ABSTRACT
By training future physicians to care for patients with backgrounds different from their own, medical schools can help reduce health disparities. To address the need for education in this area, the leaders of the Family Medicine Clerkship at the Warren Alpert Medical School of Brown University developed the Social and Community Context of Care project, required of all medical students rotating through this clerkship. Students develop a hypothetical intervention addressing a health issue seen at their preceptor site, and are assessed on their grasp of the social and contextual issues affecting that health issue in their particular community. Some interventions are actualized in later clerkships or independent study projects; one example, a health class for pregnant and parenting teens at Central Falls High School, is described here. If made a routine part of medical education, projects such as these may help medical students address the health disparities they will encounter in future practice.
Subject(s)
Clinical Clerkship/methods , Family Health/education , Healthcare Disparities , Teaching/methods , Attitude of Health Personnel , Community Health Services/organization & administration , Curriculum , Health Promotion , Humans , Residence Characteristics , Rhode Island , Schools, Medical , Students, Medical/psychologyABSTRACT
OBJECTIVE: To evaluate BMI change among pediatric refugees resettling in Providence, RI. METHODS: Retrospective chart review of pediatric refugees from the initial evaluation to year 3 post-resettlement at Hasbro Children's Hospital. Primary outcome of interest was within person change in BMI percentile at each time point. RESULTS: From 2007-2012, 181 children visited the clinic. Initial prevalence of overweight and obesity was 14.1% and 3.2% versus 22.8% and 12.6% at year 3. From visit 1 and years 1-3, there was a positive mean within person change in BMI percentile of 12.9% (95% CI 6.3-19.6%s), 16.6% (95% CI 11.2-21.9%), and 14.4% (95% CI 9.1-19.7%). CONCLUSIONS: The prevalence of overweight and obesity increased from 17.3% at initial intake to 35.4% at 3 years post-resettlement to surpass that of American children (31.7-31.8% for 2007-2012). Refugee children have additional risk factors for obesity; multidisciplinary interventions must be designed to address nutrition at each visit.
Subject(s)
Overweight/ethnology , Refugees/statistics & numerical data , Adolescent , Africa/ethnology , Asia/ethnology , Body Mass Index , Child , Child, Preschool , Female , Humans , Male , Obesity/ethnology , Prevalence , Retrospective Studies , Rhode Island/epidemiologyABSTRACT
IMPACT (Integrated Management of Physician-Delivered Alcohol Care for Tuberculosis patients) is a randomized, controlled effectiveness trial based in Tomsk, Russia, that assesses the effect of oral naltrexone and brief behavioral counseling on tuberculosis outcomes and alcohol use in 200 patients. Tuberculosis physicians without addiction experience delivered interventions as part of routine care over a 6-month period, focusing on alcohol intake reduction to support successful tuberculosis treatment. We describe design, training, and fidelity monitoring using a Russian and American team of physicians, bilingual coders, and supervisors. Culturally appropriate adaptations, limitations, and implications for future trials are discussed. The clinical trial identification number is NCT00675961. Funding came from the National Institutes of Health and National Institute on Drug Abuse.