to elucidate the views of 22 key informants from the policy and education arena, 11 directors of health centers, and 19 staff nurses on issues that contribute to low staffing and retention of nurses in underserved areas. The five stage 'framework approach' proposed by Bryman et al. (1993) was utilized for data analysis. Nursing shortage in underserved areas in Jordan are exacerbated by a lack of financial incentives, poor transportation and remoteness of these areas, bad working conditions, and lack of health education institutions in these areas, as well as by opportunities for internal and external migration. Young Jordanian male nurses usually grab any opportunity to migrate and work outside the country to improve their financial conditions; whereas, female nurses are more restricted and not encouraged to travel abroad to work. Several strategies are suggested to enhance retention in these areas, such as promoting financial incentives for staff to work there, enhancing the transportation system, and promoting continuous and academic education. Nurses' administrators and health care policy makers could utilize the findings of the present study to design and implement comprehensive interventions to enhance retention of staff in underserved areas. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Crowdsourced Microfinance for Energy Efficiency in Underserved Communities

    Energy Technology Data Exchange (ETDEWEB)

    Baird, Donnel [BlocPower LLC, New York, NY (United States); Cox, Morris [BlocPower LLC, New York, NY (United States); Harmarneh, Sarey [BlocPower LLC, New York, NY (United States); Zheng, Chen [BlocPower LLC, New York, NY (United States)

    2017-06-21

    BlocPower’s mission is to provide access to energy efficiency financing for underserved communities across the United States. This project, “Crowdsourced Microfinance for Energy Efficiency in Underserved Communities,” is an extension of that goal and is grounded in the principles of providing engineering and financing services to those in need. The project is based on the creation of a BlocPower Marketplace as a central hub for connecting shovel-ready green buildings to institutional investors. This ‘connection’ entails using online crowdfunding to aggregate debt and equity capital from institutional investors to connect to customers (building owners) across various financial portfolios. BlocPower Marketplace is intended to bring social, environmental, and financial returns to investors while also decreasing investor risk by loaning out funds for energy installations in individual buildings. In detail, the intended benefits of crowdsourcing are two-sided. Firstly, for building owners, clean energy retrofit installations improve building operations, reduce utility costs, and reduce harmful impacts to their surrounding environment. Secondly, for institutional investors, they gain access to a new market of energy efficiency and are able to provide debt or equity capital with high financial returns. This gives investors the opportunity to create social and environmental impact in communities around the country as well. With this in mind, BlocPower designed the marketplace to specifically answer exploratory research questions with respect to the pricing of energy financing. Institutional investors typically charge high rates on project financing solutions in the energy space, particularly in low and middle-income communities, because of fears that required debt service will not be made. This makes access to energy capital exorbitantly difficult for those that need it the most. Through this project, BlocPower tested investor appetite to determine if

  15. Reaching Our Successors: Millennial Generation Medical Students ...

    African Journals Online (AJOL)

    ... life as a plastic surgeon and the ability of plastic surgeons to provide good role models for medical students. Female medical students were more concerned with gender equity and work-life balance in selecting plastic surgery compared to male medical students. Keywords: Career, medical students, millennial generation, ...

  16. The Online-Counseling Debate: A View toward the Underserved

    Science.gov (United States)

    Sanchez-Page, Delida

    2005-01-01

    This article responds to some important issues that Mallen, Vogel, Rochlen, and Day raise in "Online Counseling: Reviewing the Literature from a Counseling Psychology Framework." This reaction reviews the appropriateness of online counseling for underserved populations. The author provides suggestions for better serving historically undeserved…

  17. Physician assistants as servant leaders: meeting the needs of the underserved.

    Science.gov (United States)

    Huckabee, Michael J; Wheeler, Daniel W

    2011-01-01

    The purpose of this study was to determine if the level of servant leader characteristics in clinically practicing physician assistants (PAs) in underserved populations differed from PAs serving in other locales. Five subscales of servant leadership: altruistic calling, emotional healing, wisdom, persuasive mapping, and organizational stewardship, were measured in a quantitative study of clinically practicing PAs using a self-rating survey and a similar survey by others rating the PA. Of 777 PAs invited, 321 completed the survey. On a scale of 1 to 5, mean PA self-ratings ranged from 3.52 (persuasive mapping) to 4.05 (wisdom). Other raters' scores paired with the self-rated PA scores were comparable in all subscales except wisdom, which was rated higher by the other raters (4.32 by other raters, 4.01 by PAs, P= .002). There was no significant difference in the measures of servant leadership reported by PAs serving the underserved compared to PAs serving in other populations. Servant leader subscales were higher for PAs compared to previous studies of other health care or community leader populations. The results found that the PA population studied had a prominent level of servant leadership characteristics that did not differ between those working with underserved and nonunderserved populations.

  18. A national study on nurses' retention in healthcare facilities in underserved areas in Lebanon.

    Science.gov (United States)

    El-Jardali, Fadi; Alameddine, Mohamad; Jamal, Diana; Dimassi, Hani; Dumit, Nuhad Y; McEwen, Mary K; Jaafar, Maha; Murray, Susan F

    2013-09-30

    Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon. This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student's t-test and ANOVA) tests to describe the respondents and examine the significance between nurses' characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses' intent to stay in underserved areas. A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P job satisfaction and their intent to stay. This study reveals poor retention of nurses in rural and underserved

  19. Impact of a Plant-Based Diet and Support on Mitigating Type 2 Diabetes Mellitus in Latinos Living in Medically Underserved Areas.

    Science.gov (United States)

    Ramal, Edelweiss; Champlin, Andrea; Bahjri, Khaled

    2018-03-01

    To determine the impact that a high-fiber, low-fat diet, derived from mostly plant-based sources, when coupled with support has upon self-management of type 2 diabetes mellitus in Latinos from medically underserved areas (MUAs). Experimental randomized controlled community pilot study. Three community clinics in MUAs located within San Bernardino County, California. Thirty-two randomly assigned Latinos with A1 C greater than 6.4: 15 control and 17 experimental. Participants completed a 5-week education program. Researchers provided follow-up support for 17 randomly assigned experimental group participants through focus groups held at participating clinics-1, 3, and 6 months posteducation. Changes in fat and fiber consumption were measured using a modified Dietary Screener for Mexican Americans. Self-management was measured through the Self-Efficacy for Exercise Scale and Diabetes Quality of Life Measure. Baseline characteristics for both groups were analyzed using independent t tests and χ 2 tests. A 2-way repeated-measures analysis of variance was used to analyze biometric data between baseline and 6 months for both groups. Mean A1 C levels decreased from baseline to 6 months for both groups: control, μ 1 = 9.57, μ 2 = 9.49; experimental, μ 1 = 8.53, μ 2 = 7.31. The experimental group demonstrated a statistically significant reduction in mean A1 C levels ( P = .002) when compared to the control group.

  20. Individual Breast Cancer risk assessment in Underserved Populations: Integrating empirical Bioethics and Health Disparities Research

    Science.gov (United States)

    Anderson, Emily E.; Hoskins, Kent

    2013-01-01

    Research suggests that individual breast cancer risk assessment may improve adherence to recommended screening and prevention guidelines, thereby decreasing morbidity and mortality. Further research on the use of risk assessment models in underserved minority populations is critical to informing national public health efforts to eliminate breast cancer disparities. However, implementing individual breast cancer risk assessment in underserved patient populations raises particular ethical issues that require further examination. After reviewing these issues, we will discuss how empirical bioethics research can be integrated with health disparities research to inform the translation of research findings. Our in-progress National Cancer Institute (NCI) funded study, How Do Underserved Minority Women Think About Breast Cancer?, conducted in the context of a larger study on individual breast cancer risk assessment, is presented as a model. PMID:23124498

  1. Lack of Quality Primary Health Services: The Problems of the Underserved.

    Science.gov (United States)

    Hall, Daniel A.

    1978-01-01

    Major political and economic forces, which affect the provision of primary health services, particularly to underserved populations, are reviewed. Technological, professional, governmental, fiscal, and societal solutions are proposed. (GC)

  2. Effects of racial and ethnic group and health literacy on responses to genomic risk information in a medically underserved population.

    Science.gov (United States)

    Kaphingst, Kimberly A; Stafford, Jewel D; McGowan, Lucy D'Agostino; Seo, Joann; Lachance, Christina R; Goodman, Melody S

    2015-02-01

    Few studies have examined how individuals respond to genomic risk information for common, chronic diseases. This randomized study examined differences in responses by type of genomic information (genetic test/family history) and disease condition (diabetes/heart disease), and by race/ethnicity in a medically underserved population. 1,057 English-speaking adults completed a survey containing 1 of 4 vignettes (2-by-2 randomized design). Differences in dependent variables (i.e., interest in receiving genomic assessment, discussing with doctor or family, changing health habits) by experimental condition and race/ethnicity were examined using chi-squared tests and multivariable regression analysis. No significant differences were found in dependent variables by type of genomic information or disease condition. In multivariable models, Hispanics were more interested in receiving a genomic assessment than Whites (OR = 1.93; p literacy had greater interest than those with adequate health literacy. Blacks (OR = 1.78; p = .001) and Hispanics (OR = 1.85; p = .001) had greater interest in discussing information with family than Whites. Non-Hispanic Blacks (OR = 1.45; p = .04) had greater interest in discussing genomic information with a doctor than Whites. Blacks (β = -0.41; p literacy was negatively associated with number of health habits participants intended to change. Findings suggest that race/ethnicity may affect responses to genomic risk information. Additional research could examine how cognitive representations of this information differ across racial/ethnic groups. Health literacy is also critical to consider in developing approaches to communicating genomic information.

  3. Occupational Health and Sleep Issues in Underserved Populations.

    Science.gov (United States)

    Kalliny, Medhat; McKenzie, Judith Green

    2017-03-01

    Sleep disorders and occupational hazards, injuries, and illnesses impact an individual's overall health. In the United States, substantial racial, ethnic, and socioeconomic disparities exist in sleep and occupational health. Primary care physicians working in underserved communities should be aware of this disparity and target these higher-risk populations for focused evaluation and intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Exercise and Sports Medicine Issues in Underserved Populations.

    Science.gov (United States)

    Morelli, Vincent; Bedney, Daniel L; Eric Dadush, Arie

    2017-03-01

    Primary care providers can make a strong argument for exercise promotion in underserved communities. The benefits are vitally important in adolescent physical, cognitive, and psychological development as well as in adult disease prevention and treatment. In counseling such patients, we should take into account a patient's readiness for change and the barriers to exercise. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. How to Guide: Aggregate under-served markets into buying pools

    Energy Technology Data Exchange (ETDEWEB)

    None

    2000-12-26

    This activity promotes new opportunities to increase energy security and lower energy costs for under-served markets. It involves market analysis and collaboration with community partners, as well as outreach activities to inform target markets and technical assistance for participants.

  6. Enrolling Underserved Women in mHealth Programs: Results From Text4baby Outreach Campaigns.

    Science.gov (United States)

    Bushar, Jessica A; Fishman, Jodie; Garfinkel, Danielle; Pirretti, Amy

    2018-03-01

    Public health practitioners have increasingly leveraged technology-based communication to get health information into the hands of hard-to-reach populations; however, best practices for outreach and enrollment into mobile health (mHealth) programs are lacking. This article describes enrollment results from campaigns focused on enrolling underserved pregnant women and mothers in Text4baby-a free, mHealth service-to inform outreach strategies for mHealth programs. Text4baby participants receive health and safety information, interactive surveys, alerts, and appointment reminders through at least three weekly texts and a free app-timed to users' due date or babies' birth date. Text4baby worked with partners to implement national, state, and community-based enrollment campaigns. Descriptive statistics were used to compare baseline enrollment prior to a campaign with enrollment during a campaign to generate enrollment estimates. Enrollment rates were calculated for campaigns for which the number targeted/reached was available. National television campaigns resulted in more than 10,000 estimated enrollments. Campaigns that were integrated with an existing program and text-based recruitment had the highest enrollment rates, ranging from 7% to 24%. Facebook advertisements and traditional media targeting providers and consumers were least effective. mHealth programs should consider text-based recruitment and outreach via existing programs; additional research is needed on return on investment for different outreach strategies and on the effectiveness of different outreach strategies at reaching and enrolling specific target populations.

  7. Perceptions of cardiovascular health in underserved communities.

    Science.gov (United States)

    Bryant, Lucinda L; Chin, Nancy P; Cottrell, Lesley A; Duckles, Joyce M; Fernandez, I Diana; Garces, D Marcela; Keyserling, Thomas C; McMilin, Colleen R; Peters, Karen E; Samuel-Hodge, Carmen D; Tu, Shin-Ping; Vu, Maihan B; Fitzpatrick, Annette L

    2010-03-01

    Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions. Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences. Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials. Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.

  8. Intrinsic rewards experienced by a group of dentists working with underserved populations.

    Science.gov (United States)

    Gardner, S P; Roberts-Thomson, K F; Winning, T A; Peterson, R

    2014-09-01

    The aim of this study was to explore, using qualitative methods, the intrinsic reasons why dentists work with underserved groups. Minority and marginalized groups of Australians suffer a greater burden of dental disease than the general population due to disparities in accessing care. Recruitment and retention of dentists to care for underserved groups is problematic due to personal, professional and structural reasons. What drives dentists to work with underserved groups is not widely known. Sixteen dentists were recruited using 'snowball' purposeful sampling. Semi-structured in-depth interviews were conducted. Thematic analysis was conducted on the transcriptions to identify themes. Five key themes emerged: (1) 'tapped on the shoulder', being personally approached or invited; (2) 'dental school experience', the challenges faced as a student; (3) 'empathic concern', the non-judgemental expressions of care toward others; (4) 'resilience', the ability to bounce back after setbacks; (5) 'intrinsic reward', the personal gain and satisfaction received. This study focuses on the intrinsic rewards which were found to be simple, unexpected, and associated with relieving pain, community engagement and making a difference. Emphasizing personal fulfilment and intrinsic reward could be useful when promoting dentistry as a career and when encouraging graduates to consider working with disadvantaged groups. © 2014 Australian Dental Association.

  9. Diet and Obesity Issues in the Underserved.

    Science.gov (United States)

    Mejia de Grubb, Maria C; Levine, Robert S; Zoorob, Roger J

    2017-03-01

    The goal of this article is to inform new directions for addressing inequalities associated with obesity by reviewing current issues about diet and obesity among socioeconomically vulnerable and underserved populations. It highlights recent interventions in selected high-risk populations, as well as gaps in the knowledge base. It identifies future directions in policy and programmatic interventions to expand the role of primary care providers, with an emphasis on those aimed at preventing obesity and promoting healthy weight. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Designing for Underserved Populations: Constraints and Requirements of Personal Health Record Systems

    Centers for Disease Control (CDC) Podcasts

    In this podcast, Dr. Thomas Horan discusses how language, literacy, and access barriers can be overcome with electronic Personal Health Record (PHR) systems to improve health among the most vulnerable, isolated, and underserved populations.

  11. An early stage evaluation of the Supporting Program for Obstetric Care Underserved Areas in Korea.

    Science.gov (United States)

    Na, Baeg Ju; Kim, Hyun Joo; Lee, Jin Yong

    2014-06-01

    "The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital's facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.

  12. Intercultural health and ethnobotany: how to improve healthcare for underserved and minority communities?

    Science.gov (United States)

    Vandebroek, Ina

    2013-07-30

    The present conceptual review explores intercultural healthcare--defined as the integration of traditional medicine and biomedicine as complementary healthcare systems--in minority and underserved communities. This integration can take place at different levels: individuals (patients, healers, biomedical healthcare providers), institutions (health centers, hospitals) or society (government policy). Contemporary ethnobotany research of traditional medicine has primarily dealt with the botanical identification of plants commonly used by local communities, and the identification of health conditions treated with these plants, whereas ethnopharmacology has focused on the bioactivity of traditional remedies. On the other hand, medical anthropology seems to be the scholarship more involved with research into patients' healthcare-seeking itineraries and their interaction with traditional versus biomedical healthcare systems. The direct impact of these studies on public health of local communities can be contested. To compare and discuss the body of scholarly work that deals with different aspects of traditional medicine in underserved and minority communities, and to reflect on how gaps identified in research can be bridged to help improve healthcare in these communities. The literature covers a broad range of information of relevance to intercultural healthcare. This information is fragmented across different scientific and clinical disciplines. A conceptual review of these studies identifies a clear need to devote more attention to ways in which research on traditional medicine can be more effectively applied to improve local public health in biomedical resource-poor settings, or in geographic areas that have disparities in access to healthcare. Scholars studying traditional medicine should prioritize a more interdisciplinary and applied perspective to their work in order to forge a more direct social impact on public health in local communities most in need of

  13. Breast Cancer Outreach for Underserved Women: A Randomized Trial and Cost-Effectiveness Analysis

    National Research Council Canada - National Science Library

    Pasick, Rena

    1999-01-01

    The current study, BACCIS-II, is a randomized controlled trial of an outreach intervention model designed to increase the rate of periodic mammography and clinical breast exam among underserved women...

  14. Multicultural Milky Way: Ethnoastronomy and Planetarium Shows for Under-served Arizonans

    Science.gov (United States)

    Knierman, Karen

    2018-01-01

    The astronomy outreach initiative, Multicultural Milky Way, partners the School of Earth and Space Exploration (SESE) at Arizona State University (ASU) with under-served populations in Arizona in learning about our Milky Way and other galaxies. Arizona is home to many diverse populations with rich cultural histories such as Mayan, Navajo, and Apache. Linking astronomy practiced by one’s indigenous culture to that of Western astronomy may increase the interest in science. Through multicultural planetarium shows and associated hands-on activities, under-served students and families will learn how the Milky Way is represented in different cultures and about the science of galaxies. New planetarium shows using the Mesa Community College (MCC) Digital Planetarium and STARLAB portable planetarium explore how the Milky Way is interpreted in different cultures. STARLAB shows and associated new hands-on activities have been featured during school visits, teacher trainings, and Community Astronomy Nights around Arizona. For authentic assessment, evaluation techniques and procedures were developed.

  15. Have "new" methods in medical education reached German-speaking Central Europe: a survey.

    Science.gov (United States)

    Fandler, Martin; Habersack, Marion; Dimai, Hans P

    2014-08-16

    Simulation-based-training (SBT) in the education of health professionals is discussed as an effective alternative for knowledge and skills enhancement as well as for the establishment of a secure learning environment, for learners and patients. In the Anglo-American region, SBT and simulation and training centers (STC) are numbered as standard for medical training. In German-speaking Central Europe, priority is still given to the establishment of SBT and STC. The purpose of this study was (i) to survey the status quo relating to the existence and facilities of simulation and training centers at medical universities in German-speaking Central Europe and (ii) the evaluation of training methods, especially in the area of emergency medicine skills. All public and private medical universities or medical faculties in Germany (36), Austria (4) and German-speaking Switzerland (3) were interviewed. In the survey, information regarding the existence and facilities of STCs and information with regards to the use of SBT in the area of emergency medicine was requested. The questions were partly posed in a closed-ended-, in an open-ended- and in a multiple choice format (with the possibility of selecting more than one answer). Of a total of 43 contacted medical universities/medical faculties, 40 ultimately participated in the survey. As decisive for the establishment of a STC the potential to improve the clinical-practical training and the demand by students were listed. Obligatory training in a STC during the first and sixth academic year was confirmed only by 12 institutions, before the first invasive procedure on patients by 17 institutions. 13 institutions confirmed the use of the STC for the further training of physicians and care-staff. Training for the acute care and emergency medicine skills in the field of pediatrics, for the most part, occurs decentralized. New methods in medical training have reached German-speaking Central Europe, but the simulation and training

  16. Promising Practices: A Literature Review of Technology Use by Underserved Students

    Science.gov (United States)

    Zielezinski, Molly B.; Darling-Hammond, Linda

    2016-01-01

    How can technologies and digital learning experiences be used to support underserved, under-resourced, and underprepared students? For many years, educators, researchers, and policy makers looking for strategies to close the achievement gap and improve student learning have sought solutions involving new uses of technology, especially for students…

  17. Breaking Barriers to Bike Share: Insights from Residents of Traditionally Underserved Neighborhoods

    Science.gov (United States)

    2017-06-01

    Evidence has shown that higher income and white populations are overrepresented in both access to and use of bike share. Efforts to overcome underserved communities barriers to access and use of bike share have been initiated in a number of cities...

  18. Physical Activity in an Underserved Population: Identifying Technology Preferences.

    Science.gov (United States)

    Medairos, Robert; Kang, Vicky; Aboubakare, Carissa; Kramer, Matthew; Dugan, Sheila Ann

    2017-01-01

    This study aims to identify patterns of use and preferences related to technology platforms that could support physical activity (PA) programs in an underserved population. A 29-item questionnaire was administered at 5 health and wellness sites targeting low income communities in Chicago. Frequency tables were generated for Internet, cell phone, and social media use and preferences. Chi-squared analysis was used to evaluate differences across age and income groups. A total of 291 individuals participated and were predominantly female (69.0%). Majority reported incomes less than $30,000 (72.9%) and identified as African American/Black/Caribbean (49.3%) or Mexican/Mexican American (34.3%). Most participants regularly used smartphones (63.2%) and the Internet (75.9%). Respondents frequently used Facebook (84.8%), and less commonly used Instagram (43.6%), and Twitter (20.0%). Free Internet-based exercise programs were the most preferred method to increase PA levels (31.6%), while some respondents (21.0%) thought none of the surveyed technology applications would help. Cell phone, Internet, and social media use is common among the surveyed underserved population. Technology preferences to increase PA levels varied, with a considerable number of respondents not preferring the surveyed technology platforms. Creating educational opportunities to increase awareness may maximize the effectiveness of technology-based PA interventions.

  19. NASA and Public Libraries: Enhancing STEM Literacy in Underserved Communities

    Science.gov (United States)

    Dusenbery, P.; LaConte, K.; Harold, J. B.; Randall, C.

    2016-12-01

    NASA research programs are helping humanity understand the origin and evolution of galaxies, stars, and planets, and defining the conditions necessary to support life beyond Earth. The Space Science Institute's (SSI) National Center for Interactive Learning (NCIL) was recently funded by NASA`s Science Mission Directorate (SMD) to develop and implement a project called NASA@ My Library: A National Earth and Space Science Initiative That Connects NASA, Public Libraries and Their Communities. As places that offer their services for free, public libraries have become the "public square" by providing a place where members of a community can gather for information, educational programming, and policy discussions. Libraries are developing new ways to engage their patrons in STEM learning, and NCIL's STAR Library Education Network (STAR_Net) has been supporting their efforts for the last eight years, including through a vibrant community of practice that serves both librarians and STEM professionals. Project stakeholders include public library staff, state libraries, the earth and space science education community at NASA, subject matter experts, and informal science educators. The project will leverage high-impact SMD and library events to catalyze partnerships through dissemination of SMD assets and professional development. It will also develop frameworks for public libraries to increase STEM interest pathways in their communities (with supports for reaching underserved audiences). This presentation will summarize the key activities and expected outcomes of the 5-year project.

  20. Reaching the Unreachable: Novel Approaches to Telemedicine Screening of Underserved Populations for Vitreoretinal Disease.

    Science.gov (United States)

    Murchison, Ann P; Haller, Julia A; Mayro, Eileen; Hark, Lisa; Gower, Emily; Huisingh, Carrie; Rhodes, Lindsay; Friedman, David S; Lee, David J; Lam, Byron L

    2017-07-01

    Telemedicine involves electronic communication between a physician in one location and a patient in another location to provide remote medical care. Ophthalmologists are increasingly employing telemedicine, particularly in retinal disease screening and monitoring. Telemedicine has been utilized to decrease barriers to care and yield greater patient satisfaction and lower costs, while maintaining high sensitivity and specificity. This review discusses common patient barriers to eye care, innovative approaches to retinal disease screening and monitoring using telemedicine, and eye care policy initiatives needed to enact large-scale telemedicine eye disease screening programs.

  1. Underserved Pregnant and Postpartum Women's Access and Use of Their Health Records.

    Science.gov (United States)

    Guo, Yuqing; Hildebrand, Janet; Rousseau, Julie; Brown, Brandon; Pimentel, Pamela; Olshansky, Ellen

    The purpose of this study was to examine knowledge of and experiences with use of their electronic health record (EHR) among mostly Hispanic women during pregnancy and postpartum. Women who were in the MOMS Orange County prenatal or postpartum home visitation program completed surveys and participated in focus groups. Descriptive and content analyses were used. Twenty-six women participated. Nearly all women (24, 92.3%) knew what health records were and most (80.8%) felt that keeping their records would increase or greatly increase their confidence in caring for themselves and their families. Approximately one third reported already keeping a copy of their health records. Common barriers to accessing and understanding health records included healthcare providers' noncompliance with the Health Information Technology for Economic and Clinical Health Act, limited EHR adoption, unfriendly patient portals, complicated medical terminology, rushed appointments with healthcare providers, lack of Spanish interpreters, and lack of Spanish-speaking healthcare providers. Programs are needed to educate and support women and providers in using health records to promote health literacy, pregnancy management, and patient-provider relationships in underserved populations.

  2. Effects of dance on depression, physical function, and disability in underserved adults.

    Science.gov (United States)

    Murrock, Carolyn J; Graor, Christine Heifner

    2014-07-01

    This study documented the feasibility and immediate effects of a dance intervention two times per week for 12 weeks on depression, physical function, and disability in older, underserved adults. The one-group, pretest-posttest study had a convenience sample of 40 participants recruited from a federally subsidized apartment complex located in an economically depressed, inner-city neighborhood. Depression, physical function, and disability were measured at baseline and 12 weeks. Average age was 63 years (SD = 7.9), 92% were female, and 75% were African American. At baseline, participants reported increased depression (M = 20.0, SD = 12.4), decreased physical function (M = 56.6, SD = 10.9), and increased disability limitations (M = 65.7, SD = 14.9). At posttest, paired t tests showed that the dance intervention significantly decreased depression, t = 6.11, p dance intervention may be an effective adjunct therapy to improve depression, disability, and physical function in underserved adults.

  3. The transformation of osteopathic medical education.

    Science.gov (United States)

    Gevitz, Norman

    2009-06-01

    Osteopathic medical schools and hospital-based postgraduate programs have long constituted small but important sources of physicians and surgeons, particularly for traditionally underserved areas of the United States. Though frequently marginalized in or even left out of standard histories and studies of U.S. medical education, these institutions have become much more difficult to ignore, given the rapid expansion of the number of osteopathic medical students in new and existing colleges and the size of their classes. By 2019, upwards of 25% of all U.S. medical school graduates produced annually will be doctors of osteopathic medicine. The author examines the process through which osteopathy was transformed into osteopathic medicine, how osteopathic medical schools achieved their present status as a significant source of U.S. graduates for residency training, and what challenges osteopathic medical education now faces.

  4. The Quick Peek Program: A Model for Developmental Screening within Underserved Communities

    Science.gov (United States)

    Harris, Jill; Norton, Amy

    2016-01-01

    Developmental screening of young children is important in all populations, especially underserved communities with known health care disparities. The American Academy of Pediatrics created guidelines and a toolkit for pediatricians to conduct developmental surveillance and screening, yet these guidelines are not uniformly implemented within…

  5. A Smart Partnership: Integrating Educational Technology for Underserved Children in India

    Science.gov (United States)

    Charania, Amina; Davis, Niki

    2016-01-01

    This paper explores the evolution of a large multi-stakeholder partnership that has grown since 2011 to scale deep engagement with learning through technology and decrease the digital divide for thousands of underserved school children in India. Using as its basis a case study of an initiative called integrated approach to technology in education…

  6. Workplace physical violence among hospital nurses and physicians in underserved areas in Jordan.

    Science.gov (United States)

    AbuAlRub, Raeda Fawzi; Al Khawaldeh, Abdullah Talal

    2014-07-01

    To: (1) examine the incidence, frequency and contributing factors to workplace violence among nurses and physicians in underserved areas in Jordan, and (2) identify the existing policies and the management modalities to tackle workplace violence. Workplace violence is a major problem in healthcare organisations. An understanding of the nature of violence is essential to implementing successful management. A descriptive exploratory research design. The questionnaire that was developed in 2003 by the International Labor Office, the International Council of Nurses, the World Health Organization, and the Public Services International was used to collect data from a convenience sample of 521 Jordanian physicians and nurses (396 nurses, 125 physicians) who worked in hospitals located in underserved areas. Around 15% of the participants were exposed to physical violence. The factors that contributed to workplace violence were related to absence of policies, inadequate staffing and lack of communication skills. Only 16·9% of participants indicated that there were specific policies available for dealing with physical workplace violence. Strengthening security and providing training were some of the important factors indicated by participants for decreasing violence in the workplace. Workplace violence is a problem in underserved areas that needs attention from administrators. Most participants were very dissatisfied with the way the administrators dealt with the incidents. Instituting firm policies against perpetrators and developing protective violence guidelines to support healthcare staff in managing workplace violence are paramount to tackle the problem of workplace violence. © 2013 John Wiley & Sons Ltd.

  7. Recruitment practices for U.S. minority and underserved populations in NRG oncology: Results of an online survey

    Directory of Open Access Journals (Sweden)

    Elise D. Cook

    2018-06-01

    Full Text Available Introduction: Cancer clinical trials (CCT provide much of the evidence for clinical guidelines and standards of care. But low levels of CCT participation are well documented, especially for minorities. Methods and materials: We conducted an online survey of 556 recruitment practices across the NRG Oncology network. Survey aims were 1 to learn how sites recruit minority/underserved populations; 2 to better understand the catchment areas of the NRG institutions; and 3 to aid in planning education programs for accrual of minority/underserved populations. Results: The survey response rate was 34.9%. The most effective methods reported for recruiting minority/underserved participants were patient navigators (44.4% and translators (38.9%. All institutions reported using a mechanism for eligibility screening and 71% of institutions reported using a screening/enrollment tracking system. CCT training was required at 78.1% and cultural competency training was required at 47.5% of responding institutions. Only 19.9% of sites used community partners to assist with minority recruitment and just 37.1% of respondents reported a defined catchment area. Sites reported very little race and ethnicity data. Conclusion: This NRG Oncology online survey provides useful data for improvements in trial enrollment and training to recruit minority/underserved populations to CCT. Areas for further investigation include web-based methods for recruitment and tracking, cultural competency training, definition of catchment areas, use of patient navigators, and community partnerships. The survey results will guide recruitment training programs.

  8. American Dental Association White Paper Targets Dental Care for the Underserved

    Science.gov (United States)

    Berthold, Mark

    2005-01-01

    Reaffirming its leadership role toward better oral health for all Americans, the ADA has produced a white paper that also challenges policy-makers and the US to improve access to dental services. The white paper, "State and Community Models for Improving Access to Dental Care for the Underserved," was presented October 1 to the House of…

  9. Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities.

    Science.gov (United States)

    Uscher-Pines, Lori; Rudin, Robert; Mehrotra, Ateev

    2017-06-01

    Many disadvantaged communities lack sufficient numbers of local primary care and specialty physicians. Yet tens of thousands of physicians, in particular those who are retired or semiretired, desire meaningful volunteer opportunities. Multiple programs have begun to use telehealth to bridge the gap between volunteer physicians and underserved patients. In this brief, we describe programs that are using this model and discuss the promise and pitfalls. Physician volunteers in these programs report that the work can be fulfilling and exciting, a cutting-edge yet convenient way to remain engaged and contribute. Given the projected shortfall of physicians in the United States, recruiting retired and semiretired physicians to provide care through telehealth increases the total supply of active physicians and the capacity of the existing workforce. However, programs typically use volunteers in a limited capacity because of uncertainty about the level and duration of commitment. Acknowledging this reality, most programs only use volunteer physicians for curbside consults rather than fully integrating them into longitudinal patient care. The part-time availability of volunteers may also be difficult to incorporate into the workflow of busy safety net clinics. As more physicians volunteer in a growing number of telehealth programs, the dual benefits of enriching the professional lives of volunteers and improving care for underserved communities will make further development of these programs worthwhile.

  10. Preparing Historically Underserved Students for STEM Careers: The Role of an Inquiry-based High School Science Sequence Beginning with Physics

    Science.gov (United States)

    Bridges, Jon P.

    Improving the STEM readiness of students from historically underserved groups is a moral and economic imperative requiring greater attention and effort than has been shown to date. The current literature suggests a high school science sequence beginning with physics and centered on developing conceptual understanding, using inquiry labs and modeling to allow students to explore new ideas, and addressing and correcting student misconceptions can increase student interest in and preparation for STEM careers. The purpose of this study was to determine if the science college readiness of historically underserved students can be improved by implementing an inquiry-based high school science sequence comprised of coursework in physics, chemistry, and biology for every student. The study used a retrospective cohort observational design to address the primary research question: are there differences between historically underserved students completing a Physics First science sequence and their peers completing a traditional science sequence in 1) science college-readiness test scores, 2) rates of science college-and career-readiness, and 3) interest in STEM? Small positive effects were found for all three outcomes for historically underserved students in the Physics First sequence.

  11. Need, access, and the reach of integrated care: A typology of patients.

    Science.gov (United States)

    Bridges, Ana J; Villalobos, Bianca T; Anastasia, Elizabeth A; Dueweke, Aubrey R; Gregus, Samantha J; Cavell, Timothy A

    2017-06-01

    This paper is a report on a study exploring a potential typology of primary care patients referred for integrated behavioral health care (IBHC) services. We considered whether primary care patients could be grouped into meaningful clusters based on perceived need for behavioral health services, barriers to accessing care, and past-year service utilization. We also described the development of a working partnership between our university-based research team and a federally qualified health center (FQHC). A total of 105 adult primary care patients referred for same-day behavioral health appointments completed a brief self-report questionnaire assessing past-year behavioral health concerns, service utilization, and perceived barriers to utilization. Hierarchical and k-means cluster analyses revealed 3 groups: (a) Well-Served patients, characterized by high perceived need for services, high service use, and low barriers to service use (40%); (b) Underserved patients, characterized by high perceived need, low service utilization, and high barriers to service use (20%); and (c) Subclinical patients, characterized by low perceived need, low service use, and low barriers to service use (20%). Clusters were reliably differentiated by age, primary language, insurance status, and global functioning. We found primary care patients could be grouped into 3 categories and that 60% (Underserved and Subclinical) represented groups less commonly seen in traditional mental health (MH) settings. IBHC may be a promising approach for extending the reach of MH care, and partnerships between FQHCs and university-based research teams may be a promising approach for conducting research on the IBHC service-delivery model. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  12. The safety net medical home initiative: transforming care for vulnerable populations.

    Science.gov (United States)

    Sugarman, Jonathan R; Phillips, Kathryn E; Wagner, Edward H; Coleman, Katie; Abrams, Melinda K

    2014-11-01

    Despite findings that medical homes may reduce or eliminate health care disparities among underserved and minority populations, most previous medical home pilot and demonstration projects have focused on health care delivery systems serving commercially insured patients and Medicare beneficiaries. To develop a replicable approach to support medical home transformation among diverse practices serving vulnerable and underserved populations. Facilitated by a national program team, convening organizations in 5 states provided coaching and learning community support to safety net practices over a 4-year period. To guide transformation, we developed a framework of change concepts aligned with supporting tools including implementation guides, activity checklists, and measurement instruments. Sixty-five health centers, homeless clinics, private practices, residency training centers, and other safety net practices in Colorado, Idaho, Massachusetts, Oregon, and Pennsylvania. We evaluated implementation of the change concepts using the Patient-Centered Medical Home-Assessment, and conducted a survey of participating practices to assess perceptions of the impact of the technical assistance. All practices implemented key features of the medical home model, and nearly half (47.6%) implemented the 33 identified key changes to a substantial degree as evidenced by level A Patient-Centered Medical Home-Assessment scores. Two thirds of practices that achieved substantial implementation did so only after participating in the initiative for >2 years. By the end of the initiative, 83.1% of sites achieved external recognition as medical homes. Despite resource constraints and high-need populations, safety net clinics made considerable progress toward medical home implementation when provided robust, multimodal support over a 4-year period.

  13. Liability concerns and shared use of school recreational facilities in underserved communities.

    Science.gov (United States)

    Spengler, John O; Connaughton, Daniel P; Maddock, Jason E

    2011-10-01

    In underserved communities, schools can provide the physical structure and facilities for informal and formal recreation as well as after-school, weekend, and summer programming. The importance of community access to schools is acknowledged by authoritative groups; however, fear of liability is believed to be a key barrier to community access. The purpose of this study was to investigate perceptions of liability risk and associated issues among school administrators in underserved communities. A national survey of school administrators in underserved communities (n=360, response rate of 21%) was conducted in 2009 and analyzed in 2010. Liability perceptions in the context of community access were assessed through descriptive statistics. The majority of respondents (82.2%) indicated concern for liability should someone be injured on school property after hours while participating in a recreational activity. Among those that did not allow community access, 91% were somewhat to very concerned about liability and 86% believed that stronger legislation was needed to better protect schools from liability for after-hours recreational use. Among those who claimed familiarity with a state law that offered them limited liability protection, nearly three fourths were nevertheless concerned about liability. Liability concerns are prevalent among this group of school administrators, particularly if they had been involved in prior litigation, and even if they indicated they were aware of laws that provide liability protection where use occurs after hours. Reducing these concerns will be important if schools are to become locations for recreational programs that promote physical activity outside of regular school hours. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  14. Loss of international medical experiences: knowledge, attitudes and skills at risk.

    Science.gov (United States)

    Grudzen, Corita R; Legome, Eric

    2007-11-28

    Despite the great influence International Medical Experiences (IMs) can have on young physicians and their impact on patients and communities, they are not offered in all training programs and are at risk of being reduced in some due to stringent guidelines for funding of graduate medical education. IMs provide unique experiences in clinical, epidemiologic, cultural, and political arenas. From an educational perspective, they broaden a physician's differential diagnostic skills and introduce clinical entities rarely seen in the U.S. Time spent in developing countries emphasizes the importance of community health and increases cultural and linguistic competence. Experience working with the underserved during an IM has been shown to increase interest in volunteerism, humanitarian efforts, and work with underserved populations both in the US and abroad. IMs also afford physicians the opportunity to learn about the delivery of health care abroad and are associated with an increase in primary care specialty choice. It is time for the leaders in graduate medical education to prioritize international health opportunities. Leaders in academic medicine can press for changes in reimbursement patterns at the national level or special funds for international electives. Hospitals can set up separate accounts to help finance resident salaries and benefits while abroad. Individual departments must be flexible with resident schedules to allow elective time. Medical students and housestaff can organize and lobby larger organizations such as the American Medical Association (AMA), the American Association of Medical Colleges (AAMC), and specialty groups to make IMs universally accessible.

  15. HealthATM: personal health cyberinfrastructure for underserved populations.

    Science.gov (United States)

    Botts, Nathan E; Horan, Thomas A; Thoms, Brian P

    2011-05-01

    There is an opportunity for personal health record (PHR) systems to play a vital role in fostering health self-management within underserved populations. If properly designed and promoted, it is possible that patients will use PHRs to become more empowered in taking an active role toward managing their health needs. This research examines the potential of a cyberinfrastructure-based PHR to encourage patient activation in health care, while also having population health implications. A multi-phased, iterative research approach was used to design and evaluate a PHR system called HealthATM, which utilizes services from a cloud computing environment. These services were integrated into an ATM-style interface aimed at providing a broad range of health consumers with the ability to manage health conditions and encourage accomplishment of health goals. Evaluation of the PHR included 115 patients who were clients of several free clinics in Los Angeles County. The majority of patients perceived ease of use (74%) and confidence (73%) in using the HealthATM system, and thought they would like to use it frequently (73%). Patients also indicated a belief in being responsible for their own health. However, fewer felt as though they were able to maintain necessary life changes to improve their health. Findings from the field tests suggest that PHRs can be a beneficial health management tool for underserved populations. In order for these types of tools to be effective within safety-net communities, they must be technically accessible and provide meaningful opportunities to increase patient engagement in their health care. Copyright © 2011. Published by Elsevier Inc.

  16. Identifying elements of patient-centered care in underserved populations: a qualitative study of patient perspectives.

    Directory of Open Access Journals (Sweden)

    Sheela Raja

    Full Text Available Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes.

  17. Sharing Gravity's Microscope: Star Formation and Galaxy Evolution for Underserved Arizonans

    Science.gov (United States)

    Knierman, Karen A.; Monkiewicz, Jacqueline A.; Bowman, Catherine DD; Taylor, Wendy

    2016-01-01

    Learning science in a community is important for children of all levels and especially for many underserved populations. This project combines HST research of galaxy evolution using gravitationally lensed galaxies with hands-on activities and the Starlab portable planetarium to link astronomy with families, teachers, and students. To explore galaxy evolution, new activities were developed and evaluated using novel evaluation techniques. A new set of galaxy classification cards enable inquiry-based learning about galaxy ages, evolution, and gravitational lensing. Activities using new cylinder overlays for the Starlab transparent cylinder will enable the detailed examination of star formation and galaxy evolution as seen from the viewpoint inside of different types of galaxies. These activities were presented in several Arizona venues that enable family and student participation including ASU Earth and Space Open House, Arizona Museum of Natural History Homeschooling Events, on the Salt River Pima-Maricopa Indian Community, and inner city Phoenix schools serving mainly Hispanic populations. Additional events targeted underserved families at the Phoenix Zoo, in Navajo County, and for the Pascua Yaqui Tribe. After evaluation, the activities and materials will also be shared with local teachers and nationally.

  18. Reaching out: medical students leading in local communities.

    Science.gov (United States)

    Bannon, Aidan; O'Hare, Niamh; Corr, Michael; Sterling, Margaret; Gormley, Gerard J

    2015-06-01

    Queen's University Red Cross is a medical student-led volunteer group with a key aim of promoting social change within local communities and empowering young people to aspire to higher education. We describe 'The Personal Development Certificate', a 12-week community development programme devised by third-year medical students at Queen's University Belfast to target young people who are lacking educational motivation, are disengaged at home or are marginalised through social circumstances. Community-based education is of increasing importance within undergraduate and postgraduate medical education in the UK, and further afield. We evaluated the perceived improvements in key skills such as teamwork, leadership, communication, and problem solving in students following participation in this programme, and the extent to which their attitude and appreciation of community-based medicine changed. [Students] appreciated the opportunity to translate a series of classroom-learned skills to real-life environments Following facilitation of this community-based initiative, all students reported a perceived improvement in the acquired skill sets. Students made strong links from this programme to previous clinical experiences and appreciated the opportunity to translate a series of classroom-learned skills to real-life environments and interactions. The students' appreciation and understanding of community-based medicine was the single most improved area of our evaluation. We have demonstrated that medical students possess the skills to develop and facilitate their own educational projects. Non-clinical, student-led community projects have the potential to be reproduced using recognised frameworks and guidelines to complement the current undergraduate medical curriculum. © 2015 John Wiley & Sons Ltd.

  19. Investigating the Factors of Resiliency among Exceptional Youth Living in Rural Underserved Communities

    Science.gov (United States)

    Curtin, Kevin A.; Schweitzer, Ashley; Tuxbury, Kristen; D'Aoust, Janelle A.

    2016-01-01

    Resilience is an important social justice concept that has important implications for educators working with exceptional youth in rural underserved communities who may suffer from the consequences associated with economic hardships. This multi-school qualitative study examined resilience among exceptional youth living in rural poverty through the…

  20. With Educational Benefits for All: Campus Inclusion through Learning Communities Designed for Underserved Student Populations

    Science.gov (United States)

    Fink, John E.; Hummel, Mary L.

    2015-01-01

    This chapter explores the practices of learning communities designed for specific, underserved student populations, highlighting on-campus examples and culminating with a synthesized list of core practices from these "inclusive" learning communities.

  1. Evaluating distributed medical education: what are the community's expectations?

    Science.gov (United States)

    Lovato, Chris; Bates, Joanna; Hanlon, Neil; Snadden, David

    2009-05-01

    This study aimed to explore community members' perceptions of present and future impacts of the implementation of an undergraduate medical education programme in an underserved community. We conducted semi-structured interviews with eight key informants representing the health, education, business, economy, media and political sectors. A two-stage approach was used. In the first stage, the interviews were analysed to identify sector-specific impacts informants perceived as already occurring or which they hoped to see in the future. The transcripts were then re-analysed to determine any underlying themes that crossed sectors. Community leaders described impacts that were already occurring in all sectors and also described changes in the community itself. Four underlying themes emerged: an increase in pride and status; partnership development; community self-efficacy, and community development. These underlying themes appear to characterise the development of social capital in the community. The implementation of distributed undergraduate medical education programmes in rural and underserved communities may impact their host communities in ways other than the production of a rural doctor workforce. Further studies to quantify impacts in diverse sectors and to explore possible links with social capital are needed.

  2. Pediatric Asthma Care Coordination in Underserved Communities: A Quasiexperimental Study.

    Science.gov (United States)

    Janevic, Mary R; Stoll, Shelley; Wilkin, Margaret; Song, Peter X K; Baptist, Alan; Lara, Marielena; Ramos-Valencia, Gilberto; Bryant-Stephens, Tyra; Persky, Victoria; Uyeda, Kimberly; Lesch, Julie Kennedy; Wang, Wen; Malveaux, Floyd J

    2016-11-01

    To assess the effect of care coordination on asthma outcomes among children in underserved urban communities. We enrolled children, most of whom had very poorly or not well-controlled asthma, in medical-social care coordination programs in Los Angeles, California; Chicago, Illinois; Philadelphia, Pennsylvania; and San Juan, Puerto Rico in 2011 to 2014. Participants (n = 805; mean age = 7 years) were 60% male, 50% African American, and 42% Latino. We assessed asthma symptoms and health care utilization via parent interview at baseline and 12 months. To prevent overestimation of intervention effects, we constructed a comparison group using bootstrap resampling of matched control cases from previous pediatric asthma trials. At follow-up, intervention participants had 2.2 fewer symptom days per month (SD = 0.3; P < .01) and 1.9 fewer symptom nights per month (SD = 0.35; P < .01) than did the comparison group. The relative risk in the past year associated with the intervention was 0.63 (95% confidence interval [CI] = 0.45, 0.89) for an emergency department visit and 0.69 (95% CI = 0.47, 1.01) for hospitalization. Care coordination may improve pediatric asthma symptom control and reduce emergency department visits. Expanding third-party reimbursement for care coordination services may help reduce pediatric asthma disparities.

  3. Weight status as a moderator of the relationship between motivation, emotional social support, and physical activity in underserved adolescents.

    Science.gov (United States)

    St George, Sara M; Wilson, Dawn K; Lawman, Hannah G; Van Horn, M Lee

    2013-05-01

    This study examined weight status as a moderator of the relationship between motivation (controlled, autonomous, regulatory), emotional social support (parents, peers) and moderate-to-vigorous physical activity (MVPA) in underserved adolescents (ethnic minority, low-income). Participants from the Active by Choice Today Trial (n = 1,416; 54% girls, 73% African American, 52% overweight/obese) completed baseline measures, including height and weight, psychosocial surveys, and 7-day accelerometry estimates. Weight status was defined by body mass index z-score (zBMI). Weight status moderated the effects of controlled, autonomous, and regulatory motivation on MVPA, such that these variables were more strongly associated with MVPA in adolescents with lower versus higher zBMI scores. A better understanding of why motivation is not related to MVPA in underserved youth with a higher weight status is needed. Future pediatric obesity treatment in underserved youth may need to move beyond motivation into environmental factors associated with long-term behavior change.

  4. A "Medical Mission" at Home: The Needs of Rural America in Terms of Otolaryngology Care

    Science.gov (United States)

    Winters, Ryan; Pou, Anna; Friedlander, Paul

    2011-01-01

    Objectives: Describe the population, Medicaid, uninsured, and otolaryngology practice demographics for 7 representative rural Southeastern states, and propose academic-affiliated outreach clinics as a service to help meet the specialty care needs of an underserved rural population, based on the "medical mission" model employed in…

  5. Increasing access to health workers in underserved areas: a conceptual framework for measuring results

    NARCIS (Netherlands)

    Huicho, L.; Dieleman, M.; Campbell, J.; Codjia, L.; Balabanova, D.; Dussault, G.; Dolea, C.

    2010-01-01

    Many countries have developed strategies to attract and retain qualified health workers in underserved areas, but there is only scarce and weak evidence on their successes or failures. It is difficult to compare lessons and measure results from the few evaluations that are available. Evaluation

  6. Increasing access to health workers in underserved areas : a conceptual framework for measuring results

    NARCIS (Netherlands)

    Huicho, Luis; Dieleman, Marjolein; Campbell, James; Codjia, Laurence; Balabanova, Dina; Dussault, Gilles; Dolea, Carmen

    Many countries have developed strategies to attract and retain qualified health workers in underserved areas, but there is only scarce and weak evidence on their successes or failures. It is difficult to compare lessons and measure results from the few evaluations that are available. Evaluation

  7. Enrolling Minority and Underserved Populations in Cancer Clinical Research.

    Science.gov (United States)

    Wallington, Sherrie F; Dash, Chiranjeev; Sheppard, Vanessa B; Goode, Tawara D; Oppong, Bridget A; Dodson, Everett E; Hamilton, Rhonda N; Adams-Campbell, Lucile L

    2016-01-01

    Research suggests that community involvement is integral to solving public health problems, including involvement in clinical trials-a gold standard. Significant racial/ethnic disparities exist in the accrual of participants for clinical trials. Location and cultural aspects of clinical trials influence recruitment and accrual to clinical trials. It is increasingly necessary to be aware of defining characteristics, such as location and culture of the populations from which research participants are enrolled. Little research has examined the effect of location and cultural competency in adapting clinical trial research for minority and underserved communities on accrual for clinical trials. Utilizing embedded community academic sites, the authors applied cultural competency frameworks to adapt clinical trial research in order to increase minority participation in nontherapeutic cancer clinical trials. This strategy resulted in successful accrual of participants to new clinical research trials, specifically targeting participation from minority and underserved communities in metropolitan Washington, DC. From 2012 to 2014, a total of 559 participants enrolled across six nontherapeutic clinical trials, representing a 62% increase in the enrollment of blacks in clinical research. Embedding cancer prevention programs and research in the community was shown to be yet another important strategy in the arsenal of approaches that can potentially enhance clinical research enrollment and capacity. The analyses showed that the capacity to acquire cultural knowledge about patients-their physical locales, cultural values, and environments in which they live-is essential to recruiting culturally and ethnically diverse population samples. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  8. Bolivia programme evaluation of a package to reach an underserved population: Community-based maternal and newborn care economic analysis.

    Science.gov (United States)

    Barger, Diana; Pooley, Bertha; Dupuy, Julien Roger; Cardenas, Norma Amparo; Wall, Steve; Owen, Helen; Daviaud, Emmanuelle

    2017-10-01

    To address inequitable access to health services of indigenous communities in the Bolivian highlands, the Bolivian Ministry of Health, with the support of Save the Children-Saving Newborn Lives, conducted operational research to identify, implement and test a package of maternal and newborn interventions using locally recruited, volunteer Community Health Workers (vCHW) between 2008 and 2010. The additional annual economic and financial costs of the intervention were estimated from the perspective of the Bolivian Ministry of Health in two municipalities. The cost of intervention-stimulated increases in facility attendance was estimated with national surveillance data using a pre-post comparison, adjusted for secular trends in facility attendance. Three scale-up scenarios were modelled by varying the levels of coverage and the number (per mother and child pair) and frequency of home visits. Average cost per mother and average cost per home visit are presented in constant 2015 US$. Eighteen per cent of expectant mothers in the catchment area were visited at least once. The annualized additional financial cost of the community-based intervention across both municipalities was $43 449 of which 3% ($1324) was intervention design, 20% ($8474) set-up and 77% ($33 651) implementation. Drivers of additional costs were additional paid staff (68%), 81% of which was for management and support by local implementing partner and 19% of which was for vCHW supervision. The annual financial cost per vCHW was $595. Modelled scale-up scenarios highlight potential efficiency gains. Recognizing local imperatives to reduce inequalities by targeting underserved populations, the observed low coverage by vCHWs resulted in a high cost per mother and child pair ($296). This evaluation raises important questions about this model's ability to achieve its ultimate goals of reducing neonatal mortality and inequalities through behaviour change and increased care seeking and has served to

  9. Exploration of Global Health Careers Across the Medical Fields.

    Science.gov (United States)

    Barthélemy, Ernest; Mallol, Vanessa; Hannaford, Alisse; Pean, Christian; Kutua, Rehema; de Haydu, Christopher; Anandaraja, Natasha; Asgary, Ramin; Elahi, Ebrahim; Hexom, Braden; Landrigan, Philip; Shirazian, Taraneh; Katz, Craig

    Despite expansion of interest among American medical students in global health (GH), academic medical centers face multiple obstacles to the development of structured GH curricula and career guidance. To meet these demands we sought to provide a systematic analysis of the accounts of GH experts. We developed a collaborative, interview-based, qualitative analysis of GH experiences across six career-related themes that are relevant to medical students interested in GH: justification, medical education, economics, research prospects, law and ethics, and work-life balance. Seven GH faculty members were interviewed for 30-90 minutes using sample questions as guidelines. We applied a grounded theory approach to analyze the interview transcripts to discover an emerging theory pertinent to GH trainees. Regarding justification, 4 respondents defined GH as work with the underserved irrespective of geographic location; 5 respondents found sustainability imperative; and all respondents believe GH creates better physicians. Respondents identified many physician competencies developed through GH medical education, with 5 respondents agreeing that work with underserved populations has transformative potential. Concerning economics, 3 respondents acknowledged GH's popularity among trainees, resulting in increased training opportunities, and 2 respondents emphasized an associated deficiency in program quality. All respondents described career models across specialties. Four respondents noted funding challenges when discussing research prospects. Within the theme of laws and ethics, 4 respondents perceived inadequate accountability, and 6 respondents identified ways to create accountability. Finally, 6 respondents recognized family demands can compromise one's GH career and thus work-life balance. Despite diverse perspectives on the meaning and sustainability of GH work, this analysis provides a nascent framework that may inform curricular development for GH trainees. Suggestions

  10. Randomized Trial of a Family-based, Automated, Conversational Obesity Treatment Program for Underserved Populations

    Science.gov (United States)

    Wright, J. A.; Phillips, B.D.; Watson, B.L.; Newby, P.K.; Norman, G. J.; Adams, W.G.

    2013-01-01

    Objective To evaluate the acceptability and feasibility of a scalable obesity treatment program integrated with pediatric primary care and delivered using interactive voice technology (IVR) to families from underserved populations. Design and Methods Fifty parent-child dyads (child 9–12 yrs, BMI >95th percentile) were recruited from a pediatric primary care clinic and randomized to either an IVR or a wait-list control (WLC) group. The majority were lower-income, African-American (72%) families. Dyads received IVR calls for 12 weeks. Call content was informed by two evidenced-based interventions. Anthropometric and behavioral variables were assessed at baseline and 3 mo follow-up. Results Forty-three dyads completed the study. IVR parents ate 1 cup more fruit than WLC (p 75% agreed that the calls were useful, made for people like them, credible, and helped them eat healthy foods. Conclusion An obesity treatment program delivered via IVR may be an acceptable and feasible resource for families from underserved populations. PMID:23512915

  11. Relationship of body mass index and psychosocial factors on physical activity in underserved adolescent boys and girls.

    Science.gov (United States)

    Kitzman-Ulrich, Heather; Wilson, Dawn K; Van Horn, M Lee; Lawman, Hannah G

    2010-09-01

    Previous research indicates that body mass index (BMI) and sex are important factors in understanding physical activity (PA) levels. The present study examined the influence of BMI on psychosocial variables (self-efficacy, social support) and PA in underserved (ethnic minority, low income) boys in comparison with girls. Participants (N = 669; 56% girls; 74% African American) were recruited from the "Active by Choice Today" trial. BMI ʐ score was calculated from objectively collected height and weight data, and PA was assessed with 7-day accelerometry estimates. Self-report questionnaires were used to measure self-efficacy and social support (family, peers) for PA. A 3-way interaction between BMI z score, sex, and family support on PA was shown such that family support was positively associated with PA in normal-weight but not overweight or obese boys, and was not associated with PA in girls. Self-efficacy had the largest effect size related to PA in comparison with the other psychosocial variables studied. Self-efficacy was found to be an important variable related to PA in underserved youth. Future studies should evaluate possible barriers to PA in girls, and overweight youth, to provide more effective family support strategies for underserved adolescents' PA. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  12. A medical student leadership course led to teamwork, advocacy, and mindfulness.

    Science.gov (United States)

    Warde, Carole M; Vermillion, Michelle; Uijtdehaage, Sebastian

    2014-06-01

    Many medical trainees seek work among underserved communities but may be unprepared to cope with the challenges. Relationship-centered qualities have been shown to promote physician resilience and prevent burnout. The UCLA-PRIME program aims to prepare medical students to work among vulnerable groups and begins with a 3-week leadership course. We describe this course and share lessons with those seeking to foster leadership, advocacy, and resiliency in our future physician workforce. Twenty students participated in our curriculum that emphasized five competencies: leadership, advocacy, teamwork, mindfulness, and self-care. Course activities complemented the students' work as they developed a community outreach project. They assessed and reflected on their leadership, relationship, and team behaviors, were coached to improve these, learned mindfulness meditation, and participated in community forums. Our evaluation assessed course quality, project completion, leadership, mindfulness, and team relational coordination. Students were very satisfied with all aspects of the course. They designed a medical student elective addressing the health challenges of an incarcerated and formerly incarcerated population. While we found no change in leadership practices scores, students had high team relational coordination scores and improved mindfulness scores upon course completion. Our course to develop medical students as resilient leaders, team members, and advocates for medically underserved groups consisted of a community-based service project, coupled with a facilitated relationship-centered curriculum. It promoted qualities in students that characterize effective and resilient physician leaders; they were more mindful, related to each other effectively, and coordinated their activities well with one another.

  13. Designing for Underserved Populations: Constraints and Requirements of Personal Health Record Systems

    Centers for Disease Control (CDC) Podcasts

    2009-02-11

    In this podcast, Dr. Thomas Horan discusses how language, literacy, and access barriers can be overcome with electronic Personal Health Record (PHR) systems to improve health among the most vulnerable, isolated, and underserved populations.  Created: 2/11/2009 by Coordinating Center for Health Information Service (CCHIS), Healthy Healthcare Settings Goal Team, Office of Strategy and Innovation.   Date Released: 9/2/2009.

  14. Effect of Active Videogames on Underserved Children's Classroom Behaviors, Effort, and Fitness.

    Science.gov (United States)

    Gao, Zan; Lee, Jung Eun; Pope, Zachary; Zhang, Dachao

    2016-09-30

    The purpose of this study was to examine the effect of active videogames (AVGs) on underserved minority children's on-task classroom behavior, academic effort, and fitness. A one group pre- and posttest repeated measures design was used. In Fall 2013, 95 fourth grade children (57 boys, 38 girls; 96% of minority) from three classes at an underserved urban elementary school participated in teacher-supervised AVG activities (e.g., Wii Sports, Xbox Just Dance). Specifically, students participated in a 50-minute weekly AVG program at school for 6 weeks. Children's academic effort was evaluated by classroom teachers using a validated scale that assessed activity, attention, conduct, and social/emotional behavior. Moreover, children's classroom behavior was observed immediately before and after each AVG session by trained researchers. Finally, cardiovascular fitness was also measured. A paired t-test was used to assess teacher-rated student effort, while one-way (gender) analysis of variance (ANOVA) with repeated measures was performed to analyze children's on-task classroom behavior. There was a significant effect on children's effort between the first (mean = 3.24, SD = 0.75) and last week (mean = 3.41, SD = 0.73) assessments, t = 2.42, P = 0.02. In addition, there was a significant effect on classroom behavior, F = 33.103, P < 0.01. In detail, children scored significantly higher on on-task behavior during the post-AVG observation (mean = 81.4, SD = 12.3) than seen during the pre-AVG observation (mean = 69.8, SD = 14.9). However, no main effect was indicated for gender, F = 0.39, P = 0.54. No significant improvement in cardiovascular fitness was observed, although slight improvements were seen. Offering an AVG program at school could improve underserved minority children's classroom on-task behavior and academic effort. Future studies may include a control group to further confirm the effectiveness of AVG

  15. Utility of Respondent Driven Sampling to Reach Disadvantaged Emerging Adults for Assessment of Substance Use, Weight, and Sexual Behaviors.

    Science.gov (United States)

    Tucker, Jalie A; Simpson, Cathy A; Chandler, Susan D; Borch, Casey A; Davies, Susan L; Kerbawy, Shatomi J; Lewis, Terri H; Crawford, M Scott; Cheong, JeeWon; Michael, Max

    2016-01-01

    Emerging adulthood often entails heightened risk-taking with potential life-long consequences, and research on risk behaviors is needed to guide prevention programming, particularly in under-served and difficult to reach populations. This study evaluated the utility of Respondent Driven Sampling (RDS), a peer-driven methodology that corrects limitations of snowball sampling, to reach at-risk African American emerging adults from disadvantaged urban communities. Initial "seed" participants from the target group recruited peers, who then recruited their peers in an iterative process (110 males, 234 females; M age = 18.86 years). Structured field interviews assessed common health risk factors, including substance use, overweight/obesity, and sexual behaviors. Established gender-and age-related associations with risk factors were replicated, and sample risk profiles and prevalence estimates compared favorably with matched samples from representative U.S. national surveys. Findings supported the use of RDS as a sampling method and grassroots platform for research and prevention with community-dwelling risk groups.

  16. Budget Impact Analysis of Against Colorectal Cancer In Our Neighborhoods (ACCION): A Successful Community-Based Colorectal Cancer Screening Program for a Medically Underserved Minority Population.

    Science.gov (United States)

    Kim, Bumyang; Lairson, David R; Chung, Tong Han; Kim, Junghyun; Shokar, Navkiran K

    2017-06-01

    Given the uncertain cost of delivering community-based cancer screening programs, we developed a Markov simulation model to project the budget impact of implementing a comprehensive colorectal cancer (CRC) prevention program compared with the status quo. The study modeled the impacts on the costs of clinical services, materials, and staff expenditures for recruitment, education, fecal immunochemical testing (FIT), colonoscopy, follow-up, navigation, and initial treatment. We used data from the Against Colorectal Cancer In Our Neighborhoods comprehensive CRC prevention program implemented in El Paso, Texas, since 2012. We projected the 3-year financial consequences of the presence and absence of the CRC prevention program for a hypothetical population cohort of 10,000 Hispanic medically underserved individuals. The intervention cohort experienced a 23.4% higher test completion rate for CRC prevention, 8 additional CRC diagnoses, and 84 adenomas. The incremental 3-year cost was $1.74 million compared with the status quo. The program cost per person was $261 compared with $86 for the status quo. The costs were sensitive to the proportion of high-risk participants and the frequency of colonoscopy screening and diagnostic procedures. The budget impact mainly derived from colonoscopy-related costs incurred for the high-risk group. The effectiveness of FIT to detect CRC was critically dependent on follow-up after positive FIT. Community cancer prevention programs need reliable estimates of the cost of CRC screening promotion and the added budget impact of screening with colonoscopy. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  17. Using Social Cognitive Theory to Predict Physical Activity and Fitness in Underserved Middle School Children

    Science.gov (United States)

    Martin, Jeffrey J.; McCaughtry, Nate; Flory, Sara; Murphy, Anne; Wisdom, Kimberlydawn

    2011-01-01

    Few researchers have used social cognitive theory and environment-based constructs to predict physical activity (PA) and fitness in underserved middle-school children. Hence, we evaluated social cognitive variables and perceptions of the school environment to predict PA and fitness in middle school children (N = 506, ages 10-14 years). Using…

  18. Stories From the Field: The Use of Information and Communication Technologies to Address the Health Needs of Underserved Populations in Latin America and the Caribbean.

    Science.gov (United States)

    Farach, Nasim; Faba, Gladys; Julian, Soroya; Mejía, Felipe; Cabieses, Báltica; D'Agostino, Marcelo; Cortinois, Andrea A

    2015-01-01

    As their availability grew exponentially in the last 20 years, the use of information and communication technologies (ICT) in health has been widely espoused, with many emphasizing their potential to decrease health inequities. Nonetheless, there is scarce availability of information regarding ICT as tools to further equity in health, specifically in Latin American and Caribbean settings. Our aim was to identify initiatives that used ICT to address the health needs of underserved populations in Latin America and Caribbean. Among these projects, explore the rationale behind the selection of ICT as a key component, probe perceptions regarding contributions to health equity, and describe the challenges faced during implementation. We conducted an exploratory qualitative study. Interviews were completed via Skype or face-to-face meetings using a semistructured interview guide. Following participant consent, interviews were audio recorded and verbatim transcriptions were developed. All transcriptions were coded using ATLASti7 software. The text was analyzed for patterns, shared themes, and diverging opinions. Emerging findings were reviewed by all interviewers and shared with participants for feedback. We interviewed representatives from eight organizations in six Latin American and Caribbean countries that prominently employed ICT in health communication, advocacy, or surveillance projects. ICT expanded project's geographic coverage, increased their reach into marginalized or hard-to-reach groups, and allowed real-time data collection. Perceptions of contributions to health equity resided mainly in the provision of health information and linkage to health services to members of groups experiencing greater morbidity because of poverty, remote place of residence, lack of relevant public programs, and/or stigma and discrimination, and in more timely responses by authorities to the health needs of these groups as a result of the increased availability of strategic

  19. Mobile and Portable Dental Services Catering to the Basic Oral Health Needs of the Underserved Population in Developing Countries: A Proposed Model

    Science.gov (United States)

    Ganavadiya, R; Chandrashekar, BR; Goel, P; Hongal, SG; Jain, M

    2014-01-01

    India is the second most populous country in the world with an extensive rural population (68.8%). Children less than 18 years constitute about 40% of the population. Approximately, 23.5% of the urban population resides in urban slums. The extensive rural population, school children and the urban slum dwellers are denied of even the basic dental services though there is continuous advancement in the field of dentistry. The dentist to population ratio has dramatically improved in the last one to two decades with no significant improvement in the oral health status of the general population. The various studies have revealed an increasing trend in oral diseases in the recent times especially among this underserved population. Alternate strategies have to be thought about rather than the traditional oral health-care delivery through private dentists on fee for service basis. Mobile and portable dental services are a viable option to take the sophisticated oral health services to the doorsteps of the underserved population. The databases were searched for publications from 1900 to the present (2013) using terms such as Mobile dental services, Portable dental services and Mobile and portable dental services with key articles obtained primarily from MEDLINE. This paper reviews the published and unpublished literature from different sources on the various mobile dental service programs successfully implemented in some developed and developing countries. Though the mobile and portable systems have some practical difficulties like financial considerations, they still seem to be the only way to reach every section of the community in the absence of national oral health policy and organized school dental health programs in India. The material for the present review was obtained mainly by searching the biomedical databases for primary research material using the search engine with key words such as mobile and/or portable dental services in developed and developing countries

  20. Mobile and portable dental services catering to the basic oral health needs of the underserved population in developing countries: a proposed model.

    Science.gov (United States)

    Ganavadiya, R; Chandrashekar, Br; Goel, P; Hongal, Sg; Jain, M

    2014-05-01

    India is the second most populous country in the world with an extensive rural population (68.8%). Children less than 18 years constitute about 40% of the population. Approximately, 23.5% of the urban population resides in urban slums. The extensive rural population, school children and the urban slum dwellers are denied of even the basic dental services though there is continuous advancement in the field of dentistry. The dentist to population ratio has dramatically improved in the last one to two decades with no significant improvement in the oral health status of the general population. The various studies have revealed an increasing trend in oral diseases in the recent times especially among this underserved population. Alternate strategies have to be thought about rather than the traditional oral health-care delivery through private dentists on fee for service basis. Mobile and portable dental services are a viable option to take the sophisticated oral health services to the doorsteps of the underserved population. The databases were searched for publications from 1900 to the present (2013) using terms such as Mobile dental services, Portable dental services and Mobile and portable dental services with key articles obtained primarily from MEDLINE. This paper reviews the published and unpublished literature from different sources on the various mobile dental service programs successfully implemented in some developed and developing countries. Though the mobile and portable systems have some practical difficulties like financial considerations, they still seem to be the only way to reach every section of the community in the absence of national oral health policy and organized school dental health programs in India. The material for the present review was obtained mainly by searching the biomedical databases for primary research material using the search engine with key words such as mobile and/or portable dental services in developed and developing countries

  1. 75 FR 29447 - Public Health Service Act, Rural Physician Training Grant Program, Definition of “Underserved...

    Science.gov (United States)

    2010-05-26

    ..., identified by the Regulatory Information Number (RIN), by any of the following methods: Federal eRulemaking... assisting eligible entities in recruiting students most likely to practice medicine in underserved rural... determined that good cause exists which makes the usual notice and comment procedure impractical, unnecessary...

  2. Time-variable medical education innovation in context

    Directory of Open Access Journals (Sweden)

    Stamy CD

    2018-06-01

    Full Text Available Christopher D Stamy,1 Christine C Schwartz,1 Danielle A Phillips,2 Aparna S Ajjarapu,3 Kristi J Ferguson,4,5 Debra A Schwinn6–8 1University of Iowa Carver College of Medicine, Iowa City, 2Des Moines University Osteopathic Medical Center, Des Moines, 3University of Iowa, 4Office of Consultation & Research in Medical Education, University of Iowa Carver College of Medicine, 5Department of Internal Medicine, 6Department of Anesthesia, 7Department of Biochemistry, 8Department of Pharmacology, University of Iowa Health Care, Iowa City, IA, USA Background: Medical education is undergoing robust curricular reform with several innovative models emerging. In this study, we examined current trends in 3-year Doctor of Medicine (MD education and place these programs in context. Methods: A survey was conducted among Deans of U.S. allopathic medical schools using structured phone interview regarding current availability of a 3-year MD pathway, and/or other variations in curricular innovation, within their institution. Those with 3-year programs answered additional questions. Results: Data from 107 institutions were obtained (75% survey response rate. The most common variation in length of medical education today is the accelerated 3-year pathway. Since 2010, 9 medical schools have introduced parallel 3-year MD programs and another 4 are actively developing such programs. However, the total number of students in 3-year MD tracks remains small (n=199 students, or 0.2% total medical students. Family medicine and general internal medicine are the most common residency programs selected. Benefits of 3-year MD programs generally include reduction in student debt, stability of guaranteed residency positions, and potential for increasing physician numbers in rural/underserved areas. Drawbacks include concern about fatigue/burnout, difficulty in providing guaranteed residency positions, and additional expense in teaching 2 parallel curricula. Four vignettes of

  3. International Comparisons in Underserved Health: Issues, Policies, Needs and Projections.

    Science.gov (United States)

    Hutchinson, Paul; Morelli, Vincent

    2017-03-01

    Health care globally has made great strides; for example, there are lower rates of infant and maternal mortality. Increased incomes have led to lower rates of diseases accompanying poverty and hunger. There has been a shift away from the infectious diseases so deadly in developing nations toward first-world conditions. This article presents health care statistics across age groups and geographic areas to help the primary care physician understand these changes. There is a special focus on underserved populations. New technologies in health and health care spending internationally are addressed, emphasizing universal health care. The article concludes with recommendations for the future. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Improving cardiovascular health of underserved populations in the community with Life's Simple 7.

    Science.gov (United States)

    Murphy, Marcia Pencak; Coke, Lola; Staffileno, Beth A; Robinson, Janis D; Tillotson, Robin

    2015-11-01

    The purpose of this nurse practitioner (NP) led initiative was to improve the cardiovascular health of two underserved populations in the community using the American Heart Association (AHA) Life's Simple 7 and My Life Check (MLC) tools. Two inner city community sites were targeted: (a) a senior center servicing African American (AA) older adults, and (b) a residential facility servicing homeless women. Preprogram health data (blood pressure, cholesterol, blood glucose levels, body mass index, and health behaviors) were collected to calculate MLC scores. Postprogram health data were obtained on participants with the lowest MLC scores who completed the program. Eight older adults completed the program with a 37.1% increase in average MLC score (6.2 vs. 8.5). Ten women completed the program with a 9.3% decrease in average MLC score (4.3 vs. 3.9). Favorable benefits were observed in the AA older adults. In contrast, similar benefits were not observed in the women, which may be because of a constellation of social, environmental, biological, and mental health factors. NPs are prepared to target community-based settings to address the health of underserved populations. Engaging key stakeholders in the planning and implementation is essential for success. ©2015 American Association of Nurse Practitioners.

  5. The reach of Spanish-language YouTube videos on physical examinations made by undergraduate medical students.

    Science.gov (United States)

    Ramos-Rincón, José M; Belinchón-Romero, Isabel; Sánchez-Ferrer, Francisco; Torre, Guillermo Martínez-de la; Harris, Meggan; Sánchez-Fernández, Javier

    2017-01-01

    This study was conducted to evaluate the performance and reach of YouTube videos on physical examinations made by Spanish university students. We analyzed performance metrics for 4 videos on physical examinations in Spanish that were created by medical students at Miguel Hernández University (Elche, Spain) and are available on YouTube, on the following topics: the head and neck (7:30), the cardiovascular system (7:38), the respiratory system (13:54), and the abdomen (11:10). We used the Analytics application offered by the YouTube platform to analyze the reach of the videos from the upload date (February 17, 2015) to July 28, 2017 (2 years, 5 months, and 11 days). The total number of views, length of watch-time, and the mean view duration for the 4 videos were, respectively: 164,403 views (mean, 41,101 views; range, 12,389 to 94,573 views), 425,888 minutes (mean, 106,472 minutes; range, 37,889 to 172,840 minutes), and 2:56 minutes (range, 1:49 to 4:03 minutes). Mexico was the most frequent playback location, followed by Spain, Colombia, and Venezuela. Uruguay, Ecuador, Mexico, and Puerto Rico had the most views per 100,000 population. Spanish-language tutorials are an alternative tool for teaching physical examination skills to students whose first language is not English. The videos were especially popular in Uruguay, Ecuador, and Mexico.

  6. Practices Caring For The Underserved Are Less Likely To Adopt Medicare's Annual Wellness Visit.

    Science.gov (United States)

    Ganguli, Ishani; Souza, Jeffrey; McWilliams, J Michael; Mehrotra, Ateev

    2018-02-01

    In 2011 Medicare introduced the annual wellness visit to help address the health risks of aging adults. The visit also offers primary care practices an opportunity to generate revenue, and may allow practices in accountable care organizations to attract healthier patients while stabilizing patient-practitioner assignments. However, uptake of the visit has been uneven. Using national Medicare data for the period 2008-15, we assessed practices' ability and motivation to adopt the visit. In 2015, 51.2 percent of practices provided no annual wellness visits (nonadopters), while 23.1 percent provided visits to at least a quarter of their eligible beneficiaries (adopters). Adopters replaced problem-based visits with annual wellness visits and saw increases in primary care revenue. Compared to nonadopters, adopters had more stable patient assignment and a slightly healthier patient mix. At the same time, visit rates were lower among practices caring for underserved populations (for example, racial minorities and those dually enrolled in Medicaid), potentially worsening disparities. Policy makers should consider ways to encourage uptake of the visit or other mechanisms to promote preventive care in underserved populations and the practices that serve them.

  7. Effectiveness of interventions for diagnosis and treatment of tuberculosis in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review.

    Science.gov (United States)

    Heuvelings, Charlotte C; de Vries, Sophia G; Greve, Patrick F; Visser, Benjamin J; Bélard, Sabine; Janssen, Saskia; Cremers, Anne L; Spijker, René; Shaw, Beth; Hill, Ruaraidh A; Zumla, Alimuddin; Sandgren, Andreas; van der Werf, Marieke J; Grobusch, Martin P

    2017-05-01

    Tuberculosis is over-represented in hard-to-reach (underserved) populations in high-income countries of low tuberculosis incidence. The mainstay of tuberculosis care is early detection of active tuberculosis (case finding), contact tracing, and treatment completion. We did a systematic review with a scoping component of relevant studies published between 1990 and 2015 to update and extend previous National Institute for Health and Care Excellence (NICE) reviews on the effectiveness of interventions for identifying and managing tuberculosis in hard-to-reach populations. The analyses showed that tuberculosis screening by (mobile) chest radiography improved screening coverage and tuberculosis identification, reduced diagnostic delay, and was cost-effective among several hard-to-reach populations. Sputum culture for pre-migration screening and active referral to a tuberculosis clinic improved identification. Furthermore, monetary incentives improved tuberculosis identification and management among drug users and homeless people. Enhanced case management, good cooperation between services, and directly observed therapy improved treatment outcome and compliance. Strong conclusions cannot be drawn because of the heterogeneity of evidence with regard to study population, methodology, and quality. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Medical advocacy on behalf of detained immigrants.

    Science.gov (United States)

    Venters, Homer D; Foote, Mary; Keller, Allen S

    2011-06-01

    Detention of immigrants by Immigration and Customs Enforcement (ICE) is a rapidly growing form of incarceration in the U.S. with almost 400,000 people detained in 2008 (Schriro in Immigration and Customs Enforcement, 2009, http://www.ice.gov/doclib/091005_ice_detention_report-final.pdf ). ICE detainees are predominantly from Mexico and Latin America and only a small minority of detainees are asylum seekers. Immigrant detainees lack a legal guarantee of medical care (unlike criminal arrestees and prisoners) and face challenges in receiving medical care, particularly those with chronic medical conditions (Venters and Keller in J Health Care Poor Underserved 20:951-957, 2009). Although we and others have long been involved in advocating for detained asylum seekers, few resources are dedicated to medical advocacy for the broader population of ICE detainees. At the NYU Center for Health and Human Rights (CHHR), a program of medical advocacy was initiated in 2007 on behalf of ICE detainees focused on improvement of care in detention and medical parole. Our preliminary efforts reveal a pressing need for more involvement by physicians and other health advocates in this area.

  9. Teaching the content in context: Preparing "highly qualified" and "high quality" teachers for instruction in underserved secondary science classrooms

    Science.gov (United States)

    Tolbert, Sara E.

    2011-12-01

    This dissertation research project presents the results of a longitudinal study that investigates the knowledge, beliefs, and practices of 13 preservice secondary science teachers participating in a science teacher credentialing/Masters program designed to integrate issues of equity and diversity throughout coursework and seminars. Results are presented in the form of three papers: The first paper describes changes in preservice teacher knowledge about contextualization in science instruction, where contextualization is defined as facilitating authentic connections between science learning and relevant personal, social, cultural, ecological, and political contexts of students in diverse secondary classrooms; the second paper relates changes in the self-efficacy and content-specific beliefs about science, science teaching, diversity, and diversity in science instruction; and the final paper communicates the experiences and abilities of four "social justice advocates" learning to contextualize science instruction in underserved secondary placement classrooms. Results indicate that secondary student teachers developed more sophisticated understandings of how to contextualize science instruction with a focus on promoting community engagement and social/environmental activism in underserved classrooms and how to integrate science content and diversity instruction through student-centered inquiry activities. Although most of the science teacher candidates developed more positive beliefs about teaching science in underrepresented classrooms, many teacher candidates still attributed their minority students' underperformance and a (perceived) lack of interest in school to family and cultural values. The "social justice advocates" in this study were able to successfully contextualize science instruction to varying degrees in underserved placement classrooms, though the most significant limitations on their practice were the contextual factors of their student teaching

  10. How sequestration cuts affect primary care physicians and graduate medical education.

    Science.gov (United States)

    Chauhan, Bindiya; Coffin, Janis

    2013-01-01

    On April 1, 2013, sequestration cuts went into effect impacting Medicare physician payments, graduate medical education, and many other healthcare agencies. The cuts range from 2% to 5%, affecting various departments and organizations. There is already a shortage of primary care physicians in general, not including rural or underserved areas, with limited grants for advanced training. The sequestration cuts negatively impact the future of many primary care physicians and hinder the care many Americans will receive over time.

  11. The role of motivation in understanding social contextual influences on physical activity in underserved adolescents in the ACT Trial: a cross-sectional study.

    Science.gov (United States)

    Lawman, Hannah G; Wilson, Dawn K; Van Horn, M Lee; Zarrett, Nicole

    2012-12-01

    Previous research has shown that social contextual factors are important in understanding physical activity (PA) behavior, although little is known about how these factors may relate to PA, especially in underserved adolescents (low income, minorities). This study examined how motivation may differentially mediate the relationship of two social contextual variables (i.e., peer and parent social support) and moderate-to-vigorous PA (MVPA). Baseline data (n = 1421 sixth graders, 54% female, 72% African American) from the Active by Choice Today (ACT) trial in underserved adolescents were analyzed. Motivation was examined as a mediator of the relationships between peer social support, parent social support, and MVPA (measured by 7-day accelerometer estimates). Motivation and peer but not parent support were significantly related to MVPA overall. Significant mediation effects were found indicating motivation partially mediated the relation between peer social support and MVPA and to a lesser degree parent support and MVPA. These findings provide support for the importance of social contextual influences, especially peer social support, on underserved adolescents' PA and motivation for PA.

  12. The reach of Spanish-language YouTube videos on physical examinations made by undergraduate medical students

    Directory of Open Access Journals (Sweden)

    José M. Ramos-Rincón

    2017-12-01

    Full Text Available This study was conducted to evaluate the performance and reach of YouTube videos on physical examinations made by Spanish university students. We analyzed performance metrics for 4 videos on physical examinations in Spanish that were created by medical students at Miguel Hernández University (Elche, Spain and are available on YouTube, on the following topics: the head and neck (7:30, the cardiovascular system (7:38, the respiratory system (13:54, and the abdomen (11:10. We used the Analytics application offered by the YouTube platform to analyze the reach of the videos from the upload date (February 17, 2015 to July 28, 2017 (2 years, 5 months, and 11 days. The total number of views, length of watch-time, and the mean view duration for the 4 videos were, respectively: 164,403 views (mean, 41,101 views; range, 12,389 to 94,573 views, 425,888 minutes (mean, 106,472 minutes; range, 37,889 to 172,840 minutes, and 2:56 minutes (range, 1:49 to 4:03 minutes. Mexico was the most frequent playback location, followed by Spain, Colombia, and Venezuela. Uruguay, Ecuador, Mexico, and Puerto Rico had the most views per 100,000 population. Spanish-language tutorials are an alternative tool for teaching physical examination skills to students whose first language is not English. The videos were especially popular in Uruguay, Ecuador, and Mexico.

  13. The reach of Spanish-language YouTube videos on physical examinations made by undergraduate medical students

    Science.gov (United States)

    2017-01-01

    This study was conducted to evaluate the performance and reach of YouTube videos on physical examinations made by Spanish university students. We analyzed performance metrics for 4 videos on physical examinations in Spanish that were created by medical students at Miguel Hernández University (Elche, Spain) and are available on YouTube, on the following topics: the head and neck (7:30), the cardiovascular system (7:38), the respiratory system (13:54), and the abdomen (11:10). We used the Analytics application offered by the YouTube platform to analyze the reach of the videos from the upload date (February 17, 2015) to July 28, 2017 (2 years, 5 months, and 11 days). The total number of views, length of watch-time, and the mean view duration for the 4 videos were, respectively: 164,403 views (mean, 41,101 views; range, 12,389 to 94,573 views), 425,888 minutes (mean, 106,472 minutes; range, 37,889 to 172,840 minutes), and 2:56 minutes (range, 1:49 to 4:03 minutes). Mexico was the most frequent playback location, followed by Spain, Colombia, and Venezuela. Uruguay, Ecuador, Mexico, and Puerto Rico had the most views per 100,000 population. Spanish-language tutorials are an alternative tool for teaching physical examination skills to students whose first language is not English. The videos were especially popular in Uruguay, Ecuador, and Mexico. PMID:29278903

  14. Self-care self-efficacy, religious participation and depression as predictors of poststroke self-care among underserved ethnic minorities

    Directory of Open Access Journals (Sweden)

    Suzanne M. Robertson

    2013-04-01

    Full Text Available Underserved ethnic minorities have multiple chronic disease risk factors, including tobacco, alcohol and substance use, which contribute to increased incidence of stroke. Self-efficacy (self-care self-efficacy, religious participation and depression may directly and indirectly influence engagement in post stroke self-care behaviors. The primary aim of the present study was to investigate the effects of self-care self-efficacy, religious participation and depression, on tobacco, alcohol and substance use in a sample of largely ethnic minority, underserved stroke survivors (n=52. Participants previously recruited for a culturally tailored secondary stroke prevention self-care intervention were included. The treatment group received three stroke self-care sessions. The usual care group completed assessments only. Both groups were included in these analyses. Main outcome measures included tobacco, alcohol and substance use. Self-care self-efficacy, religious participation and depression were also assessed. Logistic regression analyses, using self-efficacy, religious practice and depression as the referents, were used to predict binary outcomes of tobacco, alcohol and substance use at 4-weeks post-stroke. Higher depression and self-care self-efficacy were associated with reduced odds of smoking and substance use. Greater participation in religious activities was associated with lower odds of alcohol use. We can conclude that incorporating depression treatment and techniques to increase self-care self-efficacy, and encouraging religious participation may help to improve stroke self-care behaviors for underserved and low socioeconomic status individuals. Results are discussed in the context of stroke self-management.

  15. Factors affecting willingness to practice medicine in underserved areas: a survey of Argentine medical students.

    Science.gov (United States)

    Borracci, Raul A; Arribalzaga, Eduardo B; Couto, Juan L; Dvorkin, Mario; Ahuad Guerrero, Rodolfo A; Fernandez, Carmen; Ferreira, Luis N; Cerezo, Leticia

    2015-01-01

    Previous research has explored the effect of motivations, incentives and working conditions on willingness to accept jobs in rural and remote areas. These studies demonstrated that difficult working conditions, low job satisfaction and remuneration, and poor security, predisposed new medical graduates to select cities instead of rural districts. Since Argentina has a critical shortage of health staff in rural and low-income marginal suburban settings, and limited qualitative and quantitative local research has been done to address this issue, the present study was developed to assess the factors associated with the willingness of medical students to work in low-resource underprivileged areas of the country after graduation. A cross-sectional descriptive design was used with data collected from a self-administered questionnaire and using quantitative analysis methods. A total of 400 eligible second-year medical students were invited to participate in a survey focused on sociodemographic characteristics, incentives and working conditions expected in deprived areas, extrinsic and intrinsic motivations, university medical education and government promotion policies. Twenty-one per cent of medical students showed a strong willingness to work in a deprived area, 57.3% manifested weak willingness and 21.5% unwillingness to work in a low-resource setting. Being female, of older age, not having a university-trained professional parent, previous exposure or service in a poor area, choice of pediatrics as a specialty and strong altruistic motivations were highly associated with the willingness to practice medicine in rural or underprivileged areas. Only 21.5% of respondents considered that medical schools encourage the practice of medicine in poor deprived regions. Likewise, only 6.2% of students considered that national public health authorities suitably stimulate physician distribution in poorer districts. One-third of students expressed high altruistic motivations and

  16. Medication and Dietary Supplement Interactions among a Low-Income, Hospitalized Patient Population Who Take Cardiac Medications

    Directory of Open Access Journals (Sweden)

    Paula Gardiner

    2015-01-01

    Full Text Available Purpose. To identify characteristics associated with the use of potentially harmful combinations of dietary supplements (DS and cardiac prescription medications in an urban, underserved, inpatient population. Methods. Cardiac prescription medication users were identified to assess the prevalence and risk factors of potentially harmful dietary supplement-prescription medication interactions (PHDS-PMI. We examined sociodemographic and clinical characteristics for crude (χ2 or t-tests and adjusted multivariable logistic regression associations with the outcome. Results. Among 558 patients, there were 121 who also used a DS. Of the 110 participants having a PHDS-PMI, 25% were asked about their DS use at admission, 75% had documentation of DS in their chart, and 21% reported the intention to continue DS use after discharge. A multivariable logistic regression model noted that for every additional medication or DS taken the odds of having a PHDS-PMI increase and that those with a high school education are significantly less likely to have a PHDS-PMI than those with a college education. Conclusion. Inpatients at an urban safety net hospital taking a combination of cardiac prescription medications and DS are at a high risk of harmful supplement-drug interactions. Providers must ask about DS use and should consider the potential for interactions when having patient discussions about cardiac medications and DS.

  17. Employing Young Talent from Underserved Populations: Designing a Flexible Organizational Process for Assimilation and Productivity

    Directory of Open Access Journals (Sweden)

    Arthur Mark Langer

    2013-04-01

    Full Text Available This article describes an ongoing 13-year-old program designed to improve the ability of organizations to assimilate young talent from underserved populations, mostly students who have recently graduated from high school. Although many firms have internship and orientation programs, few have well-tested organizational approaches for assimilating 17-20 year-olds into their organizations in an efficient and productive manner. The objective of this study is to describe and evaluate the solution introduced by Workforce Opportunity Services (WOS, a non-profit agency that provides organizations with well-trained talent from underserved local communities. The WOS model is a systemic design involving a lead agency (WOS, corporate clients, training partnerships with local colleges and universities, and underutilized human capital. Over 290 students have completed the WOS program and obtained long-term employment, mostly in IT jobs that normally are outsourced. The results of the study show that companies have success employing young talent when they follow the WOS organizational process. Companies need to have patience with WOS student employees, but within six months most members of the WOS program make positive contributions to their sponsoring firm and have a strong likelihood of becoming permanently employed. Implications of the WOS model for organization design are discussed.

  18. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol

    OpenAIRE

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-01-01

    Introduction The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. Methods and analysis This systematic review addresses the following question: in underserviced populations and low-reso...

  19. Caregiver's depressive symptoms and asthma control in children from an underserved community.

    Science.gov (United States)

    Rioseco, Andrea; Serrano, Carolina; Celedón, Juan C; Padilla, Oslando; Puschel, Klaus; Castro-Rodriguez, Jose A

    2017-12-01

    Caregiver's or maternal depression has been associated with increased asthma morbidity in children from prosperous nations, but little is known about this link in low and middle-income countries. To examine if caregiver's depressive symptoms are associated with poor asthma control and abnormal immune responses in school-aged children. Case-control study of 87 asthmatic children (aged 4-11 years) attending a primary care clinic in an underserved area of Santiago (Chile). Cases were children with poor asthma control (Child Asthma Control Test [cACT] asthma control (cACT ≥20 points). The Beck Depression Inventory-II (BDI) and a locally validated family health vulnerability test (SALUFAM) were used to assess caregivers' depression and family health vulnerability. Serum from participating children was assayed for IFN-γ, IL-4, IL-13, TGF-β, cortisol, and total IgE. The mean (SD) age of study participants was 8.23 (2.15 years), and 55.2% were females. Use of inhaled corticosteroids (ICS), family health vulnerability, and caregiver's depressive symptoms were significantly more common in cases than in controls (65.4% vs. 34.6%, p = 0.003; 41.3% vs. 24.8%, p = 0.07; and 39.1% vs. 19.5%, p = 0.04, respectively). There was no significant difference in the level of any serum biomarkers between groups. In a multivariate analysis, only ICS use was significantly associated with better asthma control (OR = 3.56 [1.34-9.48], p = 0.01). Presence of caregiver's depressive symptoms is associated with poor asthma control among children from an underserved community, but this association was no longer significant after accounting for ICS use.

  20. Factors influencing participation in worksite wellness programs among minority and underserved populations.

    Science.gov (United States)

    Thompson, Sharon E; Smith, Brenda A; Bybee, Ronald F

    2005-01-01

    In the United States, employers and employees are increasingly paying a larger portion of the nation's healthcare bill. Preventive measures are being employed by businesses in an effort to contain the escalating costs of employee healthcare. The work site is an ideal setting for health promotion because 130 million Americans are employed and spend one third of their time at work. However, unhealthy workers tend to be the least likely to participate in health promotion activities. Worksite Wellness Programs must be designed to engage segments of the work force with the greatest health needs. Culturally sensitive and appropriate programs must be developed to engage economically challenged minority and other underserved populations.

  1. International students in United States’ medical schools: does the medical community know they exist?

    Directory of Open Access Journals (Sweden)

    Jashodeep Datta

    2012-06-01

    healthcare disparity eradication, minority health issues, and service in medically underserved areas.

  2. Application of handheld devices to field research among underserved construction worker populations: a workplace health assessment pilot study

    Directory of Open Access Journals (Sweden)

    Fleming Lora E

    2011-04-01

    Full Text Available Abstract Background Novel low-cost approaches for conducting rapid health assessments and health promotion interventions among underserved worker groups are needed. Recruitment and participation of construction workers is particularly challenging due to their often transient periods of work at any one construction site, and their limited time during work to participate in such studies. In the present methodology report, we discuss the experience, advantages and disadvantages of using touch screen handheld devices for the collection of field data from a largely underserved worker population. Methods In March 2010, a workplace-centered pilot study to examine the feasibility of using a handheld personal device for the rapid health assessment of construction workers in two South Florida Construction sites was undertaken. A 45-item survey instrument, including health-related questions on tobacco exposure, workplace safety practices, musculoskeletal disorders and health symptoms, was programmed onto Apple iPod Touch® devices. Language sensitive (English and Spanish recruitment scripts, verbal consent forms, and survey questions were all preloaded onto the handheld devices. The experience (time to survey administration and capital cost of the handheld administration method was recorded and compared to approaches available in the extant literature. Results Construction workers were very receptive to the recruitment, interview and assessment processes conducted through the handheld devices. Some workers even welcomed the opportunity to complete the questionnaire themselves using the touch screen handheld device. A list of advantages and disadvantages emerged from this experience that may be useful in the rapid health assessment of underserved populations working in a variety of environmental and occupational health settings. Conclusions Handheld devices, which are relatively inexpensive, minimize survey response error, and allow for easy storage of data

  3. Application of handheld devices to field research among underserved construction worker populations: a workplace health assessment pilot study.

    Science.gov (United States)

    Caban-Martinez, Alberto J; Clarke, Tainya C; Davila, Evelyn P; Fleming, Lora E; Lee, David J

    2011-04-01

    Novel low-cost approaches for conducting rapid health assessments and health promotion interventions among underserved worker groups are needed. Recruitment and participation of construction workers is particularly challenging due to their often transient periods of work at any one construction site, and their limited time during work to participate in such studies. In the present methodology report, we discuss the experience, advantages and disadvantages of using touch screen handheld devices for the collection of field data from a largely underserved worker population. In March 2010, a workplace-centered pilot study to examine the feasibility of using a handheld personal device for the rapid health assessment of construction workers in two South Florida Construction sites was undertaken. A 45-item survey instrument, including health-related questions on tobacco exposure, workplace safety practices, musculoskeletal disorders and health symptoms, was programmed onto Apple iPod Touch® devices. Language sensitive (English and Spanish) recruitment scripts, verbal consent forms, and survey questions were all preloaded onto the handheld devices. The experience (time to survey administration and capital cost) of the handheld administration method was recorded and compared to approaches available in the extant literature. Construction workers were very receptive to the recruitment, interview and assessment processes conducted through the handheld devices. Some workers even welcomed the opportunity to complete the questionnaire themselves using the touch screen handheld device. A list of advantages and disadvantages emerged from this experience that may be useful in the rapid health assessment of underserved populations working in a variety of environmental and occupational health settings. Handheld devices, which are relatively inexpensive, minimize survey response error, and allow for easy storage of data. These technological research modalities are useful in the

  4. LifeSteps: An Evidence-based Health Promotion Program for Underserved Populations – A Community Service Learning Approach

    Directory of Open Access Journals (Sweden)

    Melanie Austin-McCain

    2015-04-01

    Full Text Available Chronic diseases are the most common, costly, and preventable of all health problems in the United States. Chronic diseases represent the leading causes of death and are experienced at higher rates by minority populations (CDC, 2012. Innovative community-based health promotion programs are recommended that meet the diverse needs of underserved populations (Yeary, et al., 2011. LifeSteps is being developed as an evidence-based health promotion program focusing on health and wellness, a domain area defined within the Occupational Therapy Practice Framework (OTPF, 2008. LifeSteps will utilize a client-centered approach to coach individuals in making health behavior changes. Fieldwork and service-learning components are incorporated integrating clinical practice, academic study, and collaboration with community providers. Program evaluation measures based on the Transtheoretical Model (TTM have been identified to address all phases of program planning. The LifeSteps health promotion program aligns with local, national, and international objectives and addresses the need for programs that meet the diverse needs of underserved populations. Occupational therapists are in a unique position for implementing community-based interventions that promote health and contribute to a healthier society.

  5. A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan.

    Science.gov (United States)

    Azmat, Syed Khurram; Ali, Moazzam; Hameed, Waqas; Mustafa, Ghulam; Abbas, Ghazanfer; Ishaque, Muhammad; Bilgrami, Mohsina; Temmerman, Marleen

    2014-05-30

    High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women's health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as 'Suraj' (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group.

  6. [Medical technology and medical education].

    Science.gov (United States)

    von Mallek, D; Biersack, H-J; Mull, R; Wilhelm, K; Heinz, B; Mellert, F

    2010-08-01

    The education of medical professionals is divided into medical studies, postgraduate training leading to the qualification as a specialist, and continuing professional development. During education, all scientific knowledge and practical skills are to be acquired, which enable the physician to practice responsibly in a specialized medical area. In the present article, relevant curricula are analyzed regarding the consideration of medical device-related topics, as the clinical application of medical technology has reached a central position in modern patient care. Due to the enormous scientific and technical progress, this area has become as important as pharmacotherapy. Our evaluation shows that medical device-related topics are currently underrepresented in the course of medical education and training and should be given greater consideration in all areas of medical education. Possible solutions are presented.

  7. The eCALM Trial-eTherapy for cancer appLying mindfulness: online mindfulness-based cancer recovery program for underserved individuals living with cancer in Alberta: protocol development for a randomized wait-list controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Zernicke Kristin A

    2013-02-01

    Full Text Available Abstract Background Elevated stress can exacerbate cancer symptom severity, and after completion of primary cancer treatments, many individuals continue to have significant distress. Mindfulness-Based Cancer Recovery (MBCR is an 8-week group psychosocial intervention consisting of training in mindfulness meditation and yoga designed to mitigate stress, pain, and chronic illness. Efficacy research shows face-to-face (F2F MBCR programs have positive benefits for cancer patients; however barriers exist that impede participation in F2F groups. While online MBCR groups are available to the public, none have been evaluated. Primary objective: determine whether underserved patients are willing to participate in and complete an online MBCR program. Secondary objectives: determine whether online MBCR will mirror previous efficacy findings from F2F MBCR groups on patient-reported outcomes. Method/design The study includes cancer patients in Alberta, exhibiting moderate distress, who do not have access to F2F MBCR. Participants will be randomized to either online MBCR, or waiting for the next available group. An anticipated sample size of 64 participants will complete measures online pre and post treatment or waiting period. Feasibility will be tracked through monitoring numbers eligible and participating through each stage of the protocol. Discussion 47 have completed/completing the intervention. Data suggest it is possible to conduct a randomized waitlist controlled trial of online MBCR to reach underserved cancer survivors. Trial registration Clinical Trials.gov Identifier: NCT01476891

  8. Engaging with Underserved Urban Communities on Climate Resilience

    Science.gov (United States)

    Akerlof, K.; Moser, F. C.; Baja, K.; Dindinger, J. M.; Chanse, V.; Rowan, K. E.; Rohring, B.

    2016-12-01

    Meeting the needs of urban high-risk/low-resource communities is one of the most critical challenges in improving climate resilience nationally, but little tailored information exists to guide community engagement efforts specifically for these contexts. This case study describes a collaboration between universities, local governments, and community members working in underserved neighborhoods of the City of Baltimore and Prince George's County, Maryland. In service of current and developing community programs, the team surveyed residents door-to-door about their perceptions of the socio-environmental risks they face, their priorities for change, and the ways in which communication may build protective social capital. We highlight theoretical, applied, and pedagogical aspects of the study that inform both the promise and limitations of these collaborations. These include: 1) the role of citizen participation in climate adaptation decision-making; 2) the meaning, use, and potential impact of community data; 3) balancing differing organizational priorities, timelines, and cultures within community-based projects; and 4) research participation of undergraduate students. The results of the survey illuminate climate risk perceptions in neighborhoods facing complex stressors with lessons for communication and engagement in other urban areas facing similar adaptation challenges.

  9. Innovative Educational Initiatives to Train Psychodynamic Psychiatrists in Underserved Areas of the World.

    Science.gov (United States)

    Alfonso, César A; Michael, Marco Christian; Elvira, Sylvia Detri; Zakaria, Hazli; Kalayasiri, Rasmon; Adlan, Aida Syarinaz A; Moinalghorabaei, Mahdieh; Lukman, Petrin Redayani; San'ati, Mohammad; Duchonova, Katerina; Sullivan, Timothy B

    2018-06-01

    Psychodynamic psychiatry remains a challenging subject to teach in underserved areas, where enthusiasm to learn is substantial. Besides logistical and psychiatric workforce shortcomings, sensible cultural adaptations to make psychodynamic psychiatry relevant outside of high-income countries require creative effort. Innovative pedagogical methods that include carefully crafted mentoring and incorporate videoconferencing in combination with site visits can be implemented through international collaborations. Emphasis on mentoring is essential to adequately train future psychodynamic psychotherapy supervisors. Examples of World Psychiatric Association initiatives in countries such as Indonesia, Iran, Malaysia, and Thailand are presented as possible models to emulate elsewhere. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. Diabetes Screening and Prevention in a High-Risk, Medically Isolated Border Community

    Directory of Open Access Journals (Sweden)

    Ann V. Millard

    2017-06-01

    Full Text Available IntroductionA project in a Texas border community setting, Prevention Organized against Diabetes and Dialysis with Education and Resources (POD2ER, offered diabetes prevention information, screening, and medical referrals. The setting was a large, longstanding flea market that functions as a shopping mall for low-income people. The priority population included medically underserved urban and rural Mexican Americans. Components of the program addressed those with diabetes, prediabetes, and accompanying relatives and friends.BackgroundPeople living in the Lower Rio Grande Valley (LRGV face challenges of high rates of type 2 diabetes, lack of knowledge about prevention, and inadequate access to medical care. Recent statistics from actual community-wide screenings indicate a high diabetes prevalence, 30.7% among adults in the LRGV compared with 12.3% nationwide.MethodsA diverse team composed of public health faculty, students, a physician, a community health worker, and community volunteers conceived and developed the project with a focus on cultural and economic congruence and a user-friendly atmosphere. The program provided screening for prediabetes and diabetes with a hemoglobin A1c test. Screening was offered to those who were at least 25 years of age and not pregnant. When results indicated diabetes, a test for kidney damage was offered (urinary albumin-to-creatinine ratio. A medical appointment at a community clinic within a week was provided to those who tested positive for diabetes and lacked a medical home. Health education modules addressed all family members.DiscussionThe project was successful in recruiting 2,332 high-risk people in 26 months in a community setting, providing clinic referrals to those without a doctor, introducing them to treatment, and providing diabetes prevention information to all project participants. Implications for research and practice are highlighted.ConclusionThis study shows that a regular access point in

  11. Medical Students' Empathy for Vulnerable Groups: Results From a Survey and Reflective Writing Assignment.

    Science.gov (United States)

    Wellbery, Caroline; Saunders, Pamela A; Kureshi, Sarah; Visconti, Adam

    2017-12-01

    As medical education curricula increasingly acknowledge the contributions of the social determinants of health to individual health, new methods of engaging students in the care of vulnerable groups are needed. Empathy is one way to connect students with patients, but little is known about how to nurture students' empathy on behalf of populations. This study examined the relationship between individual and social empathy as groundwork for cultivating students' empathy for vulnerable groups. In 2014-2015, first-year medical students completed the Social Empathy Index at the start and end of a two-semester population health course, and they completed a reflective writing assignment exploring the challenges of caring for vulnerable patients. Pre- and posttest mean survey scores were compared, and reflective writing assignments were analyzed for themes concerning social empathy. Data from 130 students were analyzed. Scores for the contextual understanding of systemic barriers domain increased significantly. There was a trend toward increased cumulative social empathy scores that did not reach statistical significance. Students' essays revealed three themes relating to individual empathy as the foundation for social empathy; civic and moral obligations; and the role of institutional practices in caring for vulnerable groups. This study extends understanding of empathy beyond care for the individual to include care for vulnerable groups. Thus, social empathy may function as a valuable concept in developing curricula to support students' commitment to care for the underserved. Educators first need to address the many barriers students cited that impede both individual and social empathy.

  12. Engaging the underserved: a process model to mobilize rural community health coalitions as partners in translational research.

    Science.gov (United States)

    Davis, Melinda M; Aromaa, Susan; McGinnis, Paul B; Ramsey, Katrina; Rollins, Nancy; Smith, Jamie; Beamer, Beth Ann; Buckley, David I; Stange, Kurt C; Fagnan, Lyle J

    2014-08-01

    Community engagement (CE) and community-engaged research (CEnR) are increasingly recognized as critical elements in research translation. Process models to develop CEnR partnerships in rural and underserved communities are needed. Academic partners transformed four established Community Health Improvement Partnerships (CHIPs) into Community Health Improvement and Research Partnerships (CHIRPs). The intervention consisted of three elements: an academic-community kickoff/orientation meeting, delivery of eight research training modules to CHIRP members, and local community-based participatory research (CBPR) pilot studies addressing childhood obesity. We conducted a mixed methods analysis of pre-/postsurveys, interviews, session evaluations, observational field notes, and attendance logs to evaluate intervention effectiveness and acceptability. Forty-nine community members participated; most (78.7%) attended five or more research training sessions. Session quality and usefulness was high. Community members reported significant increases in their confidence for participating in all phases of research (e.g., formulating research questions, selecting research methods, writing manuscripts). All CHIRP groups successfully conducted CBPR pilot studies. The CHIRP process builds on existing infrastructure in academic and community settings to foster CEnR. Brief research training and pilot studies around community-identified health needs can enhance individual and organizational capacity to address health disparities in rural and underserved communities. © 2014 Wiley Periodicals, Inc.

  13. Attending to Communication and Patterns of Interaction: Culturally Sensitive Mental Health Care for Groups of Urban, Ethnically Diverse, Impoverished, and Underserved Women.

    Science.gov (United States)

    Molewyk Doornbos, Mary; Zandee, Gail Landheer; DeGroot, Joleen

    2014-07-01

    The United States is ethnically diverse. This diversity presents challenges to nurses, who, without empirical evidence to design culturally congruent interventions, may contribute to mental health care disparities. Using Leininger's theory of culture care diversity and universality, this study documented communication and interaction patterns of ethnically diverse, urban, impoverished, and underserved women. Using a community-based participatory research framework, 61 Black, Hispanic, and White women participated in focus groups around their experiences with anxiety/depression. Researchers recorded verbal communication, nonverbal behavior, and patterns of interaction. The women's communication and interaction patterns gave evidence of three themes that were evident across all focus groups and five subthemes that emerged along ethnic lines. The results suggest cultural universalities and cultural uniquenesses relative to the communication and interaction patterns of urban, ethnically diverse, impoverished, and underserved women that may assist in the design of culturally sensitive mental health care. © The Author(s) 2014.

  14. Reaching the hard-to-reach.

    Science.gov (United States)

    Valdes, C

    1992-01-01

    Guatemala's family planning (FP) programs are innovative but contraceptive use is only 23%. Total fertility is 5.3 children/woman, and the 9.5 million population will double in 23 years. The problem is poverty and illiteracy among rural residents removed from health services. 80% live in poverty and 80% are illiterate. Government effort is devoted to combating diseases such as diarrhea so there are few funds for implementing a comprehensive population policy. There is support within the national government but FP lacks priority status. APROFAM's goals are to use innovative marketing methods to inform the rural population who lack access to and knowledge about FP. Service delivery is constrained by the difficulty in reaching remote areas where 4 out of 10 indigenous Guatemalans live. Infant mortality can reach as high as 200/1000 live births. Population growth has slowed, and APROFAM plans to reach 16,000 more in the future. Promotions are conducted in several languages and aired on radio, television, and in the print media. It has been found that market research is the most effective strategy in reaching indigenous families. APROFAM has also been effective in upgrading service facilities through training, client surveys, and setting improved clinic standards. Breastfeeding, training, and voluntary sterilization programs contribute to the primary care effort. The example is given of Paulina Lebron from a very poor area who has learned how to space her children and thus improve the standard of living for her family. Eventually, she convinced herself and her family that sterilization was necessary, and now the couple enjoy the bliss of newlyweds without fear of pregnancy.

  15. A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan

    Science.gov (United States)

    2014-01-01

    Background High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women’s health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. Methods/Design This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as ‘Suraj’ (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. Discussion The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group. PMID:24885657

  16. The impact of socially-accountable, community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce.

    Science.gov (United States)

    Siega-Sur, J L; Woolley, T; Ross, S J; Reeve, C; Neusy, A-J

    2017-10-01

    Developing and retaining a high quality medical workforce, especially within low-resource countries has been a world-wide challenge exacerbated by a lack of medical schools, the maldistribution of doctors towards urban practice, health system inequities, and training doctors in tertiary centers rather than in rural communities. To describe the impact of socially-accountable health professional education on graduates; specifically: their motivation towards community-based service, preparation for addressing local priority health issues, career choices, and practice location. Cross-sectional survey of graduates from two medical schools in the Philippines: the University of Manila-School of Health Sciences (SHS-Palo) and a medical school with a more conventional curriculum. SHS-Palo graduates had significantly (p < 0.05) more positive attitudes to community service. SHS-Palo graduates were also more likely to work in rural and remote areas (p < 0.001) either at district or provincial hospitals (p = 0.032) or in rural government health services (p < 0.001) as Municipal or Public Health Officers (p < 0.001). Graduates also stayed longer in both their first medical position (p = 0.028) and their current position (p < 0.001). SHS-Palo medical graduates fulfilled a key aim of their socially-accountable institution to develop a health professional workforce willing and able, and have a commitment to work in underserved rural communties.

  17. A 5A's communication intervention to promote physical activity in underserved populations

    Directory of Open Access Journals (Sweden)

    Carroll Jennifer K

    2012-10-01

    Full Text Available Abstract Background The present study protocol describes the trial design of a clinician training intervention to improve physical activity counseling in underserved primary care settings using the 5As. The 5As (Ask, Advise, Agree, Assist, Arrange are a clinical tool recommended for health behavior counseling in primary care. Methods/Design The study is a two-arm randomized pilot pragmatic trial to examine a primary care clinician communication intervention on use of the 5As in discussion of physical activity in audio-recorded office visits in an ethnically diverse, low-income patient population. The study setting consists of two federally qualified community health centers in Rochester, NY. Eligible clinicians (n=15 are recruited and randomized into two groups. Group 1 clinicians participate in the training intervention first; Group 2 clinicians receive the intervention six months later. The intervention and its outcomes are informed by self-determination theory and principles of patient-centered communication. Assessment of outcomes is blinded. The primary outcome will be the frequency and quality of 5As discussions as judged by evaluating 375 audio-recorded patient visits distributed over baseline and in the post-intervention period (immediately post and at six months. Secondary outcomes will be changes in patients’ perceived competence to increase physical activity (Aim 2 and patients and clinicians beliefs regarding whether pertinent barriers to promoting exercise have been reduced. (Aim 3. Exploratory outcomes (Aim 4 are potential mediators of the intervention’s effect and whether the intervention affects actual enrollment in the community program recommended for exercise. The analysis will use repeated measures (in the form of recorded office visits from each clinician at each time point and aggregate measures of Groups 1 and 2 over time. Discussion Results will help elucidate the role of 5As communication training for clinicians on

  18. [Medical manuscripts in the library of the Deontology Department of the Ankara University Medical School].

    Science.gov (United States)

    Arda, B

    1998-01-01

    At every academical platform on medical history and its instruction, lack of Turkish medical historiography is mainly emphasized. There are two main factors determining the situation: 1-There isn't any comprehensive Turkish medical history textbook. 2-There are difficulties in reaching the primary sources in this field. Everybody agrees with the importance of reaching medical manuscripts easily and reading and evaluating them in medical history. For this reason, it is important to know where we can find them. In this article, medical manuscripts which are available in the library of the Deontology Department of Ankara University Medical School are introduced. The manuscripts have been listed in alphabetical order of the authors' name. The bibliographic items, such as the size, writing style, and type of paper used, are mentioned.

  19. Development and pilot evaluation of novel genetic educational materials designed for an underserved patient population.

    Science.gov (United States)

    Lubitz, Rebecca Jean; Komaromy, Miriam; Crawford, Beth; Beattie, Mary; Lee, Robin; Luce, Judith; Ziegler, John

    2007-01-01

    Genetic counseling for BRCA1 and BRCA2 mutations involves teaching about hereditary cancer, genetics and risk, subjects that are difficult to grasp and are routinely misunderstood. Supported by a grant from the Avon Foundation, the UCSF Cancer Risk Program started the first genetic testing and counseling service for a population of traditionally underserved women of varied ethnic and social backgrounds at the San Francisco General Hospital (SFGH). Informed by educational theory and clinical experience, we devised and piloted two simplified explanations of heredity and genetic risk, with the aim of uncovering how to best communicate genetics and risk to this underserved population. A "conventional" version comprised pictures of genes, pedigrees, and quantitative representations of risk. A "colloquial" pictorial version used an analogy of the "information book" of genes, family stories and vignettes, and visual representations of risk, without using scientific words such as genes or chromosomes. A verbal narrative accompanied each picture. We presented these modules to four focus groups of five to eight women recruited from the SFGH Family Practice Clinic. Overall, women preferred a picture-based approach and commented that additional text would have been distracting. The majority of women preferred the colloquial version because it was easier to understand and better conveyed a sense of comfort and hope. We conclude that simplicity, analogies, and familiarity support comprehension while vignettes, family stories, and photos of real people provide comfort and hope. These elements may promote understanding of complex scientific topics in healthcare, particularly when communicating with patients who come from disadvantaged backgrounds.

  20. Reaching Our Successors: Millennial Generation Medical Students and Plastic Surgery as a Career Choice

    Directory of Open Access Journals (Sweden)

    Abdulrasheed Ibrahim

    2016-01-01

    Full Text Available Background: Research shows that career choices are made as a result of preconceived ideas and exposure to a specialty. If plastic surgery is to continue to attract the best, factors that may dissuade the millennial generation medical students from pursuing plastic surgery as a career must be identified and addressed. We explored the determinants of interest in plastic surgery as a career choice amongst millennial generation medical students. Materials and Methods: A survey regarding factors considered important in choosing plastic surgery was conducted amongst final year medical students in September 2011. Participants were asked to rate their agreement or disagreement with 18 statements on a four-point Likert scale (1 = very unimportant; 4 = very important. Statistical analyses were performed using Chi-square test to compare categorical variables between male and female medical students. Values of P 3.0 was seen in all the subscales except in gender equity and life style concerns. There were statistically significant differences between male and female students in opinions of a spouse, a significant other, or family members in choosing plastic surgery P < 0.5 and my choice of plastic surgery will be influenced by my decision to have a family P < 0.5. Conclusion: Factors influencing the decision of medical students to choose plastic surgery were related to the perceived quality of life as a plastic surgeon and the ability of plastic surgeons to provide good role models for medical students. Female medical students were more concerned with gender equity and work-life balance in selecting plastic surgery compared to male medical students.

  1. Reaching Our Successors: Millennial Generation Medical Students and Plastic Surgery as a Career Choice

    Science.gov (United States)

    Ibrahim, Abdulrasheed; Asuku, Malachy E

    2016-01-01

    Background: Research shows that career choices are made as a result of preconceived ideas and exposure to a specialty. If plastic surgery is to continue to attract the best, factors that may dissuade the millennial generation medical students from pursuing plastic surgery as a career must be identified and addressed. We explored the determinants of interest in plastic surgery as a career choice amongst millennial generation medical students. Materials and Methods: A survey regarding factors considered important in choosing plastic surgery was conducted amongst final year medical students in September 2011. Participants were asked to rate their agreement or disagreement with 18 statements on a four-point Likert scale (1 = very unimportant; 4 = very important). Statistical analyses were performed using Chi-square test to compare categorical variables between male and female medical students. Values of P 3.0 was seen in all the subscales except in gender equity and life style concerns. There were statistically significant differences between male and female students in opinions of a spouse, a significant other, or family members in choosing plastic surgery P < 0.5 and my choice of plastic surgery will be influenced by my decision to have a family P < 0.5. Conclusion: Factors influencing the decision of medical students to choose plastic surgery were related to the perceived quality of life as a plastic surgeon and the ability of plastic surgeons to provide good role models for medical students. Female medical students were more concerned with gender equity and work-life balance in selecting plastic surgery compared to male medical students. PMID:27013852

  2. Sustainable Supply of Safe Drinking Water for Underserved Households in Kenya: Investigating the Viability of Decentralized Solutions

    Directory of Open Access Journals (Sweden)

    Pauline Chepchirchir Cherunya

    2015-10-01

    Full Text Available Water quality and safe water sources are pivotal aspects of consideration for domestic water. Focusing on underserved households in Kenya, this study compared user perceptions and preferences on water-service provision options, particularly investigating the viability of decentralized models, such as the Safe Water Enterprise (SWE, as sustainable safe drinking water sources. Results showed that among a number of water-service provision options available, the majority of households regularly sourced their domestic water from more than one source (86% Ngoliba/Maguguni, 98% Kangemi Gichagi. A majority of households perceived their water sources to be unsafe to drink (84% Ngoliba/Maguguni, 73% Kangemi Gichagi. For this reason, drinking water was mainly chlorinated (48% Ngoliba/Maguguni, 33% Kangemi Gichagi or boiled (42% Ngoliba/Maguguni, 67% Kangemi Gichagi. However, this study also found that households in Kenya did not apply these household water treatment methods consistently, thus indicating inconsistency in safe water consumption. The SWE concept, a community-scale decentralized safe drinking water source, was a preferred option among households who perceived it to save time and to be less cumbersome as compared to boiling and chlorination. Willingness to pay for SWE water was also a positive indicator for its preference by the underserved households. However, the long-term applicability of such decentralized water provision models needs to be further investigated within the larger water-service provision context.

  3. Reaching the hard to reach.

    Science.gov (United States)

    Bhiwandi, P; Campbell, M; Potts, M

    1994-01-01

    The 1994 International Conference on Population and Development proposed increasing contraceptive couple protection from 550 million in 1995 to 880 million in 2015. The task for family planning (FP) programs is to provide access to services for, sometimes, inaccessible rural populations. FP need based on desire for no more children has ranged from under 20% in Senegal to almost 80% in Peru. Socioeconomic development was found not to be a prerequisite for fertility change. Gender inequalities in education and social autonomy must be changed. FP access is very important among women with a disadvantaged background or among women unsure about FP. Bangladesh is a good example of a country with increased contraceptive prevalence despite low income. The rule of thumb is that contraception increases of 15% contribute to a drop in family size of about one child. Program effectiveness is related to a variety of factors: contraceptive availability at many locations, acceptable price of contraception, delivery of the oral contraceptives without prescriptions, and other strategies. FP is a service not a medical treatment. A range of methods must be promoted and available from a range of facilities. Contraceptive use is dependent on the woman's stage in her lifecycle and is dependent on informed choice. Community-based distribution systems are effective, whereas free distribution by poorly-trained field workers is not always very effective because patient payment of all or part of the cost assures quality and freedom of choice. Effective programs for underprivileged groups involve aggressive, easy to manage programs that can be replicated rapidly. FP serves a useful function in depressing maternal mortality among the poor in Africa, who have no access to quality health services. Social marketing is an effective strategy for reaching remote areas. Political will and robust management are necessary commodities.

  4. SU-F-E-07: Web-Based Training for Radiosurgery: Methods and Metrics for Global Reach

    International Nuclear Information System (INIS)

    Schulz, R; Thomas, E; Popple, R; Fiveash, J; Jacobsen, E

    2016-01-01

    Purpose: Webinars have become an evolving tool with greater or lesser success in reaching health care providers (HCPs). This study seeks to assess best practices and metrics for success in webinar deployment for optimal global reach. Methods: Webinars have been developed and launched to reach practicing health care providers in the field of radiation oncology and radiosurgery. One such webinar was launched in early February 2016. “Multiple Brain Metastases & Volumetric Modulated Arc Radiosurgery: Refining the Single-Isocenter Technique to Benefit Surgeons and Patients” presented by Drs. Fiveash and Thomas from UAB was submitted to and accredited by the Institute for Medical Education as qualifying for CME as well as MDCB for educational credit for dosimetrists, in order to encourage participation. MedicalPhysicsWeb was chosen as the platform to inform attendees regarding the webinar. Further IME accredited the activity for 1 AMA PRA Category 1 credit for physicians & medical physicists. The program was qualified by the ABR in meeting the criteria for self-assessment towards fulfilling MOC requirements. Free SAMs credits were underwritten by an educational grant from Varian Medical Systems. Results: The webinar in question attracted 992 pre-registrants from 66 countries. Outside the US and Canada; 11 were from the Americas; 32 were from Europe; 9 from the Middle East and Africa. Australasia and the Indian subcontinent represented the remaining 14 countries. Pre-registrants included 423 Medical Physicists, 225 Medical Dosimetrists, 24 Radiation Therapists, 66 Radiation Oncologists & other. Conclusion: The effectiveness of CME and SAM-CME programs such as this can be gauged by the high rate of respondents who state an intention to change practice habits, a primary goal of continuing medical education and self-assessment. This webinar succeeded in being the most successful webinar on Medical Physics Web as measured by pre-registration, participation and

  5. SU-F-E-07: Web-Based Training for Radiosurgery: Methods and Metrics for Global Reach

    Energy Technology Data Exchange (ETDEWEB)

    Schulz, R [Varian Medical Systems, Palo Alto, CA (United States); Thomas, E [University of Alabama - Birmingham, Birmingham, AL (United States); Popple, R [The University of Alabama at Birmingham, Birmingham, AL (United States); Fiveash, J [University Alabama Birmingham, Birmingham, AL (United States); Jacobsen, E [Univesity of California, Los Angeles, Los Angeles, CA (United States)

    2016-06-15

    Purpose: Webinars have become an evolving tool with greater or lesser success in reaching health care providers (HCPs). This study seeks to assess best practices and metrics for success in webinar deployment for optimal global reach. Methods: Webinars have been developed and launched to reach practicing health care providers in the field of radiation oncology and radiosurgery. One such webinar was launched in early February 2016. “Multiple Brain Metastases & Volumetric Modulated Arc Radiosurgery: Refining the Single-Isocenter Technique to Benefit Surgeons and Patients” presented by Drs. Fiveash and Thomas from UAB was submitted to and accredited by the Institute for Medical Education as qualifying for CME as well as MDCB for educational credit for dosimetrists, in order to encourage participation. MedicalPhysicsWeb was chosen as the platform to inform attendees regarding the webinar. Further IME accredited the activity for 1 AMA PRA Category 1 credit for physicians & medical physicists. The program was qualified by the ABR in meeting the criteria for self-assessment towards fulfilling MOC requirements. Free SAMs credits were underwritten by an educational grant from Varian Medical Systems. Results: The webinar in question attracted 992 pre-registrants from 66 countries. Outside the US and Canada; 11 were from the Americas; 32 were from Europe; 9 from the Middle East and Africa. Australasia and the Indian subcontinent represented the remaining 14 countries. Pre-registrants included 423 Medical Physicists, 225 Medical Dosimetrists, 24 Radiation Therapists, 66 Radiation Oncologists & other. Conclusion: The effectiveness of CME and SAM-CME programs such as this can be gauged by the high rate of respondents who state an intention to change practice habits, a primary goal of continuing medical education and self-assessment. This webinar succeeded in being the most successful webinar on Medical Physics Web as measured by pre-registration, participation and

  6. The Reality of Sustaining Community-Based Sport and Physical Activity Programs to Enhance the Development of Underserved Youth: Challenges and Potential Strategies

    Science.gov (United States)

    Whitley, Meredith A.; Forneris, Tanya; Barker, Bryce

    2015-01-01

    Many community-based sport and physical activity programs take a positive youth development approach when operating in underserved communities around the world (Forneris, Whitley, & Barker, 2013). However, one of the biggest challenges for these programs is sustainability (Lindsey, 2008). The purpose of this article is to present the 3…

  7. The impact of public hospital closure on medical and residency education: implications and recommendations.

    Science.gov (United States)

    Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

    2008-12-01

    Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Retrospective cohort study of medical students' and residents' and clinical placement into safety-net experiences after the closure of the primary teaching hospital. The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location.

  8. REACH MUSC: A Telemedicine Facilitated Network for Stroke: Initial Operational Experience

    Science.gov (United States)

    Adams, Robert J.; Debenham, Ellen; Chalela, Julio; Chimowitz, Marc; Hays, Angela; Hill, Cody; Holmstedt, Christine; Jauch, Edward; Kitch, Alec; Lazaridis, Christos; Turan, Tanya N.

    2012-01-01

    REACH Medical University of South Carolina (MUSC) provides stroke consults via the internet in South Carolina. From May 2008 to April 2011 231 patients were treated with intravenous (IV) thrombolysis and 369 were transferred to MUSC including 42 for intra-arterial revascularization [with or without IV tissue plasminogen activator (tPA)]. Medical outcomes and hemorrhage rates, reported elsewhere, were good (Lazaridis et al., 2011). Here we report operational features of REACH MUSC which covers 15 sites with 2,482 beds and 471,875 Emergency Department (ED) visits per year. Eight Academic Faculty from MUSC worked with 165 different physicians and 325 different nurses in the conduct of 1085 consults. For the 231 who received tPA, time milestones (in minutes) were: Onset to Door: 62 (mean), 50 (median); Door to REACH Consult: 43 and 33, Consult Request to Consult Start: was 9 and 7, Consult Start to tPA Decision: 31 and 25; Decision to Infusion: 20 and 14, and total Door to Needle: 98 and 87. The comparable times for the 854 not receiving tPA were: Onset to Door: 140 and 75; Door to REACH Consult: 61 and 41; Consult Request to Consult Start: 9 and 7, Consult Start to tPA Decision: 27 and 23. While the consultants respond to consult requests in <10, there is a long delay between arrival and Consult request. Tracking of operations indicates if we target shortening Door to Call time and time from tPA decision to start of drug infusion we may be able to improve Door to Needle times to target of <60. The large number of individuals involved in the care of these patients, most of whom had no training in REACH usage, will require novel approaches to staff education in ED based operations where turnover is high. Despite these challenges, this robust system delivered tPA safely and in a high fraction of patients evaluated using the REACH MUSC system. PMID:22435064

  9. REACH MUSC: A telemedicine facilitated network for urgent stroke: initial experience

    Directory of Open Access Journals (Sweden)

    Robert J. Adams

    2012-03-01

    Full Text Available REACH MUSC provides stroke consults via the internet in South Carolina. From May 2008 to April 2011 231 patients were treated with intravenous (IV thrombolysis and 369 were transferred to Medical University of South Carolina (MUSC including 42 for intra-arterial revascularization (with or without IV tPA. Medical outcomes and hemorrhage rates, reported elsewhere, were good (Lazaridis et al. 2011, in press. Here we report operational features of REACH MUSC which covers 15 sites with 2,482 beds and 471,875 Emergency Department (ED visits per year. Eight Academic Faculty from MUSC worked with 165 different physicians and 325 different nurses in the conduct of 1085 consults. For the 231 who received tissue plasminogen activator (tPA, time milestones were: Onset to Door: 62 min (mean, 50 (median; Door to REACH Consult: 43 and 33, Consult Request to Consult Start: was 9 and 7 minutes, Consult Start to tPA Decision: 31 and 25 minutes; Decision to Infusion: 20 and 14 minutes, and total Door to Needle: 98 and 87 minutes. The comparable times for the 854 not receiving tPA were: Onset to Door: 140 and 75 minutes; Door to REACH Consult: 61 and 41 minutes; Consult Request to Consult Start 9 and 7 minutes, Consult Start to tPA Decision 27 and 23 minutes. While the consultants respond to consult requests in < 10 minutes, there is a long delay between arrival and Consult request. Tracking of operations indicates if we target shortening Door to Call time and time from tPA decision to start of drug infusion we may be able to improve Door to Needle times to target of < 60 minutes. The large number of individuals involved in the care of these patients, most of whom had no training in REACH usage,will require novel approaches to staff education in ED based operations where turnover is high. Despite these challenges this robust system delivered tPA safely and in a high fraction of patients evaluated using the REACH MUSC system.

  10. So simple, so hard: Taking medication as directed.

    Science.gov (United States)

    Burkholder, Rebecca; Linn, Elaine

    Millions of Americans either fail to take the full course of prescribed medication or they take it incorrectly. The problem is particularly serious for people with cardiovascular disease, respiratory disease, and diabetes, and for racially and ethnically diverse populations. The (U.S.) National Consumers League through its Script Your Future medication adherence awareness campaign presented the conference "So Simple, So Hard: Taking Medications as Directed", convening health care professionals, community health workers, consumer and patient advocates, researchers, industry representatives, public agencies, and policymakers. This a one-day research symposium aimed to explore challenges and barriers to medication adherence and to highlight tools and strategies to improve adherence and health outcomes, particularly among underserved populations. The conference began with presentations on adherence research and health disparities, and continued with presentations on strategies and tools to improve adherence that could be utilized in health care practices or organizations (including assessing adherence, medication synchronization, and comprehensive medication management). Through group discussions, the conference provided a forum for participants to interact and lay the groundwork to develop partnerships for collaborative initiatives to improve appropriate medication use and adherence. Participants surveyed at the end of the day and 30 days after the conference reported that they found the meeting highly useful (rated 4.6 out of 5), with the vast majority saying they learned about research and tools they can apply in their work and made new connections for potential collaborations. The conference learnings are being shared by participants and disseminated to other interested organizations and individuals. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. The Health Sciences and Technology Academy: an educational pipeline to address health care disparities in West Virginia.

    Science.gov (United States)

    McKendall, Sherron Benson; Kasten, Kasandra; Hanks, Sara; Chester, Ann

    2014-01-01

    Health and educational disparities are national issues in the United States. Research has shown that health care professionals from underserved backgrounds are more likely than others to work in underserved areas. The Association of American Medical Colleges' Project 3000 by 2000, to increase the number of underrepresented minorities in medical schools, spurred the West Virginia School of Medicine to start the Health Sciences and Technology Academy (HSTA) in 1994 with the goal of supporting interested underrepresented high school students in pursuing college and health professions careers. The program was based on three beliefs: (1) if underrepresented high school students have potential and the desire to pursue a health professions career and are given the support, they can reach their goals, including obtaining a health professions degree; (2) underserved high school students are able to predict their own success if given the right resources; and (3) community engagement would be key to the program's success.In this Perspective, the authors describe the HSTA and its framework and philosophy, including the underlying theories and pedagogy from research in the fields of education and the behavioral/social sciences. They then offer evidence of the program's success, specifically for African American students, including graduates' high college-going rate and overwhelming intention to choose a health professions major. Finally, the authors describe the benefits of the HSTA's community partnerships, including providing mentors to students, adding legislative language providing tuition waivers and a budgetary line item devoted to the program, and securing program funding from outside sources.

  12. Reaching out for patients: public relations and events with real results.

    Science.gov (United States)

    Kuechel, Marie Czenko

    2010-02-01

    In today's market, the aesthetic physician needs to connect with patients using methods that are personal, educational, and that will glean the interest of prospective patients whose attention and dollars are sought by countless facial plastic surgery competitors near and far. Public relations, or reaching your prospective patient without a direct solicitation (advertising) for services, are traditional means that include media relations and charitable and social events. With the added component of social media, today the opportunities to reach out for new patients and garner real results are more varied and more affordable than ever before. Thieme Medical Publishers.

  13. Medical student experiences in prison health services and social cognitive career choice: a qualitative study.

    Science.gov (United States)

    Brooker, Ron; Hu, Wendy; Reath, Jennifer; Abbott, Penelope

    2018-01-02

    One of the purposes of undergraduate medical education is to assist students to consider their future career paths in medicine, alongside the needs of the societies in which they will serve. Amongst the most medically underserved groups of society are people in prison and those with a history of incarceration. In this study we examined the experiences of medical students undertaking General Practice placements in a prison health service. We used the theoretical framework of the Social Cognitive Career Theory (SCCT) to explore the potential of these placements to influence the career choices of medical students. Questionnaire and interview data were collected from final year students, comprising pre and post placement questionnaire free text responses and post placement semi-structured interviews. Data were analysed using inductive thematic analysis, with reference to concepts from the SCCT Interest Model to further develop the findings. Clinical education delivered in a prison setting can provide learning that includes exposure to a wide variety of physical and mental health conditions and also has the potential to stimulate career interest in an under-served area. While students identified many challenges in the work of a prison doctor, increased confidence (SCCT- Self-Efficacy) occurred through performance success within challenging consultations and growth in a professional approach to prisoners and people with a history of incarceration. Positive expectations (SCCT- Outcome Expectations) of fulfilling personal values and social justice aims and of achieving public health outcomes, and a greater awareness of work as a prison doctor, including stereotype rejection, promoted student interest in working with people in contact with the criminal justice system. Placements in prison health services can stimulate student interest in working with prisoners and ex-prisoners by either consolidating pre-existing interest or expanding interest into a field they had not

  14. Neighborhood Social Predictors of Weight-related Measures in Underserved African Americans in the PATH Trial.

    Science.gov (United States)

    McDaniel, Tyler C; Wilson, Dawn K; Coulon, Sandra M; Hand, Gregory A; Siceloff, E Rebekah

    2015-11-05

    African Americans have the highest rate of obesity in the United States relative to other ethnic minority groups. Bioecological factors including neighborhood social and physical environmental variables may be important predictors of weight-related measures specifically body mass index (BMI) in African American adults. Baseline data from the Positive Action for Today's Health (PATH) trial were collected from 417 African American adults. Overall a multiple regression model for BMI was significant, showing positive associations with average daily moderate-to-vigorous physical activity (MVPA) (B =-.21, Psocial interaction (B =-.13, Psocial interaction was associated with healthier BMI, highlighting it as a potential critical factor for future interventions in underserved, African American communities.

  15. Reaching Our Successors: Millennial Generation Medical Students and Plastic Surgery as a Career Choice.

    Science.gov (United States)

    Ibrahim, Abdulrasheed; Asuku, Malachy E

    2016-01-01

    Research shows that career choices are made as a result of preconceived ideas and exposure to a specialty. If plastic surgery is to continue to attract the best, factors that may dissuade the millennial generation medical students from pursuing plastic surgery as a career must be identified and addressed. We explored the determinants of interest in plastic surgery as a career choice amongst millennial generation medical students. A survey regarding factors considered important in choosing plastic surgery was conducted amongst final year medical students in September 2011. Participants were asked to rate their agreement or disagreement with 18 statements on a four-point Likert scale (1 = very unimportant; 4 = very important). Statistical analyses were performed using Chi-square test to compare categorical variables between male and female medical students. Values of P 3.0 was seen in all the subscales except in gender equity and life style concerns. There were statistically significant differences between male and female students in opinions of a spouse, a significant other, or family members in choosing plastic surgery P work-life balance in selecting plastic surgery compared to male medical students.

  16. Integrating Lesbian, Gay, Bisexual, and Transgender (LGBT) Content Into Undergraduate Medical School Curricula: A Qualitative Study.

    Science.gov (United States)

    Sequeira, Gina M; Chakraborti, Chayan; Panunti, Brandy A

    2012-01-01

    The lesbian, gay, bisexual, and transgender (LGBT) community is a diverse, underserved, and often stigmatized group that faces many barriers to accessing quality healthcare. Not only are few practicing physicians knowledgeable about and sensitive to the needs of LGBT patients, but medical school curricula include limited LGBT-related content. Our goals were to use LGBT-related educational sessions to gauge undergraduate medical students' interest and their perceptions of relevance and to eventually incorporate this topic into the curriculum. We provided 4 educational sessions to preclinical medical students at the Tulane University School of Medicine: 3 optional, 1-hour didactic sessions and 1 standardized patient encounter. Following sessions 1-3, students completed electronic feedback forms; we then analyzed their responses thematically. THE THEMATIC ANALYSIS OF STUDENT RESPONSES IDENTIFIED KEY THEMES: a current lack of exposure to LGBT content, agreement that LGBT material is applicable to students' work as future physicians, and the relevance of including such information in the medical school curriculum. The study validated the underlying assumption that LGBT educational sessions are meaningful to and valued by medical students.

  17. Enhancing the Reach of Cognitive-Behavioral Therapy Targeting Posttraumatic Stress in Acute Care Medical Settings.

    Science.gov (United States)

    Darnell, Doyanne; O'Connor, Stephen; Wagner, Amy; Russo, Joan; Wang, Jin; Ingraham, Leah; Sandgren, Kirsten; Zatzick, Douglas

    2017-03-01

    Injured patients presenting to acute care medical settings have high rates of posttraumatic stress disorder (PTSD) and comorbidities, such as depression and substance use disorders. Integrating behavioral interventions that target symptoms of PTSD and comorbidities into the acute care setting can overcome common barriers to obtaining mental health care. This study examined the feasibility and acceptability of embedding elements of cognitive-behavioral therapy (CBT) in the delivery of routine postinjury care management. The investigation also explored the potential effectiveness of completion of CBT element homework that targeted PTSD symptom reduction. This study was a secondary analysis of data from a U.S. clinical trial of the effectiveness of a stepped collaborative care intervention versus usual care for injured inpatients. The investigation examined patients' willingness at baseline (prerandomization) to engage in CBT and pre- and postrandomization mental health service utilization among 115 patients enrolled in the clinical trial. Among intervention patients (N=56), the investigation examined acceptability of the intervention and used multiple linear regression to examine the association between homework completion as reported by the care manager and six-month PTSD symptom reduction as assessed by the PTSD Checklist-Civilian DSM-IV Version. Patients in the intervention condition reported obtaining significantly more psychotherapy or counseling than patients in the control group during the six-month follow-up, as well as a high degree of intervention acceptability. Completion of CBT element homework assignments was associated with improvement in PTSD symptoms. Integrating behavioral interventions into routine acute care service delivery may improve the reach of evidence-based mental health care targeting PTSD.

  18. Camp NERF: methods of a theory-based nutrition education recreation and fitness program aimed at preventing unhealthy weight gain in underserved elementary children during summer months.

    Science.gov (United States)

    Hopkins, Laura C; Fristad, Mary; Goodway, Jacqueline D; Eneli, Ihuoma; Holloman, Chris; Kennel, Julie A; Melnyk, Bernadette; Gunther, Carolyn

    2016-10-26

    The number of obese children in the US remains high, which is problematic due to the mental, physical, and academic effects of obesity on child health. Data indicate that school-age children, particularly underserved children, experience unhealthy gains in BMI at a rate nearly twice as fast during the summer months. Few efforts have been directed at implementing evidence-based programming to prevent excess weight gain during the summer recess. Camp NERF is an 8-week, multi-component (nutrition, physical activity, and mental health), theory-based program for underserved school-age children in grades Kindergarten - 5th coupled with the USDA Summer Food Service Program. Twelve eligible elementary school sites will be randomized to one of the three programming groups: 1) Active Control (non-nutrition, physical activity, or mental health); 2) Standard Care (nutrition and physical activity); or 3) Enhanced Care (nutrition, physical activity, and mental health) programming. Anthropometric, behavioral, and psychosocial data will be collected from child-caregiver dyads pre- and post-intervention. Site-specific characteristics and process evaluation measures will also be collected. This is the first, evidence-based intervention to address the issue of weight gain during the summer months among underserved, school-aged children. Results from this study will provide researchers, practitioners, and public health professionals with insight on evidence-based programming to aid in childhood obesity prevention during this particular window of risk. NCT02908230/09-19-2016.

  19. Retaining health workforce in rural and underserved areas of India: What works and what doesn't? A critical interpretative synthesis.

    Science.gov (United States)

    Goel, Sonu; Angeli, Federica; Bhatnagar, Nidhi; Singla, Neetu; Grover, Manoj; Maarse, Hans

    2016-01-01

    Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8%), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas. We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low- and middle-income countries. Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban-rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions-are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas. A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence- based strategies are needed to ensure context-specific, field- tested and cost

  20. Workplace-based assessment for vocational registration of international medical graduates.

    Science.gov (United States)

    Lillis, Steven; Van Dyk, Valencia

    2014-01-01

    Medical regulatory authorities need efficient and effective methods of ensuring the competence of immigrating international medical graduates (IMGs). Not all IMGs who apply for specialist vocational registration will have directly comparable qualifications to those usually accepted. As general licensure examinations are inappropriate for these doctors, workplace-based assessment (WBA) techniques would appear to provide a solution. However, there is little published data on such outcomes. All cases of WBA (n = 81) used for vocational registration of IMGs in New Zealand between 2008 and 2013 were collated and analyzed. The successful completion rate of IMGs through the pathway was 87%. The majority (64%) undertook the year of supervised practice and the final assessment in a provincial center. For those unsuccessful in the pathway, inadequate clinical knowledge was the most common deficit found, followed by poor clinical reasoning. A WBA approach for assessing readiness of IMGs for vocational registration is feasible. The constructivist theoretical perspective of WBA has particular advantages in assessing the standard of practice for experienced practitioners working in narrow scopes than traditional methods of assessment. The majority of IMGs undertook both the clinical year and the assessment in provincial hospitals, thus providing a workforce for underserved areas. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  1. The Influence of Parental Health Literacy Status on Reach, Attendance, Retention, and Outcomes in a Family-Based Childhood Obesity Treatment Program, Virginia, 2013-2015.

    Science.gov (United States)

    Zoellner, Jamie M; Hill, Jennie; You, Wen; Brock, Donna; Frisard, Madlyn; Alexander, Ramine; Silva, Fabiana; Price, Bryan; Marshall, Ruby; Estabrooks, Paul A

    2017-09-28

    Few interventions have evaluated the influence of parent health literacy (HL) status on weight-related child outcomes. This study explores how parent HL affects the reach, attendance, and retention of and outcomes in a 3-month multicomponent family-based program to treat childhood obesity (iChoose). This pre-post, quasiexperimental trial occurred in the Dan River Region, a federally designated medically underserved area. iChoose research protocol and intervention strategies were designed using an HL universal precautions approach. We used validated measures, standardized data collection techniques, and generalized linear mixed-effect parametric models to determine the moderation effect of parent HL on outcomes. No significant difference in HL scores were found between parents who enrolled their child in the study and those who did not. Of 94 enrolled parents, 34% were low HL, 49% had an annual household income of less than $25,000, and 39% had a high school education or less. Of 101 enrolled children, 60% were black, and the mean age was 9.8 (standard deviation, 1.3) years. Children of parents with both low and high HL attended and were retained at similar rates. Likewise, parent HL status did not significantly influence improvements in effectiveness outcomes (eg, child body mass index [BMI] z scores, parent BMI, diet and physical activity behaviors, quality of life), with the exception of child video game/computer screen time; low HL decreased and high HL increased screen time (coefficient = 0.52, standard error, 0.11, P parents, children of parents with low HL engaged in and benefited from a family-based childhood obesity treatment program similar to children of parents with high HL.

  2. Self-collected cervicovaginal sampling for site-of-care primary HPV-based cervical cancer screening: a pilot study in a rural underserved Greek population.

    Science.gov (United States)

    Chatzistamatiou, Kimon; Chatzaki, Εkaterini; Constantinidis, Τheocharis; Nena, Evangelia; Tsertanidou, Athena; Agorastos, Theodoros

    2017-11-01

    In the present pilot study, the feasibility of a site-of-care cervicovaginal self-sampling methodology for HPV-based screening was tested in 346 women residing in underserved rural areas of Northern Greece. These women provided self-collected cervicovaginal sample along with a study questionnaire. Following molecular testing, using the cobas ® HPV Test, Roche ® , HPV positive women, were referred to colposcopy and upon abnormal findings, to biopsy and treatment. Participation rate was 100%. Regular pap-test examination was reported for 17.1%. Among hrHPV testing, 11.9% were positive and colposcopy/biopsy revealed 2 CIN3 cases. Non-compliance was the most prevalent reason for no previous attendance. Most women reported non-difficulty and non-discomfort in self-sampling (77.6% and 82.4%, respectively). They would choose self-sampling over clinician-sampling (86.2%), and should self-sampling being available, they would test themselves more regularly (92.3%). In conclusion, self-sampling is feasible and well-accepted for HPV-based screening, and could increase population coverage in underserved areas, helping towards successful prevention.

  3. The prevalence of visual impairment and blindness in underserved rural areas: a crucial issue for future.

    Science.gov (United States)

    Hashemi, H; Yekta, A; Jafarzadehpur, E; Doostdar, A; Ostadimoghaddam, H; Khabazkhoob, M

    2017-08-01

    PurposeTo determine the prevalence of visual impairment and blindness in underserved Iranian villages and to identify the most common cause of visual impairment and blindness.Patients and methodsMultistage cluster sampling was used to select the participants who were then invited to undergo complete examinations. Optometric examinations including visual acuity, and refraction were performed for all individuals. Ophthalmic examinations included slit-lamp biomicroscopy and ophthalmoscopy. Visual impairment was determined according to the definitions of the WHO and presenting vision.ResultsOf 3851 selected individuals, 3314 (86.5%) participated in the study. After using the exclusion criteria, the present report was prepared based on the data of 3095 participants. The mean age of the participants was 37.6±20.7 years (3-93 years). The prevalence of visual impairment and blindness was 6.43% (95% confidence interval (CI): 3.71-9.14) and 1.18% (95% CI: 0.56-1.79), respectively. The prevalence of visual impairment varied from 0.75% in participants aged less than 5 years to 38.36% in individuals above the age of 70 years. Uncorrected refractive errors and cataract were the first and second leading causes of visual impairment; moreover, cataract and refractive errors were responsible for 35.90 and 20.51% of the cases of blindness, respectively.ConclusionThe prevalence of visual impairment was markedly high in this study. Lack of access to health services was the main reason for the high prevalence of visual impairment in this study. Cataract and refractive errors are responsible for 80% of visual impairments which can be due to poverty in underserved villages.

  4. Service-Learning as a Model for Integrating Social Justice in the Nursing Curriculum.

    Science.gov (United States)

    Redman, Richard W.; Clark, Lauren

    2002-01-01

    A service learning nursing course grounded in social justice principles focused on minority health, poverty, environmental health, and medically underserved populations. Students worked in community agencies, advocated for the underserved, and reflected on the relationship of social justice and citizenship to nursing. (SK)

  5. Understanding the performance of community health volunteers involved in the delivery of health programmes in underserved areas: a realist synthesis

    OpenAIRE

    Vareilles, Ga?lle; Pommier, Jeanine; Marchal, Bruno; Kane, Sumit

    2017-01-01

    Background The recruitment of community health volunteers (CHVs) to support the delivery of health programmes is an established approach in underserved areas and in particular where there are health inequalities due to the scarcity of trained human resources. However, there is a dearth of evidence about what works to improve CHVs? performance. This review aimed to synthesise existing literature to explain why, how and under which circumstances intervention approaches to improve the performanc...

  6. The mCME Project: A Randomized Controlled Trial of an SMS-Based Continuing Medical Education Intervention for Improving Medical Knowledge among Vietnamese Community Based Physicians' Assistants.

    Directory of Open Access Journals (Sweden)

    Christopher J Gill

    Full Text Available Community health workers (CHWs provide critical services to underserved populations in low and middle-income countries, but maintaining CHW's clinical knowledge through formal continuing medical education (CME activities is challenging and rarely occurs. We tested whether a Short Message Service (SMS-based mobile CME (mCME intervention could improve medical knowledge among a cadre of Vietnamese CHWs (Community Based Physician's Assistants-CBPAs who are the leading providers of primary medical care for rural underserved populations.The mCME Project was a three arm randomized controlled trial. Group 1 served as controls while Groups 2 and 3 experienced two models of the mCME intervention. Group 2 (passive model participants received a daily SMS bullet point, and were required to reply to the text to acknowledge receipt; Group 3 (interactive model participants received an SMS in multiple choice question format addressing the same thematic area as Group 2, entering an answer (A, B, C or D in their response. The server provided feedback immediately informing the participant whether the answer was correct. Effectiveness was based on standardized examination scores measured at baseline and endline (six months later. Secondary outcomes included job satisfaction and self-efficacy.638 CBPAs were enrolled, randomized, and tested at baseline, with 592 returning at endline (93.7%. Baseline scores were similar across all three groups. Over the next six months, participation of Groups 2 and 3 remained high; they responded to >75% of messages. Group 3 participants answered 43% of the daily SMS questions correctly, but their performance did not improve over time. At endline, the CBPAs reported high satisfaction with the mCME intervention, and deemed the SMS messages highly relevant. However, endline exam scores did not increase over baseline, and did not differ between the three groups. Job satisfaction and self-efficacy scores also did not improve. Average

  7. Reaching Non-Traditional and Under-Served Communities through Global Astronomy Month Programs

    Science.gov (United States)

    Simmons, Michael

    2013-01-01

    Global Astronomy Month (GAM), organized each year by Astronomers Without Borders (AWB), has become the world's largest annual celebration of astronomy. Launched as a follow-up to the unprecedented success of the 100 Hours of Astronomy Cornerstone Project of IYA2009, GAM quickly attracted not only traditional partners in astronomy and space science outreach, but also unusual partners from very different fields. GAM's third annual edition, GAM2012, included worldwide programs for the sight-impaired, astronomy in the arts, and other non-traditional programs. The special planetarium program, OPTICKS, combined elements such as Moonbounce (sending images to the Moon and back) and artistic elements in a unique presentation of the heavens. Programs were developed to present the heavens to the sight-impaired as well. The Cosmic Concert, in which a new musical piece is composed each year, combined with background images of celestial objects, and presented during GAM, has become an annual event. Several astronomy themed art video projects were presented online. AWB's Astropoetry Blog held a very successful contest during GAM2012 that attracted more than 70 entries from 17 countries. Students were engaged by participation in special GAM campaigns of the International Asteroid Search Campaign. AWB and GAM have both developed into platforms where innovative programs can develop, and interdisciplinary collaborations can flourish. As AWB's largest program, GAM brings the audience and resources that provide a boost for these new types of programs. Examples, lessons learned, new projects, and plans for the future of AWB and GAM will be presented.

  8. Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: Cross-sectional analysis of data from Bangladesh, India and Nepal

    NARCIS (Netherlands)

    M. Neuman (Melissa); G. Alcock (Glyn); K. Azad (Kishwar); A. Kuddus (Abdul); D. Osrin (David); N. Shah More (Neena); N. Nair (Nirmala); P. Tripathy (Prasanta); C. Sikorski (Catherine); N. Saville (Naomi); A. Sen (Aman); T. Colbourn (Tim); A.J. Houweling (Tanja); N. Seward (Nadine); A. Manandhar; B. Shrestha (Bhim); A. Costello (Anthony); A. Prost (Audrey)

    2014-01-01

    textabstractObjectives: To describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communities in South Asia. Design: Cross-sectional study. Setting: 81 community-based geographical clusters in four locations in Bangladesh, India

  9. Smartphone threshold audiometry in underserved primary health-care contexts.

    Science.gov (United States)

    Sandström, Josefin; Swanepoel, De Wet; Carel Myburgh, Hermanus; Laurent, Claude

    2016-01-01

    To validate a calibrated smartphone-based hearing test in a sound booth environment and in primary health-care clinics. A repeated-measure within-subject study design was employed whereby air-conduction hearing thresholds determined by smartphone-based audiometry was compared to conventional audiometry in a sound booth and a primary health-care clinic environment. A total of 94 subjects (mean age 41 years ± 17.6 SD and range 18-88; 64% female) were assessed of whom 64 were tested in the sound booth and 30 within primary health-care clinics without a booth. In the sound booth 63.4% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dB HL corresponded to smartphone thresholds within ≤10 dB in 80.6% of cases with an average threshold difference of -1.6 dB ± 9.9 SD. In primary health-care clinics 13.7% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dBHL corresponded to smartphone thresholds within ≤10 dB in 92.9% of cases with an average threshold difference of -1.0 dB ± 7.1 SD. Accurate air-conduction audiometry can be conducted in a sound booth and without a sound booth in an underserved community health-care clinic using a smartphone.

  10. Cultivation and Implementation of Community-Engaged Pharmacy Services in a Free Clinic to Enhance Care for the Medically Underserved

    Directory of Open Access Journals (Sweden)

    Emmeline Tran, Pharm.D. Candidate

    2013-01-01

    Full Text Available Partnerships between community free clinics and academic medical centers improve patient outcomes and enhance learning opportunities for students. A community-academic partnership between the Maliheh Free Clinic and the University of Utah College of Pharmacy was formed to fulfill a community need for pharmacy services, to promote interdisciplinary patient care, and to provide an experiential opportunity for students. The Maliheh Free Clinic based in Salt Lake City, Utah provides free primary health care to uninsured individuals who live 150% below federal poverty guidelines. Three pharmacy services were developed and implemented. These include: 1 clinic chart reviews which involve written recommendations following a comprehensive assessment of the patient’s chart examining his or her disease states and the appropriateness of his or her medications; 2 medication reconciliations and discussion of pharmacy-related recommendations with patients during Diabetes Day, an inclusive interdisciplinary patient appointment that addresses important aspects of diabetes care; and 3 an insulin dose adjustment service through a collaborative practice agreement with the clinic to monitor a patient’s blood glucose levels and adjust his or her medications accordingly on a weekly basis.

  11. The Engineering 4 Health Challenge - an interdisciplinary and intercultural initiative to foster student engagement in B.C. and improve health care for children in under-serviced communities.

    Science.gov (United States)

    Price, Morgan; Weber-Jahnke, Jens H

    2009-01-01

    This paper describes the Engineering 4 Health (E4H) Challenge, an interdisciplinary and intercultural initiative that, on the one hand, seeks to improve health education of children in under-serviced communities and, on the other, seeks to attract students in British Columbia to professions in engineering and health. The E4H Challenge engages high school and university students in BC to cooperatively design and develop health information and communication technology (ICT) to educate children living in under-serviced communities. The E4H Challenge works with the One Laptop Per Child (OLPC) program to integrate applications for health awareness into the school programs of communities in developing countries. Although applications developed by the E4H Challenge use the low-cost, innovative XO laptop (the "$100 laptop" developed by the OLPC foundation) the software can also be used with other inexpensive hardware.

  12. Positive implications from socially accountable, community-engaged medical education across two Philippines regions.

    Science.gov (United States)

    Woolley, Torres; Cristobal, Fortunato; Siega-Sur, Jusie; Ross, Simone; Neusy, Andre-Jacques; Halili, Servando; Reeve, Carole

    2018-02-01

    Hundreds of millions of people worldwide lack access to quality health services, largely because of geographic and socioeconomic maldistribution of qualified practitioners. This study describes differences between the practice locations of Philippines medical graduates from two 'socially accountable, community-engaged' health professional education (SAHPE) schools and the practice locations of graduates from two 'conventionally trained' medical schools located in the same respective geographic regions. Licensed medical graduates were currently practising in the Philippines and had been practising for at least 6 months. Graduates were from two Philippines SAHPE schools (Ateneo de Zamboanga University-School of Medicine (ADZU-SOM) on the Zamboanga Peninsula (n=212) and the University of the Philippines Manila-School of Health Sciences (SHS-Palo) in Eastern Visayas (n=71), and from two 'conventional' medical schools Methods: Current graduate practice locations in municipalities or cities were linked with their respective population size and socioeconomic income class, and geocoded using Geographical Information System software onto a geospatial map of the Philippines. Bivariate analysis compared the population size and socioeconomic class of communities where the SAHPE medical graduates practised to communities where 'conventional' medical school graduates practised. Thirty-one percent of ADZU-SOM medical graduates practised in communities play a significant role in graduates choosing to practice in rural and/or economically disadvantaged communities. Governments experiencing medical workforce maldistributions similar to those in the Philippines should consider SAHPE as a potentially cost-effective strategy in recruiting and retaining health graduates to underserved areas.

  13. Differential access to digital communication technology: association with health and health survey recruitment within an African-American underserviced urban population.

    Science.gov (United States)

    Schneider, John; Makelarski, Jennifer A; Van Haitsma, Martha; Lipton, Rebecca B; Abramsohn, Emily; Lauderdale, Diane S; Lindau, Stacy Tessler

    2011-06-01

    Digital communication technologies (DCT), such as cell phones and the internet, have begun to replace more traditional technologies even in technology-poor communities. We characterized access to DCT in an underserved urban population and whether access is associated with health and study participation. A general probability community sample and a purposive high-turnover housing sample were recruited and re-interviewed after 3 months. Selected characteristics were compared by sample type and retention. Associations between DCT access and self-reported health were examined using multivariable logistic regression. Of 363 eligible individuals, 184 (general community = 119; high-turnover housing = 65) completed the baseline survey. Eighty-four percent of respondents had a cell phone and 62% had ever texted. Ever use of the internet was high (69%) overall, but frequency and years of internet use were higher in the general community sample. Self-reported fair or poor health was more common for residents of cell phone-only households and those with less frequent internet use. Technology use was similar for those retained and not retained. Overall, access to DCT was high in this underserved urban population but varied by sample type. Health varied significantly by DCT use, but study retention did not. These data have implications for incorporating DCT into health-related research in urban populations.

  14. Bringing cutting-edge Earth and ocean sciences to under-served and rural audiences through informal science education

    Science.gov (United States)

    Cooper, S. K.; Petronotis, K. E.; Ferraro, C.; Johnson, K. T. M.; Yarincik, K.

    2017-12-01

    The International Ocean Discovery Program (IODP) is an international marine research collaboration that explores Earth's history and dynamics using ocean-going research platforms to recover data recorded in seafloor sediments and rocks and to monitor subseafloor environments. The JOIDES Resolution is the flagship vessel of IODP and is operated by the National Science Foundation. It is an inspirational hook for STEM Earth and ocean topics for children and the general public of all ages, but is not easily accessible due to its international travels and infrequent U.S. port calls. In response, a consortium of partners has created the Pop-Up/Drill Down Science project. The multi-year project, funded by NSF's Advancing Informal Science Learning program, aims to bring the JR and its science to under-served and rural populations throughout the country. Consisting of an inflatable walk-through ship, a multi-media experience, a giant interactive seafloor map and a series of interactive exhibit kiosks, the exhibit, entitled, In Search of Earth's Secrets: A Pop-Up Science Encounter, will travel to 12 communities throughout the next four years. In each community, the project will partner with local institutions like public libraries and small museums as hosts and to train local Girl Scouts to serve as exhibit facilitators. By working with local communities to select events and venues for pop-up events, the project hopes to bring cutting edge Earth and ocean science in creative new ways to underserved populations and inspire diverse audiences to explore further. This presentation will provide details of the project's goals, objectives and development and provide avenues to become involved.

  15. Inclusion of underserved racial and ethnic groups in cancer intervention research using new media: a systematic literature review.

    Science.gov (United States)

    Thompson, Hayley S; Shelton, Rachel C; Mitchell, Jamie; Eaton, Tara; Valera, Pamela; Katz, Anne

    2013-12-01

    An increasing number of behavioral and psychosocial cancer interventions incorporate new media elements that are digital, networked, and interactive. However, it is unclear to what extent new media is being leveraged to benefit underserved racial and ethnic groups who disproportionately bear the burden of cancer. This inquiry is timely in light of growing evidence that these groups are receptive to new media. A systematic literature review was conducted to assess the inclusion of these groups in research on cancer-related new media interventions and use of new media to reduce racial and ethnic cancer disparities. A systematic search of three databases was conducted for articles published between January 2000 and March 2012 that presented studies of user experience with a behavioral or psychosocial cancer-related intervention with at least one new media component. Thirty-six articles were included in the final review. In about one-quarter of the studies, less than 20% of participants were African American, Latino, Asian American, or American Indian. In less than 10% of the studies, 80% or more of the samples were members of the aforementioned groups. Almost one-third of the studies reviewed were categorized as disparity focused but limited data were available on racial and ethnic differences in responses to new media interventions. Findings suggest that the promise and potential of new media cancer interventions are largely unrealized among the underserved. Additional research is needed to investigate a wide range of issues related to the development and delivery of such interventions in diverse racial and ethnic groups.

  16. Do spiritual patients want spiritual interventions?: A qualitative exploration of underserved cancer patients' perspectives on religion and spirituality.

    Science.gov (United States)

    Stein, Emma M; Kolidas, Evelyn; Moadel, Alyson

    2015-02-01

    This study examines religion and spirituality among advanced cancer patients from an underserved, ethnically-diverse population by exploring patient conceptualizations of religion and spirituality, the role of religion and spirituality in coping with cancer, and patient interest in spiritual support. Qualitative semi-structured interviews were conducted with patients who had participated in a study of a "mind-body" support group for patients with all cancer types. Analysis based on grounded theory was utilized to identify themes and theoretical constructs. With regard to patient conceptualizations of religion and spirituality, three categories emerged: (1) Spirituality is intertwined with organized religion; (2) Religion is one manifestation of the broader construct of spirituality; (3) Religion and spirituality are completely independent, with spirituality being desirable and religion not. Religion and spirituality played a central role in patients' coping with cancer, providing comfort, hope, and meaning. Patients diverged when it came to spiritual support, with some enthusiastic about interventions incorporating their spiritual values and others stating that they already get this support through religious communities. Spirituality plays a central role in the cancer experience of this underserved ethnically-diverse population. While spirituality seems to be a universal concern in advanced cancer patients, the meaning of spirituality differs across individuals, with some equating it with organized religion and others taking a more individualized approach. It is important that psychosocial interventions are developed to address this concern. Future research is needed to further explore the different ways that patients conceptualize spirituality and to develop spiritually-based treatments that are not "one size fits all."

  17. Integration of pharmacists into patient-centered medical homes in federally qualified health centers in Texas.

    Science.gov (United States)

    Wong, Shui Ling; Barner, Jamie C; Sucic, Kristina; Nguyen, Michelle; Rascati, Karen L

    To describe the integration and implementation of pharmacy services in patient-centered medical homes (PCMHs) as adopted by federally qualified health centers (FQHCs) and compare them with usual care (UC). Four FQHCs (3 PCMHs, 1 UC) in Austin, TX, that provide care to the underserved populations. Pharmacists have worked under a collaborative practice agreement with internal medicine physicians since 2005. All 4 FQHCs have pharmacists as an integral part of the health care team. Pharmacists have prescriptive authority to initiate and adjust diabetes medications. The PCMH FQHCs instituted co-visits, where patients see both the physician and the pharmacist on the same day. PCMH pharmacists are routinely proactive in collaborating with physicians regarding medication management, compared with UC in which pharmacists see patients only when referred by a physician. Four face-to-face, one-on-one semistructured interviews were conducted with pharmacists working in 3 PCMH FQHCs and 1 UC FQHC to compare the implementation of PCMH with emphasis on 1) structure and workflow, 2) pharmacists' roles, and 3) benefits and challenges. On co-visit days, the pharmacist may see the patient before or after physician consultation. Pharmacists in 2 of the PCMH facilities proactively screen to identify diabetes patients who may benefit from pharmacist services, although the UC clinic pharmacists see only referred patients. Strengths of the co-visit model include more collaboration with physicians and more patient convenience. Payment that recognizes the value of PCMH is one PCMH principle that is not fully implemented. PCMH pharmacists in FQHCs were integrated into the workflow to address specific patient needs. Specifically, full-time in-house pharmacists, flexible referral criteria, proactive screening, well defined collaborative practice agreement, and open scheduling were successful strategies for the underserved populations in this study. However, reimbursement plans and provider

  18. A National Long-term Outcomes Evaluation of U.S. Premedical Postbaccalaureate Programs Designed to Promote Health care Access and Workforce Diversity.

    Science.gov (United States)

    McDougle, Leon; Way, David P; Lee, Winona K; Morfin, Jose A; Mavis, Brian E; Matthews, De'Andrea; Latham-Sadler, Brenda A; Clinchot, Daniel M

    2015-08-01

    The National Postbaccalaureate Collaborative (NPBC) is a partnership of Postbaccalaureate Programs (PBPs) dedicated to helping promising college graduates from disadvantaged and underrepresented backgrounds get into and succeed in medical school. This study aims to determine long-term program outcomes by looking at PBP graduates, who are now practicing physicians, in terms of health care service to the poor and underserved and contribution to health care workforce diversity. We surveyed the PBP graduates and a randomly drawn sample of non-PBP graduates from the affiliated 10 medical schools stratified by the year of medical school graduation (1996-2002). The PBP graduates were more likely to be providing care in federally designated underserved areas and practicing in institutional settings that enable access to care for vulnerable populations. The NPBC graduates serve a critical role in providing access to care for underserved populations and serve as a source for health care workforce diversity.

  19. Hearing the Silenced Voices of Underserved Women -The Role of Qualitative Research in Gynecologic and Reproductive Care

    Science.gov (United States)

    Lawson, Angela K.; Marsh, Erica E.

    2017-01-01

    Summary for Indexing In order to provide effective evidence-based health care to women, rigorous research that examines women’s lived experiences in their own voices in needed. However, clinical health research has often excluded the experiences of women and minority patient populations. Further, clinical research has often relied on quantitative research strategies; this provides an interesting but limited understanding of women’s health experiences and hinders the provision of effective patient-centered care. In this review, we define qualitative research and its unique contributions to research, and provide examples of how qualitative research has given insights into the reproductive health perspectives and behaviors of underserved women. PMID:28160888

  20. The Inwood Astronomy Project: 100 Nights in Manhattan---An Outreach Initiative to Underserved Communities

    Science.gov (United States)

    Kendall, J. S.

    2008-11-01

    Observing the night sky in New York City is a challenge. However, there is a popular, and even club-going, interest in science in New York City. On the edges of that interest, most people that live in New York City have never had the opportunity to look through a telescope, particularly in underserved areas such as Northern Manhattan. The presenter discusses plans for frequent observing sessions utilizing the parks in New York City combined with public classes at the New York Public Library. Both observing sessions and classes will be held in the ethnically, racially and economically diverse Bronx and Manhattan neighborhoods of Washington Heights, Marble Hill and Inwood. Integration with area middle, elementary and high schools is also discussed. Particular issues surrounding publicity and the need for showmanship in an image-driven community with numerous entertainment opportunities are also discussed.

  1. Associations between positive parenting practices and child externalizing behavior in underserved Latino immigrant families.

    Science.gov (United States)

    Holtrop, Kendal; McNeil Smith, Sharde'; Scott, Jenna C

    2015-06-01

    This study examined whether five specific parenting practices (i.e., monitoring, discipline, skill encouragement, problem solving, and positive involvement) were associated with reduced child externalizing behaviors among a sample of Latino immigrant families. It utilized baseline data from 83 Latino couples with children participating in a larger randomized controlled trial of a culturally adapted parenting intervention. Results reveal that monitoring, discipline, skill encouragement, and problem solving each made independent contributions to the prediction of child externalizing behavior, although not all in the expected direction. Further analyses examining mothers and fathers separately suggest that mother-reported monitoring and father-reported discipline practices uniquely contributed to these findings. These results may have important implications for prevention and clinical intervention efforts with Latino immigrant families, including the cultural adaptation and implementation of parenting interventions with this underserved population. © 2014 Family Process Institute.

  2. Medical education for "Dreamers": Barriers and opportunities for undocumented immigrants.

    Science.gov (United States)

    Kuczewski, Mark G; Brubaker, Linda

    2014-12-01

    Medical schools should amend their admissions policies to welcome applications from qualified undocumented immigrants, often called "Dreamers." The recent creation of the Deferred Action for Childhood Arrivals (DACA) program of the U.S. Citizenship and Immigration Service removes the key obstacles to securing a license and residency eligibility for such medical school graduates. As a result, to deny application to Dreamers of DACA status represents a kind of unjustified discrimination and violates the basic ethical principle of the equality of human beings. In addition, the medical profession's duty of beneficence to patients compels medical schools to develop the talents of any and all qualified applicants so as to produce the most competent, diverse physician workforce that best represents contemporary U.S. society. Furthermore, social justice calls for medical schools to produce physicians inclined to serve populations that have traditionally been underserved, including some minority and immigrant populations. An examination of the characteristics of those granted DACA status suggests that they are a potential source of future physicians likely to be helpful in addressing these needs. The authors of this Perspective discuss the remaining challenges facing Dreamers who want to attend medical school in the United States and possible means of overcoming these hurdles. The authors' views are based on principles of social justice, their recognition of the duty to treat Dreamer applicants fairly and justly, and their belief that physicians have an obligation primarily to the patients they serve that entails developing the best health care workforce possible.

  3. Goal setting using telemedicine in rural underserved older adults with diabetes: experiences from the informatics for diabetes education and telemedicine project.

    Science.gov (United States)

    West, Susan P; Lagua, Carina; Trief, Paula M; Izquierdo, Roberto; Weinstock, Ruth S

    2010-05-01

    To describe the use of telemedicine for setting goals for behavior change and examine the success in achieving these goals in rural underserved older adults with diabetes. Medicare beneficiaries with diabetes living in rural upstate New York who were enrolled in the telemedicine intervention of the Informatics for Diabetes Education and Telemedicine (IDEATel) project (n = 610) participated in home televisits with nurse and dietitian educators every 4-6 weeks for 2-6 years. Behavior change goals related to nutrition, physical activity, monitoring, diabetes health maintenance, and/or use of the home telemedicine unit were established at the conclusion of each televisit and assessed at the next visit. Collaborative goal setting was employed during 18,355 televisits (mean of 33 goal-setting televisits/participant). The most common goals were related to monitoring, followed by diabetes health maintenance, nutrition, exercise, and use of the telemedicine equipment. Overall, 68% of behavioral goals were rated as "improved" or "met." The greatest success was achieved for goals related to proper insulin injection technique and daily foot care. These elderly participants had the most difficulty achieving goals related to use of the computer. No gender differences in goal achievement were observed. Televisits can be successfully used to collaboratively establish behavior change goals to help improve diabetes self-management in underserved elderly rural adults.

  4. Inactivation of Parietal Reach Region Affects Reaching But Not Saccade Choices in Internally Guided Decisions.

    Science.gov (United States)

    Christopoulos, Vassilios N; Bonaiuto, James; Kagan, Igor; Andersen, Richard A

    2015-08-19

    The posterior parietal cortex (PPC) has traditionally been considered important for awareness, spatial perception, and attention. However, recent findings provide evidence that the PPC also encodes information important for making decisions. These findings have initiated a running argument of whether the PPC is critically involved in decision making. To examine this issue, we reversibly inactivated the parietal reach region (PRR), the area of the PPC that is specialized for reaching movements, while two monkeys performed a memory-guided reaching or saccade task. The task included choices between two equally rewarded targets presented simultaneously in opposite visual fields. Free-choice trials were interleaved with instructed trials, in which a single cue presented in the peripheral visual field defined the reach and saccade target unequivocally. We found that PRR inactivation led to a strong reduction of contralesional choices, but only for reaches. On the other hand, saccade choices were not affected by PRR inactivation. Importantly, reaching and saccade movements to single instructed targets remained largely intact. These results cannot be explained as an effector-nonspecific deficit in spatial attention or awareness, since the temporary "lesion" had an impact only on reach choices. Hence, the PPR is a part of a network for reach decisions and not just reach planning. There has been an ongoing debate on whether the posterior parietal cortex (PPC) represents only spatial awareness, perception, and attention or whether it is also involved in decision making for actions. In this study we explore whether the parietal reach region (PRR), the region of the PPC that is specialized for reaches, is involved in the decision process. We inactivated the PRR while two monkeys performed reach and saccade choices between two targets presented simultaneously in both hemifields. We found that inactivation affected only the reach choices, while leaving saccade choices intact

  5. Integrating community-based participatory research and informatics approaches to improve the engagement and health of underserved populations.

    Science.gov (United States)

    Unertl, Kim M; Schaefbauer, Chris L; Campbell, Terrance R; Senteio, Charles; Siek, Katie A; Bakken, Suzanne; Veinot, Tiffany C

    2016-01-01

    We compare 5 health informatics research projects that applied community-based participatory research (CBPR) approaches with the goal of extending existing CBPR principles to address issues specific to health informatics research. We conducted a cross-case analysis of 5 diverse case studies with 1 common element: integration of CBPR approaches into health informatics research. After reviewing publications and other case-related materials, all coauthors engaged in collaborative discussions focused on CBPR. Researchers mapped each case to an existing CBPR framework, examined each case individually for success factors and barriers, and identified common patterns across cases. Benefits of applying CBPR approaches to health informatics research across the cases included the following: developing more relevant research with wider impact, greater engagement with diverse populations, improved internal validity, more rapid translation of research into action, and the development of people. Challenges of applying CBPR to health informatics research included requirements to develop strong, sustainable academic-community partnerships and mismatches related to cultural and temporal factors. Several technology-related challenges, including needs to define ownership of technology outputs and to build technical capacity with community partners, also emerged from our analysis. Finally, we created several principles that extended an existing CBPR framework to specifically address health informatics research requirements. Our cross-case analysis yielded valuable insights regarding CBPR implementation in health informatics research and identified valuable lessons useful for future CBPR-based research. The benefits of applying CBPR approaches can be significant, particularly in engaging populations that are typically underserved by health care and in designing patient-facing technology. © The Authors 2015. Published by Oxford University Press on behalf of the American Medical

  6. A new concept for medical imaging centered on cellular phone technology.

    Directory of Open Access Journals (Sweden)

    Yair Granot

    2008-04-01

    Full Text Available According to World Health Organization reports, some three quarters of the world population does not have access to medical imaging. In addition, in developing countries over 50% of medical equipment that is available is not being used because it is too sophisticated or in disrepair or because the health personnel are not trained to use it. The goal of this study is to introduce and demonstrate the feasibility of a new concept in medical imaging that is centered on cellular phone technology and which may provide a solution to medical imaging in underserved areas. The new system replaces the conventional stand-alone medical imaging device with a new medical imaging system made of two independent components connected through cellular phone technology. The independent units are: a a data acquisition device (DAD at a remote patient site that is simple, with limited controls and no image display capability and b an advanced image reconstruction and hardware control multiserver unit at a central site. The cellular phone technology transmits unprocessed raw data from the patient site DAD and receives and displays the processed image from the central site. (This is different from conventional telemedicine where the image reconstruction and control is at the patient site and telecommunication is used to transmit processed images from the patient site. The primary goal of this study is to demonstrate that the cellular phone technology can function in the proposed mode. The feasibility of the concept is demonstrated using a new frequency division multiplexing electrical impedance tomography system, which we have developed for dynamic medical imaging, as the medical imaging modality. The system is used to image through a cellular phone a simulation of breast cancer tumors in a medical imaging diagnostic mode and to image minimally invasive tissue ablation with irreversible electroporation in a medical imaging interventional mode.

  7. Access to Digital Communication Technology and Perceptions of Telemedicine for Patient Education among American Indian Patients with Diabetes.

    Science.gov (United States)

    Mathieson, Kathleen; Leafman, Joan S; Horton, Mark B

    2017-01-01

    Health care access for medically underserved patients managing chronic conditions is challenging. While telemedicine can support patient education and engagement, the "digital divide" may be particularly problematic among the medically underserved. This study evaluated physical access to digital devices, use of e-mail and social media tools, and perceptions of telemedicine among American Indian (AI) patients with diabetes mellitus (DM). Survey data were collected from AI patients with DM during teleophthalmology exams. Eighty-eight percent of patients had access to digital device(s), 70% used e-mail, and 56% used social media. Younger age and greater education were positively associated with e-mail and social media use (p < .05). Most (60%) considered telemedicine an excellent medium for health-related patient education. American Indian patients with DM had access enabling patient education via telemedicine. Future work should examine patient technology preferences and effectiveness of technology-based education in improving outcomes among medically underserved populations.

  8. Placement, support, and retention of health professionals: national, cross-sectional findings from medical and dental community service officers in South Africa.

    Science.gov (United States)

    Hatcher, Abigail M; Onah, Michael; Kornik, Saul; Peacocke, Julia; Reid, Stephen

    2014-02-26

    In South Africa, community service following medical training serves as a mechanism for equitable distribution of health professionals and their professional development. Community service officers are required to contribute a year towards serving in a public health facility while receiving supervision and remuneration. Although the South African community service programme has been in effect since 1998, little is known about how placement and practical support occur, or how community service may impact future retention of health professionals. National, cross-sectional data were collected from community service officers who served during 2009 using a structured self-report questionnaire. A Supervision Satisfaction Scale (SSS) was created by summing scores of five questions rated on a three-point Likert scale (orientation, clinical advising, ongoing mentorship, accessibility of clinic leadership, and handling of community service officers' concerns). Research endpoints were guided by community service programmatic goals and analysed as dichotomous outcomes. Bivariate and multivariate logistical regressions were conducted using Stata 12. The sample population comprised 685 doctors and dentists (response rate 44%). Rural placement was more likely among unmarried, male, and black practitioners. Rates of self-reported professional development were high (470 out of 539 responses; 87%). Participants with higher scores on the SSS were more likely to report professional development. Although few participants planned to continue work in rural, underserved communities (n = 171 out of 657 responses, 25%), those serving in a rural facility during the community service year had higher intentions of continuing rural work. Those reporting professional development during the community service year were twice as likely to report intentions to remain in rural, underserved communities. Despite challenges in equitable distribution of practitioners, participant satisfaction with the

  9. Envisioning a Future Governance and Funding System for Undergraduate and Graduate Medical Education.

    Science.gov (United States)

    Gold, Jeffrey P; Stimpson, Jim P; Caverzagie, Kelly J

    2015-09-01

    Funding for graduate medical education (GME) and undergraduate medical education (UME) in the United States is being debated and challenged at the national and state levels as policy makers and educators question whether the multibillion dollar investment in medical education is succeeding in meeting the nation's health care needs. To address these concerns, the authors propose a novel all-payer system for GME and UME funding that equitably distributes medical education costs among all stakeholders, including those who benefit most from medical education. Through a "Medical Education Workforce (MEW) trust fund," indirect and direct GME dollars would be replaced with a funds-flow mechanism using fees paid for services by all payers (Medicaid, Medicare, private insurers, others) while providing direct compensation to physicians and institutions that actively engage medical learners in providing clinical care. The accountability of those receiving MEW funds would be improved by linking their funding levels to their ability to meet predetermined institutional, program, faculty, and learner benchmarks. Additionally, the MEW fund would cover learners' UME tuition, potentially eliminating their UME debt, in return for their provision of health care services (after completing GME training) in an underserved area or specialty. This proposed model attempts to increase transparency and enhance accountability in medical education by linking funding to the development of a physician workforce that is able to excel in the evolving health delivery system. Achieving this vision requires physician educators, leaders of academic health centers, policy makers, insurers, and patients to muster the courage to embrace transformational change.

  10. Africa's middle class women bring entrepreneurial opportunities in breast care medical tourism to South Africa.

    Science.gov (United States)

    Ahwireng-Obeng, Frederick; van Loggerenberg, Charl

    2011-01-01

    Africa's distribution of specialized private health services is severely disproportionate. Mismatch between South Africa's excess supply and a huge demand potential in an under-serviced continent represents an entrepreneurial opportunity to attract patients to South Africa for treatment and recuperative holidays. However, effective demand for intra-African medical tourism could be constrained by sub-Saharan poverty. Results from interviewing 320 patients and five staff at the Johannesburg Breast care Centre of Excellence, however, reject this proposition, Africa's middle class women being the target market estimated to grow annually by one million while breast cancer incidence increases with middle-class lifestyles. Uncovering this potential involves an extensive marketing strategy. Copyright © 2010 John Wiley & Sons, Ltd.

  11. Experiences, opportunities and challenges of implementing task shifting in underserved remote settings: the case of Kongwa district, central Tanzania

    Directory of Open Access Journals (Sweden)

    Munga Michael A

    2012-11-01

    infrastructures are not in place before formalising tasks shifting. There was also a perception that implementation of task shifting has ensured access to services especially in underserved remote areas. Professional discontent and challenges related to the management of health personnel policies were also perceived as important issues to consider when implementing task shifting practices. Additional resources for additional training and supervisory tasks were also considered important in the implementation of task shifting in order to make it deliver much the same way as it is for conventional modalities of delivering care. Conclusions Task shifting implementation occurs as an ad hoc coping mechanism to the existing shortages of health workers in many undeserved areas of the country, not just in the study site whose findings are reported in this paper. It is recommended that the most important thing to do now is not to determine whether task shifting is possible or effective but to define the limits of task shifting so as to reach a consensus on where it can have the strongest and most sustainable impact in the delivery of quality health services. Any action towards this end needs to be evidence-based.

  12. Medical support to Sri Lanka in the wake of tsunamis: planning considerations and lessons learned.

    Science.gov (United States)

    Lane, David A

    2006-10-01

    When massive tsunamis affected the coast of Sri Lanka and other Indian Ocean littorals, elements of the Third Force Service Support Group and assigned Navy, Air Force, Army, and Coast Guard units from the U.S. Pacific Command were "task organized" to form Combined Support Group-Sri Lanka (CSG-SL), charged to conduct humanitarian assistance/disaster relief (HA/DR) operations. The specific mission was to provide immediate relief to the affected population of Sri Lanka and the Maldives, to minimize loss of life, and to mitigate human suffering. A 30-person health care team deployed to the northern province of Jaffna and provided medical assistance to that chronically underserved and acutely overstressed region. For a 12-day period, the team served as the principal medical staff of an under-resourced government hospital and conducted mobile primary care clinics at nearby welfare camps housing > 7,000 internally displaced persons made homeless by the tsunamis. By every measurable standard, CSG-SL accomplished its assigned HA/DR task in Sri Lanka, including the medical mission. In doing so, the medical team learned many important lessons, including five of particular value to planners of similar relief operations in the future. This article discusses the context in which CSG-SL planned and executed the medical aspects of its HA/DR operations in Sri Lanka, and it describes the most significant medical lessons learned.

  13. Benefits of Medical Home Care Reaching Beyond Chronically Ill Teens: Exploring Parent Health-Related Quality of Life.

    Science.gov (United States)

    Chavez, Laura J; Grannis, Connor; Dolce, Millie; Chisolm, Deena J

    2018-03-15

    Caring for teens with special health care needs places physical and mental health burdens on parents, which can be exacerbated by the stresses of transitions to independence. Medical homes can improve teen transitions to greater self-management and reduce health care-related time and financial burdens for families. We examined the association between parent-reported teen medical home status and caregiver health-related quality of life (HRQOL). The study sample included parents or caregivers of teens with special health care needs aged 15 to 18 recruited from a pediatric Medicaid accountable care organization who participated in a survey (response rate, 40.5%). The primary outcome was parent HRQOL scores (0-100 points) measured using the Pediatric Quality of Life Inventory Family Impact Module. Medical home status was based on parent report of teen's health care meeting medical home criteria. Linear regression models were used to estimate HRQOL scores, adjusted for demographic characteristics, health literacy, and teen functional limitation. Among 488 parents, 27% reported their teen received care consistent with a medical home. Adjusted parent HRQOL scores were significantly higher among those whose teens had a medical home (74.40; 95% confidence interval, 71.31-77.48), relative to those whose teens did not (65.78; 95% confidence interval, 63.92-67.65). Medical home subscale analyses showed HRQOL scores had significant positive associations with family-centered care and coordinated care, but not other subscales. Teen medical home status was positively associated with caregiver HRQOL, suggesting that the medical home may benefit overall caregiver well-being. In particular, receiving care that was family centered and coordinated appeared to be the most beneficial. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  14. The Medical School Admissions Process and Meeting the Public's Health Care Needs: Never the Twain Shall Meet?

    Science.gov (United States)

    Cleland, Jennifer

    2017-12-19

    Medical schools typically assess how good their selection process is using metrics such as students' assessment performance and the academic success of alumni on later indicators of academic ability and clinical competence, such as Royal College of Physicians or specialty board examinations. To address global issues with the maldistribution of doctors and increasing numbers of new medical school graduates choosing not to work in a clinical context requires different measurements of medical school admissions processes, like those related to graduates' career outcomes (e.g., working in underserved regions and/or working in certain specialties). This shift in focus is not straightforward. Medical education is a complex social system where, intentionally or not, medical schools focus on reproducing cultural, historical, and social norms. Simple solutions are often proposed but they are insufficient to address these complex drivers. Instead it is time to step back and think very differently about medical school admissions. In this Invited Commentary, the author proposes new solutions to address these issues, including: bringing in to the medical school selection process the perspectives of other key stakeholders; increasing collaboration and dialogue across these stakeholder groups; changing the performance metrics by which medical schools are assessed in the global education marketplace; and developing and evaluating new selection processes and tools. Medical schools must engage more reflectively and collaboratively in debates about how to align medical school admissions and meeting the health care needs of the public.

  15. Reach Address Database (RAD)

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Reach Address Database (RAD) stores the reach address of each Water Program feature that has been linked to the underlying surface water features (streams,...

  16. Medical student surgery elective in rural Haiti: a novel approach to satisfying clerkship requirements while providing surgical care to an underserved population.

    Science.gov (United States)

    Chin-Quee, Anthony; White, Laura; Leeds, Ira; MacLeod, Jana; Master, Viraj A

    2011-04-01

    The addition of global health programs to medical school training results in graduates with enhanced clinical skills and increased sensitivity to cost issues. Funding from U.S. medical schools has been unable to meet student demand, and therefore it is often a critical limiting factor to the lack of development of these programs. We describe an alternative approach for global health surgical training for medical students. Emory University medical students and faculty, in collaboration with Project Medishare for Haiti, planned, raised funds, and executed a successful short-term surgical camp to supplement available surgical services in rural Haiti. Learning objectives that satisfied Emory University School of Medicine surgery clerkship requirements were crafted, and third-year students received medical school credit for the trip. In the absence of house staff and placed in an under-resourced, foreign clinical environment, the surgical elective described here succeeded in meeting learning objectives for a typical third-year surgical clerkship. Objectives were met through a determined effort to ensure that home institution requirements were aligned properly with learning activities while students were abroad and through a close collaboration between medical students, faculty members, and the administration. Emory University's international surgery elective for medical students demonstrates that opportunities for supervised, independent student-learning and global health service can be integrated into a traditional surgical clerkship. These opportunities can be organized to meet the requirements and expectations for third-year surgery clerkships at other medical colleges. This work also identifies how such trips can be planned and executed in a manner that does not burden strained academic budgets with further demands on resources.

  17. Reaching out to the Underserved: More than Thirty Years of Outreach Job Ads

    Science.gov (United States)

    Boff, Colleen; Singer, Carol; Stearns, Beverly

    2006-01-01

    Contents of outreach position announcements posted in "College and Research Libraries News" from 1970 through 2004 were examined. Ads fell within three broad groups: distance education, multicultural services, and specialized. Overall, outreach positions have been on the rise with the exception of multicultural services librarian positions that…

  18. Reaching the underserved: Active tuberculosis case finding in urban slums in southeastern Nigeria

    Directory of Open Access Journals (Sweden)

    Chidubem L Ogbudebe

    2015-01-01

    Conclusions: There is high prevalence of TB in Nigeria slum population. Targeted screening of out-patients, TB contacts, and HIV-infected patients should be optimized for active TB case finding in Nigeria.

  19. Mediation in Medical Malpractice - Realities and Prospects

    Directory of Open Access Journals (Sweden)

    Alexandru Boroi

    2015-05-01

    Full Text Available Medical professional liability is the result of specific breaches of the medical profession, which are contained in Law 95/2006 on health reform. Beyond the motivation of blaming medical personnel activity, there are many other aspects that may give rise to controversy in terms of medical ethics, from the informed consent of the patient and to the need for reaching criminal responsibility and compensation in cases of medical malpractice.

  20. Access to expert stroke care with telemedicine: REACH MUSC

    Directory of Open Access Journals (Sweden)

    Abby Swanson Kazley

    2012-03-01

    Full Text Available Stroke is a leading cause of death and disability, and rtPA can significantly reduce the long-term impact of acute ischemic stroke (AIS if given within 3 hours of symptom onset. South Carolina is located in the stroke belt and has a high rate of stroke and stroke mortality. Many small rural SC hospitals do not maintain the expertise needed to treat AIS patients with rtPA. MUSC is an academic medical center using REACH MUSC telemedicine to deliver stroke care to 15 hospitals in the state, increasing the likelihood of timely treatment with rtPA. The purpose of this study is to determine the increase in access to rtPA through the use of telemedicine for AIS in the general population and in specific segments of the population based on age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality.We used a retrospective cross-sectional design examining Census data from 2000 and Geographic Information Systems (GIS analysis to identify South Carolina residents that live within 30 or 60 minutes of a Primary Stroke Center (PSC or a REACH MUSC site. We include all South Carolina citizens in our analysis and specifically examine the population’s age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality. Our sample includes 4,012,012 South Carolinians. The main measure is access to expert stroke care at a Primary Stroke Center (PSC or a REACH MUSC hospital within 30 or 60 minutes. We find that without REACH MUSC, only 38% of the population has potential access to expert stroke care in SC within sixty minutes given that most PSCs will maintain expert stroke coverage. REACH MUSC allows 76% of the population to be within sixty minutes of expert stroke care, and 43% of the population to be within 30 minute drive time of expert stroke care. These increases in access are especially significant for groups that have faced disparities in care and high rates of AIS. The use of telemedicine can

  1. Cardiovascular risk in minority and underserved women in Appalachian Tennessee: a descriptive study.

    Science.gov (United States)

    Pearson, Tamera Lea

    2010-04-01

    The purposes of this study were to translate current knowledge regarding cardiovascular risk factors, screening, and prevention to a disparate population of women and to ascertain the cardiovascular health status and risk factors in a sample of minority and underserved Appalachian women. Demographic data were collected from a voluntary sample of women from a disparate population living in Appalachian Tennessee. A coronary risk profile recorded family health history, personal health history, and lifestyle habits affecting risk for cardiovascular disease. Physiologic measurements included body mass index, blood pressure, fasting glucose, cholesterol levels, ankle brachial index, and carotid artery stenosis. Women in Appalachia Tennessee from a disparate population have high risks for heart disease and stroke. This is a critical time to address any modifiable risk factors and aggressively treat underlying cardiovascular diseases such as hypertension and hypercholesterolemia. Nurse practitioners (NPs) often provide primary care to women who may not be aware of their cardiovascular risks or actual disease. NPs can ensure that their practice incorporates primary and secondary cardiovascular prevention through screening, individual health education, and aggressive evidence-based treatment plans for women.

  2. Interactive web-based portals to improve patient navigation and connect patients with primary care and specialty services in underserved communities.

    Science.gov (United States)

    Highfield, Linda; Ottenweller, Cecelia; Pfanz, Andre; Hanks, Jeanne

    2014-01-01

    This article presents a case study in the redesign, development, and implementation of a web-based healthcare clinic search tool for virtual patient navigation in underserved populations in Texas. It describes the workflow, assessment of system requirements, and design and implementation of two online portals: Project Safety Net and the Breast Health Portal. The primary focus of the study was to demonstrate the use of health information technology for the purpose of bridging the gap between underserved populations and access to healthcare. A combination of interviews and focus groups was used to guide the development process. Interviewees were asked a series of questions about usage, usability, and desired features of the new system. The redeveloped system offers a multitier architecture consisting of data, business, and presentation layers. The technology used in the new portals include Microsoft .NET Framework 3.5, Microsoft SQL Server 2008, Google Maps JavaScript API v3, jQuery, Telerik RadControls (ASP.NET AJAX), and HTML. The redesigned portals have 548 registered clinics, and they have averaged 355 visits per month since their launch in late 2011, with the average user visiting five pages per visit. Usage has remained relatively constant over time, with an average of 142 new users (40 percent) each month. This study demonstrates the successful application of health information technology to improve access to healthcare and the successful adoption of the technology by targeted end users. The portals described in this study could be replicated by health information specialists in other areas of the United States to address disparities in healthcare access.

  3. Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model.

    Directory of Open Access Journals (Sweden)

    Angelo S Nyamtema

    Full Text Available In Tanzania, maternal mortality ratio (MMR, unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC services in underserved rural areas using associate clinicians.Ten health centres (HCs were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians, and forty-four nurse-midwives and clinical officers (associate clinicians were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals.After launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03 in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively. Of all deaths (maternal and IVEND 84% to 96% were considered avoidable.These findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEmONC services and to improve

  4. Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model.

    Science.gov (United States)

    Nyamtema, Angelo S; Mwakatundu, Nguke; Dominico, Sunday; Mohamed, Hamed; Pemba, Senga; Rumanyika, Richard; Kairuki, Clementina; Kassiga, Irene; Shayo, Allan; Issa, Omary; Nzabuhakwa, Calist; Lyimo, Chagi; van Roosmalen, Jos

    2016-01-01

    In Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians. Ten health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians), and forty-four nurse-midwives and clinical officers (associate clinicians) were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals. After launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03) in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS) were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND) in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively). Of all deaths (maternal and IVEND) 84% to 96% were considered avoidable. These findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEmONC services and to improve maternal and

  5. International Medical Graduates in the US Physician Workforce and Graduate Medical Education: Current and Historical Trends.

    Science.gov (United States)

    Ahmed, Awad A; Hwang, Wei-Ting; Thomas, Charles R; Deville, Curtiland

    2018-04-01

    Data show that international medical graduates (IMGs), both US and foreign born, are more likely to enter primary care specialties and practice in underserved areas. Comprehensive assessments of representation trends for IMGs in the US physician workforce are limited. We reported current and historical representation trends for IMGs in the graduate medical education (GME) training pool and US practicing physician workforce. We compared representation for the total GME and active practicing physician pools with the 20 largest residency specialties. A 2-sided test was used for comparison, with P  < .001 considered significant. To assess significant increases in IMG GME trainee representation for the total pool and each of the specialties from 1990-2015, the slope was estimated using simple linear regression. IMGs showed significantly greater representation among active practicing physicians in 4 specialties: internal medicine (39%), neurology (31%), psychiatry (30%), and pediatrics (25%). IMGs in GME showed significantly greater representation in 5 specialties: pathology (39%), internal medicine (39%), neurology (36%), family medicine (32%), and psychiatry (31%; all P  < .001). Over the past quarter century, IMG representation in GME has increased by 0.2% per year in the total GME pool, and 1.1% per year for family medicine, 0.5% for obstetrics and gynecology and general surgery, and 0.3% for internal medicine. IMGs make up nearly a quarter of the total GME pool and practicing physician workforce, with a disproportionate share, and larger increases over our study period in certain specialties.

  6. The relevance and role of homestays in medical education: a scoping study.

    Science.gov (United States)

    Hughes, Bonnie Olivia; Moshabela, Mosa; Owen, Jenni; Gaede, Bernhard

    2017-01-01

    The community-based medical education curriculum is growing in popularity as a strategy to bring universal health coverage to underserved communities by providing medical students with hands-on training in primary health care. Accommodation and immersion of medical students within the community will become increasingly important to the success of community-based curricula. In the context of tourism, homestays, where local families host guests, have shown to provide an immersive accommodation experience. By exploring homestays in the educational context, this scoping study investigates their role in providing an immersive pedagogical experience for medical students. A scoping review was performed using the online databases ScienceDirect and the Duke University Library Database, which searches Academic Search Complete, JSTOR, LexisNexis Academic, Web of Science, Proquest, PubMed and WorldCat. Using the inclusion term 'homestays' and excluding the term 'tourism', 181 results were returned. AClose assessment using inclusion criteria narrowed this to 14 relevant articles. There is very little published research specific to the experience of medical students in community homestays, indicating a gap in the literature. However, the existing educational outcomes suggest homestays may have the potential to serve a significant role in medical education, especially as a component of decentralised or community-based programmes. The literature reveals that educational homestays influence language learning, cultural immersion, and the development of professional skills for health science careers. These outcomes relate to the level of engagement between students and hosts, including the catalytic role of community liaisons. Homestays offer a unique depth of experience that has the potential to enrich the education of participating students, and require further research, particularly in the context of distributed and decentralised training platforms for medical and health sciences

  7. Austin Community College District's P-16 Initiative Graduates America

    Science.gov (United States)

    Hensley, Mary; Madsen, Gary

    2010-01-01

    Austin Community College (ACC) District's P-16 Initiative supports partnerships with 30 school districts--reaching traditionally underserved students and bridging the gap between high school and college--so more Texas students can reach their educational goals. The P-16 Initiative is a constellation of efforts designed to provide broad-based…

  8. Medication effectiveness may not be the major reason for accepting cardiovascular preventive medication

    DEFF Research Database (Denmark)

    Harmsen, Charlotte Gry; Støvring, Henrik; Jarbøl, Dorte Ejg

    2012-01-01

    Shared decision-making and patients' choice of interventions are areas of increasing importance, not least seen in the light of the fact that chronic conditions are increasing, interventions considered important for public health, and still non-acceptance of especially risk-reducing treatments...... of cardiovascular diseases (CVD) is prevalent. A better understanding of patients' medication-taking behavior is needed and may be reached by studying the reasons why people accept or decline medication recommendations. The aim of this paper was to identify factors that may influence people's decisions...... and reasoning for accepting or declining a cardiovascular preventive medication offer....

  9. Validation of English and Spanish-language versions of a screening questionnaire for rheumatoid arthritis in an underserved community.

    Science.gov (United States)

    Potter, Jeffrey; Odutola, Jennifer; Gonzales, Christian Amurrio; Ward, Michael M

    2008-08-01

    Questionnaires to screen for rheumatoid arthritis (RA) have been tested in groups that were primarily well educated and Caucasian. We sought to validate the RA questions of the Connective Tissue Disease Screening Questionnaire (CSQ) in ethnic minorities in an underserved community, and to test a Spanish-language version. The Spanish-language version was developed by 2 native speakers. Consecutive English-speaking or Spanish-speaking patients in a community-based rheumatology practice completed the questionnaire. Diagnoses were confirmed by medical record review. Sensitivity and specificity of the questionnaire for a diagnosis of RA were computed for each language version, using 2 groups as controls: patients with noninflammatory conditions, and participants recruited from the community. The English-language version was tested in 53 patients with RA (79% ethnic minorities; mean education level 11.3 yrs), 85 rheumatology controls with noninflammatory conditions, and 82 community controls. Using 3 positive responses as indicating a positive screening test, the sensitivity of the questionnaire was 0.77, the specificity based on rheumatology controls was 0.45, and the specificity based on community controls was 0.94. The Spanish-language version was tested in 55 patients with RA (mean education level 7.8 yrs), 149 rheumatology controls, and 88 community controls. The sensitivity of the Spanish-language version was 0.87, with specificities of 0.60 and 0.97 using the rheumatology controls and community controls, respectively. The sensitivity of the English-language version of the RA questions of the CSQ was lower in this study than in other cohorts, reflecting differences in the performance of the questions in different ethnic or socioeconomic groups. The Spanish-language version demonstrated good sensitivity, and both had excellent specificity when tested in community controls.

  10. Understanding Disadvantage among Medical School Applicants

    Science.gov (United States)

    Espinoza-Shanahan, Crystal C.

    2016-01-01

    The United States is a nation of peoples with highly stratified degrees of healthcare access and coverage, including many individuals with none at all. Exacerbating the problem of widespread health disparities is a persistent shortage of physicians over recent decades. Of most urgency is the need for doctors within already underserved minority…

  11. Social marketing for a farmer’s market in an underserved community: A needs assessment

    Directory of Open Access Journals (Sweden)

    Meg Skizim

    2018-01-01

    Full Text Available The aim of the present paper is to assess local residents’ awareness of utilizing Supplemental Nutrition Assistance Program (SNAP benefits to purchase fresh produce at local farmers’ markets, and to determine internet use and media preferences of study participants prior to implementation of a social marketing campaign. A needs assessment was conducted to collect baseline data in an underserved neighbourhood in New Orleans (LA, USA. The study was carried out August 2014-May 2015. The assessment revealed that 73% of the respondents were unaware that the SNAP benefits could be used to purchase food in farmers’ markets; 63% of low-income participants never attended a farmers’ market compared to 27% of mid/high-income. Over 50% of the low-income respondents have access to the internet at least once per day. The results show the potential of raising awareness among a wide range of members in the community. This needs assessment will serve as the foundation for a social marketing intervention, which will be disseminated city-wide.

  12. The power of management in medical services. Can we manage better for higher quality and more productive medical services?

    Directory of Open Access Journals (Sweden)

    Magdalena BARBU

    2010-06-01

    Full Text Available Medical services are the most important services of all since we all depend on them. Their quality and productivity can assure a wealthy nation and therefore good economical results. The offer of medical services depends on medical personnel and more than this, on the management in the medical field since any resource not managed well or not managed at all is only a lost one, regardless its value. Management is therefore the key, the “how to” method of obtaining the desired result. The same approach can be applied into our study in order to reach more productive medical services which to prove high quality to all patients. We need to use and to squeeze the entire force of management tools in order to reach our goal: accessible medical services full of quality. The current worldwide crisis situation makes us think that after job and food, even medical services (also a basic thing after all can become a “luxury” although this should never happen. Therefore we must do whatever needed to improve the way medical organizations are driven so that the quality of their medical services will be better and better and the productivity will be at a higher level. Medical management should have as a goal making it possible for patients to be able to solve their health problems as soon as possible and as good as possible.

  13. Functional reach and lateral reach tests adapted for aquatic physical therapy

    Directory of Open Access Journals (Sweden)

    Ana Angélica Ribeiro de Lima

    Full Text Available Abstract Introduction: Functional reach (FR and lateral reach (LR tests are widely used in scientific research and clinical practice. Assessment tools are useful in assessing subjects with greater accuracy and are usually adapted according to the limitations of each condition. Objective: To adapt FR and LR tests for use in an aquatic environment and assess the performance of healthy young adults. Methods: We collected anthropometric data and information on whether the participant exercised regularly or not. The FR and LR tests were adapted for use in an aquatic environment and administered to 47 healthy subjects aged 20-30 years. Each test was repeated three times. Results: Forty-one females and six males were assessed. The mean FR test score for men was 24.06 cm, whereas the mean value for right lateral reach (RLR was 10.94 cm and for left lateral reach (LLR was 9.78 cm. For females, the mean FR score was 17.57 cm, while the mean values for RLR was 8.84cm and for LLR was 7.76 cm. Men performed better in the FR (p < 0.001 and RLR tests than women (p = 0.037. Individuals who exercised regularly showed no differences in performance level when compared with their counterparts. Conclusion: The FR and LR tests were adapted for use in an aquatic environment. Males performed better on the FR and RLR tests, when compared to females. There was no correlation between the FR and LR tests and weight, height, Body Mass Index (BMI, foot length or length of the dominant upper limb.

  14. Extraterritorial reach of the FCPA: recommendations for U.S. medical device companies with activities in Europe.

    Science.gov (United States)

    Vollebregt, Erik

    2010-01-01

    Traditionally medical devices companies manage business compliance with anti-corruption and anti-fraud rules in a document-oriented way that does not always yield optimal results for the company. As a result, compliance issues are not optimally managed by the companies. Now that medical devices companies become ever more internationally active, they must also take into account the international dimensions of business compliance. This article intends to provide U.S. medical devices companies with activities in Europe with an insight in business compliance risks in the European Union (EU) and the risks related to U.S. statutes that may be applicable to a U.S. company's activities overseas. The article proposes a process-oriented and IT-supported way of structuring an international business compliance program, resulting in increased effectiveness of the program and increased competitiveness and risk management of the company as well as a high degree of acceptance of the procedures by the company's employees.

  15. Effects of a culturally tailored physical activity promotion program on selected self-regulation skills and attitudes in adolescents of an underserved, multiethnic milieu.

    Science.gov (United States)

    Laberge, Suzanne; Bush, Paula Louise; Chagnon, Miguel

    2012-01-01

    To implement a culturally tailored physical activity (PA) promotion program (FunAction) and to assess its impact on five self-regulation skills and attitudes in adolescents. Design . The design and implementation of the FunAction program were informed by social marketing principles. The study used a quasi-experimental approach to assess the impact of the program on specific outcome variables. A multiethnic, underserved middle school in Montreal, Quebec, Canada. The intervention group was made up of grade 8 students (n  =  165) and the control group was made up of grade 7 students (n  =  137). During the 16-week intervention, adolescents were able to choose from a variety of 45-minute cardiovascular PAs offered daily during their school lunch period. Adolescents participated in the activities on a voluntary basis. A self-report questionnaire was administered preintervention and postintervention to measure adolescents' scores on the following self-regulation skills and attitudes: self-control, self-esteem, attention/concentration, social competence, and interethnic relationships. Three-way repeated measures analyses of variance and correlational analyses were used. Results . A significant improvement was observed only in attention/concentration. Girls' attention/concentration scores improved significantly in the intervention group compared to the control group (F(1,127)  =  16.26, p marketing principles can help encourage adolescents from underserved, multiethnic milieus to participate in PA during their school lunch hour. Furthermore, voluntary participation in a culturally tailored PA program can improve youths' attention/concentration.

  16. Mission of Mercy.

    Science.gov (United States)

    Humenik, Mark

    2014-01-01

    Some dentists prefer solo charity work, but there is much to be said for collaboration within the profession in reaching out to those who are dentally underserved. Mission of Mercy (MOM) programs are regularly organized across the country for this purpose. This article describes the structure, reach, and personal satisfaction to be gained from such missions.

  17. The pattern of the discovery of medication errors in a tertiary hospital in Hong Kong.

    Science.gov (United States)

    Samaranayake, N R; Cheung, S T D; Chui, W C M; Cheung, B M Y

    2013-06-01

    The primary goal of reducing medication errors is to eliminate those that reach the patient. We aimed to study the pattern of interceptions to tackle medication errors along the medication use processes. Tertiary care hospital in Hong Kong. The 'Swiss Cheese Model' was used to explain the interceptions targeting medication error reporting over 5 years (2006-2010). Proportions of prescribing, dispensing and drug administration errors intercepted by pharmacists and nurses; proportions of prescribing, dispensing and drug administration errors that reached the patient. Our analysis included 1,268 in-patient medication errors, of which 53.4% were related to prescribing, 29.0% to administration and 17.6% to dispensing. 34.1% of all medication errors (4.9% prescribing, 26.8% drug administration and 2.4% dispensing) were not intercepted. Pharmacy staff intercepted 85.4% of the prescribing errors. Nurses detected 83.0% of dispensing and 5.0% of prescribing errors. However, 92.4% of all drug administration errors reached the patient. Having a preventive measure at each stage of the medication use process helps to prevent most errors. Most drug administration errors reach the patient as there is no defense against these. Therefore, more interventions to prevent drug administration errors are warranted.

  18. Big Pharma on the Farm: Students Are Exposed to Pharmaceutical Marketing More Often in Rural Clinics.

    Science.gov (United States)

    Evans, David V; Keys, Toby; Desnick, Laurel; A Andrilla, C Holly; Bienz, Danielle; Rosenblatt, Roger

    2016-07-01

    Pharmaceutical marketing techniques are effective in changing the behavior of health care providers in ways that deviate from evidence-based practices. To mitigate the influence of pharmaceutical marketing on learners, academic medical centers (AMCs) have adopted policies to limit student/industry interaction. Many clinical experiences occur outside of the AMC. The purpose of this study was to compare medical students' exposure to pharmaceutical marketing in off-campus rural and urban underserved clinical sites. The University of Washington School of Medicine Rural and Underserved Opportunities Program (RUOP) places rising second-year medical students in underserved clinical sites in five northwestern states. We surveyed RUOP students to evaluate their exposure to pharmaceutical marketing. Of 120 students, 86 (72%) completed surveys. Sixty-five (76%) did their RUOP rotation in rural areas. Students in rural locations were more likely to report exposure to pharmaceutical marketing. Distribution of free drug samples was reportedly three times higher in rural than urban sites (54% versus 15%). Doctors meeting with sales representatives were reported as four times higher in rural clinics (40% versus 10%). Students at rural sites reported exposure to pharmaceutical marketing more than those in urban settings. Rural medical educators should provide faculty development for community clinicians on the influences of pharmaceutical marketing on learners. Medical schools must review local clinic and institution-wide policies to limit pharmaceutical marketing exposure to learners in the rural learning environment.

  19. Using 340B drug discounts to provide a financially sustainable medication discharge service.

    Science.gov (United States)

    Wu, Timothy; Williams, Carla; Vranek, Kathryn; Mattingly, T Joseph

    2018-03-27

    The 340B Drug Pricing Program was intended to stretch federal resources by providing significant discounts to covered entities providing care to underserved populations. Program implementation and evidence of expanding services to higher income patients has brought more scrutiny and calls for elimination of the program. While additional review and reform may be warranted, profitability from 340B discounts enables covered entities to provide additional services that may not be feasible in absence of the program. This case report demonstrates one institution's use of 340B discounts to financially justify providing bedside medication delivery services for patients at the time of discharge from an inpatient admission. A simple financial model was developed using hospital data and inputs from available literature to estimate gross profit and earnings before interest, taxes, depreciation, and amortization (EBITDA) with and without 340B discounts. Without the 340B drug price discounts, the service would operate at a financial loss, and further investigation must be done to determine whether other clinical or economic benefits would warrant discharge medication delivery at the institution. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  20. Improving Posthospital Discharge Telephone Reach Rates Through Prehospital Discharge Face-to-Face Meetings.

    Science.gov (United States)

    Vergara, Franz H; Sheridan, Daniel J; Sullivan, Nancy J; Budhathoki, Chakra

    The purpose of this study was to determine whether a face-to-face meeting with patients by a telephonic case manager prehospital discharge would result in increased telephone follow-up (TFU) reach rates posthospital discharge. Acute care adult medicine inpatient units. A quasiexperimental design was utilized. Two adult inpatient medicine units were selected as the intervention and comparison groups. The framework of the study is the transitions theory. A convenience sampling technique was used, whereby 88 eligible patients on the intervention unit received face-to-face meetings prehospital discharge whereas 123 patients on the comparison unit received standard care (no face-to-face meetings). Cross-tabulation and chi-square tests were employed to examine the association of face-to-face meeting intervention and TFU reach rates. Implementing brief (face-to-face meetings by a telephonic case manager prehospital discharge resulted in a TFU reach rate of 87% on the intervention unit, whereas the comparison unit only had a 58% TFU reach rate (p communication with more patients posthospital discharge. A brief prehospital discharge face-to-face meeting with patients assisted them to understand the reasons for a posthospital discharge telephone call, identified the best times to call using accurate telephone numbers, and taught patients how best to prepare for the call. In addition, by meeting patients face-to-face, the telephonic case manager was no longer an unknown person on the telephone asking them questions about their medical condition. These factors combined may have significantly helped to increase TFU reach rates.

  1. Hospital-based, Multidisciplinary, youth mentoring and medical exposure program positively influences and reinforces health care career choice: "The Reach One Each One Program early Experience".

    Science.gov (United States)

    Danner, Omar K; Lokko, Carl; Mobley, Felicia; Dansby, Montreka; Maze, Michael; Bradley, Brene'; Williams, Elizabeth; Matthews, Leslie Ray; Harrington, Emma; Mack, Lisa; Clark, Clarence; Wilson, Ken; Beech, Derrick; Heron, Sheryl; Childs, Ed

    2017-04-01

    According to the National Center for Educational Statistics, underrepresented minorities (URMs) are more likely to leave science, technology, engineering and mathematics (STEM) fields at higher rates than their peers during undergraduate studies. Many institutions of higher learning have implemented pipeline programs aimed at preparing and inspiring high school and college aged students in select careers in health sciences with varying levels of success. Research has shown that a health care workforce that mirrors the community they serve is more effective in reducing health disparities and increasing positive health outcomes. We hypothesize that a hospital-based, multidisciplinary youth mentoring and medical exposure program will enhance the decision of URM high school students to choose healthcare careers. A retrospective analysis of the Reach One Each One Program (ROEO) was performed. ROEO is a hospital based, 11-week multidisciplinary youth mentoring and medical exposure program for inner-city high school students. The analysis was based on a phone survey of the twenty-six (26) seniors who completed the program and subsequently graduated from high school between May 2013 and May 2015 to assess the following: 1) College enrollment/attendance, 2) Health profession majors, and 3) Pre-med status. The study was approved by the Morehouse School of Medicine Institutional Review Board. Of the twenty-six students, 23 were female and 3 were male; 25 (96%) of the students were African American and one student was a Caucasian female. Twenty-four (92.3%) of the students were enrolled in college and 2 (7.7%) were scheduled to begin in the spring semester of 2016. Twenty-one of the 24 attending college at the time of the survey (87.5%) were enrolled in a health science degree program and 16 (66.7%) confirmed that they were enrolled in pre-medical (Pre-med) curriculum. Hospital-based, multidisciplinary medical mentoring programs can have a positive impact on the lives and

  2. Medication errors in outpatient care in Colombia, 2005-2013.

    Science.gov (United States)

    Machado-Alba, Jorge E; Moncada, Juan Carlos; Moreno-Gutiérrez, Paula Andrea

    2016-06-03

    Medication errors outside the hospital have been poorly studied despite representing an important threat to patient safety. To describe the characteristics of medication errors in outpatient dispensing pharmacists reported in a pharmaco-surveillance system between 2005 and 2013 in Colombia. We conducted a descriptive study by reviewing and categorizing medication error reports from outpatient pharmacy services to a national medication dispensing company between January, 2005 and September, 2013. Variables considered included: process involved (administration, dispensing, prescription and transcription), wrong drug, time delay for the report, error type, cause and severity. The analysis was conducted in the SPSS® software, version 22.0. A total of 14,873 medication errors were reviewed, of which 67.2% in fact occurred, 15.5% reached the patient and 0.7% caused harm. Administration (OR=93.61, CI 95%: 48.510-180.655, perrors (OR=5.64; CI 95%: 3.488-9.142, perror reaching the patient. It is necessary to develop surveillance systems for medication errors in ambulatory care, focusing on the prescription, transcription and dispensation processes. Special strategies are needed for the prevention of medication errors related to anti-infective drugs.

  3. Comparisons among three types of generalist physicians: Personal characteristics, medical school experiences, financial aid, and other factors influencing career choice.

    Science.gov (United States)

    Xu, G; Veloski, J J; Barzansky, B; Hojat, M; Diamond, J; Silenzio, V M

    1996-01-01

    A national survey of family physicians, general internists, and general pediatricians was conducted in the US to examine differences among the three groups of generalists physicians, with particular regard to the factors influencing their choice of generalist career. Family physicians were more likely to have made their career decision before medical school, and were more likely to have come from inner-city or rural areas. Personal values and early role models play a very important role in influencing their career choice. In comparison, a higher proportion of general internists had financial aid service obligations and their choice of the specialty was least influenced by personal values. General pediatricians had more clinical experiences either in primary care or with underserved populations, and they regarded medical school experiences as more important in influencing their specialty choice than did the other two groups. Admission committees may use these specialty-related factors to develop strategies to attract students into each type of generalist career.

  4. A model for training medical student innovators: the Harvard Medical School Center for Primary Care Abundance Agents of Change program.

    Science.gov (United States)

    Duong, David B; Sullivan, Erin E; Minter-Jordan, Myechia; Giesen, Lindsay; Ellner, Andrew L

    2016-01-01

    In 2013, the Harvard Medical School Center for Primary Care established the Abundance Agents of Change (AoC) program to promote interprofessional learning and innovation, increase partnership between 15 academic and community health centers (CHCs) in Boston's most under-served communities, and increase medical student interest in primary care careers. The AoC is modeled in the form of a 'grants challenge', offering $20,000 to interprofessional student teams to develop an innovative solution that addresses a healthcare delivery need identified by CHCs. The program's initial two years were characterized by a four-stage process which included working with CHCs and crafting a request for proposals, forming interprofessional 20 student teams comprising students from across and outside of Harvard University, training students using a systems-based innovation curriculum, and performing program evaluation. Our evaluation data from cohorts 1 and 2 of the AoC program demonstrate that we succeeded in training students as innovators and members of interprofessional teams. We also learned valuable lessons regarding creating better alignment with CHC priorities, extending the program cycle from 12 to 18 months, and changing the way funding is disbursed to 25 students, which will be incorporated in later versions of the program. Based on our experience and evaluation data, we believe that this program is a replicable way to train students as innovators and members of interprofessional teams to address the current complex healthcare environment.

  5. Climate change in the classroom: Reaching out to middle school students through science and math suitcase lessons

    Science.gov (United States)

    Jacobo, A. C.; Collay, R.; Harris, R. N.; de Silva, L.

    2011-12-01

    We have formed a link between the Increasing Diversity in Earth Sciences (IDES) program with the Science and Math Investigative Learning Experiences (SMILE) program, both at Oregon State University. The IDES mission is to strengthen the understanding of Earth Sciences and their relevance to society among broad and diverse segments of the population and the SMILE mission is to provide science and math enrichment for underrepresented and other educationally underserved students in grades 4-12. Traditionally, underserved schools do not have enough time or resources to spend on science and mathematics. Furthermore, numerous budget cuts in many Oregon school districts have negatively impacted math and science cirriculum. To combat this trend we have designed suitcase lessons in climate change that can be carried to a number of classrooms. These lesson plans are scientifically rich and economically attractive. These lessons are designed to engage students in math and science through climate change presentations, group discussions, and hands-on activities. Over the past year we have familiarized ourselves with the academic ability of sixth and seventh graders through in-class observation in Salem Oregon. One of the suit case lessons we developed focuses on climate change by exploring the plight of polar bears in the face of diminishing sea ice. Our presentation will report the results of this activity.

  6. An investigation of the neural circuits underlying reaching and reach-to-grasp movements: from planning to execution.

    Directory of Open Access Journals (Sweden)

    Chiara eBegliomini

    2014-09-01

    Full Text Available Experimental evidence suggests the existence of a sophisticated brain circuit specifically dedicated to reach-to-grasp planning and execution, both in human and non human primates (Castiello, 2005. Studies accomplished by means of neuroimaging techniques suggest the hypothesis of a dichotomy between a reach-to-grasp circuit, involving the intraparietal area (AIP, the dorsal and ventral premotor cortices (PMd and PMv - Castiello and Begliomini, 2008; Filimon, 2010 and a reaching circuit involving the medial intraparietal area (mIP and the Superior Parieto-Occipital Cortex (SPOC (Culham et al., 2006. However, the time course characterizing the involvement of these regions during the planning and execution of these two types of movements has yet to be delineated. A functional magnetic resonance imaging (fMRI study has been conducted, including reach-to grasp and reaching only movements, performed towards either a small or a large stimulus, and Finite Impulse Response model (FIR - Henson, 2003 was adopted to monitor activation patterns from stimulus onset for a time window of 10 seconds duration. Data analysis focused on brain regions belonging either to the reaching or to the grasping network, as suggested by Castiello & Begliomini (2008.Results suggest that reaching and grasping movements planning and execution might share a common brain network, providing further confirmation to the idea that the neural underpinnings of reaching and grasping may overlap in both spatial and temporal terms (Verhagen et al., 2013.

  7. An Effective Community?Academic Partnership to Extend the Reach of Screenings for Fall Risk

    OpenAIRE

    Schrodt, Lori A.; Garbe, Kathie C.; Chaplin, Rebecca; Busby-Whitehead, Jan; Shubert, Tiffany E.

    2013-01-01

    Older adults should be screened for fall risk annually. Community providers (people without formal medical training who work with older adults in senior centers or aging services) may be a viable group to expand the reach of screenings. Our community–academic partnership developed a program to increase and assess fall risk screenings by community providers. Community sites hosted training workshops and screening events. Community screenings were well attended and received by providers and old...

  8. Perspectives of Mobile Versus Fixed Mammography in Santa Clara County, California: A Focus Group Study.

    Science.gov (United States)

    Chen, Yi-Ren; Chang-Halpenny, Christine; Kumarasamy, Narmadan A; Venegas, Angela; Braddock Iii, Clarence H

    2016-02-12

    Our aim was to examine underserved women's perceptions on mobile versus fixed mammography in Santa Clara, California through a focus group study.  Research has shown that medically underserved women have higher breast cancer mortality rates correlated with under-screening and a disproportional rate of late-stage diagnosis. The Community Health Partnership in Santa Clara County, California runs the Community Mammography Access Project (CMAP) that targets nearly 20,000 medically underserved women over the age of 40 in the county through the collaborative effort of an existing safety net of healthcare providers. However, little data exists on the advantages or disadvantages of mobile mammography units from the patient perspective.   We assessed underserved women's perspectives on mammography services in Santa Clara County through two focus groups from women screened at mobile or fixed site programs. Patients were recruited from both CMAP clinics and a county hospital, and focus group data were analyzed using content analysis.  We found that women from both the mobile and fixed sites shared similar motivating factors for getting a mammogram. Both groups recognized that screening was uncomfortable but necessary for good health and had positive feedback about their personal physicians. However, mobile participants, in particular, appreciated the atmosphere of mobile screening, reported shorter wait times, and remarked on the good communication from the clinic staff and empathetic treatment they received. However, mobile participants also expressed concern about the quality of films at mobile sites due to delayed initial reading of the films.   Mobile mammography offers a unique opportunity for women of underserved populations to access high satisfaction screenings, and it encourages a model similar to CMAP in other underserved areas. However, emphasis should be placed on providing a warm and welcoming environment for patients and ensuring the quality of

  9. Medical tourism: game-changing innovation or passing fad?

    Science.gov (United States)

    Underwood, Howard R; Makadon, Harvey J

    2010-09-01

    Outbound medical tourism presents several concerns for U.S. providers: Potential lost revenue could reach almost $600 billion by 2017. Continuity of care can become an issue if complete medical records are not available to the patient's home physician and communications are not maintained between the domestic physician and the physician who rendered medical care abroad. Potential malpractice liability could place the U.S.-based provider at risk.

  10. ITEAMS: Increasing the Self-Identification for Girls and Underserved Youth in Pursuing STEM Careers

    Directory of Open Access Journals (Sweden)

    R. Bruce Ward

    2012-02-01

    Full Text Available We report early findings on the efficacy of a technology-based project in increasing self-identification for girls and underserved youth to self-select STEM (science, technology, engineering, and mathematics careers. ITEAMS (Innovative Technology- Enabled Astronomy for Middle Schools – an out-of-schooltime program with online, robotic telescopes as its central focus – targets girls and minority students underrepresented in STEMrelated vocations. The participating students attend urban schools in Eastern Massachusetts. ITEAMS’ twofold goal is to: a provide inspiration for the participants to pursue STEM careers, and b increase the students’ mastery of foundational subject matter so they are prepared for the rigor of further STEM study. We use an online system for surveys and assessments, the former to capture attitudinal changes about career choices, and the latter to assess the students’ subject matter knowledge. Participating students take pre-, intermediate, and post subject-matter tests and career-interest surveys. While we find statistically significant gains in subject matter knowledge free of gender, race, or school bias, we also find girls profess less interest than boys in STEM careers as early as grades five and six, although other attitudinal indicators suggest ways to reverse that trend.

  11. REACH: impact on the US cosmetics industry?

    Science.gov (United States)

    Pouillot, Anne; Polla, Barbara; Polla, Ada

    2009-03-01

    The Registration, Evaluation, Authorization and restriction of Chemicals (REACH) is a recent European regulation on chemical substances meant to protect human health and the environment. REACH imposes the "precautionary principle" where additional data and definitive action are required when uncertainty is identified. The cosmetics industry is only partially concerned by REACH: while the stages of registration and evaluation apply to cosmetics, those of authorization and restriction most likely will not, as cosmetic ingredients are already subject to regulation by various agencies and directives. REACH has potential benefits to the industry including the possibility of reassuring consumers and improving their image of chemicals and cosmetics. However, REACH also has potential disadvantages, mainly with regard to impeding innovation. The American cosmetics industry will be affected by REACH, because all US manufacturers who export substances to Europe will have to fully comply with REACH.

  12. Extending the Pathway: Building on a National Science Foundation Workforce Development Project for Underserved k-12 Students

    Science.gov (United States)

    Slattery, W.; Smith, T.

    2014-12-01

    own learning and shows promise of raising parents, teachers, administrators and other k-12 students awareness of educational opportunities in the geosciences, confidence in the ability of underserved rural students to reach their educational goals and supporting them through the critical middle and high school years towards a geoscience career.

  13. Healthy Eating for Life English as a second language curriculum: applying the RE-AIM framework to evaluate a nutrition education intervention targeting cancer risk reduction.

    Science.gov (United States)

    Martinez, J L; Duncan, L R; Rivers, S E; Bertoli, M C; Latimer-Cheung, A E; Salovey, P

    2017-12-01

    Medically underserved US immigrants are at an increased risk for death from preventable or curable cancers due to economic, cultural, and/or linguistic barriers to medical care. The purpose of this study was to describe the evaluation of the pilot study of the Healthy Eating for Life (HE4L) English as a second language curriculum. The Reach, Effectiveness Adoption, Implementation, Maintenance (RE-AIM) model was used to design a mixed-methods approach to the evaluation of the HE4L curriculum. Successful implementation was dependent upon enthusiastic teacher and manager support of the curriculum, teachers' ability to flexibly apply the curriculum to meet student needs, and researcher provision of curriculum workbooks. HE4L can be implemented successfully in various adult education settings to teach healthy eating behaviors and English language principles. Scale-up of HE4L may depend on the development of an online version of the curriculum to avoid the costs associated with printing and distributing curriculum materials.

  14. Medical student debt and major life choices other than specialty

    Directory of Open Access Journals (Sweden)

    James Rohlfing

    2014-11-01

    Full Text Available Background: Median indebtedness at graduation is now more than $170,000 for graduates of US Medical Schools. Debate still exists as to whether higher debt levels influence students to choose high paying non-primary care specialties. Notably, no previous research on the topic has taken into account cost of attendance when constructing a debt model, nor has any research examined the non-career major life decisions that medical students face. Methods: Medical students were surveyed using an anonymous electronic instrument developed for this study. The survey was delivered through a link included in a study email and students were recruited from school wide listservs and through snowball sampling (students were encouraged to share a link to the survey with other medical students. No incentives were offered for survey completion. Results: Responses were recorded from 102 US Allopathic medical schools (n=3,032, with 22 institutions (11 public, 11 private meeting inclusion criteria of 10% student body response proportion (n=1,846. Students with higher debt relative to their peers at their home institution reported higher frequencies of feeling callous towards others, were more likely to choose a specialty with a higher average annual income, were less likely to plan to practice in underserved locations, and were less likely to choose primary care specialties. Students with higher aggregate amounts of medical student loan debt were more likely to report high levels of stress from their educational debt, to delay getting married and to report disagreement that they would choose to become a physician again, if given the opportunity to revisit that choice. Increases in both aggregate and relative debt were associated with delaying having children, delaying buying a house, concerns about managing and paying back educational debt, and worrying that educational debt will influence one's specialty choice. Conclusions: Medical student debt and particularly debt

  15. Medical student debt and major life choices other than specialty.

    Science.gov (United States)

    Rohlfing, James; Navarro, Ryan; Maniya, Omar Z; Hughes, Byron D; Rogalsky, Derek K

    2014-01-01

    Median indebtedness at graduation is now more than $170,000 for graduates of US Medical Schools. Debate still exists as to whether higher debt levels influence students to choose high paying non-primary care specialties. Notably, no previous research on the topic has taken into account cost of attendance when constructing a debt model, nor has any research examined the non-career major life decisions that medical students face. Medical students were surveyed using an anonymous electronic instrument developed for this study. The survey was delivered through a link included in a study email and students were recruited from school wide listservs and through snowball sampling (students were encouraged to share a link to the survey with other medical students). No incentives were offered for survey completion. Responses were recorded from 102 US Allopathic medical schools (n=3,032), with 22 institutions (11 public, 11 private) meeting inclusion criteria of 10% student body response proportion (n=1,846). Students with higher debt relative to their peers at their home institution reported higher frequencies of feeling callous towards others, were more likely to choose a specialty with a higher average annual income, were less likely to plan to practice in underserved locations, and were less likely to choose primary care specialties. Students with higher aggregate amounts of medical student loan debt were more likely to report high levels of stress from their educational debt, to delay getting married and to report disagreement that they would choose to become a physician again, if given the opportunity to revisit that choice. Increases in both aggregate and relative debt were associated with delaying having children, delaying buying a house, concerns about managing and paying back educational debt, and worrying that educational debt will influence one's specialty choice. Medical student debt and particularly debt relative to peers at the same institution appears to

  16. Taking OSCE examiner training on the road: reaching the masses.

    Science.gov (United States)

    Reid, Katharine; Smallwood, David; Collins, Margo; Sutherland, Ruth; Dodds, Agnes

    To ensure the rigour of objective structured clinical examinations (OSCEs) in assessing medical students, medical school educators must educate examiners with a view to standardising examiner assessment behaviour. Delivering OSCE examiner training is a necessary yet challenging part of the OSCE process. A novel approach to implementing training for current and potential OSCE examiners was trialled by delivering large-group education sessions at major teaching hospitals. The 'OSCE Roadshow' comprised a short training session delivered in the context of teaching hospital 'Grand Rounds' to current and potential OSCE examiners. The training was developed to educate clinicians about OSCE processes, clarify the examiners' role and required behaviours, and to review marking guides and mark allocation in an effort to standardise OSCE processes and encourage consistency in examiner marking behaviour. A short exercise allowed participants to practise marking a mock OSCE to investigate examiner marking behaviour after the training. OSCE Roadshows at four metropolitan and one rural teaching hospital were well received and well attended by 171 clinicians across six sessions. Unexpectedly, medical students also attended in large numbers ( n= 220). After training, participants' average scores for the mock OSCE clustered closely around the ideal score of 28 (out of 40), and the average scores did not differ according to the levels of clinical experience. The OSCE Roadshow demonstrated the potential of brief familiarisation training in reaching large numbers of current and potential OSCE examiners in a time and cost-effective manner to promote standardisation of OSCE processes.

  17. Medical waste management at the University of Port Harcourt ...

    African Journals Online (AJOL)

    Background: The generation and handling of wastes from medically related procedures poses a potential health hazard to health workers and non health workers alike, and this has far reaching consequences for the public in areas where such wastes are disposed of carelessly. Aim: To investigate the medical waste ...

  18. A community-based breast cancer screening program for medically underserved women: its effect on disease stage at diagnosis and on hazard of death Programa basado en la comunidad de tamizaje de cáncer de mama en mujeres médicamente subatendidas: efecto sobre el estadio de la enfermedad en el momento del diagnóstico y el riesgo de muerte

    Directory of Open Access Journals (Sweden)

    Clyde B. McCoy

    2004-03-01

    Full Text Available OBJECTIVE: Earlier studies by this research team found that medically underserved minority women in the Miami-Dade County area of the state of Florida, United States, were in need of breast cancer screening and that there were problems with availability, accessibility, and acceptability of services. In response, a community-based comprehensive breast cancer screening program called the Early Detection Program (EDP was developed. The specific purpose of this study was to assess the effect that EDP participation had on stage at diagnosis and on hazard of death. METHODS: Existing data from the Florida Cancer Data System (FCDS, a statewide cancer registry, were linked with data from the EDP. In December 1998 we assembled a multiethnic (African-American, black Hispanic, white Hispanic, and white non-Hispanic retrospective cohort with the following inclusion criteria: all women aged 40 and older with breast cancer diagnosed and staged at University of Miami/Jackson Memorial Medical Center (which is located in the city of Miami, Florida from January 1987 through December 1997. EDP participants were medically underserved, that is, they resided in lower socioeconomic areas and/or had limited or no health insurance to cover medical costs. Subjects identified as EDP participants were compared to nonparticipants with respect to disease stage at diagnosis and hazard of death. Logistic regression and Cox regression models were used for analysis. RESULTS: EDP participants were 2.4 times as likely (95% confidence interval = 1.71 to 3.43 to present with a diagnosis of localized cancer as were nonparticipants, even after controlling for race and age at diagnosis. EDP participation was independently associated with both earlier diagnosis and reduced hazard of death. CONCLUSIONS: Participation in the EDP increases the likelihood of early detection of breast cancer and reduces the hazard of death for medically underserved women in the Miami-Dade County area of

  19. Ensuring safe access to medication for palliative care while preventing prescription drug abuse: innovations for American inner cities, rural areas, and communities overwhelmed by addiction.

    Science.gov (United States)

    Francoeur, Richard B

    2011-01-01

    This article proposes and develops novel components of community-oriented programs for creating and affording access to safe medication dispensing centers in existing retail pharmacies and in permanent or travelling pharmacy clinics that are guarded by assigned or off-duty police officers. Pharmacists at these centers would work with police, medical providers, social workers, hospital administrators, and other professionals in: planning and overseeing the safe storage of controlled substance medications in off-site community safe-deposit boxes; strengthening communication and cooperation with the prescribing medical provider; assisting the prescribing medical provider in patient monitoring (checking the state prescription registry, providing pill counts and urine samples); expanding access to lower-cost, and in some cases, abuse-resistant formulations of controlled substance medications; improving transportation access for underserved patients and caregivers to obtain prescriptions; and integrating community agencies and social networks as resources for patient support and monitoring. Novel components of two related community-oriented programs, which may be hosted outside of safe medication dispensing centers, are also suggested and described: (1) developing medication purchasing cooperatives (ie, to help patients, families, and health institutions afford the costs of medications, including tamper-or abuse-resistant/deterrent drug formulations); and (2) expanding the role of inner-city methadone maintenance treatment programs in palliative care (ie, to provide additional patient monitoring from a second treatment team focusing on narcotics addiction, and potentially, to serve as an untapped source of opioid medication for pain that is less subject to abuse, misuse, or diversion).

  20. Dental Therapists as New Oral Health Practitioners: Increasing Access for Underserved Populations.

    Science.gov (United States)

    Brickle, Colleen M; Self, Karl D

    2017-09-01

    The development of dental therapy in the U.S. grew from a desire to find a workforce solution for increasing access to oral health care. Worldwide, the research that supports the value of dental therapy is considerable. Introduction of educational programs in the U.S. drew on the experiences of programs in New Zealand, Australia, Canada, and the United Kingdom, with Alaska tribal communities introducing dental health aide therapists in 2003 and Minnesota authorizing dental therapy in 2009. Currently, two additional states have authorized dental therapy, and two additional tribal communities are pursuing the use of dental therapists. In all cases, the care provided by dental therapists is focused on communities and populations who experience oral health care disparities and have historically had difficulties in accessing care. This article examines the development and implementation of the dental therapy profession in the U.S. An in-depth look at dental therapy programs in Minnesota and the practice of dental therapy in Minnesota provides insight into the early implementation of this emerging profession. Initial results indicate that the addition of dental therapists to the oral health care team is increasing access to quality oral health care for underserved populations. As evidence of dental therapy's success continues to grow, mid-level dental workforce legislation is likely to be introduced by oral health advocates in other states. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

  1. FACTORS AFFECTING THE DEVELOPMENT OF MEDICAL TOURISM IN PUBLIC HOSPITALS

    OpenAIRE

    YİĞİT, Vahit

    2016-01-01

    Medical tourism is a burgeoning industry in the world. Nowadays, over 50countries have been identified medical tourism as a national industry. AlthoughAsian countries where India, Thailand, Singapore and Malaysia popular medicaltourism destination, medical tourism in Turkey has not reached the desiredlevel and and could not get enough share of the medical tourism market. The aimof this study is to determine the factors influencing the development ofmedical tourism in Turkey. This research was...

  2. Socially Accountable Medical Education: An Innovative Approach at Florida International University Herbert Wertheim College of Medicine.

    Science.gov (United States)

    Greer, Pedro J; Brown, David R; Brewster, Luther G; Lage, Onelia G; Esposito, Karin F; Whisenant, Ebony B; Anderson, Frederick W; Castellanos, Natalie K; Stefano, Troy A; Rock, John A

    2018-01-01

    Despite medical advances, health disparities persist, resulting in medicine's renewed emphasis on the social determinants of health and calls for reform in medical education. The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Herbert Wertheim College of Medicine provides a platform for the school's community-focused mission. NeighborhoodHELP emphasizes social accountability and interprofessional education while providing evidence-based, patient- and household-centered care. NeighborhoodHELP is a required, longitudinal service-learning outreach program in which each medical student is assigned a household in a medically underserved community. Students, teamed with learners from other professional schools, provide social and clinical services to their household for three years. Here the authors describe the program's engagement approach, logistics, and educational goals and structure. During the first six years of NeighborhoodHELP (September 2010-August 2016), 1,470 interprofessional students conducted 7,452 visits to 848 households with, collectively, 2,252 members. From August 2012, when mobile health centers were added to the program, through August 2016, students saw a total of 1,021 household members through 7,207 mobile health center visits. Throughout this time, households received a variety of free health and social services (e.g., legal aid, tutoring). Compared with peers from other schools, graduating medical students reported more experience with clinical interprofessional education and health disparities. Surveyed residency program directors rated graduates highly for their cultural sensitivity, teamwork, and accountability. Faculty and administrators are focusing on social accountability curriculum integration, systems for assessing and tracking relevant educational and household outcomes, and policy analysis.

  3. The database for reaching experiments and models.

    Directory of Open Access Journals (Sweden)

    Ben Walker

    Full Text Available Reaching is one of the central experimental paradigms in the field of motor control, and many computational models of reaching have been published. While most of these models try to explain subject data (such as movement kinematics, reaching performance, forces, etc. from only a single experiment, distinct experiments often share experimental conditions and record similar kinematics. This suggests that reaching models could be applied to (and falsified by multiple experiments. However, using multiple datasets is difficult because experimental data formats vary widely. Standardizing data formats promises to enable scientists to test model predictions against many experiments and to compare experimental results across labs. Here we report on the development of a new resource available to scientists: a database of reaching called the Database for Reaching Experiments And Models (DREAM. DREAM collects both experimental datasets and models and facilitates their comparison by standardizing formats. The DREAM project promises to be useful for experimentalists who want to understand how their data relates to models, for modelers who want to test their theories, and for educators who want to help students better understand reaching experiments, models, and data analysis.

  4. Reach and get capability in a computing environment

    Science.gov (United States)

    Bouchard, Ann M [Albuquerque, NM; Osbourn, Gordon C [Albuquerque, NM

    2012-06-05

    A reach and get technique includes invoking a reach command from a reach location within a computing environment. A user can then navigate to an object within the computing environment and invoke a get command on the object. In response to invoking the get command, the computing environment is automatically navigated back to the reach location and the object copied into the reach location.

  5. Dermatologic care in the homeless and underserved populations: observations from the Venice Family Clinic.

    Science.gov (United States)

    Grossberg, Anna L; Carranza, Dafnis; Lamp, Karen; Chiu, Melvin W; Lee, Catherine; Craft, Noah

    2012-01-01

    Dermatologic care in the homeless and impoverished urban underserved populations is rarely described despite the wide prevalence of skin concerns in this population. Because the homeless population may be subject to increased sun exposure compared to the nonhomeless population, they also may be at increased risk for skin cancer. We sought to describe the spectrum of dermatologic diseases seen in a free clinic in Venice, California--the Venice Family Clinic (VFC)--as well as the differences in diagnoses between the homeless and nonhomeless patients seen at this clinic. A retrospective chart review was performed of dermatology patients (N = 82) seen at VFC throughout the 2006 calendar year. The homeless population (n = 22) was found to have more diagnoses of malignant/premalignant growths (25% [16/64] of all homeless diagnoses) compared to their nonhomeless (n = 60) counterparts (6.1% [8/132] of all nonhomeless diagnoses; P < .0001). This difference was sustained when ethnicity was controlled, with 29.6% [16/54] of diagnoses in the homeless white group consisting of malignant/ premalignant growths compared to 8.9% [4/45] of diagnoses in the nonhomeless white cohort (P < .005). Homeless patients may have a higher incidence of skin cancers and precancerous skin lesions due to increased sun exposure and/or limited access to dermatologic care.

  6. Reaching the unreached.

    Science.gov (United States)

    Ariyaratne, A T

    1989-01-01

    Embodied in the child survival revolution are ideological, methodological, and organizational innovations aimed at radical change in the condition of the world's children as rapidly as possible. In countries such as Sri Lanka, child survival and health for all by the year 2000 often seem to be impossible goals, given the tumultuous socioeconomic and political conditions. In Sri Lanka, the quality of life has been eroded, not enhanced, by the importation of Western technology and managerial capitalism and the destruction of indigenous processes. The chaos and violence that have been brought into the country have made it difficult to reach the poor children, women, and refugees in rural areas with primary health care interventions. Sri Lanka's unreachable--the decision making elites--have blocked access to the unreached--the urban and rural poor. If governments are to reach the unreached, they must remove the obstacles to a people-centered, community development process. It is the people themselves, and the institutions of their creation, that can reach the children amidst them in greatest need. To achieve this task, local communities must be provided with basic human rights, the power to make decisions that affect their lives, necessary resources, and appropriate technologies. Nongovernmental organizations can play a crucial role as bridges between the unreached and the unreachable by promoting community empowerment, aiding in the formation of networks of community organizations, and establishing linkages with government programs. If the ruling elites in developing countries can be persuaded to accommodate the needs and aspirations of those who, to date, have been excluded from the development process, the child survival revolution can be a nonviolent one.

  7. Taking OSCE examiner training on the road: reaching the masses

    Directory of Open Access Journals (Sweden)

    Katharine Reid

    2016-09-01

    Full Text Available Background: To ensure the rigour of objective structured clinical examinations (OSCEs in assessing medical students, medical school educators must educate examiners with a view to standardising examiner assessment behaviour. Delivering OSCE examiner training is a necessary yet challenging part of the OSCE process. A novel approach to implementing training for current and potential OSCE examiners was trialled by delivering large-group education sessions at major teaching hospitals. Methods: The ‘OSCE Roadshow’ comprised a short training session delivered in the context of teaching hospital ‘Grand Rounds’ to current and potential OSCE examiners. The training was developed to educate clinicians about OSCE processes, clarify the examiners’ role and required behaviours, and to review marking guides and mark allocation in an effort to standardise OSCE processes and encourage consistency in examiner marking behaviour. A short exercise allowed participants to practise marking a mock OSCE to investigate examiner marking behaviour after the training. Results: OSCE Roadshows at four metropolitan and one rural teaching hospital were well received and well attended by 171 clinicians across six sessions. Unexpectedly, medical students also attended in large numbers (n=220. After training, participants’ average scores for the mock OSCE clustered closely around the ideal score of 28 (out of 40, and the average scores did not differ according to the levels of clinical experience. Conclusion: The OSCE Roadshow demonstrated the potential of brief familiarisation training in reaching large numbers of current and potential OSCE examiners in a time and cost-effective manner to promote standardisation of OSCE processes.

  8. A COMPARISON OF THE SIT-AND-REACH TEST AND THE BACK-SAVER SIT-AND-REACH TEST IN UNIVERSITY STUDENTS

    Directory of Open Access Journals (Sweden)

    Pedro A. López-Miñarro

    2009-03-01

    Full Text Available This study compares the forward reach score, spine and pelvis postures, and hamstring criterion-related validity (concurrent validity between the sit-and-reach test (SR and the back-saver sit-and-reach test (BS. Seventy-six men (mean age ± SD: 23.45 ± 3.96 years and 67 women (mean age ± SD: 23.85 ± 5.36 years were asked to perform three trials of SR, BS left (BSl, right (BSr, and passive straight leg raise (PSLR right and left (hamstring criterion measure in a randomized order. The thoracic, lumbar, and pelvis angles (measured with a Uni-level inclinometer and forward reach scores were recorded once the subjects reached forward as far as possible without flexing the knees. A repeated measure ANOVA was performed followed by Bonferroni´s post hoc test. Pearson correlation coefficients were used to define the relationships between SR and BS scores with respect to PSLR. In both men and women, the thoracic angle in BS was significantly greater than in SR (p<0.016. However, no significant differences were found between the tests in lumbar angle, pelvic angle, and forward reach scores. The concurrent validity of the forward reach score as a measure of hamstring extensibility was moderate in women (0.66 0. 76 and weak to moderate in men (0.51 0.59. The concurrent validity was slightly higher in SR than in BS, although no significant differences between the correlation values were observed. There were significant differences in the thoracic angle between the SR and BS, but not in the forward reach score. There was no difference in concurrent validity between the two tests. However, the traditional SR was preferred because it reached better concurrent validity than the BS

  9. Challenges and Opportunities to Improve Cervical Cancer Screening Rates in US Health Centers through Patient-Centered Medical Home Transformation

    Directory of Open Access Journals (Sweden)

    Olga Moshkovich

    2015-01-01

    Full Text Available Over the last 50 years, the incidence of cervical cancer has dramatically decreased. However, health disparities in cervical cancer screening (CCS persist for women from racial and ethnic minorities and those residing in rural and poor communities. For more than 45 years, federally funded health centers (HCs have been providing comprehensive, culturally competent, and quality primary health care services to medically underserved communities and vulnerable populations. To enhance the quality of care and to ensure more women served at HCs are screened for cervical cancer, over eight HCs received funding to support patient-centered medical home (PCMH transformation with goals to increase CCS rates. The study conducted a qualitative analysis using Atlas.ti software to describe the barriers and challenges to CCS and PCMH transformation, to identify potential solutions and opportunities, and to examine patterns in barriers and solutions proposed by HCs. Interrater reliability was assessed using Cohen’s Kappa. The findings indicated that HCs more frequently described patient-level barriers to CCS, including demographic, cultural, and health belief/behavior factors. System-level barriers were the next commonly cited, particularly failure to use the full capability of electronic medical records (EMRs and problems coordinating with external labs or providers. Provider-level barriers were least frequently cited.

  10. Maternal medical risks during pregnancy and childhood externalizing behavior.

    Science.gov (United States)

    Jackson, Dylan B; Vaughn, Michael G

    2018-04-25

    Research has indicated that maternal health during the prenatal period and at delivery carries far reaching significance for the development of offspring. Even so, the role of the accumulation of maternal medical risks during pregnancy in the development of externalizing behavior during childhood has generally been overlooked. The present study investigates whether the accumulation of maternal medical risks during the prenatal period is positively associated with childhood externalizing behavior, and whether this association is stronger among male offspring. We examined a large, nationally representative sample of children who participated in the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). Information concerning maternal medical history, including the presence of a number of medical risks during pregnancy, was obtained through hospital records. A subsample of children with both parent and teacher reports of externalizing behavior during kindergarten was employed in the present study. A greater number of maternal medical risks during pregnancy increased the odds of childhood externalizing behavior across settings, but only among male offspring. The predicted probability of persistent externalizing behavior among males increased from .084 in the absence of maternal medical risks during pregnancy to .241 in the presence of three or more maternal medical risks during pregnancy. Our findings suggest that maternal medical risks during the prenatal period can have far-reaching consequences for the behavioral development of male offspring. Treatment of medical risks among expectant mothers may have the added benefit of reducing the likelihood of childhood externalizing behavior among male progeny. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Exploring the Use of Electronic Mobile Technologies among Distance Learners in Rural Communities for Safe and Disruptive Learning

    Science.gov (United States)

    Ntloedibe-Kuswani, Gomang Seratwa

    2013-01-01

    Several studies indicated the potential of electronic mobile technologies in reaching (safe learning) under-served communities and engaging (disruptive learning) disadvantaged peoples affording them learning experiences. However, the potential benefits of (electronic mobile learning) e-mobile learning have not been well understood from the…

  12. A Practical Risk Stratification Approach for Implementing a Primary Care Chronic Disease Management Program in an Underserved Community.

    Science.gov (United States)

    Xu, Junjun; Williams-Livingston, Arletha; Gaglioti, Anne; McAllister, Calvin; Rust, George

    2018-01-01

    The use of value metrics is often dependent on payer-initiated health care management incentives. There is a need for practices to define and manage their own patient panels regardless of payer to participate effectively in population health management. A key step is to define a panel of primary care patients with high comorbidity profiles. Our sample included all patients seen in an urban academic family medicine clinic over a two-year period. The simplified risk stratification was built using internal electronic health record and billing system data based on ICD-9 codes. There were 347 patients classified as high-risk out of the 5,364 patient panel. Average age was 59 years (SD 15). Hypertension (90%), hyperlipidemia (62%), and depression (55%) were the most common conditions among high-risk patients. Simplified risk stratification provides a feasible option for our team to understand and respond to the nuances of population health in our underserved community.

  13. 78 FR 46352 - Health Resources and Services Administration

    Science.gov (United States)

    2013-07-31

    ... Tool may also be designed to be used in community-based settings where women live, work, and purchase... territories, particularly women living in medically underserved communities or who experience difficulty...

  14. Medical oncology future plan of the Spanish Society of Medical Oncology: challenges and future needs of the Spanish oncologists.

    Science.gov (United States)

    Rivera, F; Andres, R; Felip, E; Garcia-Campelo, R; Lianes, P; Llombart, A; Piera, J M; Puente, J; Rodriguez, C A; Vera, R; Virizuela, J A; Martin, M; Garrido, P

    2017-04-01

    The SEOM Future Plan is aimed at identifying the main challenges, trends and needs of the medical oncology speciality over the next years, including potential oncologist workforce shortages, and proposing recommendations to overcome them. The estimations of the required medical oncologists workforce are based on an updated Medical Oncologist Register in Spain, Medical Oncology Departments activity data, dedication times and projected cancer incidence. Challenges, needs and future recommendations were drawn from an opinion survey and an advisory board. A shortage of 211 FTE medical oncologist specialists has been established. To maintain an optimal ratio of 158 new cases/FTE, medical oncology workforce should reach 1881 FTE by 2035. Main recommendations to face the growing demand and complexity of oncology services include a yearly growth of 2.5% of medical oncologist's workforce until 2035, and development and application of more accurate quality indicators for cancer care and health outcomes measure.

  15. Medical Student Teaching and Recruiting: 50 Years of Balancing Two Educational Aims.

    Science.gov (United States)

    Schneider, Benjamin N; Chessman, Alexander; Toffler, William; Handler, Lara; Steiner, Beat; Biagioli, Frances Emily

    2017-04-01

    Family medicine (FM) undergraduate medical educators have had two distinct missions, to increase the knowledge, skills, and attitudes of all students while also striving to attract students to the field of family medicine. A five decade literature search was conducted gathering FM curricular innovations and the parallel trends in FM medical student interest. Student interest in FM had a rapid first-decade rise to 14%, a second 1990's surge, followed by a drop to the current plateau of 8-9%. This falls far short of the 30-50% generalist benchmark needed to fill the country's health care needs. Curricular innovations fall into three periods: Charismatic Leaders & Clinical Exposures (1965-1978), Creation of Clerkships of FM (1979-1998) and Curricular Innovations (1998-present). There is good evidence that having a required third-year clerkship positively impacts student interest in the field, however there is little research regarding the recruitment impact of specific clerkship curricula. Other tools associated with student interest include programming geared towards primary care or rural training and extracurricular opportunities such as FM Interest Groups. Strategic plans to improve the primary care work force should focus funding and legislative efforts on effective methods such as: establishing and maintaining FM clerkships, admitting students with rural and underserved backgrounds or primary care interest, developing longitudinal primary care tracks, and supporting extracurricular FM activities. Rigorous research is needed to assess how best to utilize limited educational resources to ensure that all students graduate with a core set of FM competence as well as an increased FM matriculation. Strategic plans to improve the primary care work force should focus funding and legislative efforts on effective methods such as: establishing and maintaining FM clerkships, admitting students with rural and underserved backgrounds or primary care interest, developing

  16. Planning of the Extended Reach well Dieksand 2; Planung der Extended Reach Bohrung Dieksand 2

    Energy Technology Data Exchange (ETDEWEB)

    Frank, U.; Berners, H. [RWE-DEA AG, Hamburg (Germany). Drilling Team Mittelplate und Dieksand; Hadow, A.; Klop, G.; Sickinger, W. [Wintershall AG Erdoelwerke, Barnstdorf (Germany); Sudron, K.

    1998-12-31

    The Mittelplate oil field is located 7 km offshore the town of Friedrichskoog. Reserves are estimated at 30 million tonnes of oil. At a production rate of 2,500 t/d, it will last about 33 years. The transport capacity of the offshore platform is limited, so that attempts were made to enhance production by constructing the extended reach borehole Dieksand 2. Details are presented. (orig.) [Deutsch] Das Erdoelfeld Mittelplate liegt am suedlichen Rand des Nationalparks Schleswig Holsteinisches Wattenmeer, ca. 7000 m westlich der Ortschaft Friedrichskoog. Die gewinnbaren Reserven betragen ca. 30 Millionen t Oel. Bei einer Foerderkapazitaet von 2.500 t/Tag betraegt die Foerderdauer ca. 33 Jahre. Aufgrund der begrenzten Transportkapazitaeten von der Insel, laesst sich durch zusaetzliche Bohrungen von der kuenstlichen Insel Mittelplate keine entscheidende Erhoehung der Foerderkapazitaet erzielen. Ab Sommer 1996 wurde erstmals die Moeglichkeit der Lagerstaettenerschliessung von Land untersucht. Ein im Mai 1997 in Hamburg etabliertes Drilling Team wurde mit der Aufgabe betraut, die Extended Reach Bohrung Dieksand 2 zu planen und abzuteufen. Die Planungsphasen fuer die Extended Reach Bohrung Dieksand 2 wurden aufgezeigt. Die fuer den Erfolg einer Extended Reach Bohrung wichtigen Planungsparameter wurden erlaeutert. Es wurden Wege gezeigt, wie bei diesem Projekt technische und geologische Risiken in der Planung mit beruecksichtigt und nach Beginn der Bohrung weiter bearbeitet werden koennen. (orig.)

  17. Hospital medication errors in a pharmacovigilance system in Colombia

    Directory of Open Access Journals (Sweden)

    Jorge Enrique Machado-Alba

    2015-11-01

    Full Text Available Objective: this study analyzes the medication errors reported to a pharmacovigilance system by 26 hospitals for patients in the healthcare system of Colombia. Methods: this retrospective study analyzed the medication errors reported to a systematized database between 1 January 2008 and 12 September 2013. The medication is dispensed by the company Audifarma S.A. to hospitals and clinics around Colombia. Data were classified according to the taxonomy of the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP. The data analysis was performed using SPSS 22.0 for Windows, considering p-values < 0.05 significant. Results: there were 9 062 medication errors in 45 hospital pharmacies. Real errors accounted for 51.9% (n = 4 707, of which 12.0% (n = 567 reached the patient (Categories C to I and caused harm (Categories E to I to 17 subjects (0.36%. The main process involved in errors that occurred (categories B to I was prescription (n = 1 758, 37.3%, followed by dispensation (n = 1 737, 36.9%, transcription (n = 970, 20.6% and administration (n = 242, 5.1%. The errors in the administration process were 45.2 times more likely to reach the patient (CI 95%: 20.2–100.9. Conclusions: medication error reporting systems and prevention strategies should be widespread in hospital settings, prioritizing efforts to address the administration process.

  18. Teratology testing under REACH.

    Science.gov (United States)

    Barton, Steve

    2013-01-01

    REACH guidelines may require teratology testing for new and existing chemicals. This chapter discusses procedures to assess the need for teratology testing and the conduct and interpretation of teratology tests where required.

  19. A randomized controlled trial to assess the efficacy of an interactive mobile messaging intervention for underserved smokers: Project ACTION.

    Science.gov (United States)

    Vidrine, Damon J; Fletcher, Faith E; Danysh, Heather E; Marani, Salma; Vidrine, Jennifer Irvin; Cantor, Scott B; Prokhorov, Alexander V

    2012-08-25

    Despite a significant decrease in smoking prevalence over the past ten years, cigarette smoking still represents the leading cause of preventable morbidity and mortality in the United States. Moreover, smoking prevalence is significantly higher among those with low levels of education and those living at, or below, the poverty level. These groups tend to be confronted with significant barriers to utilizing more traditional smoking cessation intervention approaches. The purpose of the study, Project ACTION (Adult smoking Cessation Treatment through Innovative Outreach to Neighborhoods), is to utilize a mobile clinic model, a network of community sites (i.e., community centers and churches) and an interactive mobile messaging system to reach and deliver smoking cessation treatment to underserved, low-income communities. We are using a group-randomized design, with the community site as the sampling unit, to compare the efficacy of three smoking cessation interventions: 1) Standard Care--brief advice to quit smoking, nicotine replacement therapy (NRT), and self-help materials; 2) Enhanced Care--standard care components plus a cell phone-delivered text/graphical messaging component; and 3) Intensive Care--enhanced care components plus a series of 11 cell phone-delivered proactive counseling sessions. An economic evaluation will also be performed to evaluate the relative cost effectiveness of the three treatment approaches. We will recruit 756 participants (252 participants in each of the 3 intervention groups). At the time of randomization, participants complete a baseline assessment, consisting of smoking history, socio-demographic, and psychosocial variables. Monthly cell phone assessments are conducted for 6 months-post enrollment, and a final 12-month follow-up is conducted at the original neighborhood site of enrollment. We will perform mixed-model logistic regression to compare the efficacy of the three smoking cessation intervention treatment groups. It is

  20. A randomized controlled trial to assess the efficacy of an interactive mobile messaging intervention for underserved smokers: Project ACTION

    Directory of Open Access Journals (Sweden)

    Vidrine Damon J

    2012-08-01

    Full Text Available Abstract Background Despite a significant decrease in smoking prevalence over the past ten years, cigarette smoking still represents the leading cause of preventable morbidity and mortality in the United States. Moreover, smoking prevalence is significantly higher among those with low levels of education and those living at, or below, the poverty level. These groups tend to be confronted with significant barriers to utilizing more traditional smoking cessation intervention approaches. The purpose of the study, Project ACTION (Adult smoking Cessation Treatment through Innovative Outreach to Neighborhoods, is to utilize a mobile clinic model, a network of community sites (i.e., community centers and churches and an interactive mobile messaging system to reach and deliver smoking cessation treatment to underserved, low-income communities. Methods/Design We are using a group-randomized design, with the community site as the sampling unit, to compare the efficacy of three smoking cessation interventions: 1 Standard Care - brief advice to quit smoking, nicotine replacement therapy (NRT, and self-help materials; 2 Enhanced Care - standard care components plus a cell phone-delivered text/graphical messaging component; and 3 Intensive Care - enhanced care components plus a series of 11 cell phone-delivered proactive counseling sessions. An economic evaluation will also be performed to evaluate the relative cost effectiveness of the three treatment approaches. We will recruit 756 participants (252 participants in each of the 3 intervention groups. At the time of randomization, participants complete a baseline assessment, consisting of smoking history, socio-demographic, and psychosocial variables. Monthly cell phone assessments are conducted for 6 months-post enrollment, and a final 12-month follow-up is conducted at the original neighborhood site of enrollment. We will perform mixed-model logistic regression to compare the efficacy of the three smoking

  1. National awareness campaign to prevent medication-overuse headache in Denmark

    DEFF Research Database (Denmark)

    Carlsen, Louise Ninett; Westergaard, Maria Lurenda; Bisgaard, Mette

    2018-01-01

    a four-month medication-overuse headache awareness campaign in 2016. Target groups were the general public, general practitioners, and pharmacists. Key messages were: Overuse of pain-medication can worsen headaches; pain-medication should be used rationally; and medication-overuse headache is treatable...... were distributed. Two radio interviews were conducted. A television broadcast about headache reached an audience of 520,000. Forty articles were published in print media. Information was accessible at 32 reputable websites and five online news agencies. Three scientific papers were published...

  2. REACH: Evaluation Report and Executive Summary

    Science.gov (United States)

    Sibieta, Luke

    2016-01-01

    REACH is a targeted reading support programme designed to improve reading accuracy and comprehension in pupils with reading difficulties in Years 7 and 8. It is based on research by the Centre for Reading and Language at York and is delivered by specially trained teaching assistants (TAs). This evaluation tested two REACH interventions, one based…

  3. Global reach and engagement

    Science.gov (United States)

    2016-09-01

    Popular culture reflects both the interests of and the issues affecting the general public. As concerns regarding climate change and its impacts grow, is it permeating into popular culture and reaching that global audience?

  4. Cost-Effectiveness of a School-Based Emotional Health Screening Program

    Science.gov (United States)

    Kuo, Elena; Stoep, Ann Vander; McCauley, Elizabeth; Kernic, Mary A.

    2009-01-01

    Background: School-based screening for health conditions can help extend the reach of health services to underserved populations. Screening for mental health conditions is growing in acceptability, but evidence of cost-effectiveness is lacking. This study assessed costs and effectiveness associated with the Developmental Pathways Screening…

  5. The long reach of Alzheimer's disease: patients, practice, and policy.

    Science.gov (United States)

    Bynum, Julie P W

    2014-04-01

    The impact of Alzheimer's disease and related dementias reaches well beyond the health care needs of the person with dementia. As dementia inexorably progresses, the patient becomes increasingly dependent on others for basic daily care and routine tasks, a physically safe environment, and protection from exploitation or abuse. Addressing the diverse medical and social care needs of the burgeoning US population with Alzheimer's disease and related dementias requires the adoption of a broad-based policy framework and agenda that explicitly acknowledge the complex and unique needs of people with dementia and the impacts of dementia on caregivers and society at large. Public policies related to social service providers, agencies that provide appropriate housing, financial and legal services, and law enforcement must complement other policies focused on prevention and risk reduction, effective treatment development, and efficient health care delivery.

  6. Comprehensive dental services for an underserved and medically compromised population provided through a community partnership and service learning.

    Science.gov (United States)

    Chávez, Elisa M; LaBarre, Eugene; Fredekind, Richard; Isakson, Paul

    2010-01-01

    The University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco established a comprehensive dental care program at Laguna Honda Hospital, a public, skilled nursing facility. The program had three goals: (1) to provide dental students and residents an opportunity to provide oral health care for adults who were frail and medically compromised who could not come into the clinics, (2) to increase students' access to patients who needed removable prosthodontics, and (3) to fulfill Pacific's commitment to public service. Laguna Honda and Pacific pooled their resources to bring comprehensive dental care to patients who were not able to access the dental school clinics. The long-term goals are to restore and maintain the oral health of those who reside in the facility, and to educate future dentists to provide oral health care for similar populations.

  7. Why and how to make a REACH registration of combustion ash; Moejligheter vid REACH-registrering av energiaskor

    Energy Technology Data Exchange (ETDEWEB)

    Loevgren, Linnea; Wik, Ola

    2009-10-15

    The new chemical regulation, REACH (1997/2006/EC), Registration, Evaluation, Authorization and restriction of Chemicals, took effect the 1st of June 2007. The background to this report was the introduction of REACH and the difficulties to understand the implications for ash. The most important consequence of REACH is that all chemical substances that are manufactured, handled and used above one tonne per annum per legal entity shall be registered according to this regulation. The registration includes specifying the chemical, physical, toxicity and ecotoxicity properties of the substance and risk assessing the identified areas of use. The report describes the use of ash in connection to the waste legislation and its planned end-of-waste-criteria, the chemical legislation and the Construction Products Directive. The target audience of this report is companies producing ashes and having a use or seeing a use for its ash. The report describes how to make a REACH registration of ash independent if a company did or did not pre-register ash during 2008. It describes how to change from one ash registration into another if the pre-registration was done for one type of ash but the company changes opinion during the sameness check, i.e. changing SIEF (Appendix A). Taking part in REACH registration projects during 2009-2010 can be advantageous since knowledge and financing are shared. Ash can be REACH registered also in the future but it is important to know that the registration have to be done prior the production and marketing starts. If ash is consider to be a waste the handling is covered by the community and national waste legislation. In Sweden ashes are by and large being regarded as waste, and recycling is risk assessed and permits are given case by case. End-of-waste criteria for different waste material are being elaborated within the EU. Such criteria will among other details cover chemical safety. When a material fulfils the end-of-waste criteria such material

  8. The Brotherhood Medical Center: Collaborative Foundation of Maternity and Children’s Healthcare Facility for Displaced Syrians

    Science.gov (United States)

    Aburas, Rahma; Najeeb, Amina; Baageel, Laila; Mackey, Tim K.

    2018-01-01

    The United Nations has declared the Syrian conflict, with more than 50% of Syria’s population currently displaced, as the worst humanitarian crisis of the twenty-first century. The Syrian conflict has led to a collapse of infrastructure, including access to critical and lifesaving healthcare services. Women and children account for approximately 75% of internally displaced Syrians and refugees. This population is also particularly vulnerable to poor health outcomes, a condition worsened by lack of access to maternal and child health services. In response to this crisis, a partnership of Saudi and Syrian physicians established a non-profit healthcare facility named the Brotherhood Medical Center (BMC) to serve women and children within a safe area near the Syrian–Turkish border. The project began in September 2014 and was implemented in three phases of establishment, phased construction and formal launch and operation. Currently, the BMC is working at about 70% of its capacity and is run in partnership with the Syrian Expatriate Medical Association. Although there was strong initial support from donors, the BMC continues to face many financial and operational challenges, including difficulties in transferring money to Syria, shortage of medical supplies, and lack of qualified medical personnel. Despite these challenges, the BMC represents a critical model and an important case study of the challenges of delivering healthcare services to underserved populations during an ongoing conflict. However, more robust support from the international community is needed to ensure it continues its important health and humanitarian mission. PMID:29721489

  9. The Brotherhood Medical Center: Collaborative Foundation of Maternity and Children’s Healthcare Facility for Displaced Syrians

    Directory of Open Access Journals (Sweden)

    Rahma Aburas

    2018-04-01

    Full Text Available The United Nations has declared the Syrian conflict, with more than 50% of Syria’s population currently displaced, as the worst humanitarian crisis of the twenty-first century. The Syrian conflict has led to a collapse of infrastructure, including access to critical and lifesaving healthcare services. Women and children account for approximately 75% of internally displaced Syrians and refugees. This population is also particularly vulnerable to poor health outcomes, a condition worsened by lack of access to maternal and child health services. In response to this crisis, a partnership of Saudi and Syrian physicians established a non-profit healthcare facility named the Brotherhood Medical Center (BMC to serve women and children within a safe area near the Syrian–Turkish border. The project began in September 2014 and was implemented in three phases of establishment, phased construction and formal launch and operation. Currently, the BMC is working at about 70% of its capacity and is run in partnership with the Syrian Expatriate Medical Association. Although there was strong initial support from donors, the BMC continues to face many financial and operational challenges, including difficulties in transferring money to Syria, shortage of medical supplies, and lack of qualified medical personnel. Despite these challenges, the BMC represents a critical model and an important case study of the challenges of delivering healthcare services to underserved populations during an ongoing conflict. However, more robust support from the international community is needed to ensure it continues its important health and humanitarian mission.

  10. Reducing Disparities in Cancer Screening and Prevention through Community-Based Participatory Research Partnerships with Local Libraries: A Comprehensive Dynamic Trial.

    Science.gov (United States)

    Rapkin, Bruce D; Weiss, Elisa; Lounsbury, David; Michel, Tamara; Gordon, Alexis; Erb-Downward, Jennifer; Sabino-Laughlin, Eilleen; Carpenter, Alison; Schwartz, Carolyn E; Bulone, Linda; Kemeny, Margaret

    2017-09-01

    Reduction of cancer-related disparities requires strategies that link medically underserved communities to preventive care. In this community-based participatory research project, a public library system brought together stakeholders to plan and undertake programs to address cancer screening and risk behavior. This study was implemented over 48 months in 20 large urban neighborhoods, selected to reach diverse communities disconnected from care. In each neighborhood, Cancer Action Councils were organized to conduct a comprehensive dynamic trial, an iterative process of program planning, implementation and evaluation. This process was phased into neighborhoods in random, stepped-wedge sequence. Population-level outcomes included self-reported screening adherence and smoking cessation, based on street intercept interviews. Event-history regressions (n = 9374) demonstrated that adherence outcomes were associated with program implementation, as were mediators such as awareness of screening programs and cancer information seeking. Findings varied by ethnicity, and were strongest among respondents born outside the U.S. or least engaged in care. This intervention impacted health behavior in diverse, underserved and vulnerable neighborhoods. It has been sustained as a routine library system program for several years after conclusion of grant support. In sum, participatory research with the public library system offers a flexible, scalable approach to reduce cancer health disparities. © Society for Community Research and Action 2017.

  11. 'n Beroepsplig om te genees! | Smit | South African Medical Journal

    African Journals Online (AJOL)

    The rules of South African law are analysed, especially any possible rules whic.h may impose a duty upon a medical practitioner to heal in cases where the patient refuses treatment. The conclusion is reached that a refusal of medical treatment expressed on behalf of a minor child or an unconscious patient might safely be ...

  12. Stream Habitat Reach Summary - NCWAP [ds158

    Data.gov (United States)

    California Natural Resource Agency — The Stream Habitat - NCWAP - Reach Summary [ds158] shapefile contains in-stream habitat survey data summarized to the stream reach level. It is a derivative of the...

  13. Operational Reach: Is Current Army Doctrine Adequate?

    National Research Council Canada - National Science Library

    Heintzelman, Scott

    2003-01-01

    The term operational reach, an element of operational design, is new to U.S. Army doctrine. Operational reach is not found in the previous edition of the Army's basic operational doctrine, Field Manual...

  14. Introducing medical humanities in the medical curriculum in Saudi Arabia: A pedagogical experiment

    Directory of Open Access Journals (Sweden)

    Rabie E Abdel-Halim

    2012-01-01

    Full Text Available In a marked shift from the modern positivist materialist philosophy that influenced medical education for more than a century, Western medical educators are now beginning to realize the significance of the spiritual element of human nature. Consensus is currently building up in Europe and North America on the need to give more emphasis to the study of humanities disciplines such as history of medicine, ethics, religion, philosophy, medically related poetry, literature, arts and medical sociology in medical colleges with the aim of allowing graduates to reach to the heart of human learning about meaning of life and death and to become kinder, more reflective practitioners. The medicine taught and practiced during the Islamic civilization era was a vivid example of the unity of the two components of medical knowledge: natural sciences and humanities. It was also a brilliant illustration of medical ethics driven by a divine moral code. This historical fact formed the foundation for the three medical humanities courses presented in this article reporting a pedagogical experiment in preparation for starting a humanities program in Alfaisal University Medical College in Riyadh. In a series of lectures alternating with interactive sessions, active learning strategies were employed in teaching a course on history of medicine during the Islamic era and another on Islamic medical ethics. Furthermore, a third course on medically relevant Arabic poetry was designed and prepared in a similar way. The end-of-the-course feedback comments reflected effectiveness of the courses and highlighted the importance of employing student-centered learning techniques in order to motivate medical students to become critical thinkers, problem solvers, life-long learners and self-learners.

  15. The Epidemiology of Bartonellosis in Peru

    National Research Council Canada - National Science Library

    Chamberlin, Judith

    2001-01-01

    Bartonellosis has caused debilitating illness and death since pre-Inca times. It is a vector-borne infectious disease found in the medically underserved communities of the high Andean mountain valleys of South America...

  16. Find Shortage Areas: HPSA & MUA/P by Address

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Find Shortage Areas: Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) by Address tool helps you determine if a specific...

  17. Grantee Spotlight: Elisa Rodriguez, Ph.D., M.S.

    Science.gov (United States)

    Dr. Elisa M. Rodriguez tests the feasibility of community-based participatory research approaches to engaging Hispanics, African Americans, and the medically underserved in the Buffalo, NY area in biospecimen donation for cancer research.

  18. Tailoring Systems Engineering for Rapid Acquisition

    Science.gov (United States)

    2014-03-27

    that they have worked with that had the necessary background to be included in the study. This type of snowball sampling helps to reach underserved...unwilling to participate. Another access issue was the use of the snowball sampling , which was able to increase the total number of participants...

  19. ‘Much clearer with pictures’: using community-based participatory research to design and test a Picture Option Grid for underserved patients with breast cancer

    Science.gov (United States)

    Durand, Marie-Anne; Alam, Shama; Grande, Stuart W; Elwyn, Glyn

    2016-01-01

    Objective Women of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer. Design Community-based participatory research (CBPR) using think-aloud protocols (phases 1 and 2) and semistructured interviews (phase 3). Setting Underserved community settings (eg, knitting groups, bingo halls, senior centres) and breast clinics. Participants In phase 1, we recruited a convenience sample of clinicians and academics. In phase 2, we targeted women over 40 years of age, of low SES, regardless of breast cancer history, and in phase 3, women of low SES, recently diagnosed with breast cancer. Intervention The pictorial encounter decision aid was derived from an evidence-based table comparing treatment options for breast cancer (http://www.optiongrid.org). Outcome measures We assessed the usability, acceptability and accessibility of the pictorial decision aid prototypes using the think-aloud protocol and semistructured interviews. Results After initial testing of the first prototype with 18 academics and health professionals, new versions were developed and tested with 53 lay individuals in community settings. Usability was high. In response to feedback indicating that the use of cartoon characters was considered insensitive, a picture-only version was developed and tested with 23 lay people in phase 2, and 10 target users in phase 3. Conclusions and relevance Using CBPR methods and iterative user testing cycles improved usability and accessibility, and led to the development of the Picture Option Grid, entirely guided by multiple stakeholder feedback. All women of low SES recently diagnosed with early stage breast

  20. Implementation of a Service-Learning Module in Medical Microbiology and Cell Biology Classes at an Undergraduate Liberal Arts University

    Directory of Open Access Journals (Sweden)

    Maia Larios-Sanz

    2011-03-01

    Full Text Available Here we discuss the implementation of a service-learning module in two upper-division biology classes, Medical Microbiology and Cell Biology. This exciting hands-on learning experience provided our students with an opportunity to extend their learning of in-class topics to a real-life scenario. Students were required to volunteer their time (a minimum of 10 hours in a semester at an under-served clinic in Houston, Texas. As they interacted with the personnel at the clinic, they were asked to identify the most prevalent disease (infectious for Medical Microbiology, and cellular-based for Cell seen at the clinic and, working in groups, come up with educational material in the form of a display or brochure to be distributed to patients. The material was meant to educate patients about the disease in general terms, as well as how to recognize (symptoms, prevent and treat it. Students were required to keep a reflective journal in the form of a blog throughout the semester, and present their final materials to the class orally. Students were surveyed about their opinion of the experience at the end of the semester. The vast majority of student participants felt that the project was a positive experience and that it helped them develop additional skills beyond what they learn in the classroom and understand how lecture topics relate to every day life. Here we discuss the implementation of a service-learning module in two upper division biology classes, Medical Microbiology and Cell Biology. This exciting hands-on learning experience provided our students with an opportunity to extend their learning of in-class topics into a real life scenario. Students were required to volunteer their time (a minimum of 10 hours in a semester at an under-served clinic in Houston, Texas. As they interacted with the personnel at the clinic, they were asked to identify the most prevalent disease (infectious for Medical Microbiology, and cellular-based for Cell seen at the

  1. Implementing a Healthy Food Distribution Program: A Supply Chain Strategy to Increase Fruit and Vegetable Access in Underserved Areas.

    Science.gov (United States)

    DeFosset, Amelia R; Kwan, Allison; Rizik-Baer, Daniel; Gutierrez, Luis; Gase, Lauren N; Kuo, Tony

    2018-05-24

    Increasing access to fresh produce in small retail venues could improve the diet of people in underserved communities. However, small retailers face barriers to stocking fresh produce. In 2014, an innovative distribution program, Community Markets Purchasing Real and Affordable Foods (COMPRA), was launched in Los Angeles with the aim of making it more convenient and profitable for small retailers to stock fresh produce. Our case study describes the key processes and lessons learned in the first 2 years of implementing COMPRA. Considerable investments in staff capacity and infrastructure were needed to launch COMPRA. Early successes included significant week-to-week increases in the volume of produce distributed. Leveraging partnerships, maintaining a flexible operational and funding structure, and broadly addressing store owners' needs contributed to initial gains. We describe key challenges and next steps to scaling the program. Lessons learned from implementing COMPRA could inform other jurisdictions considering supply-side approaches to increase access to healthy food.

  2. The ASSURE Summer REU Program: Introducing research to first-generation and underserved undergraduates through space sciences and engineering projects

    Science.gov (United States)

    Barron, Darcy; Peticolas, Laura; Multiverse Team at UC Berkeley's Space Sciences Lab

    2018-01-01

    The Advancing Space Science through Undergraduate Research Experience (ASSURE) summer REU program is an NSF-funded REU site at the Space Sciences Lab at UC Berkeley that first started in summer 2014. The program recruits students from all STEM majors, targeting underserved students including community college students and first-generation college students. The students have little or no research experience and a wide variety of academic backgrounds, but have a shared passion for space sciences and astronomy. We will describe our program's structure and the components we have found successful in preparing and supporting both the students and their research advisors for their summer research projects. This includes an intensive first week of introductory lectures and tutorials at the start of the program, preparing students for working in an academic research environment. The program also employs a multi-tiered mentoring system, with layers of support for the undergraduate student cohort, as well as graduate student and postdoctoral research advisors.

  3. Exploring the uncharted territory of social media: the next frontier of medical education in nephrology.

    Science.gov (United States)

    Desai, Tejas; Sridharan, Sivakumar; Parada, Xavier; Claure-Del Granado, Rolando; Orantes, Carlos; Madariaga, Hector; Penmatsa, Krishnam Raju; Basu, Gopal; Arce Amare, Fernanda

    2018-04-01

    Social media is gaining popularity amongst both medical educators and life-long learners. One of the most popular social media platforms used by the medical community is Twitter, which is popular amongst physicians, students and patients, and particularly in medical societies. Major international and regional societies commonly use Twitter to amplify their reach beyond what their live annual meetings can achieve. There has been a unique and notable effort by Nephrology societies to craft a structured social media strategy that results in the broadest reach to the community of nephrology providers. We report on the first three such experiments performed by three separate nephrology organizations.

  4. Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups

    Science.gov (United States)

    2014-01-01

    Background This study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and strategies for increasing the amount of health research conducted with socially disadvantaged groups. Methods A systematic review with narrative synthesis was conducted. Searches of electronic databases Medline, PsychInfo, EMBASE, Social Science Index via Web of Knowledge and CINHAL were conducted for English language articles published up to May 2013. Qualitative and quantitative studies as well as literature reviews were included. Articles were included if they reported attempts to increase disadvantaged group participation in research, or the barriers to research with disadvantaged groups. Groups of interest were those described as socially, culturally or financially disadvantaged compared to the majority of society. Eligible articles were categorised according to five phases of research: 1) sampling, 2) recruitment and gaining consent, 3) data collection and measurement, 4) intervention delivery and uptake, and 5) retention and attrition. Results In total, 116 papers from 115 studies met inclusion criteria and 31 previous literature reviews were included. A comprehensive summation of the major barriers to working with various disadvantaged groups is provided, along with proposed strategies for addressing each of the identified types of barriers. Most studies of strategies to address the barriers were of a descriptive nature and only nine studies reported the results of randomised trials. Conclusions To tackle the challenges of research with socially disadvantaged groups, and increase their representation in health and medical research, researchers and research institutions need to acknowledge extended timeframes, plan for higher resourcing costs and operate via community partnerships. PMID:24669751

  5. Adaptive mixed reality rehabilitation improves quality of reaching movements more than traditional reaching therapy following stroke.

    Science.gov (United States)

    Duff, Margaret; Chen, Yinpeng; Cheng, Long; Liu, Sheng-Min; Blake, Paul; Wolf, Steven L; Rikakis, Thanassis

    2013-05-01

    Adaptive mixed reality rehabilitation (AMRR) is a novel integration of motion capture technology and high-level media computing that provides precise kinematic measurements and engaging multimodal feedback for self-assessment during a therapeutic task. We describe the first proof-of-concept study to compare outcomes of AMRR and traditional upper-extremity physical therapy. Two groups of participants with chronic stroke received either a month of AMRR therapy (n = 11) or matched dosing of traditional repetitive task therapy (n = 10). Participants were right handed, between 35 and 85 years old, and could independently reach to and at least partially grasp an object in front of them. Upper-extremity clinical scale scores and kinematic performances were measured before and after treatment. Both groups showed increased function after therapy, demonstrated by statistically significant improvements in Wolf Motor Function Test and upper-extremity Fugl-Meyer Assessment (FMA) scores, with the traditional therapy group improving significantly more on the FMA. However, only participants who received AMRR therapy showed a consistent improvement in kinematic measurements, both for the trained task of reaching to grasp a cone and the untrained task of reaching to push a lighted button. AMRR may be useful in improving both functionality and the kinematics of reaching. Further study is needed to determine if AMRR therapy induces long-term changes in movement quality that foster better functional recovery.

  6. Subjective experience of depressed mood among medical students ...

    African Journals Online (AJOL)

    final-year medical students had experienced suicidal ideation in their last year, ... students may be in the best position to recognise and assist their peers at risk. ... you ever reached the point where you seriously considered taking your life, or ...

  7. Characterizing customers at medical center farmers' markets.

    Science.gov (United States)

    Kraschnewski, Jennifer L; George, Daniel R; Rovniak, Liza S; Monroe, Diana L; Fiordalis, Elizabeth; Bates, Erica

    2014-08-01

    Approximately 100 farmers' markets operate on medical center campuses. Although these venues can uniquely serve community health needs, little is known about customer characteristics and outreach efforts. Intercept survey of markets and market customers between August 2010 and October 2011 at three medical centers in different geographic regions of the US (Duke University Medical Center, Cleveland Clinic, and Penn State Hershey Medical Center) were conducted. Markets reported serving 180-2,000 customers per week and conducting preventive medicine education sessions and community health programs. Customers (n = 585) across markets were similar in sociodemographic characteristics--most were middle-aged, white, and female, who were employees of their respective medical center. Health behaviors of customers were similar to national data. The surveyed medical center farmers' markets currently serve mostly employees; however, markets have significant potential for community outreach efforts in preventive medicine. If farmers' markets can broaden their reach to more diverse populations, they may play an important role in contributing to community health.

  8. Outcomes of senior reach gatekeeper referrals: comparison of the Spokane gatekeeper program, Colorado Senior Reach, and Mid-Kansas Senior Outreach.

    Science.gov (United States)

    Bartsch, David A; Rodgers, Vicki K; Strong, Don

    2013-01-01

    Outcomes of older adults referred for care management and mental health services through the senior reach gatekeeper model of case finding were examined in this study and compared with the Spokane gatekeeper model Colorado Senior Reach and the Mid-Kansas Senior Outreach (MKSO) programs are the two Senior Reach Gatekeeper programs modeled after the Spokane program, employing the same community education and gatekeeper model and with mental health treatment for elderly adults in need of support. The three mature programs were compared on seniors served isolation, and depression ratings. Nontraditional community gatekeepers were trained and referred seniors in need. Findings indicate that individuals served by the two Senior Reach Gatekeeper programs demonstrated significant improvements. Isolation indicators such as social isolation decreased and depression symptoms and suicide ideation also decreased. These findings for two Senior Reach Gatekeeper programs demonstrate that the gatekeeper approach to training community partners worked in referring at-risk seniors in need in meeting their needs, and in having a positive impact on their lives.

  9. WE-H-201-04: Models for Developing Medical Physics Educators and Education Programs in the Developing Countries and the Potential Role of US Universities and Individual Medical Physicists

    Energy Technology Data Exchange (ETDEWEB)

    Sprawls, P. [Sprawls Educational Foundation, Montreat, NC (United States)

    2016-06-15

    The desperate need for radiotherapy in low and mid-income countries (LMICs) has been well documented. Roughly 60 % of the worldwide incidence of cancer occurs in these resource-limited settings and the international community alongside governmental and non-profit agencies have begun publishing reports and seeking help from qualified volunteers. However, the focus of several reports has been on how dire the situation is and the magnitude of the problem, leaving most to feel overwhelmed and unsure as to how to help and why to get involved. This session will help to explain the specific ways that Medical Physicists can uniquely assist in this grand effort to help bring radiotherapy to grossly-underserved areas. Not only can these experts fulfill an important purpose, they also can benefit professionally, academically, emotionally and socially from the endeavor. By assisting others worldwide with their skillset, Medical Physicists can end up helping themselves. Learning Objectives: Understand the need for radiotherapy in LMICs. Understand which agencies are seeking Medical Physicists for help in LMICs. Understand the potential research funding mechanisms are available to establish academic collaborations with LMIC researchers/physicians. Understand the potential social and emotional benefits for both the physicist and the LMIC partners when collaborations are made. Understand the potential for collaboration with other high-income scientists that can develop as the physicist partners with other large institutions to assist LMICs. Wil Ngwa - A recent United Nations Study reports that in developing countries more people have access to cell phones than toilets. In Africa, only 63% of the population has access to piped water, yet, 93% of Africans have cell phone service. Today, these cell phones, Skype, WhatsApp and other information and communication technologies (ICTs) connect us in unprecedented ways and are increasingly recognized as powerful, indispensable to global

  10. WE-H-201-04: Models for Developing Medical Physics Educators and Education Programs in the Developing Countries and the Potential Role of US Universities and Individual Medical Physicists

    International Nuclear Information System (INIS)

    Sprawls, P.

    2016-01-01

    The desperate need for radiotherapy in low and mid-income countries (LMICs) has been well documented. Roughly 60 % of the worldwide incidence of cancer occurs in these resource-limited settings and the international community alongside governmental and non-profit agencies have begun publishing reports and seeking help from qualified volunteers. However, the focus of several reports has been on how dire the situation is and the magnitude of the problem, leaving most to feel overwhelmed and unsure as to how to help and why to get involved. This session will help to explain the specific ways that Medical Physicists can uniquely assist in this grand effort to help bring radiotherapy to grossly-underserved areas. Not only can these experts fulfill an important purpose, they also can benefit professionally, academically, emotionally and socially from the endeavor. By assisting others worldwide with their skillset, Medical Physicists can end up helping themselves. Learning Objectives: Understand the need for radiotherapy in LMICs. Understand which agencies are seeking Medical Physicists for help in LMICs. Understand the potential research funding mechanisms are available to establish academic collaborations with LMIC researchers/physicians. Understand the potential social and emotional benefits for both the physicist and the LMIC partners when collaborations are made. Understand the potential for collaboration with other high-income scientists that can develop as the physicist partners with other large institutions to assist LMICs. Wil Ngwa - A recent United Nations Study reports that in developing countries more people have access to cell phones than toilets. In Africa, only 63% of the population has access to piped water, yet, 93% of Africans have cell phone service. Today, these cell phones, Skype, WhatsApp and other information and communication technologies (ICTs) connect us in unprecedented ways and are increasingly recognized as powerful, indispensable to global

  11. Medical robotics

    CERN Document Server

    Troccaz, Jocelyne

    2013-01-01

    In this book, we present medical robotics, its evolution over the last 30 years in terms of architecture, design and control, and the main scientific and clinical contributions to the field. For more than two decades, robots have been part of hospitals and have progressively become a common tool for the clinician. Because this domain has now reached a certain level of maturity it seems important and useful to provide a state of the scientific, technological and clinical achievements and still open issues. This book describes the short history of the domain, its specificity and constraints, and

  12. Meeting the Needs of Underserved Patients in Western Kenya by Creating the Next Generation of Global Health Pharmacists.

    Science.gov (United States)

    Miller, Monica L; Karwa, Rakhi; Schellhase, Ellen M; Pastakia, Sonak D; Crowe, Susie; Manji, Imran; Jakait, Beatrice; Maina, Mercy

    2016-03-25

    Objective. To describe a novel training model used to create a sustainable public health-focused pharmacy residency based in Kenya and to describe the outcomes of this training program on underserved populations. Design. The postgraduate year 2 residency was designed to expose trainees to the unique public health facets of inpatient, outpatient, and community-based care delivery in low and middle-income countries. Public health areas of focus included supply chain management, reproductive health, pediatrics, HIV, chronic disease management, and teaching. Assessment. The outcomes of the residency were assessed based on the number of new clinical programs developed by residents, articles and abstracts written by residents, and resident participation in grant writing. To date, six residents from the United States and eight Kenyan residents have completed the residency. Eleven sustainable patient care services have been implemented as a result of the residency program. Conclusion. This pharmacy residency training model developed accomplished pharmacists in public health pharmacy, with each residency class expanding funding and clinical programming, contributing to curriculum development, and creating jobs.

  13. 77 FR 55217 - Health Information Technology Implementation

    Science.gov (United States)

    2012-09-07

    ... Information Technology Implementation AGENCY: Health Resources and Services Administration (HRSA), Department... effective use of Health Information Technology (HIT). SUPPLEMENTARY INFORMATION: Former Grantee of Record... advance information technology resources of Virginia's medically underserved communities, HCHC has...

  14. The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers

    Directory of Open Access Journals (Sweden)

    Adesuwa Olomu

    2016-12-01

    Office-GAP resulted in increased use of guideline-based medications for secondary CVD prevention in underserved populations. The Office-GAP program could serve as a model for implementing guideline-based care for other chronic diseases.

  15. Mobile and portable dental services catering to the basic oral health ...

    African Journals Online (AJOL)

    Mobile and portable dental services catering to the basic oral health needs of the underserved population in developing countries: a proposed model. ... Though the mobile and portable systems have some practical difficulties like financial considerations, they still seem to be the only way to reach every section of the ...

  16. Perceiver as polar planimeter: Direct perception of jumping, reaching, and jump-reaching affordances for the self and others.

    Science.gov (United States)

    Thomas, Brandon J; Hawkins, Matthew M; Nalepka, Patrick

    2017-03-30

    Runeson (Scandanavian Journal of Psychology 18:172-179, 1977) suggested that the polar planimeter might serve as an informative model system of perceptual mechanism. The key aspect of the polar planimeter is that it registers a higher order property of the environment without computational mediation on the basis of lower order properties, detecting task-specific information only. This aspect was posited as a hypothesis for the perception of jumping and reaching affordances for the self and another person. The findings supported this hypothesis. The perception of reaching while jumping significantly differed from an additive combination of jump-without-reaching and reach-without-jumping perception. The results are consistent with Gibson's (The senses considered as perceptual systems, Houghton Mifflin, Boston, MA; Gibson, The senses considered as perceptual systems, Houghton Mifflin, Boston, MA, 1966; The ecological approach to visual perception, Houghton Mifflin, Boston, MA; Gibson, The ecological approach to visual perception, Houghton Mifflin, Boston, MA, 1979) theory of information-that aspects of the environment are specified by patterns in energetic media.

  17. Center of Excellence for Remote and Medically Under-Served Areas

    Science.gov (United States)

    2008-04-11

    healthcare projects. Telemedicine is not the sole cure for the rural health dilemma; it can be a major ingredient if aggressively deployed. Providers can...effects of this course curriculum on student health will be evidenced in BMI changes, absentee rates, and number of visits to the school nurse...ninth grade students will result in improved health as evidenced by prevention of weight gain, decreased absenteeism , and decreased number of

  18. Mammographic Breast Density in a Cohort of Medically Underserved Women

    Science.gov (United States)

    2015-12-01

    was a training year and during Years 2 through 4 a case-control study of obesity , insulin resistance and mammographic breast density was conducted. A...factors including health literacy, and to collect anthropometric measurements and fasting blood, 3) to assay blood for select hormones and growth...factors, 4) to perform statistical analyses to determine the associations between obesity and insulin resistance and mammographic breast density, and 5

  19. RECORDS REACHING RECORDING DATA TECHNOLOGIES

    Directory of Open Access Journals (Sweden)

    G. W. L. Gresik

    2013-07-01

    Full Text Available The goal of RECORDS (Reaching Recording Data Technologies is the digital capturing of buildings and cultural heritage objects in hard-to-reach areas and the combination of data. It is achieved by using a modified crane from film industry, which is able to carry different measuring systems. The low-vibration measurement should be guaranteed by a gyroscopic controlled advice that has been , developed for the project. The data were achieved by using digital photography, UV-fluorescence photography, infrared reflectography, infrared thermography and shearography. Also a terrestrial 3D laser scanner and a light stripe topography scanner have been used The combination of the recorded data should ensure a complementary analysis of monuments and buildings.

  20. Records Reaching Recording Data Technologies

    Science.gov (United States)

    Gresik, G. W. L.; Siebe, S.; Drewello, R.

    2013-07-01

    The goal of RECORDS (Reaching Recording Data Technologies) is the digital capturing of buildings and cultural heritage objects in hard-to-reach areas and the combination of data. It is achieved by using a modified crane from film industry, which is able to carry different measuring systems. The low-vibration measurement should be guaranteed by a gyroscopic controlled advice that has been , developed for the project. The data were achieved by using digital photography, UV-fluorescence photography, infrared reflectography, infrared thermography and shearography. Also a terrestrial 3D laser scanner and a light stripe topography scanner have been used The combination of the recorded data should ensure a complementary analysis of monuments and buildings.

  1. Quality, quantity and distribution of medical education and care: regulation by the private sector or mandate by government?

    Science.gov (United States)

    Anlyan, W G

    1975-05-01

    The public, the federal government and most state governments have become increasingly concerned with the lack of access to primary care as well as the specialty and geographic maldistribution problems. Currently, there is a race in progress between the private sector and the federal government to devise solutions to these problems. In the federal sector, varying pieces of legislation are under active consideration to mandate the correction of specialty and geographic maldistribution; proposals include: 1) setting up federal machinery to regulate the numbers and types of residencies; 2) make obligatory the creation of Departments of Family Practice in each medical school; 3) withdraw current education support from medical schools causing tuition levels to increase substantially--federal student loans would then provide the necessary leverage to obligate the borrower to two years of service in an under-served area in exchange for loan forgiveness. In the private sector, for the first time in the history of the United States, the five major organizations involved in medical care have organized to form the Coordinating Council on Medical Education (CCME) and the Liaison Committee on Graduate Medical Education (LCGME). One of the initial major endeavors of the CCME has been to address itself to the problem of specialty maldistribution. The LCGME has been tooling up to become the accrediting group for residency training thus providing an overview of the quality and quantity of specialty training. It will be the intent of this presentation to bring the membership of the Southern Surgical Association an up-to-date report on these parallel efforts. The author's personal hope is that the private sector can move sufficiently rapidly to set up its own regulatory mechanisms and avert another federally controlled bureaucracy that will forever change the character of the medical profession in the United States.

  2. Reaching Hard-to-Reach Individuals: Nonselective Versus Targeted Outbreak Response Vaccination for Measles

    Science.gov (United States)

    Minetti, Andrea; Hurtado, Northan; Grais, Rebecca F.; Ferrari, Matthew

    2014-01-01

    Current mass vaccination campaigns in measles outbreak response are nonselective with respect to the immune status of individuals. However, the heterogeneity in immunity, due to previous vaccination coverage or infection, may lead to potential bias of such campaigns toward those with previous high access to vaccination and may result in a lower-than-expected effective impact. During the 2010 measles outbreak in Malawi, only 3 of the 8 districts where vaccination occurred achieved a measureable effective campaign impact (i.e., a reduction in measles cases in the targeted age groups greater than that observed in nonvaccinated districts). Simulation models suggest that selective campaigns targeting hard-to-reach individuals are of greater benefit, particularly in highly vaccinated populations, even for low target coverage and with late implementation. However, the choice between targeted and nonselective campaigns should be context specific, achieving a reasonable balance of feasibility, cost, and expected impact. In addition, it is critical to develop operational strategies to identify and target hard-to-reach individuals. PMID:24131555

  3. The Role of Parenting Practices in the Home Environment among Underserved Youth.

    Science.gov (United States)

    Conlon, Beth A; McGinn, Aileen P; Lounsbury, David W; Diamantis, Pamela M; Groisman-Perelstein, Adriana E; Wylie-Rosett, Judith; Isasi, Carmen R

    2015-08-01

    The home environment, which includes parenting practices, is an important setting in which children develop their health behaviors. We examined the role of parenting practices in the home environment among underserved youth. We examined baseline data of a family-focused pediatric obesity intervention. Parenting practices (monitoring, discipline, limit setting of soda/snacks [SS] and screen media [SM], pressure to eat, and reinforcement) and availability of fruits/vegetables (FV) and sugar-sweetened beverages (SSBs), family meals, television (TV) watching during meals, TVs in the home, owning active video games/sports equipment, and household food security were assessed in 301 parent/caregivers of overweight/obese children (ages 7-12 years; BMI≥85th percentile). Associations were evaluated using Spearman's rank correlation coefficients and logistic regression models adjusted for potential confounders. Parents/caregivers (ages 22-67 years) were largely Hispanic/Latino (74.1%), female (92.4%), and reported high levels of limit setting SS and low levels of pressure to eat. Parent age, gender, country of birth, and years living in the United States accounted for differences among several parenting practices. Adjusted logistic regression models identified several statistically significant associations, including: Monitoring was positively associated with availability FV (odds ratio [OR]=2.19; 95% confidence interval [CI], 1.25, 3.82); limit setting SS was inversely associated with availability of SSBs (OR=0.40; 95% CI, 0.21, 0.75); and limit setting SM was inversely associated with TV viewing during family meals (OR=0.51; 95% CI, 0.31, 0.85). Nearly 40% of our population was food insecure, and food insecurity was positively associated with pressure to eat (OR=1.77; 95% CI, 1.01, 3.15). Parenting practices play an important role in the home environment, and longitudinal studies are needed to examine these associations in the context of family-focused pediatric obesity

  4. Seventh meeting of the Global Alliance to Eliminate Lymphatic Filariasis: reaching the vision by scaling up, scaling down, and reaching out

    Science.gov (United States)

    2014-01-01

    This report summarizes the 7th meeting of the Global Alliance to Eliminate Lymphatic Filariasis (GAELF), Washington DC, November 18–19, 2012. The theme, “A Future Free of Lymphatic Filariasis: Reaching the Vision by Scaling Up, Scaling Down and Reaching Out”, emphasized new strategies and partnerships necessary to reach the 2020 goal of elimination of lymphatic filariasis (LF) as a public-health problem. PMID:24450283

  5. Patients' rights in an underserved Nigerian environment: A cross-sectional study of attitude and practice orientation of medical professionals in Abia State

    Directory of Open Access Journals (Sweden)

    Gabriel Uche Pascal Iloh

    2017-01-01

    CONCLUSION: The level of awareness of patient's rights was very high but did not translate to comparative overall positive attitude and practice orientation. Patient rights should be the focus of intensive continuing medical education and professional development in addition to greater administrative and governmental support, especially in developing economies where there are limited options to safeguard patients' rights.

  6. Online School Psychology: Blueprint to Higher Education Conversations

    Science.gov (United States)

    Dixon, Robert J.

    2018-01-01

    The author is convinced that the school psychology profession needs to develop innovative programs to address the shortages of school psychologists across the nation, specifically, online programs that can reach the rural and underserved districts of each state. Current educators seeking to expand their skill set can be the untapped answer to…

  7. 77 FR 2734 - Health Information Technology Implementation

    Science.gov (United States)

    2012-01-19

    ... Information Technology Implementation AGENCY: Health Resources and Services Administration, HHS. ACTION... advance information technology resources of the Tennessee's medically underserved communities, TPCA has... advancement and effective use of Health Information Technology. These advancements will result in measurable...

  8. REACH: next step to a sound chemicals management.

    Science.gov (United States)

    Van der Wielen, Arnold

    2007-12-01

    REACH is the new European Regulation for Registration, Evaluation, Authorisation and Restriction of Chemicals. It entered into force on 1st June 2007 to streamline and improve the former legislative framework on new and on existing chemical substances of the European Union. Companies which manufacture or import more than 1 tonne of a substance per year will be required to register the substance at the new EU Chemicals Agency located in Helsinki. REACH places greater responsibility on industry to manage the risks that chemicals may pose to the health and the environment and to provide safety information that will be passed down the supply chain. In principle, REACH applies to all chemicals as such, as components in preparations and as used in articles. REACH is a radical step forward in the EU chemicals management. The onus will move from the authorities to industry. In addition, REACH will allow the further evaluation of substances where there are grounds for concern, foresees an authorisation system for the use of substances of very high concern and a system of restrictions, where applicable, for substances of concern. The Authorisation system will require companies to switch progressively to safer alternatives where a suitable alternative exists. Current use restrictions will remain under REACH system.

  9. Peer Support for the Hardly Reached: A Systematic Review.

    Science.gov (United States)

    Sokol, Rebeccah; Fisher, Edwin

    2016-07-01

    Health disparities are aggravated when prevention and care initiatives fail to reach those they are intended to help. Groups can be classified as hardly reached according to a variety of circumstances that fall into 3 domains: individual (e.g., psychological factors), demographic (e.g., socioeconomic status), and cultural-environmental (e.g., social network). Several reports have indicated that peer support is an effective means of reaching hardly reached individuals. However, no review has explored peer support effectiveness in relation to the circumstances associated with being hardly reached or across diverse health problems. To conduct a systematic review assessing the reach and effectiveness of peer support among hardly reached individuals, as well as peer support strategies used. Three systematic searches conducted in PubMed identified studies that evaluated peer support programs among hardly reached individuals. In aggregate, the searches covered articles published from 2000 to 2015. Eligible interventions provided ongoing support for complex health behaviors, including prioritization of hardly reached populations, assistance in applying behavior change plans, and social-emotional support directed toward disease management or quality of life. Studies were excluded if they addressed temporally isolated behaviors, were limited to protocol group classes, included peer support as the dependent variable, did not include statistical tests of significance, or incorporated comparison conditions that provided appreciable social support. We abstracted data regarding the primary health topic, categorizations of hardly reached groups, program reach, outcomes, and strategies employed. We conducted a 2-sample t test to determine whether reported strategies were related to reach. Forty-seven studies met our inclusion criteria, and these studies represented each of the 3 domains of circumstances assessed (individual, demographic, and cultural-environmental). Interventions

  10. The influence of international medical electives on career preference for primary care and rural practice.

    Science.gov (United States)

    Law, Iain R; Walters, Lucie

    2015-11-11

    Previous studies have demonstrated a correlation between medical students who undertake international medical electives (IMEs) in resource poor settings and their reported career preference for primary care in underserved areas such as rural practice. This study examines whether a similar correlation exists in the Australian medical school context. Data was extracted from the Medical Schools Outcomes Database (MSOD) of Australian medical students that completed commencing student and exit questionnaires between 2006 and 2011. Student responses were categorized according to preferred training program and preferred region of practice at commencement. The reported preferences at exit of students completing IMEs in low and middle income countries (LMIC) were compared to those completing electives in high income countries (HIC). The effect of elective experience for students expressing a preference for primary care at commencement was non-significant, with 40.32 % of LMIC and 42.11 % of HIC students maintaining a preference for primary care. Similarly there were no significant changes following LMIC electives for students expressing a preference for specialist training at commencement with 11.81 % of LMIC and 10.23 % of HIC students preferring primary care at exit. The effect of elective experience for students expressing a preference for rural practice at commencement was non-significant, with 41.51 % of LMIC and 49.09 % of HIC students preferring rural practice at exit. Similarly there were no significant changes following LMIC electives for students expressing a preference for urban practice at commencement, with 7.84 % of LMIC and 6.70 % of HIC students preferring rural practice at exit. This study did not demonstrate an association between elective experience in resource poor settings and a preference for primary care or rural practice. This suggests that the previously observed correlation between LMIC electives and interest in primary care in

  11. Becoming 'ward smart' medical students.

    Science.gov (United States)

    Walker, Beth; Wallace, Deirdre; Mangera, Zaheer; Gill, Deborah

    2017-10-01

    A small number of medical students elect to work as health care assistants (HCAs) during or prior to their undergraduate training. There is a significant body of evidence in the literature regarding the impact of HCA experience on student nurses; however, little research has examined the effects of such experience on medical students. All fourth-year medical students with self-declared experience as HCAs from a single UK medical school were invited to participate in focus groups to explore their experiences and perceptions. Ten students from the year group took part. Participants felt that their experience as HCAs enhanced their learning in the workplace through becoming 'ward smart', helping them to become socialised into the world of health care, providing early meaningful and humanised patient interaction, and increasing their understanding of multidisciplinary team (MDT) members' roles. Little research has examined the effects of [HCA] experience on medical students DISCUSSION: Becoming 'ward smart' and developing a sense of belonging are central to maximising learning in, from and through work on the ward. Experience as a HCA provides a range of learning and social opportunities for medical students, and legitimises their participation within clinical communities. HCA experience also seems to benefit in the 'hard to reach' dimensions of medical training: empathy; humanisation of patient care; professional socialisation; and providing a sense of belonging within health care environments. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  12. Characterizing customers at medical center farmers’ markets1

    Science.gov (United States)

    Kraschnewski, Jennifer L.; George, Daniel R.; Rovniak, Liza S.; Monroe, Diana L.; Fiordalis, Elizabeth; Bates, Erica

    2014-01-01

    Approximately 100 farmers’ markets operate on medical center campuses. Although these venues can uniquely serve community health needs, little is known about customer characteristics and outreach efforts. Intercept survey of markets and market customers between August 2010-October 2011 at three medical centers in different geographic regions of the US: Duke University Medical Center, Cleveland Clinic, and Penn State Hershey Medical Center were conducted. Markets reported serving 180–2000 customers per week and conducting preventive medicine education sessions and community health programs. Customers (n=585) across markets were similar in sociodemographic characteristics – most were middle-aged, white, and female, who were employees of their respective medical center. Health behaviors of customers were similar to national data. The surveyed medical center farmers’ markets currently serve mostly employees; however, markets have significant potential for community outreach efforts in preventive medicine. If farmers’ markets can broaden their reach to more diverse populations, they may play an important role in contributing to community health. PMID:24421001

  13. Locating AED Enabled Medical Drones to Enhance Cardiac Arrest Response Times.

    Science.gov (United States)

    Pulver, Aaron; Wei, Ran; Mann, Clay

    2016-01-01

    Out-of-hospital cardiac arrest (OOHCA) is prevalent in the United States. Each year between 180,000 and 400,000 people die due to cardiac arrest. The automated external defibrillator (AED) has greatly enhanced survival rates for OOHCA. However, one of the important components of successful cardiac arrest treatment is emergency medical services (EMS) response time (i.e., the time from EMS "wheels rolling" until arrival at the OOHCA scene). Unmanned Aerial Vehicles (UAV) have regularly been used for remote sensing and aerial imagery collection, but there are new opportunities to use drones for medical emergencies. The purpose of this study is to develop a geographic approach to the placement of a network of medical drones, equipped with an automated external defibrillator, designed to minimize travel time to victims of out-of-hospital cardiac arrest. Our goal was to have one drone on scene within one minute for at least 90% of demand for AED shock therapy, while minimizing implementation costs. In our study, the current estimated travel times were evaluated in Salt Lake County using geographical information systems (GIS) and compared to the estimated travel times of a network of AED enabled medical drones. We employed a location model, the Maximum Coverage Location Problem (MCLP), to determine the best configuration of drones to increase service coverage within one minute. We found that, using traditional vehicles, only 4.3% of the demand can be reached (travel time) within one minute utilizing current EMS agency locations, while 96.4% of demand can be reached within five minutes using current EMS vehicles and facility locations. Analyses show that using existing EMS stations to launch drones resulted in 80.1% of cardiac arrest demand being reached within one minute Allowing new sites to launch drones resulted in 90.3% of demand being reached within one minute. Finally, using existing EMS and new sites resulted in 90.3% of demand being reached while greatly reducing

  14. Reaching ignition in the tokamak

    International Nuclear Information System (INIS)

    Furth, H.P.

    1985-06-01

    This review covers the following areas: (1) the physics of burning plasmas, (2) plasma physics requirements for reaching ignition, (3) design studies for ignition devices, and (4) prospects for an ignition project

  15. Do working environment interventions reach shift workers?

    Science.gov (United States)

    Nabe-Nielsen, Kirsten; Jørgensen, Marie Birk; Garde, Anne Helene; Clausen, Thomas

    2016-01-01

    Shift workers are exposed to more physical and psychosocial stressors in the working environment as compared to day workers. Despite the need for targeted prevention, it is likely that workplace interventions less frequently reach shift workers. The aim was therefore to investigate whether the reach of workplace interventions varied between shift workers and day workers and whether such differences could be explained by the quality of leadership exhibited at different times of the day. We used questionnaire data from 5361 female care workers in the Danish eldercare sector. The questions concerned usual working hours, quality of leadership, and self-reported implementation of workplace activities aimed at stress reduction, reorganization of the working hours, and participation in improvements of working procedures or qualifications. Compared with day workers, shift workers were less likely to be reached by workplace interventions. For example, night workers less frequently reported that they had got more flexibility (OR 0.5; 95 % CI 0.3-0.7) or that they had participated in improvements of the working procedures (OR 0.6; 95 % CI 0.5-0.8). Quality of leadership to some extent explained the lack of reach of interventions especially among fixed evening workers. In the light of the evidence of shift workers' stressful working conditions, we suggest that future studies focus on the generalizability of results of the present study and on how to reach this group and meet their needs when designing and implementing workplace interventions.

  16. Ensuring safe access to medication for palliative care while preventing prescription drug abuse: innovations for American inner cities, rural areas, and communities overwhelmed by addiction

    Directory of Open Access Journals (Sweden)

    Francoeur RB

    2011-09-01

    Full Text Available Richard B FrancoeurSchool of Social Work, Adelphi University, Garden City, NY, USA; Center for the Psychosocial Study of Health and Illness, Columbia University, New York, NY, USAAbstract: This article proposes and develops novel components of community-oriented programs for creating and affording access to safe medication dispensing centers in existing retail pharmacies and in permanent or travelling pharmacy clinics that are guarded by assigned or off-duty police officers. Pharmacists at these centers would work with police, medical providers, social workers, hospital administrators, and other professionals in: planning and overseeing the safe storage of controlled substance medications in off-site community safe-deposit boxes; strengthening communication and cooperation with the prescribing medical provider; assisting the prescribing medical provider in patient monitoring (checking the state prescription registry, providing pill counts and urine samples; expanding access to lower-cost, and in some cases, abuse-resistant formulations of controlled substance medications; improving transportation access for underserved patients and caregivers to obtain prescriptions; and integrating community agencies and social networks as resources for patient support and monitoring. Novel components of two related community-oriented programs, which may be hosted outside of safe medication dispensing centers, are also suggested and described: (1 developing medication purchasing cooperatives (ie, to help patients, families, and health institutions afford the costs of medications, including tamper- or abuse-resistant/deterrent drug formulations; and (2 expanding the role of inner-city methadone maintenance treatment programs in palliative care (ie, to provide additional patient monitoring from a second treatment team focusing on narcotics addiction, and potentially, to serve as an untapped source of opioid medication for pain that is less subject to abuse

  17. The General Education Astronomy Source (GEAS) Project: Extending the Reach of Astronomy Education

    Science.gov (United States)

    Vogt, N. P.; Muise, A. S.

    2014-07-01

    We present a set of NASA and NSF sponsored resources to aid in teaching astronomy remotely and in the classroom at the college level, with usage results for pilot groups of students. Our goal is to increase the accessibility of general education science coursework to underserved populations nationwide. Our materials are available for use without charge, and we are actively looking for pilot instructors. Primary components of our program include an interactive online tutorial program with over 12,000 questions, an instructor review interface, a set of hands-on and imaging- and spectra-driven laboratory exercises, including video tutorials, and interviews with diverse individuals working in STEM fields to help combat stereotypes. We discuss learning strategies often employed by students without substantial scientific training and suggest ways to incorporate them into a framework based on the scientific method and techniques for data analysis, and we compare cohorts of in-class and distance-education students.

  18. Guaranteed performance in reaching mode of sliding mode ...

    Indian Academy of Sciences (India)

    R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22

    addresses the design of constant plus proportional rate reaching law-based SMC for second-order ... Reaching mode; sliding mode controlled systems; output tracking ... The uncertainty in the input distribution function g is expressed as.

  19. Medical ethics and education for social responsibility.

    Science.gov (United States)

    Roemer, M I

    1980-01-01

    The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor's responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization.

  20. Field-testing the new DECtalk PC system for medical applications

    Science.gov (United States)

    Grams, R. R.; Smillov, A.; Li, B.

    1992-01-01

    Synthesized human speech has now reached a new level of performance. With the introduction of DEC's new DECtalk PC, the small system developer will have a very powerful tool for creative design. It has been our privilege to be involved in the beta-testing of this new device and to add a medical dictionary which covers a wide range of medical terminology. With the inherent board level understanding of speech synthesis and the medical dictionary, it is now possible to provide full digital speech output for all medical files and terms. The application of these tools will cover a wide range of options for the future and allow a new dimension in dealing with the complex user interface experienced in medical practice.

  1. Action plans can interact to hinder or facilitate reach performance.

    Science.gov (United States)

    Fournier, Lisa R; Wiediger, Matthew D; Taddese, Ezana F

    2015-11-01

    Executing a reach action can be delayed while retaining another action in working memory (WM) if the two action plans partly overlap rather than do not overlap. This delay (partial repetition cost) occurs when reach responses are under cognitive control. In this study, we investigated whether facilitation (a partial repetition benefit) occurs when reach responses are automatic. We also examined whether the hemisphere controlling the limb or selection of the preferred limb (based on a free-reach task) influences reach performance when the actions partly overlap. Left- and right-handers reached to different stimulus locations to the left and right of body midline with their ipsilateral hand while maintaining an action plan in WM that required the same or the different hand. The results showed a partial repetition benefit for spatially compatible reaches to left and right stimulus locations far from the body midline, but not for those near the body midline. Also, no partial repetition cost was found at any of the stimulus-reach locations. This indicates that automatic reach responses that partly overlap with an action plan maintained in WM are not delayed, but instead can be facilitated (partial repetition benefit). The roles of hemisphere and reach-hand preference in action control and the importance of the degree of feature overlap in obtaining a partial repetition benefit (and cost) are discussed.

  2. Postdoctoral Opportunities in Medical Physics

    Science.gov (United States)

    Hogstrom, Kenneth

    2006-04-01

    The medical physicist is a professional who specializes in the application of the concepts and methods of physics to the diagnosis and treatment of human disease. Medical physicists identify their primary discipline to be radiation therapy (78%), medical imaging (16%), nuclear medicine (3%), or radiation safety (2%). They state their primary responsibility to be clinical (78%), academic (9%), research (4%), etc. Correspondingly, medical physicists reveal their primarily employment to be a private hospital (42%), university hospital (32%), physicist's service group (9%), physician's service group (9%), industry (5%), and government (3%). The most frequent job of medical physicists is clinical radiation therapy physicist, whose clinical duties include: equipment acquisition, facility design, commissioning, machine maintenance, calibration and quality assurance, patient treatment planning, patient dose calculation, management of patient procedures, development of new technology, radiation safety, and regulatory compliance. The number of medical physicists in the United States can be estimated by the number of members of the American Association of Physicists in Medicine (AAPM), which has increased 5.5% annually since 1969, currently being 5,000. New positions plus retirements create a current need >300 new medical physicists per year, which exceeds supply. This is supported by the steady growth in average salaries, being 100,000 for PhDs entering the field and reaching 180,000. Graduate programs alone cannot meet demand, and physicists entering the field through postdoctoral training in medical physics remain important. Details of postdoctoral research programs and medical physics residency programs will provide direction to physics PhD graduates interested in medical physics. [The AAPM, its annual Professional Information Report, and its Public Education Committee are acknowledged for information contributing to this presentation.

  3. Task-dependent vestibular feedback responses in reaching.

    Science.gov (United States)

    Keyser, Johannes; Medendorp, W Pieter; Selen, Luc P J

    2017-07-01

    When reaching for an earth-fixed object during self-rotation, the motor system should appropriately integrate vestibular signals and sensory predictions to compensate for the intervening motion and its induced inertial forces. While it is well established that this integration occurs rapidly, it is unknown whether vestibular feedback is specifically processed dependent on the behavioral goal. Here, we studied whether vestibular signals evoke fixed responses with the aim to preserve the hand trajectory in space or are processed more flexibly, correcting trajectories only in task-relevant spatial dimensions. We used galvanic vestibular stimulation to perturb reaching movements toward a narrow or a wide target. Results show that the same vestibular stimulation led to smaller trajectory corrections to the wide than the narrow target. We interpret this reduced compensation as a task-dependent modulation of vestibular feedback responses, tuned to minimally intervene with the task-irrelevant dimension of the reach. These task-dependent vestibular feedback corrections are in accordance with a central prediction of optimal feedback control theory and mirror the sophistication seen in feedback responses to mechanical and visual perturbations of the upper limb. NEW & NOTEWORTHY Correcting limb movements for external perturbations is a hallmark of flexible sensorimotor behavior. While visual and mechanical perturbations are corrected in a task-dependent manner, it is unclear whether a vestibular perturbation, naturally arising when the body moves, is selectively processed in reach control. We show, using galvanic vestibular stimulation, that reach corrections to vestibular perturbations are task dependent, consistent with a prediction of optimal feedback control theory. Copyright © 2017 the American Physiological Society.

  4. Engaging diverse underserved communities to bridge the mammography divide

    Directory of Open Access Journals (Sweden)

    Cully Angelia

    2011-01-01

    Full Text Available Abstract Background Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations. Methods/Design In the proposed program, community health workers will meet with rural-dwelling Latina and American Indian women one-on-one to educate them about breast cancer and screening and guide them through a computerized and culturally tailored "implementation intentions" program, called Healthy Living Kansas - Breast Health, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and be randomized to either a mammography "implementation intentions" (MI2 intervention or a

  5. A medical tourism primer for U.S. physicians.

    Science.gov (United States)

    Carabello, Laura

    2008-01-01

    As healthcare in the United States has been changing rapidly over the past few decades, so has the manner in which healthcare has been provided, billed, and paid for. There is an increasing need for Americans to reach beyond domestic borders to the international community for certain medical procedures, treatment, and care at more affordable costs. This impacts not only consumers and their physicians, but also employers, benefit plan payors, administrators, and other industry stakeholders-including America's hospitals. This article provides a framework for discussion points for physician-patient communications regarding medical tourism.

  6. Guiding Warfare to Reach Sustainable Peace

    DEFF Research Database (Denmark)

    Vestenskov, David; Drewes, Line

    The conference report Guiding Warfare to Reach Sustainable Peace constitutes the primary outcome of the conference It is based on excerpts from the conference presenters and workshop discussions. Furthermore, the report contains policy recommendations and key findings, with the ambition of develo......The conference report Guiding Warfare to Reach Sustainable Peace constitutes the primary outcome of the conference It is based on excerpts from the conference presenters and workshop discussions. Furthermore, the report contains policy recommendations and key findings, with the ambition...... of developing best practices in the education and implementation of IHL in capacity building of security forces....

  7. A description of medication errors reported by pharmacists in a neonatal intensive care unit.

    Science.gov (United States)

    Pawluk, Shane; Jaam, Myriam; Hazi, Fatima; Al Hail, Moza Sulaiman; El Kassem, Wessam; Khalifa, Hanan; Thomas, Binny; Abdul Rouf, Pallivalappila

    2017-02-01

    Background Patients in the Neonatal Intensive Care Unit (NICU) are at an increased risk for medication errors. Objective The objective of this study is to describe the nature and setting of medication errors occurring in patients admitted to an NICU in Qatar based on a standard electronic system reported by pharmacists. Setting Neonatal intensive care unit, Doha, Qatar. Method This was a retrospective cross-sectional study on medication errors reported electronically by pharmacists in the NICU between January 1, 2014 and April 30, 2015. Main outcome measure Data collected included patient information, and incident details including error category, medications involved, and follow-up completed. Results A total of 201 NICU pharmacists-reported medication errors were submitted during the study period. All reported errors did not reach the patient and did not cause harm. Of the errors reported, 98.5% occurred in the prescribing phase of the medication process with 58.7% being due to calculation errors. Overall, 53 different medications were documented in error reports with the anti-infective agents being the most frequently cited. The majority of incidents indicated that the primary prescriber was contacted and the error was resolved before reaching the next phase of the medication process. Conclusion Medication errors reported by pharmacists occur most frequently in the prescribing phase of the medication process. Our data suggest that error reporting systems need to be specific to the population involved. Special attention should be paid to frequently used medications in the NICU as these were responsible for the greatest numbers of medication errors.

  8. Nanomaterials under REACH. Nanosilver as a case study

    NARCIS (Netherlands)

    Pronk MEJ; Wijnhoven SWP; Bleeker EAJ; Heugens EHW; Peijnenburg WJGM; Luttik R; Hakkert BC; SEC; SIR; LER

    2009-01-01

    Om de risico's van nanomaterialen te kunnen inschatten en beheersen, zijn enkele aanpassingen nodig in de Europese chemicalienwetgeving REACH. De gegevens over stoffen waar REACH standaard om vraagt, zijn namelijk onvoldoende om de specifieke eigenschappen van nanomaterialen te bepalen. Hetzelfde

  9. The importance of reaching lipid targets: statins and the prevention of atherosclerosis.

    Science.gov (United States)

    Schwandt, P

    2003-06-01

    To help prevent the development of coronary heart disease (CHD), the European and NCEP guidelines have recommended target cholesterol levels for all individuals. Lifestyle changes are advocated for individuals not achieving these targets. Intervention with lipid-modifying agents may be required for patients at high risk of a cardiovascular event and statins are generally recognised as first-line therapy. Unfortunately, large numbers of patients at risk of cardiovascular events are not being treated to the guideline targets. Primary care physicians are in a good position to improve lipid management by assessing risk factors, implementing lipid management strategies, monitoring whether targets are being reached and amending treatment appropriately. Furthermore, by educating and motivating patients,primary care physicians may improve compliance with lifestyle changes and medication. These approaches may help more patients to achieve recommended lipid levels and prevent the development of cardiovascular disease.

  10. Low-socioeconomic status workers: their health risks and how to reach them.

    Science.gov (United States)

    Harris, Jeffrey R; Huang, Yi; Hannon, Peggy A; Williams, Barbara

    2011-02-01

    To help workplace health promotion practitioners reach low-socioeconomic status workers at high risk for chronic diseases. We describe low-socioeconomic status workers' diseases, health status, demographics, risk behaviors, and workplaces, using data from the Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, and Bureau of Labor Statistics. Workers with household annual incomes less than $35,000, or a high school education or less, report more chronic diseases and lower health status. They tend to be younger, nonwhite, and have much higher levels of smoking and missed cholesterol screening. They are concentrated in the smallest and largest workplaces and in three low-wage industries that employ one-quarter of the population. To decrease chronic diseases among low-socioeconomic status workers, we need to focus workplace health promotion programs on workers in low-wage industries and small workplaces.

  11. USSTRIDE program is associated with competitive Black and Latino student applicants to medical school

    OpenAIRE

    Campbell, Kendall M.; Berne-Anderson, Thesla; Wang, Aihua; Dormeus, Guy; Rodríguez, José E.

    2014-01-01

    Purpose: We compared MCAT scores, grade point averages (GPAs), and medical school acceptance rates of Black and Latino students in an outreach program called Undergraduate Science Students Together Reaching Instructional Diversity and Excellence (USSTRIDE) to non-USSTRIDE students. We hypothesized that Black and Latino participants in USSTRIDE had higher acceptance rates to medical school, higher MCAT scores, and college GPAs when compared to other Black and Latino medical school applicants f...

  12. A Behavioral Lifestyle Intervention Enhanced With Multiple-Behavior Self-Monitoring Using Mobile and Connected Tools for Underserved Individuals With Type 2 Diabetes and Comorbid Overweight or Obesity: Pilot Comparative Effectiveness Trial.

    Science.gov (United States)

    Wang, Jing; Cai, Chunyan; Padhye, Nikhil; Orlander, Philip; Zare, Mohammad

    2018-04-10

    Self-monitoring is a cornerstone of behavioral lifestyle interventions for obesity and type 2 diabetes mellitus. Mobile technology has the potential to improve adherence to self-monitoring and patient outcomes. However, no study has tested the use of a smartphone to facilitate self-monitoring in overweight or obese adults with type 2 diabetes mellitus living in the underserved community. The aim of this study was to examine the feasibility of and compare preliminary efficacy of a behavioral lifestyle intervention using smartphone- or paper-based self-monitoring of multiple behaviors on weight loss and glycemic control in a sample of overweight or obese adults with type 2 diabetes mellitus living in underserved communities. We conducted a randomized controlled trial to examine the feasibility and preliminary efficacy of a behavioral lifestyle intervention. Overweight or obese patients with type 2 diabetes mellitus were recruited from an underserved minority community health center in Houston, Texas. They were randomly assigned to one of the three groups: (1) behavior intervention with smartphone-based self-monitoring, (2) behavior intervention with paper diary-based self-monitoring, and (3) usual care group. Both the mobile and paper groups received a total of 11 face-to-face group sessions in a 6-month intervention. The mobile group received an Android-based smartphone with 2 apps loaded to help them record their diet, physical activity, weight, and blood glucose, along with a connected glucometer, whereas the paper group used paper diaries for these recordings. Primary outcomes of the study included percentage weight loss and glycated hemoglobin (HbA 1c ) changes over 6 months. A total of 26 patients were enrolled: 11 in the mobile group, 9 in the paper group, and 6 in the control group. We had 92% (24/26) retention rate at 6 months. The sample is predominantly African Americans with an average age of 56.4 years and body mass index of 38.1. Participants lost an

  13. Female medical leadership: cross sectional study.

    Science.gov (United States)

    Kvaerner, K J; Aasland, O G; Botten, G S

    1999-01-09

    To assess the relation between male and female medical leadership. Cross sectional study on predictive factors for female medical leadership with data on sex, age, specialty, and occupational status of Norwegian physicians. Oslo, Norway. 13 844 non-retired Norwegian physicians. Medical leaders, defined as physicians holding a leading position in hospital medicine, public health, academic medicine, or private health care. 14.6% (95% confidence interval 14.0% to 15.4%) of the men were leaders compared with 5.1% (4.4% to 5.9%) of the women. Adjusted for age men had a higher estimated probability of leadership in all categories of age and job, the highest being in academic medicine with 0.57 (0.42 to 0.72) for men aged over 54 years compared with 0.39 (0.21 to 0.63) for women in the same category. Among female hospital physicians there was a positive relation between the proportion of women in their specialty and the probability of leadership. Women do not reach senior positions as easily as men. Medical specialties with high proportions of women have more female leaders.

  14. Using information technology to reduce asthma disparities in underserved populations: a pilot study.

    Science.gov (United States)

    Vargas, Perla A; Robles, Elias; Harris, Judith; Radford, Peggy

    2010-10-01

    Low health literacy has been identified as an independent predictor of poor asthma control. The Institute of Medicine considers the role of information technology (IT) as critical in providing "safe, effective, patient centered, timely, efficient, and equitable" care with the potential to reduce health disparities in underserved populations. The aim of this study was to design and evaluate an interactive computer-based questionnaire to assess asthma symptoms in children of parents with limited health literacy and/or limited English proficiency. Volunteer caregivers attending a mobile asthma clinic were randomly assigned to complete the electronic or the paper-and-pencil version of an asthma screening questionnaire (ASQ) in their language of choice (English or Spanish). In the electronic version, a tablet computer was used to present the ASQ questions as video clips and to collect information through the touchscreen. Participants also completed a demographic questionnaire, a brief health literacy questionnaire, and a system usability and satisfaction questionnaire. Reliability of the paper and electronic self-assessments was evaluated by comparing each participant's answers to information they provided during a nurse-guided structured interview (gold standard). A total of 48 parents participated in the study, 26 completed the electronic ASQ and 21 the paper-and-pencil form. Thirty-five percent of the children had well-controlled asthma (n = 17). Most participants were Spanish speaking (67%) Hispanic (n = 44) mothers (n = 43) with a median age of 32 years. More than half had ≤8 years of education (n = 25) and earned education was significant (ρ = .47, p higher than concordance between the paper ASQ and the nurse interview (68% versus 54%; p technology tools may help reduce barriers to access due to inadequate levels of English proficiency and health literacy.

  15. Cerebellar inactivation impairs memory of learned prism gaze-reach calibrations.

    Science.gov (United States)

    Norris, Scott A; Hathaway, Emily N; Taylor, Jordan A; Thach, W Thomas

    2011-05-01

    Three monkeys performed a visually guided reach-touch task with and without laterally displacing prisms. The prisms offset the normally aligned gaze/reach and subsequent touch. Naive monkeys showed adaptation, such that on repeated prism trials the gaze-reach angle widened and touches hit nearer the target. On the first subsequent no-prism trial the monkeys exhibited an aftereffect, such that the widened gaze-reach angle persisted and touches missed the target in the direction opposite that of initial prism-induced error. After 20-30 days of training, monkeys showed long-term learning and storage of the prism gaze-reach calibration: they switched between prism and no-prism and touched the target on the first trials without adaptation or aftereffect. Injections of lidocaine into posterolateral cerebellar cortex or muscimol or lidocaine into dentate nucleus temporarily inactivated these structures. Immediately after injections into cortex or dentate, reaches were displaced in the direction of prism-displaced gaze, but no-prism reaches were relatively unimpaired. There was little or no adaptation on the day of injection. On days after injection, there was no adaptation and both prism and no-prism reaches were horizontally, and often vertically, displaced. A single permanent lesion (kainic acid) in the lateral dentate nucleus of one monkey immediately impaired only the learned prism gaze-reach calibration and in subsequent days disrupted both learning and performance. This effect persisted for the 18 days of observation, with little or no adaptation.

  16. Training and development needs of medical record staff at the Korle ...

    African Journals Online (AJOL)

    Ghana Library Journal ... Though the medical record services play an important role in health care delivery, indications are that the ... This neglect has far reaching implications for the quality of service required from the Ghana Health Service.

  17. Decoding natural reach-and-grasp actions from human EEG

    Science.gov (United States)

    Schwarz, Andreas; Ofner, Patrick; Pereira, Joana; Ioana Sburlea, Andreea; Müller-Putz, Gernot R.

    2018-02-01

    Objective. Despite the high number of degrees of freedom of the human hand, most actions of daily life can be executed incorporating only palmar, pincer and lateral grasp. In this study we attempt to discriminate these three different executed reach-and-grasp actions utilizing their EEG neural correlates. Approach. In a cue-guided experiment, 15 healthy individuals were asked to perform these actions using daily life objects. We recorded 72 trials for each reach-and-grasp condition and from a no-movement condition. Main results. Using low-frequency time domain features from 0.3 to 3 Hz, we achieved binary classification accuracies of 72.4%, STD  ±  5.8% between grasp types, for grasps versus no-movement condition peak performances of 93.5%, STD  ±  4.6% could be reached. In an offline multiclass classification scenario which incorporated not only all reach-and-grasp actions but also the no-movement condition, the highest performance could be reached using a window of 1000 ms for feature extraction. Classification performance peaked at 65.9%, STD  ±  8.1%. Underlying neural correlates of the reach-and-grasp actions, investigated over the primary motor cortex, showed significant differences starting from approximately 800 ms to 1200 ms after the movement onset which is also the same time frame where classification performance reached its maximum. Significance. We could show that it is possible to discriminate three executed reach-and-grasp actions prominent in people’s everyday use from non-invasive EEG. Underlying neural correlates showed significant differences between all tested conditions. These findings will eventually contribute to our attempt of controlling a neuroprosthesis in a natural and intuitive way, which could ultimately benefit motor impaired end users in their daily life actions.

  18. Probing the reaching-grasping network in humans through multivoxel pattern decoding.

    Science.gov (United States)

    Di Bono, Maria Grazia; Begliomini, Chiara; Castiello, Umberto; Zorzi, Marco

    2015-11-01

    The quest for a putative human homolog of the reaching-grasping network identified in monkeys has been the focus of many neuropsychological and neuroimaging studies in recent years. These studies have shown that the network underlying reaching-only and reach-to-grasp movements includes the superior parieto-occipital cortex (SPOC), the anterior part of the human intraparietal sulcus (hAIP), the ventral and the dorsal portion of the premotor cortex, and the primary motor cortex (M1). Recent evidence for a wider frontoparietal network coding for different aspects of reaching-only and reach-to-grasp actions calls for a more fine-grained assessment of the reaching-grasping network in humans by exploiting pattern decoding methods (multivoxel pattern analysis--MVPA). Here, we used MPVA on functional magnetic resonance imaging (fMRI) data to assess whether regions of the frontoparietal network discriminate between reaching-only and reach-to-grasp actions, natural and constrained grasping, different grasp types, and object sizes. Participants were required to perform either reaching-only movements or two reach-to-grasp types (precision or whole hand grasp) upon spherical objects of different sizes. Multivoxel pattern analysis highlighted that, independently from the object size, all the selected regions of both hemispheres contribute in coding for grasp type, with the exception of SPOC and the right hAIP. Consistent with recent neurophysiological findings on monkeys, there was no evidence for a clear-cut distinction between a dorsomedial and a dorsolateral pathway that would be specialized for reaching-only and reach-to-grasp actions, respectively. Nevertheless, the comparison of decoding accuracy across brain areas highlighted their different contributions to reaching-only and grasping actions. Altogether, our findings enrich the current knowledge regarding the functional role of key brain areas involved in the cortical control of reaching-only and reach-to-grasp actions

  19. Reaching Our Successors: Millennial Generation Medical Students ...

    African Journals Online (AJOL)

    Plastic surgeons have rewarding careers 78 (71%), and plastic surgeons provide ... of plastic surgery will be influenced by my decision to have a family P < 0.5. ..... The hierarchy goes from basic ... Asian J Psychiatr 2011;4:88‑91. 6. Piper LE.

  20. The field of medical anthropology in Social Science & Medicine.

    Science.gov (United States)

    Panter-Brick, Catherine; Eggerman, Mark

    2018-01-01

    Conceptually and methodologically, medical anthropology is well-positioned to support a "big-tent" research agenda on health and society. It fosters approaches to social and structural models of health and wellbeing in ways that are critically reflective, cross-cultural, people-centered, and transdisciplinary. In this review article, we showcase these four main characteristics of the field, as featured in Social Science & Medicine over the last fifty years, highlighting their relevance for an international and interdisciplinary readership. First, the practice of critical inquiry in ethnographies of health offers a deep appreciation of sociocultural viewpoints when recording and interpreting lived experiences and contested social worlds. Second, medical anthropology champions cross-cultural breadth: it makes explicit local understandings of health experiences across different settings, using a fine-grained, comparative approach to develop a stronger global platform for the analysis of health-related concerns. Third, in offering people-centered views of the world, anthropology extends the reach of critical enquiry to the lived experiences of hard-to-reach population groups, their structural vulnerabilities, and social agency. Finally, in developing research at the nexus of cultures, societies, biologies, and health, medical anthropologists generate new, transdisciplinary conversations on the body, mind, person, community, environment, prevention, and therapy. As featured in this journal, scholarly contributions in medical anthropology seek to debate human health and wellbeing from many angles, pushing forward methodology, social theory, and health-related practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Recruitment of hard-to-reach population subgroups via adaptations of the snowball sampling strategy.

    Science.gov (United States)

    Sadler, Georgia Robins; Lee, Hau-Chen; Lim, Rod Seung-Hwan; Fullerton, Judith

    2010-09-01

    Nurse researchers and educators often engage in outreach to narrowly defined populations. This article offers examples of how variations on the snowball sampling recruitment strategy can be applied in the creation of culturally appropriate, community-based information dissemination efforts related to recruitment to health education programs and research studies. Examples from the primary author's program of research are provided to demonstrate how adaptations of snowball sampling can be used effectively in the recruitment of members of traditionally underserved or vulnerable populations. The adaptation of snowball sampling techniques, as described in this article, helped the authors to gain access to each of the more-vulnerable population groups of interest. The use of culturally sensitive recruitment strategies is both appropriate and effective in enlisting the involvement of members of vulnerable populations. Adaptations of snowball sampling strategies should be considered when recruiting participants for education programs or for research studies when the recruitment of a population-based sample is not essential.

  2. Enhancing student perspectives of humanism in medicine: reflections from the Kalaupapa service learning project.

    Science.gov (United States)

    Lee, Winona K; Harris, Chessa C D; Mortensen, Kawika A; Long, Linsey M; Sugimoto-Matsuda, Jeanelle

    2016-05-09

    Service learning is endorsed by the Liaison Committee on Medical Education (LCME) as an integral part of U.S. medical school curricula for future physicians. Service learning has been shown to help physicians in training rediscover the altruistic reasons for pursuing medicine and has the potential to enhance students' perspectives of humanism in medicine. The Kalaupapa service learning project is a unique collaboration between disadvantaged post-baccalaureate students with an underserved rural community. This study was conducted to determine whether the Kalaupapa service learning curricula enhanced student perspectives of humanism in medicine at an early stage of their medical training. Program participants between 2008 and 2014 (n = 41) completed written reflections following the conclusion of the service learning project. Four prompts guided student responses. Reflections were thematically analyzed. Once all essays were read, team members compared their findings to condense or expand themes and assess levels of agreement. Emerging themes of resilience and unity were prominent throughout the student reflections. Students expressed respect and empathy for the patients' struggles and strengths, as well as those of their peers. The experience also reinforced students' commitment to service, particularly to populations in rural and underserved communities. Students also gained a deeper understanding of the patient experience and also of themselves as future physicians. To identify and address underserved and rural patients' health care needs, training programs must prepare an altruistic health care workforce that embraces the humanistic element of medicine. The Kalaupapa service learning project is a potential curricular model that can be used to enhance students' awareness and perspectives of humanism in medicine.

  3. Implementation of a comprehensive pharmaceutical care program for an underserved population.

    Science.gov (United States)

    Mascardo, Lisa A; Spading, Kimberly A; Abramowitz, Paul W

    2012-07-15

    The implementation of a prescription benefit program for low-income patients emphasizing clinical pharmacist services and strict formulary control is described, with a review of program expenditures and cost avoidance. In 2006, University of Iowa Hospitals and Clinics (UIHC) launched a program to provide a limited prescription benefit to indigent patients under the IowaCare Medicaid demonstration waiver. Sudden dramatic growth in IowaCare enrollment, combined with sharp budget cuts, forced UIHC pharmacy leaders to implement creative cost-control strategies: (1) the establishment of an ambulatory care clinic staffed by a clinical pharmacy specialist, (2) increased reliance on an almost exclusively generic formulary, (3) collaboration with social services staff to help secure medication assistance for patients requiring brand-name drugs, (4) optimized purchasing through the federal 340B Drug Pricing Program, and (5) the imposition of medication copayments and mailing fees for prescription refills. Now in its seventh year, the UIHC pharmacy program has expanded indigent patients' access to pharmaceutical care services while reducing their use of hospital and emergency room services and lowering program medication costs by an estimated 50% (from $2.6 million in fiscal year 2009 to $1.3 million in fiscal year 2010). The UIHC ambulatory care pharmacy implemented a prescription program in collaboration with social service workers to address the medication needs of the state's low-income and uninsured patients in a fiscally responsible manner by managing purchasing contracts, revising a generic formulary, implementing copayments and mailing fees, and reviewing medication profiles.

  4. Assessment of obesity management in medical examination

    Directory of Open Access Journals (Sweden)

    Treyzon Leo

    2005-03-01

    Full Text Available Abstract Obesity is a growing international health problem that has already reached epidemic proportions, particularly within the United States where a majority of the population is overweight or obese. Effective methods of treatment are needed, and should be taught to physicians by efficient means. There exists a disconnect between the rising obesity prevalence with its high toll on medical resources, and the lack of obesity education provided to practitioners in the course of their training. One particular shortfall is the lack of representation of obesity on standardized medical examinations. Physician attitudes toward obesity are influenced by their lack of familiarity with the management of the disease. This may include dietary restriction, increasing physical activity, behavior modification, pharmacotherapy, and surgical interventions. Thus, curricular changes in the medical education of obesity could help reduce morbidity and mortality associated with this disease.

  5. Eligibility for HIV/AIDS treatment among adults in a medical ...

    African Journals Online (AJOL)

    ART), many people in need of HIV/AIDS care in Uganda have not been reached. HIV testing and ART are not widely offered as routine medical services and data on HIV/AIDS in emergency settings in Sub-Saharan Africa is limited.We determined ...

  6. GAP-REACH

    Science.gov (United States)

    Lewis-Fernández, Roberto; Raggio, Greer A.; Gorritz, Magdaliz; Duan, Naihua; Marcus, Sue; Cabassa, Leopoldo J.; Humensky, Jennifer; Becker, Anne E.; Alarcón, Renato D.; Oquendo, María A.; Hansen, Helena; Like, Robert C.; Weiss, Mitchell; Desai, Prakash N.; Jacobsen, Frederick M.; Foulks, Edward F.; Primm, Annelle; Lu, Francis; Kopelowicz, Alex; Hinton, Ladson; Hinton, Devon E.

    2015-01-01

    Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-itemGAP-REACH© checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (κ = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article. PMID:24080673

  7. Characteristics of pediatric chemotherapy medication errors in a national error reporting database.

    Science.gov (United States)

    Rinke, Michael L; Shore, Andrew D; Morlock, Laura; Hicks, Rodney W; Miller, Marlene R

    2007-07-01

    Little is known regarding chemotherapy medication errors in pediatrics despite studies suggesting high rates of overall pediatric medication errors. In this study, the authors examined patterns in pediatric chemotherapy errors. The authors queried the United States Pharmacopeia MEDMARX database, a national, voluntary, Internet-accessible error reporting system, for all error reports from 1999 through 2004 that involved chemotherapy medications and patients aged error reports, 85% reached the patient, and 15.6% required additional patient monitoring or therapeutic intervention. Forty-eight percent of errors originated in the administering phase of medication delivery, and 30% originated in the drug-dispensing phase. Of the 387 medications cited, 39.5% were antimetabolites, 14.0% were alkylating agents, 9.3% were anthracyclines, and 9.3% were topoisomerase inhibitors. The most commonly involved chemotherapeutic agents were methotrexate (15.3%), cytarabine (12.1%), and etoposide (8.3%). The most common error types were improper dose/quantity (22.9% of 327 cited error types), wrong time (22.6%), omission error (14.1%), and wrong administration technique/wrong route (12.2%). The most common error causes were performance deficit (41.3% of 547 cited error causes), equipment and medication delivery devices (12.4%), communication (8.8%), knowledge deficit (6.8%), and written order errors (5.5%). Four of the 5 most serious errors occurred at community hospitals. Pediatric chemotherapy errors often reached the patient, potentially were harmful, and differed in quality between outpatient and inpatient areas. This study indicated which chemotherapeutic agents most often were involved in errors and that administering errors were common. Investigation is needed regarding targeted medication administration safeguards for these high-risk medications. Copyright (c) 2007 American Cancer Society.

  8. Household medical waste disposal policy in Israel.

    Science.gov (United States)

    Barnett-Itzhaki, Zohar; Berman, Tamar; Grotto, Itamar; Schwartzberg, Eyal

    2016-01-01

    Large amounts of expired and unused medications accumulate in households. This potentially exposes the public to hazards due to uncontrolled use of medications. Most of the expired or unused medications that accumulate in households (household medical waste) is thrown to the garbage or flushed down to the sewage, potentially contaminating waste-water, water resources and even drinking water. There is evidence that pharmaceutical active ingredients reach the environment, including food, however the risk to public health from low level exposure to pharmaceuticals in the environment is currently unknown. In Israel, there is no legislation regarding household medical waste collection and disposal. Furthermore, only less than 14 % of Israelis return unused medications to Health Maintenance Organization (HMO) pharmacies. In this study, we investigated world-wide approaches and programs for household medical waste collection and disposal. In many countries around the world there are programs for household medical waste collection. In many countries there is legislation to address the issue of household medical waste, and this waste is collected in hospitals, clinics, law enforcement agencies and pharmacies. Furthermore, in many countries, medication producers and pharmacies pay for the collection and destruction of household medical waste, following the "polluter pays" principle. Several approaches and methods should be considered in Israel: (a) legislation and regulation to enable a variety of institutes to collect household medical waste (b) implementing the "polluter pays" principle and enforcing medical products manufactures to pay for the collection and destruction of household medical waste. (c) Raising awareness of patients, pharmacists, and other medical health providers regarding the health and environmental risks in accumulation of drugs and throwing them to the garbage, sink or toilet. (d) Adding specific instructions regarding disposal of the drug, in the

  9. Reach/frequency for printed media: Personal probabilities or models

    DEFF Research Database (Denmark)

    Mortensen, Peter Stendahl

    2000-01-01

    The author evaluates two different ways of estimating reach and frequency of plans for printed media. The first assigns reading probabilities to groups of respondents and calculates reach and frequency by simulation. the second estimates parameters to a model for reach/frequency. It is concluded ...... and estiamtes from such models are shown to be closer to panel data. the problem, however, is to get valid input for such models from readership surveys. Means for this are discussed....

  10. [The REACH legislation: the consumer and environment protection perspective].

    Science.gov (United States)

    Gundert-Remy, Ursula

    2008-12-01

    REACH has been initiated with the aim of improving existing legislation. In order to assist in the interpretation of the REACH legislation, guidance documents have been developed, which have only lately become available. According to the REACH annexes and supported by guidance documents, waiving of test requirements will be possible, thus, opening the possibility that under REACH no new (eco)toxicological data will be required. Concerning products, a guidance document was released in April 2008 stating that the substance concentration threshold of 0.1 % (w/w) applies to the article as produced or imported and it does not relate to the homogeneous materials or parts of an article, but relates to the article as such (i.e., as produced or imported). Hence, notification will not be required for many products containing chemicals with properties which place them on the candidate list for authorization. In summary, it is at present not foreseeable whether the expected benefit of the REACH legislation will materialise for the environment and for the health of consumers and at the work place.

  11. Medical relief activities conducted by Nippon Medical School in the acute phase of the Great East Japan Earthquake 2011.

    Science.gov (United States)

    Fuse, Akira; Shuto, Yuki; Ando, Fumihiko; Shibata, Masafumi; Watanabe, Akihiro; Onda, Hidetaka; Masuno, Tomohiko; Yokota, Hiroyuki

    2011-01-01

    At 14:46 on March 11, 2011, the Great East Japan Earthquake and tsunami occurred off the coast of Honshu, Japan. In the acute phase of this catastrophe, one of our teams was deployed as a Tokyo Disaster Medical Assistance Team (DMAT) to Kudan Kaikan in Tokyo, where the ceiling of a large hall had partially collapsed as the result of the earthquake, to conduct triage at the scene: 6 casualties were assigned to the red category (immediate), which included 1 case of cardiopulmonary arrest and 1 of flail chest; 8 casualties in the yellow category (delayed); and 22 casualties in the green category (minor). One severely injured person was transported to our hospital. Separately, our medical team was deployed to Miyagi 2 hours after the earthquake in our multipurpose medical vehicle as part of Japan DMAT (J-DMAT). We were the first DMAT from the metropolitan area to arrive, but we were unable to start medical relief activities because the information infrastructure had been destroyed and no specific information had yet reached the local headquarters. Early next morning, J-DMAT decided to support Sendai Medical Center and search and rescue efforts in the affected area and to establish a staging care unit at Camp Kasuminome of the Japan Self-Defense Force. Our team joined others to establish the staging care unit. Because information was still confused until day 3 of the disaster and we could not adequately grasp onsite medical needs, our J-DMAT decided to provide onsite support at Ishinomaki Red Cross Hospital, a disaster base hospital, and relay information about its needs to the local J-DMAT headquarters. Although our medical relief teams were deployed as quickly as possible, we could not begin medical relief activities immediately owing to the severely damaged information infrastructure. Only satellite mobile phones could be operated, and information on the number of casualties and the severity of shortages of lifeline services could be obtained only through a "go and

  12. Medical rosters and the Trade Practices Act.

    Science.gov (United States)

    Pengilley, Warren

    2003-04-07

    Medical rosters are not free of trade practices problems, notwithstanding assurances by the Australian Competition and Consumer Commission (ACCC). Neither the ACCC nor the recently convened Wilkinson Committee has applied rigorous legal principles in interpreting the Trade Practices Act 1974 (Cwlth) to reach its conclusions. The Australian law should be changed to bring it into line with that of the United States and New Zealand.

  13. The role of electromagnetic separators in the production of radiotracers for bio-medical research and nuclear medical application

    CERN Document Server

    Beyer, Gerd-Jürgen

    2003-01-01

    With the growing complexity of positron emission tomography/single photon emission computed tomography imaging and the new developments in systemic radionuclide therapy there is a growing need for radioisotope preparations with higher radiochemical and radionuclidic purity that has not been achievable before. Especially important for the new applications is the specific activity of the radiotracer. Conventional methods in medical isotope production have reached their technical limitations. The role of isotope separators is discussed with examples of typical production and characterization experiments conducted at the ISOLDE and TRIUMF facilities. These preliminary experiments indicate that isotope separators have a definite role to play in the future for the production of radioisotopes for biomedical research and medical application.

  14. Faculty development programs for medical teachers in India

    Directory of Open Access Journals (Sweden)

    SANJAY ZODPEY

    2016-04-01

    Full Text Available Introduction: India has the highest number of medical colleges in the world and subsequently the higher number of medical teachers. There is a dire need of adopting a systematic approach to faculty development to enhance quality education to meet health challenges for 21st Century. This manuscript provides a landscape of faculty development programs in India, identifying gaps and opportunities for reforms in faculty development. Methods: Conventionally, FDPs are organized by medical colleges and universities through Basic Courses and Advanced Courses focusing on pedagogy. Medical Council of India is facilitating FDPs through 18 selected regional centers to enable medical teachers to avail modern education technology for teaching from July 2009. Foundation for Advancement of International Medical Education and Research has three Regional Institutes in India. Results: Recommendations include the need for formulating a national strategy for faculty development to not only enhance the quantity of medical teachers but also the quality of medical education; providing support for Departments of Medical Education/Regional Centers in terms of finance and staffing and incorporation of teaching skills in postgraduate training. Conclusion: Distance learning courses focusing on educational leadership and pedagogy for medical teachers can be an option to reach a wider audience. FDPs can be an asset in recruiting and retaining teachers as they offer valued professional development opportunities.

  15. Palliative Oncologic Care Curricula for Providers in Resource-Limited and Underserved Communities: a Systematic Review.

    Science.gov (United States)

    Xu, Melody J; Su, David; Deboer, Rebecca; Garcia, Michael; Tahir, Peggy; Anderson, Wendy; Kinderman, Anne; Braunstein, Steve; Sherertz, Tracy

    2017-12-20

    Familiarity with principles of palliative care, supportive care, and palliative oncological treatment is essential for providers caring for cancer patients, though this may be challenging in global communities where resources are limited. Herein, we describe the scope of literature on palliative oncological care curricula for providers in resource-limited settings. A systematic literature review was conducted using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Med Ed Portal databases, and gray literature. All available prospective cohort studies, case reports, and narratives published up to July 2017 were eligible for review. Fourteen articles were identified and referenced palliative care education programs in Argentina, Uganda, Kenya, Australia, Germany, the USA, or multiple countries. The most common teaching strategy was lecture-based, followed by mentorship and experiential learning involving role play and simulation. Education topics included core principles of palliative care, pain and symptom management, and communication skills. Two programs included additional topics specific to the underserved or American Indian/Alaskan Native community. Only one program discussed supportive cancer care, and no program reported educational content on resource-stratified decision-making for palliative oncological treatment. Five programs reported positive participant satisfaction, and three programs described objective metrics of increased educational or research activity. There is scant literature on effective curricula for providers treating cancer patients in resource-limited settings. Emphasizing supportive cancer care and palliative oncologic treatments may help address gaps in education; increased outcome reporting may help define the impact of palliative care curriculum within resource-limited communities.

  16. Lifelink: 3G-based mobile telemedicine system.

    Science.gov (United States)

    Alis, Christian; del Rosario, Carlos; Buenaobra, Bernardino; Mar Blanca, Carlo

    2009-04-01

    Current wired telemedicine systems encounter difficulties when implemented in archipelagic developing countries because of the high cost of fixed infrastructure. In this research, we devised Lifelink, a mobile real-time telemonitoring and diagnostic facility to command and control remote medical devices through mobile phones. The whole process is phone-based, effectively freeing offsite medical specialists from stationary monitoring consoles and endowing the system with the potential to increase the number participating consultants. The electrocardiogram (ECG) readings are analyzed using a detrended fluctuation technique and classified into pathological cases using an unassisted K-means clustering algorithm. We analyzed 30 batches of 2-hour ECG signals taken from cardiac patients (20 males, 10 females, mean age 46.7 years) with pre-diagnosed pathologies. The method successfully categorized the 30 subjects without user intervention into the following cases: normal (at 86.7% accuracy), congestive heart failure (86.7%), and atrial fibrillation (80.0%). The synergy of mobile monitoring and fluctuation analysis presents a powerful platform to reach remote, underserved communities with poor or nonexistent wired communication structures. It is likely to be essential in the development of new mobile diagnostic and prognostic measures.

  17. Medical intervention in radiological emergencies, formation and training

    International Nuclear Information System (INIS)

    Cardenas H, J.

    2006-01-01

    The work exposes the national experience in the development of training programs in medical aspects of the radiological emergencies. Implemented after valuing the existent situation, identified the necessities and the reach of the training, additionally it was elaborated the content of the training program whose purpose is guided to the invigoration of the medical answer capacity in radiological emergencies The content of the modular program it approaches theoretical- practical aspects on preparation and medical answer in radiological emergencies. The program includes an exercise that simulates a radiological accident, to evaluate during the same one, the answer capacity before this situation. The training concludes with the design of a strategy for the preparation and answer in radiological emergencies in correspondence with the potential accidental scenarios that the participants can face. (Author)

  18. Do working environment interventions reach shift workers?

    DEFF Research Database (Denmark)

    Nabe-Nielsen, Kirsten; Jørgensen, Marie Birk; Garde, Anne Helene

    2016-01-01

    PURPOSE: Shift workers are exposed to more physical and psychosocial stressors in the working environment as compared to day workers. Despite the need for targeted prevention, it is likely that workplace interventions less frequently reach shift workers. The aim was therefore to investigate whether...... the reach of workplace interventions varied between shift workers and day workers and whether such differences could be explained by the quality of leadership exhibited at different times of the day. METHODS: We used questionnaire data from 5361 female care workers in the Danish eldercare sector...

  19. Reaching Adolescents and Youth in Burkina Faso, Guinea-Bissau

    African Journals Online (AJOL)

    AJRH Managing Editor

    typical profile of individuals in contact with peer educators or attending youth ... being reached (versus not reached) by programs ... characteristics in order to serve groups that may be ... places for counseling services but the frequency of.

  20. Sociology in American medical education since the 1960s: the rhetoric or reform.

    Science.gov (United States)

    Wegar, K

    1992-10-01

    Despite recommendations by medical reformers that medical sociology be included in the curriculum, there is currently little evidence of a far-reaching integration of sociological perspectives in American medical education. Yet, support for the relevance of sociological knowledge has since the late 1960s helped to diffuse external pressures for change in health care and medical education. As a symbol of the communitarian commitment of the medical profession, claims in favor of the incorporation of sociological perspectives have thus occasionally, and largely unintentionally, served the public relations interests of biomedicine. However, the more recent interest in medical ethics has to some degree transformed medicine's educational agenda and the definition of medical 'human values'. Whereas the rhetorical expropriation of medical sociology primarily has concerned medicine's responsibility vis-à-vis society as a whole, the new medical ethics education signifies a return to a more individualistically oriented medical morality.

  1. The use of a proactive dissemination strategy to optimize reach of an internet-delivered computer tailored lifestyle intervention

    Science.gov (United States)

    2013-01-01

    intervention, the employed proactive dissemination strategy succeeded in ensuring relatively high levels of reach. Reach among at-risk individuals (e.g. low socioeconomic status and unhealthy lifestyle) was modest. It is therefore essential to further optimize reach by putting additional effort into increasing interest in the lifestyle intervention among at-risk individuals and to encourage them to actually use the intervention. Trial registration Dutch Trial Register (NTR1786) and Medical Ethics Committee of Maastricht University and the University Hospital Maastricht (NL2723506809/MEC0903016). PMID:23914991

  2. The use of a proactive dissemination strategy to optimize reach of an internet-delivered computer tailored lifestyle intervention.

    Science.gov (United States)

    Schneider, Francine; Schulz, Daniela N; Pouwels, Loes H L; de Vries, Hein; van Osch, Liesbeth A D M

    2013-08-05

    dissemination strategy succeeded in ensuring relatively high levels of reach. Reach among at-risk individuals (e.g. low socioeconomic status and unhealthy lifestyle) was modest. It is therefore essential to further optimize reach by putting additional effort into increasing interest in the lifestyle intervention among at-risk individuals and to encourage them to actually use the intervention. Dutch Trial Register (NTR1786) and Medical Ethics Committee of Maastricht University and the University Hospital Maastricht (NL2723506809/MEC0903016).

  3. Memory-guided reaching in a patient with visual hemiagnosia.

    Science.gov (United States)

    Cornelsen, Sonja; Rennig, Johannes; Himmelbach, Marc

    2016-06-01

    The two-visual-systems hypothesis (TVSH) postulates that memory-guided movements rely on intact functions of the ventral stream. Its particular importance for memory-guided actions was initially inferred from behavioral dissociations in the well-known patient DF. Despite of rather accurate reaching and grasping movements to visible targets, she demonstrated grossly impaired memory-guided grasping as much as impaired memory-guided reaching. These dissociations were later complemented by apparently reversed dissociations in patients with dorsal damage and optic ataxia. However, grasping studies in DF and optic ataxia patients differed with respect to the retinotopic position of target objects, questioning the interpretation of the respective findings as a double dissociation. In contrast, the findings for reaching errors in both types of patients came from similar peripheral target presentations. However, new data on brain structural changes and visuomotor deficits in DF also questioned the validity of a double dissociation in reaching. A severe visuospatial short-term memory deficit in DF further questioned the specificity of her memory-guided reaching deficit. Therefore, we compared movement accuracy in visually-guided and memory-guided reaching in a new patient who suffered a confined unilateral damage to the ventral visual system due to stroke. Our results indeed support previous descriptions of memory-guided movements' inaccuracies in DF. Furthermore, our data suggest that recently discovered optic-ataxia like misreaching in DF is most likely caused by her parieto-occipital and not by her ventral stream damage. Finally, multiple visuospatial memory measurements in HWS suggest that inaccuracies in memory-guided reaching tasks in patients with ventral damage cannot be explained by visuospatial short-term memory or perceptual deficits, but by a specific deficit in visuomotor processing. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. REACH and nanomaterials: current status

    International Nuclear Information System (INIS)

    Alessandrelli, Maria; Di Prospero Fanghella, Paola; Polci, Maria Letizia; Castelli, Stefano; Pettirossi, Flavio

    2015-01-01

    New challenges for regulators are emerging about a specific assessment and appropriate management of the potential risks of nanomaterials. In the framework of European legislation on chemicals, Regulation (EC) No. 1907/2006 REACH aims to ensure the safety of human health and the environment through the collection of information on the physico-chemical characteristics of the substances and on their profile (eco) toxicological and the identification of appropriate risk management linked to 'exposure to these substances without impeding scientific progress and the competitiveness of industry. In order to cover the current shortage of information on the safety of nanomaterials and tackle the acknowledged legal vacuum, are being a rich activities, carried out both by regulators both by stake holders, and discussions on the proposals for adapting the European regulatory framework for chemicals . The European Commission is geared to strengthen the REACH Regulation by means of updates of its annexes. The importance of responding to the regulatory requirements has highlighted the need for cooperation between European organizations, scientists and industries to promote and ensure the safe use of nanomaterials. [it

  5. Towards sustainable design for single-use medical devices.

    Science.gov (United States)

    Hanson, Jacob J; Hitchcock, Robert W

    2009-01-01

    Despite their sophistication and value, single-use medical devices have become commodity items in the developed world. Cheap raw materials along with large scale manufacturing and distribution processes have combined to make many medical devices more expensive to resterilize, package and restock than to simply discard. This practice is not sustainable or scalable on a global basis. As the petrochemicals that provide raw materials become more expensive and the global reach of these devices continues into rapidly developing economies, there is a need for device designs that take into account the total life-cycle of these products, minimize the amount of non-renewable materials consumed and consider alternative hybrid reusable / disposable approaches. In this paper, we describe a methodology to perform life cycle and functional analyses to create additional design requirements for medical devices. These types of sustainable approaches can move the medical device industry even closer to the "triple bottom line"--people, planet, profit.

  6. The Florida Prostate Cancer Research Training Opportunities for Outstanding Leaders (ReTOOL (registered trademark)) Program: Creating Opportunities for Minority HBCU Students

    Science.gov (United States)

    2013-03-01

    underserved. (MA Haynes & BD Smedley (Eds). National Academy Press, Washington DC. 2. Norris KC, Agodoa LY (2005). The need for health professionals... Robert Vessella, PhD University of Washington Medical Center 44 10:30 – 10:45 am S-10 A Targeted Approach to Prostate Radiotherapy Alan

  7. Alternative dispute resolution and the physician--the use of mediation to resolve hospital-medical staff conflicts.

    Science.gov (United States)

    Hall, J L; Stong, R A

    1993-01-01

    The use of adversarial methods to resolve disputes arising out of medical staff matters can be time-consuming, costly, and disruptive to the hospital-medical staff relationship. As this article suggests, mediation is the preferred method of alternative dispute resolution for reaching mutually acceptable solutions with minimal harm to relationships.

  8. Systems Engineering for Space Exploration Medical Capabilities

    Science.gov (United States)

    Mindock, Jennifer; Reilly, Jeffrey; Rubin, David; Urbina, Michelle; Hailey, Melinda; Hanson, Andrea; Burba, Tyler; McGuire, Kerry; Cerro, Jeffrey; Middour, Chris; hide

    2017-01-01

    Human exploration missions that reach destinations beyond low Earth orbit, such as Mars, will present significant new challenges to crew health management. For the medical system, lack of consumable resupply, evacuation opportunities, and real-time ground support are key drivers toward greater autonomy. Recognition of the limited mission and vehicle resources available to carry out exploration missions motivates the Exploration Medical Capability (ExMC) Element's approach to enabling the necessary autonomy. The Element's work must integrate with the overall exploration mission and vehicle design efforts to successfully provide exploration medical capabilities. ExMC is applying systems engineering principles and practices to accomplish its goals. This paper discusses the structured and integrative approach that is guiding the medical system technical development. Assumptions for the required levels of care on exploration missions, medical system goals, and a Concept of Operations are early products that capture and clarify stakeholder expectations. Model-Based Systems Engineering techniques are then applied to define medical system behavior and architecture. Interfaces to other flight and ground systems, and within the medical system are identified and defined. Initial requirements and traceability are established, which sets the stage for identification of future technology development needs. An early approach for verification and validation, taking advantage of terrestrial and near-Earth exploration system analogs, is also defined to further guide system planning and development.

  9. Medical and pharmacy student concerns about participating on international service-learning trips

    OpenAIRE

    Chuang, Chih; Khatri, Siddique H.; Gill, Manpal S.; Trehan, Naveen; Masineni, Silpa; Chikkam, Vineela; Farah, Guillaume G.; Khan, Amber; Levine, Diane L.

    2015-01-01

    Background International Service Learning Trips (ISLT) provide health professional students the opportunity to provide healthcare, under the direction of trained faculty, to underserved populations in developing countries. Despite recent increases in international service learning trips, there is scant literature addressing concerns students have prior to attending such trips. This study focuses on identifying concerns before and after attending an ISLT and their impact on students. Methods A...

  10. Improving exposure scenario definitions within REACH

    DEFF Research Database (Denmark)

    Lee, Jihyun; Pizzol, Massimo; Thomsen, Marianne

    In recent years, the paradigm of chemical management system has changed from being toxicity oriented and media based to being risk oriented and receptor based. This trend is evident not only regarding environmental quality standards, but also for industrial chemical regulations. Political...... instruments to support a precautionary chemicals management system and to protect receptor’s health have also been increasing. Since 2007, the European Union adopted REACH (the Regulation on Registration, Evaluation, Authorisation and Restriction of Chemicals): REACH makes industry responsible for assessing...... and managing the risks posed by industrial chemicals and providing appropriate safety information to their users (EC, 2007). However, to ensure a high level of protection of human health and the environment, there is a need to consider ‘aggregate exposure’ including background exposures from environment which...

  11. The medical film 1897-1997: Part I. The first half-century.

    Science.gov (United States)

    Essex-Lopresti, M

    1998-03-01

    Medicine has frequently been in the forefront of applying new illustrative media to its needs, and cinematographic film is a good example. Within a year of the introduction of moving pictures, cine-film was used for medical research and to a lesser extent for teaching. The profession took advantage of the spread of cinemas by making health education films, and during the first half century of cinematography surgeons were keen to have their operations filmed. Medical educators were slow to include film in their teaching programmes and several organizations were formed to encourage their use. After the Second World War, medical films for undergraduate and postgraduate education became accepted until, as the medical film reached its centenary, cine-film declined in favour of video-recordings.

  12. Irish medical students’ understanding of the intern year

    LENUS (Irish Health Repository)

    Gouda, P,

    2016-03-01

    Upon completion of medical school in Ireland, graduates must make the transition to becoming interns. The transition into the intern year may be described as challenging as graduates assume clinical responsibilities. Historically, a survey of interns in 1996 found that 91% felt unprepared for their role. However, recent surveys in 2012 have demonstrated that this is changing with preparedness rates reaching 52%. This can be partially explained by multiple initiatives at the local and national level. Our study aimed evaluate medical student understanding of the intern year and associated factors. An online, cross-sectional survey was sent out to all Irish medical students in 2013 and included questions regarding their understanding of the intern year. Two thousand, two hundred and forty-eight students responded, with 1224 (55.4%) of students agreeing or strongly agreeing that they had a good understanding of what the intern year entails. This rose to 485 (73.7%) among senior medical students. Of junior medical students, 260 (42.8%) indicated they understood what the intern year, compared to 479 (48.7%) of intermediate medical students. Initiatives to continue improving preparedness for the intern year are essential in ensuring a smooth and less stressful transition into the medical workforce

  13. Telemedicine to Reduce Medical Risk in Austere Medical Environments: The Virtual Critical Care Consultation (VC3) Service.

    Science.gov (United States)

    Powell, Douglas; McLeroy, Robert D; Riesberg, Jamie; Vasios, William N; Miles, Ethan A; Dellavolpe, Jeffrey; Keenan, Sean; Pamplin, Jeremy C

    One of the core capabilities of prolonged field care is telemedicine. We developed the Virtual Critical Care Consult (VC3) Service to provide Special Operations Forces (SOF) medics with on-demand, virtual consultation with experienced critical care physicians to optimize management and improve outcomes of complicated, critically injured or ill patients. Intensive-care doctors staff VC3 continuously. SOF medics access this service via phone or e-mail. A single phone call reaches an intensivist immediately. An e-mail distribution list is used to share information such as casualty images, vital signs flowsheet data, and short video clips, and helps maintain situational awareness among the VC3 critical care providers and other key SOF medical leaders. This real-time support enables direct communication between the remote provider and the clinical subject matter expert, thus facilitating expert management from near the point of injury until definitive care can be administered. The VC3 pilot program has been extensively tested in field training exercises and validated in several real-world encounters. It is an immediately available capability that can reduce medical risk and is scalable to all Special Operations Command forces. 2016.

  14. Recruiting hard-to-reach United States population sub-groups via adaptations of snowball sampling strategy

    Science.gov (United States)

    Sadler, Georgia Robins; Lee, Hau-Chen; Seung-Hwan Lim, Rod; Fullerton, Judith

    2011-01-01

    Nurse researchers and educators often engage in outreach to narrowly defined populations. This article offers examples of how variations on the snowball sampling recruitment strategy can be applied in the creation of culturally appropriate, community-based information dissemination efforts related to recruitment to health education programs and research studies. Examples from the primary author’s program of research are provided to demonstrate how adaptations of snowball sampling can be effectively used in the recruitment of members of traditionally underserved or vulnerable populations. The adaptation of snowball sampling techniques, as described in this article, helped the authors to gain access to each of the more vulnerable population groups of interest. The use of culturally sensitive recruitment strategies is both appropriate and effective in enlisting the involvement of members of vulnerable populations. Adaptations of snowball sampling strategies should be considered when recruiting participants for education programs or subjects for research studies when recruitment of a population based sample is not essential. PMID:20727089

  15. [Efficacy of tramadol/acetaminophen medication for central post-stroke pain].

    Science.gov (United States)

    Tanei, Takafumi; Kajita, Yasukazu; Noda, Hiroshi; Takebayashi, Shigenori; Hirano, Masaki; Nakahara, Norimoto; Wakabayashi, Toshihiko

    2013-08-01

    Central post-stroke pain(CPSP)is the most difficult type of central neuropathic pain to control with medical treatment. Opioids are commonly used for chronic neuropathic pain, but their efficacy in treating central neuropathic pain, particularly CPSP, is not clear. Tramadol is an opioid analgesic that, in combination with acetaminophen, has been approved since 2011 for the treatment of non-cancer pain in Japan. In this study we evaluated the efficacy of tramadol/acetaminophen medication for CPSP. We retrospectively reviewed nine cases of CPSP that received oral tramadol/acetaminophen medication. All cases received tramadol/acetaminophen medication after first taking pregabalin then antidepressant medication. Pain levels were assessed before tramadol/acetaminophen medication began and one month after a maintenance dose was reached, using a visual analogue scale(VAS)and the McGill pain questionnaire(MPQ). The mean dose of tramadol was 121±61.6 mg/day. Tramadol/acetaminophen medication was effective in reducing pain in seven of nine cases(77.8%). The VAS improved 32.9±13.8% from pre-to post-medication, and the MPQ improved from 15.4±9.1 pre-medication to 8.1±4.7 post-medication(ppain levels in patients with CPSP, and is a medication option for the treatment of CPSP.

  16. The Integrated Medical Model - Optimizing In-flight Space Medical Systems to Reduce Crew Health Risk and Mission Impacts

    Science.gov (United States)

    Kerstman, Eric; Walton, Marlei; Minard, Charles; Saile, Lynn; Myers, Jerry; Butler, Doug; Lyengar, Sriram; Fitts, Mary; Johnson-Throop, Kathy

    2009-01-01

    The Integrated Medical Model (IMM) is a decision support tool used by medical system planners and designers as they prepare for exploration planning activities of the Constellation program (CxP). IMM provides an evidence-based approach to help optimize the allocation of in-flight medical resources for a specified level of risk within spacecraft operational constraints. Eighty medical conditions and associated resources are represented in IMM. Nine conditions are due to Space Adaptation Syndrome. The IMM helps answer fundamental medical mission planning questions such as What medical conditions can be expected? What type and quantity of medical resources are most likely to be used?", and "What is the probability of crew death or evacuation due to medical events?" For a specified mission and crew profile, the IMM effectively characterizes the sequence of events that could potentially occur should a medical condition happen. The mathematical relationships among mission and crew attributes, medical conditions and incidence data, in-flight medical resources, potential clinical and crew health end states are established to generate end state probabilities. A Monte Carlo computational method is used to determine the probable outcomes and requires up to 25,000 mission trials to reach convergence. For each mission trial, the pharmaceuticals and supplies required to diagnose and treat prevalent medical conditions are tracked and decremented. The uncertainty of patient response to treatment is bounded via a best-case, worst-case, untreated case algorithm. A Crew Health Index (CHI) metric, developed to account for functional impairment due to a medical condition, provides a quantified measure of risk and enables risk comparisons across mission scenarios. The use of historical in-flight medical data, terrestrial surrogate data as appropriate, and space medicine subject matter expertise has enabled the development of a probabilistic, stochastic decision support tool capable of

  17. Implementation of a Service-learning Module in Medical Microbiology and Cell Biology Classes at an Undergraduate Liberal Arts University.

    Science.gov (United States)

    Larios-Sanz, Maia; Simmons, Alexandra D; Bagnall, Ruth Ann; Rosell, Rosemarie C

    2011-01-01

    Here we discuss the implementation of a service-learning module in two upper-division biology classes, Medical Microbiology and Cell Biology. This exciting hands-on learning experience provided our students with an opportunity to extend their learning of in-class topics to a real-life scenario. Students were required to volunteer their time (a minimum of 10 hours in a semester) at an under-served clinic in Houston, Texas. As they interacted with the personnel at the clinic, they were asked to identify the most prevalent disease (infectious for Medical Microbiology, and cellular-based for Cell) seen at the clinic and, working in groups, come up with educational material in the form of a display or brochure to be distributed to patients. The material was meant to educate patients about the disease in general terms, as well as how to recognize (symptoms), prevent and treat it. Students were required to keep a reflective journal in the form of a blog throughout the semester, and present their final materials to the class orally. Students were surveyed about their opinion of the experience at the end of the semester. The vast majority of student participants felt that the project was a positive experience and that it helped them develop additional skills beyond what they learn in the classroom and understand how lecture topics relate to every day life.

  18. Medical record search engines, using pseudonymised patient identity: an alternative to centralised medical records.

    Science.gov (United States)

    Quantin, Catherine; Jaquet-Chiffelle, David-Olivier; Coatrieux, Gouenou; Benzenine, Eric; Allaert, François-André

    2011-02-01

    The purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  19. Proprioceptive body illusions modulate the visual perception of reaching distance.

    Directory of Open Access Journals (Sweden)

    Agustin Petroni

    Full Text Available The neurobiology of reaching has been extensively studied in human and non-human primates. However, the mechanisms that allow a subject to decide-without engaging in explicit action-whether an object is reachable are not fully understood. Some studies conclude that decisions near the reach limit depend on motor simulations of the reaching movement. Others have shown that the body schema plays a role in explicit and implicit distance estimation, especially after motor practice with a tool. In this study we evaluate the causal role of multisensory body representations in the perception of reachable space. We reasoned that if body schema is used to estimate reach, an illusion of the finger size induced by proprioceptive stimulation should propagate to the perception of reaching distances. To test this hypothesis we induced a proprioceptive illusion of extension or shrinkage of the right index finger while participants judged a series of LEDs as reachable or non-reachable without actual movement. Our results show that reach distance estimation depends on the illusory perceived size of the finger: illusory elongation produced a shift of reaching distance away from the body whereas illusory shrinkage produced the opposite effect. Combining these results with previous findings, we suggest that deciding if a target is reachable requires an integration of body inputs in high order multisensory parietal areas that engage in movement simulations through connections with frontal premotor areas.

  20. Impact of the rural pipeline in medical education: practice locations of recently graduated family physicians in Ontario.

    Science.gov (United States)

    Wenghofer, Elizabeth F; Hogenbirk, John C; Timony, Patrick E

    2017-02-20

    The "rural pipeline" suggests that students educated in rural, or other underserviced areas, are more likely to establish practices in such locations. It is upon this concept that the Northern Ontario School of Medicine (NOSM) was founded. Our analysis answers the following question: Are physicians who were educated at NOSM more likely to practice in rural and northern Ontario compared with physicians who were educated at other Canadian medical schools? We used data from the College of Physicians and Surgeons of Ontario. We compared practice locations of certified Ontario family physicians who had graduated from NOSM vs. other Canadian medical schools in 2009 or later. We categorized the physicians according to where they completed their undergraduate (UG) and postgraduate (PG) training, either at NOSM or elsewhere. We used logistic regression models to determine if the location of UG and PG training was associated with rural or northern Ontario practice location. Of the 535 physicians examined, 67 had completed UG and/or PG medical education at NOSM. Over two thirds of physicians with any NOSM education were practicing in northern areas and 25.4% were practicing in rural areas of Ontario compared with those having no NOSM education, with 4.3 and 10.3% in northern and rural areas, respectively. Physicians who graduated from NOSM-UG were more likely to have practices located in rural Ontario (OR = 2.57; p = 0.014) whereas NOSM-PG physicians were more likely to have practices in northern Ontario (OR = 57.88; p education was associated with an increased likelihood of practicing in rural (NOSM-UG) and northern (NOSM-PG) Ontario.

  1. The pipeline of physiology courses in community colleges: to university, medical school, and beyond.

    Science.gov (United States)

    McFarland, Jenny; Pape-Lindstrom, Pamela

    2016-12-01

    Community colleges are significant in the landscape of undergraduate STEM (science technology, engineering, and mathematics) education (9), including biology, premedical, and other preprofessional education. Thirty percent of first-year medical school students in 2012 attended a community college. Students attend at different times in high school, their first 2 yr of college, and postbaccalaureate. The community college pathway is particularly important for traditionally underrepresented groups. Premedical students who first attend community college are more likely to practice in underserved communities (2). For many students, community colleges have significant advantages over 4-yr institutions. Pragmatically, they are local, affordable, and flexible, which accommodates students' work and family commitments. Academically, community colleges offer teaching faculty, smaller class sizes, and accessible learning support systems. Community colleges are fertile ground for universities and medical schools to recruit diverse students and support faculty. Community college students and faculty face several challenges (6, 8). There are limited interactions between 2- and 4-yr institutions, and the ease of transfer processes varies. In addition, faculty who study and work to improve the physiology education experience often encounter obstacles. Here, we describe barriers and detail existing resources and opportunities useful in navigating challenges. We invite physiology educators from 2- and 4-yr institutions to engage in sharing resources and facilitating physiology education improvement across institutions. Given the need for STEM majors and health care professionals, 4-yr colleges and universities will continue to benefit from students who take introductory biology, physiology, and anatomy and physiology courses at community colleges. Copyright © 2016 The American Physiological Society.

  2. REACH-related substitution within the Danish printing industry

    DEFF Research Database (Denmark)

    Larsen, Henrik Fred; Bøg, Carsten; Markussen, Helene

    are running a substitution project. A major part of the work has been mapping the presence of chemicals which are potential candidates for substitution (e.g. PBT, CMR, vPvB, EDS) within the Danish printing industry. The mapping comprises a combination of a literature study and an investigation of the actual......The accomplishment of the EU REACH regulation will most probably promote substitution within sectors handling a lot of different chemicals like the printing industry. With the aim of being at the cutting edge of this development the Danish EPA together with the Danish printing industry and IPU...... fulfil one or more of the criteria (e.g. CMR, EDS) for the REACH Annex XIV candidate list (authorisation). The paper presents the results of the mapping of chemical candidates and the first results of the actual substitutions. Keywords: REACH, chemicals, substitution, printing industry....

  3. Cancer Risk Assessment by Rural and Appalachian Family Medicine Physicians

    Science.gov (United States)

    Kelly, Kimberly M.; Love, Margaret M.; Pearce, Kevin A.; Porter, Kyle; Barron, Mary A.; Andrykowski, Michael

    2009-01-01

    Context: Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region. Purpose: To examine primary care physicians' identification of hereditary cancers. Methods: A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United…

  4. Addressing the primary care physician shortage in an evolving medical workforce

    Directory of Open Access Journals (Sweden)

    Lakhan Shaheen E

    2009-05-01

    resources, some of the problems being faced by this nation's healthcare industry may be ameliorated. Summary To improve our nation's heath and healthcare, it is our opinion in this commentary that we must determine a comprehensive approach to increase the number of practicing physicians in primary care which may include minority and underserved medical student recruitment, and acceptance of international medical graduates and osteopathic physicians. Although overtime some of the more underlying causes of primary care under-representation must be addressed, these previous options may offer more immediate aid, while recognizing and augmenting populations who already contribute greatly to our nation's medical system.

  5. Distribution of innate psychomotor skills recognized as important for surgical specialization in unconditioned medical undergraduates.

    Science.gov (United States)

    Moglia, Andrea; Morelli, Luca; Ferrari, Vincenzo; Ferrari, Mauro; Mosca, Franco; Cuschieri, Alfred

    2018-03-14

    There is an increasing interest for a test assessing objectively the innate aptitude for surgery as a craft specialty to complement the current selection process of surgical residents. The aim of this study was to quantify the size of individuals with high, average, and low level of innate psychomotor skills among medical students. A volunteer sample of 155 medical students, without prior experience with surgical simulator, executed five tasks at a virtual simulator for robot-assisted surgery. They had to reach proficiency twice consecutively in each before moving to the next one. A weighting based on time and number of attempts needed to reach proficiency was assigned to each task. Nine students (5.8%) out of 155 significantly outperformed all the others on median (i.q.r.) weighted time [44.7 (42.2-47.3) min vs. 98.5 (70.8-131.8) min, p specialization in other (non-craft) medical specialties.

  6. Artificial Intelligence in Medical Practice: The Question to the Answer?

    Science.gov (United States)

    Miller, D Douglas; Brown, Eric W

    2018-02-01

    Computer science advances and ultra-fast computing speeds find artificial intelligence (AI) broadly benefitting modern society-forecasting weather, recognizing faces, detecting fraud, and deciphering genomics. AI's future role in medical practice remains an unanswered question. Machines (computers) learn to detect patterns not decipherable using biostatistics by processing massive datasets (big data) through layered mathematical models (algorithms). Correcting algorithm mistakes (training) adds to AI predictive model confidence. AI is being successfully applied for image analysis in radiology, pathology, and dermatology, with diagnostic speed exceeding, and accuracy paralleling, medical experts. While diagnostic confidence never reaches 100%, combining machines plus physicians reliably enhances system performance. Cognitive programs are impacting medical practice by applying natural language processing to read the rapidly expanding scientific literature and collate years of diverse electronic medical records. In this and other ways, AI may optimize the care trajectory of chronic disease patients, suggest precision therapies for complex illnesses, reduce medical errors, and improve subject enrollment into clinical trials. Copyright © 2018 Elsevier Inc. All rights reserved.

  7. Predictors of Willingness to Use a Smartphone for Research in Underserved Persons Living with HIV

    Science.gov (United States)

    Schnall, Rebecca; Cho, Hwayoung; Webel, Allison

    2017-01-01

    Objectives The burden of HIV/AIDS is borne disproportionally by a growing number of racial and ethnic minorities and socioeconomically disadvantaged individuals. Developing mHealth interventions for the everyday self-management needs of persons living with HIV (PLWH) can be challenging given the current constraints of the U.S. healthcare system, especially for those from underserved communities. In order to develop effective, evidence-based mHealth self-management interventions, we need a better understanding of the factors associated with mHealth research. The purpose of this study was to assess factors associated with PLWH's participation in research using smartphones. Methods We conducted a prospective cohort study (parent study) to examine the relationships among HIV self-management, age, gender and mental wellness. Relevant to this study, we analyzed the relationship between self-reported use of smartphones, willingness to use a smartphone for research, and other predictor variables including: HIV stigma, social isolation, social integration functions, and depression. We selected these variables because previous work indicated they may influence smartphone or mHealth use and because they also tend to be elevated in PLWH. Results We found increased age, HIV stigma and social isolation were negatively associated with smartphone use, which supports the use of smartphones for conducting research with PLWH but also suggest that age, stigma, social integration functions and social isolation need to be considered in research involving PLWH. Conclusions Findings here support smartphone use in research involving PLWH. However, future mHealth interventions targeting PLWH should take into account the inverse relationship between smart phone use and age, HIV stigma, and social isolation, and other predictor variables PMID:28118922

  8. Environmental stressors afflicting tailwater stream reaches across the United States

    Science.gov (United States)

    Miranda, Leandro E.; Krogman, R. M.

    2014-01-01

    The tailwater is the reach of a stream immediately below an impoundment that is hydrologically, physicochemically and biologically altered by the presence and operation of a dam. The overall goal of this study was to gain a nationwide awareness of the issues afflicting tailwater reaches in the United States. Specific objectives included the following: (i) estimate the percentage of reservoirs that support tailwater reaches with environmental conditions suitable for fish assemblages throughout the year, (ii) identify and quantify major sources of environmental stress in those tailwaters that do support fish assemblages and (iii) identify environmental features of tailwater reaches that determine prevalence of key fish taxa. Data were collected through an online survey of fishery managers. Relative to objective 1, 42% of the 1306 reservoirs included in this study had tailwater reaches with sufficient flow to support a fish assemblage throughout the year. The surface area of the reservoir and catchment most strongly delineated reservoirs maintaining tailwater reaches with or without sufficient flow to support a fish assemblage throughout the year. Relative to objective 2, major sources of environmental stress generally reflected flow variables, followed by water quality variables. Relative to objective 3, zoogeography was the primary factor discriminating fish taxa in tailwaters, followed by a wide range of flow and water quality variables. Results for objectives 1–3 varied greatly among nine geographic regions distributed throughout the continental United States. Our results provide a large-scale view of the effects of reservoirs on tailwater reaches and may help guide research and management needs.

  9. Radiation protection in medical applications

    International Nuclear Information System (INIS)

    Maldonado M, H.

    2008-12-01

    The justification of the practices is the fundamental principle on which rests the peaceful use of ionizing radiations. They actually contain as aspirations to improve the quality of people's lives, contributing to sustainable development through environmental protection, so that the sources security and the individuals protection will be conditions which are not and should can not be operated. For medical applications is a highly illustrative example of this, since both for the diagnosis and therapy, the goal is to achieve what is sought for the white tissue, secured the least possible damage to the neighboring tissues so that in turn reduce the negative effects for the patient. As a basis for achieving the above, it is essential to have qualified personnel in all areas incidents, for example users, workers, officials and staff members. There are a variety of specialists in the field of medical applications as, nuclear chemistry, nuclear engineering, radiation protection, medical physics, radiation physics and others. Among the human resource in the country must make up the majority are medical radiologists, highlighting gaps in the number of radiotherapy and nuclear medicine but specially in the medical physics, who is in some way from a special viewpoint of the formal school, new to the country. This is true for the number of facilities which are in the country. The radiation protection responsibilities in medical applications focus primarily on two figures: the radiology safety manager, who is primarily dedicated to the protection of occupationally exposed personnel and the public, and the medical physicist whose functions are geared towards the radiological protection of the patient. The principal legislation in the medical applications area has been enacted and is monitored by the Health Secretary and National Commission on Nuclear Safety and Safeguards, entities that have reached agreements to avoid overlap and over-regulation. Medical applications in the

  10. Scientific governance and the process for exposure scenario development in REACH

    NARCIS (Netherlands)

    Money, C.D.; Hemmen, J.J. van; Vermeire, T.G.

    2007-01-01

    The primary process established by the European Commission to address the science needed to define key REACH concepts and to help rationally implement REACH's ambitions is enshrined in a series of activities known as the REACH Implementation Projects (RIPs). These are projects that aim to define the

  11. Medical education resources initiative for teens program in baltimore: A model pipeline program built on four pillars.

    Science.gov (United States)

    Mains, Tyler E; Wilcox, Mark V; Wright, Scott M

    2016-01-01

    Less than 6% of U.S. medical school applicants are African-American. The lack of diversity among physicians, by race as well as other measures, confers a negative impact on the American healthcare system because underrepresented minority (URM) physicians are more likely to practice in underserved communities and deliver more equitable, culturally competent care. MERIT (Medical Education Resources Initiative for Teens) is a nonprofit organization based in Baltimore, Maryland, USA. MERIT prepares URM high school students for health careers by providing a holistic support system for seven consecutive years. The program model, which utilizes weekly Saturday sessions, summer internships, and longitudinal mentoring, is built on four foundational pillars: (1) Ignite the Fire, (2) Illuminate the Path, (3) Create the Toolkit, and (4) Sustain the Desire. Since 2011, MERIT has supported 51 students in the Baltimore City Public School System. For the past two years, 100% (n = 14) of MERIT seniors enrolled in universities, compared to only 20.2% of Baltimore City students overall. While it is too early to know whether MERIT alumni will realize their goals of becoming healthcare professionals, they are currently excelling in universities and over 75% (n = 17) are still planning to pursue graduate degrees in health-related fields. After piloting an effective program model, MERIT now has three key priorities moving forward: (1) Creating a sustainable and thriving organization, (2) increasing the number of scholars the program supports in Baltimore, and (3) expanding MERIT to other cities.

  12. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol.

    Science.gov (United States)

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-05-18

    The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-built online platform. Two investigators will independently extract methodological variables and outcomes related to patient-level morbidity and mortality and community-level effects on resilience or emergency care capacity. Two investigators will independently assess external validity, selection bias, performance bias, measurement bias, attrition bias and confounding. We will summarise the findings using a narrative approach to highlight similarities and differences between the gathered studies. Formal ethical approval is not required. The results will be disseminated through a peer-reviewed publication and knowledge translation strategy. CRD42014009685. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. Registered Nurses' personal rights vs. professional responsibility in caring for members of underserved and disenfranchised populations.

    Science.gov (United States)

    Maze, Claire D Martino

    2005-05-01

    Health disparities exist and refer to the chasms in health status between the advantaged and disadvantaged. Intense multiculturalism will require different approaches and moral obligations to work with these groups and urgency exists to develop nursing caring strategies when dealing with these populations. Development of nursing curricula which identify prejudicial thinking and intolerance for marginalized groups will help to decrease fears and increase nurses' willingness to provide culturally competent health care for underserved and disenfranchised populations. Caring for members of disenfranchised groups instills fear at some level in nurses who are working with these individuals. This fear may be due, in part, to the potential harm nurses perceive the patient may cause them, or perhaps it is because they feel they could possibly be in the individual's situation at some point in their lives. Prejudice and discrimination continue to exist in society and have adversely affected the health care system and the nursing profession. Discrimination may be based on differences due to age, ability, gender, race, ethnicity, religion, sexual orientation, or any characteristics by which people differ. Registered Nurses are accountable for nursing decisions and actions regardless of personal preferences. Due to the rapidly changing healthcare system the nurse faces increasing ethical dilemmas and human rights issues. Nurses are individually accountable for caring for each patient and the right to refuse an assignment should be carefully interpreted to avoid patient abandonment. Nurses' objections can be based on moral, ethical, or religious beliefs not on personal preferences and in an emergency the nurse must provide treatment regardless of any personal objections.

  14. Patients' Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings.

    Science.gov (United States)

    Restivo, Léa; Apostolidis, Thémis; Bouhnik, Anne-Déborah; Garciaz, Sylvain; Aurran, Thérèse; Julian-Reynier, Claire

    2016-01-01

    ' attributes and the medical decisions made at these meetings show that these attributes should be taken into account in order to understand how medical decisions are reached in difficult situations of this kind.

  15. Medical Education Videos for the World: An Analysis of Viewing Patterns for a YouTube Channel.

    Science.gov (United States)

    Tackett, Sean; Slinn, Kyle; Marshall, Tanner; Gaglani, Shiv; Waldman, Vincent; Desai, Rishi

    2018-01-02

    Medical education videos can enhance learning and easily integrate into common instructional methods. YouTube permits worldwide access to high-quality medical education videos; however, no studies have described the reach of medical education videos on YouTube or what topics are preferred. One year of YouTube analytics data (February 1, 2016, to January 31, 2017) was collected for a medical education-focused channel called Osmosis. Created December 20, 2015, the channel had 189 disease-focused videos by January 2017. Viewer and subscriber data were analyzed according to the World Bank's 4 income and 7 region classifications. Topic viewing was analyzed according to income level. The channel had accumulated 105,117 subscribers and 5,226,405 views for 20,153,093 minutes (38.3 years) from viewers located in 213/218 (97.7%) World Bank economies. While the number of videos increased 4.8 fold from February 2016 to January 2017, monthly views increased 50 fold and subscribers increased 117 fold. Low or middle income countries generated 2.2 million (42%) views and 53,000 (50%) subscribers, with similar view proportions across income level during the 12 months. A plurality of views (1.5 million, 29%) came from North America; Sub-Saharan Africa had the lowest number (150,000, 2.9%). Topic viewing generally corresponded to population health statistics. Medical education content on YouTube can immediately and consistently reach a global viewership with relevant content. Educators may consider posting videos to YouTube to reach a broad audience. Future work should seek to optimize assessment of learning and investigate how videos may affect patients.

  16. Identifying medication error chains from critical incident reports: a new analytic approach.

    Science.gov (United States)

    Huckels-Baumgart, Saskia; Manser, Tanja

    2014-10-01

    Research into the distribution of medication errors usually focuses on isolated stages within the medication use process. Our study aimed to provide a novel process-oriented approach to medication incident analysis focusing on medication error chains. Our study was conducted across a 900-bed teaching hospital in Switzerland. All reported 1,591 medication errors 2009-2012 were categorized using the Medication Error Index NCC MERP and the WHO Classification for Patient Safety Methodology. In order to identify medication error chains, each reported medication incident was allocated to the relevant stage of the hospital medication use process. Only 25.8% of the reported medication errors were detected before they propagated through the medication use process. The majority of medication errors (74.2%) formed an error chain encompassing two or more stages. The most frequent error chain comprised preparation up to and including medication administration (45.2%). "Non-consideration of documentation/prescribing" during the drug preparation was the most frequent contributor for "wrong dose" during the administration of medication. Medication error chains provide important insights for detecting and stopping medication errors before they reach the patient. Existing and new safety barriers need to be extended to interrupt error chains and to improve patient safety. © 2014, The American College of Clinical Pharmacology.

  17. Solar Hydrogen Reaching Maturity

    Directory of Open Access Journals (Sweden)

    Rongé Jan

    2015-09-01

    Full Text Available Increasingly vast research efforts are devoted to the development of materials and processes for solar hydrogen production by light-driven dissociation of water into oxygen and hydrogen. Storage of solar energy in chemical bonds resolves the issues associated with the intermittent nature of sunlight, by decoupling energy generation and consumption. This paper investigates recent advances and prospects in solar hydrogen processes that are reaching market readiness. Future energy scenarios involving solar hydrogen are proposed and a case is made for systems producing hydrogen from water vapor present in air, supported by advanced modeling.

  18. Lossless medical image compression with a hybrid coder

    Science.gov (United States)

    Way, Jing-Dar; Cheng, Po-Yuen

    1998-10-01

    The volume of medical image data is expected to increase dramatically in the next decade due to the large use of radiological image for medical diagnosis. The economics of distributing the medical image dictate that data compression is essential. While there is lossy image compression, the medical image must be recorded and transmitted lossless before it reaches the users to avoid wrong diagnosis due to the image data lost. Therefore, a low complexity, high performance lossless compression schematic that can approach the theoretic bound and operate in near real-time is needed. In this paper, we propose a hybrid image coder to compress the digitized medical image without any data loss. The hybrid coder is constituted of two key components: an embedded wavelet coder and a lossless run-length coder. In this system, the medical image is compressed with the lossy wavelet coder first, and the residual image between the original and the compressed ones is further compressed with the run-length coder. Several optimization schemes have been used in these coders to increase the coding performance. It is shown that the proposed algorithm is with higher compression ratio than run-length entropy coders such as arithmetic, Huffman and Lempel-Ziv coders.

  19. [Rational choice, prediction, and medical decision. Contribution of severity scores].

    Science.gov (United States)

    Bizouarn, P; Fiat, E; Folscheid, D

    2001-11-01

    The aim of this study was to determine what type of representation the medical doctor adopted concerning the uncertainty about the future in critically ill patients in the context of preoperative evaluation and intensive care medicine and to explore through the representation of the patient health status the different possibilities of choice he was able to make. The role played by the severity classification systems in the process of medical decision-making under probabilistic uncertainty was assessed according to the theories of rational behaviour. In this context, a medical rationality needed to be discovered, going beyond the instrumental status of the objective and/or subjective constructions of rational choice theories and reaching a dimension where means and expected ends could be included.

  20. The Cognition of Maximal Reach Distance in Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Satoru Otsuki

    2016-01-01

    Full Text Available This study aimed to investigate whether the cognition of spatial distance in reaching movements was decreased in patients with Parkinson’s disease (PD and whether this cognition was associated with various symptoms of PD. Estimated and actual maximal reaching distances were measured in three directions in PD patients and healthy elderly volunteers. Differences between estimated and actual measurements were compared within each group. In the PD patients, the associations between “error in cognition” of reaching distance and “clinical findings” were also examined. The results showed that no differences were observed in any values regardless of dominance of hand and severity of symptoms. The differences between the estimated and actual measurements were negatively deviated in the PD patients, indicating that they tended to underestimate reaching distance. “Error in cognition” of reaching distance correlated with the items of posture in the motor section of the Unified Parkinson’s Disease Rating Scale. This suggests that, in PD patients, postural deviation and postural instability might affect the cognition of the distance from a target object.

  1. The association between women's self-rated health and satisfaction with environmental services in an underserved community in Lebanon.

    Science.gov (United States)

    Habib, Rima R; Elzein, Kareem; Hojeij, Safa

    2013-01-01

    This research evaluated the association between women's self-rated health and a number of socioeconomic and environmental health indicators relating to drinking water services in an underserved Lebanese community. A population-based, cross-sectional survey using interviews was adopted to obtain information from female homemakers of 2,223 households in the town of Bebnine, Lebanon. The questionnaire included indicators on self-rated health, satisfaction with water quality, source of drinking water, occurrence of diarrhea, and socioeconomic variables, such as education, occupation, and perceived economic status. Self-rated health was categorized as poor, fair, and good. Odds ratios for poor and fair compared to good self-rated health values were calculated using multinomial logistic regression. A total of 712 women (32%) reported poor self-rated health. Women who perceived their household income to be worse than others in town were four times as likely to report poor health. Compared to women who were satisfied with drinking water quality, dissatisfied women were 42% more likely to report poor health. Women living in households reporting recent episodes of diarrheal illness had poorer health ratings than those without. The findings suggest a positive relationship between individual perceptions of water quality and self-rated health. Community concerns over their surrounding environment serve as a primary guide for infrastructural development and government policy.

  2. Integrating Education on Addressing Health Disparities into the Graduate Social Work Curriculum

    Science.gov (United States)

    Mitchell, Jamie Ann

    2012-01-01

    The purpose of this article is to propose an elective social work course as a means of better preparing social workers entering practice in healthcare to meet the challenges of promoting health and reducing health disparities in minority and underserved communities. Course offerings specifically targeting health or medical social work training…

  3. National High Blood Pressure 12-Month Kit. May 1988.

    Science.gov (United States)

    National Heart and Lung Inst. (DHHS/NIH), Bethesda, MD. National High Blood Pressure Education Program.

    Part I of this kit provides information for program planners and health professionals on ways to overcome barriers to health care among the medically underserved, promote high blood pressure control through the media and other community channels, and improve adherence to treatment among hypertensive patients. It lists additional resources for…

  4. Approaching the Affective Factors of Information Seeking: The Viewpoint of the Information Search Process Model

    Science.gov (United States)

    Savolainen, Reijo

    2015-01-01

    Introduction: The article contributes to the conceptual studies of affective factors in information seeking by examining Kuhlthau's information search process model. Method: This random-digit dial telephone survey of 253 people (75% female) living in a rural, medically under-serviced area of Ontario, Canada, follows-up a previous interview study…

  5. Streaming Media Seminar--Effective Development and Distribution of Streaming Multimedia in Education

    Science.gov (United States)

    Mainhart, Robert; Gerraughty, James; Anderson, Kristine M.

    2004-01-01

    Concisely defined, "streaming media" is moving video and/or audio transmitted over the Internet for immediate viewing/listening by an end user. However, at Saint Francis University's Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA), streaming media is approached from a broader perspective. The working definition includes…

  6. Small-scale medical waste incinerators - experiences and trials in South Africa

    International Nuclear Information System (INIS)

    Rogers, David E.C.; Brent, Alan C.

    2006-01-01

    Formal waste management services are not accessible for the majority of primary healthcare clinics on the African continent, and affordable and practicable technology solutions are required in the developing country context. In response, a protocol was established for the first quantitative and qualitative evaluation of relatively low cost small-scale incinerators for use at rural primary healthcare clinics. The protocol comprised the first phase of four, which defined the comprehensive trials of three incineration units. The trials showed that all of the units could be used to render medical waste non-infectious, and to destroy syringes or render needles unsuitable for reuse. Emission loads from the incinerators are higher than large-scale commercial incinerators, but a panel of experts considered the incinerators to be more acceptable compared to the other waste treatment and disposal options available in under-serviced rural areas. However, the incinerators must be used within a safe waste management programme that provides the necessary resources in the form of collection containers, maintenance support, acceptable energy sources, and understandable operational instructions for the incinerators, whilst minimising the exposure risks to emissions through the correct placement of the units in relation to the clinic and the surrounding communities. On-going training and awareness building are essential in order to ensure that the incinerators are correctly used as a sustainable waste treatment option

  7. Children's Visual Processing of Egocentric Cues in Action Planning for Reach

    Science.gov (United States)

    Cordova, Alberto; Gabbard, Carl

    2011-01-01

    In this study the authors examined children's ability to code visual information into an egocentric frame of reference for planning reach movements. Children and adults estimated reach distance via motor imagery in immediate and response-delay conditions. Actual maximum reach was compared to estimates in multiple locations in peripersonal and…

  8. Reference data for the medical treatment by 'Yayoi'

    International Nuclear Information System (INIS)

    1976-12-01

    ''Yayoi'' is the nickname for the fast neutron reactor of the University of Tokyo and reached to the critical range in April, 1970 for the first time. It is an air cooled type fast reactor for condensed uranium installed in Tokai Village, Ibaraki Prefecture with thermal powers of 2 Kw (steady working), 200 Kw (unsteady working) or 1 Gw (reactive pulse working). There were submitted to explain about summaries of irradiation equipment and medical irradiation field, and technical capacity of irradiation treatment by ''Yayoi''. Additional data were also prepared explaining the purpose of medical treatment, expected dose, counterplans for security, minimization of general exposed dose radiation control and in emergency cases. (Kobatake, H.)

  9. Key Design Requirements for Long-Reach Manipulators

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, D.S.

    2001-01-01

    Long-reach manipulators differ from industrial robots and teleoperators typically used in the nuclear industry in that the aspect ratio (length to diameter) of links is much greater and link flexibility, as well as joint or drive train flexibility, is likely to be significant. Long-reach manipulators will be required for a variety of applications in the Environmental Restoration and Waste Management Program. While each application will present specific functional, kinematic, and performance requirements, an approach for determining the kinematic applicability and performance characteristics is presented, with a focus on waste storage tank remediation. Requirements are identified, kinematic configurations are considered, and a parametric study of link design parameters and their effects on performance characteristics is presented.

  10. Key design requirements for long-reach manipulators

    International Nuclear Information System (INIS)

    Kwon, D.S.; March-Leuba, S.; Babcock, S.M.; Hamel, W.R.

    1993-09-01

    Long-reach manipulators differ from industrial robots and teleoperators typically used in the nuclear industry in that the aspect ratio (length to diameter) of links is much greater and link flexibility, as well as joint or drive train flexibility, is likely to be significant. Long-reach manipulators will be required for a variety of applications in the Environmental Restoration and Waste Management Program. While each application will present specific functional kinematic, and performance requirements an approach for determining the kinematic applicability and performance characteristics is presented, with a focus on waste storage tank remediation. Requirements are identified, kinematic configurations are considered, and a parametric study of link design parameters and their effects on performance characteristics is presented

  11. Key Design Requirements for Long-Reach Manipulators

    International Nuclear Information System (INIS)

    Kwon, D.S.

    2001-01-01

    Long-reach manipulators differ from industrial robots and teleoperators typically used in the nuclear industry in that the aspect ratio (length to diameter) of links is much greater and link flexibility, as well as joint or drive train flexibility, is likely to be significant. Long-reach manipulators will be required for a variety of applications in the Environmental Restoration and Waste Management Program. While each application will present specific functional, kinematic, and performance requirements, an approach for determining the kinematic applicability and performance characteristics is presented, with a focus on waste storage tank remediation. Requirements are identified, kinematic configurations are considered, and a parametric study of link design parameters and their effects on performance characteristics is presented

  12. Eroding students' rural motivation: first do no harm?

    Science.gov (United States)

    Hurst, Samia

    2014-01-01

    Migration of health professionals is one of the drivers of vast inequalities in access to healthcare, as medical graduates tend to move away from both poorer countries and rural areas. One of the central ethical problems raised in attempting to alleviate these inequalities is the tension between the healthcare needs of under-served patients and the rights of medical graduates to choose their place of work and specialty. If medical graduates had greater motivation to work in under-served rural areas, this tension would decrease accordingly. Medical schools have a duty to avoid eroding existing motivation for such training and practice. This duty has practical implications. Medical students' motivation regarding their choice of specialty changes during medical training, turning them away from choices such as primary care and rural practice towards more highly specialised, more hospital based specialties. Although students may be victims of a number of biases in the initial assessment, this is unlikely to be the whole story. Students' priorities are likely to change based on their admiration for specialist role models and the visibility of the financial and non-financial rewards attached to these specialties. Students may also have a false expectation upon admission that they will be proficient in rural medicine on graduation, and change their mind once they realise the limits of their skills in that area. Although the measures required to reverse this effect currently lack a solid evidence base, they are plausible and supported by the available data.

  13. Preparing for change: the plan, the promise, and the parachute.

    Science.gov (United States)

    Nation, Cathryn L; Gerstenberger, Andrea; Bullard, Dena

    2007-12-01

    The University of California's (UC's) medical education programs are on the brink of change. In January 2007, the UC system completed a multiyear health sciences planning effort that is the most comprehensive undertaken in decades. For medical student education, the plan calls for an approximately one-third increase in enrollment across the system -- from approximately 650 current medical school graduates per year to a projected 920 graduates annually by the year 2020. During the same period, California's population is expected to increase in size and diversity in ways unmatched by any other state in the nation. The plan calls for development of new programs that will increase enrollment in unique and unprecedented ways. The first phase of this growth is under way and is planned to continue through a series of programs that seek to address the needs of California's medically underserved communities. Areas of focus include rural health and telemedicine (Davis); the Spanish-speaking Latino community (Irvine); diverse, disadvantaged communities (Los Angeles); health disparities and health equity (San Diego); and the urban underserved (San Francisco and Berkeley). In November 2006, UC medical schools received $200 million in bond funding to support this growth and to create new telemedicine programs to increase access to services provided by faculty physicians. In the coming years, UC medical schools will face demographic and budgetary challenges that will require perseverance, creativity, and certain leaps of faith. Public expectations are high.

  14. Dynamic channel adjustments in the Jingjiang Reach of the Middle Yangtze River

    Science.gov (United States)

    Xia, Junqiang; Deng, Shanshan; Lu, Jinyou; Xu, Quanxi; Zong, Quanli; Tan, Guangming

    2016-03-01

    Significant channel adjustments have occurred in the Jingjiang Reach of the Middle Yangtze River, because of the operation of the Three Gorges Project (TGP). The Jingjiang Reach is selected as the study area, covering the Upper Jingjiang Reach (UJR) and Lower Jingjiang Reach (LJR). The reach-scale bankfull channel dimensions in the study reach were calculated annually from 2002 to 2013 by means of a reach-averaged approach and surveyed post-flood profiles at 171 sections. We find from the calculated results that: the reach-scale bankfull widths changed slightly in the UJR and LJR, with the corresponding depths increasing by 1.6 m and 1.0 m the channel adjustments occurred mainly with respect to bankfull depth because of the construction of large-scale bank revetment works, although there were significant bank erosion processes in local regions without the bank protection engineering. The reach-scale bankfull dimensions in the UJR and LJR generally responded to the previous five-year average fluvial erosion intensity during flood seasons, with higher correlations being obtained for the depth and cross-sectional area. It is concluded that these dynamic adjustments of the channel geometry are a direct result of recent human activities such as the TGP operation.

  15. Medical Informatics Idle YouTube Potential.

    Science.gov (United States)

    Hucíková, Anežka; Babic, Ankica

    2017-01-01

    YouTube as an online video-sharing service in the context of Web 2.0 goes beyond the bounds of pure fun, for which the platform was primarily established. Nowadays, commonly to other social media, it serves also educational, informational and last but not least, marketing purposes. The importance of video sharing is supported by several predictions about video reaching over 90% of global internet traffic by 2020. Using qualitative content analysis over selected YouTube videos, paper examines the current situation of the platform's marketing potential usage by medical informatics organizations, researches and other healthcare professionals. Results of the analysis demonstrate several ways in which YouTube is already used to inform, educate or promote above-mentioned medical institutions. However, their engagement in self-promo or spreading awareness of their research projects via YouTube is considered to be low.

  16. Differential Recruitment of Parietal Cortex during Spatial and Non-spatial Reach Planning

    Directory of Open Access Journals (Sweden)

    Pierre-Michel Bernier

    2017-05-01

    Full Text Available The planning of goal-directed arm reaching movements is associated with activity in the dorsal parieto-frontal cortex, within which multiple regions subserve the integration of arm- and target-related sensory signals to encode a motor goal. Surprisingly, many of these regions show sustained activity during reach preparation even when target location is not specified, i.e., when a motor goal cannot be unambiguously formed. The functional role of these non-spatial preparatory signals remains unresolved. Here this process was investigated in humans by comparing reach preparatory activity in the presence or absence of information regarding upcoming target location. In order to isolate the processes specific to reaching and to control for visuospatial attentional factors, the reaching task was contrasted to a finger movement task. Functional MRI and electroencephalography (EEG were used to characterize the spatio-temporal pattern of reach-related activity in the parieto-frontal cortex. Reach planning with advance knowledge of target location induced robust blood oxygenated level dependent and EEG responses across parietal and premotor regions contralateral to the reaching arm. In contrast, reach preparation without knowledge of target location was associated with a significant BOLD response bilaterally in the parietal cortex. Furthermore, EEG alpha- and beta-band activity was restricted to parietal scalp sites, the magnitude of the latter being correlated with reach reaction times. These results suggest an intermediate stage of sensorimotor transformations in bilateral parietal cortex when target location is not specified.

  17. Efficacy of REACH Forgiveness across cultures.

    Science.gov (United States)

    Lin, Yin; Worthington, Everett L; Griffin, Brandon J; Greer, Chelsea L; Opare-Henaku, Annabella; Lavelock, Caroline R; Hook, Joshua N; Ho, Man Yee; Muller, Holly

    2014-09-01

    This study investigates the efficacy of the 6-hour REACH Forgiveness intervention among culturally diverse undergraduates. Female undergraduates (N = 102) and foreign extraction (46.2%) and domestic (43.8%) students in the United States were randomly assigned to immediate treatment or waitlist conditions. Treatment efficacy and the effect of culture on treatment response were assessed using measures of emotional and decisional forgiveness across 3 time periods. Students in the treatment condition reported greater improvement in emotional forgiveness, but not decisional forgiveness, relative to those in the waitlist condition. Gains were maintained at a 1-week follow-up. Although culture did not moderate the effect of treatment, a main effect of culture on emotional forgiveness and marginally significant interaction effect of culture on decisional forgiveness were found. The REACH Forgiveness intervention was efficacious for college students from different cultural backgrounds when conducted in the United States. However, some evidence may warrant development of culturally adapted forgiveness interventions. © 2014 Wiley Periodicals, Inc.

  18. Development of a community-based participatory colorectal cancer screening intervention to address disparities, Arkansas, 2008-2009.

    Science.gov (United States)

    Yeary, Karen; Flowers, Eric; Ford, Gemessia; Burroughs, Desiree; Burton, Jackie; Woods, Delores; Stewart, Chara; Mehta, Paulette; Greene, Paul; Henry-Tillman, Ronda

    2011-03-01

    The death rate from colorectal cancer is high and affects poor and medically underserved populations disproportionately. In the United States, health disparities are particularly acute in the Lower Mississippi River Delta region. Because many in the region have limited access to basic health care resources, they are not screened for cancer, even though screening is one of the most effective strategies to prevent colorectal cancer. Community-based participatory research is a promising approach to prevent colorectal cancer in this population. The Empowering Communities for Life program was implemented in 2 underserved counties in the Arkansas Lower Mississippi River Delta. The program arose from a 9-year partnership between the University of Arkansas for Medical Sciences and 9 cancer councils across Arkansas. Empowering Communities for Life is a community-based participatory intervention designed to increase colorectal cancer screening in rural, underserved communities through fecal occult blood testing. Community and academic partners collaborated to develop research infrastructure, intervention materials and methods, and the assessment instrument. Project outcomes were strengthened community-academic partnerships, certification of community partners in conducting human subjects research, development of a randomized controlled design to test the intervention's efficacy, an interactive PowerPoint presentation, an informational pamphlet, the certification of 6 lay health advisors and 22 role models to provide the intervention, and an assessment tool using an audience response system. Lessons learned in working collaboratively with diverse groups include the importance of meeting face to face and listening.

  19. Pharmaceutical direct-to-consumer advertising and US Hispanic patient-consumers.

    Science.gov (United States)

    Barker, Kristin K; Vasquez Guzman, Cirila Estela

    2015-11-01

    Hispanic Americans use prescription medications at markedly lower rates than do non-Hispanic whites. At the same time, Hispanics are the largest racial-ethnic minority in the USA. In a recent effort to reach this underdeveloped market, the pharmaceutical industry has begun to create Spanish-language direct-to-consumer advertising (DTCA) campaigns. The substantive content of these campaigns is being tailored to appeal to the purported cultural values, beliefs and identities of Latino consumers. We compare English-language and Spanish-language television commercials for two prescription medications. We highlight the importance of selling medicine to a medically under-served population as a key marketing element of Latino-targeted DTCA. We define selling medicine as the pharmaceutical industry's explicit promotion of medicine's cultural authority as a means of expanding its markets and profits. We reflect on the prospects of this development in terms of promoting medicalisation in a US subgroup that has heretofore eluded the pharmaceutical industry's marketing influence. Our analysis draws on Nikolas Rose's insights concerning variations in the degree to which certain groups of people are more medically made up than others, by reflecting on the racial and ethnic character of medicalisation in the USA and the role DTCA plays in shaping medicalisation trends. A video abstract of this article can be found at: https://www.youtube.com/watch?v=ZabCle9-jHw&feature=youtu.be. © 2015 Foundation for the Sociology of Health & Illness.

  20. Association of medication errors with drug classifications, clinical units, and consequence of errors: Are they related?

    Science.gov (United States)

    Muroi, Maki; Shen, Jay J; Angosta, Alona

    2017-02-01

    Registered nurses (RNs) play an important role in safe medication administration and patient safety. This study examined a total of 1276 medication error (ME) incident reports made by RNs in hospital inpatient settings in the southwestern region of the United States. The most common drug class associated with MEs was cardiovascular drugs (24.7%). Among this class, anticoagulants had the most errors (11.3%). The antimicrobials was the second most common drug class associated with errors (19.1%) and vancomycin was the most common antimicrobial that caused errors in this category (6.1%). MEs occurred more frequently in the medical-surgical and intensive care units than any other hospital units. Ten percent of MEs reached the patients with harm and 11% reached the patients with increased monitoring. Understanding the contributing factors related to MEs, addressing and eliminating risk of errors across hospital units, and providing education and resources for nurses may help reduce MEs. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. BROOKHAVEN: Proton goal reached

    International Nuclear Information System (INIS)

    Anon.

    1995-01-01

    On March 30 the 35-year old Alternating Gradient Synchrotron (AGS) exceeded its updated design goal of 6 x 10 13 protons per pulse (ppp), by accelerating 6.3 x 10 13 ppp, a world record intensity. This goal was set 11 years ago and achieving it called for the construction of a new booster and the reconstruction of much of the AGS. The booster was completed in 1991, and reached its design intensity of 1.5 x 10 13 ppp in 1993. The AGS reconstruction was finished in 1994, and by July of that year the AGS claimed a new US record intensity for a proton synchrotron of 4 x 10 13 ppp, using four booster pulses. Reaching the design intensity was scheduled for 1995. In 1994, the AGS had seemed to be solidly limited to 4 x 10 13 ppp, but in 1995 the operations crew, working on their own in the quiet of the owl shift, steadily improved the intensity, regularly setting new records, much to the bemusement of the machine physicists. The physicists, however, did contribute. A second harmonic radiofrequency cavity in the booster increased the radiofrequency bucket area for capture, raising the booster intensity from 1.7 to 2.1 x 10 13 ppp. In the AGS, new radiofrequency power supplies raised the available voltage from 8 to 13 kV, greatly enhancing the beam loading capabilities of the system. A powerful new transverse damping system successfully controlled instabilities that otherwise would have destroyed the beam in less than a millisecond. Also in the AGS, 35th harmonic octupole resonances were found

  2. BROOKHAVEN: Proton goal reached

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1995-09-15

    On March 30 the 35-year old Alternating Gradient Synchrotron (AGS) exceeded its updated design goal of 6 x 10{sup 13} protons per pulse (ppp), by accelerating 6.3 x 10{sup 13} ppp, a world record intensity. This goal was set 11 years ago and achieving it called for the construction of a new booster and the reconstruction of much of the AGS. The booster was completed in 1991, and reached its design intensity of 1.5 x 10{sup 13} ppp in 1993. The AGS reconstruction was finished in 1994, and by July of that year the AGS claimed a new US record intensity for a proton synchrotron of 4 x 10{sup 13} ppp, using four booster pulses. Reaching the design intensity was scheduled for 1995. In 1994, the AGS had seemed to be solidly limited to 4 x 10{sup 13} ppp, but in 1995 the operations crew, working on their own in the quiet of the owl shift, steadily improved the intensity, regularly setting new records, much to the bemusement of the machine physicists. The physicists, however, did contribute. A second harmonic radiofrequency cavity in the booster increased the radiofrequency bucket area for capture, raising the booster intensity from 1.7 to 2.1 x 10{sup 13} ppp. In the AGS, new radiofrequency power supplies raised the available voltage from 8 to 13 kV, greatly enhancing the beam loading capabilities of the system. A powerful new transverse damping system successfully controlled instabilities that otherwise would have destroyed the beam in less than a millisecond. Also in the AGS, 35th harmonic octupole resonances were found.

  3. The Effect of Medical Student Volunteering in a Student-Run Clinic on Specialty Choice for Residency.

    Science.gov (United States)

    Brown, Ashley; Ismail, Rahim; Gookin, Glenn; Hernandez, Caridad; Logan, Grace; Pasarica, Magdalena

    2017-01-09

     Student-run free clinics (SRFCs) are a recent popular addition to medical school education, and a subset of studies has looked at the influence of SRFC volunteering on the medical student's career development. The majority of the research done in this area has focused on understanding if these SRFCs produce physicians who are more likely to practice medicine in underserved communities, caring for the uninsured. The remainder of the research has investigated if volunteering in an SRFC influences the specialty choice of medical school students. The results of these specialty choice studies give no definitive answer as to whether medical students chose primary or specialty care residencies as a result of their SRFC experience. Keeping Neighbors in Good Health through Service (KNIGHTS) is the SRFC of the University of Central Florida College of Medicine (UCF COM). Both primary and specialty care is offered at the clinic. It is the goal of this study to determine if volunteering in the KNIGHTS SRFC influences UCF COM medical students to choose primary care, thereby helping to meet the rising need for primary care physicians in the United States.  A survey was distributed to first, second, and third-year medical students at the UCF COM to collect data on demographics, prior volunteering experience, and specialty choice for residency. Responses were then combined with records of volunteer hours from the KNIGHTS Clinic and analyzed for correlations. We analyzed the frequency and Pearson's chi-squared values. A p value of less than 0.05 was considered statistically significant.  Our survey had a total response rate of 39.8%. We found that neither the act of becoming a KNIGHTS Clinic volunteer nor the hours volunteered at the KNIGHTS Clinic influenced the UCF COM student's choice to enter a primary care specialty (p = NS). Additionally, prior volunteering/clinical experience or the gender of the medical school student did not influence a student's choice to volunteer at

  4. Channel morphodynamics in four reaches of the Lower Missouri River, 2006-07

    Science.gov (United States)

    Elliott, Caroline M.; Reuter, Joanna M.; Jacobson, Robert B.

    2009-01-01

    Channel morphodynamics in response to flow modifications from Gavins Point Dam are examined in four reaches of the Lower Missouri River. Measures include changes in channel morphology and indicators of sediment transport in four 6 kilometer long reaches located downstream from Gavins Point Dam, near Yankton, South Dakota, Kenslers Bend, Nebraska, Little Sioux, Iowa, and Miami, Missouri. Each of the four reaches was divided into 300 transects with a 20-meter spacing and surveyed during the summer in 2006 and 2007. A subset of 30 transects was randomly selected and surveyed 7-10 times in 2006-07 over a wide range of discharges including managed and natural flow events. Hydroacoustic mapping used a survey-grade echosounder and a Real Time Kinematic Global Positioning System to evaluate channel change. Acoustic Doppler current profiler measurements were used to evaluate bed-sediment velocity. Results indicate varying amounts of deposition, erosion, net change, and sediment transport in the four Lower Missouri River reaches. The Yankton reach was the most stable over monthly and annual time-frames. The Kenslers Bend and Little Sioux reaches exhibited substantial amounts of deposition and erosion, although net change was generally low in both reaches. Total, or gross geomorphic change was greatest in the Kenslers Bend reach. The Miami reach exhibited varying rates of deposition and erosion, and low net change. The Yankton, Kenslers Bend, and Miami reaches experienced net erosion during the time period that bracketed the managed May 2006 spring rise event from Gavins Point Dam.

  5. The introduction of medical humanities in the undergraduate curriculum of Greek medical schools: challenge and necessity.

    Science.gov (United States)

    Batistatou, A; Doulis, E A; Tiniakos, D; Anogiannaki, A; Charalabopoulos, K

    2010-10-01

    Medical humanities is a multidisciplinary field, consisting of humanities (theory of literature and arts, philosophy, ethics, history and theology), social sciences (anthropology, psychology and sociology) and arts (literature, theater, cinema, music and visual arts), integrated in the undergraduate curriculum of Medical schools. The aim of the present study is to discuss medical humanities and support the necessity of introduction of a medical humanities course in the curriculum of Greek medical schools. Through the relevant Pub-Med search as well as taking into account various curricula of medical schools, it is evident that medical education today is characterized by acquisition of knowledge and skills and development of medical values and attitudes. Clinical observation with the recognition of key data and patterns in the collected information, is crucial in the final medical decision, i.e. in the complex process, through which doctors accumulate data, reach conclusions and decide on therapy. All sciences included in medical humanities are important for the high quality education of future doctors. The practice of Medicine is in large an image-related science. The history of anatomy and art are closely related, already from the Renaissance time. Studies have shown that attendance of courses on art critics improves the observational skills of medical students. Literature is the source of information about the nature and source of human emotions and behavior and of narratives of illness, and increases imagination. Philosophy aids in the development of analytical and synthetical thinking. Teaching of history of medicine develops humility and aids in avoiding the repetition of mistakes of the past, and quite often raises research and therapeutic skepticism. The comprehension of medical ethics and professional deontology guides the patient-doctor relationship, as well as the relations between physicians and their colleagues. The Medical Humanities course, which is

  6. Access to healthcare for disabled persons. How are blind people reached by HIV services?

    Science.gov (United States)

    Saulo, Bryson; Walakira, Eddy; Darj, Elisabeth

    2012-03-01

    Disabled people are overlooked and marginalised globally. There is a lack of information on blind people and HIV-related services and it is unclear how HIV-services target blind people in a sub-Saharan urban setting. To explore how blind people are reached by HIV-services in Kampala, Uganda. A purposeful sample of blind people and seeing healthcare workers were interviewed, and data on their opinions and experiences were collected. The data were analysed by qualitative content analysis, with a focus on manifest content. Three categories emerged from the study, reaching for HIV information and knowledge, lack of services, and experiences of discrimination. General knowledge on HIV prevention/transmission methods was good; however, there was scepticism about condom use. Blind people mainly relied on others for accessing HIV information, and a lack of special services for blind people to be able to test for HIV was expressed. The health service for blind people was considered inadequate, unequal and discriminatory, and harassment by healthcare staff was expressed, but not sexual abuse. Concerns about disclosure of personal medical information were revealed. Access to HIV services and other healthcare related services for blind people is limited and the objectives of the National Strategic Plan for HIV/AIDS 2007-2012 have not been achieved. There is a need for alternative methods for sensitisation and voluntary counselling and testing (VCT) for blind people. Copyright © 2011 Elsevier B.V. All rights reserved.

  7. Whisker and Nose Tactile Sense Guide Rat Behavior in a Skilled Reaching Task

    Directory of Open Access Journals (Sweden)

    Pierantonio Parmiani

    2018-02-01

    Full Text Available Skilled reaching is a complex movement in which a forelimb is extended to grasp food for eating. Video-recordings analysis of control rats enables us to distinguish several components of skilled reaching: Orient, approaching the front wall of the reaching box and poking the nose into the slot to locate the food pellet; Transport, advancing the forelimb through the slot to reach-grasp the pellet; and Withdrawal of the grasped food to eat. Although food location and skilled reaching is guided by olfaction, the importance of whisker/nose tactile sense in rats suggests that this too could play a role in reaching behavior. To test this hypothesis, we studied skilled reaching in rats trained in a single-pellet reaching task before and after bilateral whisker trimming and bilateral infraorbital nerve (ION severing. During the task, bilaterally trimmed rats showed impaired Orient with respect to controls. Specifically, they detected the presence of the wall by hitting it with their nose (rather than their whiskers, and then located the slot through repetitive nose touches. The number of nose touches preceding poking was significantly higher in comparison to controls. On the other hand, macrovibrissae trimming resulted in no change in reaching/grasping or withdrawal components of skilled reaching. Bilaterally ION-severed rats, displayed a marked change in the structure of their skilled reaching. With respect to controls, in ION-severed rats: (a approaches to the front wall were significantly reduced at 3–5 and 6–8 days; (b nose pokes were significantly reduced at 3–5 days, and the slot was only located after many repetitive nose touches; (c the reaching-grasping-retracting movement never appeared at 3–5 days; (d explorative paw movements, equal to zero in controls, reached significance at 9–11 days; and (e the restored reaching-grasping-retracting sequence was globally slower than in controls, but the success rate was the same. These findings

  8. How infants' reaches reveal principles of sensorimotor decision making

    Science.gov (United States)

    Dineva, Evelina; Schöner, Gregor

    2018-01-01

    In Piaget's classical A-not-B-task, infants repeatedly make a sensorimotor decision to reach to one of two cued targets. Perseverative errors are induced by switching the cue from A to B, while spontaneous errors are unsolicited reaches to B when only A is cued. We argue that theoretical accounts of sensorimotor decision-making fail to address how motor decisions leave a memory trace that may impact future sensorimotor decisions. Instead, in extant neural models, perseveration is caused solely by the history of stimulation. We present a neural dynamic model of sensorimotor decision-making within the framework of Dynamic Field Theory, in which a dynamic instability amplifies fluctuations in neural activation into macroscopic, stable neural activation states that leave memory traces. The model predicts perseveration, but also a tendency to repeat spontaneous errors. To test the account, we pool data from several A-not-B experiments. A conditional probabilities analysis accounts quantitatively how motor decisions depend on the history of reaching. The results provide evidence for the interdependence among subsequent reaching decisions that is explained by the model, showing that by amplifying small differences in activation and affecting learning, decisions have consequences beyond the individual behavioural act.

  9. Amplified Erosion above Waterfalls and Oversteepened Bedrock Reaches

    Science.gov (United States)

    Haviv, I.; Enzel, Y.; Whipple, K. X.; Zilberman, E.; Stone, J.; Matmon, A.; Fifield, K. L.

    2005-12-01

    Although waterfalls are abundant along steep bedrock channels, none of the conventional erosion laws can predict incision at the lip of a waterfall where flow is non-uniform and bed slope can be vertical. Considering the expected increase in flow velocity and shear stress at the lip of a vertical waterfall we determine erosion amplification at a waterfall lip as: Elip/Enormal= (1+0.4/Fr2)3n, where Fr is the Froude number and n ranges between 0.5-1.7. This amplification expression suggests that erosion at the lip could be as much as 2-5 times higher than normally expected in a setting with identical hydraulic geometry. It also demonstrates that a freefall is expected to amplify upstream incision rates even when the flow approaching the waterfall is highly supercritical. Utilizing this erosion amplification expression in numerical simulations in conjunction with a standard detachment-limited incision model we demonstrate its impact on reach-scale morphology above waterfalls. These simulations indicate that amplified erosion at the lip of a waterfall can trigger the formation of an oversteepened reach whose length is longer than the flow acceleration zone, provided incision velocity (Vi) at the edge of the flow acceleration zone is higher than the retreat velocity of the waterfall face. Such an oversteepened reach is expected to be more pronounced when Vi increases with increasing slope. The simulations also suggest that oversteepening can eventually lead to quasi steady-state gradients upstream from a waterfall provided Vi decreases with increasing slope. Flow acceleration above waterfalls can thus account, at least partially, for oversteepened bedrock reaches that are prevalent above waterfalls. Such reaches have been reported for the escarpments of southeast Australia, western Dead Sea, and at Niagara Falls. Using the cosmogenic isotope 36Cl we demonstrate that Vi upstream of a waterfall at the Dead Sea western escarpment is high enough for freefall

  10. Adaptation of reach-to-grasp movement in response to force perturbations.

    Science.gov (United States)

    Rand, M K; Shimansky, Y; Stelmach, G E; Bloedel, J R

    2004-01-01

    This study examined how reach-to-grasp movements are modified during adaptation to external force perturbations applied on the arm during reach. Specifically, we examined whether the organization of these movements was dependent upon the condition under which the perturbation was applied. In response to an auditory signal, all subjects were asked to reach for a vertical dowel, grasp it between the index finger and thumb, and lift it a short distance off the table. The subjects were instructed to do the task as fast as possible. The perturbation was an elastic load acting on the wrist at an angle of 105 deg lateral to the reaching direction. The condition was modified by changing the predictability with which the perturbation was applied in a given trial. After recording unperturbed control trials, perturbations were applied first on successive trials (predictable perturbations) and then were applied randomly (unpredictable perturbations). In the early predictable perturbation trials, reach path length became longer and reaching duration increased. As more predictable perturbations were applied, the reach path length gradually decreased and became similar to that of control trials. Reaching duration also decreased gradually as the subjects adapted by exerting force against the perturbation. In addition, the amplitude of peak grip aperture during arm transport initially increased in response to repeated perturbations. During the course of learning, it reached its maximum and thereafter slightly decreased. However, it did not return to the normal level. The subjects also adapted to the unpredictable perturbations through changes in both arm transport and grasping components, indicating that they can compensate even when the occurrence of the perturbation cannot be predicted during the inter-trial interval. Throughout random perturbation trials, large grip aperture values were observed, suggesting that a conservative aperture level is set regardless of whether the

  11. Reaching the Overlooked Student in Physical Education

    Science.gov (United States)

    Esslinger, Keri; Esslinger, Travis; Bagshaw, Jarad

    2015-01-01

    This article describes the use of live action role-playing, or "LARPing," as a non-traditional activity that has the potential to reach students who are not interested in traditional physical education.

  12. Medication Adherence Improvements in Employees Participating in a Pharmacist-Run Risk Reduction Program

    Directory of Open Access Journals (Sweden)

    Mallory C. McKenzie

    2012-01-01

    Full Text Available Objective: To evaluate the medication adherence of individuals participating in a pharmacist-run employee health Cardiovascular and Diabetes Risk Reduction Program. Design: Retrospective analysis of medication adherence using pharmacy refill data. Setting: A medium sized university located in the Midwest United States and the organization's outpatient pharmacy. Participants: 38 participants ≥ 18 years of age, employed and receiving their health insurance through the organization, and have a diagnosis of hypertension, hyperlipidemia, diabetes mellitus, or a combination thereof. Intervention: Participation in the risk reduction program that emphasizes medication therapy management (MTM, lifestyle medicine and care coordination. Main Outcome Measures: The Proportion of Days Covered (PDC and the Medication Possession Ratio (MPR. Results: PDC and MPR analysis showed a statistically significant improvement in medication adherence for 180 days and 360 days post enrollment versus the 180 days prior to enrollment (P<0.01. The PDC analysis demonstrated a statistically significant improvement in the number of medications that achieved a PDC ≥ 80% (high adherence for the 180 days post enrollment versus the 180 days prior to enrollment (+30%, P<0.01. The MPR analysis showed a non-statistically significant improvement in the number of medications that achieved an MPR ≥ 80% (high adherence pre enrollment versus post enrollment (+10%, P=0.086. The percentage of participants in the program that reached a PDC and MPR adherence rate ≥ 80% at 180 days post enrollment was 78.9% and 94.4%, respectively which exceeds that of a matched cohort that reached a PDC and MPR adherence rate ≥ 80% of 66.4% and 82.8%, respectively. Conclusion: Pharmacists can improve medication adherence as measured by PDC and MPR when working with employees enrolled in a novel pharmacist-run employee health risk reduction program. Medication adherence was shown to be sustainable for

  13. Adaptive upstream rate adjustment by RSOA-ONU depending on different injection power of seeding light in standard-reach and long-reach PON systems

    Science.gov (United States)

    Yeh, C. H.; Chow, C. W.; Shih, F. Y.; Pan, C. L.

    2012-08-01

    The wavelength division multiplexing-time division multiplexing (WDM-TDM) passive optical network (PON) using reflective semiconductor optical amplifier (RSOA)-based colorless optical networking units (ONUs) is considered as a promising candidate for the realization of fiber-to-the-home (FTTH). And this architecture is actively considered by Industrial Technology Research Institute (ITRI) for the realization of FTTH in Taiwan. However, different fiber distances and optical components would introduce different power budgets to different ONUs in the PON. Besides, due to the aging of optical transmitter (Tx), the power decay of the distributed optical carrier from the central office (CO) could also reduce the injection power into each ONU. The situation will be more severe in the long-reach (LR) PON, which is considered as an option for the future access. In this work, we investigate a WDM-TDM PON using RSOA-based ONU for upstream data rate adjustment depending on different continuous wave (CW) injection powers. Both standard-reach (25 km) and LR (100 km) transmissions are evaluated. Moreover, a detail analysis of the upstream signal bit-error rate (BER) performances at different injection powers, upstream data rates, PON split-ratios under stand-reach and long-reach is presented.

  14. Self-reported Medication Adherence and CKD Progression

    Directory of Open Access Journals (Sweden)

    Esteban A. Cedillo-Couvert

    2018-05-01

    Full Text Available Introduction: In the general population, medication nonadherence contributes to poorer outcomes. However, little is known about medication adherence among adults with chronic kidney disease (CKD. We evaluated the association of self-reported medication adherence with CKD progression and all-cause death in patients with CKD. Methods: In this prospective observational study of 3305 adults with mild-to-moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC Study, the baseline self-reported medication adherence was assessed by responses to 3 questions and categorized as high, medium, and low. CKD progression (50% decline in eGFR or incident end-stage renal disease and all-cause death were measured using multivariable Cox proportional hazards. Results: Of the patients, 68% were categorized as high adherence, 17% medium adherence, and 15% low adherence. Over a median follow-up of 6 years, there were 969 CKD progression events and 675 deaths. Compared with the high-adherence group, the low-adherence group experienced increased risk for CKD progression (hazard ratio = 1.27, 95% confidence interval = 1.05, 1.54 after adjustment for sociodemographic and clinical factors, cardiovascular medications, number of medication types, and depressive symptoms. A similar association existed between low adherence and all-cause death, but did not reach standard statistical significance (hazard ratio = 1.14 95% confidence interval = 0.88, 1.47. Conclusion: Baseline self-reported low medication adherence was associated with an increased risk for CKD progression. Future work is needed to better understand the mechanisms underlying this association and to develop interventions to improve adherence. Keywords: CKD, death, medication adherence, progression

  15. Expanding your gay and lesbian patient base: what savvy medical practices know.

    Science.gov (United States)

    Kahn, Ellen; Sullivan, Tom

    2008-01-01

    Many medical practices are looking at options to reach out to the gay, lesbian, bisexual, and transgender community as a means of expanding business and improving quality of care. This article sets out steps that any practice can take to market to this community and improve its cultural competence.

  16. Olefins and chemical regulation in Europe: REACH.

    Science.gov (United States)

    Penman, Mike; Banton, Marcy; Erler, Steffen; Moore, Nigel; Semmler, Klaus

    2015-11-05

    REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) is the European Union's chemical regulation for the management of risk to human health and the environment (European Chemicals Agency, 2006). This regulation entered into force in June 2007 and required manufacturers and importers to register substances produced in annual quantities of 1000 tonnes or more by December 2010, with further deadlines for lower tonnages in 2013 and 2018. Depending on the type of registration, required information included the substance's identification, the hazards of the substance, the potential exposure arising from the manufacture or import, the identified uses of the substance, and the operational conditions and risk management measures applied or recommended to downstream users. Among the content developed to support this information were Derived No-Effect Levels or Derived Minimal Effect Levels (DNELs/DMELs) for human health hazard assessment, Predicted No Effect Concentrations (PNECs) for environmental hazard assessment, and exposure scenarios for exposure and risk assessment. Once registered, substances may undergo evaluation by the European Chemicals Agency (ECHA) or Member State authorities and be subject to requests for additional information or testing as well as additional risk reduction measures. To manage the REACH registration and related activities for the European olefins and aromatics industry, the Lower Olefins and Aromatics REACH Consortium was formed in 2008 with administrative and technical support provided by Penman Consulting. A total of 135 substances are managed by this group including 26 individual chemical registrations (e.g. benzene, 1,3-butadiene) and 13 categories consisting of 5-26 substances. This presentation will describe the content of selected registrations prepared for 2010 in addition to the significant post-2010 activities. Beyond REACH, content of the registrations may also be relevant to other European activities, for

  17. Proximal and distal adjustments of reaching behavior in preterm infants.

    Science.gov (United States)

    de Toledo, Aline Martins; Soares, Daniele de Almeida; Tudella, Eloisa

    2011-01-01

    The authors aimed to investigate proximal and distal adjustments of reaching behavior and grasping in 5-, 6-, and 7-month-old preterm infants. Nine low-risk preterm and 10 full-term infants participated. Both groups showed the predominance of unimanual reaching, an age-related increase in the frequency of vertical-oriented and open hand movement, and also an increase in successful grasping from 6 to 7 months. The frequency of open hand was higher in the preterm group at 6 months. Intrinsic restrictions imposed by prematurity did not seem to have impaired reaching performance of preterm infants throughout the months of age.

  18. [Medicine in the digital age : Telemedicine in medical school education].

    Science.gov (United States)

    Kuhn, S; Jungmann, F

    2018-03-01

    The increasing digitization of our lives and work has also reached medicine and is changing the profession of medical doctors. The modern forms of communication and cooperation in everyday medical practice demand new skills and qualifications. To enable future doctors to comply with this digitally competent profile, an innovative blended learning curriculum was developed and first implemented at the University Medical Center Mainz in summer semester 2017-Medicine in the Digital Age. The teaching concept encompasses five modules, each consisting of an e‑learning unit and a 3-hour classroom course. This publication presents the teaching concept, the initial implementation and evaluation of the module "Telemedicine". The competency development in the field of telemedicine showed a significant increase for the subcomponents "knowledge" and "skills". The neutral attitude towards telemedicine at the beginning of the module could be changed to a positive opinion after the session. The teaching of digital skills is a relevant component of future curriculum development in medical studies and also a challenge for continuing medical education.

  19. Increase in antidepressant medication in the US adult population between 1990 and 2003.

    Science.gov (United States)

    Mojtabai, Ramin

    2008-01-01

    The rate of antidepressant treatment in the US has significantly increased in the past decade. There are, however, concerns about undertreatment among traditionally underserved groups and overtreatment in less severely ill individuals. This study examines trends in the prevalence of antidepressant drug treatment in two US general population surveys. The prevalence of antidepressant treatment within a 12-month period was compared in the US National Comorbidity Survey (1990-1992) and the National Comorbidity Survey-Replication (2001-2003). Variations in trends across groups were examined using bivariate and multivariate logistic regression models. The rate of antidepressant drug treatment increased more than four times between early 1990s and early 2000s. The trend was similar across sociodemographic groups. Younger adults, men and racial/ethnic minorities continued to receive antidepressant treatment at a lower rate compared to middle-aged adults, women and non-Hispanic whites, respectively. The rate of antidepressant treatment increased more in the group of less severely ill individuals than in those with more severe psychopathology. Sociodemographic disparities in antidepressant treatment persisted over the last decade in the US, lending support to concerns about undertreatment among traditionally underserved groups, whereas the greater increase in the rate of antidepressant treatment in the less severely ill group lends support to concerns about antidepressant overtreatment in this population.

  20. Does workplace health promotion reach shift workers?

    DEFF Research Database (Denmark)

    Nabe-Nielsen, Kirsten; Garde, Anne Helene; Clausen, Thomas

    2015-01-01

    OBJECTIVES: One reason for health disparities between shift and day workers may be that workplace health promotion does not reach shift workers to the same extent as it reaches day workers. This study aimed to investigate the association between shift work and the availability of and participation...... in workplace health promotion. METHODS: We used cross-sectional questionnaire data from a large representative sample of all employed people in Denmark. We obtained information on the availability of and participation in six types of workplace health promotion. We also obtained information on working hours, ie......). RESULTS: In the general working population, fixed evening and fixed night workers, and employees working variable shifts including night work reported a higher availability of health promotion, while employees working variable shifts without night work reported a lower availability of health promotion...

  1. [The aims of German medical anthropology in countries of the European Community].

    Science.gov (United States)

    Sterly, J

    1992-07-01

    Medical Anthropology deals with the anthropological conditions of health, illness and health care in different societies and cultures, and has to be distinguished in that respect from Social and Industrial Medicine in German language countries which could be considered a kind of official and governmental medicine. While in North America Medical Anthropology has been established at nearly all universities and medical colleges during the last 25 years, corresponding activities in Germany and most other European countries have not reached university level up to now. After referring to general anthropology during the period of enlightenment and to philosophical and medical anthropology in the first half of our century, both to be considered forerunners of medical anthropology in german-speaking countries, an outline of medical anthropology in German-speaking countries, an outline of medical anthropology in the USA is given followed by a survey of questions and problems with which medical anthropology in German-speaking and other European countries has to cope, and would be confronted after the opening of the EC Market in 1993. The article concludes by briefly going into the circumstance of teaching medical anthropology in the Federal Republic of Germany.

  2. [Sponsorship, conflict of interest and corruption: promoting science in discussion of medical ethics].

    Science.gov (United States)

    Frewer, A

    2002-01-01

    Even in health care systems corruption is an increasing problem. Since the German Anti-Corruption-Law (1997) the areas of financial support, sponsoring and corruption in medicine are analyzed much more intensively. This article sketches the crucial points of the debate on medical funding and shows the consequences of the new jurisdiction. Most important is the balance between a transparent documentation and a too-far-reaching bureaucracy, which hinders medical research. Finally, this article presents core principles as helpful rules in practice.

  3. Telerobotic operation of structurally flexible, long-reach manipulators

    International Nuclear Information System (INIS)

    Kwon, D.S.; Hwang, D.H.; Babcock, S.M.

    1994-01-01

    As a part of the Department of Energy's Environmental Restoration and Waste Management Program, long-reach manipulators are being considered for the retrieval of waste from large storage tanks. Long-reach manipulators may have characteristics significantly different from those of typical industrial robots because of the flexibility of long links needed to cover the large workspace. To avoid structural vibrations during operation, control algorithms employing various types of shaping filters were investigated. A new approach that uses embedded simulation was developed and compared with others. In the new approach, generation of joint trajectories considering link flexibility was also investigated

  4. National awareness campaign to prevent medication-overuse headache in Denmark.

    Science.gov (United States)

    Carlsen, Louise Ninett; Westergaard, Maria Lurenda; Bisgaard, Mette; Schytz, Julie Brogaard; Jensen, Rigmor Højland

    2017-01-01

    Background Medication-overuse headache is prevalent, but in principle preventable. Objective To describe the Danish national awareness campaign for medication-overuse headache. Methods The Danish Headache Center, the Association of Danish Pharmacies, and headache patient organizations implemented a four-month medication-overuse headache awareness campaign in 2016. Target groups were the general public, general practitioners, and pharmacists. Key messages were: Overuse of pain-medication can worsen headaches; pain-medication should be used rationally; and medication-overuse headache is treatable. A range of communication technologies was used. A survey on the public's awareness of medication-overuse headache was conducted. Results The Danish adult population is 4.2 million. Online videos were viewed 297,000 times in three weeks. All 400 pharmacies received campaign materials. Over 28,000 leaflets were distributed. Two radio interviews were conducted. A television broadcast about headache reached an audience of 520,000. Forty articles were published in print media. Information was accessible at 32 reputable websites and five online news agencies. Three scientific papers were published. Information was available at an annual conference of general practitioners, including a headache lecture. The survey showed an increase in percentage of the public who knew about medication-overuse headache (from 31% to 38%). Conclusion A concerted campaign to prevent medication-overuse headache can be implemented through involvement of key stakeholders.

  5. [The perception of ethics from the point of view of medical students].

    Science.gov (United States)

    García-Mangas, José Alberto; García-Vigil, José Luis; Lifshitz, Alberto

    2016-01-01

    The present study was conducted to characterize the ethical environment in which medical students and internal are trained. The aim of this article is to identify the perception of ethics in medical students. The instrument was constructed by pairs: the socially desirable and socially undesirable exploring 10 principles and 24 ethical values. Through rounds of experts the instrument was validated with 35 pairs with 70 statements. The internal consistency of the instrument with the coefficient of determination "r2" reached a "p" value of ethics (RPE). The were statistically significant differences between groups with a "p" value of ethical reflection and changes depending on the degree in training in medical school, with a worse perception in greater degrees.

  6. Compact muon solenoid magnet reaches full field

    CERN Multimedia

    2006-01-01

    Scientist of the U.S. Department of Energy in Fermilab and collaborators of the US/CMS project announced that the world's largest superconducting solenoid magnet has reached full field in tests at CERN. (1 apge)

  7. Reach-to-grasp movement as a minimization process.

    Science.gov (United States)

    Yang, Fang; Feldman, Anatol G

    2010-02-01

    It is known that hand transport and grasping are functionally different but spatially coordinated components of reach-to-grasp (RTG) movements. As an extension of this notion, we suggested that body segments involved in RTG movements are controlled as a coherent ensemble by a global minimization process associated with the necessity for the hand to reach the motor goal. Different RTG components emerge following this process without pre-programming. Specifically, the minimization process may result from the tendency of neuromuscular elements to diminish the spatial gap between the actual arm-hand configuration and its virtual (referent) configuration specified by the brain. The referent configuration is specified depending on the object shape, localization, and orientation. Since the minimization process is gradual, it can be interrupted and resumed following mechanical perturbations, at any phase during RTG movements, including hand closure. To test this prediction of the minimization hypothesis, we asked subjects to reach and grasp a cube placed within the reach of the arm. Vision was prevented during movement until the hand returned to its initial position. As predicted, by arresting wrist motion at different points of hand transport in randomly selected trials, it was possible to halt changes in hand aperture at any phase, not only during hand opening but also during hand closure. Aperture changes resumed soon after the wrist was released. Another test of the minimization hypothesis was made in RTG movements to an object placed beyond the reach of the arm. It has previously been shown (Rossi et al. in J Physiol 538:659-671, 2002) that in such movements, the trunk motion begins to contribute to hand transport only after a critical phase when the shifts in the referent arm configuration have finished (at about the time when hand velocity is maximal). The minimization rule suggests that when the virtual contribution of the arm to hand transport is completed

  8. [Conservative treatment of cervical radiculopathy with 5% lidocaine medicated plaster].

    Science.gov (United States)

    Mattozzi, I

    2015-02-01

    Cervical radiculopathy is a mixed pain syndrome characterized by neuropathic, skeletal and myofascial pain. This condition is frequently found in developed countries and is a significant source of disability and a reason for frequent medical consultation. In our Pain Therapy Centre, cervical radiculopathy is initially treated with bi-weekly cycles of mesotherapy coupled, at least 15 days later, with physiotherapy to reach the complete mobilization of cervical spine. Cervical radiculopathy is a localized neuro-pathic pain and in agreement with international guidelines, we checked if patients treated topically with 5% lidocaine medicated plaster may benefit in improving pain management and in reducing the time necessary to start physiotherapy. A retrospective study was carried out on 60 patients, of which 30 were treated with mesotherapy and 30 were treated with 5% lidocaine medicated plaster. Data for a total of 30 days observation were collected from the patient medical records. In particular, besides medical history, intensity of pain, intensity of allodynia and pain were considered. For all analyzed parameters, both treatments were effective, but patients treated with 5% lidocaine medicated plaster showed faster control of the painful symptoms, an essential condition for an earlier rehabilitative treatment.

  9. Should these potential CMR substances have been registered under REACH?

    DEFF Research Database (Denmark)

    Wedebye, Eva Bay; Nikolov, Nikolai Georgiev; Dybdahl, Marianne

    2013-01-01

    (Q)SAR models were applied to screen around 68,000 REACH pre-registered substances for CMR properties (carcinogenic, mutagenic or toxic to reproduction). Predictions from 14 relevant models were combined to reach overall calls for C, M and R. Combining predictions may reduce “noise” and increase...

  10. The problematization of medical tourism: a critique of neoliberalism.

    Science.gov (United States)

    Smith, Kristen

    2012-04-01

    The past two decades have seen the extensive privatisation and marketisation of health care in an ever reaching number of developing countries. Within this milieu, medical tourism is being promoted as a rational economic development strategy for some developing nations, and a makeshift solution to the escalating waiting lists and exorbitant costs of health care in developed nations. This paper explores the need to problematize medical tourism in order to move beyond one dimensional neoliberal discourses that have, to date, dominated the arena. In this problematization, the paper discusses a range of understandings and uses of the term 'medical tourism' and situates it within the context of the neoliberal economic development of health care internationally. Drawing on theory from critical medical anthropology and health and human rights perspectives, the paper critically analyzes the assumed independence between the medical tourism industry and local populations facing critical health issues, where social, cultural and economic inequities are widening in terms of access, cost and quality of health care. Finally, medical tourism is examined in the local context of India, critiquing the increasingly indistinct roles played by government and private sectors, whilst linking these shifts to global market forces. © 2012 Blackwell Publishing Ltd.

  11. Dark Skies, Bright Kids Year 8

    Science.gov (United States)

    Bittle, Lauren E.; Wenger, Trey; Johnson, Kelsey E.; Angell, Dylan; Burkhardt, Andrew; Davis, Blair; Firebaugh, Ariel; Hancock, Danielle; Richardson, Whitney; Rochford Hayes, Christian; Linden, Sean; Liss, Sandra; Matthews, Allison; McNair, Shunlante; Prager, Brian; Pryal, Matthew; Troup, Nicholas William

    2017-01-01

    We present activities from the eighth year of Dark Skies Bright Kids (DSBK), an entirely volunteer-run outreach organization based out of the Department of Astronomy at the University of Virginia. Our core mission is to enhance elementary science education and literacy in Central Virginia through fun, hands-on activities that introduce basic Astronomy concepts. Over the past seven years, our primary focus has been hosting an 8-10 week after-school astronomy club at underserved elementary and middle schools, and over the past several years, we have partnered with local businesses to host our Annual Central Virginia Star Party, a free event open to the community featuring star-gazing and planetarium shows. This past summer we expanded our reach through a new initiative to bring week-long summer day camps to south and southwest Virginia, home to some of the most underserved communities in the commonwealth.

  12. Nursing and Nursing Education: Public Policies and Private Actions.

    Science.gov (United States)

    Institute of Medicine (NAS), Washington, DC.

    Results are presented of a study of nursing and nursing education that focused on the need for continued federal support of nursing education, ways to attract nurses to medically underserved areas, and approaches to encourage nurses to stay in the profession. Findings are presented on whether the aggregate supply of generalist nurses will be…

  13. Do children perceive postural constraints when estimating reach or action planning?

    Science.gov (United States)

    Gabbard, Carl; Cordova, Alberto; Lee, Sunghan

    2009-03-01

    Estimation of whether an object is reachable from a specific body position constitutes an important aspect in effective motor planning. Researchers who estimate reachability by way of motor imagery with adults consistently report the tendency to overestimate, with some evidence of a postural effect (postural stability hypothesis). This idea suggests that perceived reaching limits depend on an individual's perceived postural constraints. Based on previous work with adults, the authors expected a significant postural effect with the Reach 2 condition, as evidenced by reduced overestimation. Furthermore, the authors hypothesized that the postural effect would be greater in younger children. They then tested these propositions among children aged 7, 9, and 11 years by asking them to estimate reach while seated (Reach 1) and in the more demanding posture of standing on 1 foot and leaning forward (Reach 2). Results indicated no age or condition difference, therefore providing no support for a postural effect. When the authors compared these data to a published report of adults, a developmental difference emerged. That is, adults recognize the perceived postural constraint of the standing position resulting in under- rather than overestimation, as displayed in the seated condition. Although preliminary, these observations suggest that estimates of reach (action planning) continue to be refined between late childhood and young adulthood.

  14. Zika Virus: Medical Countermeasure Development Challenges.

    Directory of Open Access Journals (Sweden)

    Robert W Malone

    2016-03-01

    Full Text Available Reports of high rates of primary microcephaly and Guillain-Barré syndrome associated with Zika virus infection in French Polynesia and Brazil have raised concerns that the virus circulating in these regions is a rapidly developing neuropathic, teratogenic, emerging infectious public health threat. There are no licensed medical countermeasures (vaccines, therapies or preventive drugs available for Zika virus infection and disease. The Pan American Health Organization (PAHO predicts that Zika virus will continue to spread and eventually reach all countries and territories in the Americas with endemic Aedes mosquitoes. This paper reviews the status of the Zika virus outbreak, including medical countermeasure options, with a focus on how the epidemiology, insect vectors, neuropathology, virology and immunology inform options and strategies available for medical countermeasure development and deployment.Multiple information sources were employed to support the review. These included publically available literature, patents, official communications, English and Lusophone lay press. Online surveys were distributed to physicians in the US, Mexico and Argentina and responses analyzed. Computational epitope analysis as well as infectious disease outbreak modeling and forecasting were implemented. Field observations in Brazil were compiled and interviews conducted with public health officials.

  15. Zika Virus: Medical Countermeasure Development Challenges

    Science.gov (United States)

    Malone, Robert W.; Homan, Jane; Callahan, Michael V.; Glasspool-Malone, Jill; Damodaran, Lambodhar; Schneider, Adriano De Bernardi; Zimler, Rebecca; Talton, James; Cobb, Ronald R.; Ruzic, Ivan; Smith-Gagen, Julie; Janies, Daniel; Wilson, James

    2016-01-01

    Introduction Reports of high rates of primary microcephaly and Guillain–Barré syndrome associated with Zika virus infection in French Polynesia and Brazil have raised concerns that the virus circulating in these regions is a rapidly developing neuropathic, teratogenic, emerging infectious public health threat. There are no licensed medical countermeasures (vaccines, therapies or preventive drugs) available for Zika virus infection and disease. The Pan American Health Organization (PAHO) predicts that Zika virus will continue to spread and eventually reach all countries and territories in the Americas with endemic Aedes mosquitoes. This paper reviews the status of the Zika virus outbreak, including medical countermeasure options, with a focus on how the epidemiology, insect vectors, neuropathology, virology and immunology inform options and strategies available for medical countermeasure development and deployment. Methods Multiple information sources were employed to support the review. These included publically available literature, patents, official communications, English and Lusophone lay press. Online surveys were distributed to physicians in the US, Mexico and Argentina and responses analyzed. Computational epitope analysis as well as infectious disease outbreak modeling and forecasting were implemented. Field observations in Brazil were compiled and interviews conducted with public health officials. PMID:26934531

  16. A mixed-methods examination of communication between oncologists and primary care providers among primary care physicians in underserved communities.

    Science.gov (United States)

    Shen, Megan Johnson; Binz-Scharf, Maria; D'Agostino, Tom; Blakeney, Natasha; Weiss, Elisa; Michaels, Margo; Patel, Shilpa; McKee, M Diane; Bylund, Carma L

    2015-03-15

    Research has demonstrated that communication and care coordination improve cancer patient outcomes. To improve communication and care coordination, it is important to understand primary care providers' (PCPs') perceptions of communication with oncologists as well as PCPs' communication needs. A mixed-methods approach was used in the present study. In the qualitative phase of the study, 18 PCPs practicing in underserved, minority communities were interviewed about their experiences communicating with oncologists. In the quantitative phase of the study, 128 PCPs completed an online survey about their preferences, experiences, and satisfaction with communication with oncologists. Results indicated a PCP-oncologist gap in communication occurred between diagnosis and treatment. PCPs wanted more communication with oncologists, updates on their patients' prognosis throughout treatment, and to be contacted via telephone or email and saw their role as crucial in providing supportive care for their patients. Although PCPs recognize that they play a critical, proactive role in supporting patients throughout the continuum of their cancer care experience, existing norms regarding postreferral engagement and oncologist-PCP communication often hinder activation of this role among PCPs. Expected standards regarding the method, frequency, and quality of postreferral communication should be jointly articulated and made accountable between PCPs and oncologists to help improve cancer patients' quality of care, particularly in minority communities. © 2014 American Cancer Society.

  17. Locations of serial reach targets are coded in multiple reference frames.

    Science.gov (United States)

    Thompson, Aidan A; Henriques, Denise Y P

    2010-12-01

    Previous work from our lab, and elsewhere, has demonstrated that remembered target locations are stored and updated in an eye-fixed reference frame. That is, reach errors systematically vary as a function of gaze direction relative to a remembered target location, not only when the target is viewed in the periphery (Bock, 1986, known as the retinal magnification effect), but also when the target has been foveated, and the eyes subsequently move after the target has disappeared but prior to reaching (e.g., Henriques, Klier, Smith, Lowy, & Crawford, 1998; Sorrento & Henriques, 2008; Thompson & Henriques, 2008). These gaze-dependent errors, following intervening eye movements, cannot be explained by representations whose frame is fixed to the head, body or even the world. However, it is unknown whether targets presented sequentially would all be coded relative to gaze (i.e., egocentrically/absolutely), or if they would be coded relative to the previous target (i.e., allocentrically/relatively). It might be expected that the reaching movements to two targets separated by 5° would differ by that distance. But, if gaze were to shift between the first and second reaches, would the movement amplitude between the targets differ? If the target locations are coded allocentrically (i.e., the location of the second target coded relative to the first) then the movement amplitude should be about 5°. But, if the second target is coded egocentrically (i.e., relative to current gaze direction), then the reaches to this target and the distances between the subsequent movements should vary systematically with gaze as described above. We found that requiring an intervening saccade to the opposite side of 2 briefly presented targets between reaches to them resulted in a pattern of reaching error that systematically varied as a function of the distance between current gaze and target, and led to a systematic change in the distance between the sequential reach endpoints as predicted by

  18. The public production and sharing of medical information. An Australian perspective

    Directory of Open Access Journals (Sweden)

    Henry C.H. Ko

    2010-03-01

    Full Text Available There is a wealth of medical information now available to the public through various sources that are not necessarily controlled by medical or healthcare professionals. In Australia there has been a strong movement in the health consumer arena of consumer-led sharing and production of medical information and in healthcare decision-making. This has led to empowerment of the public as well as increased knowledge-sharing. There are some successful initiatives and strategies on consumer- and public-led sharing of medical information, including the formation of specialised consumer groups, independent medical information organisations, consumer peer tutoring, and email lists and consumer networking events. With well-organised public initiatives and networks, there tends to be fairly balanced information being shared. However, there needs to be caution about the use of publicly available scientific information to further the agenda of special-interest groups and lobbying groups to advance often biased and unproven opinions or for scaremongering. With the adoption of more accountability of medical research, and the increased public scrutiny of private and public research, the validity and quality of medical information reaching the public is achieving higher standards.

  19. Translating the REACH Caregiver Intervention for Use by Area Agency on Aging Personnel: the REACH OUT Program

    Science.gov (United States)

    Burgio, Louis D.; Collins, Irene B.; Schmid, Bettina; Wharton, Tracy; McCallum, Debra; DeCoster, Jamie

    2009-01-01

    Purpose: The aim of this study was to translate the evidence-based Resources for Enhancing Alzheimer's Caregiver Health (REACH) II intervention for use in 4 Area Agencies on Aging (AAAs). A secondary aim was to examine possible moderators of treatment outcome. Design and Methods: We used a quasi-experimental pre-post treatment design with no…

  20. Analysis of reaching movements of upper arm in robot assisted exercises. Kinematic assessment of robot assisted upper arm reaching single-joint movements.

    Science.gov (United States)

    Iuppariello, Luigi; D'Addio, Giovanni; Romano, Maria; Bifulco, Paolo; Lanzillo, Bernardo; Pappone, Nicola; Cesarelli, Mario

    2016-01-01

    Robot-mediated therapy (RMT) has been a very dynamic area of research in recent years. Robotics devices are in fact capable to quantify the performances of a rehabilitation task in treatments of several disorders of the arm and the shoulder of various central and peripheral etiology. Different systems for robot-aided neuro-rehabilitation are available for upper limb rehabilitation but the biomechanical parameters proposed until today, to evaluate the quality of the movement, are related to the specific robot used and to the type of exercise performed. Besides, none study indicated a standardized quantitative evaluation of robot assisted upper arm reaching movements, so the RMT is still far to be considered a standardised tool. In this paper a quantitative kinematic assessment of robot assisted upper arm reaching movements, considering also the effect of gravity on the quality of the movements, is proposed. We studied a group of 10 healthy subjects and results indicate that our advised protocol can be useful for characterising normal pattern in reaching movements.