The impact of trained patient educators on musculoskeletal clinical skills attainment in pre-clerkship medical students

<p>Abstract</p> <p>Background</p> <p>Despite the high burden of musculoskeletal (MSK) diseases, few generalists are comfortable teaching MSK physical examination (PE) skills. Patient Partners^®in Arthritis (PP^®IA) is a standardized patient educator program that could potentially supplement current MSK PE teaching. This study aims to determine if differences exist in MSK PE skills between non-MSK specialist physician and PP^®IA taught students.</p> <p>Methods</p> <p>Pre-clerkship medical students attended 2-hour small group MSK PE teaching by either non-MSK specialist physician tutors or by PP^®IA. All students underwent an MSK OSCE and completed retrospective pre-post questionnaires regarding comfort with MSK PE and interest in MSK.</p> <p>Results</p> <p>83 students completed the OSCE (42 PP^®IA, 41 physician taught) and 82 completed the questionnaire (42 PP^®IA, 40 physician taught). There were no significant differences between groups in OSCE scores. For all questionnaire items, post-session ratings were significantly higher than pre-session ratings for both groups. In exploratory analysis PP^®IA students showed significantly greater improvement in 12 of 22 questions including three of five patient-centred learning questions.</p> <p>Conclusions</p> <p>PP^®IA MSK PE teaching is as good as non-MSK specialist physician tutor teaching when measured by a five station OSCE and provide an excellent complementary resource to address current deficits in MSK PE teaching.</p

Challenges to immunization: the experiences of homeless youth

<p>Abstract</p> <p>Background</p> <p>Homelessness is a critical social issue, both a product of, and contributing to, poor mental and physical health. Over 150,000 young Canadians live on the streets. Homeless youth experience a high incidence of infectious diseases, many of which are vaccine preventable. Early departure from school and limited access to public health services makes them a particularly vulnerable high-risk group. This study explores challenges to obtaining essential vaccines experienced by homeless youth.</p> <p>Methods</p> <p>A qualitative research study to explore knowledge, attitudes, beliefs, and experiences surrounding immunization of hard-to-reach homeless youth was designed. Participants were recruited for focus groups from Phoenix House and Shelter, a non-profit, community-based organization assisting homeless youth in Halifax, Nova Scotia, Canada. An experienced facilitator guided the recorded discussions. Transcripts of audiotapes were analyzed using a constant comparative method until data revealed a set of exemplars and themes that best captured participants’ knowledge, attitudes, beliefs and experiences surrounding immunization and infectious diseases.</p> <p>Results</p> <p>Important themes emerged from our analysis. Considerable variability in knowledge about immunization and vaccine preventable diseases was found. The homeless youth in the study had limited awareness of meningitis in contrast to a greater knowledge about sexually transmitted infections and influenza, gained during the H1N1/09 public health campaign. They recognized their poverty as a risk for contracting infectious diseases, along with their inability to always employ known strategies to prevent infectious diseases, due to circumstances. They showed considerable insight into the detrimental effects of poor hygiene, sleeping locations and risk behaviour. Interviewed homeless youth regarded themselves as good compliers of health professional advice and offered valuable suggestions to improve immunization in their population.</p> <p>Conclusions</p> <p>To provide effective public health interventions, it is necessary to consider the knowledge, attitudes, beliefs, and experiences of hard to reach, high risk groups. Our study shows that homeless youth are interested and capable in discussing immunization. Active targeting of homeless youth for public health immunization programs is needed. Working collaboratively with non-profit organizations that assist homeless youth provides an opportunity to increase their knowledge of infectious risks and to improve immunization strategies in this vulnerable group.</p

Algorithms for enhancing public health utility of national causes-of-death data

<p>Abstract</p> <p>Background</p> <p>Coverage and quality of cause-of-death (CoD) data varies across countries and time. Valid, reliable, and comparable assessments of trends in causes of death from even the best systems are limited by three problems: a) changes in the <it>International Statistical Classification of Diseases and Related Health Problems </it>(ICD) over time; b) the use of tabulation lists where substantial detail on causes of death is lost; and c) many deaths assigned to causes that cannot or should not be considered underlying causes of death, often called garbage codes (GCs). The Global Burden of Disease Study and the World Health Organization have developed various methods to enhance comparability of CoD data. In this study, we attempt to build on these approaches to enhance the utility of national cause-of-death data for public health analysis.</p> <p>Methods</p> <p>Based on careful consideration of 4,434 country-years of CoD data from 145 countries from 1901 to 2008, encompassing 743 million deaths in ICD versions 1 to 10 as well as country-specific cause lists, we have developed a public health-oriented cause-of-death list. These 56 causes are organized hierarchically and encompass all deaths. Each cause has been mapped from ICD-6 to ICD-10 and, where possible, they have also been mapped to the <it>International List of Causes of Death </it>1-5. We developed a typology of different classes of GCs. In each ICD revision, GCs have been identified. Target causes to which these GCs should be redistributed have been identified based on certification practice and/or pathophysiology. Proportionate redistribution, statistical models, and expert algorithms have been developed to redistribute GCs to target codes for each age-sex group.</p> <p>Results</p> <p>The fraction of all deaths assigned to GCs varies tremendously across countries and revisions of the ICD. In general, across all country-years of data available, GCs have declined from more than 43% in ICD-7 to 24% in ICD-10. In some regions, such as Australasia, GCs in 2005 are as low as 11%, while in some developing countries, such as Thailand, they are greater than 50%. Across different age groups, the composition of GCs varies tremendously - three classes of GCs steadily increase with age, but ambiguous codes within a particular disease chapter are also common for injuries at younger ages. The impact of redistribution is to change the number of deaths assigned to particular causes for a given age-sex group. These changes alter ranks across countries for any given year by a number of different causes, change time trends, and alter the rank order of causes within a country.</p> <p>Conclusions</p> <p>By mapping CoD through different ICD versions and redistributing GCs, we believe the public health utility of CoD data can be substantially enhanced, leading to an increased demand for higher quality CoD data from health sector decision-makers.</p

Intramural haematoma of the thoracic aorta: who's to be alerted the cardiologist or the cardiac surgeon?

This review article is written so as to present the pathophysiology, the symptomatology and the ways of diagnosis and treatment of a rather rare aortic disease called Intra-Mural Haematoma (IMH). Intramural haematoma is a quite uncommon but potentially lethal aortic disease that can strike as a primary occurrence in hypertensive and atherosclerotic patients to whom there is spontaneous bleeding from vasa vasorum into the aortic wall (media) or less frequently, as the evolution of a penetrating atherosclerotic ulcer (PAU). IMH displays a typical of dissection progress, and could be considered as a precursor of classic aortic dissection. IMH enfeebles the aortic wall and may progress to either outward rupture of the aorta or inward disruption of the intima layer, which ultimately results in aortic dissection. Chest and back acute penetrating pain is the most commonly noticed symptom at patients with IMH. Apart from a transesophageal echocardiography (TEE), a tomographic imaging such as a chest computed tomography (CT), a magnetic resonance (MRI) and most lately a multy detector computed tomography (MDCT) can ensure a quick and accurate diagnosis of IMH. Similar to type A and B aortic dissection, surgery is indicated at patients with type-A IMH, as well as at patients with a persistent and/or recurrent pain. For any other patient (with type-B IMH without an incessant pain and/or without complications), medical treatment is suggested, as applied in the case of aortic dissection. The outcome of IMH in ascending aorta (type A) appears favourable after immediate (emergent or urgent) surgical intervention, but according to international bibliography patients with IMH of the descending aorta (type B) show similar mortality rates to those being subjected to conservative medical or surgical treatment. Endovascular surgery and stent-graft placement is currently indicated in type B IMH

Access to housing subsidies, housing status, drug use and HIV risk among low-income U.S. urban residents

<p>Abstract</p> <p>Background</p> <p>Much research has shown an association between homelessness and unstable housing and HIV risk but most has relied on relatively narrow definitions of housing status that preclude a deeper understanding of this relationship. Fewer studies have examined access to housing subsidies and supportive housing programs among low-income populations with different personal characteristics. This paper explores personal characteristics associated with access to housing subsidies and supportive housing, the relationship between personal characteristics and housing status, and the relationship between housing status and sexual risk behaviors among low-income urban residents.</p> <p>Methods</p> <p>Surveys were conducted with 392 low-income residents from Hartford and East Harford, Connecticut through a targeted sampling plan. We measured personal characteristics (income, education, use of crack, heroin, or cocaine in the last 6 months, receipt of welfare benefits, mental illness diagnosis, arrest, criminal conviction, longest prison term served, and self-reported HIV diagnosis); access to housing subsidies or supportive housing programs; current housing status; and sexual risk behaviors. To answer the aims above, we performed univariate analyses using Chi-square or 2-sided ANOVA's. Those with significance levels above (0.10) were included in multivariate analyses. We performed 2 separate multiple regressions to determine the effects of personal characteristics on access to housing subsidies and access to supportive housing respectively. We used multinomial main effects logistic regression to determine the effects of housing status on sexual risk behavior.</p> <p>Results</p> <p>Being HIV positive or having a mental illness predicted access to housing subsidies and supportive housing, while having a criminal conviction was not related to access to either housing subsidies or supportive housing. Drug use was associated with poorer housing statuses such as living on the street or in a shelter, or temporarily doubling up with friends, acquaintances or sex partners. Living with friends, acquaintances or sex partners was associated with greater sexual risk than those living on the street or in other stable housing situations.</p> <p>Conclusions</p> <p>Results suggest that providing low-income and supportive housing may be an effective structural HIV prevention intervention, but that the availability and accessibility of these programs must be increased.</p

Prevenção da hipertensão e sua relação com o estilo de vida de trabalhadores Prevención de la hipertensión y de su relación a la forma de vida de trabajadores Prevention of hypertension and its relation to the lifestyle of workers

A hipertensão arterial é uma doença de fácil diagnóstico e com uma diversidade terapêutica eficaz para seu controle. Entretanto, grande parte dos hipertensos continuam ignorando-a, não controlando seus níveis tensionais, mesmo após diagnosticados. Dessa maneira, objetivou-se averiguar o conhecimento dos trabalhadores de uma Universidade Pública acerca do controle e da manutenção da pressão arterial dentro dos parâmetros normais e analisar a prática das medidas preventivas com vista à adoção de um estilo de vida compatível com o nível funcional ótimo. Foi realizado estudo descritivo com 32 trabalhadores de uma Universidade Pública Estadual em Fortaleza-Ceará. Utilizou-se um roteiro de entrevista semi-estruturado, sendo as falas categorizadas em unidades temáticas. Depreendeu-se que os trabalhadores conhecem as mudanças de hábito a serem adotadas para prevenção da hipertensão. Relativo à obesidade, 26 (81%) a consideram como fator de risco para a hipertensão. Quanto ao álcool e à raiva, 25 (78%) e 17 (53%), respectivamente, afirmaram serem indicativos para elevação da pressão arterial, bem como o fumo, citado por 23 (72%) respondentes. Entretanto, a alimentação desses trabalhadores urge maior atenção, visto que 19 (60%) não seguem uma dieta balanceada, tornando-se obesos ou com sobrepeso. Assim, notou-se que alterar hábitos é difícil, sobretudo os alimentares. Porém, a mudança de estilo de vida relaciona-se a ações educativas e à necessidade imperiosa de cada indivíduo frente aos seus problemas de saúde e sua resolução de querer atingir seu nível funcional ótimo.<br>La hipertensión arterial es una enfermedad de fácil diagnóstico y con una diversidad terapéutica eficaz para su control. Sin embargo, gran parte de los hipertensos siguen ignorándola, no controlando sus niveles tensionales, incluso después de diagnosticados. De ese modo, se objetivó averiguar el conocimiento de los trabajadores de una Universidad Pública sobre el control y sobre el mantenimiento de la tensión arterial dentro de los parámetros normales y analizar la práctica de las medidas preventivas con miras a la adopción de un estilo de vida compatible con el nivel funcional óptimo. Se realizó un estudio descriptivo con 32 trabajadores de una Universidad Pública Estatal en Fortaleza, Ceará. Se procesó los datos y se categorizaron las hablas en unidades temáticas. Se percibió que los trabajadores conocen los cambios de hábito a ser adoptados para la prevención de la hipertensión. Con relación a la obesidad, 26 (el 81%) la consideran como factor de riesgo para la hipertensión. En cuanto al alcohol y a la rabia, 25 (el 78%) y 17 (el 53%), respectivamente, afirmaron ser indicativos para la elevación de la tensión arterial, bien como el tabaco, citado por 23 (el 72%) de los entrevistados. Sin embargo, la alimentación de esos trabajadores urge mayor atención, una vez que 19 (el 60%) no siguen una dieta equilibrada, volviéndose obesos o con sobrepeso. Así, se percibió que alterar hábitos es difícil, sobre todo los alimentarios. No obstante, el cambio de estilo de vida está relacionado a acciones educativas y a la necesidad imperiosa de cada individuo frente a sus problemas de salud y su resolución de querer alcanzar su nivel funcional óptimo.<br>Arterial hypertension is an easily diagnosed illness and with efficient therapeutic diversity for its control. However, a large number of those affected continue to ignore it, not controlling their pressure levels even after diagnosis. In this way, the objective was to verify the awareness of workers at a public university concerning the control and maintenance of arterial pressure within normal parameters, and analyze the practice of preventative measures with a view to adopting a lifestyle compatible with an optimal functional level. A descriptive study was conducted with 32 workers of the Public State University in Fortaleza, Ceará, Brazil. The data and comments were categorized in thematic units. The conclusion was that the workers knew which changes of habits need to be adopted to prevent hypertension. With respect to obesity, 26 (81%) considered it a risk factor for hypertension. Concerning alcohol and anger, 25 (78%) and 17 (53%) respectively agreed that they were indicative for a rise in arterial pressure. Similarly, smoking was mentioned by 23 (72%) interviewees. Nevertheless, the eating habits of these workers demands more attention, as 19 (60%) were not following a balanced diet, becoming obese or overweight. Thus it was observed that changing habits is difficult, especially eating habits. However, a change in lifestyle is related to awareness activities and the imperious needs of each individual with respect to his health problems and his determination to want to attain his optimal functional level