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This article uses the problems associated with citizenship verification in U.S. government health insurance programs to argue that paper needs to be analyzed as a media technology. To examine paper as a media technology is to ask, “How does paper work?” and “What are the rules and habits that enable paper to be used in paperwork?” To consider paper as a media technology, this article makes 2 arguments. First, it argues that there is a set of skills and knowledge associated with paper documents that need to be recognized as a distinct form of literacy. Second, this article argues that the relation between paper and identity is an argument about the materiality of information. In focusing on how paper facilitates the materialization of information, this case study illustrates how distinct practices of use create specific relationships between technology and information that give information a distinct functional presence. [ABSTRACT FROM PUBLISHER]

The purpose of this paper is to describe the Caribbean HIV Evaluation Support demonstration program, a five-site HRSA-funded demonstration project that aimed to implement a peer support intervention to help HIV-positive Caribbeans living in the United States. This paper provides a framework of the demonstration including the rationale for the program, program requirements, and eligibility of participants. In addition, this paper describes each of the five programs including, Brookdale University Hospital and Medical Center, Brooklyn, NY; Lutheran Medical Center, Brooklyn, NY; Community Healthcare Network, New York, NY; University of Miami, Miami, FL; and Montefiore Medical Center, Bronx, NY. The background of each program description includes: setting, theoretical frameworks, peer training, client recruitment & staffing and content of the intervention. Finally, lessons learned including the utility and feasibility of the peer-support intervention program is identified at the closing. [ABSTRACT FROM AUTHOR]

EMS personnel in the U.S. continue to be overwhelmingly Caucasian and male, with 75% being male and 85% identifying as nonminority. While the population of the United States becomes more diverse in ethnicity, religion, and race, the EMS workforce remains largely homogenous and does not reflect the diversity of the population it serves. Given the growing diversity across the country, EMS personnel will increasingly be responding to calls for service involving patients with different cultural backgrounds than their own. This growing gap between providers and the population they serve may exacerbate already existing disparities in care. [ABSTRACT FROM AUTHOR]

Introduces a series of articles regarding the U.S. healthcare industry selected from the papers presented at the annual Business and Health Administration Association Conference in 2002.

Deals with the position paper presented to the President's Committee on Health Education in Boston, Massachusetts on January 6, 1972 concerning health promotion in the U.S. Basis of the health promotion recommendations of the paper; Importance of having a massive consumer health education effort; Establishment of state health education training centers.

China has been contributing to new approaches to global governance. The Health Silk Road (HSR), a significant component of the Belt and Road Initiative (BRI), was proposed by China in 2016. This paper claims that HSR is a new institution introduced alongside the existing WHO-led multilateral health system, and its relationship with the existing system can be described as layering. Having explored the new development of HSR during COVID-19, this paper further argues that while HSR has its unique strength in making contributions to global health governance and economic recovery, it faces a prominent issue of securitisation in the context of China-U.S. strategic competition, suspicion of the quality of medical products and sectoral fragmentation. [ABSTRACT FROM AUTHOR]

Research, policy and practice in the field of interprofessional collaboration have focused on how medical, nursing, allied health and social care practitioners work together to positively impact patient care. This paper extends conceptual thinking about interprofessional practice by focusing on lawyers as part of the interprofessional mix. This attention is prompted by medical–legal partnerships (MLPs), a service model by which lawyers join health care settings to assist patients with unmet, and often health-harming, legal needs. MLPs are present in around 450 hospitals and other health care sites across the United States and the model has spread to other countries, including Australia, the United Kingdom and Canada. However, enthusiasm for the MLP model is not yet matched by good evidence on how, when and for whom the model works. Interprofessional scholars contend that imprecise terminology and poor conceptualization of interprofessional arrangements hinder high-quality research and evaluation. In response to their critiques, this paper formulates a stepwise conceptual framework to guide the design, implementation and study of interprofessional arrangements that connect health, social care and legal practitioners. This framework draws on findings from national surveys of MLP initiatives in several countries and adapts several key conceptual frameworks that have been developed from systematic reviews of interprofessional working in primary health care. These conceptual frameworks are valuable because they promote clarity about different modes of interprofessional working and characterize the factors at macro (policy, funding), meso (organizational) and micro (practitioner, patient) levels that help or hinder professionals from different disciplines in working together. The paper considers factors at these three levels that require particular attention when lawyers join health care settings and proposes questions for future research in this emerging area. [ABSTRACT FROM AUTHOR]

Reproductive coercion (RC) can be conceptualized as any behavior that limits one's ability to make decisions about their reproductive health. Here, we broaden this definition to consider the impact of systemic and sociocultural factors on RC using an ecological model. Specifically, we use Bronfenbrenner's model as a framework for organizing the multilevel factors that influence reproductive coercion (RC) and its impacts on individual health. This paper is intended to offer a primer to historical, sociocultural, community, interpersonal, and individual processes that may interact to shape reproductive decision-making and its effect on individual health outcomes. We emphasize the importance of conceptualizing RC within the broader sociocultural and community context, and the potential implications for reproductive and sexual health research, clinical care, and policy in the United States. [ABSTRACT FROM AUTHOR]

In the wake of COVID-19, mental health providers and treatment programs are adapting rapidly to the challenges in engaging people and delivering treatment with limited guidance. This paper will explore the challenges associated with delivering treatment within coordinated specialty care (CSC) programs for people with first episode psychosis. Suggestions for treatment will take into consideration experiences with stress, changes to the pursuit of work and school, and increased time spent with families. Drawing on the experience of several CSC programs in the United States, Israel, and China, we describe the impact and modifications to the core treatment elements in CSC including medication, family interactions, supported employment and education, individual therapy, peer support and the way they are delivered. The paper includes recommendations based on experiences from CSC programs to help staff members, participants, and family members better identify, prepare, cope and respond to the unique new challenges and suggests modifications that can be made during various stages of the coronavirus pandemic. [ABSTRACT FROM AUTHOR]

This paper focuses on the development and feasibility of a digitally-based educational intervention, titled Recognize & Resist (R&R), for writers of One Direction (1D) fanfiction on Wattpad.com. The goal of R&R is to reduce the prevalence of social norms that are supportive of sexual violence within 1D fanfiction. 1D fanfictions, or fictional romance stories written by fans of this British boy band, have hundreds of millions of views on Wattpad.com. Formative research has found that social norms supportive of sexual violence are prevalent in 1D fanfictions and that some authors have internalized these norms. R&R aims to motivate 1D fanfiction writers to highlight sexual consent and egalitarian gender roles in their writing. To evaluate the intervention’s feasibility, 15 1D fanfiction authors completed a survey and participated in an interview or focus group. Results demonstrate R&R’s feasibility, with high ratings of its acceptability and demand. Insights from the interviews and focus groups provide suggestions for revising R&R before rigorously evaluating its efficacy. Additionally, results demonstrate the utility of using popular culture as a vehicle for attitude-change regarding sensitive health issues. [ABSTRACT FROM AUTHOR]

This paper reports findings from a qualitative study on the triggers of hospital social workers' moral distress at a large southern U.S. health system. Moral distress occurs when ethical conflict cannot be resolved in a way that aligns with an individual's personal and professional values and ethics. Participants indicated that moral distress derives from both individual interactions and the culture and climate of health systems. For example, participants expressed how sources of moral distress derived from client-centered decisions, such as end-of-life care and patient autonomy; interpersonal dynamics, including team or supervisory conflict; structural issues, such as insurance barriers or internal hospital policies; and organizational values, such as perceptions of institutional support and validation. Implications of this research suggest that health systems need to foster positive ethical environments that nurture clinicians' health and mental health through programs that aim to increase moral resilience, promote empowerment, and foster wellness. [ABSTRACT FROM AUTHOR]

In light of some concerning trends regarding social service delivery, this paper syntheses the emerging literature on religious congregations. After government, congregations are the most prominent providers of social services in the United States. Because the long-term viability of government human services is threatened by growing deficits and escalating social needs, congregations are likely to be an increasingly important vehicle for alleviating human suffering. Congregations also offer serval unique strengths. For example, they frequently assist underserved populations that more traditional secular providers may not reach, a practice that may help ameliorate health disparities. They also provide a forum in which entrepreneurial social enterprises can be incubated. This paper concludes by offering several suggestions to assist social workers and other helping professionals work with congregations to enhance client wellness. [ABSTRACT FROM AUTHOR]

The impact of COVID-19 on the psychology training community has included modifications to internship and postdoctoral fellowship training programs to assure the safety of patients, trainees, and staff. Studies assessing the impact of COVID-19 on training in health service psychology are emerging; however, few studies have provided the opportunity for psychology trainees to candidly report about their experiences during the ongoing pandemic. This paper aims to describe how the pandemic effected internship and fellowship training experiences from the trainee's perspective. Participants included 58 trainees from pediatric psychology internship and postdoctoral fellowship programs in the United States. A survey containing open- and close-ended questions was distributed to trainees via their training directors to assess training experiences during COVID-19. Qualitative analysis of responses revealed four themes describing 1) reduced depth and breadth of training opportunities, 2) social isolation and limited professional and personal support, 3) increased use of telepsychology and reduced in-person training, and 4) increased levels of stress and burnout combined with decreased morale. Many internship trainees described pandemicrelated challenges to completion of dissertation, and postdoctoral fellows experienced altered or delayed professional trajectories due to financial, mental health, and career readiness factors. Implications and future directions include the need for increased support both professionally and personally for trainees who are completing internship and postdoctoral fellowship training in the midst of COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Poor prescription drug adherence is common, jeopardizing the benefits of treatment and increasing the costs of health care in the United States. A frequently reported barrier to adherence is patient out-of-pocket (OOP) costs. Areas Covered: This systematic review examines interventions that address patient cost-sharing to improve adherence to prescription drugs and reduce costs of care. Twenty-eight published studies were identified with 22 distinct interventions. Most papers were published in or after 2010, and nearly a third were published after 2014. Expert Opinion: Many of the interventions were associated with improved adherence compared to controls, but effects were modest and varied across drug classes. In some studies, adherence remained stable in the intervention group, but declined in the control group. Patient OOP costs generally declined following the intervention, usually as a direct result of the financial structure of the intervention, such as elimination of copayments, and costs to health plans for prescription drugs increased accordingly. For those studies that reported drug and nondrug costs, lower health plan nondrug medical spending generally compensated for increased spending on prescription drugs. With increasing health-care spending, especially for prescription drugs, efforts to improve prescription drug adherence in the United States are important. Federal policies regarding prescription drug prices may have an impact on cost-related nonadherence, but the content and timing of any policies are hard to predict. As such, employers and health plans will face greater pressure to explore innovative approaches to lowering costs and increasing access for beneficiaries. Value-based financial incentive models have the potential to be a part of this effort; research should continue to evaluate their effectiveness. [ABSTRACT FROM AUTHOR]

The article presents news briefs regarding community health nursing. A report which has been released by the Centers for Disease Control and Prevention (CDC) regarding the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) is discussed. Guidelines which have been provided by the American Nurses Association (ANA) regarding the way in which health care workers should respond to emergencies and disasters are mentioned.

This paper draws upon published literature, focus groups, workshops, and individual patient views to identify general use of Internet for health information and, specifically, use of cross-border Internet pharmacy Web sites to locate and purchase prescription drugs. The paper applies the theoretical frameworks of risk perception theory and social cognition theory to attempt to explain why American patients continue to shop for prescription medications through cross-border Internet pharmacies (CBIP) despite its questionable legal status and potential for serious harm. [ABSTRACT FROM PUBLISHER]

Based on data from an eight year longitudinal study of Ohio's long-term care use patterns, this paper describes the changes now being experienced by this industry. Although Ohio has been a state with a heavy reliance on institutional services, the data suggest a change in how long-term care is provided in the state. Over the past eight years, despite an increasing disabled older population, nursing home occupancy rates have fallen from 92.5% to 83.5%. At the same time, in-home service and assisted living use has increased. The paper concludes by describing how such changes are likely to impact the system of the future. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been stressful for many, increasing levels of anxiety, depression and other mental health concerns worldwide. With the spread of the virus, many youth found themselves physically isolated from their peers and confined to their homes, and medical and mental health services previously provided in person had to adapt by providing virtual sessions. The transition to virtual care created many new challenges for clinicians and patients, including some specific to transgender youth and their families. Pre-pandemic, transgender youth comprised a marginalized and vulnerable population, with elevated risk for adverse mental health outcomes. However, community support, strong group identification and family affirmation can serve as important mitigating factors. In this paper, we will discuss unique challenges encountered in working with the parents and caregivers of transgender youth during virtual visits that have the potential to interfere with development of a therapeutic alliance and the movement toward increased family acceptance. We will provide clinical case examples and propose methods through which to address difficulties and improve care. [ABSTRACT FROM AUTHOR]

The 2010 Affordable Care Act (ACA) increased healthcare access for many Americans. But, its exclusion of most noncitizens and imperfect state-level implementation stratified coverage by documentation status, place, income level, race, and ethnicity across the U.S.A. Drawing from the sociological literature on boundaries, this paper argues that these demographic boundaries facilitate de jure and de facto stratification for immigrants and low-income Americans of various ethnoracial backgrounds. Using existing survey research regarding national ACA implementation and a qualitative study of ACA implementation in Boston, MA, this paper shows how such stratification may worsen existing disparities in healthcare coverage and access among the U.S. population. Implications regarding President Donald Trump and conservative lawmakers’ plans to repeal the ACA are also discussed. The paper contributes to researchers’ understanding of how public policies produce boundaries by place, documentation status, race, ethnicity, and income that facilitate inequality. [ABSTRACT FROM AUTHOR]

This paper examines the grid of sentiment that structures medical travel to India. In contrast to studies that render emotion as ancillary, the paper argues that affect is fundamental to medical travel's ability to ease the linked somatic, emotional, financial, and political injuries of being ill 'back home'. The ethnographic approach follows the scenes of medical travel within the Indian corporate hospital room, based on observations and interviews among foreign patients, caregivers, and hospital staff in Mumbai, New Delhi, Chennai, and Bangalore. Foreign patients conveyed diverse sentiments about their journey to India ranging from betrayal to gratitude, and their expressions of risk, healthcare costs, and cultural difference help sustain India's popularity as a medical travel destination. However, although the affective dimensions of medical travel promise a remedy for foreign patients, they also reveal the fault lines of market medicine in India. [ABSTRACT FROM AUTHOR]

This study provides an insight into the difficulties companies encounter in transposing basic science into commercially viable healthcare technologies, focusing on the issue of establishing a dominant supply model within a highly regulated market. The core issue is how to scale-up customised scientific processes into products able to supply wider and possibly mass markets. In tracing the development of approaches to scaling-up, the paper highlights the influence regulatory regimes have on high technology regulated products and services. The paper details the implications of two contrasting supply initiatives towards operationalising tissue engineering, based on differences in regulatory regimes between Europe and the USA. [ABSTRACT FROM AUTHOR]

The article offers a review of various articles related to family medicine. It notes the move of the American public to become a model of medical care that occupies with the patient where they can direct their care with their chosen providers. It mentions the vitality of critical thinking to assist all clinicians in the processes of decision-makings. The move of physicians towards a structured interview for training posts is also cited.

On October 2, 1919, President Woodrow Wilson suffered a stroke that paralyzed the left half of his body. Wilson's stroke forced the American public to confront stroke, and laypeople came to identify stroke as a nervous disorder, rather than a condition rooted solely in psychological phenomena. His medical care was overseen by Cary Grayson, his personal internist, and Francis X. Dercum, a remarkably accomplished neurologist from Philadelphia. Dercum was very involved in the treatment of the President, from the day of the stroke until years later. While the medical records have been destroyed, some basic facts of Wilson's treatment and rehabilitation can be inferred from the literature. Although Woodrow Wilson was an exceptional patient, his care, albeit administered by some of the most famous physicians of the era, was typical of the time. Therefore, this paper's approach to Wilson's 1919 stroke contextualizes the President's case into the larger scheme of early twentieth-century neurology. [ABSTRACT FROM AUTHOR]

Hospice social workers face many challenges in attempts to replicate or supplement the holistic support and unique services hospice provides for individuals discharged alive. This discontinuity in care can impact the types of supports needed by individuals and caregivers, which may or may not be accessible within their community. Patients and families who have access to community-based palliative care programs following a discharge generally tend to navigate the process with fewer challenges. This qualitative study (N = 24) explored both the challenges of the live discharge process and the opportunities within social work practice in the US. Results from this study emphasize the need for a framework to better approach a live discharge to ensure appropriate supports are accessible for all patients and caregivers. Specifically, results highlight both the concrete and psychosocial challenges in live discharges as a result of tension between current eligibility requirements and individual feelings and needs. Social workers also provided suggestions to improve the live discharge process, including attention to communication and preparation. This paper outlines specific challenges of live discharge from hospice, a framework for understanding presented challenges, and implications for policy and practice. [ABSTRACT FROM AUTHOR]

Three complementary and overlapping foci for interprofessional education (IPE) - preparing individuals for collaborative practice; learning to work in teams; and developing services to improve care - have been presented previously as a threefold classification derived from a systematic review (Barr et al., 2005). This paper adds discussion of a fourth: improving the quality of life in communities. The fourth focus is less often found in the literature and is described more fully in this paper. It embodies six approaches to interprofessional learning, discussed in the paper, that are thought to be particularly relevant to the work of Pathways into Health with American Indian and Alaska Native tribes, and more widely wherever collaborative learning and practice are invoked to improve quality of community life. [ABSTRACT FROM AUTHOR]

Approximately 200 million people in the United States have an addiction disorder that significantly disrupts employment, family relationships, financial stability, and personal health. As a result, addiction has become one of the most critical health care challenges presently facing the American health care system. Research in the last five years has provided substantial evidence that addiction is a neurobiological condition rooted in genetic factors. During the addiction process neurologic changes occur that are responsible for tolerance, craving, and relapse. It appears that once addiction becomes chronic, the brain enters an addicted state that may be irreversible without pharmaceutical intervention. Such alterations in neurochemistry-rather than poor volitional control-account for why addiction is characterized by a chronic, relapsing-remitting course. This paper discusses (a) the neurobiological factors underlying the addiction process, (b) available pharmaceutical treatment, and (c) how recent research regarding the neurobiology of addiction affects occupational therapy's role in addiction rehabilitation. A case study follows that illustrates how occupational therapists can contribute to addiction intervention. [ABSTRACT FROM AUTHOR]

Few studies have examined the impact of government support and policies on immigrant services within ethnic enclaves. This paper seeks to address this gap and examines the structure and challenges of ethnic community based organizations (CBOs) that serve low income immigrant populations and the impact of government support and policies on these CBOs. The study utilized case study and ethnographic methodologies and examined 2 Chinese and 2 Vietnamese CBOs in the San Francisco Bay Area. The findings show that ethnic CBOs critically depend on government fiscal support for survival. In exchange for fiscal support, ethnic CBOs represent public assistance and legitimacy interests for government in immigrant communities. However, culturally proficient and community leadership resources of ethnic CBOs can serve as bargaining chips to secure government funding, reduce compliance to government demands, and advance immigrant community interests. Nevertheless, in times of government fiscal crisis, ethnic CBOs and immigrant services tend to be most vulnerable to budget cuts due to lack of political voice. In sum, government-community collaboration through ethnic CBOs has a central role to play in facilitating and strengthening health and human services for rapidly growing, culturally diverse immigrant populations. These collaborative efforts in immigrant services are vital to cultivating healthy immigrant human capital and multicultural communities across the United States. [ABSTRACT FROM AUTHOR]

In all aspects of health and mental health care-the emergency room, the outpatient clinic, inpatient facilities, rehab centers, nursing homes, and hospices-social workers interact with patients from many different cultures. This paper will introduce an assessment tool for health care professionals to advance understanding of culturally diverse patients and their families. [ABSTRACT FROM AUTHOR]

A substantial amount of healthcare and costs are attributable to arthritis, which is a very common chronic disease. This paper presents the results of a systematic review of arthritis cost studies published from 2008 to 2013. MEDLINE, Embase, EconLit databases were searched, as well as governmental and nongovernmental organization websites. Seventy-one reports met the inclusion/exclusion criteria, and 24 studies were included in the review. Among these studies, common methods included the use of individual-level data, bottom-up costing approach, use of both an arthritis group and a control group to enable incremental cost computation of the disease, and use of regression methods such as generalized linear models and ordinary least squares regression to control for confounding variables. Estimates of the healthcare cost of arthritis varied considerably across the studies depending on the study methods, the form of arthritis and the population studied. In the USA, for example, the estimated healthcare cost of arthritis ranged from $1862 to $14,021 per person, per year. The reviewed study methods have strengths, weaknesses and potential improvements in relation to estimating the cost of disease, which are outlined in this paper. Caution must be exercised when these methods are applied to cost estimation and monitoring of the economic burden of arthritis. [ABSTRACT FROM PUBLISHER]

The outbreak of COVID-19 has raised concerns about the availability of health care facilities globally. Disruptive innovations in health care may impact a new system that provides a continuum of treatment tailored to each patient's specific requirements. In light of this evolution, this study aimed to visualize global research output on disruptive innovation in health care between 2001 to 2021 as indexed in the Scopus database. The dataset was extracted on January 10, 2022, and 204 records were identified for data analysis. Various bibliometric indicators were used to identify publication trends. VOSviewer visualization software was also used to analyze data. The findings revealed the increasing pattern of publication growth with slight fluctuation over time. M. Friebe was the most prolific author having contributed four publications. The Harvard Medical School was the most productive institution with eight publications and the United States was the most productive country with 84 publications on disruptive innovation in health care. Furthermore, human, health care, and disruptive innovation were the top keywords in this field. These findings are expected to be useful to academics and administrators all across the world. This study also gives readers insight into this domain and will allow them to begin their research by selecting a topic of their choice. [ABSTRACT FROM AUTHOR]

Generating effective results is the mission and responsibility of residential treatment providers. With increasing demands to demonstrate comparative effectiveness it is critical for providers to develop and implement systems for measuring outcomes. This paper from the American Association of Children’s Residential Centers addresses the importance of this effort, defines differing types of measurements, offers tis and strategies for designing an outcome measurement system, and addresses issues and concerns. The importance of readiness and community partnerships is critical in this work. [ABSTRACT FROM AUTHOR]

This paper outlines a framework for conceptualizing the contributions that psychoanalytically-informed therapeutic professionals working within education settings can make to school staff and systems as well as to children and families. The paper combines theoretical concepts with case examples of work undertaken in different education settings, to illustrate the opportunities provided by offering a 'therapeutic presence' within schools. Examples include direct work with children and their families, as well as work with teachers and other education professionals, and include work in mainstream nursery, primary and secondary settings, as well as settings offering specialist provision. [ABSTRACT FROM AUTHOR]

In Australia we have become preoccupied with the potential adverse impact of our ageing population on our health and social systems. The projected cost of having increasing proportions of our population in the over 70s, retired, chronically ill category of the demographic profile is emerging as a major challenge for governments and private insurers: so much so in fact that the government is now urging older people to stay at work longer. In America, new approaches to the management and self-management of chronic diseases have been invoked to encourage and support older people to improve their quality of life and reduce their recourse to and dependence upon health care technologies, clinical interventions and health care management systems. Unless this is achieved, it is argued, the cost of looking after this emerging ‘bubble’ of elderly people will become increasingly unsustainable as fewer and fewer (proportionately) younger people work to pay the taxes that support ageing, retired, sick and dependent populations. This paper argues that we are at real risk of having our economic wealth and productivity impeded and truncated by the financial burden of looking after high demand and high cost dependants at the aged end of the social demographic. This paper offers an alternative view of our ageing population, as well as highlighting some of the assets we have in our elderly populations, and providing suggestions as to an alternative view of the phenomenon of ageing that incorporates elements such as flexible working arrangements and the application of new, enabling technologies. This approach to our ageing population dilemma is predicated on a concept of lifelong learning and social participation along with better preventive and early intervention systems of health care. [ABSTRACT FROM AUTHOR]

The Society for Teachers of Family Medicine (STFM; http://www.stfm.org) is a community of professionals devoted to teaching family medicine through undergraduate, graduate, and continuing medical education. This multidisciplinary group of physicians, educators, behavioral scientists, and researchers works to further STFM's mission of improving the health of all people through education, research, patient care, and advocacy. STFM holds an annual conference each spring and a predoctoral education conference each winter. STFM held its 33rd annual Predoctoral Education Conference in Memphis, Tennessee, from January 25 to 28, 2007. Elizabeth Garrett, MD, MSPH, professor and predoctoral director in the Department of Family and Community Medicine at the University of Missouri, Columbia, opened the conference with a stirring plenary about the direction of family medicine and the legacy we, as predoctoral educators, must create in the future of our students. Thomas Schwenk, MD, chair of the Department of Family Medicine at the University of Michigan, discussed the implications of training students in the era of new technologies and innovative approaches to delivering family medical care. Laurence Bauer, MSW, MEd, clinical associate professor in the Department of Family Medicine at Wright State University, delivered a motivating talk about funding opportunities from private foundations. Participants shared ideas and learned new skills in more than 65 workshops, seminars, and discussions as well as 38 education research and evaluation papers. Unifying themes included LCME ED2 (Educational Directive) requirements, community medicine, technology in medical education, preceptor development and learner and program evaluation. From the educational research or curriculum evaluation papers presented at the conference, a subcommittee of the STFM Education Committee selected 12 papers that we felt would be of interest to readers of Teaching and Learning in Medicine. These papers represent completed studies involving undergraduate medical education. [ABSTRACT FROM AUTHOR]

This paper explores historical and recent trends in the delivery of residential adolescent substance abuse treatment, looking specifically at the impact of managed care on the service delivery system. Three historical eras are conceptualized by the authors: (1) an era prior to managed care in which services were provided on a fee for service basis by health insurance companies and lengths of stay were relatively longer; (2) an era of managed care in which services were funded through managed care organizations and lengths of stay were significantly reduced; and (3) the current era in which residential services are provided through self-pay and through other service systems. Awareness of these changes is important for all practitioners who provide services to adolescents and demonstrate the need to advocates for residential substance abuse services for all adolescents. [ABSTRACT FROM AUTHOR]

Improving the conditions under which incarcerated populations give ‘informed consent’ is a desirable goal given prisoners' lack of autonomy; part of the Institutional Review Board's (IRB) procedures is the inclusion of representative voices from the prisoner population as a mechanism to reduce harms. The most recent review of the ethics of research on pnsoners by the Institute of Medicine recommends an expanded role for prisoner involvement, outlining a collaborative research approach involving prisoners as active participants in all aspects of the research, including design, planning and implementation, not just at the IRB stage. In this paper, we briefly outline the existing state of IRB protections for prisoners selected for research, and focus on the effectiveness of prisoner representatives in this process. We suggest that there are weaknesses within the existing system such that representation may provide little more than ideological legitimation for the process. Moreover, we argue that while the Institute of Medicine's recommendations mark a major improvement in protection vis-à-vis prisoner representation, it does not go far enough in articulating the process whereby the voices of prisoners, their advocates or their representatives are included in the different stages of the process. In short, we question whether ‘being heard’ is enough. We suggest that research needs to be conducted to more extensively map the scope of this issue and to raise some critical questions in order to improve the effectiveness of the ethical considerations for research on prisoners, as well as the RB process and any post-IRB oversight, in protecting this vulnerable population. [ABSTRACT FROM AUTHOR]

The primary focus of this paper is to analyze the Mexican health care system and the forces driving its change. To facilitate this, the paper conducts an analysis of the key stakeholders in both the U.S. and Mexican health care systems. The Mexican system is dominated by an autocratic federal government that is gradually relinquishing its role as provider of health care in exchange for control of the reform efforts. The U.S. system is characterized by a relatively equal distribution of power among the key stakeholders, in which changes occur primarily through incrementalism. The results of the analysis indicate that the key differences lie in terms of relative stakeholder power and rate of change in the systems. Compared with the U.S., Mexico is making rapid changes to its health care system and both countries are struggling with the same key issues: Cost, access, and quality. [ABSTRACT FROM AUTHOR]

Drug abuse and addiction continues to negatively impact many lives in this country. The United States health care system has grappled with how to best serve this vulnerable population. Since the personal and societal costs of addiction are high, all recent iterations of the United States strategic health plans (such as Healthy People 2010) have prioritized this area for improvement. At the local level, health care providers who care for those with addictions are challenged with shrinking insurance coverage for services, a difficult patient population, lack of treatment options, growing ranks of indigent patients, as well as a plethora of additional management challenges. It is known that successful treatment is integrally linked with patient satisfaction with services. The most critical factors in successful addiction treatment (from a patient's perspective) are (1) their belief that the counselor cares about them and, (2) their belief that they can recover. This paper reports a case study in the use of a patient satisfaction survey as a quality management/service refinement tool within a methadone treatment setting. Results indicate that the use of the survey itself provides patients with a tangible cue supporting the presence of the critical success factors. Further, the use of a survey provides a baseline for future measurements and trending. The paper concludes with a discussion of the marketing and organizational implications of incorporating the patient satisfaction survey into the ongoing delivery program for addiction services. [ABSTRACT FROM AUTHOR]

This paper fills an informational gap for multidisciplinary providers of services to the former Soviet Union (FSU) immigrants in the United States, highlighting the long-term medical and mental health consequences of this group's pre-migration exposure to the 1986 Chernobyl nuclear disaster. The international literature is selectively-presented together with recent findings of Chernobyl mental health sequelae in a cohort residing in the United States. Guidelines for service providers, as well as Russian language health service resources in US cities populated by significant FSU communities, are also furnished. [ABSTRACT FROM AUTHOR]

This paper proposes a new framework for describing well-being and hardship among low-income families. We describe previously unmeasured costs of being poor as latent, those costs that are hidden and not counted in other poverty measures, and sequential, those costs that are consequential and have subsequent cost implications. Using data from in-depth interviews with cash assistance recipients and working poor heads of household, we explore latent and sequential costs of poverty related to health. Families experience a wide variety of latent and sequential costs associated with their dental, vision, and general health needs. [ABSTRACT FROM AUTHOR]

Manpower shortages in health care provision appear to be more notorious in pharmacy, and so it is a continuing subject for both economic analysis and policy debate. At the same time, employer practices and employee job preferences are becoming more flexible and efforts are being made to bring them into alignment {e.g.. through "sign-on bonus" offers). Therefore, this study constructs an economic model of the determinants of full-time versus part-time job opportunities for US pharmacists. Controlling for a number of fixed effects (e.g., US regions), the paper takes into account demand and supply factors in the estimation of a logit regression model fitted to micro-data for the 1990s. The findings indicate that the probability of full-time job vacancies tends to favor management than staff pharmacist positions. There is also no statistically significant difference in the odds of full-time job openings for clinical versus management positions, and the production of new Pharm.D. degree graduates involving prolonged schooling tends to worsen pharmacists" shortages. Finally, the growth of pediatric (age < 5), early adult (ages 18-24) and senior adult Cages 65-74) population cohorts is likely to raise the demand for professional pharmacists in the near future. This has implications for the new Medicare prescription drug benefits that just began in January 2006. Additional policy implications are given. [ABSTRACT FROM AUTHOR]

An organization's ability to correct service errors is an important factor in achieving success in today's service economy. This paper examines service recovery in hospitals in the U.S. First is a general review of service recovery theories. Next is a discussion of specific service issues related to the hospital environment. The literature on service recovery is used to make specific recommendations to hospitals for ways to improve their ability to remedy service errors when they occur. Suggestions for future research in the field of service recovery are also made. [ABSTRACT FROM PUBLISHER]

The foreign-born population comprised 11.5% of the U.S. population in 2002. Immigration to the U.S. has grown substantially and continues to grow. A close examination of the immigration data shows that immigrant community in the U.S. is not homogeneous and in fact is very diverse both within itself and from the native-born population. U.S. Census Bureau data reveal that these differences create pockets of divergent populations within the country. How these populations assimilate into the U.S. healthcare system is not clearly understood. Cultural values, beliefs, and practices often juxtapose the immigrant to the healthcare system. Religious differences coupled with educational and income disparities add to the challenge of developing and implementing healthcare programs. This paper concludes with suggestions for more research in healthcare to immigrants. [ABSTRACT FROM PUBLISHER]

Since elder abuse was first acknowledged as a health care and social problem, incidence and prevalence of mistreatment has been assessed sparingly in the United States and other countries around the world. Standardized instruments for determining the prevalence of elder abuse have not been developed and other instruments measuring a person's function and spousal violence have been adapted for the measurement of eider abuse prevalence. The purposes of this paper are to (1) ascertain the reading grade level of the most frequently used elder abuse prevalence instrument's text and (2) determine the content validity of the instruments with respect to the types of elder abuse included in them. A review of the instruments used to measure elder abuse prevalence was completed and a questionnaire was developed to measure the reading grade level and type of elder abuse content in four instruments. The Fry Readability. Flesch Reading Ease, and McLaughlin Grading formulas were used to determine reading grade level. A questionnaire regarding content validity was sent to 69 faculty and staff in one university department and a 59% return was achieved. The Conflict Tactics Scale and the Hwalek-Sengstock Elder Abuse-Screening Test had the lowest mean score at the 6th grade reading level. Results of content analysis for types of elder abuse demonstrated none of the instruments are comprehensive. Instruments to measure the prevalence are needed which balance readability and content validity. [ABSTRACT FROM AUTHOR]

The goals of this paper are to describe the initial implementation of a service-learning experience at the Duquesne University Mylan School of Pharmacy, discuss the challenges that presented throughout its first offering, explain how these challenges are being met, and reflect upon how to make future course offerings more effective. The School's newly required service-learning experience was given its own course name and number but was designed to complement a survey course in the American health care system wherein students learn the roles of a pharmacist in the delivery of medical care and of non-profit agencies in advancing public health. Students selected a site to complete the service-learning requirement through Duquesne University Volunteers (DUV) office, which had contacts with numerous agencies throughout Southwestern, Pennsylvania. Many of the sites did not distinguish adequately the difference between volunteerism and service-learning, resulting in a number of students performing menial tasks. In the second offering, many sites were eliminated and new options for completing the service-learning requirement were added. Additionally, course instructors initiated a relationship with faculty and graduate students from Duquesne University's English department in an effort to facilitate improvement in the students' writing abilities. [ABSTRACT FROM PUBLISHER]

This paper reviews the experience of evaluating a cultural competence workshop series for social workers practicing in a mental health care setting. The study used a pretest-posttest nonequivalent comparison group design, and evaluation was based on both quantitative and qualitative data collections. Between subjects analyses suggested that there were no differences between the intervention and comparison group after the intervention was completed, hut within-subjects analyses revealed that the intervention group had made superior gains in their scores on the Awareness subscale of the Multicultural Counseling Inventory. Qualitative data contributed additional information about important individual and group processes that affected the experience of training and contributed to self-reported outcomes from training. The study suggests that evaluating process and outcomes of training at both the individual and group levels may be particularly important to understanding how cultural competence develops for social work practitioners in interdisciplinary settings. [ABSTRACT FROM AUTHOR]

In 1905, Massachusetts General Hospital initiated the first medical social work program in the United States. Based on the writings of its leaders, this paper presents the early history of medical social work in the United States. Inspired by developments in European health care that emphasized the community context of disease, medical social work pioneers saw a need to individualize the patient while also promoting public health measures in the community, improving the patient's environment to eliminate the causes of disease. In addition, since they served patients because of their diseases rather than their poverty, medical social workers were among the first to provide social work services to the non-poor. In spite of their emphasis on environmental change, many of early medical social work leaders had an anti-institutional bias; they were suspicious of large-scale solutions for what they saw as fundamentally individual problems. Consequently, methods for promoting individual adaptation developed more rapidly than methods for promoting environmental change. Ironically, the medicalization of social problems in contemporary times has resulted in a focus on individual pathology rather than social and lifestyle causation in health, even as the rising cost and complexity of the system challenges health care consumers in the United States. Reaffirming the environmental emphasis of medical social work pioneers provides a way for today's health care social workers to incorporate environmental modification into their practice and promote the health of all citizens. [ABSTRACT FROM PUBLISHER]

This paper reviews the evolution of patient empowerment in the United States over the last thirty years and ways the practice of evidence-based medicine (EBM) has impacted and paralleled the history of the American consumer health movement. EBM is the practice of supporting clinical decision making with systematic research, while taking into account the personal values, unique biology, and individual concerns of each patient. EBM has improved medical practice by judiciously integrating the best studies (better evidence) into the medical decision-making process. In this era of patient-centered care, EBM impacts not only the decisions consumers make about their health care, but the professional and consumer health literature used to inform and support medical decision making. While an evidence-based consumer health literature is still nascent, twenty-first century medicine is now seeing resources created to translate systematic research in a format and language appropriate for the general public. [ABSTRACT FROM AUTHOR]

Presents developments on neuroimaging and metal health from journals and websites in the healthcare industry in the U.S. as of March 2004. Role of alpha-theta neurofeedback in the production of higher within-session theta/alpha ratios than does non-contingent feedback relaxation; Disruption of early-related theta synchronization of human electroencephalography (EEG) in alexithymics; Quality of EEG in simultaneous EEG-fMRI for epilepsy.

Early newborn discharge legislation began a movement in health policy towards incremental changes in how medical consumers receive services. While well intentioned, these initiatives may undermine national efforts to address problems through more comprehensive reform, while stifling smaller efforts to address the problems locally. This paper discusses early newborn discharge legislation in Kansas: its origins, apparent impact, and implications. Findings from a hospital survey and two-year follow-up suggest a minimal effect of the legislation on health services in the state. Though acute hospital care appeared to replace home-based programs in many hospitals we spoke with, the more longstanding impact of the legislation seems to have been its precedent in how health policy is now made. [ABSTRACT FROM AUTHOR]