Family Medicine and Community Health Journal最新文献

{"title":"Integrated primary care–behavioral health program development and implementation in a rural context","authors":"Kendra Campbell, Loren McKnight, Ángel R. Vásquez","doi":"10.15212/FMCH.2018.0113","DOIUrl":"https://doi.org/10.15212/FMCH.2018.0113","url":null,"abstract":"Objective Despite the known benefits of integrated primary care and behavioral health services, integrated behavioral health services have not been readily used in medical clinics in interior Alaska. With minimal resources, we recently developed an integrated primary care–behavioral health program in a medical clinic in interior Alaska to meet clinic and community needs. The objective of this study was to explore initial program outcomes and determine the feasibility of program development and implementation. Methods We initially conducted a needs assessment for integrating behavioral health services into primary care. Program development was informed by specific clinic needs. Following program implementation, initial program outcomes were tracked with use of data from the electronic health record and patient and provider use and satisfaction surveys. The level of integration of primary care and behavioral health services was evaluated with the Practice Integration Profile. Results A total of 188 patients were seen by behavioral health consultants during the initial pilot phase, including 44.0% referred for mental health symptoms, 33.1% referred for physical health issues, and 22.3% referred for both mental and physical health issues. The initial program outcomes indicate modest clinical improvement (measured by the nine-item Patient Health Questionnaire) as well as patient and provider satisfaction with the model, and a moderate level of practice integration. Conclusion On the basis of the initial findings, it appears that our integrated primary care–behavioral health program has the potential to serve an important role in addressing the behavioral health needs of the local population. Our implementation procedure and initial program outcomes suggest that such models are feasible in rural and small-scale settings with minimal overhead costs. Significance statement Integrating behavioral health services into primary care medical settings offers a variety of benefits, including improved continuity of care and access to service, more effective health prevention and management, and clinical cost-effectiveness. Integrated models have not been readily used in rural US settings. With minimal resources, we developed an integrated primary care–behavioral health program in the family medicine department of a semirural medical clinic in Alaska to meet clinic and community needs. The initial program outcomes suggest that this integrated primary care–behavioral health program is helping to address the behavioral health needs of the local population. Our findings suggest that integrated healthcare models are feasible in rural or small-scale settings.","PeriodicalId":152216,"journal":{"name":"Family Medicine and Community Health Journal","volume":"161 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127553600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the teaching practice in undergraduate medical education: A perspective from the United States of America","authors":"M. Fetters, Joanna Rew, J. Heidelbaugh","doi":"10.15212/FMCH.2018.0111","DOIUrl":"https://doi.org/10.15212/FMCH.2018.0111","url":null,"abstract":"This article describes and reflects on the role of teaching practices in undergraduate medical education on the basis of teaching experience in the United States of America. China in particular, but also other family medicine–emerging countries, continues to embark on a path of creating and embracing a family medicine–centric system. The purpose of this article is to provide a US perspective on teaching priorities and strategies for medical students, and how these fit into a larger structure of the family medicine clinical clerkship. We emphasize knowledge, clinical skills, clinical behaviors, and strategies for succeeding as a preceptor. We introduce key aspects of the University of Michigan family medicine clerkship and the highly effective structure provided by the leadership of the course directors. This organizational structure provides a framework for implementing the family medicine clerkship for teaching medical students. As China and other family medicine–emerging countries increasingly embrace the discipline, we hope these ideas will provide a meaningful reference. Significance statement Despite the growth of family medicine for more than 50 years in many countries, there remain many family medicine–emerging countries that have limited experience in the teaching of family medicine to medical students. This article provides suggestions for specific educational practices when one is teaching a medical student engaged in a clinical clerkship. Specifically, it focuses on both what to teach and how to teach family medicine–relevant clinical skills, knowledge, and behaviors to a medical student during a clinical rotation. Moreover, the article includes a series of formative and summative evaluation forms that are used at the University of Michigan that have content similar to the formats used in many US medical student training programs and that can be adapted for use in other settings.","PeriodicalId":152216,"journal":{"name":"Family Medicine and Community Health Journal","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130706133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure–controlling behavior in relation to educational level and economic status among hypertensive women in Ghana","authors":"B. Ghose, S. Yaya","doi":"10.15212/FMCH.2018.0112","DOIUrl":"https://doi.org/10.15212/FMCH.2018.0112","url":null,"abstract":"Objective To explore the association between economic status and educational level with self-management behavior (medication adherence, controlling body weight, reducing salt intake, performing physical exercise, reducing alcohol consumption, abstaining from smoking, increasing fruit and vegetable consumption) among hypertensive women in Ghana. Methods Cross-sectional data on 598 women were collected from the Ghana Demographic and Health Survey of 2014. The association between economic status and educational level with self-management behavior was measured by logistic regression methods. Results Mean systolic blood pressure and diastolic blood pressure were 131.4 and 86.58 mm Hg, respectively. With regard to self-management behavior, 81.8% of women reported taking medication to control high blood pressure, 44.4% reported controlling body weight, 22.5% reported reducing salt intake, 48.3% reported performing physical exercise, 74.2% reported reducing alcohol consumption, 74.2% reported abstaining from alcohol and smoking, and 20.2% reported consuming more fruits and vegetables. Women living in the wealthiest households had significantly higher odds of maintaining healthy weight, reducing salt intake, and exercising. Conclusion The findings imply that socioeconomic factors may play important roles in women’s adherence to blood pressure–controlling behavior. It is therefore suggested that policy makers focus on improving women’s economic status as a strategy to encourage cardiovascular health–promoting behavior. Significance statement This is the first study to assess the effect of socioeconomic status on blood pressure–controlling behavior among adult women with hypertension in Ghana. The findings could be of crucial importance to health and social policy makers who are working toward reducing the burden of heart diseases and promoting healthy behavior among adult women in Ghana as well as in neighboring countries.","PeriodicalId":152216,"journal":{"name":"Family Medicine and Community Health Journal","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134041037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of the Mothers of Preterm Babies Postpartum Depression Scale","authors":"Ajibola Abdulrahamon Ishola, C. C. Obasi, Ismail T. Sholuke","doi":"10.15212/FMCH.2018.0109","DOIUrl":"https://doi.org/10.15212/FMCH.2018.0109","url":null,"abstract":"Postpartum depression, a common complication in childbearing women, is of great public health concern. Previous screening tools have focused on depressed mood, with less attention paid to postpartum anxiety and suicidal ideation. This study developed and validated a tool to measure postpartum depression among mothers of preterm babies. From the clinical interviews and a pilot survey (n=121) the Mothers of Preterm Babies Postpartum Depression Scale was developed. The Mothers of Preterm Babies Postpartum Depression Scale and the Edinburgh Postnatal Depression Scale questionnaires were completed by 152 mothers who delivered preterm babies at Massey Street Children’s Hospital, Lagos. Data were analyzed with use of confirmatory factor analysis, principal component analysis, and Cronbach’s alpha at the P≤0.05 level of significance. The new scale demonstrated a reliability (α) of 0.91. Construct validity with exploratory factor analysis (Kaiser-Meyer-Olkin measure 0.70) yielded three dimensions of cognitive and emotional difficulty (α=0.92), hopelessness and suicidal ideation (α=0.93), and physiological distress (α=0.71). Confirmatory factor analysis demonstrated a good fit: 18 degrees of freedom; goodness of fit index 0.97; adjusted goodness of fit index 0.93; and root mean square error of approximation 0.04. Convergent validity was established with the Edinburgh Postnatal Depression Scale (r=0.66, P=0.00). The new screening tool was demonstrated to have meritorious validity, faster and easier to administer to the obstetric population. Significance statement Having a baby is often marked by disturbance in mood, and the birth of a premature baby can put mothers at greater risk of psychological distress than the birth of a full-term baby. Available screening tools assess postpartum depression symptoms without consideration of mitigating sources of postpartum stress. Edinburgh Post-natal Depression scale is the commonest measure for differential diagnosis in Nigeria but limited in screening women for suicidal ideation and anxiety. This study developed a new tool that improves the efficiency of, and reduces the time spent diagnosing postpartum depression among mothers of preterm babies. Efficiency in diagnosing the pathological reaction of mothers of preterm babies to the child’s condition and the corresponding depression symptoms is highly important for implementation of cost-effective intervention by mental health practitioners.","PeriodicalId":152216,"journal":{"name":"Family Medicine and Community Health Journal","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117166856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-sectional study to assess the out-of-pocket expenditure of families on the health care of children younger than 5 years in a rural area","authors":"S. Shrivastava, P. Shrivastava","doi":"10.15212/FMCH.2018.0114","DOIUrl":"https://doi.org/10.15212/FMCH.2018.0114","url":null,"abstract":"Objective This study aimed to estimate the out-of-pocket expenditure of families on the health care of children younger than 5 years in a rural area of Kancheepuram district. Methods A cross-sectional descriptive study was performed in a rural area of Kancheepuram district for 5 months. All households with at least one child younger than 5 years were eligible for the study, and 153 households were selected for the final study. A semistructured and pretested schedule was used to obtain information about various study variables during home visits. Ethics approval was obtained before the start of the study. Data were entered into Microsoft Excel, and statistical analysis was done with IBM SPSS Statistics version 23. Frequency distributions were calculated for all the variables. Results The findings indicate that most children younger than 5 years were males (62.7%). The maximum out-of-pocket expenditure was for accidents/trauma and in cases of fever/malaria. Further, 96 households (53.1%) preferred private-sector health care for their ailments. Conclusion The findings indicate that 93 of the children younger than 5 years (60.8%) had experienced one episode of illness in the previous 3 months. Further, the maximum out-of-pocket expenditure was for accident/trauma cases, and overall the largest share was for buying medications for the treatment. Significance statement In India, a developing nation with a weak public health care delivery system, most of the general population seeks health care from the private sector. Even though the private sector neutralizes most of the deficiencies of the public sector, it accounts for a major financial burden on individuals, families, and the community through enormous health care expenditure. This study aimed to identify the out-of-pocket expenditure of families on the health care of children younger than 5 years in a rural area of Kancheepuram district, which will help policy makers to identify the prevailing trends, and thus provide them with the evidence to strengthen the response of the public health sector in the rural area.","PeriodicalId":152216,"journal":{"name":"Family Medicine and Community Health Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129713144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic screening for quality-of-life improvement and post–genetic testing consideration in Saudi Arabia","authors":"Faten Dhawi, Faisal Alotaibi","doi":"10.15212/FMCH.2018.0108","DOIUrl":"https://doi.org/10.15212/FMCH.2018.0108","url":null,"abstract":"The Saudi genome project started in 2013 with a great hope to improve medical care and disease prevention. Among the genes are those related to nutrition and fitness that can optimize an individual’s lifestyle. Our aim was to review the knowledge and acceptance of nutrition and fitness genetic testing to enhance the quality of life among the population of Saudi Arabia. For the study an electronic questionnaire consisting of 27 questions was prepared, and it was answered by 302 respondents. The respondents’ demographics showed about 50% of respondents were aged 18–25 years and about 50% of respondents were aged 26–60 years. More than 50% of respondents were interested in having a genetic test to enhance their health, while 40% were interested in having a genetic test to enhance their fitness. Less than 50% of respondents had an understanding of the effects of coffee, macronutrition and micronutrition, elements, and enzyme activity. These results represented a contribution to the discussion on the relevance of genetic testing validity and acceptance among the population of Saudi Arabia. The results might help in producing specific guidelines on genetic testing and genomic analysis and help in the implementation of fitness and future health plans in cooperation with Saudi genome projects. Future study will focus on population structure and genetic frequency related to specific diets or fitness. Significance statement The availability of genetic information in the era of omics has made it possible to use genetic information beyond rare genetic diseases. To test the population’s acceptance and knowledge of genetic testing use in disease prevention and improvement of wellness, we conducted a survey study. The outcomes indicate great acceptance and knowledge that will help us in the future to detect the frequency of different genes related to nutrition and fitness. These results might help in producing specific guidelines on genetic testing and genomic analysis and help in the implementation of fitness and future health plans in cooperation with Saudi genome projects.","PeriodicalId":152216,"journal":{"name":"Family Medicine and Community Health Journal","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123711200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Has Mayaro virus always existed or is it new?","authors":"Juan Vargas","doi":"10.15212/FMCH.2018.0103","DOIUrl":"https://doi.org/10.15212/FMCH.2018.0103","url":null,"abstract":"","PeriodicalId":152216,"journal":{"name":"Family Medicine and Community Health Journal","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114554127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic and health system correlates of interprofessional oral health practice","authors":"S. Boynes, A. Lauer, Amy B. Martin","doi":"10.15212/FMCH.2018.0104","DOIUrl":"https://doi.org/10.15212/FMCH.2018.0104","url":null,"abstract":"Objective This study explores geographic, system, and organizational constructs that predict medical care teams’ willingness to administer fluoride varnish and conduct oral health risk assessments. Methods A cross-sectional survey of voluntary health professionals attending trainings on interprofessional oral health practice was completed at ten meetings across the United States from April through September, 2016. Bivariate and multivariate analyses were used to examine unknown correlates of oral health prevention and intervention at geographic, organizational, and system levels relating to the impact of referral mechanisms and systems as well as health information technology on fluoride varnish administration and risk-based oral evaluations. Results A convenience cohort (n = 560) from 44 states was examined. Most (68.7%, n = 385) agreed with the dependent variable “medical providers at our site, or part of our network, are administering fluoride varnish and identifying oral health risk factors in the majority of patients seen.” In bivariate analysis, organization type (P = 0.0067), having successful referral systems (P < 0.0001), and electronic health record (EHR) utility (P < 0.0001) were associated with the dependent variable. No geographic indicators were significant. All referral system indicators were significant in multivariate analysis. Dependable referrals (P < 0.0001), EHR utility (P = 0.0054), and type of referral (P = 0.0009) were predictors of the dependent variable. The odds of those reporting a dependable referral system and dependent variable agreement were 4.5 times greater than for those who lacked dependable referral systems (odds ratio 4.54, confidence interval 2.79–7.39). The odds of those who had dependable EHRs and dependent variable agreement were 2.4 times greater than for those who lacked useful EHRs (odds ratio 2.4, confidence interval 1.29–4.37). Conclusion The dependability of medical-to-dental referral systems and processes impacts the administration of fluoride varnish and identification of oral health risk factors by motivated primary care teams. Additionally, the ease of EHR use and the availability of electronic information exchange were found to impact primary care oral health practice. Significance statement Caries activity is one of the most common diseases of childhood, and prevention/intervention by primary care teams can positively impact patient results. This analysis examined unknown correlates of oral health prevention and intervention at geographic, organizational, and system levels relating to the impact of referral mechanisms and systems as well as health information technology on fluoride varnish administration and risk-based oral evaluations.","PeriodicalId":152216,"journal":{"name":"Family Medicine and Community Health Journal","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127509163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the teaching practice in undergraduate education – A British perspective","authors":"Patricia Houlston","doi":"10.15212/FMCH.2018.0106","DOIUrl":"https://doi.org/10.15212/FMCH.2018.0106","url":null,"abstract":"This article describes and reflects on the role of the teaching practice in undergraduate education on the basis of the author’s experience in the United Kingdom. Recognizing that China is addressing the huge task of developing a general practice workforce in an unprecedented short time, I hope that sharing these ideas will be helpful. General practitioners are well able to teach the basics of medicine. However, their real strengths come when they are focusing on key consulting skills needed for general practice, developing reflective lifelong learners, and cultivating good attitudes. The practice is also able to demonstrate preventive medicine, chronic disease management, and multidisciplinary care. By providing exposure to general practice at this early stage in a medical career, the teaching practice will hopefully inspire and attract the general practice workforce of the future.","PeriodicalId":152216,"journal":{"name":"Family Medicine and Community Health Journal","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115114136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-sectional analysis of obesity and high blood pressure among undergraduate students of a university medical college in South India","authors":"S. Chenji, C. Rao, Saranya Sivanesan, V. Kamath, A. Kamath","doi":"10.15212/FMCH.2017.0134","DOIUrl":"https://doi.org/10.15212/FMCH.2017.0134","url":null,"abstract":"Objective To estimate the prevalence of obesity and high blood pressure among undergraduate students of a university medical college. Methods A cross-sectional study was conducted at a medical college among 434 medical students. A questionnaire was used to collect basic demographic details, followed by anthropometric measurements. Body mass index (BMI) was classified according to the World Health Organization classification. Blood pressure was measured with a standard mercury sphygmomanometer and classified according to the seventh report of the Joint National Committee (JNC VII) on prevention, detection, evaluation, and treatment of high blood pressure. Data were entered into and analyzed with SPSS version 15.0. Results Nearly 65.0% of students had normal BMI, 9.9% were underweight, 17.9% were overweight, and 7.6% were obese. Obesity was more prevalent among males than among females on the basis of anthropometric variables such as BMI, waist-hip ratio, and waist-stature ratio, and this difference was found to be statistically significant. Blood pressure was in the normal range among 55.0% of the students, 36.6% had blood pressure in the prehypertensive range, 7.6% had blood pressure in the stage 1 category of the JNC VII criteria, and 0.5% had blood pressure in the stage 2 category of the JNC VII criteria. Among the students who had blood pressure greater than 140/90 mm Hg, 63.0% were males and 37.0% were females, and this difference was statistically significant. Conclusion The prevalence of obesity was 7.6% and that of high blood pressure was 8.1% among the medical students, which were higher than those reported in the literature for the same age group and warrant further evaluation. Statement of Significance Non-communicable diseases have been described as the modern epidemic of the current era. A retrograde age shift is being noted in the prevalence of diseases such as diabetes mellitus, hypertension, and obesity, which is alarming. Young adults are at an increased risk of developing these diseases because of indulgence in faulty lifestyle practices. The present study attempted to quantify the risk among medical students. The prevalence of obesity was 7.6% and that of high blood pressure was 8.1% among the medical students, which were higher than those reported in the literature for the same age group. Future medical professionals need to be aware of their own risk factors and take proactive steps before advising and encouraging their patients to adopt healthy lifestyles.","PeriodicalId":152216,"journal":{"name":"Family Medicine and Community Health Journal","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131937282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}