The prevention of cardiovascular disease in blacks

Cardiovascular disease (CVD) in black patients involves a complex interplay of risk, geographic, socioeconomic, and cultural factors. Modifiable risk factors such as high blood pressure, diabetes, cigarette smoking, high blood cholesterol, and physical inactivity contribute to the excess CVD mortality and morbidity in blacks. Health perceptions, health care seeking behavior, and willingness to submit to long-term preventive therapies are significantly influenced by cultural and socioeconomic factors. Early detection and control of these risk factors are particularly important because blacks tend to have multiple cardiovascular risks. The importance of churches and religious organizations in the black community should be harnessed by long-term strategies of CVD prevention. Emphasis on training of minority health care professionals who are most likely to practice in medically underserved areas should involve minority health professional schools. In the final analysis, CVD prevention in blacks should focus on control of risk factors; however, the role of environmental factors should be recognized, including socioeconomic status on access to health care and prevention. Long-term strategies of CVD prevention must involve active collaboration of health care providers and researchers to develop and test effective strategies. Churches and other religious organizations are effective but underutilized partners in CVD prevention in blacks.     

Effects of a late-life suicide risk--assessment training on multidisciplinary healthcare providers

Older adults are among the highest at risk for completing suicide, and they are more likely to seek mental health services from providers outside of traditional mental health care, but providers across the spectrum of care have limited training in suicide risk assessment and management and particularly lack training in suicide prevention for older adults. An educational program was developed to increase awareness and improve suicide risk assessment and management training for a range of healthcare providers who may see older adults in their care settings. One hundred thirty-two participants from two Veterans Affairs Medical Centers participated in a 6.5-hour-long workshop in the assessment and management of suicide risk in older adults. Participants were asked to complete pre- and postworkshop case notes and report on subjective changes in knowledge, attitudes, and confidence in assessment and managing suicide risk in older adults. Participants included social workers, nurses, physicians, psychologists, and occupational therapists from a variety of care settings, including outpatient and inpatient medical, outpatient and inpatient mental health, specialty clinics, home, and community. After the workshop, participants demonstrated improvement in the overall quality of case notes (P = .001), greater ability to recognize important conceptual suicide risk categories (P = .003), and reported heightened awareness of the importance of late-life suicide. The results suggest that educational training may have beneficial effect on the ability of multidisciplinary care providers to identify and manage suicide risk in elderly adults.     

基层医务人员STD/AIDS专业知识现况调查

目的了解基层医务人员性病艾滋病专业知识现况,为加强性病艾滋病(STD/AIDS)专业培训提供基础信息。方法邀请来自四川某市、县医院和疾病预防控制中心及18个乡镇卫生院、妇幼保健院的49名医务人员接受STD/AIDS专业知识匿名问卷测试。结果平均不及格(48.49分)。乡镇级医疗单位、综合医院、中专以下学历和内外科医务人员知识测试分较低,分别是41.56分、45.24分、41.53分和30.82分。对梅毒与淋病的临床表现、男性尿道炎的病因、国家性病治疗方案等性病基本诊疗知识不够熟悉,对STD/AIDS咨询、安全套促进等预防方面的知识也存在误区。结论应加强对基层尤其是乡镇医务人员的STD/AIDS专业培训。培训内容除要有基本的性病艾滋病临床诊疗专业知识外,还应包括STD/AIDS咨询、安全套促进、母婴传播预防等方面的信息。     

Healthcare provider training in tobacco treatment: building competency

One of the most effective disease prevention and health promotion strategies available is the treatment of tobacco dependence. The Agency for Healthcare Research and Quality (AHRQ) clinical practice guideline for treating tobacco use and dependence provides a number of recommendations for interventions by health care systems and providers, including that treatment be reimbursed, identification of tobacco users be institutionalized, and all patients be offered brief treatment and have more intensive treatment available to them. Unfortunately, these recommended interventions have not been routinely implemented. As part of a comprehensive approach to improving implementation, provider training is needed. Three models for training healthcare providers in brief tobacco treatment intervention (medical education, professional education, and community-based education) are described, a model for training providers in intensive tobacco treatment interventions is presented, and a rationale for a national training and certification program is made.     

Access to Care and Cardiovascular Disease Prevention: A Cross-Sectional Study in 2 Latino Communities

Cardiovascular disease (CVD) is the leading killer of Americans. CVD is understudied among Latinos, who have high levels of CVD risk factors. This study aimed to determine whether access to health care (ie, insurance status and having a usual source of care) is associated with 4 CVD prevention factors (ie, health care utilization, CVD screening, information received from health care providers, and lifestyle factors) among Latino adults and to evaluate whether the associations depended on CVD clinical risk/disease.Data were collected as part of a community-engaged food environment intervention study in East Los Angeles and Boyle Heights, CA. Logistic regressions were fitted with insurance status and usual source of care as predictors of the 4 CVD prevention factors while controlling for demographics. Analyses were repeated with interactions between self-reported CVD clinical risk/disease and access to care measures.Access to health care significantly increased the odds of CVD prevention. Having a usual source of care was associated with all factors of prevention, whereas being insured was only associated with some factors of prevention. CVD clinical risk/disease did not moderate any associations.Although efforts to reduce CVD risk among Latinos through the Affordable Care Act could be impactful, they might have limited impact in curbing CVD among Latinos, via the law''s expansion of insurance coverage. CVD prevention efforts must expand beyond the provision of insurance to effectively lower CVD rates.     

Epidemiological transition in type 2 diabetes mellitus: the role and function of a sub-district health promoting hospital

Health authorities in Thailand implemented a policy especially to cope with chronic diseases in that they transformed former health stations into sub-district health promoting hospitals (SHPH). The “top down” measure left the staff of the SHPH somewhat confused and uncertain how to manage their duties effectively. One of the weak points was the questionable outreach of care into the community. In an attempt to demonstrate how to enhance community participation, one SHPH was selected and assisted in improving the care of type 2 diabetes mellitus (T2DM) patients. Patients from another SHPH served as controls. The combined efforts of patients, their families, SHPH staff, and the community with the help of village health workers succeeded in improving the control of T2DM in that a steady decline in capillary blood glucose (CBG) could be observed and the results could also be verified by the determination of glycated hemoglobin (HbA1c).     

全国疾病预防控制在职人员接受培训需求调查的现况分析

目的了解疾病预防控制在职人员接受培训需求调查的现况及相关因素,提示培训管理部门重视培训需求调查工作。方法问卷调查1168名国家级、省级、地县级疾病预防控制在职人员接受培训需求调查的现况。结果总培训需求调查率为24.0%,国家级疾病预防控制在职人员的培训需求调查率为29.4%,明显高于省级的18.3%和地县级的16.4%(P<0.01),社区卫生服务专业人员的培训需求调查率为38.6%,明显高于地方病与寄生虫病预防控制专业人员的6.5%(P<0.01)。结论当前培训需求调查工作的覆盖面偏低且不均衡,各级疾病预防控制机构应重视培训需求调查工作,切实掌握在职人员的各种培训需求,为科学、合理制订培训计划提供参考依据。     

Infection control and preventing the transmission of tuberculosis in high-risk centres - recovery shelter for homeless people

The term “infection control” refers to the policies and practices used in hospitals and other healthcare facilities to limit the spread of illnesses with the primary goal of lowering infection rates. The objective is to reduce the chance of infection in patients and Healthcare workers (HCWs). This may be achieved by making all the HCWs to follow and practice the infection prevention and control (IPC) guidelines and by providing safe and quality healthcare. Because of more exposure to TB patients and insufficient TB infection prevention and control (TBIPC) procedures in a healthcare facility, healthcare workers (HCWs) working in TB centers are at an elevated risk of contracting TB. Although there are a number of TBIPC guidelines, there is limited knowledge of their contents, if they are applicable in the given situation, and whether they are being properly applied in TB centers. The purpose of this study was to observe the TBIPC guidelines' implementation in CES (Centre of equity studies) recovery shelters well as the elements that affect it. The percentage of public health care personnel who used proper TBIPC practices was low. The execution of TBIPC guidelines in tuberculosis (TB) centers was poor. It was impacted because TB treatment institutions and centers have unique health systems and TB disease burdens.     

How Will the U.S. Healthcare System Meet the Challenge of the Ethnogeriatric Imperative?

Much of the geriatric imperative that is facing providers in the United States is an ethnogeriatric imperative, because one-third of older Americans are projected to be from one of the minority populations by mid-century, and that vastly underrepresents the actual diversity providers will see. Because of the vast heterogeneity of culture, language, health beliefs, risk for disease, and other factors, it is important for policy makers and health providers to be familiar with the diverse characteristics and needs of the various groups that will need geriatric care if they are to receive effective services. Challenges to high-quality ethnogeriatric care include disparities in health status and health care, differences of acculturation level and other characteristics within the populations, language and limited English proficiency, health literacy, culturally defined health beliefs and syndromes, and specific beliefs and preferences about long-term and end-of-life care. Some models of successful ethnogeriatric care have been identified and have in common the involvement of members of the target population in the development and design of the services and the use of cultural liaisons from the ethnic community being served, such as community health workers, or promatores . Thirteen recommendations are suggested for policy and practice changes in multiethnic and ethnic-specific health programs to provide competent ethnogeriatric care in the U.S. healthcare system.     

The Long Road to Better ACHD Care

The care of adult patients with congenital heart defects in the United States is spotty at best, and needs to improve greatly if the needs of these patients are to be met. The care of American children with congenital heart defects is generally excellent. Pediatric cardiac services are well established and well supported. The care of adults with congenital heart disease (CHD) is well established in only a few American centers. While there are an increasing number of clinics, they are generally poorly resourced with relatively few patients. If located in adult cardiology programs, they are usually minor players. If located in pediatric cardiac programs, they are usually minor players as well. Training programs for adult CHD (ACHD) caregivers are few, informal, and poorly funded. To improve the situation, we need perhaps 25 well-resourced and well-established regional ACHD centers in the United States. We need to stop the loss to care of CHD patients at risk of poor outcomes. We need to educate patients and families about the need for lifelong and skilled surveillance and care. We need to effect an orderly transfer from pediatric to adult care. We need to strengthen the human resource infrastructure of ACHD care through the training and hiring of healthcare professionals of a quality equivalent to those working in the pediatric care environment. We need to demonstrate that adult care is high quality care. We need more high-quality ACHD research. The ACHD community needs to establish its credibility with pediatric cardiac providers, adult cardiology groups, with governments, with professional organizations, and with research funding agencies. Accordingly, there is a need for strong political action on behalf of American ACHD patients. This must be led by patients and families. These efforts should be supported by pediatric cardiologists and children's hospitals, as well as by national professional organizations, governments, and health insurance companies. The goal of this political action should be to see that ACHD patients can receive high-quality lifelong surveillance, that we lose fewer patients to care, and that the staff and other services needed are available nationwide.     

The integrated team approach to the care of the patient with cardiovascular disease

Cardiovascular disease (CVD) is a costly, worldwide problem with significant annual morbidity and mortality. Guideline-based primary and secondary prevention is effective in preventing and controlling CVD. Such prevention must be implemented by an integrated team of physician-directed health professionals, during both the inpatient and the outpatient phases of care. Appropriate team members may include, but are not limited to, nurses, advanced practice nurses, physician assistants, dietitians, physical therapists, psychologists, pharmacists, cardiac fellows, exercise physiologists, and case managers. During the acute phase of care, various teams are activated as appropriate to specific needs of the patient in the medical (invasive and noninvasive) and surgical specialties. The outpatient phase varies with diagnosis and condition of the patient and team members are involved as needed. An integrated team effort is essential to the best care for each patient regarding individual management and will assure that evidence-based guidelines, in both treatment and secondary prevention, are implemented.     

Information on Cardiovascular Disease in the Digital Era: Results From a Cross-Sectional Patient Survey

Public health strategies to reduce cardiovascular disease (CVD) rely on the effective dissemination of evidence-based information to at-risk populations. An improved understanding of the information sources patients use can facilitate content development and promote awareness of effective interventions for CVD prevention, monitoring, and management. We therefore sought to determine the contemporary patterns of CVD information source usage via a prospective, cross-sectional survey study of CVD information sources in a primary care centre in Ontario, Canada. Primary source(s) used for CVD information were defined as: traditional media (television or print media), Internet-based sources, or community resources (community agencies and health care providers). Of 4682 consecutively screened patients aged > 18 years 3189 (68%) participated in the survey. The mean age of the survey respondents was 37 ± 14 years and 54.4% were female. Traditional media (71%) were used more frequently than Internet-based sources (45%) or community health services (23%). Only 20% of respondents identified health care providers as the source of information for CVD. Compared with respondents aged ≥ 55 years, the adjusted odds of Internet-based source use were significantly higher among younger age groups, whereas the adjusted odds of print media and health services usage was lowest among ages 25-34 years. Although traditional print and electronic media remain the primary resource for CVD-related information, younger individuals increasingly rely on Internet-based sources. These findings have important implications for public health policy and resource allocation, highlighting the importance of maintaining traditional media presence in addition to the development of high-quality Internet-based sources of CVD information.     

甘肃省医疗卫生人员高血压病知识调查和培训

目的 :为了解甘肃省部分医疗卫生人员对原发性高血压 (EH)相关知识掌握程度及对培训指导结果进行分析研究。方法 :对来自甘肃省级、地市级、县级医院和乡卫生院的医生及省、地市、县、乡的疾病控制部门人员共 14 3例进行填式问卷调查。然后对调查对象进行EH相关基础和临床知识培训 ,培训结束后同样填式问卷调查。对调查结果进行统计学分析。结果 :女性得分高于男性 (P <0 .0 1) ;答题得分与从事专业、学历、医院级别不同有差异 ,从事专业得分依次为 :心内科 >内科 >预防专业 (P <0 .0 1) ;学历的得分依次为 :大学 >大专 >中专 (均P <0 .0 1) ;所在医院级别得分依次为 :省级 >地市级 >县级 >乡级 (均P <0 .0 1)。单因素分析显示性别、从事专业、学历、所在医院级别与EH知识评分相关 (P <0 .0 1)。多元线性分析提示性别、专业和医院级别对EH知识评分有独立的影响 (P <0 .0 1) ,与年龄、工作时间和学历不相关 (P >0 .0 5 )。各类观察对象培训后对EH相关知识均有显著提高 (均P <0 .0 1) ;培训后性别、从事专业、学历、所在医院级别之间评分差异均无统计学意义 (均P >0 .0 5 )。结论 :医疗卫生人员工作的环境与EH知识的掌握程度有关 ,疾病控制人员和基层医疗工作者应加强学习 ,继续医学教育应作为提高医疗卫     

The sexual and reproductive health of young people in Adjumani district, Uganda: qualitative study of the role of formal, informal and traditional health providers

This qualitative study of young people and health care workers in Adjumani, northern Uganda, found that young people are generally very knowledgeable about STD spread and prevention as well as methods for prevention of pregnancy. Health workers are the most important category of people providing information on sexual and reproductive health (SRH) for young people. However, many health workers are conservative with regard to adolescent sexuality. There is a lack of training in and guidelines for working with adolescents. This, along with inadequate access to SRH services for young people, accounts for the failure to adequately deal with young people's problems. Physical, social, psychological and economic factors create barriers to service accessibility. Socio-economic, religious and cultural factors affect sexual behaviour and outcomes in Adjumani district, making some young people vulnerable, particularly young women. In an effort to find alternative services that meet their needs better, young people visit informal and traditional health care providers despite having to pay for these services. The confidentiality and privacy that they offer could be a lesson for formal health care providers. Further training and integration of traditional health care providers is essential as they already play a major part in SRH service delivery to young people.     

Multi-Discipline HIV Longitudinal Training

Abstract

This article describes a multi-disciplinary HIV clinical training model developed and implemented by the Division of AIDS Education at the University of Medicine and Dentistry of New Jersey (UMDNJ)-Center for Continuing and Outreach Education (CCOE), the New Jersey Local Performance Site (LPS) of the New York/New Jersey AIDS Education and Training Center (AETC). The Longitudinal Training (LT) model combines AETC, Minority AIDS Initiative (MAI) and other available training resources into an adaptable framework that can be implemented by any clinical training entity (e.g., other AETCs, Public Health Training Centers, Center for Mental Health Services grantees, state health departments, STD/HIV Prevention Training Centers, etc.) to provide needs-based, multi-discipline longitudinal training of healthcare providers so as to enhance the HIV care capacity of community health centers serving predominantly minority populations. In addition to describing the AETC and MAI Programs, this paper will discuss the methods used in developing the Longitudinal Training model and will include styles of training, identification of program successes and barriers, a composite case study and continuous outcome measures.     

上海市各级医护人员对《中国糖尿病防治指南》知晓现状的抽查及分析

了解医护人员对<中国糖尿病防治指南>相关知识的掌握情况,为进一步推广和更好开展糖尿病相关防治工作打下基础.根据<中国糖尿病防治指南>相关知识点设计问卷,对上海市175名内分泌专业及社区医护人员进行调查,分析比较被调查者基本情况、专业培训和对糖尿病防治知识要点的掌握情况.接受<指南>培训的医护人员占16.6%(社区、三级和二级医院医护人员分别为46.67%、14.75%和7.14%,P＜0.01).临床医生参加糖尿病专业培训的比例均高于护理人员(P＜0.01).<指南>相关知识的总体正确知晓率37.36%,社区医院医护人员低于三级和二级医院(P＜0.05),被调查医生的总体正确知晓率高于护士(P＜0.05),不同医疗机构的医护人员对糖尿病关键知识点的掌握情况存在相当大的差异,当前糖尿病专业培训方法的有效性值得探讨.我国糖尿病防治工作有待加强,尤其应统一各级医院医护人员对糖尿病防治重要环节的认识、加强<中国糖尿病防治指南>的推广、有效开展糖尿病专业培训、建立医院和社区糖尿病防治的专业化合作.

Abstract：

To analyze and evaluate the knowledge of Chinese Guidelines of Diabetes Prevention and Treatment in Shanghai medical staff. 175 medical staff working in endocrinology or community health were enrolled and evaluated by a questionnaire of guidelines about the state of professional, training, and related knowledge. Only 16. 6% medical staffwere trained about the guidelines( 46. 67% from the general hospitals, 14. 75% from secod-level hospital and 7. 14% persons from the community hospitals, P＜0. 01 ). The total correct answer rate of the guidelines was 37. 36%. The correct rate of community hospitals was lower than others( P＜0. 05 ). The rate of doctors' was higher than nurses'( P＜0. 05 ). There were difference between doctors and nurses with the key point of diabetes care knowledge in different level hospitals. The effective method of clinical training in diabetes care should be explored. We still have to work hard to promote the effect of diabetes control and prevention. Effective training about the guidelines should be enhanced. The cooperation between general hospitals and community health institutions in diabetes prevention and treatment should be enhanced.     

Leadership in creating accountable care organizations

General internists need to take an active leadership position in the creation of accountable care organizations (ACOs). The basic idea behind ACOs is relatively simple. Physicians, hospitals, and other health care providers will continue to be paid fee-for-service by the Medicare program, but if they can work together to better manage people with chronic conditions, reduce avoidable complications, reduce unnecessary specialty referrals, and improve transfer of beneficiaries as they transition from one care provider to another; then there is the possibility of shared savings with the Medicare program. ACOs are likely to alter existing referral patterns among general internists and specialty physicians and engender debates over how to allocate any financial savings. They are scheduled to begin operation on January 2012. As ACOs are established, general internists should review the operation of the care management and disease management programs. They should understand the financial arrangements and quality indicators that the ACOs establish. They should be involved in identifying the patients that would benefit from better care management. They should identify changes in care processes and payment reforms that would improve the care for these patients. ACOs represent an opportunity for general internists to change the way medical care is delivered.     

Prescribers and Pharmaceutical Representatives: Why Are We Still Meeting?

CONTEXT  Research suggests that pharmaceutical marketing influences prescribing and may cause cognitive dissonance for prescribers. This work has primarily been with physicians and physician–trainees. Questions remain regarding why prescribers continue to meet with pharmaceutical representatives (PRs). OBJECTIVE  To describe the reasons that prescribers from various health professions continue to interact with PRs despite growing evidence of the influence of these interactions. DESIGN, SETTING, AND PARTICIPANTS  Multi-disciplinary focus groups with 61 participants held in practice settings and at society meetings. RESULTS  Most prescribers participating in our focus groups believe that overall PR interactions are beneficial to patient care and practice health. They either trust the information from PRs or feel that they are equipped to evaluate it independently. Despite acknowledgement of study findings to the contrary, prescribers state that they are able to effectively manage PR interactions such that their own prescribing is not adversely impacted. Prescribers describe few specific strategies or policies for these interactions, and report that policies are not consistently implemented with all members of a clinic or institution. Some prescribers perceive an inherent contradiction between academic centers and national societies receiving money from pharmaceutical companies, and then recommending restriction at the level of the individual prescriber. Prescribers with different training backgrounds present a few novel reasons for these meetings. CONCLUSIONS  Despite evidence that PR detailing influences prescribing, providers from several health professions continue to believe that PR interactions improve patient care, and that they can adequately evaluate and filter information presented to them by PRs. Focus group comments suggest that cultural change is necessary to break the norms that exist in many settings. Applying policies consistently, considering non-physician members of the healthcare team, working with trainees, restructuring the current primary care model and offering convenient, individualized, non-biased educational options may aid success. This work was funded by the Attorney General Consumer and Prescriber Grants Program.     

Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, Center for International Blood and Marrow Transplant Research, and the American Society for Blood and Marrow Transplantation (EBMT/CIBMTR/ASBMT)

More than 40,000 hematopoietic cell transplants (HCTs) are performed worldwide each year. With improvements in transplant technology, larger numbers of transplant recipients survive free of the disease for which they were transplanted. However, there are late complications that can cause substantial morbidity. Many survivors are no longer under the care of transplant centers and many community health-care providers may be unfamiliar with health matters relevant to HCT. The Center for International Blood and Marrow Transplant Research (CIBMTR), European Group for Blood and Marrow Transplantation (EBMT), and American Society for Blood and Marrow Transplantation (ASBMT) have developed these recommendations to offer care providers suggested screening and prevention practices for autologous and allogeneic HCT survivors.