American journal of preventive medicine
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The recent and profound changes in the American health care delivery system have created a need for physicians who are trained and willing to assume a high level of responsibility for managing evolving health care organizations. Yet most physicians receive no formal training in medical administration and management because changes in medical school and residency education have lagged behind changes in clinical practice and reimbursement. To avoid haphazard approaches and unnecessary duplication of resources, it is important for physicians involved in managerial medicine to collectively identify competencies in this area needed in the marketplace. ⋯ This article describes the strategy we followed in reaching consensus among a diverse group of physician executives and preventive medicine residency program directors, and includes the list of medical management competencies and performance indicators developed. Recurrent issues that can sidetrack competency development projects are also presented as well as suggestions for overcoming them. The competencies can serve as a framework for expanding current core preventive medicine training in management and administration and for developing new training programs to equip physicians with the special expertise they will need to provide management leadership within the changing landscape of health care delivery.
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To describe the prevalence of smoking in junior secondary school students in Hong Kong and to analyse the relationship between a range of risk factors and ever-smoking experience, including tobacco advertisements. ⋯ Smoking among young people is an important public health problem. Although the causes are multifactorial, in Hong Kong environmental tobacco advertising is an important risk factor that can be removed by banning all forms of tobacco promotion to young people.
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Sarcoidosis is a granulomatous disorder of unknown cause that usually first involves the lungs. After the diagnosis of a deck grinder was changed from sarcoidosis to dust-induced lung disease by the VA, the Navy asked the National Institute for Occupational Safety and Health (NIOSH) to determine if Navy work environments have been associated with lung diseases, some of which may have been reported as "sarcoidosis." ⋯ These findings suggest that sarcoidosis-like diseases in the military may be associated with environmental factors. To implement effective primary prevention, early detection, and treatment programs for sarcoidosis-like disease, these trends and work environment patterns need to be explained. Clinical studies of Vietnam-War-era veterans, which assess their work exposures and job activities in more detail, may identify preventable causes among this generation, which has a historically high rate of disease.
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The need for more physicians trained in prevention, research methods, and management has been argued by many leaders in medical education. Columbia University attempts to address this need by providing medical students with a variety of options for studying public health. ⋯ Public health educators can serve a variety of career needs for future physicians. In addition to personal interests, the presence of role models is an important reason students begin studying public health.
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Reducing violence is a critical health and economic priority. In Minnesota, as in other parts of the United States, violence is increasingly viewed as a public health problem. Helping people work together to prevent violence is one way that managed care organizations are collaborating with public health to improve the health of communities. ⋯ Outcomes of the initiative included: participation by over 1,000 Minnesotans in 12 community violence prevention forums; a widely distributed action plan; Students Stop Guns, a school-based intervention to keep Minnesota schools gun-free; the Governor's Task Force on Violence as a Public Health Problem, which led to a commitment of resources to prevent violence and respond to the victims and consequences of violence, and the Health Care Coalition on Violence, to institutionalize strategies within the Minnesota health care environment. The project's qualitative evaluation resulted in lessons and advice on how to execute a collaborative health improvement initiative. These lessons have been widely shared with Minnesota community health advocates.