Christine A. Stroup-Benham

The effect of medical conditions on the functional limitations of Mexican-American elderly

We examined the relationship of self-reported functional status to common medical conditions using a probability sample of 3050 noninstitutionalized Mexican-American men and women aged 65 or older and residing in the Southwestern United States (Arizona, California, Colorado, New Mexico, and Texas). All subjects were interviewed in person (n = 2,873) or by proxy (n = 177) in their homes during late 1993 and early 1994. The questionnaire obtained information on self-reported functional status and prevalence of arthritis, cancer, diabetes, stroke, heart attack, and hip fracture. The prevalence of medical conditions ranged from 4.1% for hip fracture to 40.8% for arthritis. Prevalence of impairments in seven activities of daily living ranged from 5.4% for eating to 11.7% for bathing, while 25.1% could not walk up and down stairs, and 28.9% could not walk a half mile without help. In multiple logistic regression analyses, previous diagnoses of stroke and hip fracture were most predictive of functional limitations, though all conditions examined (arthritis, cancer, diabetes, stroke, heart attack, and hip fracture) were independently associated with increased odds of impairment in some activities of daily living. In general, the odds for functional impairment associated with specific medical conditions were higher than those previously published for non-Hispanic white populations. The fact that Mexican-American elderly who live in the community and who have medical conditions, especially stroke and hip fracture, are at high risk for functional impairment probably reflects the low rate of institutionalization in this population and has implications for the provision of community-based long-term care services for Mexican-American elderly.

The measurement of health-related quality of life: Major dimensions identified by factor analysis

The measurement of quality of life is becoming more important in the evaluation of medical technologies and pharmaceuticals. Particularly when the several available therapies have similar effects on survival, quality of life measures may help decide which should be the therapy of choice. The Recovery Study utilized a multidisciplinary array of indicators of health-related quality of life and recovery. This paper reports factor analyses of 58 outcome measures on a study group of 469 persons who had undergone coronary artery bypass or cardiac valve surgery 6-months previously. The factor analyses revealed 5 orthogonal dimensions. We have named them: low morale, symptoms of illness, neuropsychological function, interpersonal relationships, and economic-employment. The data argue that health-related quality of life is a multidimensional construct, and that these dimensions can be measured quantitatively with relatively simple interview and questionnaire approaches. The next research step is to determine whether the five dimensions of post-operative quality of life have different pre-operative predictors, and whether intervention on these predictors can improve the recovery and rehabilitation process.

Lower-extremity functioning in older Mexican Americans and its association with medical problems

OBJECTIVE: To describe lower‐extremity functioning in community‐dwelling older Mexican Americans and to examine its relationship with medical problems.

Correlates of prescription and over-the-counter medication usage among older Mexican Americans: The hispanic EPESE study

OBJECTIVES: To determine the prevalence rates of prescription and over‐the‐counter (OTC) medication usage among community‐dwelling older Mexican Americans.

Relationship between low Blood pressure and depressive symptomatology in older people

OBJECTIVES: To determine if low blood pressure is associated with a definable constellation of somatic and psychological symptoms in older persons.

Undertreatment of Hypertension in Older Mexican Americans

OBJECTIVE: To identify the prevalence of hypertension and factors associated with nontreatment and poor control of hypertension in Mexican Americans aged 65 years and older.

Medical student perception of the academic environment: a prospective comparison of traditional and problem-based curricula.

No abstract available.

Association between change in systolic blood pressure and cognitive decline among elderly Mexican Americans: Data from the hispanic established population for epidemiology study of the elderly

Abstract The longitudinal association between the rate of change in blood pressure and cognitive decline was examined in an area probability sample from a population-based survey of elderly Mexican Americans, 65 years of age or older obtained in 1993–1994, 1995–1996, 1998–1999, and 2000–2001 (n = 2859). The sample was divided into two groups at baseline: hypertensives had a systolic blood pressure (SBP) ≥ 140 mm Hg, a diastolic blood pressure (DBP) ≥ 90 mm Hg, or indicated a prior diagnosis of hypertension, and the normotensive group. Cognition was indexed by the Mini-Mental State Examination (MMSE). Neither SBP nor DBP at baseline predicted cognitive decline. However, the mean slope for SBP in the normotensive group showed an increase of 4.55 mm Hg (increase from Time 1 to Time 2 was 123 mm Hg to 132 mm Hg) and was significant in a regression model predicting cognitive decline even after adjusting for covariates. These findings suggest an association between increasing SBP and cognitive decline for normotensive elderly in this study population.

Cognitive benefits of problem-based learning: do they persist through clinical training?

The use of problem-based learning (PBL) is increasing in preclinical medical education. In comparison with students in traditional lecture-based curricula, students completing two-year PBL curricula report favorable changes in cognitive behaviors, specifically decreased reliance on rote memorization and greater reflection on the material they learn and how they learn. Students also report increased relevance of and greater satisfaction with their learning experience. Improved teamwork, an expected consequence of the small-group PBL environment, has been indirectly studied by assessing students’ relations with their peers, with mixed results in several studies. Of course, preclinical education represents only the first two years of medical training, which typically spans seven to ten years. It is not clear whether benefits derived from preclinical curriculum changes persist through the undergraduate clinical years, not to mention postgraduate training. We undertook the present study to examine whether differences in cognitive behaviors and intellectual satisfaction resulting from traditional and PBL preclinical curricula persisted through a common clinical curriculum.

Effect of curriculum reform on students' preparedness for clinical clerkships: a comparison of three curricular approaches in one school.

As medical schools revise preclinical curricula to emphasize active learning, clinical relevance of the basic sciences, and early clinical experiences, critical evaluation of the results of the changes is important. Such changes in preclinical curricula are expected to help students develop better skills in communication, interpersonal relationships, critical thinking, and other areas essential to the practice of medicine, resulting in better preparation to begin clinical clerkships. How does changing foundational aspects of preclinical curricula affect students’ preparedness for clinical work? How can that be assessed? Performance on the USMLE Step 1 is certainly the most visible outcome of preclinical education. Although the Step 1 is commonly taken just before clinical clerkships are undertaken, its scores are not likely to reflect effects of all curricular changes. Changes such as adopting small-group, problem-based learning (PBL) or early clinical experiences might be expected to impact noncognitive aspects of students’ performances beyond the cognitive outcomes measured by Step 1 scores. Scores on knowledge-based examinations are not likely to be useful measures of students’ preparedness for noncognitive elements of clinical clerkships, such as cross-disciplinary teamwork or patient communication, in which procedural knowledge must be applied in clinical tasks. Might students’ preclinical course performances predict their readiness for clinical clerkships? Studies of preclinical course performances as predictors of clerkship performance, such as those by Baciewicz et al. and Roop and Pangaro, tend to demonstrate a relationship between those measures and students’ clinical course examination scores or grades. We felt, however, that preclinical course grades had not been shown to be a sensitive measure of readiness for the noncognitive demands of clinical training. While students are frequently asked to evaluate course objectives, instructional delivery, and other curriculum features, they are not often asked how well their curriculum has prepared them to undertake the next training level. Fincher, Lewis, and Kuske used interns’ self-assessments to examine their preparedness in competencies required to begin the intern year, including history and physical examination, patient diagnosis and management, and interpersonal skills. We adopted a similar approach to study important noncognitive outcomes of preclinical curriculum change. Over the past seven years, the University of Texas Medical Branch (UTMB) implemented stepwise preclinical curricular reform. In 1995, a problem-based learning (PBL) track featuring selfdirected learning in small groups and early clinical experiences opened to 24 students chosen by lottery from approximately twice that number of volunteer students per class, running parallel to the traditional didactic curriculum (TC). The PBL track’s student assessment procedures relied heavily on essay tests, standardized-patient (SP) examinations, and evaluation of small-group work; the TC assessments relied predominantly on multiple-choice questions (MCQs), with less use of SP examinations. In 1998, the TC was replaced with the Integrated Medical Curriculum (IMC), a hybrid curriculum combining the problem-based, small-group, self-directed aspects of the PBL track with some didactic teaching. The hybrid IMC retained the TC’s heavy reliance on MCQs for cognitive assessment with some SP-based examinations but added the PBL track’s small-group assessment. The PBL track, meanwhile, remained essentially unchanged. All three tracks featured early clinical experiences, but the PBL track’s emphasis was heavier than that of the TC or IMC. The curriculum labels used in this study (‘‘PBL,’’ ‘‘traditional,’’ ‘‘hybrid IMC’’) may unintentionally call attention to each curriculum’s instructional characteristics more than the curriculum features more relevant to this study. Our use of these labels references all features of each curriculum, including amount of early clinical experience and array of assessment methods. UTMB’s curriculum evolution process provided an uncommon opportunity to examine the effects of three distinct preclinical curricula within a single institution on students’ perceptions of their preparedness for clinical training. To that end, we developed a clinical-preparedness survey and administered it to students as they finished their preclinical curriculum. We hypothesized that if differences were found between students’ self-assessments of preparedness for clinical training those differences would correspond to the differing emphases in the three preclinical curricula.