New York Medical College: An early center of excellence in American Medical education

Originating in 1850, the New York Medical College was one of the earliest medical schools to adopt the educational reforms advocated by the American Medical Association. This college lengthened the school term, employed more professors than usual and established a separate Board of Censors to approve students for their medical degrees. In addition, the New York Medical College initiated bedside clinical teaching using a 27 bed hospital under its own control. In an era when many medical schools were little more than diploma mills, the New York Medical College created educational reforms that were not adopted by other schools until many years later. Due to a combination of causes the New York Medical College only existed from 1850 to 1864. However, the effort to reform medical education was significant and should not be overlooked. Incidentally, the New York Medical College of 1850 to 1864 was in no way related to the currently existing medical school of the same name.Allen D. Spiegel is Professor, Department of Preventive Medicine and Community Health at the State University of New York, Health Science Center at Brooklyn, 450 Clarkson Avenue, Brooklyn, New York.     

Screening for cervical and breast cancer among Caribbean immigrants

A screening program for cervical and breast cancer, focused on immigrant Caribbean women, was carried out at neighborhood sites (churches, schools, etc.) in a low-income area of Brooklyn, New York.The yield of abnormal Pap tests was 13.3/1000 women screened; the yield of breast cancer was 2.2/1000 women examined. Approximately half of the Haitian immigrants (N=361) had no prior Pap test, compared to one-quarter of the English-speaking Caribbean immigrants (N=228) and one-tenth of the U.S.-born Black women (N=264). Only 47% of Haitian women had a regular source of health care compared to 74% of the English speaking Caribbean women and 83% of the U.S.-born Black women. Haitian women were much less likely to practice breast self-examination or to use contraception than were U.S.-born Black women.This program reveals significant needs for preventive health services among low-income Caribbean immigrant women, and demonstrates that selective neighborhood-site programs can be effective in reaching those in need.Rachel G. Fruchter, MPH, PhD, is Assistant Professor, Department of Obstetrics and Gynecology. Carolyn Wright, MS, is Community Health Educator/Coordinator, Department of Preventive Medicine and Community Health. Barbara Habenstreit, MA, is Assistant to the Chairman, Department of Preventive Medicine and Community Health. Jean Claude Remy, MD, is Assistant Professor, Department of Obstetrics and Gynecology. John G. Boyce, MD, is Professor, Department of Obstetrics and Gynecology. Pascal James Imperato, MD, MPH & TM is Professor and Chairman, Department of Preventive Medicine and Community Health, State University of New York, Downstate Medical Center.This research was supported by grants from the New York Community Trust and the Morgan Guaranty Trust Company of New York Charitable Trust     

Hospital reported complications of laparoscopic cholecystectomy among Medicare and Medicaid patients

The purpose of this study was to initiate a hospital-based case review of all laparoscopic cholecystectomies performed on Medicare and Medicaid patients in New York State in 1991 where there were one or more complications. Another purpose was to facilitate efforts by hospitals to monitor the performance of laparoscopic cholecystectomy through an educational process of data-sharing.There were 2,940 Medicare and 1,108 Medicaid cholecystectomies in New York State in 1991. Of these, 351 (11.9%) Medicare and 107 (9.7%) Medicaid patients were reported as having complications. The complication rate for Medicare patients was slightly lower than that observed (15.8%) in an epidemiologic study of Medicare patients in New York State who underwent laparoscopic cholecystectomy during the period January 1, 1990–June 30, 1991.Both of these observed rates for Medicare patients are higher than the mean 6.0% complication rate reported for open cholecystectomy in the literature. These increased rates may in part be due to age related risk factors present among Medicare patients. The absence of age related risk factors may also largely account for the lower laparoscopic cholecystectomy complication rate (9.7%) observed among Medicaid patients.The complication rate of 9.7% for Medicaid patients is similar to rates reported in other recent studies. The 11.9% complication rate for Medicare patients is higher than that reported in other recent studies. However, careful patient selection, the absence of age related risk factors, and greater surgical experience may account for the lower complication rates reported in some published series.Overall, the coding of complications was found to be accurate. The coding of laparoscopic cholecystectomy was found to be slightly flawed.Few of the adverse events leading to complications were deemed preventable by the hospitals. Surgeons often dealt with intraoperative problems by converting to a conventional open procedure.Hospitals should continue to monitor their experience with laparoscopic cholecystectomies over time, and should provide educational feedback to their medical staffs regarding these findings.Raphael P. Nenner, M.D. is Vice President for Medical Affairs for the Island Peer Review Organization (IPRO), 1979 Marcus Ave, Lake Success, NY 11042; Pascal James Imperato, M.D. is Medical Director for Research, Development, and Epidemiology (IPRO) and Professor and Chairman, Department of Preventive Medicine and Community Health, State University of New York (SUNY), Health Science Center at Brooklyn, 450 Clarkson Ave, Brooklyn, NY 11203; Theodore O. Will, M.P.A., is Executive Vice President (IPRO); Harriet Starr, M.A. is Vice-President for Management Information Systems (IPRO); Harry S. Soroff, M.D., (IPRO) and Professor, Department of Surgery, State University of New York, Health Sciences Center at Stony Brook, Stony Brook, NY 11794- 3399.We wish to acknowledge the assistance of Gary B. Beringer, Dr. P.H., Director, Department of Data Analysis, Island Peer Review Organization (IPRO); John Zetsche, M.A., Research Analyst, and H. Peter Lee, S.B., Research Analyst, IPRO.     

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     

Predictors of Partner Notification for C. trachomatis and N. gonorrhoeae: An Examination of Social Cognitive and Psychological Factors

Efforts to control chlamydial and gonococcal infections include notifying eligible sexual partners of possible infection, primarily by asking the diagnosed patient to notify their partners. This approach, known as patient referral, is widely used but poorly understood. The current study examined psychosocial and cognitive factors associated with patient referral among an urban, minority sample of 168 participants recently diagnosed with Chlamydia trachomatis or Neisseria gonorrhoeae. At a follow-up interview 1-month from diagnosis, participants were more likely to have notified all eligible partners if they had greater intention to notify at baseline (OR = 3.72; 95% CI = 1.34, 10.30) and if they had only one partner at baseline (OR = 4.08; 95% CI = 1.61, 10.31). There were also gender differences as well as differences based on type of partner (i.e., regular, casual, one-time). The implications of these findings for the design of programs to promote patient referral for sexually transmitted infections are discussed. Schwartz, Malka, Augenbraun, McCormack, and Wilson are with the State University of New York, Downstate Medical Center, Brooklyn, NY, USA; Rubin is with the New York City Department of Health, Bureau of STD Control, New York, NY, USA; Rubin, Hogben, and Liddon are with the Centers for Disease Control and Prevention, Atlanta, GA, USA; Schwartz is with the Department of Preventive Medicine and Community Health, SUNY Downstate Medical Center, Box 1240, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.     

Innovation in international training in occupational and environmental health: challenging unspoken assumptions.

The Department of Community and Preventive Medicine of the Mount Sinai School of Medicine, in collaboration with Queens College of the City University of New York, is conducting a research training program in cooperation with partner institutions in Mexico, Brazil, and Chile to assist them to develop an enhanced capacity to identify, document, and ameliorate environmental and occupational health problems of major public significance. The Fogarty International Center of the National Institutes of Health sponsors the program, which focuses on tailoring training to the host countries' needs and conditions. The program's centerpiece is the Selikoff Fellowship, which had been awarded to 15 Fellows by 1998. Each Fellow spends three one-month training periods in New York, interspersed with distance learning, and, with the help of a mentor, completes a research project in the home country. Details of the program are provided.     

Primary medical care for elderly patients part II: Results of a survey of office based clinicians

Evidence of the degree of fit between the special needs of the elderly and the service mix and payment level of ambulatory services offered under the Medicare program is presented in this second part of a two-part study of geriatric office care. Results from interviews with a focus group of 60 practicing clinicians, incorporating diversity of geography and practice setting, are described and compared with the view of geriatricians. Between 30 and 57% of the clinicians are aware of negative effects of Medicare's benefit structure on specific aspects of their practice.Marianne C. Fahs, Ph.D., M.P.H., is Assistant Professor of Health Economics, Department of Community Medicine, Mount Sinai School of Medicine.Charlotte Muller, Ph.D., 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.Malvin Schechter, M.S., is Assistant Professor of Geriatrics 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, Ph.D., 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.     

Aging and HIV Infection

With the advent of highly active antiretroviral therapy (HAART) in mid-1995, the prognosis for HIV-infected individuals has brightened dramatically. However, the conjunction of potent antiviral therapy and longer life expectancy may engender a variety of health risks that, heretofore, HIV specialists have not had to confront. The long-term effects of HIV infection itself and exposure to antiretroviral agents is unknown. Several aspects of aging, including psychiatric disease, neurocognitive impairment, and metabolic and hormonal disorders, may be influenced by chronic exposure to HIV and/or HIV therapeutics. In this paper, we discuss the health issues confronting HIV-infected older adults and areas for future research. Dr. Klein and Dr. Schoenbaun are with the Division of Infectious Diseases, Department of Medicine and The AIDS Research Program, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Dr. Anastos is with the Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Dr. Minkoff is with the Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY; Dr. Sacks is with the Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY.     

The Development of a Master of Public Health Program with an Initial Focus on Urban and Immigrant Health at the State University of New York,Downstate Medical Center

The State University Downstate Medical Center initiated a Master of Public Health (MPH) degree program in July 2001 following planning efforts that began in 1995. Twelve Students entered the program in June 2002. Currently, eighty students are enrolled in the program and eighteen have graduated from it in 2004 and 2005. With an initial focus on urban and immigrant health, the program aims to train public health professionals who can assist in addressing through population-based interventions the health issues of Brooklyn’s 2,465,326 people, of whom 38.5% are immigrants to the United States. Starting with four courses in the summer 2002 semester, the program now offers twenty-four courses over the three semesters of the academic year. The program is housed in the Department of Preventive Medicine and Community Health of the College of Medicine and is part-time in nature for most students. In addition to completing required course work, students must also complete a 250-hour practicum experience in which they apply theoretical knowledge in a public health practice setting. Student practicum experiences play a vital role in linking the program to communities and serve as conduits for the initiation of further community based collaboratives. This article describes the challenges encountered in initiating an MPH program in an academic medical center, the importance of both intramural and community support to its success, and the vital role it plays in addressing the health issues of various communities. The program became a leading priority of the Strategic Plan of the Downstate Medical Center in 2000, and received the full support of Downstate’s then new president, Dr. John C. LaRosa. This prioritization and support proved essential to the rapid development of the program. The Downstate MPH program offers a concurrent degree to medical students who are able to complete both degrees in a four year period. The Alumni Fund of the College of Medicine provides each MD/MPH student with a one-time scholarship which covers a quarter of the MPH tuition. Concurrent MPH degrees are also offered for graduate students enrolled in occupational therapy, nursing, and several other health programs. The Council on Education for Public Health (CEPH) conducted an accreditation site visit of the Downstate MPH program in December 2004. On June 10, 2005, the CEPH Board accredited the program for 5 years. Pascal James Imperato, MD, MPH & TM is Distinguished Service Professor and Chair, Department of Preventive Medicine and Community Health and Director of the Master of Public Health Program, SUNY Downstate Medical Center; Judith H. LaRosa, PhD, RN is Professor of Preventive Medicine and Community Health and Deputy Director of the Master of Public Health Program, SUNY Downstate Medical Center; Leslie Schechter, MA is the Administrator for the Department of Preventive Medicine and Community Health and the Master of Public Health Program, SUNY Downstate Medical Center.     

The 1974 reorganization of the British National Health Service: An analysis

The British National Health Service was reorganized on April 1, 1974, for the first time since its formation in 1948. The Reorganization attacked one serious problem: the anomalous separation of the general practitioners (and other nonhospital, non-local authority ambulatory services), hospitals, local government authority public health services, and teaching hospitals into different administrative units with different boundaries. These services are now integrated into one structure. However, other important problems will not be affected substantially.Dr. Jonas is Associate Professor of Community Medicine in the Health Sciences Center, State University of New York, Stony Brook, New York 11794. Dr. Banta is Associate Professor of Community Medicine at the Mount Sinai School of Medicine of the City University of New York and Robert Wood Johnson Health Policy Fellow in the Institute of Medicine, National Academy of Sciences, Washington, D.C. An earlier version of this paper was presented by Dr. Jonas at the American Public Health Association annual meeting, San Francisco, California, November 8, 1973. Dr. Banta is grateful to the Milbank Memorial Fund, whose support made possible visits to Britain in 1970, 1971, and 1974. The authors would like to thank Drs. Brian Abel-Smith, Peter Draper, Geoffrey Gibson, Wilfred Harding, David Stark Murray, and Julian Tudor-Hart for the helpful comments they made on the earlier paper by Dr. Jonas and also Dr. John Brotherston for his contributions to this work.     

A Third world international health elective for U.S. medical students. The 16-year experience of the State University of New York,Health Science Center at Brooklyn

The Department of Preventive Medicine and Community Health at the State University of New York, Health Science Center at Brooklyn (SUNY, HSCB) instituted an eight-week third world international health elective for fourth year medical students in 1980. Since that time, ninety students have participated. The purposes of this elective are to provide fourth year medical students with an opportunity to observe and study the structure and functions of a health care delivery system in a third world country, to provide medical service, and to have a crosscultural experience. The emphasis in this elective is on public health, preventive medicine, and primary care. There is a high level of student competition for this elective, with 46.9% of applicants having been accepted over a fifteen-year period. Although women comprise 40% of the average medical school class, they represent 50% of participants in this elective program. The percentage of African-American and Hispanic students has been 20%. These two minority groups represented from 8% to 10% of the student body during the period under study. Careful screening, including an examination of academic records and personal interviews, has resulted in the selection of highly motivated, adaptable, and dedicated students who have performed well at overseas sites. Student satisfaction levels with this elective are extremely high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to going overseas. This covers issues related to individual health and safety, travel and lodging, and the nature of the host country culture, health care system, and assignment site. Our students are especially experienced at cross-cultural understanding because of the unusual diversity of the patients they treat in Brooklyn, and the ethnic diversity of local hospital staffs and the medical school class. This Brooklyn experience in cross-cultural understanding has been cited by many participants as having been the best preparation for functioning in a foreign culture. The Alumni Fund of the College of Medicine has strongly and consistently supported this elective both with philosophical commitment and financial grants to help defray travel costs. This type of support is unusual among medical schools in New York City. Overseas preceptors have willingly given of their time and institutional resources to make these experiences available and meaningful for students.     

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.     

Understanding Immigrant Chinese Americans’ Participation in Cancer Screening and Clinical Trials

The purpose of this study was to identify potential barriers and facilitators to Chinese immigrant participation in cancer screening and clinical trials. A series of focus groups, in English, Cantonese, and Mandarin, were conducted with physicians, community leaders, and first generation members of the Manhattan Chinatown community. Participants were asked to discuss their beliefs about cancer, cancer screening, clinical trials, and cancer health education materials. Focus group data were stratified by respondent group and analyzed for thematic content. Eleven physicians, 15 community leaders, and 38 community members participated. Some community members were not familiar with cancer screening as a preventive measure and had not received common screens such as PAP smears or mammograms. They described widespread misconceptions about cancer that act as screening deterrents, e.g. testing for cancer can cause cancer. Community members were unfamiliar with clinical trials and would not participate in a clinical trial unless “sick,” and only on the recommendation of their physicians. Physicians did not see the relevance or value of clinical trials for their patients. Among first generation Chinese immigrants, there are many perceptual barriers to cancer screening and clinical trials recruitment. There is a need for effective culturally tailored health education on these health topics to address persistent misconceptions about cancer and to increase knowledge about cancer screening and clinical trials. Health education efforts and clinical trial recruitment in this community must involve community physicians. Jennifer S. Lin, MD was Senior Chief Resident at New York University School of Medicine, Department of Medicine and is currently a Bowen-Brooks Fellow, New York Academy of Medicine; Alyssa Finlay, MD was a General Internal Medicine Fellow at New York University School of Medicine, Department of Medicine, Primary Care and is currently an Epidemic Intelligence Service Officer, Center for Disease Control; Angela Tu, MD is a Resident at New York University School of Medicine, Department of Medicine, Primary Care; Francesca M. Gany, MD, MS is Director at the Center for Immigrant Health and Assistant Professor at New York University School of Medicine, Division of General Internal Medicine, Primary Care.     

Strengthening epidemiologic competencies among local health professionals in New York: teaching evidence-based public health

Starting in 2004, the New York State Department of Health and the University at Albany Prevention Research Center collaboratively developed a course entitled Evidence-Based Public Health for Local Health Practice to strengthen epidemiologic and other competencies of public health professionals in local health departments. This article describes the development of the course and its adaptation to the needs of local public health staff. The course utilizes didactic sessions, computer labs, and scenario-based exercises to demonstrate the use of data and evidence in the decision-making process. Follow-up surveys found that information and skills that emphasized epidemiologic competencies were likely to be used regularly or occasionally by the majority of participants. Half of the participants said that their agency's use of evidence-based public health practices had increased. Few respondents were trained as epidemiologists, yet most reported they used those skills in the workplace, suggesting a need to strengthen these competencies among non-epidemiologists.     

The Establishment of the School of Public Health at the State University of New York,Downstate Medical Center: The First Nationally Accredited School of Public Health in a Public University in New York City

The State University of New York (SUNY), Downstate Medical Center initiated a Master of Public Health (MPH) degree program in July 2001 following planning efforts that began in 1995. Twelve students entered the program in June 2002, and currently some 110 MPH students and 12 Doctor of Public Health (DrPH) students are enrolled. This article describes the long and complex process of transforming the original MPH degree program, with its single focus on urban and immigrant health, with a student enrollment of 12 and 8 full-time faculty, into a school of public health with a large student enrollment of 122 students, 25 full-time faculty, five MPH degree tracks, and four DrPH degree tracks. The process of establishing the SUNY Downstate School of Public Health in 2009 from its inception as an MPH program in 2001 spanned a period of 8 years. This process was guided by a commitment to two basic principles. The first was to maintain the original 2005 program accreditation by the Council on Education for Public Health (CEPH). The second was to sequentially secure accreditation for all subsequent four MPH and four DrPH degree tracks through CEPH’s procedure of substantive change approval. This policy assured continuous national CEPH accreditation of the original Urban and Immigrant Health MPH degree track and all added degree programs. The 5-year period following the initial CEPH accreditation of the MPH program in 2005 was one of intense development during which all of the essential elements for CEPH accreditation of a school of public health were put into place. This rapid development was made possible by the vision and full support of Downstate’s president, John C. LaRosa, MD, FACP, and the dedicated efforts of many. This included the students, faculty, staff, and administrators of the School of Public Health, the school’s Community Advisory Group, several external advisors, and many in the medical center’s Central Administration, College of Medicine, School of Graduate Studies, College of Nursing, College of Health Related Professions, and the University Hospital of Brooklyn. From the very beginning of the planning phase for an MPH program and through the ultimate accreditation of the School of Public Health in 2010, broad participation was solicited from all major units in the medical center. Thus, the MPH program became a center-wide initiative and not merely that of the College of Medicine’s Department of Preventive Medicine and Community Health. This broad participation has been continuously maintained through the involvement of leaders of other medical center academic units and the University Hospital of Brooklyn in the program’s and then the school’s standing and ad hoc committees, and in other activities as well. Similarly, community representation has been maintained, some through formal linkages relevant to the practical field experiences required of all students. In October 2010, the Board of Councilors of CEPH accredited the SUNY Downstate School of Public Health for a 5-year period through 31 December 2015. The accreditation of the school was a major milestone for Downstate, Brooklyn, and New York City. The SUNY Downstate School of Public Health is the first CEPH accredited school of public health in the history of Brooklyn, and only the second such school in New York City. It is also the first CEPH accredited school of public health at a publicly supported university in New York City. The school has already had a major impact on improving the health and well-being of the people of Brooklyn through its numerous collaborative community-based health promotion and disease prevention programs.     

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.     

The debate over Diagnosis Related Groups

With the advent of the Prospective Payment System (PPS) using Diagnosis Related Groups (DRGs) as a classification method, the pros and cons of that mechanism have been sharply debated. Grouping the comments into categories related to administration/management, DRG system and quality of care, a review of relevant literature highlights the pertinent attitudes and views of professionals and organizations. Points constantly argued include data utilization, meaningful medical classifications, resource use, gaming, profit centers, patient homogenieity, severity of illness, length of stay, technology limitations and the erosion of standards.Allen D. Spiegel, M.P.H., Ph.D. and Florence Kavaler, M.D., M.P.H. are Professors of Preventive Medicine & Community Health at Downstate Medical Center, 450 Clarkson Avenue, Box #43, Brooklyn, New York 11203     

The religious community as a partner in health care

In-depth structured interviews were conducted with spokespeople for 176 inner-city churches regarding perceptions of existing community problems, number of currently offered church-based social and health programs, and potential interest in church sponsorship of new maternal and child health programs. The sample of respondents represented 78% of the 227 churches located in a low-income, primarily black urban area with 150,000 residents. The typical church participating in the survey was Baptist with a congregation of 100 to 500 people, most of whom were not community residents. The leading community problems identified by the clergy were, in descending order: lack of jobs, teenage pregnancy, gang crime, school drop-outs, and hunger. The perception of community problems matched the church services offered as measured by the number of food and clothing pantries. Few churches had ongoing programs for neighborhood youths. Although many of these same churches expressed interest in expanding services for mothers, adolescents and children, few perceived themselves as having the necessary staff, funds, or technical expertise to conduct such programs.Lynn M. Olson, Ph.D. is Assistant Professor, Center for Urban Affairs and Policy Research. Northwestern University, 2040 Sheridan Road, Evanston, Illinois 60208.Janet Reis, Ph.D. is Assistant Professor, School of Nursing. State University of New York at Buffalo, Buffalo, New York.Larry Murphy, Ph.D. is Associate Professor, Institute for Black Religious Research. Garrett-Evangelican Seminary, Evanston, Illinois.Jennifer H. Gehm, B.A. is Research Analyst, Center for Health Economics Research, Boston, Massachusetts.This work is supported in part by grants to the Center for Health Services and Policy Research, Northwestern University; The Ford Foundation; The Chicago Community Trust; and The Field Foundation of Illinois. An earlier version of this paper was presented at the Annual Meeting of the American Public Health Association, Las Vegas, Nevada, September 1986.     

Teenage pregnancy in an urban hospital setting

Recent research suggests that adverse consequences of teenage pregnancy are largely a function of social background factors and adequacy of prenatal care. This study examines the situation of young mothers with new babies in a low income, urban environment. The study explores the relationship between age and ethnicity and various life circumstance and life style differences which might effect long term developmental outcome. 475 Hispanic and black mothers were interviewed using a structured questionnaire. The majority are poorly educated, single parents. Educational attainment is higher for blacks than for Hispanics and for older mothers than for younger. Older mothers are more likely to be living with the father, to be married, and to have received adequate prenatal care. Hispanic parents are more likely than Blacks to be planning to live together. Hispanic mothers are more likely than blacks to be planning to be the primary caretaker for their babies. Adequacy of prenatal care is related to both prematurity and low birth weight. The implications of these findings are discussed in relation to pregnancy prevention and parenting education programs.J. Kent Davis, Ph.D. is Chief of Psychological Services and Assistant Professor in the Department of Pediatrics at the New York Medical College, Valhalla, New York. Raymond Fink, Ph.D. is Professor in the Department of Community Medicine at the New York Medical College, Valhalla, New York. Benamana Rajegowda, M.D. is Associate Professor in the Department of Pediatrics at the New York Medical College and Director of the Neonatal Intensive Care Unit at the Lincoln Medical and Mental Health Center, Bronx, New York. Arun Yesupria, M.D. is Chairman of STAT Clinical Laboratories in India. Rasila Lala, M.D. is Assistant Professor in the Department of Pediatrics at the New York Medical College and an attending Neonatologist at Lincoln Medical and Mental Health Center, Bronx, New York.     

The health beliefs of health fair participants

The motivations and health beliefs of adults who participate in community-based health promotion were studied through a survey of 303 adults attending five community health fairs. Subjects were predominately female (69.9%), over age 60 (66.8%), and had at least yearly contact with a family physician (85.3%). Obtaining laboratory testing services was the sole reason for attendance for 47% of participants, was thought to be of much greater importance than health educational materials also offered at the health fair, and identified as providing a sense of control over personal health care. Receiving their own normal test results was perceived as assuring a healthy future for 86% of participants and few used these results to support erroneous health beliefs. A theme of positive health feedback, identified through factor analysis of survey responses, may prove useful for family physicians to incorporate into more directed and useful health promotion efforts for enhanced patient participation and satisfaction.John M. Heath, MD is Research Assistant Professor Department of Family Medicine, State University of New York Health Science Center at Syracuse. Karen S. Lucic, BSc is a Research Assistant, University of Cincinnati. David Hollifield, BS was a Medical Student, University of Cincinnati. John R. Kues, PhD is Assistant Professor, Department of Family Medicine, University of Cincinnati.This research was conducted during the senior author's faculty development fellowship training at the University of Cincinnati Department of Family Medicine and supported in part by US Dept. H.H.S. Grant #PE85025.