Continuing competence in selected health care professions

Health services professionals are confronting the challenge of maintaining and improving competence over the course of lengthy careers in diverse practice specialties. This article reviews the efforts of a selection of health care professions to ensure lifetime competence and reviews some of the challenges encountered in these efforts. Although each profession has its own issues, significant generic questions are common to all.     

Occupational attainment in selected allied health professions

This study examined the factors in the process of occupational attainment for a single group, the allied health professions. A 14-variable causal model was developed to explain postcollege attainment of a job in one of five allied health professions: medical dietetics, medical social work, occupational therapy, physical therapy, or speech therapy. The sample was composed of 272 college students who responded to the Cooperative Institutional Research Program surveys of 1971 and 1980. Analysis indicated that several variables, including academic integration, having a science major, and being oriented to service, had significant direct effects on attainment in the allied health professions. Knowledge of the personal characteristics and achievements of those who successfully enter jobs in the allied health professions may allow informed student and faculty choices and reduce recruitment and retention problems in schools of allied health.     

Graduate health professions education: an interdisciplinary university - community partnership model 1996 - 2001

INTRODUCTION: In 1996, East Tennessee State University (ETSU) reinforced its historical commitment to multidisciplinary community engagement by developing a graduate level community partnerships program in the Division of Health Sciences. While the university's earlier health partnership efforts relied primarily on curricular innovation, the approach to graduate health professions education was to seed a series of curricular enhancements and interdisciplinary, community-based learning experiences and service into traditional curricula. This paper presents the experience of one school in crafting a regional network that became the basis of a division-wide graduate level teaching and learning initiative. INNOVATIONS AND EVALUATION: Carefully selected planning and implementation techniques enabled multidisciplinary practitioners and community members from across a 20-county region to participate with university faculty in training ETSU learners in community-based medical care. By year four of the project, curricular "enhancements" were institutionalized in over five departments across the Division and engaged 1160 medical residents and graduate learners in a give - get model of health education. Programme evaluation methodology was collaboratively defined and documentation of programme effort and outcomes regularly reported and strategically reviewed. CONCLUSIONS: Programme evaluation demonstrates mutual benefit to community and university. Faculty involvement in programme activity increased fourfold and community involvement in training of health professions graduate learners increased threefold by year four. Educational innovations were adopted into traditional curricula, thousands of hours of clinical services were provided to underserved communities and the university-community team forged by network links continues to promote multidisciplinary interests through joint public policy endeavors.     

Gender, health professions and public health

In this article we review the main results of historical-social research on gender and medical practice, propose a model for applying a gender perspective to the study of healthcare professions, and analyze some current forms of gender bias in Spanish public health societies and publications. The main conclusions indicate: the historic construction of gendered professional identities; the existence of vertical segregation by sex in scientific societies and in journal editorial boards; the existence of androcentric practices in the scientific journals, exemplified by the style of using the initial letter of the authors' first name; the fact that scientific societies do not collect data by sex; the difficulties that all of this implies for quantitative investigations that study the sex variable and adopt a gender perspective; and the need to promote qualitative research on the issue.     

Cholera epidemic in Senegal in 1995-1996: an example of geographic approach to health

There have been many cholera outbreaks in Senegal since 1971. The last outbreak began in the Dakar region in August 1995. It spread to the Diourbel, Fatick, Saint-Louis and Thies regions. In January 1996, the outbreak hit the Niakhar study area in the Fatick region. A team from ORSTOM (the French Institute of Scientific Research for Development in Cooperation) has been recording demographic events in this area for almost 15 years. The geographic approach is based on the automated mapping of cholera in hamlets and villages. Such studies investigate the factors determining the spread of diseases, within the context of land use. Three sets of data were used: demographic data that had been routinely collected and were available from a database, digitized maps and epidemiological data from a surveillance system set up to monitor the outbreak. A series of incidence maps, over time and on various scales, were generated using specialized software. The maps were analyzed and the outbreak was found to be heterogeneous over time. There were two waves of the outbreak and differences according to age and gender. The degree of heterogeneity depended on the place of residence. Heterogeneity was probably determined by village size, roads and the concentration of inhabitants within hamlets, which is roughly equivalent to the number of people per bore hole. These preliminary results suggest that further research is necessary, looking at different geographical scales (e.g. households, districts and regions). Qualitative studies of water use and the organization of the water supply are also required.     

A moment in time: selected results from the 1996-1997 New Zealand health survey.

This article presents key results from the 1996-1997 New Zealand Health Survey, the second of two nationally representative surveys on the health status and health service utilization of New Zealanders. This survey involved a face-to-face interview with 7,862 adults and 1,019 children carried out during the period of a year. The survey had an adult response rate of 73.8%. Using the results of this survey, this article highlights some of the major public health issues facing New Zealanders. These issues include smoking, physical inactivity, alcohol use, asthma, and diabetes. The results presented here show that significant disparities exist between particular demographic and socioeconomic groups in New Zealand in relation to both health risk factors and specific chronic diseases. The policy implications of the results are discussed in relation to existing public health strategies and future initiatives.     

Patterns of individual health insurance coverage, 1996-2000

Information about patterns of individual health insurance coverage is limited. Knowledge gaps include the extent to which individual insurance provides transitional versus long-term coverage, and participants' insurance status before and after being covered by an individual plan. In this study we use data from the 1996-2000 Survey of Income and Program Participation (SIPP) to examine how long the individually insured maintain their coverage; sources of coverage before and after enrolling in an individual health plan; and characteristics of those who rely on individual insurance coverage. Understanding the dynamics of this market will better inform federal and state insurance reform efforts.     

Contribution of selected metabolic diseases to early childhood deaths--Virginia, 1996-2001

Sudden infant death syndrome (SIDS), or the death of an infant aged <1 year that remains unexplained after a thorough investigation, is the third most common cause of death among infants in the United States. Sudden, unexplained deaths also occur among children aged >/=1 year; however, the number of these deaths is not well documented. Certain cases of SIDS and sudden unexplained death beyond infancy might be attributable to complications of unrecognized metabolic diseases. Tandem mass spectrometry (tandem MS) can be used to screen for several of these disorders. Despite the low prevalence of these diseases, newborn screening for these disorders has been found to compare favorably with the cost of other screening programs. However, the contribution of these diseases to early childhood deaths is not well understood. To determine the proportion of sudden, unexpected early childhood deaths associated with selected metabolic diseases, CDC, the Office of the Chief Medical Examiner (ME) in Virginia, and a private laboratory conducted a population- based study. This report summarizes the results of the study, which indicate that 1% of children had a positive postmortem metabolic screen using tandem MS. Of the eight children with positive screening tests, seven might have had improved outcomes had they been identified and treated during the newborn period. The use of tandem MS in newborn screening programs could offer an opportunity to prevent early childhood mortality.     

Equity and geographic distribution of financial resources in health systems

This study focuses on equity in health and specifically the geographic distribution of financial resources. The author reviews the main contemporary theories of social justice and discusses the concept of equity in general and specifically in the health field. Based on the discussion of selected international experiences (United Kingdom, Spain, and Italy), the Resource Allocation Working Party (RAWP) formula used in the United Kingdom is identified as the most adequate distributive methodology, sizing the relative needs based on the population's demographic and epidemiological profiles. Finally, the results are presented from a simulation performed for the Brazilian case, showing that a more equitable geographic distribution of financial resources would require a redistribution favoring the States of the North and Northeast. The article concludes by highlighting that a comparison of actual fund outlays by the Ministry of Health in 1994 and the results of the simulation with the RAWP methodology for the Brazilian case show that the principles written into Brazilian legislation were absent from the geographic distribution of financial resources.     

Technology, specialization, and the allied health professions

Medical specialization has been made possible through the evolution and dominance of the anatomic theory of disease and the growth of technology. Through the view offered by anatomy, the idea of dividing and studying portions of the body seemed natural and desirable. Through technology, diagnostic and therapeutic actions on these parts became possible. Specialization has affected all aspects of medicine, particularly the allied health professions. The narrow perspective on illness that specialization can produce in allied health professionals may be forestalled through systematic educational efforts to broaden their understanding of illness by delineating the ethical dimensions of their relationship to patients, creating a view of their place in the historical evolution of medicine, and examining how technology influences medicine and its role in shaping allied health careers.     

Blood lead levels in young children--United States and selected states, 1996-1999

Lead exposure adversely affects the cognitive development and behavior of young children (1). For children aged < 6 years, CDC has defined an elevated blood lead level (BLL) as > or = 10 microg/dL, but evidence exists for subtle effects at lower levels (2). Data from CDC's Third National Health and Nutrition Examination Survey, Phase 2 (1991-1994) (NHANES) showed that average BLLs in children had decreased approximately 80% since the late 1970s but that elevated BLLs remained more common among low-income children, urban children, and those living in older housing (3,4). Although these data provide national estimates of the prevalence of elevated BLLs among children, they do not provide information at the state or local level. To target prevention efforts and monitor progress toward reducing BLLs at the state and local level, CDC's Childhood Blood Lead Surveillance (CBLS) program supports state blood lead surveillance programs on the basis of blood lead tests from public and private clinical laboratories. This report summarizes data on BLLs in children aged 1-5 years from NHANES data collected in 1999 and children aged < 6 years from state surveillance data provided to CDC by 19 state surveillance programs during 1996-1998. The findings indicate that, despite the decreases in mean BLL among children, the problem remains concentrated on a local level. Surveillance efforts should be used to target screening efforts to communities at highest risk.     

Images within the allied health professions.

The purpose of this study was to identify the perceived images, understanding, and respect shared by employed members of six allied health professions and to determine the nature and extent of interactions these professions share as members of the hospital team. The results indicate a large variance in levels of understanding and respect among the professions. Most responded that they understood the other professions but the other professions did not understand them. The results also indicate that the professions interact on an average of no more than five hours per week, with their common interactive roles being peer relationships.