American journal of preventive medicine
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Cultural, linguistic, and economic barriers place many Asian Americans in jeopardy of missing opportunities for disease prevention, early diagnosis, prompt treatment, and participation in clinical trials. One way to learn how to address these barriers is through the development of a demonstration health education and prevention program focused on an indicator disease such as cancer. ⋯ Reaching this population with the help of ethnically and linguistically compatible students was effective, but the barriers they faced when trying to connect with their potential audience were still considerable. Rigorous evaluation of the strategies used in this intervention is warranted.
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The recent and profound changes in the American health care delivery system have created a need for physicians who are trained and willing to assume a high level of responsibility for managing evolving health care organizations. Yet most physicians receive no formal training in medical administration and management because changes in medical school and residency education have lagged behind changes in clinical practice and reimbursement. To avoid haphazard approaches and unnecessary duplication of resources, it is important for physicians involved in managerial medicine to collectively identify competencies in this area needed in the marketplace. ⋯ This article describes the strategy we followed in reaching consensus among a diverse group of physician executives and preventive medicine residency program directors, and includes the list of medical management competencies and performance indicators developed. Recurrent issues that can sidetrack competency development projects are also presented as well as suggestions for overcoming them. The competencies can serve as a framework for expanding current core preventive medicine training in management and administration and for developing new training programs to equip physicians with the special expertise they will need to provide management leadership within the changing landscape of health care delivery.
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Reducing violence is a critical health and economic priority. In Minnesota, as in other parts of the United States, violence is increasingly viewed as a public health problem. Helping people work together to prevent violence is one way that managed care organizations are collaborating with public health to improve the health of communities. ⋯ Outcomes of the initiative included: participation by over 1,000 Minnesotans in 12 community violence prevention forums; a widely distributed action plan; Students Stop Guns, a school-based intervention to keep Minnesota schools gun-free; the Governor's Task Force on Violence as a Public Health Problem, which led to a commitment of resources to prevent violence and respond to the victims and consequences of violence, and the Health Care Coalition on Violence, to institutionalize strategies within the Minnesota health care environment. The project's qualitative evaluation resulted in lessons and advice on how to execute a collaborative health improvement initiative. These lessons have been widely shared with Minnesota community health advocates.
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Sarcoidosis is a granulomatous disorder of unknown cause that usually first involves the lungs. After the diagnosis of a deck grinder was changed from sarcoidosis to dust-induced lung disease by the VA, the Navy asked the National Institute for Occupational Safety and Health (NIOSH) to determine if Navy work environments have been associated with lung diseases, some of which may have been reported as "sarcoidosis." ⋯ These findings suggest that sarcoidosis-like diseases in the military may be associated with environmental factors. To implement effective primary prevention, early detection, and treatment programs for sarcoidosis-like disease, these trends and work environment patterns need to be explained. Clinical studies of Vietnam-War-era veterans, which assess their work exposures and job activities in more detail, may identify preventable causes among this generation, which has a historically high rate of disease.
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Mammography screening reduces mortality by 25% to 30% in women aged 50 to 69. Because mammography screening is often used less frequently than the recommended guidelines, many descriptive and intervention studies are underway to increase use of this important screening tool. Assessment of intervention effect is dependent on valid measurement of mammography use. Although several studies have shown a close correspondence between self-report and medical records, most had few minority participants. ⋯ Self-report alone may not provide accurate rates of mammography compliance. Further research is necessary with ethnic and low-income women.