Evaluation of the rural South Australian Tri-division Adolescent Health Project

ABSTRACT: The Adolescent Health Project (AHP) was a rural pilot project aimed at strengthening the relationship between general practitioners (GPs) and adolescents within three Divisions of general practice. The evaluation assessed the implementation of the AHP model and strategies and their impact. The AHP used a centralised management/support and local delivery model. The AHP improved GP relationships and comfort with dealing with young people, and improved GP relationships with school counsellors. Divisional relationships with local schools improved. Students reported increased knowledge about GPs, increased confidence and comfort with accessing GPs. The AHP delivered a popular project to GPs, GP clinics, schools, school counsellors and students, which built the capacity of divisions, GPs, and schools to improve adolescent health care provision. Further research questions have emerged: What are the patterns of relationships between GPs and adolescents, and between GPs and school counsellors, and what strategies work best to sustain such relationships?     

Housing for ageing LGBTQ people in Sweden: a descriptive study of needs,preferences, and concerns

Background/aim: With an increasing number of ageing people who identify themselves as lesbian, gay, bisexual, transgender, or queer (LGBTQ), there is a risk that traditional housing for older people fails to meet the needs of these people. The aim of this study was to describe LGBTQ people’s needs, preferences, and concerns according to ageing and housing.

Materials and methods: Based on a survey (n?=?487), and six focus-group discussions (n?=?30), with LGBTQ persons, quantitative and qualitative approaches were used to analyse the findings.

Results: When comparing the ranking of preferences (in terms of activity options, environmental features, and staff competence) in a senior housing setting between the LGBTQ people (n?=?200) and heterosexual matched controls (n?=?198), only minor differences were detected. The findings from the focus groups included: (1) a dilemma between segregation and openness, (2) the importance of safety associated with ageing together with persons with similar experiences, and (3) networks of persons at different ages connected through close friendship supported participation in activities in LGBTQ-profiled senior housing.

Conclusion and significance: The findings provide knowledge to improve awareness of sexual orientation when it comes to needs and preferences in relation to ageing and housing in a Swedish context.     

Improving attending rounds: Qualitative reflections from multidisciplinary providers

Background. Attending rounds, the time for the attending physician and the team to discuss the team’s patients, take place at teaching hospitals every day, often with little standardization. Objective. This hypothesis-generating qualitative study sought to solicit improvement recommendations for standardizing attending rounds from the perspective of a multi-disciplinary group of providers. Methods. Attending physicians, housestaff (residents and interns), medical students, nurses and pharmacists at an academic medical center participated in a quality improvement initiative between January and April 2013. Participants completed an individual or focus group interview or an e-mail survey with three open-ended questions: (1) What are poor or ineffective practices for attending rounds? (2) How would you change attending rounds structure and function? (3) What do you consider best practices for attending rounds? We undertook content analysis to summarize each clinical stakeholder group’s improvement recommendations. Results. Sixty stakeholders participated in our study including 23 attending hospitalists, 24 housestaff, 7 medical students, 2 pharmacists and 4 nurses. Key improvement recommendations included (1) performing a pre-rounds huddle, (2) planning of the visit schedule based on illness or pending discharge, (3) real-time order writing, (4) patient involvement in rounds with shared decision-making, (5) bedside nurse inclusion and (6) minimizing interruption of intern or student presentations. Conclusions. The practice improvement recommendations identified in this study will require deliberate systems changes and training to implement, and they warrant rigorous evaluation to determine their impact on the clinical and educational goals of rounds.     

Most Cited Authors and Publications In Health Education Journals For 1970–79

This study attempted to answer the following questions about the journals Health Education, Health Education Monographs and the Journal of School Health. What authors have been cited the most in health education journals during the decade of the 70s? What authors have been cited the most in each health education journal? What articles and books have been the most cited in health education journal? What have been the most cited articles and books in each health education journal? It was found that the most cited author was L. W. Green, the most cited articles were L. W. Green “Toward Cost-Benefit Evaluations of Health Education: Some Concepts, Methods and Examples.” Health Education Monographs and S. V. Kasl “Health Behavior, Illness Behavior and Sick-Role Behavior.” Archives of Environmental Health and the most cited books was School Health Education Study, Health Education: A Conceptual Approach to Curriculum Design. Most cited authors, articles and books varied across the three journals.     

Psychological,Social, and Environmental Factors Associated With Utilization of Senior Centers Among Older Adults in Korea

Objectives

The purpose of the study was to examine the relationships among the psychological, social, and environmental factors influencing the utilization of senior centers among older adults in Korea.

Methods

A questionnaire survey was administered to two types of older adults who lived in Seoul, Korea: 262 older adults who used senior centers (3 places) and 156 older adults who did not use senior centers.

Results

Our results showed clearly that the utilization of the senior centers in Korea is affected by higher self-efficacy (odds ratio [OR], 6.08; 95% confidence interval [CI], 3.31 to 12.32), higher perceived benefits (OR, 1.71; 95% CI, 1.16 to 4.36), lower perceived barriers (OR, 6.43; 95% CI, 3.07 to 11.45), higher family support (OR, 4.21; 95% CI, 2.02 to 8.77), and higher support from friends (OR, 4.08; 95% CI, 2.38 to 7.81). The results also showed that participants whose total travel time was 15 to 29 minutes (OR, 2.84; 95% CI, 1.21 to 3.64) or less than 14 minutes (OR, 4.68; 95% CI, 3.41 to 8.41) were more likely to use a senior center than those who had to travel more than 30 minutes.

Conclusions

This study showed that the utilization of senior centers in Korea is affected by psychological, social, and environmental factors, specifically by self-efficacy, perceived benefits, perceived barriers, social support, convenience of transportation, and total travel time to the senior centers. The effects of longer-term utilization of the senior centers by non-users on health-related outcomes in a large population warrant attention.     

Use of senior center and the health-related quality of life in Korean older adults

Objective

The purpose of the present study was to examine the relationship between the use of senior center and health-related quality of life in Korean older adults.

Methods

A questionnaire survey was conducted to two types of older adults who lived in Busan, Korea: 154 older adults who used a senior center and 137 older adults who did not use a senior center. The Korean version of short-form 36-item health survey was administered to assess the health-related quality of life. Demographic variables were obtained from a questionnaire. These were gender, age, family status, marital status, education, monthly income, present illness, body mass index and physical activity.

Results

The 8-domain scales of physical function and role-physical were significantly higher in the users of the senior center compared with the non-users (F=4.87, p=0.027 and F=7.02, p=0.009, respectively). The 8-domain scales of vitality was also significantly higher in the users of the senior center compared with the non-users (F=7.48, p=0.007).

Conclusions

The present study showed that the users of the senior center have higher physical function, role-physical and vitality compared with the non-users. These findings suggest that although the results are unable to specify causal relationships using the senior center may lead to some improvement in health-related quality of life.     

A multi-group path analysis of the relationship between perceived racial discrimination and self-rated stress: how does it vary across racial/ethnic groups?

Objective: The objective of this study was to answer three questions: (1) Is perceived discrimination adversely related to self-rated stress via the social capital and health care system distrust pathways? (2) Does the relationship between perceived discrimination and self-rated stress vary across race/ethnicity groups? and (3) Do the two pathways differ by one’s race/ethnicity background?

Design: Using the Philadelphia Health Management Corporation’s Southeastern Pennsylvania Household Survey, we classified 9831 respondents into 4 race/ethnicity groups: non-Hispanic White (n?=?6621), non-Hispanic Black (n?=?2359), Hispanic (n?=?505), and non-Hispanic other races (n?=?346). Structural equation modeling was employed to simultaneously estimate five sets of equations, including the confirmatory factor analysis for both social capital and health care distrust and both direct and indirect effects from perceived discrimination to self-rated stress.

Results: The key findings drawn from the analysis include the following: (1) in general, people who experienced racial discrimination have higher distrust and weaker social capital than those without perceived discrimination and both distrust and social capital are ultimately related to self-rated stress. (2) The direct relationship between perceived discrimination and self-rated stress is found for all race/ethnicity groups (except non-Hispanic other races) and it does not vary across groups. (3) The two pathways can be applied to non-Hispanic White and Black, but for Hispanic and non-Hispanic other races, we found little evidence for the social capital pathway.

Conclusions: For non-Hispanic White, non-Hispanic Black, and Hispanic, perceived discrimination is negatively related to self-rated stress. This finding highlights the importance of reducing interpersonal discriminatory behavior even for non-Hispanic White. The health care system distrust pathway can be used to address the racial health disparity in stress as it holds true for all four race/ethnicity groups. On the other hand, the social capital pathway seems to better help non-Hispanic White and Black to mediate the adverse effect of perceived discrimination on stress.     

AIDS/HIV Articles Published in Selected Professional Health Journals: 1981–1990

ABSTRACT: Journals from five professional associations were reviewed to determine the response to AIDS/HIV in their journal: Association for the Advancement of Health Education (AAHE) and Journal of Health Education; American College Health Association (ACHA) and Journal of American College Health; American Public Health Association (APHA) and American Journal of Public Health; American School Health Association (ASHA) and Journal of School Health, and the Society for Public Health Education (SOPHE) and Health Education Quarterly. The project posed the following questions: 1) How many articles on AIDS/HIV were published in the selected journals during the 10-year period from 1981 through 1990? 2) What types of articles were published during the period, such as editorials, recommendations, guidelines, and research? and 3) What approaches were shown effective in changing knowledge, attitudes, and behavior? The first article appeared in 1984; 239 articles were published in the five journals reviewed. Each journal devoted at least one entire issue to AIDS/HIV. The articles were categorized as either applied (43.9%) or data-based (56.1 %). Since most articles with a research focus did not include pretest and posttest measurements, it proved difficult to determine the most effective methods for changing knowledge, attitudes, and behavior. Evaluation methods that assess the effectiveness of interventions in changing knowledge, attitudes, and behavior are needed.     

The Effect of Commuting Patterns on HIV Care Attendance Among Men Who Have Sex With Men (MSM) in Atlanta,Georgia

Background

Travel-related barriers to human immunodeficiency virus (HIV) care, such as commute time and mode of transportation, have been reported in the United States.

Objective

The objective of the study was to investigate the association between public transportation use and HIV care attendance among a convenience sample of Atlanta-based, HIV-positive men who have sex with men (MSM), evaluate differences across regions of residence, and estimate the relationship between travel distance and time by mode of transportation taken to attend appointments.

Methods

We used Poisson regression to estimate the association between use of public transportation to attend HIV-related medical visits and frequency of care attendance over the previous 12 months. The relationship between travel distance and commute time was estimated using linear regression. Kriging was used to interpolate commute time to visually examine geographic differences in commuting patterns in relation to access to public transportation and population-based estimates of household vehicle ownership.

Results

Using public transportation was associated with lower rates of HIV care attendance compared to using private transportation, but only in south Atlanta (south: aRR: 0.75, 95% CI 0.56, 1.0, north: aRR: 0.90, 95% CI 0.71, 1.1). Participants living in south Atlanta were more likely to have longer commute times associated with attending HIV visits, have greater access to public transportation, and may live in areas with low vehicle ownership. A majority of attended HIV providers were located in north and central Atlanta, despite there being participants living all across the city. Estimated commute times per mile traveled were three times as high among public transit users compared to private transportation users.

Conclusions

Improving local public transit and implementing use of mobile clinics could help address travel-related barriers to HIV care.     

Poison Center Data for Public Health Surveillance: Poison Center and Public Health Perspectives

Objective

To describe the use of poison center data for public health surveillance from the poison center, local, state, and federal public health perspectives and to generate meaningful discussion on how to address the challenges to collaboration.

Introduction

Since 2008, poisoning has become the leading cause of injury-related death in the United States (US); since 1980, the poisoning-related fatality rate in the US has almost tripled.1 Many poison-related injuries and deaths are reported to regional poison centers (PCs) which receive about 2.4 million reports of human chemical and poison exposures annually.2 Federal, state, and local public health (PH) agencies often collaborate with poison centers and use PC data for public health surveillance of poisoning-related health issues. Many state and local PH agencies have partnerships with regional PCs for direct access to local PC data which help them perform this function. At the national level, CDC conducts public health surveillance for exposures and illnesses of public health significance using the National Poison Data System (NPDS), the national PC reporting database.Though most PC and PH officials agree that PC data play an important role in PH practice and surveillance, collaboration between PH agencies and PCs has been hindered by numerous challenges. To address these challenges and bolster collaboration, the Poison Center and Public Health Collaborations Community of Practice (CoP) was created in 2010 by CDC as a means to share experiences, identify best practices, and facilitate relationships among federal, state and local public health agencies and PCs. To date, the Poison Center and Public Health Collaborations CoP includes over 200 members from state and local public health, regional PCs, CDC, the American Association of Poison Control Centers (AAPCC), and the Environmental Protection Agency (EPA). A leadership team was created with representatives of the many stakeholders of the community to drive its direction and oversee activities.

Methods

The panel will consist of 4 presenters and 1 moderator, who are members of the Poison Center and Public Health Collaborations CoP leadership team. Each presenter will bring a unique perspective of the use of PC data for PH practice and surveillance: CDC, state department of health, a local department of health, and a PC. Royal Law from the CDC National Center for Environmental Health will present on using PC data for identification of exposures and illnesses of public health significance identified from NPDS data collected from all 57 PCs. Dr. Jay Schauben from the Florida/USVI Poison Information Center - Jacksonville will discuss PC participation in surveillance and use of PC data for tracking and mitigation of PH events in Florida. Dr. Prakash Mulay from the Florida Department of Health will discuss utilization of PC data to enhance ESSENCE-based chemical-associated exposure and illness surveillance in Florida. Katherine Wheeler from the New York City (NYC) Department of Health and Mental Hygiene will discuss NYC’s use of PC data in surveillance of potential emerging issues, from energy drinks to synthetic marijuana. Each presenter will discuss the use of PC data for PH practice and surveillance in his or her organization and jurisdiction, the successes of using PC data, and their challenges.

Results

The moderator will engage the audience by facilitating discussion of the successes and challenges to using PC data for PH practice and surveillance with the audience.Sample questions:What are your current capacities and collaborative activities between your state/local health department and your poison center?What non-funding related barriers hinder the collaboration between your state/local health department and poison center?If more funding were available, how would you use this funding to increase the level of interactivity with the poison center and state/local health department?     

Gesundheitsförderung älterer türkischer Migrantinnen

Background

Elderly persons with an immigration background often face health problems due to specific living and working conditions. Focussing on this target group, health courses which concentrate on nutrition and exercise have been developed and tried out in three interventions within the “Sa?lik” project (Turkish: health).

Purpose of this study (question)

Based on instruments for evaluation which are immanent within the courses, the following questions are answered: which knowledge is transferred subject to what kind of conditions of intervention? What kinds of learning targets can be achieved? What are the limits of the interventions?

Material and methods

Health courses are characterized by a subjective data collection. While courses are undertaken data is gathered on account of documenting personal goals and achievements. Moreover, a status of course-related knowledge or behavior is queried at the end of the intervention.

Results and discussion

It is crucial that the interventions cause changes in behavior. Within the given project’s perspective, however, these changes could only be followed up to the end of the intervention. Apart from this it became evident that the health courses undertaken can only reach persons who implicitly intend or are prepared for changes in behavior. Therefore, with respect to the perspective of the project it can be asked how behavior promoting health can be constantly supported. Furthermore, it remains to be clarified whether and how people can be reached if they do not give preference to healthy behavior.     

城市卫生资源配置适应疾病模式转变研究——背景、问题及研究框架

本文提出了城市卫生资源配置适应疾病模式转变研究课题的理论框架和基本思路。本研究所回答的主要问题是:在不干预的条件下,慢性病患病及其治疗费用将增加多少?在加强社区预防和治疗的条件下,卫生费用的增长将在多大程度上得到控制。     

Compulsory medical rural placements: senior student opinions of early-year experiential learning

Objective: The aim of this study was to determine senior medical student (year 3–5) opinions of their early‐year (year 1–2) rural placement. Design: We assessed the impact of MBBS early‐year rural placements through a follow up of this cohort in their later years using a cross‐sectional questionnaire. Setting: The questionnaire was administered to year 3–5 medical students at their clinical school. Participants: There were 97 participants (49% response rate) in the study. Twenty‐nine per cent were male and 71% were female; 44% were from a rural background and 56% were from a metropolitan background; 48% were year 3 students, 32% were year 4 students and 20% were year 5 students; and 59% of the students were, at the time, situated at a rural clinical school and 41% were at a metropolitan clinical school. Main outcome measure: Closed‐ended questions were quantified and statistically analysed. Open‐ended responses were thematically analysed to determine what their experience of early‐year rural placements were like. Results: Seventy‐nine per cent of students considered the year 1 placement length as ‘about right’. Overall, most students found year 1 rural placements positive and grasped the placement aims and objectives. Most students were also pleased with year 2 rural placements, mainly due to the clinical aspects. Conclusions: Medical students appear to prefer shorter early‐year rural placements and understand the benefits and importance of such placements. They also have a desire for greater clinical exposure during these early‐year placements.     

A.S.P.E.N. Clinical Guidelines

Background: Premature infants are at increased risk for metabolic bone disease, with resulting delayed bone growth, osteopenia, and rickets. Method: A systematic review of the best available evidence to answer a series of questions regarding neonatal patients at risk of metabolic bone disease receiving parenteral or enteral nutrition was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the American Society for Parenteral and Enteral Nutrition Board of Directors. Questions: (1) What maternal risk factors predispose the neonate to metabolic bone disease? (2) What is the optimal type of feeding to promote neonatal bone health? (3) When and how should vitamin D supplements be administered? (4) Does parenteral nutrition (PN) predispose a neonate to metabolic bone disease, and if so, are there PN formulation recommendations to minimize this risk?     

Alcohol,stress-related factors,and short-term absenteeism among urban transit operators

Transit operators, relative to workers in many other occupations, experience high levels of work-related stress, as documented through neuroendocrine elevations on the job vis-à-vis resting states (J Occup Health Psychol. 1998;3:122–129). Previous research suggests that self-reported job stress is associated with higher levels of alcohol consumption among transit operators (Alcohol Clin Exp Res. 2000;24:1011–1019) and with absenteeism (Working Environment for Local Public Transport Personnel, Stockholm: Swedish Work Environmental Fund, 1982; Work Stress. 1990;4:83–89). The purpose of this study was to examine the interrelationships between alcohol use, stress-related factors (stressful life events, job stressors, and burnout), and short-term absenteeism among a multiethnic cohort of urban transit operators. Self-reported measures of alcohol, stress-related factors, and short-term absenteeism were obtained from a sample (n=1,446) of San Francisco municipal transit operators who participated in the 1993–1995 Municipal Railway Health and Safety Study. Multivariate logistic regression analyses showed that absenteeism among drinkers was associated with risk for alcohol dependence [odds ratio (OR)=2.46, heavy drinking (OR=1.87), alcohol0related harm (OR=2.17), increased drinking since, becoming a transit operator (OR=1.74), and having any problem drinking indicator (OR=1.72). The association between absenteeism and stress-related factors varied by gender and drinking status. Final multivariate models among drinkers indicated that among males, problem drinking (OR=1.82), stressful life events (OR=1.62), and job burnout (OR=1.22) were independently associated with elevated odds of absenteeism. Among female drinkers, only stressful life events (OR=5.17) was significantly associated with elevated odds of absenteeism. Findings suggest that workplace interventions that address both individual and environmental stressors are most likely to have a positive impact on health-related outcomes, including problem drinking, thereby reducing absenteeism.     

BOOK REVIEWS

Book reviewed in this article: Marilyn Hatton (ed.): Work & Health: Issues in Occupational Health. J.C. McDonald (ed.): Recent Advances in Occupational Health, No. 1 June Huntington: Social Work and General Medical Practice: Collaboration or Conflict? P.I. Ahmed and G.V. Coelho (eds.): Toward a New Definition of Health: Psychosocial Dimensions Peter Davis: Health and Health Care in New Zealand Carl A. Meilicke and Janet L. Storch (eds.): Perspectives on Canadian Health and Social Services Policy: History and Emerging Trends. Joseph L. Falkson: HMOs and the Politics of Health System Reform Raymond Illsley: Professional or Public Health? Sociology in Health and Medicine I. McPherson and A. Sutton (ed.): Reconstructing Psychological Practice Reinhold Bergler: Advertising and Cigarette Smoking — A Psychological Study Milton J. Roemer and Ruth J. Roemer: Health Care Systems and Comparative Manpower Policies P.M. Tatchell (ed.): Economics and Health 1980; and P.M. Tatchell (ed.): Economics and Health 1981. Michael Koetting: Nursing-Home Organisation and Efficiency T.J. Wood, E. Hughes: An Evaluation of the Cost Effectiveness of Surgical and Related Hospital Services Provided to Patients of the Monash Department of Surgery. B.R. Selecki et al: Injuries to the Head, Spine and Peripheral Nerves: Report on a study. R.D. Blair and S. Rubin (eds.): Regulating the Professions Martin Bulmer (ed.): Social Research and Royal Commissions. Duncan Boldy (ed.): Operational research applied to health services Ruth Hurst Vose: Agoraphobia Russell Scott The Body as Property F. Falkner (ed.): Prevention in Childhood of Health Problems in Adult Life Louis Lowy: Social Policies and Programs on Aging (Lexington Books Mass 1980) Harvey W. Feldman (et al): Angel Dust. An Ethnographic Study of PCP Users.     

Why are You Calling Me? How Study Introductions Change Response Patterns

Purpose: Research on survey methodology has demonstrated that seemingly innocuous aspects of a survey’s design, such as the order of questions, can produce biased results. The current investigation extends this work by testing whether standard survey introductions alter the observed associations between variables. Methods: In two experimental studies, we invited Parkinson’s disease (PD) patients to participate in a telephone survey of (a) Parkinson’s patients, conducted by a regional medical center, or (b) the general population, conducted by a regional university. The survey in Study 1 (n = 156) first assessed life-satisfaction, and subsequently health satisfaction. In Study 2 (n = 99), we reversed the order of the two questions, asking the health questions first. Results: When the introduction focused on Parkinson’s disease, we observed an increased correlation between life-satisfaction and a later question about health satisfaction (r = 0.34 vs. 0.63 after general population versus Parkinson’s introduction, respectively; Study 1). In Study 2, asking the health questions first resulted in high correlations regardless of the introduction; in addition, judgments of life-satisfaction were lower after the Parkinson’s-focused introduction. Conclusions: When participants were informed prior to the survey that its purpose was to examine well-being in PD, health satisfaction was a much more important component of life-satisfaction, accounting for three times as much variation. We hypothesize that the survey introduction primed participants’ health status, resulting in an artificially large correlation with life-satisfaction.     

Research priorities for accelerating progress toward measles and rubella elimination identified by a cross-sectional web-based survey

BackgroundIn 2012, the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP) that set a target to eliminate measles and rubella in five of the six World Health Organization (WHO) regions by 2020. Significant progress has been made toward achieving this goal through intensive efforts by countries and Measles & Rubella Initiative (M&RI) partners. Accelerating progress will require evidence-based approaches to improve implementation of the core strategies in the Global Measles and Rubella Strategic Plan. The M&RI Research and Innovation Working Group (R&IWG) conducted a web-based survey as part of a process to identify measles and rubella research priorities. Survey findings were used to inform discussions during a meeting of experts convened by the M&RI at the Pan American Health Organization in November 2016.MethodsThe cross-sectional web-based survey of scientific and programmatic experts included questions in four main topic areas: (1) epidemiology and economics (epidemiology); (2) new tools for surveillance, vaccine delivery, and laboratory testing (new tools); (3) immunization strategies and outbreak response (strategies); and (4) vaccine demand and communications (demand). Analyses were stratified by the six WHO regions and by global, regional, or national/sub-national level of respondents.ResultsThe six highest priority research questions selected by survey respondents from the four topic areas were the following: (1) What are the causes of outbreaks in settings with high reported vaccination coverage? (epidemiology); (2) Can affordable diagnostic tests be developed to confirm measles and rubella cases rapidly and accurately at the point of care? (new tools); (3) What are effective strategies for increasing coverage of the routine first dose of measles vaccine administered at 9 or 12 months? (strategies); (4) What are effective strategies for increasing coverage of the second dose given after the first year of life? (strategies); (5) How can communities best be engaged in planning, implementing and monitoring health services including vaccinations? (demand); (6) What capacity building is needed for health workers to be able to identify and work more effectively with community leaders? (demand). Research priorities varied by region and by global/regional/national levels for all topic areas.ConclusionsResearch and innovation will be critical to make further progress toward achieving the GVAP measles and rubella elimination goals. The results of this survey can be used to inform decision-making for investments in research activities at the global, regional, and national levels.     

Introducing professional educators into academic medicine: stories of exemplars

This article describes an oral history project aimed at documenting the history and contributions of the innovation of hiring professional educators in medical schools to improve the education of medical students, residents, and fellows. Six professional educators who spent their careers in medical schools were chosen as Exemplars: Stephen Abrahamson, Ph.D.; Charles Dohner, Ph.D.; Arthur Elstein, Ph.D.; Hilliard Jason, M.D., Ph.D.; Christine McGuire, M.A.; and Frank Stritter, Ph.D. Pairs of senior professional educators currently working in medical schools interviewed the six Exemplars using a standardized protocol. Articles describing each Exemplar appear consecutively in this and subsequent issues of Advances in Health Professions Education. The series culminates with an article that presents the consensus conclusions of the series authors, based on the five study questions that guided the study and interview protocol. This revised version was published online in June 2006 with corrections to the Cover Date.     

Emergency hospital admission for pain in palliative patients: A crucial role for general practitioners

Abstract

Introduction: In previous papers we analysed the incidence of wheezing in young children living near the iron and steel factory in C?l?ra?i, and in a control region (Rose?i) without industrial air pollution. Research question: Is industrial air pollution exposure during the first years of life a risk factor for the presence of asthmatic symptoms in children at school age? Methods: We assessed the prevalence of asthma symptoms using the ISAAC short form questionnaire for children aged 6–7 years, and measured the FEV1 and PEF in the children of both municipalities (297 children in C?l?ra?i, i.e. the exposed cohort, and 237 in Rose?i, i.e. the non-exposed cohort). Results: We found an OR of 7.2 (95% CI: 3.6–14.3) for affirmative answers to at least one of ISAAC questions for children living in C?l?ra?i compared to the children in Rose?i. The numbers of affirmative answers to all but one of the ISAAC questions were significantly higher in C?l?ra?i. The main result remained robust after adjusting for a series of co-variables using multiple logistic regression analysis (OR 14.8; 95% CI: 4.8–46.1). There was a strong relation between early life wheezing and asthma symptoms at school age (OR 9.0; 95%CI: 3.4–23.5).

Conclusion: Children, who had been living near an iron and steel factory during their early years, are still at increased risk for asthma symptoms at school age.