American journal of preventive medicine
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Effective clinical prevention practice is the objective of the long journey from laboratory and epidemiologic studies to clinical understanding, interventions, and prevention practice with individual patients. The ability to ask ever more fundamental questions about the molecular basis of disease, as is rapidly being developed by NIH's Human Genome Project, promises to make this journey even longer and more complicated, but eventually to make screening and intervention for preventable disease even more amenable to clinical intervention. As we expect in the future, much of what we currently do in clinical prevention practice had its genesis in earlier federal support for basic and clinical research. ⋯ Current national concerns for the weakening of support for clinical research are in part due to the reduced availability of patient care revenue to support clinical research brought about by managed care. The academic and practice communities that share concern for prevention research should recognize the increasing gap between basic and applied prevention knowledge. Those committed to the clinical application of this knowledge should encourage increased federal research support to assure that what we think we know is indeed so, that what is efficacious is available to all in the society that so generously supports research.
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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.