RESUMO
BACKGROUND AND OBJECTIVES: Learners in medical education are often inadequately prepared to address the underlying social determinants of health and disease. The objective of this article is to describe the development, implementation, and evaluation of a Health Policy and Advocacy curriculum incorporated into our family medicine clerkship. METHODS: We developed a Health Policy and Advocacy course for medical students within our family medicine clerkship. We evaluated the curriculum using a survey of our own design administered to students before and after their clerkship year. We created a mean score for each subscale that measured (1) physician's role, (2) knowledge, and (3) confidence in ability and calculated differences between the pre-survey and the post-survey scores for four medical school classes. We also conducted a focus group to get student input on the new curriculum. RESULTS: Mean scores on the pre- and post-surveys were highest for the subscale regarding attitudes about a physician's role in health policy and advocacy and did not change over time. Scores for self-reported knowledge and confidence in abilities increased significantly from the beginning to the end of the clerkship year. Students were generally positive about the curriculum but had some concerns about finding time for advocacy in their future practices. CONCLUSIONS: Training in health care policy and advocacy can be successfully implemented into a medical school curriculum with positive outcomes in students' self-reported knowledge and confidence in their abilities. Work remains on providing advocacy role models for students.
Assuntos
Estágio Clínico/organização & administração , Medicina de Família e Comunidade/educação , Política de Saúde , Estudantes de Medicina/psicologia , Atitude do Pessoal de Saúde , Currículo , Feminino , Humanos , Conhecimento , Masculino , New Mexico , Papel do MédicoRESUMO
BACKGROUND: Substantial numbers of people are medically underserved because of rural residence and/or economic circumstances. The mission of many medical schools is service to this group, so the ability to identify applicants likely to serve this population is valuable. METHOD: In 2009, the authors asked graduates from their medical school, class of 1997 and forward, if they practiced in a medically underserved community in the past year. Variables obtained from medical school applications and scores from a survey of attitudes toward the underserved measured at matriculation were analyzed using logistic regression. RESULTS: Of 244 practitioners, 35% reported working in an underserved community. Rural background, older age (25+) at matriculation, and being a member of an underrepresented minority were independent, statistically significant predictors of practice in an underserved community. CONCLUSIONS: Schools wanting to increase the number of practitioners caring for the underserved could consider older as well as rural and minority applicants.
Assuntos
Área Carente de Assistência Médica , Médicos de Família/provisão & distribuição , Padrões de Prática Médica/estatística & dados numéricos , Área de Atuação Profissional/estatística & dados numéricos , Faculdades de Medicina , Adulto , Fatores Etários , Escolha da Profissão , Medicina Comunitária , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Grupos Minoritários/estatística & dados numéricos , New Mexico , Médicos de Família/estatística & dados numéricos , Serviços de Saúde Rural , População Rural , Recursos HumanosRESUMO
OBJECTIVE: To evaluate the prevalence rates, risk factors, and pattern of depressive symptoms in elderly Hispanic and non-Hispanic Whites (NHWs). METHODS: This survey was a community-based, cross-sectional survey of randomly selected Medicare recipients living in Bernalillo County (Albuquerque, New Mexico). The survey's objective was to examine the health and health-related issues of Hispanic and NHW elderly persons (> or =65 years of age). As part of the survey, participants were administered the Geriatric Depression Scale-short form (GDS). RESULTS: Complete data were available on 798 subjects with a mean age of 73.7 years, age range 65-96. The prevalence of a GDS score > or =6 was: Hispanic males, 9.5%; Hispanic females, 19.2%; NHW males, 5.4%; and NHW females, 8.7%. Hispanics (P=.001) and women (P=.003) had higher prevalence rates. Sociodemographic variables, health, social support, and the activities of daily living (ADLs) were significantly related to symptoms. English skills (P<.0001) and birthplace (P=.011) were associated with symptoms in Hispanics. Significant differences were found in the response patterns between Hispanics and NHWs. Logistic regression analyses showed that ethnic differences were largely explained by differences in the level of education and income among Hispanics and NHWs. CONCLUSION: A difference was seen in the prevalence rates of depressive symptoms between Hispanic and NHW elderly persons and between men and women. In addition to the traditional risk factors for depressive symptoms, we found that ethnic differences in prevalence rates can be largely explained by education and income differences in the two groups.
Assuntos
Depressão/etnologia , Hispânico ou Latino , População Branca , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , New Mexico/epidemiologia , Prevalência , Fatores de RiscoRESUMO
BACKGROUND: Recent epidemiological studies have shown that individuals who ingest alcohol regularly have a higher level of cognitive function and are less likely to develop dementia than those who abstain. The purpose of this study was to compare nine measures of cognitive function in drinkers compared to abstainers. METHODS: A cross-sectional community survey was conducted of 883 randomly selected Hispanic and non-Hispanic white men and women, age >or=65 years of age, undergoing a paid home interview and 4-hour interview/examination in a senior health clinic (The New Mexico Elder Health Survey). The interviews included questions on frequency and quantity of alcohol ingested. RESULTS: Participants who consumed alcohol had significantly better mean scores on 7 of 9 cognitive function tests and less frequently had scores below selected "cut points" compared to those who abstained from all alcohol intake. Scoring used multivariate linear and logistic regression models adjusted for sex, ethnicity, age, level of education, and evidence of depression. CONCLUSIONS: Participants in the New Mexico Elder Health Survey (nearly equal numbers of Hispanic and non-Hispanic white men and women) who consumed alcohol had better scores on their cognitive tests than did those participants who abstained.
Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Cognição , Temperança/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , New Mexico , Características de ResidênciaRESUMO
The serum/plasma total homocysteine (tHcy) concentration, now recognized as an independent risk factor for accelerated atherosclerotic disease, is increased in overtly hypothyroid patients, and it decreases with thyroid replacement therapy. Whether or not individuals with subclinical hypothyroidism also increase their tHcy concentrations, and whether this elevation might help to explain the increased prevalence of the atherosclerotic diseases observed in this condition, remains unclear. If individuals with subclinical hypothyroidism have higher tHcy concentrations than euthyroid subjects, there would be added incentive to treat this condition earlier. In this cross-sectional study (New Mexico Elder Health Survey) of a randomly selected sample of Medicare recipients (age > or =65 years), no significant difference in serum tHcy concentrations could be detected between the 112 participants with subclinical hypothyroidism (Groups 2 and 3) and the 643 participants with thyrotropin (TSH) values < or =4.6 microU/mL (Group 1) after adjusting for differences in gender, ethnicity, age, and serum concentrations of folate, vitamin B(12), and creatinine. Only those participants with the highest TSH levels (>10 microU/mL) (Group 3) had a significantly higher prevalence of coronary heart disease (CHD) when compared against Group 1 participants (p = 0.007). No consistent significant differences in the prevalences of CHD or in the CHD risk factors examined were observed when all participants with subclinical hypothyroidism (Groups 2 and 3 combined) were compared against Group 1 participants.