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Balancing the role of the dental school in teaching, research and patient care; including care for underserved areas

HOLBROOK, W. P.; BRODIN, P.; BALCIUNIENE, I.; BRUKIENE, V.; BUCUR, M. V.; CORBET, E.; DILLENBERG, J.; DJUKANOVIC, D.; EKANAYAKE, K.; ERIKSEN, H.; FISHER, J.; GOFFIN, G.; HULL, P.; KUMCHAI, T.; LUMLEY, P.; LUND, J.; MATHUR, V.; NOVAES JR., A.; PURIENE, A.;
Fonte: WILEY-BLACKWELL PUBLISHING, INC Publicador: WILEY-BLACKWELL PUBLISHING, INC
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
37%
Inequalities within dentistry are common and are reflected in wide differences in the levels of oral health and the standard of care available both within and between countries and communities. Furthermore there are patients, particularly those with special treatment needs, who do not have the same access to dental services as the general public. The dental school should aim to recruit students from varied backgrounds into all areas covered by the oral healthcare team and to train students to treat the full spectrum of patients including those with special needs. It is essential, however, that the dental student achieves a high standard of clinical competence and this cannot be gained by treating only those patients with low expectations for care. Balancing these aspects of clinical education is difficult. Research is an important stimulus to better teaching and better clinical care. It is recognized that dental school staff should be active in research, teaching, clinical work and frequently administration. Maintaining a balance between the commitments to clinical care, teaching and research while also taking account of underserved areas in each of these categories is a difficult challenge but one that has to be met to a high degree in a successful...

A 10-year analysis of metastatic prostate cancer as an initial presentation in an underserved population

Winer,Andrew G.; Sfakianos,John P.; Hyacinthe,Llewellyn M.; McNeil,Brian K.
Fonte: Sociedade Brasileira de Urologia Publicador: Sociedade Brasileira de Urologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2014 EN
Relevância na Pesquisa
37.15%
Objective To analyze patients from an underserved area who presented initially with metastatic prostate cancer in order to identify patients in our population who would suffer greatly if PSA screening was eliminated. Materials and Methods A prospectively maintained androgen deprivation therapy database from an inner city municipal hospital was queried to identify patients who presented with metastatic prostate cancer. We identified 129 individuals from 1999 to 2009 eligible for study. Those who underwent previous treatment for prostate cancer were excluded. We examined metastatic distribution and analyzed survival using Kaplan Meier probability curves. Results The median age of presentation was 68 with a median Gleason sum of 8 per prostate biopsy. Thirty-two patients presented with hydronephrosis with a median creatinine of 1.79, two of whom required emergent dialysis. Of those patients who underwent radiographic imaging at presentation, 35.5% (33/93) had lymphadenopathy suspicious for metastasis, 16.1% (15/93) had masses suspicious for visceral metastases. Of the patients who underwent a bone scan 93% (118/127) had positive findings with 7.9% (10/127) exhibiting signs of cord compression. The 2 and 5- year cancer specific survival was 92.1% and 65.6%...

Family physicians for underserved areas. The role of residency training.

Gessert, C; Blossom, J; Sommers, P; Canfield, M D; Jones, C
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /02/1989 EN
Relevância na Pesquisa
27.33%
Graduates of four rural and four urban family practice programs were interviewed to determine the nature of their practices and the factors that had influenced their practice location decisions. All programs gave residents substantial experience providing continuity of care for underserved populations. Of the 158 physicians surveyed, 58 (46%) were working in areas designated as underserved. The percentage of physicians in underserved areas was higher than that reported in other studies and was much higher than would be expected if practice sites were selected on the basis of population distribution alone. Notable differences in personal and practice characteristics were found between the physicians who chose to work in underserved areas and those who did not and between those who established practices in rural and in urban underserved areas.

Are "medically underserved areas" medically underserved?

Kleinman, J C; Wilson, R W
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //1977 EN
Relevância na Pesquisa
27.15%
A comparison of medically underserved areas (MUAs) and adequately served areas (ASAs) is presented. Nonmetropolitan areas represented in the Health Interview Survey (HIS) are classified as MUAs or ASAs by the official criterion of their scores on the Index of Medical Underservice (IMU), and HIS data from the two types of areas are examined for differences. Standard metropolitan statistical areas are also compared with the nonmetropolitan MUAs and ASAs. Results show no difference between MUA and ASA residents in number of physician visits per year or proportion with at least one visit in the past year, although MUA residents reported poorer health status, used some preventive services less, and used nonsurgical hospitalization more than did ASA residents. In gereral, most MUA-ASA differences tend to be similar in size to differences between ASAs and SMSAs. An alternative to the IMU, using HIS data to identify underserved areas, is discussed.

Primary care physicians in underserved areas. Family physicians dominate.

Burnett, W H; Mark, D H; Midtling, J E; Zellner, B B
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /12/1995 EN
Relevância na Pesquisa
27.33%
Using the definitions of "medically underserved areas" developed by the California Health Manpower Policy Commission and data on physician location derived from a survey of California physicians applying for licensure or relicensure between 1984 and 1986, we examined the extent to which different kinds of primary care physicians located in underserved areas. Among physicians completing postgraduate medical education after 1974, board-certified family physicians were 3 times more likely to locate in medically underserved rural communities than were other primary care physicians. Non-board-certified family and general physicians were 1.6 times more likely than other non-board-certified primary care physicians to locate in rural underserved areas. Family and general practice physicians also showed a slightly greater likelihood than other primary care physicians of being located in urban underserved areas.

Caring for the Underserved: Exemplars in Teaching

Assemi, Mitra; Shane-McWhorter, Laura; Scott, Doneka R.; Chen, Judy T.; Seaba, Hazel H.
Fonte: American Journal of Pharmaceutical Education Publicador: American Journal of Pharmaceutical Education
Tipo: Artigo de Revista Científica
Publicado em 19/02/2009 EN
Relevância na Pesquisa
27.25%
The objective was to identify exemplars in teaching pharmacy students awareness, knowledge, and the skills needed to provide care and services to the underserved. A call for exemplars was sent out in spring 2007. A subcommittee of the AACP Task Force on Caring for the Underserved reviewed all applications received. The 3 best exemplars for teaching pharmacy students the awareness, attitudes, knowledge, and skills needed to care for the underserved were selected and are described in this manuscript. Included are 1 didactic, 1 experiential, and 1 international experience. These exemplars in educating students on working with the underserved provide schools with models which could be adapted to fit individual programmatic curricular needs.

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions

Bärnighausen, Till; Bloom, David E
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em 26/06/2009 EN
Relevância na Pesquisa
27.39%
In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload.

Health Care Utilization and Self-Care Behaviors of Medicare Beneficiaries with Diabetes: Comparison of National and Ethnically Diverse Underserved Populations

Remler, Dahlia K.; Teresi, Jeanne A.; Weinstock, Ruth S.; Ramirez, Mildred; Eimicke, Joseph P.; Silver, Stephanie; Shea, Steven
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em /02/2011 EN
Relevância na Pesquisa
27.5%
Caring for persons with diabetes is expensive, and this burden is increasing. Little is known about service use, behaviors, and self-care of older individuals with diabetes who live in underserved communities. Information about self-care, informal care, and service utilization in urban (largely Latino, n = 695) and rural (mostly white, n = 819) Medicare beneficiaries with diabetes living in federally designated medically underserved areas was collected using computer-aided telephone interviews as part of the baseline assessment in the Informatics and Diabetes Education and Telemedicine (IDEATel) Project. Where items were comparable, service use was compared with that of a nationally representative group of Medicare beneficiaries with diabetes, using data from the Medical Expenditure Panel Survey. Compared to nationally representative groups, the underserved groups reported worse general health but similar health care service use, with the exception of home care. However, compared to the underserved rural group, the underserved, largely minority urban group, reported worse general health (P < 0.0001); more inpatient nights (P = 0.003), emergency room visits (P < 0.001), and home health care (P < 0.001); spent more time on self-care; and had more difficulty with housework...

Teleophthalmology: A Model for Eye Care Delivery in Rural and Underserved Areas of India

Prathiba, Vijayaraghavan; Rema, Mohan
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
27.15%
Objectives. To describe the application of teleophthalmology in rural and underserved areas of India. Study Design. This paper describes the major teleophthalmology projects in India and its benefits. Results. Teleophthalmology is the use of telecommunication for electronic transfer of health-related data from rural and underserved areas of India to specialities in urban cities. The MDRF/WDF Rural Diabetes Project has proved to be very beneficial for improvement of quality health care in Tamilnadu and can be replicated at the national level. This community outreach programme using telemedicine facilities has increased awareness of eye diseases, improved access to specialized health care, helped in local community empowerment, and provided employment opportunities. Early detection of sight threatening disorders by teleophthalmology and prompt treatment can help decrease visual impairment. Conclusion. Teleophthalmology can be a very effective model for improving eye care delivery system in rural and underserved areas of India.

Breast Screening Navigator Programs within Three Settings that Assist Underserved Women

Burhansstipanov, Linda; Dignan, Mark B.; Schumacher, Ann; Krebs, Linda U.; Alfonsi, Grace; Apodaca, CeCilia Ceci
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/2010 EN
Relevância na Pesquisa
27.15%
Medically underserved women in the Greater Denver Metropolitan Area had low rates of routine repeat mammograms in the latter 1990s. “Increasing Mammography Adherence among Medically Underserved Women” was designed to increase annual rescreening among medically underserved populations living in this area. Four community-based organizations collaborated to implement this 5-year study. A culturally modified navigator model including both face-to-face and telephone formats was used to facilitate mammography for African Americans, Latinas, Native Americans, and poor White women who had not been rescreened in more than 18 months. The navigator-implemented intervention was statistically significant at the 0.05 level for increasing rescreening.

Challenges and Possible Solutions to Colorectal Cancer Screening for the Underserved

Gupta, Samir; Sussman, Daniel A.; Doubeni, Chyke A.; Anderson, Daniel S.; Day, Lukejohn; Deshpande, Amar R.; Joseph Elmunzer, B.; Laiyemo, Adeyinka O.; Mendez, Jeanette; Somsouk, Ma; Allison, James; Bhuket, Taft; Geng, Zhuo; Green, Beverly B.; Itzkowitz,
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
Publicado em 28/03/2014 EN
Relevância na Pesquisa
27.47%
Colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. CRC incidence and mortality can be reduced through screening. However, in the United States, screening participation remains suboptimal, particularly among underserved populations such as the uninsured, recent immigrants, and racial/ethnic minority groups. Increasing screening rates among underserved populations will reduce the US burden of CRC. In this commentary focusing on underserved populations, we highlight the public health impact of CRC screening, list key challenges to screening the underserved, and review promising approaches to boost screening rates. We identify four key policy and research priorities to increase screening among underserved populations: 1) actively promote the message, “the best test is the one that gets done”; 2) develop and implement methods to identify unscreened individuals within underserved population groups for screening interventions; 3) develop and implement approaches for organized screening delivery; and 4) fund and enhance programs and policies that provide access to screening, diagnostic follow-up, and CRC treatment for underserved populations. This commentary represents the consensus of a diverse group of experts in cancer control and prevention...

Health disparities and underserved populations: a potential solution, medical school partnerships with free clinics to improve curriculum

VanderWielen, Lynn M.; Vanderbilt, Allison A.; Crossman, Steven H.; Mayer, Sallie D.; Enurah, Alexander S.; Gordon, Samuel S.; Bradner, Melissa K.
Fonte: Co-Action Publishing Publicador: Co-Action Publishing
Tipo: Artigo de Revista Científica
Publicado em 21/04/2015 EN
Relevância na Pesquisa
27.25%
Health-care educators share the social responsibility to teach medical students about social determinants of health and health-care disparities and subsequently to encourage medical students to pursue residencies in primary care and medical practice in underserved communities. Free clinics provide care to underserved communities, yet collaborative partnerships with such organizations remain largely untapped by medical schools. Free clinics and medical schools in 10 US states demonstrate that such partnerships are geographically feasible and have the potential to mutually benefit both organizational types. As supported by prior research, students exposed to underserved populations may be more likely to pursue primary care fields and practice in underserved communities, improving health-care infrastructure.

Financial Incentives for Return of Service in Underserved Areas: a Systematic Review

Bärnighausen, Till; Bloom, David E.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
27.58%
Background: In many geographic regions, both in developing and in developed countries, the number of health workers is insufficient to achieve population health goals. Financial incentives for return of service are intended to alleviate health worker shortages: A (future) health worker enters into a contract to work for a number of years in an underserved area in exchange for a financial pay-off. Methods: We carried out systematic literature searches of PubMed, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, and the National Health Services Economic Evaluation Database for studies evaluating outcomes of financial-incentive programs published up to February 2009. To identify articles for review, we combined three search themes (health workers or students, underserved areas, and financial incentives). In the initial search, we identified 10,495 unique articles, 10,302 of which were excluded based on their titles or abstracts. We conducted full-text reviews of the remaining 193 articles and of 26 additional articles identified in reference lists or by colleagues. Forty-three articles were included in the final review. We extracted from these articles information on the financial-incentive programs (name...

Intrinsic rewards experienced by a group of dentists working with underserved populations

Gardner, S.P.; Roberts-Thomson, K.F.; Winning, T.A.; Peterson, R.
Fonte: Wiley Publicador: Wiley
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
Relevância na Pesquisa
37.25%
BACKGROUND: The aim of this study was to explore, using qualitative methods, the intrinsic reasons why dentists work with underserved groups. Minority and marginalized groups of Australians suffer a greater burden of dental disease than the general population due to disparities in accessing care. Recruitment and retention of dentists to care for underserved groups is problematic due to personal, professional and structural reasons. What drives dentists to work with underserved groups is not widely known. METHODS: Sixteen dentists were recruited using 'snowball' purposeful sampling. Semi-structured in-depth interviews were conducted. Thematic analysis was conducted on the transcriptions to identify themes. RESULTS: Five key themes emerged: (1) 'tapped on the shoulder', being personally approached or invited; (2) 'dental school experience', the challenges faced as a student; (3) 'empathic concern', the non-judgemental expressions of care toward others; (4) 'resilience', the ability to bounce back after setbacks; (5) 'intrinsic reward', the personal gain and satisfaction received. This study focuses on the intrinsic rewards which were found to be simple, unexpected, and associated with relieving pain, community engagement and making a difference. CONCLUSIONS: Emphasizing personal fulfilment and intrinsic reward could be useful when promoting dentistry as a career and when encouraging graduates to consider working with disadvantaged groups.; SP Gardner...

Reaching an Underserved Wine Customer: Connecting with the African American Wine Consumer

Hammond, Rhonda; Sydnor, Sandra; Kang, Eunjoo
Fonte: FIU Digital Commons Publicador: FIU Digital Commons
Tipo: Artigo de Revista Científica Formato: application/pdf
Relevância na Pesquisa
37%
Marketing strategies addressing underserved African American wine customers’ needs that also positively impact producers’ and retailers’ clientele was the impetus for this exploratory, qualitative paper. African Americans demonstrate a thirst to elevate their education about and be more involved in the wine industry as evidenced by the proliferation of African American wine-tasting groups designed to help educate and expose their membership to a variety of wines. Moreover, compared to the average adult, African-American wine drinkers are 241% more likely to have spent $20 or more on a bottle of store bought wine (Arbitron, 2005). Despite African Americans’ representation as one of the fastest growing ethnic minority segments in the U.S., wine industry strategies don't appear to connect with this market segment. Like Alice in Wonderland, we characterize this phenomenon by suggesting this market segment is ‘peering through the looking glass’. Three focus groups were conducted to specify possible targeted media strategies as well as to identify attitudes and opinions that influence this segment's wine purchasing and consumption behaviors. Industry strategies were suggested that would appear to benefit producers, retailers...

Designing Financial-Incentive Programmes for Return of Medical Service in Underserved Areas: Seven Management Functions

Bärnighausen, Till; Bloom, David E.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
27.58%
In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes...

Residents' preferences and preparation for caring for underserved populations

Weissman, Joel S.; Campbell, Eric G.; Gokhale, Manjusha; Blumenthal, David
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Publicado em /09/2001 EN
Relevância na Pesquisa
27.33%
Access to care by low-income persons and residents of rural and poor innercity areas is a persistent problem, yet physicians tend to be maldistributed relative to need. The objectives were to describe prefernces of resident physicians to locate in underserved areas and to assess their preparedness to provide service to low-income populations. A national survey was made of residents completing their training in eight specialties at 162 USacademic health center hospitals in 1998, with 2,626 residents responding. (Of 4,832 sampled, 813 had invalid addresses or were no longer in the residency program. Among the valid sample of 4,019, the response rate was 65%). The percentage of residents ranking public hospitals, rural areas, and poor inner-city areas as desirable employment locations and the percentage feeling prepared to provide specified services associated with indigent populations were ascertained. Logistic regressions were used to calculate adjusted percentages, controlling for sex, race/ethnicity, international medical graduate (IMG) status, plans to subspecialize, ownership of hospital, specialty, and exposure to underserved patients during residency. Only one third of residents rated public hospitals as desirable settings, although there were large variations by specialty. Desirability was not associated with having trained in a public hospital or having greater exposure to underserved populations. Only about one quarter of respondents ranked rural (26%) or poor inner-city (25%) areas as desirable. Men (29%. P<.01) and noncitizen IMGs (43%...

Impact of desire to work in underserved communities on selection of specialty among fourth-year medical students.

Bazargan, Mohsen; Lindstrom, Richard W.; Dakak, Alan; Ani, Chizobam; Wolf, Kenneth E.; Edelstein, Ronald A.
Fonte: National Medical Association Publicador: National Medical Association
Tipo: Artigo de Revista Científica
Publicado em /09/2006 EN
Relevância na Pesquisa
27.33%
OBJECTIVE: The objective of this study was to explore the specific factors that influence medical student's choice of primary care as a specialty. Special attention is given to the influence of desire to work in underserved communities on selection of a specialty. DESIGN AND SETTINGS: A web-based survey of factors affecting choice of specialty was completed by 668 fourth-year students from 32 medical schools. RESULTS: Students interested in primary care reported an increased likelihood of working with underserved populations when compared with other specialties. The independent impact of both student's social compassion attitudes and values, and subjective and reinforcing influences on the selection of primary care, when compared with all other specialties, was strong. Personal practice-oriented considerations showed an independent negative impact on the selection of primary care when compared with surgery and support specialties. Financial considerations strongly influence the selection of support specialties. Medical training experiences showed an independent influence on the selection of surgery over primary care. CONCLUSION: The need for primary care physicians and specialists in underserved communities is considerable. Addressing health disparities in underserved communities requires a concerted effort to increase the availability of primary care providers in these communities. This study observed that primary care practice or specialty selection by medical students is influenced by individual values and subjective external influences other than predicted by medical training alone. This observation necessitates a closer determination of strategies required to ensure an increase in the number of primary care physicians serving underserved communities.

Effectiveness of educational strategies preparing physician assistants, nurse practitioners, and certified nurse-midwives for underserved areas.

Fowkes, V K; Gamel, N N; Wilson, S R; Garcia, R D
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //1994 EN
Relevância na Pesquisa
27.33%
A study of physician assistant, nurse practitioner, and certified nurse midwifery programs was undertaken to identify and assess the effectiveness of recruitment, educational, and deployment strategies that programs use to prepare practitioners for medically underserved areas. The 51 programs studied were those having mission statements or known track records relating to this goal. A total of 170 interviews were conducted with faculty, students, graduates, and employers from 9 programs visited on-site and 42 programs surveyed by telephone. All programs had some recruitment and training activities in underserved sites. Only about half of the programs were able to submit data on their graduates' practice settings and specialties. These data suggest that older students who have backgrounds in underserved areas and clearly identified practice goals are more likely to practice in underserved areas. Programs that actively promote service to the underserved do so through publicly stated missions and recruitment and educational strategies that complement these missions. Such programs also are more likely to evaluate and document their success than programs that lack strategies.

The impact of multiple predictors on generalist physicians' care of underserved populations.

Rabinowitz, H K; Diamond, J J; Veloski, J J; Gayle, J A
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/2000 EN
Relevância na Pesquisa
27.5%
OBJECTIVES: This study examined the relative and incremental importance of multiple predictors of generalist physicians' care of underserved populations. METHODS: Survey results from a 1993 national random sample of 2955 allopathic and osteopathic generalist physicians who graduated from medical school in 1983 or 1984 were analyzed. RESULTS: Four independent predictors of providing care to underserved populations were (1) being a member of an underserved ethnic/minority group, (2) having participated in the National Health Service Corps, (3) having a strong interest in practicing in an underserved area prior to attending medical school, and (4) growing up in an underserved area. Eighty-six percent of physicians with all 4 predictors were providing substantial care to underserved populations, compared with 65% with 3 predictors, 49% with 2 predictors, 34% with 1 predictor, and 22% with no predictors. Sex, family income when growing up, and curricular exposure to underserved populations during medical school were not independently related to caring for the underserved. CONCLUSIONS: A small number of factors appear to be highly predictive of generalist physicians' care for the underserved, and most of these predictive factors can be identified at the time of admission to medical school.