American journal of preventive medicine
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We surveyed members of a recent master of public health (MPH) degree program to learn more about how, when, and why physicians and medical students decided to seek formal training in public health. We interviewed physicians and medical students to determine how and why these MPH students became involved in what they considered public health work; how and why they decided to attend public health school; and what their career plans were following completion of the degree program. All 47 medical students and physicians responded to the survey. ⋯ A personal contact directed 62% towards public health school. Those with previous public health work experience were more likely to pursue what they considered public health careers after completion of public health school than those without such previous work experience. The continuing need for qualified practitioners and leaders in public health challenges the medical community to characterize further those factors motivating medical students and physicians to formalize their training in public health.
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Comparative Study
Health promotion in primary care: The British perspective.
The structure of the British primary health care system allows for the development of a facilitator movement that can organize and encourage health care providers in local communities to coordinate health promotion efforts. We describe the Wycombe Primary Care Prevention Project to show how the facilitator movement can work in a local health district. The project's development and results to date demonstrate that the majority of primary care practices in the health district, departing from exclusive focus on individual care, now include community needs assessment and work on community-based health problems. We identify causative factors and discuss the generalizability of the project to other primary health care settings.
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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
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
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.