American journal of preventive medicine
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Comparative Study
When children have children: the teen pregnancy predicament.
Despite developments in contraceptive technology and changes in societal norms, adolescent pregnancy remains a key issue for politicians, social scientists, health care providers, and educators. The adolescent's access to contraception and abortion services continues to spark legal debate. The implications of research call for the development of innovative programs to address larger issues, such as poverty and limited access to health care, in the management and prevention of adolescent pregnancies. Clinical interventions, such as school-linked clinics to provide contraception and prenatal care programs to reduce perinatal morbidity, have varied in their approaches and their subsequent success.
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Comparative Study
Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale).
We derived and tested a short form of the Center for Epidemiologic Studies Depression Scale (CES-D) for reliability and validity among a sample of well older adults in a large Health Maintenance Organization. The 10-item screening questionnaire, the CESD-10, showed good predictive accuracy when compared to the full-length 20-item version of the CES-D (kappa = .97, P < .001). Cutoff scores for depressive symptoms were > or = 16 for the full-length questionnaire and > or = 10 for the 10-item version. ⋯ The CESD-10 showed an expected positive correlation with poorer health status scores (r = .37) and a strong negative correlation with positive affect (r = -.63). Retest correlations for the CESD-10 were comparable to those in other studies (r = .71). We administered the CESD-10 again after 12 months, and scores were stable with strong correlation of r = .59.
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Comparative Study
Smoking prevalence during pregnancy for women who are and women who are not Medicaid-funded.
Maternal smoking has been related to a number of adverse pregnancy outcomes. Although maternal smoking prevalence has decreased over time, certain populations have retained a high smoking prevalence and remain at high risk for adverse pregnancy outcomes. This study used the Washington State First Steps Program Database to estimate the difference in maternal smoking prevalence between mothers whose prenatal or delivery care was Medicaid-funded and mothers whose care was not Medicaid-funded. ⋯ Adequacy of prenatal care also influences smoking prevalence. For white and black mothers, the maternal smoking prevalence was lower for those receiving adequate prenatal care than for mothers of the same race who received inadequate prenatal care. The increased maternal smoking prevalence in older single mothers and the higher maternal smoking prevalence in women with Medicaid-funded deliveries suggest that infants born to these mothers may be particularly susceptible to smoking-related health effects.
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Of the currently available literature on assessment of physician competency, very little applies to the needs of preventive medicine specialists. Yet the diversity of the field and the confusion among other medical specialists about the particular expertise of preventive medicine physicians suggest a need for consensus on fundamental competencies expected of graduates of preventive medicine residency training programs. We apply theoretical material on competency-based education from teacher training and instructional development to professional training in preventive medicine. ⋯ This article includes this list of core competencies for preventive medicine residents. In addition, the article describes assumptions about competency development that guided the process and identifies recurrent problems in competency development. This information may be helpful to readers who wish to develop additional competencies or to tailor these competencies for their own preventive medicine residency programs.