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PubMedDate not supplied

Students with learning disabilities and hearing impairment: issues for the secondary and postsecondary teacher.

Although the number of students with both learning disability and hearing impairment (LDHI) currently enrolled in secondary and postsecondary programs has not been precisely determined, it is clear that these students are currently receiving inadequate assessment and support in many institutions. The best route for serving these students would seem to be collaborative efforts between deaf educators and learning disabilities specialists, yet serious gaps exist between these two professions in regard to interpretation of laws governing special services, training of professionals, and locations of educational programs. The difficulties of developing collaborative work have been compounded by controversies within each field and the heterogeneity of the populations served by both disciplines. Those interested in creating good LDHI assessments should begin by considering the qualifications needed by those conducting evaluation procedures. The inadequacies of current formal assessment devices for this population need to be recognized; informal procedures, such as teacher observation and curriculum-based assessments, are still some of the best tools available for identification and educational planning.

Achievement↗

PubMed2005

Illuminating the clinical nurse specialist role of advanced practice nursing: a qualitative study.

As the advanced practice nursing initiative in Canada gains momentum, effort is being directed towards clarifying and defining advanced practice roles. A qualitative study was undertaken to increase understanding of the clinical nurse specialist role of advanced practice. Sixteen nurses who worked in advanced practice roles, organizing and providing healthcare for children with complex health needs and their families across the continuum of care, participated in in-depth conversations about the nature of their practice, the knowledge that informs it and the factors that influence it. Findings suggest that clinical nurse specialists have a unique role in the organization and delivery of healthcare for specialized populations with complex health needs in their dual focus on the system level of healthcare and on population health needs. Initiatives directed to children and families within the study participants' specialties included program development, consultation and educational outreach and the development of clinical guidelines and policies. Although the nurses described their practice as focusing both on individual children and families and on the population of children and families within their specialty, it is at the population level that they see their greatest potential for contributing to the delivery of high-quality, cost-effective healthcare.

Attitude of Health Personnel↗

PubMed1992

Clinical training in human immunodeficiency virus disease for community physicians. The Los Angeles experience.

In the past decade, the increased number of persons being treated for infection with the human immunodeficiency virus (HIV) has placed an enormous burden on specialty clinics. This is especially true in Los Angeles, where care of patients with the acquired immunodeficiency syndrome (AIDS) has been termed a "crisis" situation. Especially in its early stages, HIV disease can be appropriately managed by primary care physicians who provide patients with medical and psychological counseling and refer them to specialists when major AIDS-related complications develop. Physicians completing their training as recently as 5 years ago, however, received little systematic preparation in the care of HIV-infected patients and thus may lack important skills such as the ability to recognize opportunistic infections early in their course. By means of a 1-week intensive preceptorship in a high-volume AIDS clinic, we are preparing community physicians to assume a more active role in providing care for this growing patient population. In the preceptorship, participants receive one-on-one training from specialists in infectious diseases, pulmonary diseases, and hematology and oncology, as well as from internists and family physicians. Evaluation of the clinical experience demonstrated a greater level of confidence on the part of program participants in treating HIV-infected patients and showed that participants screen and test high-risk patients in their practices and devote a substantial proportion of their practices to caring for HIV-infected patients.

Community Medicine↗

PubMed1969

Morbidity, mortality and medical care in the Keewatin area of the Central Arctic--1967.

The available medical facilities in the Keewatin area of Canada's Central Arctic have been described, along with the problems relating to provision of medical care. Causes of death and population statistics for 1967 have been detailed. The more frequent disease conditions have been discussed.Recommendations for improvements in medical care have been made; these include research into various conditions, an increased number of specialist visits and the inclusion of Churchill Hospital in a residency training program. Other recommendations relate to community planning, community sanitation and employment opportunities.

Arctic Regions↗

PubMed2004

General practice encounters for psychological problems in rural, remote and metropolitan areas in Australia.

OBJECTIVE: Previous Australian research suggests there is very little difference in the prevalence of mental health disorders across rural, remote and metropolitan areas. However, mental health specialists are particularly scarce in rural and remote areas and some researchers have argued that non-metropolitan residents rely heavily on general practitioners (GPs) for mental health care. This article investigated rates of GP services for psychological problems across rural, remote and metropolitan areas. METHOD: The Bettering the Evaluation and Care of Health (BEACH) program, Medicare and Pharmaceutical Benefits Scheme data were used in this report. Data included all psychological, depression and anxiety problems reported as managed by GPs and prescriptions for mental health medications (written and filled). Problem and medication rates are given per 100 patient encounters and per 1000 population. RESULTS: Only a few regional differences were evident in the rate of psychological problems and prescriptions for mental health medications per 100 GP-patient encounters. However, rural and remote residents visited GPs less frequently than their metropolitan counterparts. Lower rates of GP encounters for psychological problems were evident for residents of most non-metropolitan areas (per 1000 population). Additionally, GPs prescribed mental health medications at half the rate for residents of remote areas than capital cities. CONCLUSIONS: General practitioners provide fewer mental health services per capita in non-metropolitan areas. This difference could represent completely untreated psychological problems or fewer follow-up consultations. While non-metropolitan residents have limited access to specialists, rates of GP encounters for psychological problems are also very low.

Anti-Anxiety Agents↗

PubMed2005

Multidisciplinary vascular screening program modestly improves the medical treatment of vascular risk factors.

PURPOSE: This study investigated whether recommendations given to the treating vascular specialist and the GP by a multidisciplinary team of vascular specialists concerning the medical treatment of risk factors, based on international guidelines, led to an increased medication use in a high-risk population. METHODS: Data were obtained from 618 patients enrolled in the SMART study, an ongoing single-center prospective cohort study of patients referred to the University Medical Center Utrecht for atherosclerotic vascular diseases. All patients underwent a vascular screening and their physicians received recommendations concerning the medical treatment of newly detected or not yet sufficiently treated vascular risk factors. After a median follow-up of 29 months, questionnaires about medication use were sent to 618 patients; 534 (86%) questionnaires were returned. Actual use of medication was compared with medical treatment recommendation given at baseline. RESULTS: The proportion of patients on antihypertensive medication with hypertension (> or =140/90 mmHg) and not diagnosed with coronary heart disease increased from 56% to 68% (95% confidence interval (95% CI) 2 - 23). The frequency of lipid-lowering medication use increased substantially from 47% to 69% (95% CI 17 - 28). The frequency of glucose-lowering medication use increased slightly from 11% to 14% (95% CI 1 - 7). The use of folic acid increased from 2% to 14% (95% CI 9 - 15) in patients with hyperhomocysteinaemia. CONCLUSIONS: Medical treatment recommendations, formulated by a multidisciplinary team, led to a significant increase in medication use. The increase is marginal compared with trends in medication use without this intervention in usual care.

Adolescent↗

PubMed2006

Validation of a single survey that can be used for case identification and assessment of asthma control: the Breathmobile Program.

BACKGROUND: Underdiagnosis of asthma and underrecognition of disease severity in lower socioeconomic populations continue to be significant health care concerns despite national efforts to better educate health care providers. OBJECTIVE: To validate a 1-page survey as a point-in-time tool identifying uncontrolled vs controlled asthma and moderate-to-severe disease activity in an urban, lower-socioeconomic pediatric population. METHODS: A previously validated survey (the Breathmobile Case Identification Survey) was evaluated as a point-in-time tool for identifying children with poorly controlled disease. Clinical validation was achieved in children (n = 1,826) presenting to a school-based asthma program for either an initial (n = 666) or a follow-up (n = 1,170) visit. Responses were compared with a comprehensive evaluation by a physician specialist as the gold standard. Response patterns were used to construct multimodel tiered scoring algorithms for baseline and follow-up visits that identify children with uncontrolled asthma, and children are likely to have moderate-to-severe disease activity at that time. RESULTS: Surveys scored using the developed algorithms identified children with uncontrolled asthma (sensitivity: baseline, 77.0%; follow-up, 71.6%; specificity: baseline, 72.7%; follow-up, 71.5%) and detected moderate-to-severe disease activity (sensitivity: baseline, 69.2%; follow-up, 77.4%; specificity: baseline, 70.2%; follow-up, 70.3%). CONCLUSIONS: The Breathmobile Case Identification Survey can be used in lower-socioeconomic, urban populations as a point-in-time tool for identifying children with uncontrolled vs controlled asthma and moderate-to-severe disease activity.

Adolescent↗

PubMed2003

Health care needs of the growing Latino population in rural America: focus group findings in one midwestern state.

Latinos represent nearly 13% of the U.S. population, surpassing African-Americans as the nation's largest racial/ethnic group. Many rural midwestern communities are seeing unprecedented growth in their Latino populations, creating new challenges and pressures for health and social service providers. This study is based on four focus groups conducted in three rural communities to examine concerns with health care services and access to care. Focus group analysis found several key barriers to health care access, including cost of health care services and frustration with the complexity of the U.S. health care system, as well as language and cultural issues that adversely affect patient-provider relationships. In addition, a number of impediments related to employer-sponsored health coverage were identified, including prohibitive premium costs as well as concerns about occupational injuries and access to care during work hours. The growth of the Latino population in the rural Midwest will require changes in existing health and social service systems to serve as a bridge to new systems in this country. We recommend several policy options including premium subsidies for low-wage jobs, community-based enrollment specialists for public programs, and continued research and data collection to monitor change and progress.

Adult↗

PubMed2000

Canadian Network for International Surgery: development activities and strategies.

The Canadian Network for International Surgery (CNIS) is a surgical development and research organization, whose objective is to reduce death and disability from surgical disorders in low income countries. The organization has 4 main activities: (1) the Essential Surgical Skills (ESS) program teaches surgery to general practitioners and is predicated on the assumption that there will not be enough surgeons in Africa in the foreseeable future and therefore nonsurgeons must do surgery; (2) the injury control program, which is predicated on the conclusion that the incidence of injury in Africa is unacceptably high, therefore injury prevention is an imperative surgical strategy; (3) the library project, which sends new and recent books and journals to the surgical libraries of our African partners; and (4) the members' projects, which encourage individual or organization members to use their own creativity in meeting CNIS objectives. The CNIS has direct activity in 4 African countries and presents its project check list as a means to help others succeed. Canadian surgical and allied specialists can help in the reduction of needless suffering by supporting the CNIS.

Africa↗

PubMed1990

[Profile of the nurse in the outpatient units of INAMPS in Brazil. O Instituto Nacional de Assistência Médica da Previdência Social].

The objective of this study was to outline a profile of the nurses working within the INAMPS (National Health Service) outpatients centers in Brasil. Its purpose was to offer some assistance on the understanding of the subject, to the nursing educational system, to the employers of the product of that system, to the nurses' associations and to the nurses themselves. In the pursue of the objective, the author depicted: personal and professional traits of the nurses; job satisfaction and perceived support from the administration; the most frequent nurses activities performed. It also established the relations between nurses traits, job satisfaction, perceived support, and activities performed. Data was collected from March to December 1984. The questionnaires were sent to the universe of working nurses in the outpatient centers--1158 nurses. 927 (80.1%) answers were obtained. The population studied represented: 94.3% female, majority married; 30 to 40 years old, year of graduation and year of admission in the INAMPS in the 70's. Gross results were: job satisfaction 83.6%, perception of support from administration 75.2%, prepared as specialists 71.3%, and frequence to continuing educational programs 84.1%. Mains activities performed by nurses in decreasing order: supervision of nursing personnel 39.3%, direct nursing care 36.7%, teaching of patients and families 21.7%, administrative--functions 17.9%, and inservice training of personnel 3.6%. No relation was demonstrated between graduate preparation and job satisfaction nor perceived support from administration. Positive relation was found between educative activities and job satisfaction, and between supervision of nursing personnel or performance of administrative functions and perception of support from the administration.

Adult↗

PubMed1989

[Hearing handicap in childhood--responsibilities of public health, early diagnosis].

Serious congenital hearing impairment occur in 1 per 1,000 people. Hereditary disease, perinatal complications, and postnatal disease present particular risk factors. Children, who do not hear or are extremely hard of hearing are slow in their language development and thus become retarded in their mental growth if not given appropriate stimulation. The Counseling Center for the hearing impaired was stablished as a multidisciplinary institution of the Health Office of Berlin-Neukölln for early recognition of and therapy for hearing impaired children. The average age at initial diagnosis of children with hearing impairment in the Federal Republic of Germany is between 3.3-3.4 years according to statistics from 1981. An effort should be made, however, to use the time before the completion of the first year of on's life for an optimal early therapy. Statistics from the Counseling Center for the hearing impaired indicate that at the present time all children with distinct hearing impairments, born in the FRG and West-Berlin, are diagnosed before they reach 32 months of age and are then assigned to special education programs. The average age of recognizing hearing impairments is 13.4 months. This favorable, however not optimal result can be attributed to the situation of a metropolis and its population informed by special professional events for target groups including employees of theYouth Health Services, established pediatricians and ENT specialists, teachers, social workers, educators, and also to the model of the "Berlin-Neukölln Counseling Center" which has proven successful over the past 30 years.

Child, Preschool↗

PubMed1995

The impact of physician financial incentives on high-risk populations in managed care.

The challenge of managed care is to design a system in which rules and incentives together create a system of checks and balances that ensure both efficient and high-quality care. Incentives need to be administered so that physicians--both primary care providers and specialists--are not forced to choose between personal and/or organizational financial viability and patients' care. To accomplish this goal, payment needs to be linked both to quality and productivity and appropriately risk-adjusted. Quality assurance programs must ensure that both efficient and high-quality care is being provided and must maintain the satisfaction of both physicians and members. AIDS patients may be harmed by a system in which the more services a physician performs, the more he or she is paid--the traditional way in which American health care has been delivered heretofore. Managed care may undermine the care of high-risk patients if it arbitrarily reduces the high volume of care they require. However, a managed care system with effective checks and balances on financial incentives and quality of care can ensure that an efficient and high standard of care is being met--across all populations, including both healthy and high-risk patients.

Acquired Immunodeficiency Syndrome↗

PubMed1989

The effectiveness of pro cardiac pacemaker review in reducing implantation in the Medicare population.

Cardiac pacemaker insertions experienced an explosive growth in utilization following the introduction of this highly beneficial technology. Cost considerations prompted critical evaluation of the appropriateness of their use and raised the specter of potential abuse. The Connecticut Peer Review Organization (CPRO) program of pacemaker review to Medicare patients, based on physician input, criteria setting, dissemination of information, and specialist peer review, resulted in a dramatic reduction in the insertion of permanent pacemakers with minimal need for denials and appeals.

Aged↗

PubMed1992

The diffusion of new genetic tests for predicting disease.

This paper examines the pathways by which new genetic tests will become available to the public. In view of the scarcity of genetic specialists, the pathway is likely to involve primary care physicians. Other pathways entail state-mandated testing, community-based programs, or testing by laboratories without much involvement of primary care physicians. When testing does become available the "destination" will be either family-centered testing or population-oriented screening. The deterrent to screening will not be the inability to detect disease-causing mutations but the costs and attitudes of providers and the public. When tests are provided primarily to provide information about risks to future children, some people will oppose screening on religious or moral grounds. When there are no inexpensive treatments, some will fear that insurance companies and employers will use tests to deny them health care coverage. Some may not want to know their risks for disorders about which little can be done. For common, multifactorial disorders, genetic tests will have low predictive value. Because of these problems, the decision to be tested, regardless of the destination, requires that "testees" be fully informed and consent to testing. When acceptance rates are low, screening is less likely to be cost-effective; family-centered testing becomes the default destination.

Genetic Diseases, Inborn↗

PubMed1993

[Sanitary and epidemiologic wellbeing of children and adolescents and training programs for physicians].

New requirements to sanitary and epidemiological conditions of the population life which are to be introduced according to the law of the Russian Federation demand comprehensive knowledge of general hygiene, epidemiology, nutrition, labor hygiene, human ecology, etc., by general practitioners. The network of existing prophylactic, educational and scientific centers should not be destroyed, but improved to train skilled specialists.

Adolescent↗

PubMed1997

Prepaid capitation versus fee-for-service reimbursement in a Medicaid population.

Utilization of health resources by 37,444 Medicaid recipients enrolled in a capitated health maintenance organization was compared with that of 227,242 Medicaid recipients enrolled in a traditional fee-for-service system over a 1-year period (1983-1984) in the state of Kentucky. Primary care providers in the capitated program had financial incentives to reduce downstream costs like specialist referral, emergency room use, and hospitalizations. The average number of physician visits was similar for both groups (4.47/year in the capitated program; 5.09/year in the fee-for-service system). However, the average number of prescriptions (1.9 versus 4.9 per year), average number of hospital admissions per recipient (0.11 versus 0.22 per year), and average number of hospital days per 1,000 recipients (461 versus 909 per year) were 5% to 60% lower in the capitated group than in the fee-for-service group. The Citicare capitated program resulted in a dramatic reduction in healthcare resource utilization compared with the concurrent fee-for-service system for statewide Medicaid recipients.

Aid to Families with Dependent Children↗

PubMed1977

[Experiences in neurology education in Cuba].

The state of medicine and neurology in the past years, since 1962, is described. The initial personnel with which neurology and neurosurgery began working, the manner in which the group was formed and the subsequent formation of specialists in this area are commented. We describe the hours and subjects studied by the residents and the modifications that the program has experienced since 1962, until 1971, in which a program of philosophy, social and political lectures, combined with the specialization classes, exists. An evaluation system, created by the group and number of specialists formed since its initiation, also exists. Subsequent to their formation, physicians integrate neurologist and neurosurgeon teams and are situated in areas of provinces which cover a population of 500 000 to 1 500 000 inhabitants.

Cuba↗

PubMed1999

Planning to meet the needs of offenders with mental disorders in the United Kingdom.

During the last decade the planning of services for offenders with mental disorders in the United Kingdom has been geared toward diverting them from the criminal justice system to appropriate levels of psychiatric and social care. Although a seamless service system is yet to be developed, the central government has made a concerted effort to promote a better understanding of the needs of offenders with mental disorders and encourage collaboration between the relevant agencies. A major program of research has been initiated, and local health authorities have been encouraged to use a consortium approach to planning and delivery of specialist services. The authors discuss the activities of the Wessex consortium, composed of five local health authorities and a social services department serving a catchment area with a population of 2.5 million in southern England. The consortium has commissioned needs assessments for all offenders with mental illness from the catchment area and a survey of the resources for secure residential treatment in the region. Based on data from this research, the consortium is planning the development of two long-stay secure units to accommodate offenders with a history of repeated inpatient and prison stays and poor response to previous treatment and rehabilitation efforts.

Commitment of Persons with Psychiatric Disorders↗