Epidemiology and primary health care

University departments of epidemiology and primary medical care have tended to develop separately because they require very different skills. The Department of Community Medicine at St. Thomas's Hospital Medical School, London, is an example of a harmonious, combined development of the two disciplines. Working as a multidisciplinary team, the department has conducted studies initiated by epidemiologists, primary physicians and the interaction of the two. Examples are given from past and current research of the department. Through mutual cooperation the scientific knowledge of the epidemiologist and the down-to-earth practical knowledge of the clinician have complemented each other to produce valid research of practical relevance. The association has also provided educational facilities for medical students for whom, as physicians, protocol thinking, analysis and questioning of accepted "facts" will become increasingly important.     

Difficulties in family practice residency training: Recommendations for training health psychologists in primary care settings.

We attempt to pursue a model for health psychologists by developing recommendations for behavioral science input into family practice residencies, gleaned from experiences of several health psychologists specifically trained to be directors of behavioral science programs of such medicine departments. This information is accumulated and based on a 7-year period at one university-based, inner-city program and two community-based hospitals. These recommendations are offered in the hope that health psychology training specialists will anticipate roadblocks associated with family practice residency training programs and will plan accordingly. Specifically, we make recommendations regarding program overview and training background, roadblocks (including medicine as the final authority), theoretical versus practical teaching orientation, resident time constraints, administrative support and priorities, and training effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Undergraduate training in primary health care: 6 years' experience at the University of Alicante

OBJECTIVE: To assess the opinion of medical students on the teaching offered in the Primary Care context (TOPC). DESIGN: Observational and crossover study. The assessment used an opinion questionnaire. PARTICIPANTS: 296 sixth-year medical students between 1987 and 1992. INTERVENTIONS: The TOPC consisted of four weeks stay in a Health Centre with an eminently practical programme. However this also included hour-long theoretical seminars on the most important Primary Care questions and the student's completion of a research project related to Primary Care. RESULTS: The students expressed satisfaction with the TOPC (average score of 4 out of 5). Moreover this satisfaction increased over the five years (from 3.7 to 4.6, p = 0.0001). They believed the TOPC to be useful (3.6 to 4.7, p = 0.0001) and relevant to their future professional activity (3.1 to 4.6, p = 0.0001). They thought that the tutors were very competent (4 out of 5, with no significant variation) and the Health Centres' teaching facilities suitable (3.8 to 4, with no significant variation). Finally, they considered that TOPC should become a compulsory undergraduate subject (3.9 out of 5). CONCLUSIONS: Medical students give a positive rating to the Primary Care teaching offered and believe it should be integrated into the Medicine syllabus as a compulsory subject.     

Psychotropic drug use in primary health care units in Nigeria

A large number of medical information is available on the Internet for laymen as well as for medical experts. This is used to answer medical questions in concrete situations and is likely to influence health related behaviour directly. Therefore the questions arises how health is affected and how the effects can be measured. The classical way of performing clinical studies can be applied to the Internet only in part. New methods must be developed and evaluated in individuals studies.     

Training of surgeons for primary health care

It has been the view of the Association of Surgeons of East Africa (ASEA) that, like primary health care, there is primary surgery. The unit of provision of primary surgery is the district hospital. The training of surgeons for district hospitals starts at the undergraduate level, leading to the attainment of Bachelor of Medicine and Bachelor of Surgery (M.B. Ch.B.) degree. After internship the doctor works in a district or provincial hospital for 2-3 years, then trains for the degree of Master of Medicine (M. Med. (Surg.)) for a period of 3 years. The training involves rotation through all branches of surgery, so that the surgeon should be able to handle all aspects of routine surgery in a district hospital. To equip the surgeon further, a period in an outside setting is considered advisable. There are arrangements for regional surgical colleges to standardise the form of surgical training in the ASEA region. To keep surgeons in touch with the outside world, specialist training is done outside the region, but arrangements are being made for localised specialised units to offer this training.     

Postdoctoral training in primary care health psychology: Duties, observations, and recommendations.

The need for postdoctoral training in health psychology has taken on added importance following transformations of the U.S. health care delivery system toward primary care models of delivery. This transformation provides psychologists with the opportunity to work as primary care practitioners, educators, and researchers, and it suggests the need for postdoctoral training that prepares students for those opportunities. The author addresses issues relevant to postdoctoral training from the perspective of a former participant in a postdoctoral fellowship training program in primary care health psychology. The duties and contributions of a primary care health psychologist are described. These include the provision of graduate medical education and clinical services tailored to primary care. The author also offers recommendations regarding postdoctoral health psychology training in order to enhance psychologists' ability to collaborate with medical professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health service use among young children receiving pediatric primary care

OBJECTIVE: To investigate the factors associated with mental health service use among young children. METHOD: Five hundred ten preschool children aged 2 through 5 years were enrolled through 68 primary care physicians, with 388 (76% of the original sample) participating in a second wave of data collection, 12 to 40 months later. Consensus DSM-III-R diagnoses were assigned using best-estimate procedures. The test battery included the Child Behavior Checklist, a developmental evaluation, the Rochester Adaptive Behavior Inventory, and a videotaped play session (preschool children) or structured interviews (older children). At wave 2, mothers completed a survey of mental health services their child had received. RESULTS: In logistic regression models, older children, children with a wave 1 DSM-III-R diagnosis, children with more total behavior problems and family conflict, and children receiving a pediatric referral were more likely to receive mental health services. Among children with a DSM-III-R diagnosis, more mental health services were received by children who were older, white, more impaired, experiencing more family conflict, and referred by a pediatrician. CONCLUSIONS: Young children with more impairment and family conflict are more likely to enter into treatment. Services among young children of different races with diagnoses are not equally distributed. Pediatric referral is an important predictor of service use.     

Community analysis for health planning: strategies for primary care practitioners

Primary care practitioners have an important role in planning for the health of individuals and selected target populations. Community analysis and needs assessment are the first steps in health planning. Community analysis involves identifying health issues within a community; gathering data about the community, the target group, and the health concern; analyzing data; and assessing community needs. Community needs assessment involves identifying both existing and potential health problems as well as health promotion needs. By using appropriate skills in carrying out needs assessments, primary care practitioners become active contributors in planning for the health of individuals, groups, and the nation as a whole. This article provides strategies for identifying, analyzing, and evaluating the health needs of a community.     

Primary health care for people with learning disabilities

Health screening and education for people with learning disabilities is often given low priority by service providers, but the input of community nurses can make a great difference. Helen Cook charts the success of two teams.     

Ambulatory care training in cardiology: redefining the traditional arena of learning

Fiscal restraint, consolidation of resources and services, and restructuring have led to changes in the case mix of teaching hospitals, which places limitations on the education of medical trainees in this environment and has sparked growing interest in the teaching of clinical medicine in the ambulatory care setting. Early attempts to emphasize ambulatory care in training programs, and the strengths and weaknesses of this teaching forum are reviewed, and a model of its application to the discipline of cardiology is offered.     

Post polio syndrome: an update for the primary health care provider

Post Polio Syndrome, or PPS, is defined as a clinical syndrome of new weakness, fatigue, and pain in people who have previously recovered from acute paralytic poliomyelitis. Other common symptoms include cold intolerance, dysphagia, dyspnea, and overuse syndromes. PPS afflicts an estimated 50% of polio survivors, a population estimated at 1.6 million people, and begins roughly 30 years after the acute disease. The main impact of PPS is on mobility related activities affecting one's daily routine. With an insidious onset, and several differential diagnoses for each symptom, PPS can be difficult to diagnose and to validate. However, once identified, there are treatment plans and many avenues of support for this disabling syndrome. The purpose of this article is to provide an overview of the pathophysiology of both acute paralytic poliomyelitis as well as PPS. This article also reviews the current literature concerning the etiology and pathophysiology of both poliomyelitis and PPS, symptom evaluation and differential diagnoses, and treatment recommendations. The psychosocial impact and care of the client are also identified, and several resources for support and education of both the client and provider are provided.     

Psychology and primary health care for children.

There is an emerging consensus among those responsible for primary health care to children that such care should not only include medical concerns but also should assist parents with common problems of development and behavior. Psychologists are increasingly included among the personnel of medical groups that provide primary care to children. A model for this relatively new type of practice is described. Such pediatric primary-care settings also offer new research opportunities for psychologists. An important public policy issue concerns how comprehensive primary health care, including psychological services, can be made accessible to all children, and how research to evaluate such services and improve their efficacy can be encouraged. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation psychology in primary care: Preparing for a changing health care environment.

Restructuring of health care delivery systems has deemphasized tertiary and specialty services with a resultant increase in primary medical care. These reform efforts are anticipated to continue, highlighting the need for rehabilitation psychologists to expand beyond tertiary care settings to sustain the growth and prosperity of their profession. New models of service delivery and training are needed to help them transition into the new health care environment. A recently developed model for integrating behavioral medicine into primary care may serve as a guide. In this paper we discuss a model for integrating behavioral science into the medical management of primary care patients. The model is applicable to the functions and philosophy of rehabilitation psychologists. A discussion of the new model and its relation to rehabilitation psychology is provided along with implications for predoctoral training and strategies for overcoming barriers to primary care integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing technical training efficiency: Peer training via computer-assisted instruction.

Conducted 2 studies of peer training via computer-assisted instruction (CAI) in the technical training of electronics in the military. Ss were 182 male US Air Force personnel. Study 1 compared a peer-trained CAI group (n?=?72) to both an individually trained CAI group (n?=?55) and a conventionally trained group (n?=?55). Results indicate no differences in achievement levels, but the mean training times of both CAI groups were significantly less than that of the conventionally trained group. The mean peer-trained CAI training time was significantly lower than that of the individually trained group, and the variability of training time was also significantly lower. Study 2, using the peer-trained subsample from Study 1 and an additional 48 Ss, investigated optimum pairing strategies. Ss were paired for training based on their previously demonstrated ability. Pairing strategies did not affect individual achievement scores, but some strategies were consistently superior in reducing training times. Implications of CAI peer training in both military and civilian technical training are discussed. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evolution of health care: Implications for the training and careers of psychologists.

Congress failed to pass legislation in 1994, but the general principles guiding reform are clearly embedded in state-level legislation and the inexorable movement toward managed care in the private employer–insurer markets. These principles, legislated by statute or realized incrementally through private market reforms, present challenges and opportunities to psychology as a science and a profession. Psychologists must significantly modify the way they currently work, and university-based training programs must modify the way they educate future psychologists. The issues go beyond the dominant concern with benefit plan coverage and professional prerogatives and affect the very organizational structures in which psychologists work and the ways they get paid. Psychologists now share with every health-related science and profession the public's demand for research-based evidence of cost-effective solutions to individual and community-wide health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)