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Objective: Although there is research that indicates financial difficulties among adults with ADHD, little research has examined financial well-being among college students with ADHD. Method: The present study explored the relationships between symptoms of ADHD and credit card and student loan debt, expected student loan debt, perceived financial well-being, worries about student loans, and financial strain behaviors among 612 college students at two public universities in different states. Results: Results indicated that students with more symptoms of ADHD reported lower perceived financial well-being, but there was no relationship between symptomatology and credit card and student loan debt or expected student loan debt. Conclusion: These results highlight the opportunity for interventions to address current perceived financial well-being and to prevent future financial concerns.

The authors met during a career development experience where they discussed the commonalities of their successes and challenges conducting creative strengths-based health promotion research with underserved communities during their graduate and postgraduate training. They identified changes to health promotion pedagogy that they would like to see in the future. These include understanding both the strengths and the challenges of creative strengths-based health promotion research conducted with underserved communities, ensuring that reflexivity and flexibility is a component of the process, developing support networks for trainees, understanding personal limitations to effect change, and supporting self-care. They hope that trainees and health education programs will learn from their experiences.

Background Most stroke research is conducted in high income countries, yet most stroke occurs in low- and middle-income countries. There is an urgent need to build stroke research capacity in low- and middle-income countries. Aims To review the global health literature on how to improve research capacity in low- and middle-income countries, provide additional data from the recently completed ATTEND Trial and provide examples from our own experience. Summary of review The main themes from our literature review were: manpower and workload, research training, research question and methodology and research funding. The literature and our own experience emphasized the importance of local stakeholders to ensure that the research was appropriate, that there were robust local ethics and regulatory processes, and research was conducted by trained personnel. Research training opportunities can be developed locally, or internationally, with many international schemes available to help support new researchers from low- and middle-income country settings. International collaboration can successfully leverage funding from high income countries that not only generate data for the local country, but also provide new data appropriate to high income countries. Conclusions Building stroke research capacity in low- and middle-income countries will be vital in improving global health given the huge burden of stroke in these countries.

In this Career Development commentary, the author highlights the value of tailored mentoring and experiential learning from the perspective of a first-generation college student. University faculty and practitioners in diverse settings have the opportunity to mentor emerging public health professionals but may not have experience mentoring first-generation college students. We hope that this commentary encourages our readers to reflect on mentoring strategies, opportunities, and benefits for first-generation college students.

Academic institutions funded by the Clinical and Translational Science Awards (CTSA) Program of the National Institutes of Health were challenged recently by the Institute of Medicine to expand traditional mentoring of graduate and postdoctoral scholars to include training and continuing education for faculty, professional staff, and community partners. A systematic review was conducted to determine whether researcher development interventions, alone or in any combination, are effective in improving researcher behavior. PubMed, CINAHL, and Education Research Complete databases and select journals were searched for relevant articles published from January 2000 through October 2012. A total of 3,459 papers were identified, and 114 papers were retrieved for in-depth analysis. None included randomization. Twenty-two papers reported subjects with professional degrees, interventions, and outcomes. Interventions were meetings, outreach visits, colleague mediation, audit and feedback, and multifaceted interventions. Most studies reported multifaceted interventions (68.2%), often involving mentored learning experiences, and meetings. All studies reported a change in performance, including numbers of publications or grant applications. Nine studies reported changes in competence, including writing, presentation, or analytic skills, and performance in research practice (40.9%). Even as, the quality of evidence was weak to establish causal linkages between researcher development and improved researcher behavior, nearly all the projects (81.8%) received funding from governmental agencies, professional societies, or other organizations. Those who design researcher development activities and those who evaluate the programs are challenged to develop tools and conduct studies that measure the effectiveness, costs, and sustainability of researcher development in the CTSA Program.

To evaluate the competing claims on the impact of microfinance programs on multidimensional poverty, a village study in Bangladesh was conducted where three microfinance programs had been operating for more than five years. The study found that microfinance has resulted in a moderate reduction in the poverty of borrowers, as measured by a variety of socio-economic indicators, but has not reached many of the poorest in the village. To make microfinance a more effective means of poverty reduction other services such as skills training, technological support, education and health related strategies should be included with microfinance.

This article describes a project designed to use student leaders to increase the awareness of HIV/AIDS among college students. Student organizations apply for a competitive mini-grant that is used to increase their members’ knowledge level about HIV/AIDS and increase the likelihood of individuals’ practicing behaviors that would reduce the risk of transmission or contraction. Four student organizations receive funds to design a unique HIV/ AIDS prevention intervention that match its members’ needs for a total of 126 individuals receiving HIV/AIDS education. An evaluation indicates positive behavioral intentions related to sexual communication and safer sex practices. Moreover, the majority of participants report the education received as relevant and applicable. The methods, intervention applications, and benefits to using an award competition to deliver HIV prevention education to college students in a nontraditional and innovative approach are detailed within this article.

In his seminal book, L. Festinger (1957) emphasized the role of attitude importance in cognitive dissonance. This study (N = 308) explored whether people's use of dissonance reduction strategies differs as a function of level of attitude importance and whether the personal importance of an attitude is salient. Results showed that level and salience of attitude importance interacted to affect high-choice (HC) participants' tendency to use attitude change and trivialization to reduce dissonance. When HC participants were not reminded of the personal importance of their attitude (i.e., it was not salient), they changed their attitudes equally irrespective of attitude importance, but engaged in greater trivialization with increasing levels of importance. In contrast, when attitude importance was salient, HC participants changed their attitudes less with increasing attitude importance and showed no evidence of trivializing under any level of importance.

Objective: The aim of this paper is to demonstrate the principles of the conversational model in two therapies with a patient, at 16 years of age and again 20 years later.Method: Described is the first therapy of L, which commenced in hospital and continued twice weekly after discharge. L was an acutely disturbed 16-year-old female admitted for 4 months to the psychiatry ward, a dynamically oriented milieu of a University teaching hospital where I was training. This is followed by a brief description of L's second therapy. Supervision was through audiotape of sessions.Results: At the conclusion of the first therapy, L was functioning well. Five years later, she married and had a child. She was referred to me again after she attempted suicide following an acute stressful event which resulted in hospitalization. She is more aware and reflective at present but continues to be vulnerable.Conclusions: Attention to certain aspects of the psychotherapeutic relationship is important as demonstrated in the conversational model.

Aboriginal youth is one of the fastest growing of all populations in Saskatchewan today. This is a prime group to target for training in the health care professions. The need for strategies to support recruitment and retention in these programs is critical for maintaining our present standard and increasing demands of quality health care. Program initiatives and supports need to be implemented to encourage this population to enroll in and complete health care programs. Although only 5 years old, the University of Saskatchewan, First Nations University of Canada, and Saskatchewan Institute of Applied Science and Technology (SIAST) have created a viable northern nursing program with a retention rate of Aboriginal postsecondary students 13% greater than the provincial norm. They graduated their first class of nursing students from and for the North, May 2006.

Objective: Interest in training in psychiatry appears to be in decline. To pursue reasons why a career in psychiatry is not regarded as an attractive option for trainees, attitudes of senior Australian medical students were surveyed. Method: Fifty five medical students from one university were set a question inviting them to detail reasons why doctors might be less likely to train in psychiatry as part of their written examination in psychiatry. Several major themes and salient statements were identified from a qualitative analysis. Results: Analysis identified several multifaceted factors, including a difficult and pressured work environment and lack of resources due to chronic underfunding; perceived deficiency of personal skills, such as empathy; inadequate income; negative implications of stigma, low prestige, and limited patient gratitude and job satisfaction. These issues, coupled with the widespread belief that the discipline is unscientific and not “real medicine”, may contribute to later decisions not to pursue training in psychiatry. Conclusions: While the framing of the research question was biased towards eliciting negative evaluations of a career in psychiatry, the responses are nonetheless instructive in helping to understand the reasons why potential trainees might be discouraged from the field. If psychiatry is to attract high-quality recruits, there is clearly a need to address stigmatizing attitudes within the medical hierarchy, and provide positive educational experiences for medical students that excite their imagination about a career or even a calling – as against its negative ‘job’ status.

This article attempted to examine the relationship between cultural competence education and increasing diversity in nursing schools and practice settings. In addition to the review of the literature, a panel of experts was interviewed regarding institutional practices in response to the challenge of increasing diversity and cultural competence education. Evidence of positive outcomes of cultural competent care and impact of race and ethnic concordance between patients and providers are presented. The challenge of increasing underrepresented minorities in health care professions remains elusive. An ecological analysis is recommended to address the social and cultural barriers that transcend the micro system of the school and the macro system of the society. The challenge of increasing diversity and realizing outcomes of cultural competence education requires social and comprehensive remedies to level life inequities that perpetuate a history of disadvantages in some groups.

As guest editors, we are pleased to introduce the first issue of Public Health Reports entirely devoted to the subject of tobacco use prevention and treatment, with an emphasis on the education of public health pro fessionals to equip them with the tools and expertise required to combat this devastating epidemic. The American Legacy Foundation's partnership with the Association of Schools of Public Health, described in the Foreword, has come a long way toward reaching its goal of seeding the next generation of tobacco control leaders, researchers, and practitioners to stem the ris ing tide of tobacco addiction and related disease and death. This has been accomplished largely through the partnership's Scholarship, Training, and Education Pro gram for Tobacco Use Prevention (STEP UP) project. The grant initiative has served to increase awareness and resources, build infrastructure and capacity, and provide mentorship and teaching within schools of public health to begin training the workforce desper ately needed for this purpose. Figure 1 summarizes the STEP UP project's goals and objectives. Between 2002 and 2005, 22 grants were awarded to 11 schools of public health in four grant categories: cur ricular innovation, pre-doctoral scholarship, doctoral dissertation scholarship, and small grants/pilot studies for junior faculty (Figure 2). The initiative was designed

This policy paper addresses the problem of underrepresentation of minorities in the health care professions. Projections are that by 2050 minorities will represent 49% of the U.S. population. Several notable reports suggest that the health care of underrepresented minorities is improved when providers of similar ethnic and racial backgrounds provide the care. However, minority representation in the health care professions has not kept pace with the increase of minorities in the population. A variety of groups (federal, state, private, and health professional educational institutions) have provided billions of dollars toward increasing the number of underrepresented minority health care providers. However, the effectiveness of these programs is not readily evident. Therefore, we recommend comprehensive evaluations of programs funded to increase diversity in the health professions and the development of a Minority Health Care Professionals Center to assume accountability for monitoring programs that receive funding to increase the number of underrepresented minority health care providers.

The Genitourinary Medicine Non-Consultant Career Grade Group (GUM NCCG Group) was established for the purpose of looking at training and contractual issues for this heterogeneous group of doctors. In June 2003, 700 questionnaires were posted to NCCG doctors in the UK to enquire about various aspects of working conditions. A summary of the 244 replies (35% response) is presented. Eighty-four (34%) had a job plan and 81 (33%) had had an appraisal. Just over one-third (38%) had time allocated for continuing medical education (CME), audit and administration. The response of employers to attempts by NCCGs to upgrade, was poor. In all, 195 (80%) said they were registered for the purpose of continuing professional development (CPD), 43 (18%) were not and six people did not know whether they were registered or not. These results give cause for real concern at this point regarding revalidation pathways. Our survey highlights that NCCGs are disadvantaged in terms of appraisal, CPD and career progression and some jobs will be at risk as revalidation approaches.

The article addresses a number of initiatives taken in 2005 by the Bush Administration to address nursing issues. Summaries are provided of the investments in the Nurse Reinvestment Act, Financial Aid, access issues (including expanded community health centers), costs (including medical liability reform), information technology and the revised fair labor standards. Finally, the author concludes with rationale for complete workforce and workplace system redesign and the need for advanced practice nurses to engage in full scope practice without artificially imposed boundaries.

Providing access to higher education across all income groups is a national priority. This analysis assessed the performance, career choice, and educational indebtedness of medical college students whose educational pursuits were assisted by the provision of financial support. The study looked at designated outcomes (academic performance, specialty choice, accumulated debt) in relation to the independent variable, family (parental) income, of 1,464 students who graduated from Jefferson Medical College between 1992 and 2002. Students were classified into groups of high, moderate, and low income based on their parental income. During the basic science years, the high-income group performed better; however, in the clinical years, performance measures were similar. Those in the high-income group tended to pursue surgery, while those in the low-income group preferred family medicine. The mean of accumulated educational debt was significantly higher for the low-income group. The study provides support for maintaining economic diversity in medical education.

The components of a professional development model designed to empower school nurses to become leaders in school health services is described. The model was implemented during a 3-day professional development institute that included clinical and leadership components, especially coalition building, with two follow-up sessions in the fall and spring. Coalition building is an important tool to enhance the influence of the school nurse in improving the health of individuals, families, and communities. School nurses and nursing educators with expertise in the specialty of school nursing could replicate this model in their own regions.

Eight instruments to evaluate grant interventions aimed at increasing recruitment and retention of Hispanic/Latino and American Indian nurses were developed for a Nursing Workforce Diversity Grant. This article compares expert reviewer responses during content validation of these instruments with (a) current literature and (b) seven filmed intervals of Hispanic/Latino and American Indian nurses speaking about their educational experiences. White reviewers responded differently to certain items than did Hispanic/Latinoand American Indian reviewers (or reviewers closely affiliated with such persons). Responses of Hispanic/Latino and American Indian experts were aligned with one another but not alignedwith the responses of White experts, who also agreed with one another, prompting literature and film comparisons with their responses. Faculty development may be needed to help teachers uncover their assumptions about students of color, acquire knowledge about cultural perspectives, recognize institutional racism, and attain the skills necessary to develop and implement a curriculum of inclusion.

The era of globalization has brought substantially less progress than was achieved in the preceding 20 years. This study by the Center for Economic and Policy Research concludes that the data provide no evidence that the policies associated with globalization have improved outcomes for developing countries, and its findings challenge economists and policymakers who cite globalization as an engine of growth while pressing for policies that strengthen the trend. The study also served as a backdrop to the release of the United Nations Development Program's Human Development Report on July 11, 2001. Using standard measures of economic growth, health outcomes, education, and literacy, the CEPR study compares the progress achieved during the period preceding globalization, 1960–80, with the period from 1980 to 2000, which was characterized by the reduction of tariff and nontariff barriers to trade, the removal of restrictions on international investment flows, and increasing intervention by the International Monetary Fund and World Bank on a wide range of economic and policy issues. While the evidence presented here does not prove that the policies associated with globalization were responsible for the deterioration in economic performance, it does present a very strong prima facie case that some structural and policy changes implemented during the last two decades are at least partly responsible for these declines.

In 1992 and 1997, all US and Canadian dental schools were surveyed by mail regarding the preferred initial radiographic examination prescribed for non-emergency, comprehensive-care patients (dentulous adults, edentulous adults, and children). In both survey years, a minority of US and Canadian dental schools reported using selection criteria for dentulous adults and children, while nearly all schools reported doing so for edentulous adults. The purpose of this secondary analysis was to investigate the relationship between the use of radiology selection criteria (vs. pre-determined routine examinations) in US and Canadian dental school clinics and three factors: (1) the credentials of the chief-of-service, (2) institutional funding, and (3) geographic region. "Credentials of the chief-of-service" is the single factor significantly related to the distributions of radiographic examinations prescribed for dentulous adults in both years (Fisher exact test, p ≤ 0.02). There are no statistically significant relationships for edentulous adults or children in either year. Multivariate analyses (logistic regression) of the 1997 data reveal that institutions with a credentialed chief-of-service are 2.39 times more likely to report using selection criteria than institutions with a non-credentialed chief-of-service; private institutions are 1.13 times more likely than public institutions, and Canadian schools are 3.65 times more likely than US schools. A similar trend was identified for children. Analysis of the 1992 data revealed similar trends for the credentials of the chief-of-service and the geographic region, but showed no association between institutional funding source and the use of selection criteria. Contrary to accreditation standards, most US and Canadian dental schools obtained pre-determined routine radiographic examinations on most new patients. However, the presence of a credentialed chief-of-service had a positive effect on the use of selection criteria for dentulous adults and children.

This article provides an overview of developments in training programs in the Pacific Island countries (PICs) from the perspective of two Australians who assist in the promotion of health in area. There is historical evidence of successive waves of education in health promotion bringing a sequence of different approaches: from didactic health education to an individualistic approach to disease prevention to an era of social marketing. The latest and potentially the most influential new wave is the Healthy Islands Movement which started in 1995. Although health education for prevention of disease remained a consideration the primary focus has been on development of supportive environments for health through multiple approaches. It involves not only training in production and use of information education and communication (IEC) program materials but also building the capacity of PIC people to create and sustain health more effectively. The paper concludes with a commentary on the developments noting three aspects that need consideration for future education in health promotion. First local short courses must be made to meet local needs. Second the Healthy Island framework should be constructed as a regional umbrella under which local health promotion action can be nurtured. Third the myth that disease-prevention approaches are better than health-optimizing approaches should be examined. Health educators should assist others to ride the new wave in education for health promotion in PICs.

As managed care has grown, much concern has been expressed about the potential plight of the nation’s 125 academic health centers (AHCs). Less concern has focused on non-AHC teaching hospitals, although most studies of graduate medical education (GME) costs include these hospitals in their estimates. While most studies have found that costs increase positively with various measures of “teaching intensity,” some have concluded that hospitals with smaller programs have costs that are the same or less than comparable nonteaching hospitals. However, few studies have tested whether AHCs’ cost structures are sufficiently similar to those of other hospitals to reliably include them in the same estimation. This article tests that assumption for Maryland hospitals, finds it violated, and presents results for non-AHC teaching hospitals. The results reveal that, at least in Maryland, even small teaching programs add to hospital costs.

Mention the possibility of surgery to a patient and most will react with a feeling of apprehension at best. Some will be horrified at the mere thought of being ‘cut open’. For others, it will be the suggestion of entering a hospital for anything longer than an out patient appointment. Newspaper reports of healthcare-acquired infections (HAIs) may spring to mind: ‘Will I leave with more than I came in for?’; ‘What if it goes wrong?’; ‘Who will look after the family?’. All this worrying leads to increased anxiety and stress, and the patient has not even been put on the waiting list yet, let alone been admitted.

Nursing has a long history of focusing on the cultural dimension of care, dating back to Florence Nightingale and the early days of public health nursing. Nursing education studies advocated for including social science concepts in nursing curricula well before the founding of the first university school of nursing in the United States in 1910. A brief review of the highlights of major nursing curriculum, licensing, funding, accreditation studies, and initiatives reveals that culture competence in nursing education continues to receive increasing emphasis and support.

The public health workforce in Australia is highly skilled, multifunctional, and drawn from a variety of backgrounds, including clinical practice and non-health areas. A wide range of activities is needed to meet the educational and training requirements of this workforce, including on the job inservice training, context specific continuing education programs and short courses, distance and self-directed learning packages, and postgraduate University level courses. The core components of public health today include: a social and political commitment to health, a shared responsibility between government and the public, and a multidisciplinary field of action. The challenge for those providing education and training for the public health workforce is to ensure graduates have the broad range of knowledge and skills needed in this climate. A system-wide approach to learning, where knowledge and skill development is related to the practices and settings of service and program delivery, will ensure strong links between education and practice.

Training for transplant coordinators is not mandatory in the United Kingdom, although the United Kingdom Transplant Coordinators Association has provided informal courses since 1988. The authors of this article were responsible for the development of an accredited training program for transplant coordinators in the United Kingdom. Accredited by the University of Central England, the course modules have been run and managed by the Association since 1996. The course consists of 3 modules: Introduction to Transplant Coordination, Interpersonal and Professional Skills for Transplant Coordinators, and Introduction to Research Methods for Transplant Coordinators. Between 1996 and 1999, 64 transplant coordinators (60% of transplant coordinators currently in post) in the United Kingdom have undertaken at least 1 module. The Association feels that the accredited training program means one step further on the road to professional recognition of transplant coordinators in the United Kingdom.

A survey examining the level of Australian Intensive Care Unit involvement in the education of Asian critical care doctors and nurses was performed. Of the 49 hospitals surveyed, 34% have ongoing links. An analysis of countries involved, proportion of medical and nursing numbers, and whether the teaching was performed in Australia or the Asian country was undertaken. The survey revealed that a high proportion of Australian Intensive Care Units are actively involved, or would consider future participation, in educational links with Asian units.

number of factors. Principally, the trainee is in a position of weakness regarding both knowledge and experience. The feeling that there is a wrong approach to a problem can be difficult to articulate under any conditions. When confronted by a summary of the literature, however recent, or simply by the senior surgeon’s experience, it may be nearly impossible to engage in honest debate. However, the trainee’s exposure to multiple attendings, and even multiple institutions, may provide a more up-to-date, thorough review of possibilities. Of course, the trainee also has a social consideration; the attending has the power of the evaluation. In the hierarchy that is a surgical team, there may be a fine line between perceived debate and insubordination. Under the best of conditions, there is a relationship between those of different levels of experience, which makes the communication easy. However, a clash over a single patient encounter may tarnish the relationship and may cloud patient care issues with personal conflict. Fortunately, the simpler the problem, the simpler the resolution. “Because I said so” is an effective means of justifying slight variations from the routine delivery of care. However, there are situations when a trainee may feel that a procedure is being withheld or that the effective therapy is being misapplied. The first role of the trainee in this instance is to question the authority. There is no substitute for direct question and answer. It may be that the attending has a strong reason, which becomes obvious through a few moments of discussion. However, should that fail to clarify matters for the trainee, it can rapidly reach the point of conflict. What typically happens is some degree of acceptance. What the attending surgeon wants, the attending usually gets. Ultimately, this is just, as the legal responsibility for the care of the patient rests Do the right thing. It is an easy phrase to say and even easier to remember. You would have probably heard it countless times. It is a catchphrase. It is a movie. It is even a bumper sticker. Yet in the realm of surgical judgment, the right thing may not be the obvious course of action. The care of surgical patients in difficult cases is highly nuanced and not readily reduced to discrete algorithms. As a trivial example, the “right” antibiotic for a young woman may be exactly the “wrong” antibiotic if she is pregnant. Judgment extends well beyond the routine, day-by-day choices we make in the postoperative period. The nuances of determining whether someone deserves an operation and the timing of that intervention can take a full surgical lifetime to master. This is widely acknowledged and universally accepted by the surgical community. We place substantial emphasis on the thought process behind operations and not just on the technical aspects of surgery. For example, every week we enjoy a morbidity and mortality conference, and each surgeon sits in front of a jury of peers during the oral board certifying examination. Clearly, as a group, we value good decision making. So what do trainees do when they feel that the surgical attending is doing the wrong thing? This is a complex issue but one sure to face every student, resident, or fellow. It is complicated by a Surgical Innovation Volume 15 Number 1 March 2008 74-75 © 2008 Sage Publications 10.1177/1553350608316670 http://sri.sagepub.com hosted at http://online.sagepub.com Editorial

Attempts to achieve equity in special education funding encounter significant problems and contingencies similar to those encountered in funding general education services. These factors include variations in population, in needs, in service delivery, in governance structure, in resources, and in system costs. With these six identified factors as a base, a field study was conducted in 1979 in New York State to solicit reactions from individuals who play a key role in policy process in regard to the relevance and exhaustiveness of suggested factors, the factors' relative importance, diversity among role groups as to perception of factors, and perceptions regarding New York State fiscal policies in addressing the factors. The most important concern voiced by policy influencers was over the actual amount of money available for financing special education.

In the 1960s the federal government of the United States added a wide range of new health programs—Medicare, Medicaid, health manpower training, occupational safety, and others—to its long-established support for biomedical research and hospital construction. Total federal health outlays rose from $5 billion in 1965 to almost $37 billion in 1975. This paper describes the legislative history of federal health programs and reports the recent trends in expenditures by functional category. The expenditures of major programs are related to the populations they serve and data are presented to document the enormous inflow of resources to medical care during the last 10 years. This inflow has been induced by the structural changes in the medical care market first set in motion by private health insurance, and accelerated by the new federal programs. Designing some way to control it is a major problem in health policy for the late 1970s.