Primary medical care for elderly patients part I: Service mix as seen by an expert panel

A survey of six geriatric experts concerning the normative role content of physicians providing primary care for the elderly emphasizes the importance of distinguishing reversible and irreversible components of a patient's problems and of conducting multidimensional functional assessments. Appreciation of the role of the environment in maintaining functional capacity should be inculcated in practitioners treating the elderly. Medicare payment methods should recognize that the elderly require more professional time for adequate care, and should address transportation needs.Charlotte Muller, PhD, is Professor of Economics and Sociology, City University of New York Graduate School, and Professor of Health Economics, Department of Community Medicine, Mount Sinai School of Medicine.Marianne C. Fahs, PhD, MPH, is Assistant Proffessor in Community Medicine, Mount Sinai School of Medicine.Malvin Schechter, MS, is an Assistant Professor, Ritter Department of Geriatrics and Adult Medicine, Mount Sinai School of Medicine.Supported by a conference grant from the National Center for Health Services Research, Herbert C. Traxler, PhD, project director.A briefer version of this paper was presented at the annual meeting of the Association for the Social Sciences in Health, Las Vegas, Nevada, 1986.The research assistance of Helen Hooke is gratefully acknowledged.     

Community-oriented health services education: A strategy for international cooperation

This paper describes the approach of the Department of Community Medicine of the Mount Sinai School of Medicine in the education of local and foreign physicians and their participation in the development of community oriented health care systems. It also presents the first steps taken by this medical school to create an international program whose aims are to develop long-term partnership agreements with foreign universities by bringing together and integrating medical education with the development of community-oriented health care services.Samuel J. Bosch, M.D., is Charles G. Bluhdorn Professor of International Community Medicine, Department of Community Medicine, The Mount Sinai School of Medicine of the City University of New York. One Gustave L. Levy Place, New York, N.Y. 10029.Alan Silver, M.D. is Assistant Professor and Director of the Education Unit, Department of Community Medicine, The Mount Sinai School of Medicine of the City University of New York. One Gustave L. Levy Place, New York, N.Y. 10029     

A medical school's involvement in the development of a community-based health center

This paper presents a planning model developed by the Department of Community Medicine of the Mount Sinai School of Medicine to facilitate the interactions between the medical school and the community. The planning process involved application of the model, exemplified through the growth and development of a neighborhood health center governed by a community agency. The main characteristics of the medical school, of the community, and of the community agency are presented briefly and the seven-year history of the development of the neighborhood health center is summarized. In recapitulating that history three distinct phases are identified in the planning process: how the planning was planned, how the plan was prepared, and how the services program was implemented. The role of the Department of Community Medicine in each phase is analyzed.Dr. Merino is Assistant Professor, Department of Community Medicine, Mount Sinai School of Medicine, New York, NY 10029. Dr. Rose is Instructor, Departments of Medicine and Community Medicine, Mount Sinai School of Medicine, New York, NY 10029. Dr. Bosch is Professor and Deputy Chairman, Department of Community Medicine, Mount Sinai School of Medicine, New York, NY 10029.     

Self-instructional teaching of biostatistics for medical students

A growing body of literature deals with the use of self-instructional methods for teaching biostatistics to medical students. The University of Tennessee Department of Community Medicine tested the hypothesis that, in controlled, randomized situations, learning of statistical material by self-instruction is equivalent to learning identical material by the lecture method. An analysis of student performance, in terms of the grades obtained on two separate examinations, showed that students learning by self-instruction did as well or better than their colleagues taking lectures. On the basis of these results, self-instructional biostatistics for medical students at the University of Tennessee has been selected as the major teaching method of that subject.Dr. Robinson is Professor and Chief of Biostatistics in the Department of Community Medicine, University of Tennessee College of Medicine, 800 Madison Avenue, Memphis, Tennessee 38163. Mr. Burke is Instructor in the Department of Community Medicine, University of Tennessee, and Director of Statistical Services in the Memphis and Shelby County Health Department. Dr. Stahl was Assistant Professor of Community Health and Medical Practice, Section of Health Care Studies, University of Missouri, Columbia, Missouri, during this study. He is currently Assistant Professor of Sociology, Purdue University, School of Humanities, Social Science and Education, Lafayette, Indiana. Requests for reprints should be addressed to Dr. Robinson. John W. Runyan, Jr., M.D., and Stephen T. Miller, M.D., of the Department of Community Medicine, University of Tennessee, made valuable suggestions during the preparation of this paper.     

Ethical issues in primary health care: A survey of practitioners' perceptions

While most health care is provided at the primary care level, little research has been done to document the ethical issues of such care. A stratified random sample of 702 physicians, nurses, physical therapist, and physician assistants within one southeastern state was surveyed to determine the frequency of ethical issues in primary care. The most frequently occurring issue concerned moral decisions about the amount of time to spend with each patient. A comparison of physician and nonphysician professional groups revealed significant differences in frequencies of the issues. Age had a slight impact on the responses, while gender, religion, and region of practice had none. The study showed that the most frequently occurring issues are pragmatic, not dramatic, and center on patient self-determination, adequacy of care and professional responsibility, and distribution of resources.Helen M. Robillard, R.N.-C., M.S.N., is a doctoral student in Organizational Psychology at the University of Michigan, Ann Arbor. Dallas M. High, Ph.D., is Professor in the Department of Philosophy and Associate of the Sanders-Brown Center on Aging, University of Kentucky, Lexington. Juliann G. Sebastian, R.N., M.S.N., is Associate Professor, College of Nursing, University of Kentucky, Lexington. Janet I. Pisaneschi, Ph.D., is Associate Professor and Assistant Dean, College of Allied Health Professions, University of Kentucky, Lexington. Lea J. Perritt, Ph.D., is Assistant Professor, Allied Health Education and Research, College of Allied Health Professions, University of Kentucky, Lexington. D. Mark Mahler, M.D., is Assistant Clinical Professor, Indiana University School of Medicine, Indianapolis. Requests for reprints should be addressed to: Dallas M. High, Ph.D., Professor, Department of Philosophy, University of Kentucky, Lexington, KY, 40506.     

Self-reported referral patterns in practices of Family/General Practitioners,Internists, and Obstetricians/Bynecologists

A profile of referrals can help to define the characteristics of a physician's practice. Self-reported referral patterns in the practices of Family/General Practitioners (FP/GP), Internists (IM), and Obstetricians/Gynecologists (OB/GYN) in Maryland were assessed with a questionnaire mailed to an area sample of 1,715 physicians. A 65% response rate was obtained after three mailings (weighted N=1,487). Self-reported referrals received per month averaged 16% of patients seen (six percent FP/GP, 13% OB/GYN, 23% IM), and were more frequent among self-employed, younger, metropolitan and female physicians who spent less time in patient care. Self-reported referrals made per month averaged ten percent (10% FP/GP), 11% IM, and eight percent OB/GYN), and were higher for physicians in metropolitan areas. The correlation between percentage referrals received and percentage referrals made was r=.19 (r=.03 FP/GP, r=.21 IM, r=.25 OB/GYN). Self-reported practice referral patterns are similar to referrals reported in prior studies, and can be used to consider specialty differences in referral behavior of physicians.Jeffery Sobal, Ph.D., M.P.H. is an Assistant Professor in the Department of Family Medicine at the University of Maryland, School of Medicine, Baltimore, Maryland, 21201. Herbert L. Muncie, Jr., M.D. is an Associate Professor in the Department of Family Medicine at the University of Maryland, School of Medicine, Baltimore, Maryland, 21201. Carmine Valente, Ph.D. is the Director of the Center for Health Education, Inc., 1204 Maryland Avenue, Baltimore, Maryland, 21201. David M. Levine, M.D., Sc.D. is a Professor in the Department of Medicine at the Johns Hopkins University School of Medicine, Baltimore, Maryland 21205. Bruce R. DeForge, M.A. is a Research Associate in the Department of Family Medicine at the University of Maryland, School of Medicine, Baltimore, Maryland, 21201. Requests for reprints should be addressed to: Jeffery Sobal. The authors would like to thank the Department of Family Medicine at the University of Maryland School of Medicine (Grant 2D32PE13000 from the U.S. Department of Health and Human Services), the Center for Health Education, Inc., Johns Hopkins University School of Hygiene and Public Health, Blue Cross/Blue Shield of Maryland, Inc., and the Medical and Chirurgical Faculty of the State of Maryland for support for this research. An earlier version of this paper was presented at the annual meeting of the North American Primary Care Research Group.     

Teaching community-oriented primary care (COPC): A practical approach

To improve education in community-oriented primary care (COPC) and to promote its practice in the community, the University of California's School of Public Health in Berkeley and School of Medicine in San Francisco are collaborating in an innovative program in cooperation with several federally-funded community clinics in the San Francisco Bay Area. The School of Public Health designed a COPC track for graduate public health students from various departments of the school who wished to work in community health care. The track includes a seminar given in the spring of the students' first year in which COPC theory is taught and teams of students working with a faculty advisor and a clinic preceptor design COPC projects for the primary care sites. These projects are then implemented in the summer and fall by students who elect to use this experience to satisfy their fieldwork requirement. This paper is a report of the first year's experience with this collaborative effort.Emilie H.S. Osborn, M.D., M.P.H. is Assistant Professor, Family and Community Medicine, University of California at San Francisco. Norman Hearst, M.D., M.P.H. is Assistant Clinical Professor, Clinical Epidemiology and Family and Community Medicine, University of California at San Francisco. Joyce C. Lashof, M.D., is Dean, School of Public Health, University of California at Berkeley. W. McFate Smith, M.D., M.P.H. is Director, Preventive Medicine Residency, School of Public Health, University of California at Berkeley.This project has been supported in part with Federal funds from the Bureau of Health Care Delivery and Assistance, Health Resources and Services Administration, U.S. Public Health Service, under contract #240-84-0124. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services.     

HMO development in an academic medical center: The rise and fall of a prepaid health program in New York City

Through a documented case study the authors identify the critical factors that impede the introduction of prepaid medical care as part of education and practice within a prestigious and well established academic medical center. The inherent conflicts between individual fee-for-service practice and population-based prepaid practice and the resistance to innovations in medical care organization as they surfaced in that center, are presented. The need for a clear understanding of the complexities of HMO development and of an appreciation for the importance of a planning process in which all interested parties are involved, is emphasized. A clear commitment by policy makers, administrators and providers is highlighted as fundamental for the implementation of a system where practitioners are motivated to assume responsibility for the comprehensive care of a defined population that prepays for their services. The rewards as well as the difficulties for institutionalizing commitment to this form of health care delivery and impacting on medical education are discussed.Samuel J. Bosch, MD, is Professor Emeritus of Community Medicine and International Health, Mount Sinai School of Medicine; Kurt W. Deuschle, MD, is Chairman Emeritus and Professor of Community Medicine, Mount Sinai School of Medicine.     

The role and functions assumed by a department of community medicine in planning a group practice.

This paper describes the technical assistance role and the functions assumed by the Department of Community Medicine of the Mount Sinai School of Medicine in a planning process that led to the development of a group practice in the Department of Medicine of the Mount Sinai Hospital. Three distinct phases are identified in the process: how the planning was planned, how the plan was prepared, and how the implementation was planned. The role of Community Medicine in each phase is analyzed.     

How mothers treat their children's physical symptoms

An important area of concern in community health is the widespread practice of individuals undertaking courses of treatment in the absence of medical advice or direction. This is especially a problem when it involves the administration of medicines to children. This study examines the extent, determinants, and quality of the independent use by mothers of medications for treating their children's symptoms. Data on mother-initiated medication behavior (MIMB) were obtained from a random sample of 500 mothers of children at two pediatric ambulatory care sites. Six expert pediatric judges rated every reported medication use (N=3,908) along three dimensions (usefulness, correctness, and harmfulness/helpfulness) and also evaluated the overall appropriateness of each mother's MIMB. Results indicate that: 1) mothers keep available and use for their children a considerable number of different medications; 2) clear relationships exist between mothers' socioeconomic status and the different categories of medications they employ; 3) mothers' perceptions of their children's vulnerability to specific illnesses, and of the efficacy of over-the-counter medications for treating those illnesses, were related to the possession and use of relevant medications; and 4) judges' ratings indicated little enthusiasm for the mothers' therapeutic actions. These findings suggest the need for pediatricians to become aware of the medications their patients may be ingesting as a result of MIMB, and to educate mothers concerning use and misuse of over-the-counter (and other) treatments.Lois A. Maiman, Ph.D., is Assistant Professor, Department of Pediatrics, and Department of Preventive, Family and Rehabilitation Medicine, School of Medicine and Dentistry, University of Rochester, New York. Marshall H. Becker, Ph.D., M.P.H., is Professor and Chairman, Department of Health Behavior and Health Education, School of Public Health, and Professor, Department of Pediatrics and Communicable Diseases, School of Medicine, University of Michigan, Ann Arbor, Michigan. Anne W. Katlic, B.A., is Research Assistant, Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York. Address reprint requests to: Dr. Lois A. Maiman, Department of Pediatrics, Box 777, School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642.This research was supported by Grants HD15357 and HD00538 from the National Institute of Child Health and Human Development, National Institutes of Health.     

Clinical validation of a nutritional risk index

This research assessed the clinical validity of a nutritional risk index (NRI). Subjects were 377 male veterans, aged 55+, attending general medicine and geriatric outpatient clinics. Data were collected by personal interviews, anthropometric measurements, laboratory assay of nutritional parameters, three-day food records, and medical record reviews. Although the results showed that the NRI correlated significantly with only two nutritional measures (body mass index, total energy intake), critical values or threshold levels of NRI were identified that significantly discriminated low risk from high risk patients on four nutritional parameters (body mass index, total energy intake, laboratory risk, and medications risk). It was concluded that the NRI is a valid measure of health status and contains a nutritional dimension.John M. Prendergast, MD, MPH is Medical Director, Program on Aging, Mercy Hospital, Pittsburgh, PA 15219; Rodney M. Coe, PhD is Professor, Department of Community Medicine, St. Louis University School of Medicine and Education Coordinator, Geriatric Research, Education and Clinical Center (GRECC), VA Medical Center, St. Louis, MO 63104; M. Noel Chavez, PhD, RD is Assistant Professor, Department of Community Health Sciences, School of Public Health, University of Illinois, Chicago, IL 60612; James C. Romeis, PhD is Associate Professor, Center for Health Services, Education and Research, St. Louis University and Coordinator, Health Services Research and Development, VA Medical Center, St. Louis, MO 63104; Douglas K. Miller, MD is Assistant Professor, Department of Internal Medicine, St. Louis University School of Medicine, St. Louis, MO 63104; Fredric D. Wolinsky, PhD is Professor, Department of Sociology, Texas A&M University, College Station, TX 77843.This project was supported in part by grant #84-017 from the Veterans Administration and by K07-AG-00302 and K04-AG00328 from the National Institute on Aging.     

Factors associated with success among southern Cheyenne and Arapaho Indians

Researchers in applied social science are seeking ways of approaching the facilitation of community-based development at the grass-roots level. Much research to date has focused on negative social aspects in communities, such as substance abuse and high numbers of school drop-outs. An innovative approach was developed that involved looking instead at successful individuals in communities. Individuals identified as successful were interviewed about the factors they associated with their own success. The experience of supportive parenting during their childhoods and moderation in alcohol and other substance use as adults were strongly correlated with success in life. The interview process provided an effective springboard for discussions and the development of intervention strategies at the community level.Alfred K. Neumann, M.A., M.D., M.P.H., is Professor in the Department of Community Health and Director of the Preventive Medicine Residency Program at the School of Public Health, University of California at Los Angeles. Velma Mason, Ph.D., is Special Assistant to the Director, Office of Indian Education, U.S. Department of Education, Washington, D.C. Emmett Chase, M.D., M.P.H., is National AIDS Coordinator of the Indian Health Service in Albuquerque, New Mexico, and was formerly Chief Physician of the American Indian Free Clinic in Compton, California, and Chief Resident of the UCLA Preventive Medicine Residency Program, School of Public Health at UCLA, Los Angeles. Bernard Albaugh, M.S.W., M.P.A., is Chairman of the Human Services Department, U.S. Public Health Service in Clinton, Oklahoma.The authors gratefully acknowledge the generous support of the UCLA Institute of American Cultures, the UCLA American Indian Studies Center, the New Era Foundation for International Development, the advice and encouragement of colleagues, and the Cheyenne/Arapaho Business Committee. Thanks also go to Ms. Melody Knutson and Ms. Julia George for their work in research and editing.     

Importance of community size in practice location decisions of final year residents

Final year residents in training in Louisiana were surveyed regarding plans for medical practice and their perceptions of the importance of various factors in choosing practice locations. Most specialty groups selected smaller communities at similar rates. Growing up in small towns is associated with wanting to practice in small towns while concerns about opportunities for the family and income of the region are associated with wanting to practice in a larger city.This study was supported by the Louisiana Council for Statewide Planning for Physician Manpower through Contract No. 23058, Louisiana Department of Health and Human Resources.Ms. Samaha is a data analyst for the Louisiana Council for Statewide Planning for Physician Manpower; Robert R. Franklin, M.D. is Executive Secretary of the Council and Assistant Professor, Department of Biostatistics and Epidemiolgy, Tulane University School of Public Health and Tropical Medicine; Janet C. Rice is Assistant Pofessor, Department of Biostatistics and Epidemiology at the Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112.     

Development of faculty consultants in a problem-based third year community medicine clerkship

This paper describes the development of consultancy groups in behavioral science, epidemiology and biostatistics, and information science in a required community medicine rotation with a twenty year history. The addition of consultants to individual student tutors and field preceptors has led to a structure which promotes student-project flexibility, development of critical assessment skills and independent learning while maximizing faculty expertise and effectiveness.Alan Silver is Assistant Chairman and Education Director of the Department of Community Medicine, Mount Sinai School of Medicine of The City University of New York. Clyde Schechter and Virginia Walther are the Co-directors of the third year community medicine clerkship. Kurt Deuschle is Professor and past chairman of the Department of Community Medicine.The authors wish to thank current and former clerkship directors and consultants for their invaluable skills in the ongoing evolution of the clerkship. These include Samuel J. Bosch, Bess Dana, James Godbold, George Jackson, Harriet Meiss, David Rose, Edward Speedling and Jean Sullivant.     

A review of dietary interventions aimed at controlling hypertension

Before planning programs to change dietary behavior in groups of individuals, evidence about the effectiveness of different interventions is needed. Articles published in the journals indexed by Index Medicus between the years 1975–84 were reviewed for evidence concerning the effectiveness of dietary modification programs in achieving dietary change. All program evaluations published in English and aimed at control of blood pressure levels in adults were eligible for review. Twenty-nine articles relevant to the synthesis contained sufficient information evaluating the contribution of dietary intervention. These 20 studies addressed changes in fat consumption, reduction in salt intake and reduction in calories consumed. The methods of intervention ranged from residential programs, through individual counseling and group discussion involving spouses, to audiovisual tapes. The studies had varying periods of follow-up; among those with one or more years of follow-up, a number of studies were able to demonstrate effectiveness using different outcome measures. For some dietary components, notably changes in fat intake and reduction in salt consumption, it has been possible to identify a minimal effective intervention, such as self-help materials or individual instruction, while changes in calorie intake or weight seem to require group counseling with family member involvement. The findings from this information synthesis should prove useful to those planning dietary interventions.Deborah E. Bender, Ph.D., M.P.H., is a Clinical Assistant Professor at the Department of Maternal & Child Health, School of Public Health. University of North Carolina, Chapel Hill. Shirley A.A. Beresford, Ph.D., is an Assistant Professor at the Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle. Stephanie L. McFall, Ph.D., is the Project Director, Center for Health Services & Policy Research, Northwestern University, Evanston.The research as funded by the Health Services Research & Development Field Program, VA Medical Center, Durham, NC, where each of the authors were members at the time of the study.     

Process and outcome evaluation of preventive care for infants in two types of practices

Process and outcome of preventive and promotive infant care have been evaluated in a maternal and child health (MCH) service and compared with that of a comprehensive care family practice (FP), both serving a low middle class population in West Jerusalem. Both services are provided by the Community Health Center of the Department of Social Medicine. Community oriented primary care is integrated into the practices, including ongoing surveillance of the communities' health status. Preventive and promotive programs have been developed, implemented and evaluated.The process evaluation indicated a similar use of the preventive service in the MCH and FP services. Some of the routines were carried out to a lesser extent in the FP than in the MCH framework, such as growth monitoring, hearing tests and advice on iron supplementation. The small difference in compliance with routines did not affect a child's growth between birth and one year of age, but the anemia rate in the FP practice was higher than in the MCH practice. The high level of care and relatively small differences in process and outcome between the two types of services have been achieved by ongoing inservice training, a high level of personnel, similar protocols and supervision in both practices.H. Palti, M.D. M.P.H., Associate Professor, Head of Maternal and Child Health Unit, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; D. Haustein, M.D. M.P.H., former student at the School of Public Health, Hebrew University and Hadassah, Jerusalem. Present address: Chabrier 179, San Isidro, Lima 27, Peru; R. Gofin, M.D. M.P.H., Lecturer & Physician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; B. Knishkowy, M.D. M.P.H., Family Physician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; B. Adler, M.Sc., Statistician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel.This study was supported by The Temin Endowment Fund. We wish to express our thanks to staff of MCH and FP practices of the Hadassah Community Research and Health Center, for their ongoing contribution to the MCH programs.     

A baseline evaluation of family support programs

This paper presents a baseline evaluation of four demonstration family support programs located in communities identified as having a disproportionate number of families at risk for malfunctioning. In this baseline evaluation, a one year cohort of 422 family support participants were assessed along key dimensions of parenting known to contribute to child well-being and potentially to the incidence of child abuse or child neglect. These dimensions include parents' attitudes toward child rearing, knowledge of child development, level of perceived social support, and level of depression.Black participants and teenage parents had more punitive attitudes toward child rearing, less knowledge of child development, and less perceived social support than white or older parents. Overall, attitudes, knowledge, level of perceived social support and depression are inter-related in accordance with previous clinical observations and developmental theory, e.g., depressed parents are less knowledgeable, more punitive and have less support than nondepressed parents. The results of the baseline evaluation suggest that the demonstration projects are successful in reaching some subgroups of families at risk for parenting problems.Janet Reis, Ph.D. is Assistant Professor, Center for Health Services and Policy Research, 629 Noyes Street, Northwestern University, Evanston, Illinois 60201. Linda Barbera-Stein, Ph.D. is Assistant Research Professor, Center for Health Services and Policy Research, Northwestern University. Elicia Herz, Ph.D. is Assistant Research Professor, Center for Health Services and Policy Research, Northwestern University. John Orme, Ph.D. is Assistant Professor, School of Social Work, Louisiana State University. Susan Bennett, M.A. is Research Associate, Center for Urban Affairs and Policy Research, Northwestern University.This work was supported in part by a contract from the Illinois Department of Children and Family Services and the Pittway Charitable Fund to the Center for Health Services and Policy Research, Northwestern University. Special thanks are given to Dr. Edward Zigler for his early guidance on this project. An earlier version of this work was presented at the American Public Health Association, Washington, D.C., November 1985.     

Correlates of a measure of coping in older veterans: A preliminary report

Sense of Coherence (SOC) is a specific measure of perception of coping ability which is examined here in relation to demographic characteristics and measures of physical and mental health status of older veterans (N=240). Results suggest that the SOC is strongly correlated with measures of subjective health status. It does not uniquely contribute to that dimension but does exhibit appropriate psychometric properties to encourage its use in further research.Rodney M. Coe, Ph.D., is Professor, St. Louis University School of Medicine and Education Coordinator, Geriatric Research, Education and Clinical Center, St. Louis VA Medical Center, St. Louis, Missouri, 63104; James C. Romeis, Ph.D., is Associate Professor, Center for Health Services Education and Research, St. Louis University and Coordinator, Health Services Research and Development, St. Louis VA Medical Center, St. Louis, Missouri, 63104; Boxiong Tang, MD., M.P.H., is a doctoral student in the Center for Health Services Education and Research, St. Louis University, St. Louis, Missouri 63104; and Fredric D. Wolinsky, Ph.D., is Professor, Department of Sociology, Texas A&M University, College Station, Texas, 77842.Supported in part by the Small Grants Program, Great Lakes Regional HSR&D Field Program of the Department of Veterans Affairs and NIA Grant AG00302.     

Time accounting in community medicine education

This paper describes the approach used by the Department of Community Medicine of the Mount Sinai School of Medicine in the formulation of personnel time requirements for undergraduate medical education. The results presented reveal that the two required undergraduate courses utilize a total of 5627 hours of faculty and support staff time. Implications of this method are discussed for program budgeting in medical education and the use of various course methods (e.g., lecture, seminar, tutorial).     

Health effects from indoor air pollution: Case studies

In recent years there has been a growing awareness of the health effects associated with the presence of contaminants in indoor air. Numerous agents can accumulate in public buildings, homes and automobiles as a result of ongoing activities that normally occur in these closed spaces. Ventilation is a major factor in the control of indoor air pollutants since proper movement of air can prevent or minimize the build up of compounds in buildings. The recent emphasis on energy conservation has lead to measures which economize on energy for heating and air conditioning, but which also trap pollutants within a building. Three cases of indoor air pollution were investigated. A typical investigation of indoor air pollutant problems includes the following: 1) interviews with building occupants; 2) history of the building with regard to maintenance, pesticide treatment, etc.; 3) a survey of the building and ventilation; and when warranted, 4) sampling and analysis of air. Each case presented is unique in that atypical situations caused agents to accumulate in a building or section of a building. The indoor air problems in these cases were solved by identifying and removing the source of the offending agent and/or improving the ventilation in the building.LuAnn E. White, Ph.D., DABT is Associate Professor Department of Environmental Health Sciences Tulane University School of Public Health and Tropical Medicine 1501 Canal Street New Orleans, Louisiana, 70112. Jacqueline R. Clarkson, MSPH is with the Louisiana Department of Health and Human Resources P.O. Box 60630 New Orleans, Louisiana, 70160. Shau-Nong Chang, Ph.D., CIH is Assistant Professor, Department of Environmental Health Sciences Tulane University School of Public Health and Tropical Medicine 1501 Canal Street New Orleans, Louisiana, 70112.