9 reflexions on health and medical education in Mexico

In Mexico's case, the fields of healthcare and medical education are closely vinculated. On the other hand, contemporary society lives in a deep transformation process. In the present article, some paradoxes and contrasts in relation to health and medical education characterize the reality in Mexico. Particular emphasis is made on the analysis of the profound differences which exist between the two federative entities which present the extreme figures on life expectancy at birth. The thesis which supports the document, recognizes the need for integral analysis of the organizational and administrative processes of healthcare and medical education in Mexico.     

Presidential address. Changing world of health care competition and the spinal neurosurgeon

A case of early autograft endocarditis occurring three weeks after a Ross operation is described. The origin of the infection appeared to be the proximal suture line of the autograft and the pathology included subvalvular destruction of the autograft, a pseudoaneurysm between the autograft and the left atrium, and a fistula to and a vegetation in the roof of the left atrium. The valve cusps were unaffected and there was only slight autograft insufficiency (grade I-II). The autograft was removed and successfully replaced with a homograft.     

Measuring psychosocial work quality and health: Development of health care measures of measurement.

Demands on workload and work efficiency have increased because of ongoing global changes in health care organizations. Assessing and evaluating effects of changes on organizational and individual well-being require valid and reliable methods. Questionnaires from 3 large health care studies were used to develop instruments for work quality and health. Study 1 included 2,935 participants from all occupational groups. Study 2 sampled 3,545 nurses and midwives. Participants in Study 3 consisted of 3,506 employees at a large hospital. Variable fields of work quality, health and well-being, and modifying factors were factor analyzed with replicated structures in new samples, including 6 factors of work quality, 5 health factors, and 2 modifying factors. All except 2 factors had high internal consistency (Cronbach's α?=?.69–84) and low factor intercorrelations within areas. Social climate (but not individual resources) had, according to our model, a modifying effect on the work-health interaction (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social work roles in America''s changing health care

The development of the human lateral vestibular nucleus was studied on serial sections of the brain of 8 fetuses and neonates at 12-40 weeks of gestation, an infant at 2 months of age and an adult of 63 years using a microscope with a drawing tube and an image-analysing computer system. A morphometric analysis revealed that the lateral vestibular nucleus, whose neurons were distinguished from glia after 16 weeks of gestation, divided cytoarchitectonically into the medial and the lateral subnuclei at 21 weeks of gestation onwards, and showed the moderate development in terms of the columnar length and volume, neuronal size and neuropil.     

Transformations in public health systems

Public health systems are undergoing major changes. Historically, population-oriented services framed the responsibilities of the public health system. Yet over time, clinical services, particularly maternal and child health care, became an important component. More recently, many public health agencies have begun to refocus on traditional services, largely in response to Medicaid managed care and an associated decline in clients. This paper examines such transformations in thirteen states.     

Occupational levels and perceptions of the world of work in the inner city.

Investigated the relationship of family occupational level to perceptions of the world of work for 180 9th-grade inner-city Black pupils attending school in a low-income Black community. Ss were given the Hall Occupational Orientation Inventory, and the Occupational scale of the Index of Social Position was used to establish family occupational level. Findings indicated that family occupational level was salient to perceptions of the world of work. Implications for guidance programs for Black inner-city pupils are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The productivity of physician assistants and nurse practitioners and health work force policy in the era of managed health care

Managed care is spreading rapidly in the United States and creating incentives for physician practices to find the most efficient combination of health professionals to deliver care to an enrolled population. Given these trends, it is appropriate to reexamine the roles of physician assistants (PAs) and nurse practitioners (NPs) in the health care workforce. This paper briefly reviews the literature on PA and NP productivity, managed care plans' use of PAs and NPs, and the potential impact of PAs and NPs on the size and composition of the future physician workforce. In general, the literature supports the idea that PAs and NPs could have a major impact on the future health care workforce. Studies show significant opportunities for increased physician substitution and even conservative assumptions about physician task delegation imply a large increase in the number of PAs and NPs that can be effectively deployed. However, the current literature has certain limitations that make it difficult to quantify the future impact of PAs and NPs. Among these limitations is the fact that virtually all formal productivity studies were conducted in fee-for-service settings during the 1970s, rather than managed care settings. In addition, the vast majority of PA and NP productivity studies have viewed PAs and NPs as physician substitutes rather than as members of interdisciplinary health care teams, which may become the dominant health care delivery model over the next 10-20 years.     

Psychology doctoral training in work and health.

Psychology as a profession has an opportunity and obligation to advocate for and develop healthy work environments. This will require the design and conduct of doctoral-level training in occupational health psychology. A model for training might well be based on the assumptions that there is a viable role for occupational health psychologists trained at the doctoral level for both academic and applied work settings, and that doctoral training would be based on the integration of health psychology and public health. Issues remaining to be addressed in the development of doctoral training programs include appropriate predoctoral training, academic standards, the interdisciplinary nature of faculties, and appropriate settings for training. Future directions in establishing doctoral training in occupational health psychology will best be taken in dialogue with several other professions and institutions that share a common interest in reducing leading work-related disease and injuries and promoting public health in the workplace. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methodology for the assessment of activities in primary health care]

Polyribosomal complexes beneath postsynaptic sites on dendrites provide a substrate for local translation of particular mRNAs, but the signals that target mRNAs to synapses remain to be defined. Here, we report that high frequency activation of the perforant path projections to the dentate gyrus causes newly synthesized mRNA for the immediate-early gene (IEG) Arc to localize selectively in activated dendritic segments. Newly synthesized Arc protein also accumulates in the portion of the dendrite that had been synaptically activated. The targeting of Arc mRNA was not disrupted by locally inhibiting protein synthesis, indicating that the signals for mRNA localization reside in the mRNA itself. This novel mechanism through which newly synthesized mRNA is precisely targeted to activated synapses is well suited to play a role in the enduring forms of activity-dependent synaptic modification that require protein synthesis.     

A Preliminary Study of the Phase Transformations in Rolled Al-Fe-Si Alloy

The precipitation of phases in the Al-Fe-Si system has been studied using differential scanning calorimetry (DSC) and thermoelectric power (ΔS) in homogenized and deformed by rolling samples. Two predominant associated effects being observed on homogenized samples: the first one, after precipitation of Fe and Si at temperatures lower than 673 K (400 °C) and the second, the Al₃Fe phase, at a temperature close to 773 K (500 °C). In DSC, the effect of severe deformation by rolling is manifest in two ways: (1) displacing the peaks reported in homogenized samples and (2) introducing two new exothermic transformations associated with the processes of recovery and recrystallization. In ΔS, the two transformations are maintained, although displaced and magnified by the effect of a faster and more abundant Fe precipitation. The isoconversional method is used to calculate the activation of precipitated phases.     

An examination of nonresponse in a work environment questionnaire mailed to psychiatric health care personnel.

Nonresponse to surveys, which seems to plague work environment studies and studies of health care personnel in particular, may pose problems of generalizability and validity. The aim of this study was to provide an estimate of nonresponse error in a self-administered survey concerning the work environment of psychiatric health care personnel. A random sample of 10% of the original survey population (N?=?693) was selected to participate in a telephone follow-up of a postal survey that had a response rate of 51%. There were no differences between the responders and nonresponders to the postal survey on the exposure or outcome variables. There was no evidence of nonresponse bias in this study, although recall bias may have been a problem. In those cases in which generalizability is deemed important, it is recommended that nonresponse studies be regularly carried out when response rates are less than 100%. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The challenge of health care social work with gay men and lesbians

Inflammation in the subarachnoid space represents the pathological hallmark of bacterial meningitis. The intrathecal accumulation of leukocytes, in response to bacterial pathogens, and the subsequent release of endogenous inflammatory mediators are associated with a breakdown of the blood-brain barrier function and poor prognosis. Complement has been shown to play a major role in the inflammatory response within the intrathecal compartment in bacterial meningitis. In the present review, we provide an outline of the current understanding of the involvement of the complement system in the pathophysiology of bacterial meningitis, and propose future directions of investigation.     

Mental health care in the USSR.

The author received a scientist exchange grant from the National Institutes of Health and visited the USSR as a health-science representative in 1976. He reports that mental health services in the USSR are provided primarily by the medical profession through state mental hospitals and psychiatric sections in general hospitals and clinics. Drug therapy is the main treatment method, but psychotherapy is beginning to make some inroads. Family therapy settings are the newest additions to preventive mental health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occupational upper extremity disorders in the federal workforce. Prevalence, health care expenditures, and patterns of work disability

Upper extremity disorders (UEDs) account for a significant number of work-related illnesses in the US workforce. Little information exists on the distribution of UEDs, their associated health care and indemnity costs, or patterns of work disability. The study presented is an analysis of upper extremity claims within the federal workforce. In this study, the universe consisted of all claims accepted by the US Department of Labor, Office of Workers' Compensation Programs (OWCP), from October 1, 1993, through September 30, 1994. A total of 185,927 claims of notices of injury were processed during the study period, and of these, 8,147 or 4.4% had an UED diagnosis coded according to the International Classification of Diseases, Clinical Modification (ICD-9-CM). 5,844 claims involved a single UED diagnosis and were the only claims field by these employees between October 1, 1990, and September 30, 1994. These single claims with single diagnoses comprised the sample for further analysis. Mononeuritis and enthesopathies of the upper limb were the most common diagnoses, accounting for 43% and 31% of the claims, respectively. Women had a higher proportion of carpal tunnel syndrome, "unspecified" mononeuritis, and "unspecified" enthesopathies. The majority of claimants for both the mononeuritis- and enthesopathy-related diagnoses were between 31 and 50 years of age, received only health care benefits, and did not incur wage loss. Health care costs for mononeuritis and enthesopathy claims were $12,228,755 (M = $2,849). Carpal tunnel syndrome (CTS) and enthesopathy of the elbow were the most costly diagnoses, accounting for 57% and 16% of the total, respectively. Surgical services represented the highest expenditures in CTS claims. Physical therapy accounted for the majority of health care costs for enthesopathy cases. The mean number of workdays lost for CTS and enthesopathy claims were 84 and 79, and the average indemnity costs were $4,941 and $4,477, respectively. These findings indicate that while UEDs represent a relatively small percentage of all workers' compensation cases, the health care and indemnity costs are considerable. Also mean duration and pattern of work disability revealed that these disorders can result in chronic work disability similar to that observed in low back pain. The results highlight the need to determine whether interventions that account for the majority of costs significantly impact long-term outcomes. There is also a need to identify risk factors for prolonged disability in those who experience problems with delayed recovery.