Non-physician Health Professionals Research Articles

Similar Problem in the Activities of Daily Living but Different Experience: A Qualitative Analysis in Six Rheumatic Conditions and Eight European Countries

The aim of the present study was to compare and contrast the concepts of functioning in daily life which were important to patients with different rheumatological conditions. The study comprised a qualitative analysis of 44 focus groups in eight European countries, in 229 patients with fibromyalgia, hand osteoarthritis, psoriatic arthritis, rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis, using the World Health Organization, 2001 International Classification of Functioning, Disability and Health as a framework. Concepts and - where necessary - also sub-concepts and transcripts were combined and compared independently by two researchers who, in case of disagreement, achieved consensus through discussion. Twenty concepts out of 109 (e.g. body image, fatigue, emotional issues, mobility and hand function) were similarly described in all six diseases. However, even if the same concept was mentioned, patients' experiences were different, such as mental AND physical aspects limiting the ability to drive in patients with fibromyalgia compared with ONLY physical problems in all other diseases. Within body functions and structures, several concepts were relevant for certain conditions only. A large number of similar problems are mentioned as 'typical' by patients with different rheumatic conditions. These could probably be targeted, using a disease-specific approach, in interventions by non-physician health professionals.

Use of Medicines and Adherence to Standard Treatment Guidelines in Rural Community Health Centers, Timor-Leste

The use of medicines and nurses'/midwives' adherence to standard treatment guidelines (STGs) were examined in Timor-Leste during the early stage of the nation's new health system development. A cross-sectional study was conducted as the quantitative element of mixed methods research. Retrospective samples from patient registration books and prospective observations were obtained in 20 randomly selected rural community health centers. The medicines use indicators, in particular the level of injection use, in Timor-Leste did not suggest overprescription. Prescribers with clinical nurse training prescribed significantly fewer antibiotics than those without such training (P < .01). The adjusted odds ratio of prescribing adherence for clinical nurse training, after accounting for confounders and prescriber clustering, was 6.6 (P < .01). STGs for nonphysician health professionals at the primary health care level have potential value in basic health care delivery, including appropriate use of medicines, in resource-limited communities when strategically developed and introduced.

The Movement Disorder Society and Movement Disorders: A Modern History

The Movement Disorder Society (MDS) developed out of a merger with two short-lived organizations, the Movement Disorder Society, primarily organized to develop a journal for the subspecialty, and the International Society of Motor Disturbances, primarily organized to develop international congresses. The formal merger of the Movement Disorder Society and the International Society of Motor Disturbances into the Movement Disorder Society took place at the 2nd International Congress of Movement Disorders in Munich, Germany, in June 1992. Whereas the journal, Movement Disorders, and the annual International Congress of Parkinson's Disease and Movement Disorders remain the anchors of the society, the goals now include the development of regional symposia, regional sections, Web-based educational programs, and outreach efforts to include young investigators, wide international membership, and inclusion of non-neurologists, including basic scientists, neurosurgeons, and nonphysician health professionals. Movement Disorders has a continuingly growing subscribership and rising impact factor.

Extended Roles of Non‐physician Health Professionals and Innovative Models of Care within Europe: Results from a Web‐based Survey

Due to the increasing prevalence of rheumatic diseases, extended roles of non-physician health professionals and innovative models of care may be important options in rheumatology in the future. Extended roles have been pioneered in the UK, Canada, USA and Australia and been found to be effective and safe. However, few data are available about mainland Europe, so the aim of this study was to explore the current status of the extended roles undertaken by health professionals within Europe, and the corresponding models of care used. Non-physician health professionals from various European countries were asked to complete a web-based survey using convenience and snowball sampling techniques. Data analysis involved calculating descriptive statistics and frequencies based on the countries where the participants currently worked. Of the 479 health professionals who filled in the survey, 430 (92%) indicated that they were performing extended roles. Considerable differences between the 27 participating countries existed, in terms of which extended roles and which innovative models of care were being used. Barriers to performing extended roles were cited as the attitude of rheumatologists in all but eight countries, while attitudes of patients were less common barriers. Lack of knowledge, education and educational opportunities were also experienced in several countries. The present study produced the first data on extended roles for non-physician health professionals and corresponding innovative models of care in rheumatology within Europe. We recommend increasing educational opportunities, as well as developing strategies to limit the barriers experienced.

An interprofessional collaborative practice model: Primary-care clinical associates at the family practice setting

A persistent physician shortage challenges the ability of our healthcare system to meet the growing health needs of our aging population. Health system redesign must maximize the efficient use of available human resources. The Alberta Westview Primary Care Network (WPCN) introduced the Primary Care Clinical Associate (CA) program in 2005. This interprofessional collaborative practice model recruits nonphysician health professionals from various disciplines as autonomous, independent practitioners. They are associates of the family physician and use their full scope of practice to jointly care for a panel of patients in family practice settings. Three years after its inception, the CA program has grown steadily from two initial participating family practices to its current implementation in six of seven WPCN clinics. The present direction of Canadian primary healthcare reform is towards team approaches. Accordingly, the CA program has wide applicability provincially across Canada. The objective of this article is to describe in detail the design of the WPCN CA program including its conceptual framework and operational strategies and to share program implementation learning. This knowledge transfer will enable replication of the WPCN CA model, where appropriate, in other jurisdictions.

Abstract B86: Health care utilization during transition to Medicare coverage in patients with prostate cancer: Evidence from CaPSURE registry

Abstract Introduction: While Medicare eligibility for all adults who reach 65 years of age provide universal insurance coverage, disparity in utilization of medical services still persists. The purpose of our study is to evaluate utilization of medical services and general health-related quality of life outcomes in patients with prostate cancer during their transition to the Medicare coverage. We hypothesize that transition to universal coverage, especially the one that provides expanded services will lead to increase in utilization of the medical services and improvements in quality of life. Methods: Data from CaPSURE™ (Cancer of the Prostate Strategic Urological Research Endeavor), a longitudinal, observational registry of men with biopsy-proven prostate adenocarcinoma, was used for this study. Patients, who were diagnosed within 6 months of treatment, treated with Radical Prostatectomy (RP), External Beam Radiation (EBRT) and Brachytherapy (BT) and were younger than 65 at diagnosis were eligible for the study. In addition, participants had to have questionnaire assessments within 4 years (2 years before and 2 years after) of turning 65. Utilization of the medical services was measured by 1) total number of office visits; 2) number of visits related to prostate cancer care; 3) number of visits not related to prostate cancer care; 4) number of visits to physicians, 5) number of visits to non-physician health professionals, 6) total number of diagnostic tests, 7) number of diagnostic tests related to prostate cancer, and 8) number of diagnostic tests not related to prostate cancer. Change in insurance coverage was identified by No change in coverage, Change to Medicare only and change to Medicare plus supplement. Repeated measures analysis with mixed modeling was implemented to evaluate relationship between utilization of medical services, general HRQOL and transition in the insurance coverage overtime. Results: 861 participants met study inclusion and exclusion criteria. Utilization of the medical services and general health related outcomes differed among participants in different categories of transition when evaluated by univariate analysis. Participants in Medicare+ group had higher number of total office visits, non-prostate cancer related visits, physician, and non-physician medical professional visits, and diagnostic tests compared to NC and Medicare groups. However, number of visits and diagnostic tests related to prostate cancer was not affected by insurance transition. In the multivariate analysis, transition to Medicare+ was associated with higher total and non-prostate cancer related diagnostic tests. Office visits utilization was higher in Medicare+ group but association did not retain statistical significance. Similar to univariate analysis utilization of the visits and diagnostic tests related to prostate cancer was not associated with changes in insurance coverage. Conclusion: Our study demonstrated that in the population of men diagnosed with prostate cancer disparity in utilization of medical visits and use of diagnostic tests was associated with presence or absence of expanded Medicare coverage. This information provides an important insight on burden of health care expenditures in older adults with cancer. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B86.

Rauchstopp-Weiterbildung für Ärzte und nicht-ärztliche Fachpersonen in der Schweiz

Almost one third of the Swiss population smokes. Of these persons a large percentage would like to quit smoking each year. It is well known that the odds to quit successfully are improved by professional counseling and medication support. In order to counsel the numerous smokers interested in quitting a sufficient number of professionals needs to be trained in smoking cessation. For this training a short and extended course in smoking cessation for physicians is available (Frei von Tabak project). For non-physician health professionals there is a postgraduate course in tobacco prevention and smoking cessation and for both groups of professionals there is the Hospital QuitSupport workshop, which aims to support and promote hospital-based smoking cessation counseling. Smoking cessation counseling by physicians is remunerated in the outpatient setting. For non-physician smoking cessation counselling, however, there is no such tarif for remuneration. This drawback presents a considerable obstacle for the establishment of a large-scale smoking cessation counseling network in Switzerland.

Identifying 4-Month-Old Infants at Risk in Community Screening

To validate a 2-step infant developmental screening protocol administered by nonphysician health professionals. The Parent Concerns Survey and the Meade Movement Checklist (MMCL) were administered during 5 community clinics. Infant scores at 4 months were compared with the Bayley Scales of Infant Development II and Movement Assessment of Infants at 6 months and to the Ages and Stages Questionnaires at 8 months. Parents identified significantly more concerns on the Parent Concerns Survey (x2 = 6.43, p = 0.011) than parents not attending clinics. The correlation between infant MMCL scores at 4 months and Movement Assessment of Infants was r = 0.58 (p = 0.01) and r = -0.48 (p = 0.01) with Bayley Scales of Infant Development II scores at 6 months. The MMCL demonstrated 87.5% sensitivity, 91.4% specificity, and 70% positive predictive value. Combining parent concerns and observational screening effectively identified infants for further evaluation. This 2-step screening by nonphysician health professionals provides a valid, new perspective for screening young infants.

When Is Social Support Important? The Association of Family Support and Professional Support with Specific Diabetes Self-management Behaviors

Social support is associated with better diabetes self-management behavior (SMB), yet interventions to increase family and friend support (FF support) have had inconsistent effects on SMB. To test whether FF support differentially affects specific SMBs and compare the influence of support from health professionals and psychological factors on specific SMBs to that of FF support. Cross-sectional survey of people with diabetes recruited for a self-management intervention One hundred sixty-four African-American and Latino adults with diabetes living in inner-city Detroit For every unit increase in FF support for glucose monitoring, the adjusted odds ratio (AOR) of completing testing as recommended was 1.77 (95% CI 1.21-2.58). FF support was not associated with four other SMBs (taking medicines, following a meal plan, physical activity, checking feet). Support from non-physician health professionals was associated with checking feet [AOR 1.72 (1.07-2.78)] and meal plan adherence [AOR = 1.61 (1.11-2.34)]. Diabetes self-efficacy was associated with testing sugar, meal plan adherence, and checking feet. Additional analyses suggested that self-efficacy was mediating the effect of FF support on diet and checking feet, but not the FF support effect on glucose monitoring. The association between FF support and SMB performance was stronger for glucose monitoring than for other SMBs. Professional support and diabetes self-efficacy were each independently associated with performance of different SMBs. SMB interventions may need to differentially emphasize FF support, self-efficacy, or professional support depending on the SMB targeted for improvement.

Drs. Yager and Rabjohn Reply

Back to table of contents Previous article Next article Letters to the EditorFull AccessDrs. Yager and Rabjohn ReplyJOEL YAGER M.D.PATRICK A. RABJOHN M.D., Ph.D.,JOEL YAGER M.D.Search for more papers by this authorPATRICK A. RABJOHN M.D., Ph.D.Search for more papers by this author,Published Online:1 Jul 2008https://doi.org/10.1176/appi.ajp.2008.08030404rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We appreciate the comments by Drs. Caplan, Querques, Freudenreich, and Kontos on the consultation-liaison psychiatrist’s perspective regarding the effect of work-hour regulation on the declining “ownership” of patients by non-psychiatrist physicians. One potential cost of work-hour regulations is that these requirements may further fragment the already complex and confusing team-based care that often occurs in general hospital services. In these settings, multiple teams of consultants, residents, and fellows and rotating hospitalist-physicians strive to provide comprehensive, 24-hour, 7-day-per-week care to very sick patients who are often cognitively impaired by the nature of their medical and surgical conditions. Many patients have difficulty knowing who their “doctor” is.Beyond the consultation-liaison environment, how certain are we that the fragmentation of medical services described by Drs. Caplan, Querques, Freudenreich, and Kontos has not transpired in psychiatric units as well? Imposing strict work-hour regulations has, in some settings, further fostered team-based care by psychiatric residents and their co-workers. What are we doing in our own shops to prevent physician-patient relationships between our residents and psychiatric inpatients from being diluted? To what extent do fragmented psychiatric resident work schedules contribute to situations in which non-physician mental health professionals rather than psychiatric residents are—de facto—the ones who provide the primary clinician-patient relationships for psychiatric inpatients? We wouldn’t do that, would we?Albuquerque, N.M.The authors’ disclosures accompany the original article.This letter (doi: 10.1176/appi.ajp.2008.08030404r) was accepted for publication in April 2008. FiguresReferencesCited byDetailsCited ByNone Volume 165Issue 7 July, 2008Pages 916-916THE AMERICAN JOURNAL OF PSYCHIATRY July 2008 Volume 165 Number 7 Metrics PDF download History Published online 1 July 2008 Published in print 1 July 2008

Growing old at home – A randomized controlled trial to investigate the effectiveness and cost-effectiveness of preventive home visits to reduce nursing home admissions: study protocol [NCT00644826

BackgroundRegarding demographic changes in Germany it can be assumed that the number of elderly and the resulting need for long term care is increasing in the near future. It is not only an individual's interest but also of public concern to avoid a nursing home admission. Current evidence indicates that preventive home visits can be an effective way to reduce the admission rate in this way making it possible for elderly people to stay longer at home than without home visits. As the effectiveness and cost-effectiveness of preventive home visits strongly depends on existing services in the social and health system existing international results cannot be merely transferred to Germany. Therefore it is necessary to investigate the effectiveness and cost-effectiveness of such an intervention in Germany by a randomized controlled trial.MethodsThe trial is designed as a prospective multi-center randomized controlled trial in the cities of Halle and Leipzig. The trial includes an intervention and a control group. The control group receives usual care. The intervention group receives three additional home visits by non-physician health professionals (1) geriatric assessment, (2) consultation, (3) booster session.The nursing home admission rate after 18 months will be defined as the primary outcome. An absolute risk reduction from a 20% in the control-group to a 7% admission rate in the intervention group including an assumed drop out rate of 30% resulted in a required sample size of N = 320 (n = 160 vs. n = 160).Parallel to the clinical outcome measurement the intervention will be evaluated economically. The economic evaluation will be performed from a society perspective.DiscussionTo the authors' knowledge for the first time a trial will investigate the effectiveness and cost-effectiveness of preventive home visits for people aged 80 and over in Germany using the design of a randomized controlled trial. Thus, the trial will contribute to the existing evidence on preventive home visits especially in Germany.

Podagra, Uric Acid, and Cardiovascular Disease

Hippocrates would not be surprised to read that persons with gout had higher mortality, and particularly cardiovascular-related mortality, than persons without gout.1 On the other hand, he might well have been bemused, nearly 2500 years after he described the syndrome, that this made news. Article p 894 He should not have been. All too often, rigorous examination debunks conventional wisdom. Reassuringly, in this case, Drs Choi and Curhan found evidence to support long-standing belief. These dedicated and productive students of the pathogenesis and natural history of gout have here reported empiric data from the 51 000 male nonphysician health professionals who participated in the Health Professions Follow-up Study. From initial examination in 1986 through nearly 600 000 person-years of follow-up, 5825 deaths occurred, of which 2132 were cardiovascular and 1576 were ascribed to coronary heart disease, rates that attest to the generally good health of the group. The ≈6% prevalence of gout, at baseline, in men in their mid-50s, who mirror the general US population in body mass index, reported history of hypertension, hypercholesterolemia, and diabetes mellitus, was higher than expected. Interim biennial questionnaires identified incident cases of gout. Participants with gout were both more likely to report coronary heart disease (CHD) at baseline and, regardless of CHD status, more likely than gout-free persons to have cardiovascular disease (CVD) risk factors. Results were presented after stratification by CHD status at baseline. As expected, the incidence of all-cause and CHD mortality was much greater in those with than in those without prevalent CHD. The adjusted increased relative risk of those with gout (compared with those without) for all-cause, CVD, and CHD mortality was ≈25%. The single exception was a near doubling of increased relative risk of CHD mortality among those free of CHD at baseline. Neither the inclusion of incident …

Who Can Call Themselves Physicians: Law Would Draw the Line

Back to table of contents Previous article Next article Government NewsFull AccessWho Can Call Themselves Physicians: Law Would Draw the LineRich DalyRich DalySearch for more papers by this authorPublished Online:21 Jul 2006https://doi.org/10.1176/pn.41.14.0002The Healthcare Truth and Transparency Act aims to bar practitioners who have not graduated from medical school from misrepresenting themselves as physicians through advertising. Under the legislation, sponsored by Rep. John Sullivan (R-Okla.), nonphysician health professionals who continue to misrepresent themselves would face investigation and fines by the Federal Trade Commission.The legislation is backed by APA as a member of the Coalition for Health Care Accountability, Responsibility, and Transparency (CHART), a physicians' advocacy group. The legislation is needed to help patients avoid“ substandard—and perhaps even dangerous—care” through misleading claims, said APA President-elect Carolyn Robinowitz, M.D., in a written statement.“Information is power—the power to make better choices, to protect you and your family's safety, and to keep costs in check by getting you the care you need the first time,” she said.The legislation aims to eliminate practices such as those of Louisiana psychologists, who in recent years won the right to prescribe psychoactive medications and to refer to themselves as “medical psychologists.” That title is misleading, APA maintains, because the law that gave Louisiana psychologists prescribing privileges placed their oversight with the nonphysician Louisiana State Board of Examiners of Psychologists rather than with a state medical board.“The term `medical psychologist' encourages a patient to believe he or she is being seen by a medical doctor, when they're really being seen by someone without a medical degree. To me, that is deceptive,” Robinowitz said.Sullivan said that the increasingly complex health care system has created a need to help consumers understand the differences in the kind of care they are offered.The vast majority of Americans (90 percent) appear to be concerned about the qualifications of the professionals who provide their health care, according to a recent CHART survey. It found 86 percent support federal legislation that would make it easier for them to understand the qualifications of the health care professionals who treat them and their families.The measure comes as changes in state laws in recent years related to practitioners' scope of practice have blurred the line between physicians, other clinicians who have some degree of medical training, and nonmedically trained practitioners. Adding to the confusion are nonphysician clinicians who use “physician” inaccurately or employ misleading uses of“ doctor.”“While non-M.D. practitioners have an important role in the health care system, in fairness to the patients, the line must be clear as to the qualifications of the providers treating them,” Sullivan said. “As we focus on improving the delivery of health care in America, we must start by insisting on a level of transparency and truth in advertising that will empower patients to make an informed decision when it comes to their health care.”In addition to APA, CHART members include the American Academy of Ophthalmology, American Academy of Otolaryngology–Head and Neck Surgery, American College of Surgeons, American Medical Association, and American Society of Anesthesiologists.The text of the Healthcare Truth and Transparency Act is posted at<http://thomas.loc.gov/cgi-bin/query/z?c109:H.R.5688:>.▪ ISSUES NewArchived

Surfing for Scoliosis: The Quality of Information Available on the Internet

A cross section of Web sites accessible to the general public was surveyed. To evaluate the quality and accuracy of information on scoliosis that a patient might access on the Internet. The Internet is a rapidly expanding communications network with an estimated 765 million users worldwide by the year 2005. Medical information is one of the most common sources of inquires on the Web. More than 100 million Americans accessed the Internet for medical information in the year 2000. Undoubtedly, the use of the Internet for patient information needs will continue to expand as Internet access becomes more readily available. This expansion combined with the Internet's poorly regulated format can lead to problems in the quality of information available. Since the Internet operates on a global scale, implementing and enforcing standards have been difficult. The largely uncontrolled information can potentially negatively influence consumer health outcomes. To identify potential sites, five search engines were selected and the word "scoliosis" was entered into each search engine. A total of 50 Web sites were chosen for review. Each Web site was evaluated according to the type of Web site, quality content, and informational accuracy by three board-certified academic orthopedic surgeons, fellowship trained in spinal surgery, who each has been in practice for a minimum of 8 years. Each Web site was categorized as academic, commercial, physician, nonphysician health professional, and unidentified. In addition, each Web site was evaluated according to scoliosis-specific content using a point value system of 32 disease-specific key words pertinent to the care of scoliosis on an ordinal scale. A list of these words is given. Point values were given for the use of key words related to disease summary, classifications, treatment options, and complications. The accuracy of the individual Web site was evaluated by each spine surgeon using a scale of 1 to 4. A score of 1 represents that the examiner agreed with less than 25% of the information while a score of 4 represents greater than 75% agreement. Of the total 50 Web sites evaluated, 44% were academic, 18% were physician based, 16% were commercial, 12% were unidentified, and 10% were nonphysician health professionals. The quality content score (maximum, 32 points) for academic sites was 12.6 +/- 3.8, physician sites 11.3 +/- 4.0, commercial sites 11 +/- 4.2, unidentified 7.6 +/- 3.9, and nonphysician health professional site 7.0 +/- 1.8. The accuracy score (maximum, 12 points) was 6.6 +/- 2.4 for academic sites, 6.3 +/- 3.0 for physician-professional sites, 6.0 +/- 2.7 for unidentified sites, 5.5 +/- 3.8 for nonphysician professional sites, and 5.0 +/- 1.5 for commercial Web sites. The academic Web sites had the highest mean scores in both quality and accuracy content scores. The information about scoliosis on the Internet is of limited quality and poor information value. Although the majority of the Web sites were academic, the content quality and accuracy scores were still poor. The lowest scoring Web sites were the nonphysician professionals and the unidentified sites, which were often message boards. Overall, the highest scoring Web site related to both quality and accuracy of information was www.srs.org. This Web site was designed by the Scoliosis Research Society. The public and the medical communities need to be aware of these existing limitations of the Internet. Based on our review, the physician must assume primary responsibility of educating and counseling their patients.

Manejo da epilepsia na rede básica de saúde no Brasil: os profissionais estão preparados?

To assess attitudes and beliefs concerning epilepsy held by physicians and allied health professionals who work in the primary care network in Brazil. The data were collected during a national family and community medicine conference held in Rio de Janeiro in 2004, which was attended by 1,200 health professionals from throughout the country. Two questionnaires were used, one for physicians and another for nonphysician health workers. A total of 598 conference participants (345 physicians and 253 nonphysician health professionals) completed a questionnaire. Both the physicians and the nonphysician health professionals had acceptable personal attitudes towards persons with epilepsy. According to data from 286 physicians who provided information, the estimated mean percentage of individuals with epilepsy in the populations cared for by the physicians' health care systems in the preceding year was 0.78% (range, 0 to 8%; median = 0.37%). The estimated mean percentage of seizure-free patients was 60%. The estimated mean percentage of persons on monotherapy was 55%. The estimated mean percentage of referrals to a neurologist was 59%. The estimated mean percentage of patients who were working or studying was 56%. Of the 345 physicians, 252 of them (73%) reported not feeling confident about managing individuals with epilepsy, whereas 84 (24%) felt confident, and 9 (3%) were not sure. Of the 252 physicians who did not feel confident, 226 (90%) said that they would participate in a training program to improve the quality of the care provided to individuals with epilepsy. The professionals participating in the study indicated that the primary care system has the essential elements needed to provide comprehensive epilepsy care, including professional personnel who want to improve their skills. However, establishing an efficient, effective program of epilepsy management in the primary care network will require an effective referral network, regular distribution of antiepileptic drugs, the close monitoring of epilepsy management by using the federal primary health information system, and the ongoing education of health professionals, with emphasis on psychological support and the inclusion in society of individuals with epilepsy.

What nutritional factors affect the risk of gout?

A recent report published in the New England Journal of Medicine looked at the relationship between diet and gout using data from the Health Professionals’ Follow-Up Study. This all-male study explores men’s health issues, relating nutritional factors to the incidence of disease, and complements the all-female Nurses’ Health Study. The researchers investigated the reported intake of purine-rich foods, dairy foods, and protein, as well as the incidence of gout in 47,150 men who had no history of gout at baseline ( 1 Choi H.K. Atkinson K. Karlson E.W. Willett W. Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004; 340: 1093-1103 Google Scholar ). This ongoing study of male nonphysician health professionals begun in 1986 included food frequency questionnaires. Responses regarding the individual food items were converted to average daily servings, and the average daily intakes of individual items were combined in order to compute the totals for four food groups: meat, seafood, purine-rich vegetables, and dairy products. This large prospective cohort study found evidence that meat consumption and seafood consumption are associated with an increased risk of gout. By contrast, moderate intake of purine-rich vegetables or protein is not associated with an increased risk of gout, and consumption of dairy products, especially low-fat dairy products, is associated with a substantially reduced risk of gout. Having one no-fat or low-fat dairy product per day reduced gout risk by approximately 21%, and having two or more servings was associated with a 50% risk reduction. The researchers suggest that the milk proteins casein and lactalbumin may help reduce gout risk by increasing elimination of uric acid, an end product of purine metabolism, from the body. This article was written by Eleese Cunningham, RD, of ADA’s Knowledge Center Team in Chicago, IL.

Psychiatric education in an era of rapidly occurring scientific advances.

Scientific advances in the fields of molecular biology, neurobiology, pharmacology, epidemiology, genetics, neuroimaging, and cognitive neuroscience are influencing psychiatric diagnosis and treatment, and this influence will grow substantially in the future. The current shortage of psychiatrists will increase over the next several decades, resulting in the need to train primary care physicians in basic psychiatric care and the use of non-physician mental health professionals to administer time-intensive, formal psychotherapies. The juxtaposition of these two trends-an increasing scientific influence on the clinical practice of psychiatry and fewer psychiatrists to deliver that treatment-is cause for changes in the approach to psychiatric education. In addressing these issues, the authors suggest that (1) psychiatry should be more integrated into undergraduate medical education in both basic science and clinical curricula, (2) residents in primary care disciplines should have more direct exposure to psychiatric training, (3) joint instructional experiences involving psychiatry and primary care residents should be encouraged, (4) psychiatry residency programs should maintain flexibility in order to incorporate rapid advances in diagnostic procedures and treatments into residency training, (5) research experience should be integrated into psychiatry residency programs, and (6) departments of psychiatry must develop the leadership and expertise necessary to implement the incorporation of rapidly advancing scientific discoveries into the psychiatric curriculum.

Trends in the Epidemiology of COPD in Canada, 1980 to 1995

To describe trends in the epidemiology of COPD in Canada from 1980 to 1995, in terms of perceived prevalence, mortality, and hospital morbidity. We limited the analysis to data related to chronic bronchitis, emphysema, or chronic airway obstruction not classified elsewhere, and excluded asthma (Ninth International Classification of Diseases, codes 490 to 492 and 496). The perceived prevalence rate of COPD was derived from the 1994-1995 National Health Survey. Mortality and hospital morbidity data (from 1980 to 1995) were obtained from the Health Statistics Division of Statistics Canada. From the National Health Survey, it was estimated that 750,000 Canadians had chronic bronchitis or emphysema diagnosed by a health professional. Prevalence rates were the following: ages 55 to 64 years, 4.6%; ages 65 to 74 years, 5.0%; > or =75 years, 6.8%. From 1980 to 1995, the total number of deaths from COPD increased from 4,438 to 8,583. Although the age-standardized mortality rate remained stable throughout this period in men (around 45/100,000 population), it doubled in women (8.3/100,000 in 1980 to 17.3/100,000 in 1995). There were 55,782 hospital separations in 1993-1994 with COPD as the primary discharge diagnosis (compared to 42,102 in 1981-1982). In people aged > or =65 years, the age-specific hospital separation rate increased over this period, especially in women > or =75 years (from 504/100,000 to 1,033/100,000). The average in-hospital length of stay was 9.6 days in 1981-1982 and 8.3 days in 1993-1994. COPD represents a major health issue in Canada and will likely remain so for decades. Physician and non-physician health professionals who provide health care, as well as those who fund it must actively encourage approaches for primary and secondary prevention of this condition as well as approaches shown to be effective in addressing its associated impairment, disability, and handicap.

Defining the scope of practice of nonphysician health professionals

Defining the scope of practice of nonphysician health professionals

Psychiatrist and nonphysician mental health provider staffing levels in health maintenance organizations.

This study attempts to determine the ratio of full-time-equivalent psychiatrists to members and that of nonphysician mental health professionals to psychiatrists in staff and group model health maintenance organizations (HMOs), and to compare the psychiatrist-to-member ratio with previous estimates of the required psychiatrist-to-population ratios in fee-for-service and managed care environments. The Group Health Association of America (now the American Association of Health Plans) collected data on mental health staffing, enrollments, and other characteristics for 30 staff and group model HMOs. The authors evaluated the number of full-time-equivalent psychiatrists and nonphysician mental health professionals per 100,000 HMO members, and the ratio of full-time-equivalent nonphysician mental health professionals to psychiatrists. The overall mean number of full-time-equivalent psychiatrists and nonphysician mental health professionals per 100,000 members in the responding HMOs was 6.8 and 22.9, respectively. The overall mean ratio of nonphysician professionals to psychiatrists was 4.5. The overall number of psychiatrists per 100,000 members is less than half the requirement estimated by the Graduate Medical Education National Advisory Committee in 1980, which assumed a fee-for-service environment, but it is about 40% to 80% greater than that estimated by other studies under the assumption of a managed care environment. Although a practice environment dominated by managed care may not require as high a psychiatrist-to-population ratio as a predominantly fee-for-service environment, it may well support a greater number of psychiatrists than previous studies have suggested.