The determinants of attitudinal change among medical students participating in home care training: a multi-center study.

PURPOSE: To report attitudinal changes of medical students from five medical schools rotating through a home care program, and to determine which of the program characteristics influenced attitudes the most. METHOD: A survey instrument covering four home care domains (general attitudes, home-based therapies, home care training, and time and reimbursement) was designed and validated by the five schools involved. Using pre- and post-rotation scores, analyses were done to evaluate for attitudinal changes within and among schools. The programs had similar basic characteristics (home visits, attending physicians' involvement, didactics), but had differing degrees of these components. RESULTS: Significant improvements in attitude scores were found in three domains: general attitudes, homebased therapies, and home care training. For time and reimbursement, only three schools improved significantly between pre- and post-rotation scores. Among the five schools, there were significant differences in the homebased therapies and home care training domains (p <.05), and in the time and reimbursement domain the difference approached significance (p =.06). None of the students' characteristics but all of the programs' characteristics significantly correlated with changes in total scores. In the first multiple regression model, educational level (third year instead of fourth) was the only independent predictor of change in score, (adjusted r(2) =.14). In Model 2, the strongest predictor was "contact with physician-program director," followed by "number of visits" and "physician-precepted visits" (r(2) =.23). CONCLUSION: Educational home care programs of varying intensities can positively affect medical students' attitudes towards home care. At least three program characteristics, (the physician-program director, number of visits, and physician-precepted home visits), are important parts of a successful program.     

Contaminated sediments from tributaries of the Great Lakes: Chemical characterization and carcinogenic effects in medaka (Oryzias latipes)

Sediments from four inshore industrial sites and a reference site in the Great Lakes were extracted with organic solvents to produce a crude extract, which was separated on alumina into two fractions: predominantly polycyclic aromatic hydrocarbons; and predominantly nitrogencontaining polycyclic aromatic compounds. Crude extracts were redissolved in acetone and analyzed by gas chromatography and gas chromatography-mass spectrometry. The acetone-redissolved crude extracts from the four industrialized sites contained 5.6–313.3 g total polycyclic aromatic compounds/g sediment and 3.0–36.4 g other compounds/g sediment. In addition to the typical EPA priority pollutants, a substantial amount (228.7 g/g sediment) of alkyl-polycyclic-aromatic compounds was detected in sediments from one of the industrialized sites. Extracts from the reference site contained 1.55 g total polycyclic aromatic compounds/ g sediment. Medaka (Oryzias latipes) were exposed to multiple pulse doses of acetone-redissolved extracts and fractions. Medaka were also exposed to a known carcinogen, methylazoxymethanol acetate, to verify that chemicals produced tumors in the test fish. Acetone-redissolved extracts and fractions from contaminated sediments were toxic to medaka. Fin erosion and non-neoplastic liver abnormalities were more prevalent in medaka after exposure to acetoneredissolved extracts and fractions from contaminated sediments. Neoplasms previously associated with chemical exposure in wild fishes were induced in medaka exposed to acetone-redissolved extracts and fractions from two of the contaminated sites, but not from the reference site or controls. These findings further support the hypothesis that chemical contaminants in sediments are involved in epizootics of neoplasms in wild fishes at contaminated sites.     

Longitudinal cohort study on preoperative pain as a risk factor for chronic postoperative inguinal pain after groin hernia repair at 2-year follow-up

Hernia - To assess the rate of late chronic postoperative inguinal pain (CPIP) after groin hernia repair in patients with different categories of preoperative VRS (Verbal Rating Scale) pain and to...     

Psoriatic arthritis with hyperuricemia: more peripheral,destructive, and challenging to treat

Clinical Rheumatology - To study the impact of hyperuricemia on clinical presentation, severity, and associated comorbidities of psoriatic arthritis (PsA). Retrospective bicentric...     

Validation of an instrument designed to assess medical student attitudes toward home care

OBJECTIVES: To develop and validate an instrument to assess medical students' attitudes toward home care. DESIGN: Survey administration before and following participation in a home care training program. SETTING: Five medical schools in the United States. PARTICIPANTS: 326 third and fourth year medical students. MEASUREMENTS: Factor analysis was performed on all posttests. Domains were tested for internal reliability (Chronbach's alpha). Interdomain correlation was tested. One-way analysis of variance (ANOVA) was used to determine whether the results for each domain differed among the five programs. RESULTS: Using exploratory factor analysis, the original 20-item survey was revised to yield a 14-item survey consisting of four domains (general attitudes, home-based therapies, home care training, and time and reimbursement). Domain intra-item reliability ranged from 0.60 to 0.82. Interdomain correlations were found to be significant with the exception of one comparison (time and reimbursement and home care training). One-way ANOVA showed significant differences between the training programs for two of the four domains (home-based therapies and home care training). For a third domain, time and reimbursement, there was a trend toward differences across the schools (P = 0.06). CONCLUSION: The instrument described in this paper is a reliable and valid instrument for assessing the impact of home care training on medical student attitudes across a series of important domains.     

Home safety and fall prevention.

In conclusion, the majority, or at least a large proportion, of accidental injuries in the elderly are preventable with careful medical and environmental evaluation and intervention. A vigorous diagnostic, therapeutic, and preventive approach is appropriate in all older patients who fall in addition to those at a high risk of falling. Any intervention that can make inroads on this major cause of death and disability in the elderly population will clearly have major impact.     

Induction of hepatic mixed-function oxidase enzymes in adult and neonatal mice by kepone and mirex.

The effects of 1, 10, and 50 ppm dietary kepone on hepatic mixed-function oxidases of adult male mice were measured. After 14 days dose-dependent increases in liver weight, hepatic microsomal protein, cytochrome P-450, Type I and Type II ligand binding to cytochrome P-450 and O- and N-demethylation of p-nitroanisole and aminopyrine were observed. Induction was approximately two-fold for all parameters measured at the 50-ppm level. The results obtained suggest that kepone is a nonspecific inducer, the no-effect level for induction based on O-demethylase activity in mice being less than 10 ppm. Body weight gain decreased in mice treated with 50 ppm kepone for 14 days. The effects of kepone and mirex fed to the mother after parturition on hepatic tissue of male and female neonatal mice were also measured. It is suggested that the increases observed in O- and N-demethylation of p-nitroanisole and aminopyrine in hepatic tissue from neonates result from the transfer of kepone and mirex through the milk. Induction in neonates was greater than that observed in adult male mice treated with kepone.     

Socioeconomic and health status differences between depressed and nondepressed ED elders

The objective of the study was to describe differences in demographics, medical conditions, and social situation between depressed and nondepressed elderly emergency department (ED) patients. We studied a prospective convenience sample of English-speaking ED patients greater-than-or-equal 65 years, without altered mental status, obvious dementia or delirium, participating in a depression screening study during an ED visit for a nonpsychiatric complaint. Demographics were collected. Research personnel administered the Geriatric Depression Scale (GDS), the Folstein Mini-Mental State Examination and a health questionnaire. A total of 103 subjects were enrolled. GDS identified 33 patients (32%) with DEP. DEP patients were more likely to report the following: lower income, lower education level, more medical conditions, less independence, assisted living, and poorer overall health than ND patients. A third of these elderly ED patients report symptoms consistent with depression. There are significant differences in socioeconomic characteristics, health status, and functional ability. Future depression studies should focus on elders with these characteristics.