A partnership in health education between a neighborhood school and a community hospital

This paper reports the results of a cooperative effort between a community teaching hospital and a neighborhood Inter-mediate School to promote health education in an urban setting. The liaison stemmed from the need to educate a large, multi-ethnic student population and, through it, the community. To this end, the administrative, teaching, and medical staffs of the school and hospital prepared a series of health education events designed to provide needed information. The subjects incuded: Mental Health, Urgent Care, Personal Hygiene, Nutrition, Eating Disorders, Substance Abuse, Teenage Sexuality, Depression, Suicide, and Family Relationships.This paper describes the results of a student questionnaire designed to measure the effectiveness of one of the programs and provide a venue for student suggestions. These suggestions were incorporated into subsequent programs.This cost-free partnership was one of six programs chosen as being outstanding in the field of education in New York City. It was the recipient of the Council of Supervisors and Administrators Education Program Award for 1987, New York City.Phyllis D. Weiner, M.D. is Director of Pediatric Ambulatory Care and Emergency Medicine, Flushing Hospital Medical Center, 4500 Parsons Boulevard, Flushing, New York 11355. Joseph D. Cantara, P.D. is Assistant Principal, Rachel L. Carson, Intermediate School, 46–21 Colden Street, Flushing, New York, 11355. Nicetas H. Kuo, M.D., M.P.H. is Director of Community Medicine and Ambulatory Care Services, Flushing Hospital Medical Center, 4500 Parsons Boulevard, Flushing, New York 11355. James Lione, M.D. is Chairman of the Department of Pediatrics. Flushing Hospital Medical Center, 4500 Parsons Boulevard, Flushing, New York, 11355. Address requests for reprints to Dr. Weiner.     

Hôpital Albert Schweitzer and the Republic of Haiti

The Hôpital Albert Schweitzer was established near the village of Deschapelles in Haiti in 1956 by Dr. and Mrs. William Larimer Mellon of Arizona. The hospital currently has 162 acute care beds and provides inpatient and outpatient services to a district of about 160,000 people. In 1983, visits to the hospital and its dispensaries totaled 39,163. Since its founding the hospital has evolved into a tertiary care facility but has also established primary care programs through seven satellite dispensaries. Health agents and midwives play an important role in the hospital's field programs. Outreach programs concentrate on health and nutrition education, immunization, supplementary food programs, tuberculosis screening, oral rehydration for infants with diarrheal diseases and cord cutting clinics for the prevention of neonatal tetanus.This paper describes the principal causes of morbidity and mortality in this area of Haiti, the functioning of the hospital and both its medical and non-medical programs. The latter include agricultural irrigation and well digging projects, and wood working, weaving and ceramic facilities to encourage local artisans.

William Shakespeare

Richard Long, M.D., F.R.C.P. is a pulmonologist, St. Boniface General Hospital, 409 Taché Avenue, Winnipeg, Canada. He was a short stay physician at the Hôpital Albert SchweitzerMarcella Scalcini, M.D., F.A.C.P., M.P.H. & T.M. is the Medical Director of St. Jude Hospital, St. Lucia and was formerly head of the Department of Medicine at Hôpital Albert Schweitzer.The authors would like to thank everyone at H.A.S. for making this review possible. They are especially grateful to Dr. and Mrs. William Larimer Mellon, Founders and Directors of H.A.S., Dr. J. Fett, Medical Director, H.A.S., Dr. E. Gucchi, Head, Department of of Anesthesia, Dr. A. M. Daney, Head, Department of Public Health, and Dr. F. Vilmé, Head, Department of Pediatrics.     

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.     

Evaluation of a primary health care program for the poor

This paper examines the success in implementing a major program involving a partnership between public and private providers to deliver primary health care services to the poor. In 1985, the 69th Texas Legislature passed the Primary Health Care Services Act, authorizing the Texas Department of Health to contract for or directly provide primary health care services in those parts of the state that are medically underserved and have large numbers of people in poverty. This paper evaluates the potential impact of the projects with respect to access and cost. The study revealed that the basic concept of allowing local public and private providers to develop projects reflecting their community's unique needs and resources was successful. The approach lead to a wide variety of different types of projects, but the basic goals and activities of the projects are consistent with the legislation. The evaluation identified three major program areas that could be improved: (1) patient monitoring and follow-up to ensure the accessibility of the priority primary care services, (2) the need for the development of projects in other high need areas of the state, and (3) greater efficiency in service delivery.Charles E. Begley, Ph.D. is an Assistant Professor at the School of Public Health, The University of Texas Health Science Center at Houston, P.O. Box 20186, Houston, Texas 77225.Lu Ann Aday, Ph.D. is an Associate Professor at the School of Public Health, The University of Texas Health Science Center at Houston.Roy McCandless is a Faculty Associate, Center for Health Policy Studies, School of Public Health, The University of Texas Health Science Center at Houston.The research on which this paper is based was supported by the Bureau of Dental and Chronic Disease Prevention, Texas Department of Health. The authors wish to acknowledge the substantial contributions of Margaret Frank, M.H.S. and Kiyoko Parrish, M.P.H., Faculty Associates with the Center for Health Policy Studies, in the development and conduct of this research.     

The use of asbestos-cement pipe for public water supply and the incidence of cancer in selected communities in Utah

We tested the hypothesis that there is an association between the use of asbestos-cement piping for drinking water supplies and the incidence of gastrointestinal and kidney cancer. Cancer incidence in 14 Utah communities that had used predominantly asbestos-cement piping for transporting their drinking water supplies for 20 years or more were compared to 27 Utah communities that had never used asbestos-cement piping.Cancer incidence was tabulated for 11 cancer sites for the years 1967–1976. Increased Standard Incidence Ratios (SIRs) were found for cancer of the kidney in men (SIR 192) and leukemia (a control site) in women (SIR 203). No increased SIRs were found for the opposite sex at these sites or for the other gastrointestinal sites singly or in combination. There was no increase in age-adjusted cancer incidence for the 11 sites in 4 of the 14 study communities that had used asbestos-cement piping for 30 years or more. Limitations of the study were that the water supplies were nonaggressive, and leaching from the pipes was minimal if at all. Furthermore, the latent period for observation was very short, suggesting that these results should be considered preliminary.Terry D. Sadler, M.S.C.M., is with the Rocky Mountain Center for Occupational and Environmental Health, Departments of Internal and Family and Community Medicine, University of Utah, and the Salt Lake City-County Health Department. William N. Rom, M.D., M.P.H., and Joseph L. Lyon, M.D., M.P.H., are with the Rocky Mountain Center for Occupational and Environmental Health, Departments of Internal and Family and Community Medicine, University of Utah. James O, Mason, M.D., Dr. P.H., is with the Utah Department of Health, Salt Lake City, Utah     

Meningococcal disease in Louisiana 1978–1985

Data were analyzed from 729 meningococcal cases reported to the Epidemiology Section, Office of Preventive and Public Health Services, Louisiana Department of Health and Human Resources from 1978 through 1985. A total of 122 deaths (16.8%) occurred from these cases, with the highest case fatality rate (23.7%) noted in 1981. The eight-year average incidence rate per 100,000 population was 2.1. For individual years, the incidence rate was highest (3.6) in 1978 and lowest (0.8) in 1985. Although incidence rates per 100,000 population were greater for males during all years except 1978 and 1985 and greater for nonwhites in 1978, 1980, 1981, 1983 and 1984, the eight-year average incidence rates by sex and race were almost the same. Incidence rates were found to be highest in the less than one, and one to four-year age groups. For all eight years, over half of the cases were in the four years and under age group; the same was true for deaths, except in 1982 (46.7%). February was found to be the month with the highest frequency of reported case onset and death. The mean difference between date of disease onset and death for all fatal cases was 2.716 days (S.D.=6.48). Ten of the 64 Louisiana parishes reported no meningococcal disease cases from 1978–1985. There were 25 parishes with an eight-year average incidence rate of greater than 2.1. The overall incidence rates in Louisiana were greater than rates in the United States for the time periods reviewed.John B. Vaughn, D.V.M., M.P.H. Chairman and Professor, Department of Applied Health Sciences, Tulane University School of Public Health and Tropical Medicine, Theresa J. Forti, B.S.N., M.S. Hyg., Dr. P.H. Associate Professor, Department of Applied Health Sciences, Tulane University School of Public Health and Tropical Medicine. James E. Banta, M.D., M.P.H. Dean and Professor Tulane University School of Public Health and Tropical Medicine, Louise McFarland, M.P.H., Dr. P.H. is Chief, Epidemiology Section State of Louisiana Department of Health and Human Resources, and Karen Y. Kelso, C.R.N., B.S. is Nurse Epidemiologist State of Louisiana Department of health and Human Resources.The authors extend thanks to Mrs. Audrey P. Collins, Biostatistician, Louisiana Department of Health and Human Resources, and Barbara H. Denton, Demographer, Louisiana Tech University for their assistance in providing population data. Gratitude is also expressed to Dr. Charles T. Caraway for help with review of data.     

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.     

The morbidity,mortality, and economic costs of cigarette smoking in New Hampshire

The Surgeon General of the United States Public Health Service has identified cigarette smoking as the single most important source of preventable morbidity and premature mortality. An analysis was conducted in the state of New Hampshire to determine the consequences of smoking: morbidity, mortality, and economic costs to the population. Data were collected on smoking prevalence, smoking attributed deaths, years of potential life lost, hospital days attributed to smoking diagnoses, direct medical costs, and per capita incomes. Smoking attributable fractions were applied to these data. In 1983, 16% of total statewide deaths were attributable to cigarette smoking. These deaths included 15% of the cardiovascular deaths, 20% of cancer deaths, 42% of respiratory disease deaths, 3% of digestive disease deaths, and 5% of infant deaths, in a population of less than 1 million. These deaths represented almost 3100 years of potential life lost. Smoking attributable hospital days totaled almost 70,000, for 8% of male and 4% of female hospital days. Direct medical care costs attributable to cigarette smoking were over $76 million, 7% of the total statewide medical costs. Indirect costs (present value of lost earnings due to premature mortality and morbidity attributable to smoking) were almost $118 million. These economic costs totaled almost $200 million. The results of this study were used extensively by the New Hampshire media and volunteer agencies. This methodology can be a model for other local area analyses.Robin D. Gorsky, Ph.D. is an Assistant Professor in the Department of Health Management and Policy, University of New Hampshire, Durham, NH 03824. Eugene Schwartz, M.D., M.P.H. is Epidemiologist and Director of the Bureau of Cancer Control, Washington, DC. David Dennis, M.D., M.P.H., is the Director of the Bureau of Disease Control, Commonwealth of Pennsylvania, and in the Division of Field Services, Epidemiology Program Office, Centers for Disease Control, Atlanta, GA. This study was completed at and supported in part by the Bureau of Disease Control, Division of Public Health Services, Department of Health and Human Services, Concord, NH, and the Department of Health Management and Policy, University of New Hampshire, Durham, NH. Requests for reprints should be addressed to: Robin D. Gorsky, Ph.D., Department of Health Management and Policy, University of New Hampshire, Durham, NH 03824.     

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.     

The Vermont health risk survey and the design of community wide preventive health programs

A Vermont health risk survey was performed to gain information on health knowledge and behaviors of the population. Telephone interviews with 1,594 individuals ascertained respondents' demographic characteristics, preventive health behaviors, and health knowledge. Risk prevalence was obtained on five health risks: alcohol (12%), smoking (33%), lack of exercise (70%), overweight (39%), and non-use of seatbelts (86%). Low income, less education, and blue collar occupation status were associated with increased risks of smoking, lack of exercise, and non-use of seatbelts. Increased prevalence of certain risks are associated with the 18–24 year old age group; 32% of those males reported an alcohol risk and 94% reported non-use of seatbelts. Combined risk scores were increased in groups with low income, less education, and blue collar occupations. These variations in health behaviors by social group were not explained by differences in health knowledge. Design of primary prevention activities needs to (1) be community wide, (2) utilize information on the epidemiology of health behaviors, (3) influence diverse community groups and (4) intervene before risk behaviors are established.Lloyd F. Novick, M.D., M.P.H., is Director of the Arizona Department of Health Services, 1740 W. Adams, Phoenix, Arizona 85007.David Jillson, PH.D. is Senior Research and Statistics Analyst at the Vermont Department of Health, 60 Main Street, Burlington, Vermont 05401.Roberta Coffin, M.D. is Commissioner of the Vermont Department of Health, 60 Main Street, Burlington, Vermont 05401.Mary Freedman, M.A. is Director, Public Health Statistics, Vermont Department of Health, 60 Main Street, Burlington, Vermont 05401.This article was presented at the Association of State and Territorial Health Officials Annual Meeting April 24, 1984, in Little Rock, Arkansas.     

Reviews of Books and Reports

Book reviewed in this article:
Nemir, Alma, M.D., The School Health Program
Anderson, C. L., Health Principles and Practice
H. Frederick Kilander. Sex Education in the Schools .
Fox, John P., M.D., Ph.D., M.P.H., Carrie E. Hall, R.N., M.P.H., and Lila R. Elveback, Ph.D. Epidemiology: Man and Disease
BOVINE TUBERCULOSIS CONTROL IN MAN AND ANIMALS—J. Arthur Myers, M.D., Ph.D., and James H. Steele, DVM, MPH. Warren A. Green, Inc.
Kogan, Benjamin A., M.D., Dr. P.H., Health, Man in a Changing Environment     

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.     

Second year medical student opinion about public health and a second year course in preventive medicine and community health

The results of five annual surveys of second year medical students over an eight year period of time (1978–1985) concerning perceptions and attitudes toward public health and a course in preventive medicine and community health are presented. The questionnaire format was a combined fixed alternate and free response type and was structured to require only ten to 15 minutes for its completion. Participation rates were generally high varying from 60.2% (1980) to 93.8% (1985). The majority of students in all years favorably evaluated most components of structure, content and presentation of the course. It was found that opinions about the course can be modified by the introduction of variables that are unrelated to the scope of the quality of the course as occurred in 1979, with a difficult midterm examination. Student anger over this examination was translated and expressed as negative opinion about many other aspects of the course which in other years were highly rated. This finding underscores the vulnerability of surveys of subjective opinion and demonstrates that course evaluations must include other objective aspects in addition to student perceptions.Pascal James Imperato, M.D., M.P.H. & T.M., is Professor and Chairman of the Department of Preventive Medicine and Community Health, State University of New York Health Science Center at Brooklyn.Joseph Feldman, Dr. P.H. is Professor, Department of Preventive Medicine and Community Health, State University of New York Health Science Center at Brooklyn.Kamran Nayeri, B.A. is Instructor, Department of Preventive Medicine and Community Health, State University of New York Health Science Center at Brooklyn.     

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.     

Home-based Health Risk Appraisal and screening program

In an effort to improve Health Risk Appraisals and to induce individuals to change their lifestyles, comprehensive evaluations and counseling sessions were carried out for 476 participants of an experimental preventive care program (1984). Nurse practitioners interviewed participants in their homes and collected information about their lifestyle, medical history, and family history. In addition, physical examinations were performed and blood samples were obtained for laboratory analysis. This information was used to formulate health risk profiles for all participants who were then counseled on how to decrease identified health risks. Interventions included education about health risks and specific programs which were administered to help modify high-risk behaviors. At one year follow-up, significant risk reductions were reported in many areas of increased risk.Victor W. Acquista, M.D., is a Fellow in General Internal Medicine, Rhode Island Hospital. Tom J. Wachtel, M.D., is Director, Medical Primary Care Unit, Rhode Island Hospital, and Assistant Professor of Community Health, Brown University. Celia I. Gomes, M.P.H., is Health Education Coordinator, Blue Cross/Blue Shield of Rhode Island. Michael Salzillo, M.S., is Team Leader, Statistical Analysis Department, Blue Cross/Blue Shield of Rhode Island. Melanie Stockman, R.N., is Director of Ambulatory Nursing, Rhode Island Hospital.     

Marketing strategies for recruiting gay men into AIDS research and education projects

Recruiting gay and bisexual men into AIDS-related research and education programs will become increasingly common as federal, state and local funds become available. The Pitt Men's Study, a study of the natural history of Human Immunodeficiency Virus (HIV) infection, developed a recruitment strategy based on marketing principles. These techniques allowed the study to target particular gay and bisexual groups for inclusion. 1718 gay and bisexual men were recruited. Non-whites and unemployed men were targeted and recruited in numbers comparable to their representation in the larger community.Anthony Silvestre, M.A., is Director of Community Programs for the Pitt Men's Study, Department of Infections Diseases and Microbiology, University of Pittsburgh. David W. Lyter, M.D., is Clinical Director of the Pitt Men's Study, Department of Medicine, University of Pittsburgh. Charles R. Rinaldo, Jr., Ph.D., is the Principal Investigator of the Pitt Men's Study, Departments of Pathology and Infectious Diseases and Microbiology, University of Pittsburgh. Lawrence A. Kingsley, Dr. P.H., is the Epidemiologist of the Pitt Men's Study, Department of Medicine, University of Pittsburgh. Randall Forrester, B.A., is a consultant with the Pitt Men's Study and the Executive Director of the Persad Center. James Huggins, M.S.W., A.C.S.W., is a consultant of the Pitt Men's Study and the Director of Clinical Programs of the Persad Center.This study was supported by NIH Contract NO 1-AI32513.We are indebted to Pittsburgh's gay community for its support of our project. We thank Brett Cassens, Nick Ifft, Art Duprat, Albert Pasquarelli, Nnena Odim, the late Daniel Sbrochi, Deborah C. Laurie, Alan Simmons, Richard Witt and Douglas Johnson.A portion of this paper was presented at the International Conference on AIDS in Atlanta in April, 1985.     

Role disagreement in primary care practice

To measure the extent of disagreement on roles between nurse practitioners (NPs) and physicians working together and to look for characteristics of joint practices that are associated with disagreement, patient vignettes were sent to 15 NP/M.D. dyads, and both M.D.s and NPs were asked how appropriate it would be for them and for their co-practitioner to provide care for the problem presented in each vignette. Measures of disagreement on patient care roles were developed by comparing responses within the dyad. For all practices, there was moderate agreement on roles, and this agreement seemed to favor a complementary practice. Disagreement on the NP's role was most often in the direction of NP feeling capable of providing more care than the M.D. felt she could provide. Various factors, such as job satisfaction, age differences between providers, and training level of the NP, were associated with the disagreement that was found. Some disagreement on roles exists between NPs and M.D.s practicing together. Resolution of these differences may lead to greater job satisfaction and more effective interaction between providers.The authors are with the University of North Carolina, Chapel Hill where Dr. Davidson is an Assistant Professor of Medicine in the Division of General Medicine and Clinical Epidemiology, Dr. Earp is an Assistant Professor of Health Education in the School of Public Health and Dr. Fletcher is Co-Chief of the Division of General Medicine, Associate Professor of Medicine and Clinical Epidemiology, and Director of the Robert Wood Johnson Clinical Scholars Program. Reprints may be obtained from Richard Alan Davidson, M.D., M.P.H., Department of Medicine, 3041 Old Clinic Building, University of North Carolina, Chapel Hill, North Carolina 27514. This work was presented at the American Federation for Clinical Research Meetings, May, 1980. This project was supported in part by the Robert Wood Johnson Clinical Scholars Program. The authors would like to acknowledge the assistance of David McKay in the planning of this study.     

REVIEWS

Book reviewed in this article:
Your Child's Teeth . By Vivian V. Drenckhahn, M.S., C.P.H., and C. R. Taylor, D.D.S., M.S.P.H.
Community Organization for Health Education . A Committee Report Presented by The Committee on Community Organization for Health Education of the American Public Health Association to the Public Health Education Section and the Health Officers Section. Clair E. Turner, Dr.P.H., Sc.D., Chairman.     

The National Institute for Health and Clinical Excellence: an interview with Gillian Leng, MD

Within Great Britain's National Health Service, the National Institute for Health and Clinical Excellence (NICE) is the agency charged with the task of developing and disseminating guidelines to be followed by all National Health Service providers and provider organizations. Dr Gillian Leng is the Director of Implementation Systems and a member of the Board of Directors of NICE. As a member of the Wolfson Unit for the Prevention of Peripheral Vascular Diseases in the Department of Health Sciences of the University of Edinburgh Glasgow, Dr Leng took an active role in the unit's research. She was a member of the Editorial Team of the Cochrane Peripheral Vascular Disease Group, of the Edinburgh University Medical School. Prior to joining NICE, Dr Leng, a board-certified internist, conducted a practice in internal medicine. Dr Leng was interviewed by QMHC at the London offices of NICE in October 2006.     

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.