Richard Maisiak

Medical status of adolescents at time of admission to a juvenile detention center

PURPOSE To examine the medical status and history of health care utilization of adolescents at the time of their admission to a juvenile detention facility. METHODS Data were collected over an 18-month period on all detainees admitted for the first time to a juvenile detention facility in a major southeastern city in the United States. Information was gathered through a private, confidential interview completed by a medical social worker and a physical examination by a physician. Information was obtained regarding past medical history, complaints at the time of admission, health care utilization, and physical examination. RESULTS Approximately 10% of teenagers admitted to a detention facility have a significant medical problem (excluding drug/alcohol abuse, or uncomplicated sexually transmitted diseases) that requires medical follow-up. The majority of these conditions were known to the adolescent at the time of admission. Only a third of adolescents admitted to the detention facility reported a regular source of medical care, and only about 20% reported having a private physician. A majority of all the detainees had already fallen behind in or dropped out of school. More than half of the families of the adolescents with a medical problem appeared to be unable or unwilling to assist in ensuring proper medical follow-up. CONCLUSIONS A significant percentage of adolescents entering a detention facility have a medical problem requiring health care services. Detention facilities offer an opportunity to deliver and coordinate medical care to high-risk adolescents. Programs linking public and private health care providers with the correctional care system may provide juveniles with an acceptable option for obtaining needed health care services.

Racial Similarities and Differences in Predictors of Mobility Change over Eighteen Months

AbstractOBJECTIVES: To define racial similarities and differences in mobility among community-dwelling older adults and to identify predictors of mobility change. DESIGN: Prospective, observational, cohort study. PARTICIPANTS: Nine hundred and five community-dwelling older adults. MEASURES: Baseline in-home assessments were conducted to assess life-space mobility, sociodemographic variables, disease status, geriatric syndromes, neuropsychological factors, and health behaviors. Disease reports were verified by review of medications, physician questionnaires, or hospital discharge summaries. Telephone interviews defined follow-up life-space mobility at 18 months of follow-up. RESULTS: African Americans had lower baseline life-space (LS-C) than whites (mean 57.0 ± standard deviation [SD] 24.5 vs. 72.7 ± SD 22.6; P<.001). This disparity in mobility was accompanied by significant racial differences in socioeconomic and health status. After 18 months of follow-up, African Americans were less likely to show declines in LS-C than whites. Multivariate analyses showed racial differences in the relative importance and strength of the associations between predictors and LS-C change. Age and diabetes were significant predictors of LS-C decline for both African Americans and whites. Transportation difficulty, kidney disease, dementia, and Parkinson’s disease were significant for African Americans, while low education, arthritis/gout, stroke, neuropathy, depression, and poor appetite were significant for whites. CONCLUSIONS: There are significant disparities in baseline mobility between older African Americans and whites, but declines were more likely in whites. Improving transportation access and diabetes care may be important targets for enhancing mobility and reducing racial disparities in mobility.

Comparing In-Person, Video, and Telephonic Medical Interpretation

ABSTRACTBACKGROUNDUsing trained interpreters to provide medical interpretation services is superior to services provided on an ad hoc basis, but little is known about the effectiveness of providing their services remotely, especially using video.OBJECTIVETo compare remote medical interpretation services by trained interpreters via telephone and videoconference to those provided in-person.DESIGNQuasi-randomized control study.PARTICIPANTSTwo hundred and forty-one Spanish speaking patient volunteers, twenty-four health providers, and seven interpreters.APPROACHPatients, providers and interpreters each independently completed scales evaluating the quality of clinical encounters and, optionally, made free text comments. Interviews were conducted with 23 of the providers, the seven interpreters, and a subset of 30 patients. Time data were collected.RESULTSEncounters with in-person interpretation were rated significantly higher by providers and interpreters, while patients rated all methods the same. There were no significant differences in provider and interpreter ratings of remote methods. Provider and interpreter comments on scales and interview data support the higher in-person ratings, but they also showed a distinct preference for video over the phone. Phone interviews were significantly shorter than in-person.DISCUSSIONPatients rated interpretation services highly no matter how they were provided but experienced only the method employed at the time of the encounter. Providers and interpreters were exposed to all three methods, were more critical of remote methods, and preferred videoconferencing to the telephone as a remote method. The significantly shorter phone interviews raise questions about the prospects of miscommunication in telephonic interpretation, given the absence of a visual channel, but other factors might have affected time results. Since the patient population studied was Hispanic and predominantly female care must be taken in generalizing these results to other populations.

Participation in Health Education, Health Promotion, and Health Research by African Americans: Effects of the Tuskegee Syphilis Experiment

Abstract This study investigates the effect of the Tuskegee Syphilis Experiment (TSE) on participation in health promotion activities and research studies by African Americans. Random-digit dialing was used to interview 421 adults with telephones living in households in Jefferson County, Alabama in the summer of 1994. Respondents were asked if they had ever heard of the TSE and, if yes, because they knew about the experiment, were they less interested in participating in health promotion or research activities. The primary results were that African Americans, in general, reported less interest in participating in health promotion and research because of their knowledge of the TSE. African American males in particular reported a high degree of resistance because of knowledge of the TSE. These results may have implications for practitioners and researchers recruiting African American subjects for research studies and participation in health promotion and health education programs. It may be necessary to dis...

Heart failure mortality among older Medicare beneficiaries: association with left ventricular function evaluation and angiotensin-converting enzyme inhibitor use.

Background Left ventricular function evaluation and angiotensin-converting enzyme (ACE) inhibitor use are the two basic indicators of heart failure quality of care. In this retrospective follow-up study, we analyzed the association between these two quality indicators and mortality in elderly hospitalized heart failure patients. Methods The patients in our study were older Alabama Medicare beneficiaries discharged with a diagnosis of heart failure in 1994. Cox regression analyses, adjusted for various patient and care characteristics, were performed to estimate the overall mortality rate. Results The mean age of the 1,090 patients in our study was 79 ± 7.5 years. Both left ventricular function evaluation (hazard ratio, 0.83; 95% confidence interval, 0.705–0.976) and ACE inhibitor use (hazard ratio, 0.77; 95% confidence interval, 0.655–0.905) were associated with a lower 3-year mortality rate. Adjustment for various patient and care characteristics did not alter these associations. Conclusion Left ventricular function evaluation and ACE inhibitor use were each associated with increased survival time in older Medicare beneficiaries with heart failure. Key PointsLeft ventricular function evaluation and angiotensin-converting enzyme inhibitor use, the 2 key quality indicators of heart failure care, are often underutilized.Randomized, controlled trials of angiotensin-converting enzyme inhibitors often excluded older patients, and were restricted to those with systolic dysfunction and without contraindications to the angiotensin-converting enzyme inhibitor.Of 1,090 older Alabama Medicare beneficiaries discharged with a diagnosis of heart failure, 732 (67%) died within 3 years of discharge.Patients receiving left ventricular function evaluation had a risk reduction of 24% in 3-year risk-adjusted mortality rate, and those taking angiotensin-converting enzyme inhibitors at discharge had a 19% risk reduction.Heart failure remains a disease with a poor prognosis that can be favorably altered by following recommended management guidelines.

An exploratory study of co-location as a factor in synchronous, collaborative medical informatics distance education

BackgroundThis study determined differences in learning, judgments of teaching and technology, and interaction when videoconferencing was used to deliver instruction on telemedicine to medical students in conditions where they were co-located and dispersed. A lecture on telemedicine was given by videoconference to medical students at a distant site. After a question and answer period, students were then given search problems on the topic and encouraged to collaborate. Half the students were randomly assigned to a co-located condition where they received the presentation and collaborated in a computer lab, and half were assigned to a dispersed condition where they were located in different rooms to receive the presentation and collaborate online using the videoconferencing technology. Students were observed in both conditions and they individually completed a test on presentation content and a rating scale about the quality of the teaching and the technology.FindingsThere were no differences between the two groups in the learning outcomes or judgments about the teaching and technology, with the exception that more students in the dispersed condition felt more interaction was fostered. The level and patterns of interaction were very different in the two conditions and higher for dispersed students.ConclusionsSynchronous communication at a distance via videoconference may give sufficient sense of presence that the learning experience may be similar to that in actual classrooms, even when students are far apart. The technology may channel interaction in desirable ways.

Communication and proximity effects on outcomes attributable to sense of presence in distance bioinformatics education

BackgroundOnline learning is increasingly popular in medical education and sense of presence has been posited as a factor contributing to its success. Communication media influences on sense of presence and learning outcomes were explored in this study. Test performance and ratings of instruction and technology, factors influenced by sense of presence, are compared under four conditions involving different media and degrees of student physical presence: 1) videoconference co-located, 2) webcast co-located, 3) videoconference dispersed, and 4) webcast dispersed.MethodsEighty one first to forth year medical students heard a lecture on telemedicine and were asked to collaboratively search a telemedicine website under conditions where the lecture was delivered by videoconference or one way streaming (webcast) and where students were either co-located or dispersed. In the videoconference conditions, co-located students could use the technology to interact with the instructor and could interact with each other face to face, while the dispersed students could use the technology to interact with both the instructor and each other. In the webcast conditions, all students could use chat to communicate with the instructor or each other, although the co-located students also could interact orally. After hearing the lecture, students collaboratively searched a telemedicine website, took a test on lecture-website content and rated the instruction and the technology they used. Test scores on lecture and website content and ratings of instruction and technology for the four conditions were compared with analysis of variance and chi-square tests.ResultsThere were no significant differences in overall measures, although there were on selected ratings of instruction. Students in both webcast conditions indicated they were encouraged more to follow up on their own and felt instruction was more interactive than co-located videoconferencing students. Dispersed videoconferencing students indicated the highest levels of interaction and there was evidence they interacted more.ConclusionResults do not strongly support proximity as a sense of presence factor affecting performance and attitudes, but do suggest communication medium may affect interactivity.

Effects of summer internship and follow-up distance mentoring programs on middle and high school student perceptions and interest in health careers

BackgroundMinorities are underrepresented in health professions and efforts to recruit minority students into health careers are considered a way to reduce health disparities. There is little research about the effectiveness of these programs, other than satisfaction. This study aimed to measure program effects on student understanding of and interest in health careers.MethodsStudents took a career interest inventory, completed a scale measuring their self-reported understanding and interest in health careers, and wrote essays about health careers before and after completing a 1 week on campus internship on health careers and after a 9 month follow up distance mentoring program where they continued to interact with university faculty by videoconference about career options. Changes in inventory, scale, and essay scores were analyzed for changes over time using Wilcoxon and Mann-Whitney tests.ResultsInventory scores were unchanged over time, but scale and essay scores trended upward significantly post internship and mentoring.ConclusionHealth career education and mentoring programs can positively affect student knowledge of health careers and their attitudes about them. The study’s methods extend measures of program impact beyond satisfaction.

Using NBME Subject Examinations as a Pretest to Identify Medical Students “At Risk” in a Behavioral Sciences Course

Pretesting students has been considered a sound educational practice but the reports of its utility in medical education are sparse. The purpose of the study was to demonstrate the usefulness of the NBME Subject Examination as a pretest to identify students “at risk” in a medical school behavioral sciences course. The results indicated that the pretest was helpful in documenting course effectiveness and that it and other measures could be used to provide an early prediction of students’ behavioral sciences course grades.

Tap: An Interactive Test Analysis Program for Health Education

Tap is a comprehensive, flexible computer system designed to score and to analyze objective educational tests. The goals of the designers were to construct a program which would be user-oriented, flexible, and clear in structure and in output. TAP includes a wide variety of features.