ABSTRACT
PURPOSE: There is no current centralized database of structured global health programs at U.S. medical schools and no published review in the past decade. This study aims to describe the prevalence, characteristics, and requirements of non-degree, longitudinal, structured global health programs in U.S. allopathic and osteopathic medical schools. MATERIALS AND METHODS: In July 2021, the authors performed a web-based review of existing structured global health programs for the 154 U.S. allopathic medical schools and 35 U.S. osteopathic medical schools established prior to 2019. RESULTS: Of 189 institutions examined, 74 (39%) had online information about a structured global health program. Forty-three (53%) programs reported coursework requirements, 44 (54%) required a global health experience, and one program required demonstration of language or cultural knowledge. More internally administered programs required experiential work, while more externally administered programs required didactic work. There were few differences in program requirements between allopathic and osteopathic medical schools. CONCLUSIONS: There has been a 75% increase over the past ten years in the number of U.S. allopathic medical schools with websites for structured global health programs. There appeared to be little standardization in their structure and requirements. The findings support the need for a web-based central repository for updated information regarding medical school global health curricula.
Subject(s)
Osteopathic Medicine , Schools, Medical , Humans , Curriculum , Global Health , Internet , Osteopathic Medicine/education , United StatesABSTRACT
BACKGROUND: This randomized trial evaluated an integrated model of primary medical care for a cohort of patients with serious mental disorders. METHODS: A total of 120 individuals enrolled in a Veterans Affairs (VA) mental health clinic were randomized to receive primary medical care through an integrated care initiative located in the mental health clinic (n = 59) or through the VA general medicine clinic (n = 61). Veterans who obtained care in the integrated care clinic received on-site primary care and case management that emphasized preventive medical care, patient education, and close collaboration with mental health providers to improve access to and continuity of care. Analyses compared health process (use of medical services, quality of care, and satisfaction) and outcomes (health and mental health status and costs) between the groups in the year after randomization. RESULTS: Patients treated in the integrated care clinic were significantly more likely to have made a primary care visit and had a greater mean number of primary care visits than those in the usual care group. They were more likely to have received 15 of the 17 preventive measures outlined in clinical practice guidelines. Patients assigned to the integrated care clinic had a significantly greater improvement in health as measured by the physical component summary score of the 36-Item Short-Form Health Survey than patients assigned to the general medicine clinic (4.7 points vs -0.3 points, P<.001). There were no significant differences between the 2 groups in any of the measures of mental health symptoms or in total health care costs. CONCLUSION: On-site, integrated primary care was associated with improved quality and outcomes of medical care.
Subject(s)
Delivery of Health Care, Integrated/methods , Health Services Research/statistics & numerical data , Mental Disorders/therapy , Adult , Cohort Studies , Continuity of Patient Care/standards , Delivery of Health Care, Integrated/standards , Female , Follow-Up Studies , Health Status Indicators , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Middle Aged , Outcome Assessment, Health Care , Patient Education as Topic/methods , Patient Satisfaction/statistics & numerical data , Practice Guidelines as Topic , Preventive Health Services/standards , Preventive Health Services/statistics & numerical data , Primary Health Care/methods , Primary Health Care/standards , Primary Health Care/statistics & numerical data , Quality Indicators, Health Care , Severity of Illness Index , Treatment OutcomeABSTRACT
BACKGROUND: The Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) program provides individualized interdisciplinary mental health treatment and care coordination to elderly veterans whose comorbid depression, anxiety, or alcohol abuse may result in overuse of inpatient services and underuse of outpatient services. OBJECTIVES: To determine whether proactive screening of hospitalized patients can identify unrecognized comorbid psychiatric conditions and whether comprehensive assessment and psychogeriatric intervention can improve care while reducing inpatient use. DESIGN: Randomized trial. SUBJECTS: Veterans aged 60 and older hospitalized for nonpsychiatric medical or surgical treatment in 9 VA sites (UPBEAT, 814; usual care, 873). MEASURES: The Mental Health Inventory (MHI) anxiety and depression subscales, the Alcohol Use Disorder Identification Test (AUDIT) scores, RAND 36-Item Health Survey Short Form (SF-36), inpatient days and costs, ambulatory care clinic stops and costs, and mortality and readmission rates. RESULTS: Mental health and general health status scores improved equally from baseline to 12-month follow-up in both groups. UPBEAT increased outpatient costs by $1,171 (P <0.001) per patient, but lowered inpatient costs by $3,027 (P = 0.017), for an overall savings of $1,856 (P = 0.156). Inpatient savings were attributable to fewer bed days of care (3.30 days; P = 0.016) rather than fewer admissions. Patients with 1 or more pre-enrollment and postenrollment hospitalizations had the greatest overall savings ($6,015; P = 0.069). CONCLUSIONS: UPBEAT appears to accelerate the transition from inpatient to outpatient care for acute nonpsychiatric admissions. Care coordination and increased access to ambulatory psychiatric services produces similar improvement in mental health and general health status as usual care.
Subject(s)
Alcoholism/complications , Alcoholism/diagnosis , Anxiety Disorders/complications , Anxiety Disorders/diagnosis , Continuity of Patient Care/organization & administration , Depressive Disorder/complications , Depressive Disorder/diagnosis , Geriatric Assessment , Geriatric Psychiatry/organization & administration , Hospitals, Veterans/statistics & numerical data , Mass Screening/organization & administration , Mental Health Services/organization & administration , Patient Care Team/organization & administration , United States Department of Veterans Affairs/statistics & numerical data , Aged , Alcoholism/therapy , Analysis of Variance , Anxiety Disorders/therapy , Comorbidity , Cost-Benefit Analysis , Depressive Disorder/therapy , Female , Follow-Up Studies , Health Status , Hospitals, Veterans/economics , Humans , Male , Mental Health , Middle Aged , Outcome Assessment, Health Care , Program Evaluation , Psychiatric Status Rating Scales , United States , United States Department of Veterans Affairs/economics , VeteransSubject(s)
Dementia/epidemiology , Life Change Events , Stress Disorders, Post-Traumatic/epidemiology , Survivors/psychology , Aged , Aged, 80 and over , Combat Disorders/epidemiology , Combat Disorders/etiology , Combat Disorders/psychology , Comorbidity , Dementia/diagnosis , Dementia/psychology , Disasters/statistics & numerical data , Female , Holocaust/psychology , Humans , Male , Ships/statistics & numerical data , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychology , Survivors/statistics & numerical dataABSTRACT
OBJECTIVE: The authors assessed the association between depressive symptoms and health costs for a national Veterans Administration (VA) sample. METHOD: The Rand Depression Index was administered to 1,316 medical or surgical inpatients over the age of 60 at nine VA hospitals. Scores were merged with utilization, demographic, and hospital data from national VA inpatient and outpatient files. RESULTS: Medical costs for respondents with the highest quartile of symptoms were approximately $3,200-or 50%-greater than medical costs for those in the least symptomatic quartile. Depressive symptoms were not associated with any statistically significant mental health expenditures. CONCLUSIONS: The study extends previous reports of the high medical costs associated with depressive disorders to an older, public sector population. The mechanisms underlying increased medical costs associated with depressive symptoms, while the subject of much speculation in the literature, still remain largely unknown.
Subject(s)
Depressive Disorder/economics , Health Care Costs , Age Factors , Aged , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Geriatric Assessment , Health Care Surveys , Hospital Costs , Hospitals, Veterans/economics , Hospitals, Veterans/statistics & numerical data , Humans , Middle Aged , United StatesABSTRACT
A case of a man with Tourette's disorder associated with obsessive-compulsive disorder, multiple sexual paraphilias, and aggressive behavior is described. Treatment with haloperidol led to improvement in the characteristic tics of Tourette's disorder as well as to improvement in these three complex-associated behaviors. After haloperidol was discontinued, an exacerbation of tics and the associated behaviors occurred.
Subject(s)
Aggression , Obsessive-Compulsive Disorder/complications , Paraphilic Disorders/complications , Tourette Syndrome/complications , Adult , Haloperidol/therapeutic use , Humans , Male , Tourette Syndrome/drug therapy , Tourette Syndrome/psychologyABSTRACT
The lifetime course of illness in older outpatient men who remained symptomatic despite adequate pharmacologic treatment for depression was examined. A bimodal distribution of age of onset of first major depression was found, with 75% having onset before age 35 years and 25% having onset after age 50 years. At all ages, episodes of chronic depression developed after episodes of major depression and appeared to be partially resolved major depression. In 88% of patients, anxiety disorders developed before age 35 years, preceded onset of other disorders, and continued throughout the patient's lifetime. Seventy percent developed alcoholism and 25% had a medical illness that impaired function to a significant degree. The importance of obtaining a lifetime course of illness in older patients is discussed.
Subject(s)
Anxiety Disorders/psychology , Depressive Disorder/psychology , Aged , Alcoholism/psychology , Chronic Disease , Humans , Male , Middle Aged , Time FactorsABSTRACT
Weight loss and malnutrition despite adequate dietary intake has been reported to be part of the clinical course in advanced dementia of the Alzheimer type. We present a case of reversible weight loss associated with neuroleptic use in a patient with Alzheimer's disease and discuss a possible pathophysiological basis for the weight loss.
Subject(s)
Alzheimer Disease/drug therapy , Anorexia/chemically induced , Antipsychotic Agents/adverse effects , Feeding and Eating Disorders/chemically induced , Weight Loss/drug effects , Aged , Antipsychotic Agents/administration & dosage , Drug Administration Schedule , Dyskinesia, Drug-Induced/etiology , Female , Fluphenazine/adverse effects , Haloperidol/adverse effects , Humans , Perphenazine/adverse effectsSubject(s)
Affect , Depression/psychology , Irritable Mood , Aged , Aged, 80 and over , Depression/diagnosis , Female , Humans , MaleABSTRACT
Organophosphorus compounds have been shown to exhibit toxic behavior as insecticides, pesticides, and mammalicides. Soman and 21 related compounds were studied for possible structure-activity relationships. Computer-aided methods were used to generate a linear expression relating the activity (ln [1/LD50], rabbit I.V.) of the compounds to three structure-based descriptors (R = 0.96). Principal components regression and jackknife analysis were performed to assess the stability of the model.
